YOUR GUIDE TO LIVING WELL
HEALTH POST A SHELFISH PURSUIT >PAGE 8
GOING THE DISTANCE >PAGES 9-11
Growth industry The future of stem cell research >PAGE 6
TUESDAY, FEBRUARY 19, 2013
2 NEWS BIOTECHNOLOGY
HEALTH BITES ......................................................
Rat run offers hope for those with severe spinal injuries ...................................................... Jeanette Wang jeanette.wang@scmp.com Last year, Gregoire Courtine and his research team made paralysed lab rats with severe spinal cord injury walk – and run – again. At the Annual Meeting of the American Association for the Advancement of Science (AAAS) in Boston two days ago, the scientist from the École Polytechnique Fédérale de Lausanne (EPFL) announced plans to begin clinical trials in human patients within the next two years. Through a quality known as neuroplasticity, the brain and spinal
After a couple of weeks … the rats were walking, sprinting, climbing stairs and avoiding obstacles
A previously paralysed rat walks with the aid of a harness after weeks of rehabilitation. Photo: AP
cord are able to adapt and recover from moderate injury. But prior to Courtine’s groundbreaking study last year, recovery after severe injury to the spinal cord was impossible. Courtine and his team injected into rats a chemical solution that triggers cell responses by binding to specific receptors located on the spinal neurons. This replaces neurotransmitters – dopamine, adrenaline and serotonin – released by brainstem pathways in healthy subjects and acts to prepare the neurons to co-ordinate lower body movement when the time is right. Five to 10 minutes after the injection, these chemically excited neurons were then given a jolt through continuous electrical signals sent through the spinal cord’s nerve fibres through implanted electrodes. After a couple of weeks of neurorehabilitation – the electricalchemical stimulation coupled with a robotic harness – the rats were walking, sprinting, climbing stairs and avoiding obstacles. At AAAS, Courtine – who holds the International Paraplegic Foundation (IRP) chair in spinal cord repair at EPFL – presented the ¤9 million (HK$94 million) European project NeuWalk (neuwalk.com). The four-year project was launched in 2010 to transfer the technology from rats to humans with spinal cord damage through development of effective neuroprosthetic systems. The first phase of human trials will be held at the University Hospital of Lausanne (CHUV), which has developed extensive expertise in the electrical-chemical stimulation. The second phase will take place at the newly planned EPFL Valais Wallis academic cluster in Valais, Switzerland, to be inaugurated in 2015. This health and biotechnology centre will focus on new treatments and rehabilitation.
ASK THE DOCTORS DR MAHESH CHOOLANI Q: I am 23. I was anorexic for three years and I have been in recovery for two. At the moment I have a healthy weight, I eat a balanced diet, I work out regularly, although not excessively, and I feel good. However, I haven’t had a period in about three years. I was told they would return once I reached a healthy weight, but so far they have not, even though I’ve been at this weight for more than a year now. What should I do?
coming, then you should target a weight of about two or more kilograms above that particular weight. Also it would be good idea to follow up with a reproductive endocrinologist who would review and track the hormones within your hypothalamic-pituitaryovarian axis and, in particular, your serum estradiol levels which, have shown correlation with resumption of menses.
A: The female hormonal profile gets affected during anorexia. If you know the exact weight at which your menses stopped
Dr Mahesh Choolani is a consultant obstetrician and gynaecologist with the Choolani Clinic at Mount Elizabeth Novena Specialist Centre
Jeanette Wang jeanette.wang@scmp.com
They’re a crazy bunch This year’s edition of annual charity run Beat the Banana! on March 17 will be a real family affair. A one-kilometre Kids Banana Run has been introduced by the race organiser, World Cancer Research Fund Hong Kong, to get children aged eight and under involved. Just as in the usual three-kilometre Fun Run undertaken by families, participants will chase after someone dressed as a banana – the Banana Kid – who will be selected through online voting. A Banana Man for the three-kilometre race has been picked: former Australian national athlete Troy de Haas, the winner of last year’s three-kilometre race. There’ll also be a six-kilometre Elite Race with a prize of a return flight to London. All races run along the Tsim Sha Tsui East Promenade. To sign up, go to wcrf-hk.org. All funds raised will go to support the fund’s cancer-prevention work.
Read you loud and clear Babies growing up in a bilingual environment develop strategies to distinguish between – and begin to learn – the two languages from as young as seven months, according to new research published in the journal Nature Communications. The study, by the University of British Columbia and Université Paris Descartes, shows that such infants use pitch and duration cues to identify the languages, particularly those with very different grammatical structures, such as English and Japanese. In English, a function word comes before a content word (the dog, his hat, with friends, for example) and the duration of the content word is longer, while in Japanese or Hindi, the order is reversed, and the pitch of the content word is higher. “Your baby is very equipped to keep these languages separate and they do so in remarkable ways,” says UBC psychologist Janet Werker, a co-author of the study.
Booze and you lose Alcohol consumption is responsible for the deaths through cancer of about 20,000 people annually in the US – about 3.5 per cent of all fatal cancer cases – say researchers who examined recent data from the US on alcohol consumption and cancer mortality. “The relationship between alcohol and cancer is strong, but it is not widely appreciated by the public and remains underemphasised, even by physicians,” says the study’s senior author, Dr Timothy Naimi from Boston University School of Medicine. “Alcohol is a big preventable cancer risk factor that has been hiding in plain sight.” The study, published in the American Journal of Public Health, found that the most common cause of alcohol-attributable cancer deaths was breast cancer in women, and cancers of the mouth, throat and oesophagus in men. Although higher levels of alcohol consumption led to a higher risk of cancer, an average consumption of 1.5 drinks per day or less accounted for 30 per cent of all alcohol-attributable cancer deaths.
