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September-October, 2010

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Pieces of us are off doing science, now

You may have read about 1,250 tissue samples from NPF’s Victor Henschel BioBank going to Dr. Elder at University of Michigan for comparative genetic studies. (Click here for the story at psoriasis.org .) According to the story, the study will “identify new genes that increase a person’s risk for developing psoriasis and also examine the connection between psoriasis and other autoimmune diseases, such as Crohn’s disease.”

This is another step in the continuation of a nearly two decade focus (so far) on the “genetics of psoriasis.” In my May 2009 interview with Dr. Bruce Bebo (Ph.D.), Director of research and medical programs for the National Psoriasis Foundation, he said “I do think manipulating the immune system is one of, if not the most promising area of focus for psoriasis.” Given the Foundation’s involvement in this research direction, I was somewhat surprised – but very delighted – that Dr. Bebo said “one of” the most promising areas of focus. I’ve become an advocate for examining other paths, too.

But right now we’re talking about genetics. As I understand it, we have already identified at least 9 genes that have some relationship to psoriasis. Bear in mind, if we accept the notion that psoriasis results from some misfiring of the immune system, gene relationships to psoriasis are likely to be gene relationships to immune system function at large (hence the suspected connection between psoriasis and other immune system disorders). Multiple genes offer uncertain combinations of causes and effects and immune system function and dysfunction are just as likely to have consequences in addition to skin lesions and joint inflammation. All this means — to me, at least — that actual therapies based on gene activation or inhibition are a long ways away. Identifying even more genes that may have some role in psoriasis doesn’t hurry up our road to gene therapies, but its complicating nature may prevent us from killing ourselves as we rush into experimental treatments.

Bear in mind, none of the current therapies for treating P derive from manipulating gene function. Our biologic therapies — the current mainstream rave — work by controlling the action of specific but various lymphocytes. These are white blood cells that have specific roles in our immune system response. Normally, in combination these cells fight invasive harmful cells and substances in our bodies, but when they misfire in certain ways, they become damaging themselves. Psoriasis lesions are inflammatory battlegrounds where no obvious enemy exists. Biologic meds “turn off” aspects of communication between and amongst these lymphocytes and thereby arrest processes that create lesions and inflamed joints. They are not a cure because they do not quell whatever causes the immune system to misfire. We don’t really understand those causes and maybe, someday, we’ll be able to adjust gene behavior to accomplish a cure. That, I believe, is the hope.

But I hope we do not ignore or shortchange other courses for treating P. I have over the years paid more than a little attention here to alternative therapies that suggest other causes for our misfiring immune systems. I get disturbed by the prospect of changing the behavior of my genes when, perhaps, the same end might be achieved by a change in my diet. The conundrum here is that I also get disturbed by the prospect of learning an entire new eating behavior when one simple subcutaneous injection per week accomplishes the same end. A mitigating factor may be the cost of the biologic: $15,000 or more per year. I can’t imagine any dietary change costing nearly that much (but, a dietary treatment plan will not be covered by my insurance).

I realize the progress of science does not depend on how excited I am about research trends. Irrespective of what our tissues in the Biobank reveal, I’m not likely to chase the scientists probing them up a hill and into a windmill where I’ll set fire to the lot of them in hopes of killing a monster. My more pacific response is to keep seeking logic in the alternatives. Meanwhile, I’m trying to learn ways to prepare asparagus so its “life force” is not cremated on the way to becoming a compound I can smile about swallowing. As of yet, no vehicle driven by me sports a bumper sticker that acclaims “vegan ueber alles!” but that might change if I ever buy a Volkswagen.


Psoriasis and a New Job

Lilly S. — an email correspondent in this update — and I have something in common. We’ve both acquired new jobs recently. Lilly’s “flaker unveiling” was unfortunate; mine was more of a floor show.

The question raised in our correspondence is “How much information is appropriate to share with a supervisor?” Lilly’s tendency was not to volunteer much info; I wanted to thrust my flaker story upon this new stage.

I hope our correspondence will seed more from others. How we handle our flaky dilemmas at work is an issue for many of us.


New In Flaker Creativity

Sherry Sheehan gives Keith White the nod in her most recent poetry contribution, “Interiors.” (The Keith White interview debuted in the Sept. ’10 update of FlakeHQ. While White is plenty articulate, nobody can say it like Sheehan. Her line, “we don’t wick enough” hangs now in my head like a jingle I can’t shut off. Read “Interiors” here ... and visit the Sherry Sheehan page to spend several very pleasant minutes reviewing old favorites.


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