Tuesday, October 31, 2017

What have HIV and hepatitis C treatments, Tamiflu and breast cancer treatment got to do with particle physics?

The main theme of this post is to say “science for the science’s sake” makes more sense than “art for the art’s sake,” a French slogan in 19th century.  We cannot be always sure where the pursuit of science may lead us to.  Science is to seek ‘truth’, to understand the nature; thus pursuit of it can never go wrong.

The difficulty to convince you that pursuit of gravitational waves will benefit mankind     
Why do we have to concern ourselves with the gravitational waves (so-called “ripples in spacetime”) that were caused by the merger/collision of the two colossal black holes, leaving behind a single black hole some 50 times heavier than our sun.  This event happened about 3 billion light-year away and some 3 billion years ago.  For better perspective of how far away it is, it takes sun lights 8 minutes 20 seconds to reach us, traveling at speed of light.

This is almost like a science fiction.  Accordingly it would be difficult for me to argue that gravitational waves matter.  But, it does matter, otherwise its observation/detection won’t yield three Nobel Prizes in physics this year.

Why particle physics matters?  It gave us synchrotron.
I have lost track of how many particle physicists who have been decorated with Nobel Prizes in physics. What is the use to study subatomic particles? Atom has long been not indivisible; but to know atom is composed of leptons (electron, muon and tau, not interacting with strong nuclear force, thus staying outside the nucleus) and quarks (interacting with strong nuclear force, thus found inside the nucleus, such as proton and neutron). Let’s not forget the force-carrying particles, bosons, that produced the 2013 Nobel Prize in physics.

All the subatomic particles are discovered by using particle accelerators or so-called Super Collider.  Synchrotron is a device/technology that is evolved from super collider; it gives off light of such brilliance that it illuminates molecular structures or ‘sees’ the details of it.

Using x ray crystallography to learn the molecular structures is the road to Nobel glory
Using X-ray crystallography (think about it like a CT scan for molecules) to unravel the molecular structure has helped 40 some laureates (and 29 prizes) to get the Nobel Prizes.  Some of the works have been done with the help of synchrotron, complementing to x-ray crystallography.

Synchrotron is a better tool when the molecule of interest cannot be crystallized or has to be studied in the presence of liquid.  Simply put, the synchrotron is to accelerate electrons in a circular path (see photo below), not to crush them to find subatomic particles, but to let them emit the most brilliant light possible, and use the light to 'see' the details of the molecules, almost down to the atomic level.

Dr. Ramakrishnan showed four synchrotron centers in his Nobel Lecture
Ribosome structure: Synchrotron propels the advance of basic science research
V. Ramakrishnan, in his 2009 Nobel Lecture for unraveling the structure of ribosome, (upon which genetic codes of DNA was translated into amino acid sequence to make proteins) said “It was made possible by many technical developments, not least the development of synchrotron radiation sources. . .”

RNA polymerase II and transcription: Synchrotron made it possible for Roger Kornberg’s Nobel glory
Arthur and Roger Kornberg are one of the few father and son (William Henry Bragg and William Lawrence Bragg; Niels Bohr and Aage Bohr) or mother and daughter (Marie Curie and Irene Joliot-Curie) who’re Nobel laureates:  All in the family.



The elder Arthur Kornberg was so honored by his discovery/isolation of DNA polymerase, leading to our understanding of DNA synthesis (I read his memoir, For the Love of Enzymes, twice, about 20 years apart).  The younger Roger Kornberg followed the father’s footstep and figured out RNA polymerase II structure almost down to atomic resolution, using the synchrotron technology.  His research was mostly done at Stanford Synchrotron Radiation Laboratory, located at the Stanford Linear Accelerator Center and also at the synchrotron light source, located at the Lawrence Berkeley National Laboratory.  (This info is proudly presented at the Department of Energy (DOE) online page as both synchrotron facilities are funded by DOE.)