Omega 6 passes the acid test While the jury is still out on whether omega-6 fatty acids reduce or increase the risk of cardiovascular disease, a new study has uncovered potential clues as to the mechanism which underlies their health benefits. Researchers from the Massachusetts General Hospital have found that feeding the fatty acids to roundworms or adding them to cultured human cells activates a cellular renewal process called autophagy. “It has been suggested that autophagy can extend lifespan by maintaining cellular function, and in humans a breakdown in autophagic function may be involved in diseases including inflammatory bowel disease, Parkinson’s disease and – in a more complex way – in cancer and metabolic syndrome,” says study lead author Eyleen O’Rourke. Roundworms that consumed a full normal diet supplemented with omega-6 fatty acids – commonly found in meats, poultry and vegetable oils – lived 20 to 25 per cent longer than usual.
NEWS 3 BOOK REVIEW THE MELT METHOD
TELEVISION
Embrace the self-care Excessive TV linked to antisocial behaviour approach to well-being ...................................................... Jeanette Wang jeanette.wang@scmp.com
...................................................... Jeanette Wang jeanette.wang@scmp.com About 11 per cent of Hong Kong’s adult population is affected by chronic pain and insomnia, according to University of Hong Kong researchers. If you’re among those suffering despite trying various therapies, Sue Hitzmann’s new book, The MELT Method, could be your answer. MELT is short for myofascial energetic length technique, a self-care treatment system that Hitzmann developed based on more than 20 years of experience in the fitness and health industry. Starting out as an international fitness presenter and instructor, in the past decade she has been cultivating a private practice as a manual therapist. She set herself apart by taking manual therapy work and bringing it into the fitness industry, creating a technique that’s teachable to the general public. “Myofascial” refers to the layer of loose but strong connective tissue – fascia – that surrounds muscles. According to Hitzmann, “stuck stress” from daily living manifests as chronic pain in fascia. MELT works to rehydrate connective tissue and rebalance nervous system regulation, as well as boost the body’s natural healing and repair mechanisms. This is done through easy and precise movements that use a foam roller and small balls to simulate the hands-on techniques manual therapists use to help clients living with pain. Hitzmann has trained more than 500 instructors in the US to teach MELT. While learning the right technique under an expert is best, you could also pick it up through her 295-page book, which has many step-by-step photos and clear explanations. She lays out sequences that can be tailored for many specific body conditions, including arthritis, chronic lower back pain, digestion or sleep problems, and chronic illnesses such as cancer, multiple sclerosis and Parkinson’s disease. I approached the book with apprehension, as Hitzmann’s opening line was a bit too “out there” for practical me: “For as long as I can remember, I’ve had the
Many people say they have benefited. They boast of less pain, improved sleep and increased mobility ability to feel the subtle vibrations that exist in all living things. When I touch a person, an animal, or a tree, if I focus my attention, I physically sense vibrations with my hands.” But using the foam roller is familiar to me – it’s a regular selfmassage tool for releasing tight muscles and knots of tension after a tough workout. So Hitzmann is definitely no hippie; what she has done is cleverly package, brand and market these techniques – and herself – to those suffering in pain. The testimonials speak of her success. Her book has 11 reviews on Amazon, all giving the full five stars. From sufferers of severe anxiety and insomnia, to people with lower back pain, runners and golfers seeking performance, to a physical therapist working with children with special needs – many people say they have benefited from MELT. They boast of less pain, improved sleep, increased flexibility and mobility, and better body alignment, posture, breathing and digestion. Hitzmann says that MELT helps with your body and mind. “You’ll notice a change right away.”
> CONTACT US Deputy Culture Editor: Choong Tet Sieu tetsieu.choong@scmp.com Health Post Editor: Jeanette Wang jeanette.wang@scmp.com General inquiries: healthpost@scmp.com Advertising: tel: 2565 2435; e-mail advertising@scmp.com Printed and published by South China Morning Post Publishers Ltd, Morning Post Centre, 22 Dai Fat Street, Tai Po Industrial Estate, Tai Po, Hong Kong. Tel: 2680 8888
Video killed the radio star – and television could be harming your child’s social skills. A new study published online in the journal Pediatrics has found that children and adolescents who watch a lot of television are more likely to indulge in antisocial and criminal behaviour when they become adults. Researchers from the University of Otago in New Zealand came to the conclusion after following a group of about 1,000 children born in Otago’s capital, Dunedin, in 1972 and 1973. Between the ages of five and 15, the children were polled every two years on how much television they watched. Every hour that children spent watching television on an average weeknight represented about a 30 per cent increase in the risk of having a criminal conviction by early adulthood, say the researchers. Watching TV excessively during childhood was also linked to the development of more aggressive personality traits during adulthood,
including an increased tendency to experience negative emotions and an increased risk of antisocial personality disorder. The researchers found that the relationship between television viewing and antisocial behaviour was not explained by socio-economic status, the presence of aggressive or antisocial behaviour during early childhood, or parenting factors. A study co-author, Lindsay Robertson, says it is not that
Children who watched a lot of television were likely to go on to manifest antisocial behaviour and personality traits STUDY CO-AUTHOR LINDSAY ROBERTSON
children who were already antisocial watched more television, but “rather, children who watched a lot of television were likely to go on to manifest antisocial behaviour and personality traits”. As the study was based purely on observation, the results cannot prove that watching too much television caused the antisocial outcomes. But the findings are consistent with what many previous studies have found, and provides further evidence that excessive television can have long-term consequences for behaviour. “Antisocial behaviour is a major problem for society. While we’re not saying that television causes all antisocial behaviour, our findings do suggest that reducing TV viewing could go some way towards reducing rates of antisocial behaviour in society,” says study co-author, associate professor Bob Hancox. The American Academy of Pediatrics recommends that children should watch no more than one to two hours of quality television programming each day.
4 MEDICAL CASE HISTORY
Call in the big guns ...................................................... Eileen Aung-Thwin healthpost@scmp.com Hanson Yip was an energetic young man with a heart for helping others. But while studying for a un iversity degree in social work, the 26-year-old Yip (whose full has been withheld for reasons of patient confidentiality) started feeling twinges of pain in his upper abdomen. Initially he tried to ignore it, but the pain persisted for weeks. Uneasy, he went to his family doctor, who found that he had an enlarged liver, which was highly unusual for a man of his age. He was referred to a specialist, where a CT (computed tomography) scan showed he had a tumour the size of an orange lodged in his liver. Blood tests showed that Yip’s levels for a cancer marker called alphafetoprotein (AFP) was off the charts.
