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ACOG Refines Fetal Heart Rate Monitoring Guidelines
Refinements of the definitions, classifications, and interpretations of fetal heart rate (FHR) monitoring methods were issued today in new guidelines released by The American College of Obstetricians and Gynecologists (ACOG). The objective of the guidelines is to reduce the inconsistent use of common terminology and the wide variability that sometimes occurs in FHR interpretations. ACOG"s Practice Bulletin, published in the July 2009 issue of Obstetrics & Gynecology, supports the recommendations of the Eunice Kennedy Shriver National Institute of Child and Health Development workshop* on electronic fetal monitoring (EFM) held in April 2008.

D.C. Federal Court Rules People With Diabetes Cannot Be Denied Employment Based On Disease Management
Yesterday, a jury in the United States District Court for the District of Columbia found that the Federal Bureau of Investigation (FBI) discriminated against Jeff Kapche when it refused to hire him as a Special Agent because of his diabetes.
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Study Links Drop In Teen Contraception Use To Abstinence-Only Policies, NYT Editorial States
A recent study from Columbia University"s Mailman School of Public Health shows that since 2003, there has been a 10% decrease in contraception use among teenagers, while their level of sexual activity has not changed, a New York Times editorial states. From 1991 to 2003, increased use of contraceptives among teens was a significant factor in declining rates of teenage pregnancy, the editorial says. According to the study"s authors, the decrease in contraception use since 2003 is consistent with recent increases in teen birth rates. According to the editorial, the study"s authors suggest a "link between the shift in use of contraception and one of former President George W. Bush"s great social-policy follies: highly restrictive abstinence-only sex education programs that deny young people information about sexually transmitted diseases, contraceptives and pregnancy." The editorial adds, "To the extent that these programs even mention condoms, typically it is to disparage their effectiveness." In response to "mounting evidence of the program"s danger as a public health strategy," many states have forgone federal abstinence-only funds, the editorial says. As part of his budget proposal, President Obama has called for redirecting some abstinence-only funds and additional money to a new teen pregnancy prevention initiative that stresses comprehensive sex education. The editorial concludes that this "science-based effort to protect the health of young people" and reduce the number of unintended pregnancies "should win support from lawmakers on both sides of the aisle -- and both sides of the abortion divide" (New York Times, 6/18).
Public Health

Combined Stem Cell Gene Therapy Approach Cures Human Genetic Disease In Vitro

A study led by researchers at the Salk Institute for Biological Studies, has catapulted the field of regenerative medicine significantly forward, proving in principle that a human genetic disease can be cured using a combination of gene therapy and induced pluripotent stem (iPS) cell technology. The study, published in the May 31, 2009 early online edition of Nature, is a major milestone on the path from the laboratory to the clinic. "It"s been ten years since human stem cells were first cultured in a Petri dish," says the study"s leader Juan-Carlos Izpis��a Belmonte, Ph.D., a professor in the Gene Expression Laboratory and director of the Center of Regenerative Medicine in Barcelona (CMRB), Spain. "The hope in the field has always been that we"ll be able to correct a disease genetically and then make iPS cells that differentiate into the type of tissue where the disease is manifested and bring it to clinic." Although several studies have demonstrated the efficacy of the approach in mice, its feasibility in humans had not been established. The Salk study offers the first proof that this technology can work in human cells. Belmonte"s team, working with Salk colleague Inder Verma, Ph.D., a professor in the Laboratory of Genetics, and colleagues at the CMRB, and the CIEMAT in Madrid, Spain, decided to focus on Fanconi anemia (FA), a genetic disorder responsible for a series of hematological abnormalities that impair the body"s ability to fight infection, deliver oxygen, and clot blood. Caused by mutations in one of 13 Fanconi anemia (FA) genes, the disease often leads to bone marrow failure, leukemia, and other cancers. Even after receiving bone marrow transplants to correct the hematological problems, patients remain at high risk of developing cancer and other serious health conditions. After taking hair or skin cells from patients with Fanconi anemia, the investigators corrected the defective gene in the patients" cells using gene therapy techniques pioneered in Verma"s laboratory. They then successfully reprogrammed the repaired cells into induced pluripotent stem (iPS) cells using a combination of transcription factors, OCT4, SOX2, KLF4 and cMYC. The resulting FA-iPS cells were indistinguishable from human embryonic stem cells and iPS cells generated from healthy donors. Since bone marrow failure as a result of the progressive decline in the numbers of functional hematopoietic stem cells is the most prominent feature of Fanconi anemia, the researchers then tested whether patient-specific iPS cells could be used as a for transplantable hematopoietic stem cells. They found that FA-iPS cells readily differentiated into hematopoietic progenitor cells primed to differentiate into healthy blood cells. "We haven"t cured a human being, but we have cured a cell," Belmonte explains. "In theory we could transplant it into a human and cure the disease." Although hurdles still loom before that theory can become practice - in particular, preventing the reprogrammed cells from inducing tumors - in coming months Belmonte and Verma will be exploring ways to overcome that and other obstacles. In April 2009, they received a $6.6 million from the California Institute Regenerative Medicine (CIRM) to pursue research aimed at translating basic science into clinical cures. "If we can demonstrate that a combined iPS-gene therapy approach works in humans, then there is no limit to what we can do," says Verma. Researchers who also contributed to the work include first author Ángel Raya, as well as Ignasi Rodríguez-Pizà, Rita Vassena, María José Barrero, Antonella Consiglio, Eduard Sleep, Federico González, Gustavo Tiscornia, Elena Garreta, Trond Aasen, and Anna Veiga of the Center for Regenerative Medicine in Barcelona, Spain; Guillermo Guenechea, Susana Navarro, Paula Río, and Juan Bueren of the Hematopoiesis and Gene Therapy Division, Centro de Investigaciones Energéticas, Medioambientales y Tecnol��gicas in Madrid, Spain; and Maria Castellà and Jordi Surrallés of the Department of Genetics and Microbiology, Universitat Autonoma de Barcelona. Gina Kirchweger Salk Institute


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