Roger Kornberg (then 12-year old) was in Stockholm in 1959 when his dad was awarded the Nobel Prize.  He is the boy sitting on the left in the family photo [see above] taken then and there.  I am so glad that Arthur Kornberg lived to see his son also to get the Nobel Prize in 2006; he passed away one year later.

father & son: Arthur and Roger Kornberg at the 2006 Nobel Prize press conference
Structure based drug design
Applied science, of which clinical medicine is one, reaps what the basic science research has sown.  The structure based drug design is made possible by using synchrotron technology; the examples abound, the resultant drugs have been in clinical use for nearly 20 years.

HIV and hepatitis C protease inhibitors
The success of using protease inhibitors in treating HIV was applied to hepatitis C treatments, resulting in an even more stunning success.  HIV and hepatitis C viruses replicate by growing a long protein chain that must be cut into smaller pieces to work.  Protease, like a scissor, does the cutting; so by blocking this cutting will prevent the replication of viruses.

The first HIV protease inhibitor (Invirase) hit the market in 1996.  Thankfully viral protease is different from human protease, blocking the viral protease will not block the human one.

Synchrotron technology is used to figure out the viral protease structure down to the atomic resolution, including the active site of this enzyme, so a blocker/inhibitor can be designed.

The story of Herceptin (trastuzumab), a breast cancer drug, making of which was helped by synchrotron
EGFR is a receptor that sits on cell surface, transmitting signals into the cell to make it grow and divide.  HER2 (or HER2/ErbB2 or HER2/neu) is a member of EGFR family.  Overexpression of HER2 (which means the number of receptors increases from normally 20,000 to up to 2 million on each cell surface) is found in 20–30% (some say 25-30%) of breast cancers, and correlates with more aggressive behavior and a poorer prognosis.  Dr. Dennis Slamon (the son of a WV coal miner, a W&J graduate) from UCLA made this important discovery.

This is why HER2 is targeted in making drugs to treat breast cancer.  Art Levinson and Axel Ullrich (from Genentech) successfully cloned HER2 gene, which makes HER2 receptor.  The process involved synchrotron technology.  One needs to know the structure before elucidation of its function.

Axel Ullrich made the first mouse antibody to HER2 receptor that didn’t work as it was rejected as a foreign invader, until it was “humanized” (fusion of a mouse antibody with a human antibody, chimeric) in 1992.  The clinical trial went on from 1992 to1998 when FDA approved it for breast cancer patients who are HER2-positive (overexpression).

Tamiflu: Synchrotron is used to design a drug against influenza virus
Influenza virus has an enzyme, neuraminidase, that cuts the sialic acid which is found in a glycoprotein of the surface of human cell, thus releases new virions.  Tamiflu blocks the cutting action of this enzyme, preventing new viral particles (virions) from being released.

Elucidation of neuraminidase structure was done with the help of synchrotrons.
Radiation therapy also uses accelerator-based technology
Certain radiation therapies for cancers are made possible by using accelerator-based technology.  I do not know enough to elaborate.

The project that led to the detection of gravitational waves was funded by the National Science Foundation that spent $1 billion over the fore decades.  It was managed by Dr. Barry Barish (one of the three Nobel laureates in physics this year) who was also the director of the Super Collider that would have been the world’s largest particle accelerator (proposed by President Reagan) until it was canceled by the Congress that got cold feet.  The best U.S. particles physicists flocked to CERN in Switzerland.

Like Churchill, the scientists would say, “Give us the tools, and we’ll finish the job.”

Thursday, October 26, 2017

It ain’t over until it’s over

Watching the Game 2 of the LA Dodgers vs Houston Astros World Series, one would agree that it ain’t over until it’s over.  The tenacious Astros never wanted to give up; trailing 3 to 1 when we heard God Bless America at the bottom of the 7th inning.  They made it a one-run game at the top of 8th inning and tied the game (3 to 3) at the top of 9th inning.