Normal levels should hover around 10 ng/ml (nanograms per millilitre), but Yip’s reading was 120,000 ng/ml. The CT scan and blood test indicated he had a very aggressive primary liver cancer, also known as hepatoma or hepatocellular carcinoma (HCC). A PET (positron emission tomography) scan to measure metabolic activity confirmed that the tumour in the left lobe of his liver was malignant. The diagnosis was shocking. Although Yip tested positive for hepatitis B, which carries a risk for liver cancer, it was unusual for the disease to strike someone so young. Furthermore, there was no history of liver cancer in his family. Liver cancer is the third biggest killer among cancers in Hong Kong. Its obscure symptoms thwart early detection of the disease. Yip’s best hope for a cure at the time was surgery and he was operated on at Hong Kong
Liver cancer cells are so notoriously resistant to medication that Leung used four types of drugs, instead of the typical one or two for chemotherapy
Sanatorium and Hospital in September 2011. During the surgery, however, doctors discovered a number of smaller tumours in his liver. They removed three or four but more remained. At this point, 40 per cent of Yip’s liver had been cut out, so the doctors were reluctant to remove any more. They used high frequency electric currents to heat and destroy the tumours in a procedure called radiofrequency ablation (RFA). Although the surgery went ahead uneventfully and Yip appeared to recover well from the procedure, doctors were not optimistic about his prognosis. The multiple small tumours were a bad sign, and it was likely more remained. Yip’s AFP levels dropped to 13,000 ng/ml after surgery but while this was a vast improvement, the results were far from normal. It was not long before the AFP levels climbed further to 14,000 ng/ml.
AGENT ORANGE
A crippling legacy ...................................................... Prime Sarmiento
In a special school, about 11 kilometres southwest of Hanoi, more than 100 students learn to read, write and count, and also pick up vocational skills such as embroidery, sewing and making decorative plastic flowers. It is hoped these skills will help them set up a small business in future, as they are unlikely to get traditional employment after “graduating” from this Vietnamese school. The children, along with 40 war veterans, are residents of the Vietnam Friendship Village in Van Canh Commune in Ha Tay province. They all suffer from mental and physical ailments caused by exposure to Agent Orange, the herbicide that US
military forces sprayed on lands in Vietnam and Laos between 1962 and 1971 to remove forest cover, destroy crops and clear vegetation. One of the world’s most toxic poisons, Agent Orange – so named because it came in chemical drums marked with orange stripes – is linked to cancers, diabetes, birth defects and other disabilities. It’s a bitter and lasting legacy of the
We will continue to remind everybody that chemical warfare should not happen again MAI DUC CHINH, VAVA SPOKESMAN
Vietnam war. “The Agent Orange victims are among the poorest in Vietnam,” says Dang Vu Dung, director of the Friendship Village. Not only are the victims unable to find jobs to support themselves, Dung says, the children’s parents – most Agent Orange victims themselves – spend a lot of money for years, or even a lifetime, on therapy and medication. According to Oanh, a teacher at the village for 15 years, the children usually stay for three to four years. Some only see their families just once a year as most live in remote provinces and can’t afford the trip to Hanoi. Oanh, who has a degree in special education, says it takes a lot of patience to teach the children as they often don’t listen and sometimes run away from the classroom. “But after some time, they get
used to this environment and stay in the classroom,” she says. The children learn to draw, colour, count and sing, and also study their country’s history. They are also taught personal hygiene, such as how to wash their hands, brush their teeth, and take a bath. They make handicrafts, such as paper flowers, silk wallets and embroidered pictures, and sell these products to supplement the donations that support the village. To be alive and in school, the children are luckier than the thousands of Agent Orange victims who have either died or been disabled and have no hope of supporting themselves. The military spraying exposed about 4.8 million Vietnamese – soldiers, villagers, their children and grandchildren – to the chemical. The US government denied responsibility over the chemical
Doctors attempted to use intra-arterial chemoembolisation, a conventional therapy for liver cancer in which chemotherapy is delivered directly to the liver via the hepatic artery while reducing blood flow to the tumours. Unfortunately, this therapy failed to put a dent in Yip’s AFP levels and it appeared he was out of options with a life expectancy of only three to four months. He turned to Dr Thomas Leung
MEDICAL 5
Illustration: Angela Ho
Wai-tong, associate director of the sanitorium’s comprehensive oncology centre, in a last-ditch attempt to rid himself of the cancer. A MRI (magnetic resonance imaging) scan showed multiple recurrent cancers 2cm to 3cm in size barely two months after surgery. Leung told Yip that any treatment he could offer would be palliative and the options were few. But Yip was ready to try anything – he had little left to lose.
They both decided on an aggressive approach, using both chemotherapy with cytotoxic drugs and a treatment called selective internal radiation therapy (SIRT). SIRT uses millions of radiationfilled microspheres that are injected into the artery feeding the cancer. The microspheres, which are onethird the diameter of a human hair, then accumulate inside the tumours where the radiation is released, killing the cancer cells.
A study conducted at HKSH showed that after two months of treatment with SIRT, 36 per cent of patients had their liver tumours reduced in size. Their AFP levels also dropped. The one-year survival rate was about 31 per cent. Other studies found that the median survival of patients who received SIRT was between 13.5 months and 16.4 months. In comparison, a 2008 British study found that patients receiving placebo treatment survived an average of just 7.9 months. Yip had one treatment of SIRT followed by six cycles of chemotherapy. Liver cancer cells are so notoriously resistant to medication that Leung used four types of drugs, instead of the typical one or two for
chemotherapy. Because Yip was young and relatively strong, he could withstand the treatments, although he suffered hair loss, nausea and fatigue. He managed the pain in his liver arising from the SIRT treatment with analgesics. His liver had also regenerated 20 per cent to 30 per cent by this time, which also helped him tolerate the treatments better. At the end of the six-month treatment, Yip’s AFP levels dropped to a normal range – the first time since his diagnosis. MRI scans also showed that the cancer was in remission and there was no sign of the disease in his liver. An elated Yip had beat the odds. He returned to school to complete his degree and has started working. Leung continues to monitor Yip’s AFP levels and liver scans every quarter and if the disease stays at bay for the next two to three years, Yip will be in the clear.
