Research Notes

Dexterity through Dextrose For osteoarthritis sufferers, injections of a sugar solution could be much more than placebo, a new study suggests (K.D. Reeves et al., "Randomized prospective double-blind prolotherapy for knee osteoarthritis with or without ACL laxity," Alternative Therapies in Health and Medicine, 6:68-80, March 2000). Prolotherapy, the injection of growth factors or their stimulators, is aimed at inducing an inflammatory response, to effect tissue repair or growth. A dextrose solution commonly is used to create temporary cellular stress, but in this study, the concentration of dextrose was only 10 percent, too low to cause inflammation. This not only protected double blinding, but also tested whether the elevation of extracellular glucose that is known to cause proliferation of growth factors in human cells would provide effective prolotherapy without an inflammatory mechanism. Sixty-eight of 77 patients with osteoarthritis in one or both knees, who were randomly assigned to either the treatment or to a control group, finished the one-year, six-injection study. The dextrose-treated group showed significant improvements in pain, swelling, knee buckling frequency, and flexion, by objective and subjective measures. Also, eight of 13 dextrose-treated knees with anterior cruciate ligament (ACL) laxity were no longer lax. "Nobody can make any money from dextrose. That's why I had to self-fund this [study]," comments coauthor Kenneth D. Reeves, section chief for physical medicine and rehabilitation at Bethany Medical Center in Kansas City. Low-cost, Third World applications are possible, he believes. Combination therapy with nutritional supplements and growth factor injections also could eventuate.--Steve Bunk Editor's Note: The following items are all from the annual meeting of the American Association for the Advancement of Science, held last month in Washington, D.C. Hearts and Chocolate Chocolate may actually do more than satisfy a sweet tooth and make you feel good. Harold Schmitz, a chemist and group manager of analytic and applied sciences at Mars Inc. of Hackettstown, N.J., reported that certain chocolates are "uniquely rich with procyanadins, which epidemiological literature suggests may potentially alter cardiovascular disease risk." Procyanadins are a class of antioxidants found in plants. And as the procyanadin content increases, chocolate's antioxidant activity goes up. Describing work that has been submitted to the Journal of Nutrition, Schmitz reported that in vitro, procyanadins at "probably relevant physiological concentrations" inhibited the oxidation of LDL cholesterol. When this form of cholesterol is oxidized, it leads to the formation of arterial plaques, a precursor to heart disease. Schmitz also found that cocoa procyanadins inhibited the inflammatory molecules cyclooxygenase 1 and 2 in cow blood. The inhibition level was similar to that of indeomethacin, a nonsteroidal anti-inflammatory drug. Schmitz also found that in umbilical vein endothelial cell culture, procyanadins induced the formation of nitric oxide. Nitric oxide enhances the flexibility of these cells, which line blood vessels. Loss of this flexibility is regarded as a risk factor for heart disease. The way the chocolate is processed affects the levels of these compounds and their possible impact in people, he noted. Not all chocolate is created equal. "What this research does is suggest that there may be effects of interest. You have to feed people products and follow up. This research does not prove anything. It suggests a lot," he said. He emphasized that much more research is needed before chocolate can, if ever, be touted as actually offering health benefits.--Harvey Black Antibiotic Resistance Resistance to fluoroquinolone antibiotics increased markedly in the United States last year, according to the Centers for Disease Control and Prevention (CDC). And the blame falls on the use of this class of antibiotics in the poultry industry, according to Fred Angulo, medical epidemiologist with CDC's Foodborne and Diarrheal Diseases Branch. In a nearly complete analysis of 1999 figures by CDC, Angulo said that 21 percent of the samples of Campylobacter and Salmonella were resistant to these drugs--a more than 50 percent jump from 1998, when 13 percent of isolates were fluoroquinolone resistant. Anugulo blames the FDA's controversial approval of the use of two fluoroquinolone drugs--sarafloxacin in 1995 and enrofloxacin in 1996--in drinking water for chickens as a way to treat and prevent infections. Resistance to fluoroquinolones, which are usually extremely effective against these bacteria and have saved lives of people with Campylobacter infections, has also surfaced in Europe. Though some scientists call the link between use of antibiotics in animals and resistance in humans circumstantial, Angulo unhesitatingly blames their use in animals. "There's evidence of increasing resistance. There's evidence of a human health consequence that's already present that has a potential to be much more severe, and we believe that agricultural use is the dominant source of that resistance," he says.--Harvey Black Scientists and 'We the People' "Descartes had it right--up to the eyeballs, but he had a very vague notion of what went on inside the brain," charged Esther M. Sternberg, chief of the section on neuroendocrinology and behavior at the National Institute of Mental Health (NIMH). In a lecture titled "Does Stress Make You Sick and Believing Make You Well?", she noted that while "we the people" have always believed this, "scientists have either resisted or rejected this notion." The molecular and pharmacological tools that have come along in recent years, however, have allowed Sternberg and others to open the window on the intricate network between the immune system and the brain. They can see how the two continuously signal and communicate with each other through chemicals and hormones, how stress hormones can alter immune response, and how state of mind can influence health. "Throughout the day, our stress hormones are changing through a circadian rhythm .... [T]oo much production of stress hormones makes one susceptible to infection because the immune system will be tuned down too much," she explained. "Too little and one will be more susceptible to inflammation, because the immune system is not suppressed enough by the glucocorticoids that should be there to turn it down." As for the concept that believing makes you well, Sternberg mentioned the placebo effect and cited "mounting evidence" from scientific studies that "suggest that belief or the state that is induced by belief could change one's physiological responses and therefore could affect the workings of one's immune system." These findings are changing the way we think about and treat diseases, she maintained. "Diseases we previously thought of as in separate boxes--infectious diseases like neuroAIDS, degenerative diseases like Alzheimer's, inflammatory diseases like multiple sclerosis, and vascular diseases like stroke and nerve trauma--can all be thought of in a common final pathway of nerve cell death that is mediated through the effects of immune molecules like cytokines." By understanding the stress and belief mechanisms at a detailed molecular and neuroanatomical level, she said, "we can develop new approaches to therapy in a whole range of diseases ... and cognitive interventions can be used selectively as an adjunct for treating cancer and HIV." She concluded, "We can begin to put the mind and body back together again."--A.J.S. Rayl

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