Photo credit to NY Times
Astros had a consecutive one-run homer at the top of 10th inning.  Dodgers returned the favor in kind to tie it again at the bottom of the 10th.

The ferocious Astros hit a two-run homer at the top of 11th inning (the ‘star’—George Springer—is shining), Dodgers quickly hit another one-run home run, but ran out of steam.  Astros took the game 7 to 6 and evened the World Series at one game apiece.

Who said the game is not won by home runs?  There are combined 8 home runs in this game.

Heading back to Houston Friday (Oct. 27), Astros will be more confident, but Dodgers has realized that the best World Series will be the one to be decided at 9th inning or beyond at Game 7.

There are many heroes in this game that played more than 4 hours, approaching the status of an Epic Game.  I am puzzled by Dodgers manager who took out the start pitcher, Rich Hill, after throwing 60 pitches in just 4 innings, and then paraded 8 relievers; he changed his relievers more often than Henry VIII his queens.  Astros start pitcher, Justin Verlander (The 2017 M.V.P. of A.L.C.S.) lasted for 6 innings.


Photo credit to NY Times
Justin Verlander, Photo credit to NY Times

Thursday, October 12, 2017

Watching baseball, thinking about medicine

Watching baseball, I have so many medicine stories to tell, and yet I am not talking about sport medicine.

Andrew Mcutchen
The lowly Pittsburgh Pirates finished another losing season.  I have to look for teams to root during the October Fest.  Red Sox has bowed out of the race and the manager, John Farrell is not coming back next season.  It is less fun to watch Red Sox after its slugger, David Ortiz, retired last year.  Someone please reminds Pirates owner/manager that having a star player is crucial when they think about trading Andrew McCutchen.

My reading has been focusing on the history of cancer treatment, which will be an ongoing project for years to come.  Watching baseball, I found out many related stories.

Jon Lester beat non-Hodgkin’s lymphoma
Jon Lester was diagnosed to have anaplastic, large-cell non-Hodgkin’s lymphoma during his rookie year as a Red Sox pitcher during 2006 season. Terry Francona, then Red Sox manager visited Lester at Massachusetts General Hospital (MGH) and brought the news to the team, ending the rookie’s season prematurely.  He had the first round of chemotherapy at Dana Farber Cancer Institute, and finished it at Fred Hutchinson Cancer Research Center at Seattle, his home state.

Jon Lester in action
I wrote a post after watching the Red Sox game when Lester returned only a few months after finishing the chemotherapy in 2007.  He beat Cleveland Indians and cancer.  I recall watching his parents watching the game with great relief and gratification.  Praise the Lord! He went on to pitch the game that clinched the World Series champion that year (2007) for Red Sox, the first since 1908.

Last month I attended a six-day cancer medicine conference at Boston, given by Dana Faber Cancer Institute, MGH and Brigham and Women’s Hospital.  On the lecture of non-Hodgkin’s lymphoma, the speaker mentioned Jon Lester with pride and gratification as Dana Faber participated in his treatment.  He mentioned that Lester was not doing too well, not the best of him this season, not medically, though.  He was struggling on the ball field at times.

Another game lost for Jon Lester yesterday
It was painful to watch how the Chicago Cubs collapsed at the bottom of 8th inning yesterday.  Jon Lester left the game at the bottom of 8th inning with Cubs trailing Washington Nationals 0 to 1, Cubs pitcher was changed again when the bases were full of Nationals players.  Two out, all bases occupied.  The Nationals hit a grand slam homer upon the second pitch, how could Wrigley Field full of people be so quiet?

Now both teams tie at 2:2, the division champion will be decided at Washington, DC tonight, good for politicians on either aisle; they will finally cheer the same thing.  So root for the Chicago Cubs, especially if you were not happy with the politicians.