Child victims of Agent Orange are taught vocational skills at Friendship Village. Photo: AFP
warfare for years. But in August last year, it announced the allocation of US$43 million to clean up its former military base in Danang. Prior to that, Hillary Rodham Clinton, then the US secretary of state who visited Vietnam in July last year, called it “a legacy issue that we remain concerned about and we have increased our financial commitment to dealing with it”. But more than the clean-up, the victims are hoping for much needed compensation. Most of them depend on a monthly government subsidy of US$19, which isn’t enough to cover medical bills. “Our government doesn’t have enough money to support all victims,” says Mai Duc Chinh, a spokesman for the Vietnamese Association for Victims of Agent Orange (VAVA), a humanitarian organisation formed in 2003 by a group of Vietnamese doctors, veterans and other advocates. The Vietnamese government, local organisations such as VAVA, and several international groups have extended assistance to victims, and since 2004 have donated US$7.5 million in cash and kind. The Friendship Village, set up by an American war veteran in 1988,
has been one of the beneficiaries of generous donors. It receives international aid managed by a committee with representatives from the US, Canada, France, Germany, Japan and Vietnam. Similar centres can be found in other provinces of Vietnam. The village spends about US$290,000 a year on school maintenance, salaries and treatment of the war veterans. Dung says about 20 per cent more is needed, just to cover inflation and the rising cost of maintenance. He adds that more financial aid is needed for the students to use as seed capital for a small business after they leave the village. There have been several success stories from the village. One student graduated and went on to journalism school, while a couple of students who met at the village got married and set up a business making decorative flowers. “The [Agent Orange] victims live a hard life,” says Chinh. “We will continue to remind everybody that chemical warfare should not happen again.” This article was first published in Asian Scientist magazine. asianscientist.com
6 COVER STORY
I
magine this: a car crash victim who suffers serious trauma to the brain avoids neurological damage after the doctors regenerate his lost brain matter using stem cells in the lab. In the future, this could become reality. A research team from Karolinska Institutet in Sweden has tried this in experimental trials on rats and mice with positive results. At the scientific AAAS annual meeting in Boston yesterday, Paolo Macchiarini, a professor of regenerative surgery at Sweden’s Karolinska Institute, revealed how pioneering stem cell-based transplant technology is being developed and tested on new organs and tissues. Macchiarini is renowned for a groundbreaking transplant in 2011 where a patient successfully received an artificial trachea (windpipe) covered in his own stem cells. To date, five operations replacing diseased windpipes have been done using this technique. Next month, Macchiarini plans to operate on a two-year-old girl in the US who was born without a trachea and has lived her entire life in intensive care. Macchiarini also plans to use the technique to recreate more complex tissues, such as the oesophagus and diaphragm, or organs such as the heart and lungs. “The aim is to make as much use of the body’s own healing potential as we can,” he says. The term “stem cell” first appeared in scientific literature in 1868, when German biologist Ernst Haeckel used the phrase to describe the fertilised egg that becomes an organism, and also to describe the single-celled organism that acted as the ancestor cell to all living things in history. Scientists have been researching these cells for many years to unlock their secrets. Most recently, the focus has been on induced pluripotent stem cells (iPSCs), which are generated by reprogramming a mature cell type into an immature state. These stem cells can then, in theory, be coaxed to become any type of specialised cell. They hold potential not only for drug development but also for studying disease. A four-year-old boy born with a life-threatening irregular heartbeat was recently thrown a lifeline when researchers at Columbia University Medical Centre in New York devised a course of treatment based on the toddler’s own iPSCs that were matured into heart muscle cells in the lab. Studies using these cells revealed that the child’s condition, a congenital disorder called Long QT syndrome, was caused by the mutation of a particular gene. Stem cells are unspecialised cells that generate copies of themselves as well as cells that mature into specialised cell types. There are two general types of stem cells: embryonic and adult. Embryonic stem cells are “master cells” and include stem cells made from embryos and iPSCs. They are pluripotent, which means they can
Grow your own Stem cell transplants tap into the body’s own healing potential, writes David Tan
develop into any tissue type in the body. Through a process called differentiation (maturation), a stem cell turns into a mature cell type such as a neuron or a muscle cell. Adult stem cells are long-lived specialised stem cells that are able to maintain various tissues in the body throughout life. Some organs, such as the skin, are constantly turning over and rely on resident adult stem cells to maintain a constant supply of new cells. Dr Alan Colman, executive director of the Singapore Stem Cell
We can use this information to develop ways of selectively killing these dangerous cells in people who are most at risk PROFESSOR NICK BARKER (BELOW)
Consortium, believes that stem cell research is headed in two important directions. First, researchers are focusing on fine-tuning the maturation of pluripotent stem cells into cells of clinical relevance for drug discovery and testing. And second, iPSCs are being used to investigate the impact of genetic background on disease development. “Every individual has a different genetic make-up, which influences drug reactions,” says Colman. “We now have an opportunity through the development of iPSCs to study the underlying genetic and molecular causes of this without always having to test first on the patients or volunteers.” It was believed that specialised cells were restricted in their fate. But in 1962, British development biologist John Gurdon proved the opposite: that a specialised cell could return to its immature, pluripotent state. He replaced the immature cell nucleus in an egg cell of a frog with the nucleus from a mature intestinal cell. This modified egg cell developed into a normal tadpole. More than 40 years later, in 2006, Professor Shinya Yamanaka of Kyoto University in Japan built on this finding, reprogramming mature cells to a pluripotent state by introducing just four genes. Yamanaka’s iPSC technology opens up exciting possibilities of using almost any cell type within the body to produce stem cells with unlimited potential. This paves the way for personalised medicine, where a patient’s own cells could be used to derive pluripotent cells to repair damaged organs. Both scientists were jointly awarded the 2012 Nobel Prize in physiology or medicine for their groundbreaking discoveries
Use of allogeneic mesenchymal stem cells carries risks ... as the cells are not from the same patient PROFESSOR LEE ENG HIN (ABOVE)
that have revolutionised our understanding of how cells and organisms develop. Stem cell research has greatly enriched our understanding of how our bodies function. The gut lining renews itself every three to five days and is the most rapidly selfrenewing tissue in the body. Gut stem cells generate all the different cell types in the intestine lining and scientists are working to understand how these stem cells function. To do this, scientists use molecular markers on the cell surface and an example is a protein
called Lgr5. Identified by a team led by Professor Nick Barker, now at the Institute of Medical Biology in Singapore, the protein is now widely used to study features of the gut stem cell. Scientists use this knowledge to shed light on deadly diseases such as cancer. Barker and colleagues have discovered that the Lgr5-expressing stem cell is responsible for colon cancer, one of the biggest killers in the world and the second most common cancer in Hong Kong. When a genetic mutation occurs in a stem cell that causes it to divide uncontrollably, a cancerous tumour forms. By virtue of a stem cell’s ability to renew itself, many copies of actively proliferating cells are produced. This causes the tumour to grow. Barker believes that with this knowledge, scientists are better able to design strategies to target cancer. “Now that we know that mutations in the stem cells are the cause of colon cancer, we can use this information to try to develop ways of selectively killing these dangerous cells in people who are most at risk of developing the disease during their lifetime.” Stem cell research is also opening up avenues for improving the detection of cancer. Dr Roberta Pang is a gastrointestinal stem cell specialist and assistant professor at the University of Hong Kong’s department of surgery. At the Frontiers in Biomedical Sciences symposium held at HKU in December, Pang talked about how stem cell research is breaking new ground in the detection of metastasis in colon cancer. Pang described a subset of cancer stem cells known as CD26-positive (CD26+) cells that not only initiate tumour growth in the colon but are capable of migrating to a distant organ, such as the liver, and propagating tumour growth there as well. According to Pang, “CD26+ cancer stem cells can be readily detected in the peripheral blood of patients, and quantification of CD26+ in blood of colorectal cancer patients … can accurately serve as a prognostic marker to predict the development of metastasis.” While the application of iPSC technology in clinical therapy is still years in the making, some forms of stem cell therapy are already being used to treat deadly diseases. Bone marrow transplantation has been developed over decades and is probably the best known form of stem cell therapy. It involves the use of blood stem cells to treat cancers such as leukaemia. After radiation that destroys both the patient’s cancerous and healthy blood cells, blood stem cells from a donor are injected to replenish the patient’s blood supply. Stem cells derived from fat are being tested to treat a variety of diseases. Scientists believe that these cells, known as mesenchymal stem cells, have a regulatory effect
COVER STORY 7
on the immune system and may be used to treat multiple sclerosis. This is a disease where the immune system attacks components of nerves. Stem cell therapies are not without risks. Transplanting donated stem cells, a process known as allogeneic transplantation, could cause compatibility problems. According to Lee Eng Hin, professor of orthopaedic surgery at the National University of Singapore, “Use of allogeneic mesenchymal stem cells carries risks such as immunogenicity and disease transmission as the cells are not from the same patient.” Another fear is that stem cells could grow in unexpected ways or could migrate elsewhere in the body and produce unwanted tissue. A Californian woman learned this the hard way when she had bits of bone growing in her face after fat stem cell injections, as was reported recently in Scientific American. To reduce the appearance of wrinkles, cosmetic surgeons had injected her face with dermal filler together with stem cells taken from her abdomen fat. Unfortunately, the principal component of the filler was a compound that stimulated her fat stem cells to transform into bone. While this is an example of a stem cell treatment for cosmetic reasons, it nevertheless underlines the importance of understanding how stem cells might develop after being transplanted. Another risk is the possibility of contamination when cells are extracted, treated and subsequently injected back into the body. In October last year, four women who underwent “skin revitalisation therapy” at a beauty salon at Causeway Bay were admitted to hospital with blood poisoning. One died from septic shock. Pang sums up the situation: “Unfavourable incidents suggest that in stem cell treatments, there is always unanticipated interaction between stem cells and the microenvironment. Stem cell therapy technology is in its infancy and we are far from a state where scientists can completely control or regulate stem cell differentiation into specific cell types.” But research into stem cell transplants could lead scientists in new directions. For example, scientists hope to uncover signals and components made by stem cells, paving the way to design drugs that could stimulate the body to heal itself. Colman believes this to be an exciting time for stem cell research. “Cell transfer experiments, as well as potentially providing benefit directly, may only be the prelude to the discovery, manufacture and clinical use of curative molecules made by stem cells, and future research will succeed in identifying these molecules and developing drugs based on their mode of action,” Colman says. healthpost@scmp.com
Clockwise from top: Professor Paolo Macchiarini; Dr Alan Colman; stem cell researcher in Seoul; a vial containing embryonic stem cells. Photos: Steffan Larsson, Reuters, AFP
8 DIET HEALTHY GOURMET ...................................................... Andrea Oschetti healthpost@scmp.com At the end of the world, at the bottom of South America, just short of Antarctica, is Isla Navarino. This remote island looks south to Cape Horn and its fearsome sea. To the north it looks over the Beagle Channel, named after the boat Charles Darwin sailed on the voyage that led to the theory of evolution. Navarino is now a paradise for hikers and fly-fishers. Pristine rivers can still be found if you hike for a few days and spend a week in nature. My wife and I recently spent five days in the raw beauty of its mountains and forests. When we headed back to Puerto Williams, the only village on the island, we were happy about the experience, but hungry. Our host, Patty Ureta, prepared the famous king crab soup of Fireland for us. Most people know the healthy advantages of fish: it is a highquality protein, full of omega-3 fatty acids, vitamins and minerals. It helps lower blood pressure and reduces the risk of a heart attack. Different fish carry different nutrients and qualities, hence variation is important. While most types of fish can be eaten up to four times per week, some precautions are imperative. Mercury (methylmercury), which is contained in some fish, could harm the nervous system as well as slow down cell development in fetuses. Hong Kong’s Centre for Food Safety suggests a moderate consumption of a variety of fish, and warns that predatory fish species such as shark, swordfish, marlin and tuna can have high mercury levels. Whether fish caught in Hong Kong waters have a higher level of mercury than their counterparts around the world is open to debate. However, the risk exists worldwide, and those who are pregnant or breastfeeding should be vigilant. Those who love raw fish also need to be careful. Selecting fish and other seafood A fresh fish has bright eyes and its flesh is firm. Its skin looks metallic, the colour vivid. It has a slight smell of the sea. The gills should be a rich red. Any fish that smells strongly, or is opaque and has dull eyes, is past its prime. When you buy a fish fillet in the supermarket, check for a milky liquid in the package, as this is the first stage of decay. For live lobsters and crabs choose the liveliest ones, not those sitting motionless in the tank. For clams and oysters, choose those that react: if you touch them they should close tighter. But the opposite is true after cooking. Dead clams do not open after being cooked. For shrimps, bright eyes and brilliant coloured shell are what to look for. Storing fish The best rule is to always eat the fish immediately after buying it. The whole fish should be gutted at once, cleaned under running water, dried,
Chef Andrea Oschetti and his wife recently spent five days enjoying the raw beauty and pristine wilderness of the remote Isla Navarino.