What is anaplastic, large-cell non-Hodgkin’s lymphoma?
Anaplastic, large-cell non-Hodgkin’s lymphoma is a rare form of lymphoma (seen in 1-2% of all lymphoma, 10% of all childhood lymphoma, and 50% of large-cell pediatric lymphoma, the second most common T-cell lymphoma), most commonly seen in children or young adults.  It is a high grade (aggressive with a rapidly progressive course if untreated) cancer that is also highly responsive to chemotherapy.

The prestigious Fred Hutchinson Cancer Research Center is related to baseball
Fred Hutchinson Cancer Research Center was founded by William Hutchinson, M.D. in honor of his brother, a former all-star pitcher with Detroit Tigers and later manager of various teams, including the Detroit Tigers, St. Louis Cardinals, and Cincinnati Reds.  He died of cancer in 1964, at age 45.

Dr. E. Donnall Thomas was awarded a Nobel Prize in Medicine in 1990 for pioneering bone marrow transplant.  He is from Fred Hutchinson Cancer Research Center.

The serendipitous car accident led to the discovery of cancer for Jon Lester
The discovery of Lester’s cancer was the result of an auto-accident in which Lester’s care was rear-ended; he was on his way to Fenway Park on August 18, 2006.  He began to notice back pain after the car accident. He went to see his uncle, who is a physician in Tacoma when Red Sox were in Seattle for a West Coast swing.  His physician uncle detected several enlarged lymph nodes that eventually led to the diagnosis of lymphoma.

Money talk in baseball
Jon Lester was traded to Oakland Athletics in July 2014.  After a short sting at Athletics, he joined Chicago Cubs with a six-year $155 million deal.  Red Sox tried to get him back with a $135 million offer.  San Francisco was a close bid of $150 million. Lester went on to help Chicago Cubs clinch the World Series champion in 2016, the first in 108 years.

Terry Francona had a cardiac ablation
Just last week the Cleveland Indians, beating Yankees two games in a row, literally shouted “Yankees Go Home!”  What a comeback for Yankees whose starting pitcher CC Sabathia (yes, we do need a star pitcher) beat Cleveland Indians on Game 5 of the “Best-of-Five” of the 2017 ALDS yesterday.

It must be quite a disappointment for Cleveland Indians manager, Terry Francona (a longtime Red Sox manager), who underwent cardiac ablation procedure for some sort of cardiac arrhythmia in July this year, thus missing the chance of managing the American League team in All-Star game.

Jameson Taillon
Testicular cancer afflicts young men
Pittsburgh Pirates pitcher Jameson Taillon underwent surgery for testicular cancer on May 8, 2017, he has since returned pitching.  Colorado Rockies starting pitcher Chad Bettis was also diagnosed to have testicular cancer in November 2016, on the day of his first wedding anniversary. He has since returned pitching this year.  Three years after beating the advanced testicular cancer, Lance Armstrong won the 1999 Tour de France.

For some unknown reason the incidence of testicular cancer seems to be on the rise.  It used to be less than 7,000 cases in the States annually; it has reached 8,850 cases so far this year.  It primarily afflicts young men, no wonder so many young athletes were stricken.  It is the most frequent cause of cancer in men age 15-34 years.

Using pop culture (Deadpool) as cancer advocacy
Dr. William Oh
Dr. William Oh (an urologist, Chief, Medical Oncology at Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai NYC) was one of several guest speakers during the six-day oncology medicine conference that I attended last month.

At the end of the lecture, Dr. Oh showed a Youtube (“Deadpool [a comics character]: Gentlemen, Touch Yourself Tonight”) of how we’re using pop culture for cancer advocacy.  It also features in an article in Lancet Cancer. To detect it while in early stage, still confined to the testicle, yields the best result.




Monday, October 2, 2017

It is but the garden of a patriot

We saw this sign of “It is but the farm of a patriot” in front of John Adams’ (the second President) and John Quincy Adams’ (the sixth President) house in Quincy, Massachusetts.  

You may say it is my grandiose delusion if I put a sign of “It is but the garden of a patriot” in our garden, but these photos can attest to it.