A dish from the end of the world covered in aluminium foil and kept in the lower part of the fridge. Eat it within a couple of days. If the fish is fresh and was not previously frozen, like many of the fish sold in local supermarkets, it can also be frozen at home, following the procedure outlined above. It will last for 10 days in a home freezer. Cooking fish Fish fillets swimming in butter will always taste good. But they are not healthy, and you are essentially paying the price of fish for the taste of burned butter. Fish meat is delicate, and harsh cooking will kill it. More gentle cooking methods like steaming and cartoccio (cooking in parchment) retain all the nutrients and bring out the beautiful flavours. Personally, I believe marinade is used in cooking to hide bad flavours and tenderise the fibres of low quality, hard meat. If you have a high-quality fish, my advice is not to marinate it. Just add few drops of
olive oil and you will have the most succulent dish. If the recipe calls for marinating, remember that the process should be brief. Otherwise, the acid in the marinade will begin to denature the delicate protein. Parchment cooking is my favourite method as it holds in the moisture, concentrates the flavour and protects the delicate flesh. Make the parchment bag by folding a sheet of parchment paper in half and folding two of the loose edges to make a tight seam. Cooked this way, the fish only needs to bake for about 10 minutes, depending on the size, at 200 degrees Celsius. Alternatively, use a bamboo steamer. Place water or stock in a large saucepan and add seasoning ingredients. Place the bamboo steamer with the fish over the simmering water, making sure the water never boils. Depending on the size, the fish should cook for between eight and 10 minutes.
King Crab Soup of Fireland Serves 6
A fresh fish has firm flesh, bright eyes, a metallic skin and the slight smell of the sea
500 grams bread 1 litre of milk or water 1 onion 1 tbsp of olive oil Salt, pepper and chilli powder 1kg cooked king crab 1 tbsp of fresh coriander 100 grams grated parmesan (optional) • Mix the bread with milk (or water for a lighter soup) and leave for 1 hour. • Sweat the onion with the olive oil on a low heat until translucent. • Add the bread mix. Season with salt, pepper and chilli powder. • Cook on a low heat until most of the water is absorbed. • Add the crab and mix well. • Pour the soup into the serving bowl and sprinkle with coriander. Add cheese. • Place the bowls in a 200 degrees Celsius oven for 10 minutes to brown. Healthy Gourmet is a weekly column by private chef Andrea Oschetti
DIET/ FITNESS 9 THE TASTE TEST OLIVES ...................................................... Jeanette Wang jeanette.wang@scmp.com
MARATHON MANIA FINAL WEEK
Under starter’s orders ...................................................... Rachel Jacqueline healthpost@scmp.com It’s finally here. Three months of arduous training have flown by, and on Sunday, I will run the Standard Chartered Hong Kong Marathon. It will be my first 42 kilometre road race. To keep the nerves at bay and put my mind at ease, I sought advice from seasoned professionals to help me prepare for the big day.
Olives Et Al Moorish Olives HK$69.90 for 260 grams, Jason’s Kalamata olives, named after the Greek city where they are grown, are given a Moroccan touch with the addition of cumin, coriander and cardamom. The extra virgin olive oil is perfect for roasting vegetables. Verdict: smooth and meaty with a rich and deep flavour. Spices help to counter the slight bitterness.
Lindsay Spanish Manzanilla Olives HK$37 for 198 grams, Jason’s A familiar guest in a Martini, this is stuffed with pimiento, a larger and sweeter variety of the red bell pepper. Soaked in brine, with just five calories per piece, they make a low-guilt snack. Verdict: bitter and tart – where’s that Martini?
Lombardi Olive Giganti Condite HK$70 for 290 grams, City’super These huge green and black olives are from Tuscany, where the fruit has symbolised peace and a pleasant lunch for hundreds of years. They’re soaked in extra virgin olive oil, along with parsley, oregano and chilli peppers. Verdict: need more bite. They’re so soft they disintegrate in the mouth.
Prep early The best way to beat the butterflies is to begin preparations early, says Alison Chow Chi-ngan, one of Hong Kong’s top female distance runners Chow, 32, who will be competing in her fourth Hong Kong Marathon, recommends getting plenty of sleep in the days before the race. “I will get at least eight hours sleep a night from Thursday,” she says. She will also sneak in a few afternoon naps where possible. Eating sensibly is also essential to ensure I have enough energy on the day. The night before the race, Chow has a ritual of consuming five bowls of rice with vegetables, and heading to bed by 8pm. Prepare your race kit the night before (see checklist ) and plan your race morning schedule. Keep it simple Resist the urge to bring too much. “Keeping it simple is most important,” says Chow. She will run in comfortable shorts and a singlet, wear a watch, and carry a few energy gels for sustenance. As the weather on the day can get cold, Chow suggests arm sleeves and gloves to keep warm. Chan Ka-ho, another top Hong Kong runner who will compete in the 10-kilometre event, suggests packing a disposable raincoat in case of foul weather. Use it to keep warm before the race. Mind over muscle If I start feeling pain during the run, Chow says, I should engage in positive self-talk. “When I’m hurting, I just keep encouraging myself to keep going,” she says. “If the pain is really bad, then I will stop. Of course, you need to listen to your body, but believe in your ability.” I confess that my biggest concern is boredom, particularly during the lengthy Western Tunnel section. Yiu Kit-ching, who ran last year’s half marathon in 81 minutes and 31 seconds, staves off monotony by invoking her competitive streak. “Locate another runner as a target to motivate you,” she says. Her other tactic is to constantly look at her watch and ensure she stays on pace. But what if I am seized by the temptation to quit? “Think about all your training. You can’t give up,” says Chow. “Because if you do, all your training will go to waste.”
Rachel Jacqueline (black top) trains with top local female marathon runner, Alison Chow. Photo: Nora Tam
Eat, drink and be merry Eating and drinking on the run is essential to keep your energy levels up over the distance. Chow’s nutrition plan: she has a gel 15 minutes before the race, at 15 kilometres, and at 30 kilometres. But everyone is different, she cautions. Clinton Mackevicius, my trainer, suggests I should aim to take a gel every 45 minutes. Hydration is also a key factor. “You must drink at least one cup at every water station, even if you don’t feel thirsty,” says Chow. Have a course strategy The Hong Kong Marathon was described by 2011 winner Nelson Rotich as the world’s toughest marathon due to its hills. Chow agrees. Her advice: it’s all in your head. “Say to yourself, ‘It’s not too hard for me, I can fight for it.’ Even if you are tired, just run a little bit slower and then run at your faster pace after that.” The course becomes very windy around Tsing Ma Bridge at the turnaround point, so Chow recommends safety in numbers. “Find someone or a group to run behind, to shield you from the wind. Don’t lead them, let them lead you.” Lastly, she urges the importance of pace flexibility, but always staying within a certain range over the distance. Due to the changing terrain, it’s difficult to run at a constant speed, so Chow suggests running up to 10 seconds per kilometre slower in the tougher sections, and offsetting it by going 10
DON’T FORGET ... • Shoes and anti-chafing socks • Comfortable clothing (running tights, singlet, arm sleeves) • Light waist belt to carry iPhone (with my favourite running playlist) and some energy gels • Visor • GPS watch to keep track of pacing • Number tag • Anti-chafing cream • Clothes to keep warm before the race • Warm clothes for after the race, along with something to eat and a recovery drink
There’s no need to worry about what you haven’t done. Instead, concentrate on what you can do CLINTON MACKEVICIUS, TRAINER
seconds per kilometre faster in the flatter sections. But if you start to fall behind, don’t overcompensate and run too fast. “Just let it go,” she says. It’s more important to stick to your race plan and avoid exhaustion. Believe in yourself Chow says I need to give myself a reality check. “Personally, I just remember that I have trained enough and have confidence in my ability.” But as I have skipped a few training sessions due to ongoing niggles, I begin to wonder if I’ve done enough Mackevicius tells me not to be concerned. “Once you toe the line, there’s nothing more you can do to increase your fitness. There’s no need to worry about what you haven’t done. Instead, concentrate on what you can do,” he says. He also suggests I turn my nervous energy into a challenge. “Think of it as putting your training to the test,” he says. By focusing on my race strategy, I will keep my restless mind at ease. “The marathon demands a calculated approach to pacing, nutrition and hydration. It’s a game of numbers: knowing when to increase or decrease pace, but not to overdo it in order to finish strong.” Finally, keep it in perspective, says Chow. It’s just a race. “Whatever the result, I just remember that I have tried my best.” Getting to the start line is an achievement in itself, Chow adds. “I know I’ve done the hard work, [so] the rest will be easy.” Let’s hope she’s right.
10 FITNESS MARATHON MANIA
Running on inspiration What motivates someone to run a marathon? Rachel Jacqueline talks to three runners with different goals who are undertaking the challenge I’m running for my diabetic daughter Upon hearing of the Standard Chartered Hong Kong Marathon slogan “run for a reason” last year, Paul Evans knew he had to sign up. Despite having never run a marathon in his life, Evans, 39, was motivated to run by his nine-year-old daughter who suffers from type 1 diabetes. Originally from Wales, Evans hopes to raise HK$50,000 for the Hong Kong Juvenile Diabetes Association (HKJDA). The funds will be used to buy a Continuous Glucose Monitoring system – a device that records blood sugar levels throughout the day and night. If he achieves his target, manufacturer Medtronic will donate a second machine and maintain both. HKJDA will loan the machines to affected families, enabling them to gauge their child’s insulin levels without the need for constant intrusive finger pricks. Type-1 diabetes, otherwise
Photo: Jonathan Wong
known as juvenile diabetes, affects about 400 children and young adults in Hong Kong. It compromises the body’s immune system, attacking cells in the pancreas and inhibiting the production of insulin, a hormone that is important for metabolism and utilisation of energy from ingested food, particularly glucose. The disease is fatal unless sufferers take external insulin, and this requires constant monitoring of the body – which is extremely demanding for young children. For an added challenge, Evans will run his first marathon on a diet of natural foods, which he hopes will heighten awareness of the disease. “It will be the most difficult physical and mental challenge I have accomplished so far,” he says. “I will celebrate by using the CGM for the first time with my daughter.” A headhunter in the finance industry and a martial arts veteran, Evans has been preparing by running five days a week for the last
four months, gradually building on the distance. Training over the scenic MacLehose Trail near his Sai Kung home has been less taxing than he expected. “The greatest challenge has actually been fitting in the running time with a demanding job and four kids,” he says. Even though he has enjoyed the process, it hasn’t been without sacrifice. He has completely overhauled his diet, given up alcohol, stuck to a whole foods diet
Helping others teaches me a lot and enriches my life. This is why I run for charity DISABLED RUNNER MARTHA NG HOI-KEI
and detoxed for two weeks. To keep him motivated, his daughter has been monitoring his progress. “She’s been keeping track of my training and also tallying the donations raised,” he says. They are just over halfway towards their goal. He doesn’t have any targeted finishing time, but after recently clocking a 35-kilometre training run in three hours, he is confident of producing a respectable time. “It’s more important for me to run using natural fuels and run for something that means something to me,” he says. “I’m competitive – so I’m sure I’m not going to be walking by the end of it.” Donate to Evans’ cause by e-mailing hk.runningforacause@gmail.com I’m running to show that the disabled are able Martha Ng Hoi-kei has been a runner for as long as she can remember. But five years ago, her running days seemed over when she had a stroke caused by a vascular malformation of the central nervous system that she was born with. She underwent emergency surgery to remove part of her brain, resulting in permanent disability. She emerged with poor balance, memory impairment and speech loss. In a matter of days, she went from being an energetic person in her 20s to having an invisible physical disability. Yet Ng persevered and today, remarkably, she runs three times a week for up to two hours at a time, despite her disability and full-time job as an insurance agent. “It’s all about attitude,” Ng says. “If you think positive, everything will become positive. Just like your health, if you believe you can get a healthy body, you can.” She will run the 10-kilometre event on Sunday to raise funds for the Hong Kong Paralympic Committee & Sports Association, of which she is a member. “I want to help others where I have the ability – I feel like this is my responsibility,”
she says. “Helping others teaches me a lot and enriches my life. This is why I run for charity.” Ng regularly competes in races to support various causes, such as the Unicef Charity Run and the Orbis Moonwalkers. In October she came in fifth overall in the Hong Chi Climbathon Charity Stair Run for the intellectually disabled, scaling 1,688 steps in 19 minutes. Sunday will be Ng’s third time in the Hong Kong Marathon. Through running, she hopes to show people that the physically handicapped can enjoy the same opportunities that others do. “We encounter whatever challenges we have to and overcome them in the run just like we do in our daily life,” she says. She hopes to inspire other physically handicapped people to take on daunting challenges and to embrace the future. While she aims to complete the 10-kilometres within one hour, her
FITNESS 11 Marathon runners Martha Ng (left) and Francis Ngai at West Kowloon Waterfront Promenade; Paul Evans trains on the MacLehose Trail in Sai Kung (bottom left). Photos: Jonathan Wong
ultimate goal is to have fun. “It’s most important to me to enjoy my life, so I will just focus on completing the race. I hope to keep running for the rest of my life,” she says. Donations to the Hong Kong Paralympic Committee & Sports Association for the Physically Disabled can be made at hkmarathoncharity.com I’m running to promote the benefits of going meat-free once a week Don’t be alarmed if you see a sea of green on Sunday. Along with about 500 runners, Francis Ngai will run the Hong Kong Marathon with a green bib on his back to raise awareness for “Green Monday”, an initiative that encourages people to give up meat once a week. Ngai, 40, believes the project is an easy way in which people can make a difference to the environment by reducing carbon emissions. “For a long time environmental issues have been very important, but not many
people know how they can help as an individual,” he notes. “Green Monday represents a baby step for everyone to get involved.” Hong Kong is the world’s largest consumer of meat per capita and a weekly vegetarian day saves about 62kg of carbon dioxide each year per person – the amount of energy it takes to light a fluorescent bulb for 4,430 hours, according to the Green Monday website (greenmonday.org.hk). “We’re not saying become a
vegetarian, we’re just saying make a change in your diet one day a week. Everyone can do it,” Ngai says. Seeds for the project were planted when Ngai and his wife skipped a Monday meat dish after a weekend of over-indulgence four years ago. Feeling good, he continued. “It was like a marathon: first I did it for one day, then one week, one month, one year.” Ngai didn’t look back and 10 months ago set up Green Monday with David Yeung, a vegetarian of 12 years.
CHARITIES IN THE RACE The Standard Chartered Hong Kong Marathon Charity Programme • Launched in 2011, the programme has raised more than HK$30 million. • The three key beneficiaries: Orbis – Seeing is Believing; the Hong Kong Paralympic Committee and Sports Association for the Physically Disabled; the Hong Kong Anti-Cancer Society. • 1,983 runners have started a personal fundraising page for the charities.
Since then, Green Monday has collaborated with the business sector (including marathon sponsor Standard Chartered) and schools to introduce a vegetarian option on their canteen menu. To celebrate the project’s one-year anniversary and also world Earth Day on April 22, they have committed 13 of the largest school caterers in Hong Kong to offer a vegetarian option on that day, reaching out to 90 per cent of Hong Kong’s students. Vegetarianism is having a positive impact on Ngai’s health – and his running. When racing 250 kilometres for seven days through the Gobi desert last year, his says his times and recovery were better than those of his carnivorous competitors of a similar standard. Although a seasoned runner embarking on his 12th Hong Kong Marathon, Ngai’s major challenge this year is his lack of training. A
busy work schedule as CEO of Social Ventures Hong Kong – a nonprofit organisation which invests in and incubates social enterprise (including Green Monday) – has affected his training. He admits that he will be relying on fitness and mental endurance on the day. “Without enough training, the only way to finish it is treating it as a mind game. The vision of my charity in mind will help my spirit for sure.” He is particularly looking forward to the final 12 kilometres and hopes to finish at between four and 4½ hours. “I always enjoy that part [of the race],” he adds. “I will start having some deep thinking and really enjoy the endurance experience.” Support the Green Monday initiative by picking up a green bib. For more information, go to or greenmonday.org.hk or facebook.com/ GreenMondayHK
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FEBRUARY 19, 2013 SOUTH CHINA MORNING POST