- U.S. researchers have used a synthetic version of "good
cholesterol" to almost magically reverse the effects of one of the
most common forms of heart disease.
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- The drug, derived from a group of Italian villagers blessed
with unusually potent high-density lipoproteins (HDL), markedly reduced
atherosclerosis in just six weeks.
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- "The concept is sort of Liquid Drano for the coronary
arteries," said the study's lead author, Steven Nissen, a cardiologist
at Ohio's Cleveland Clinic.
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- HDL, or good cholesterol, protects the heart by removing
fatty buildups from blood vessels.
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- The experimental research, the results of which are published
in today's edition of the Journal of the American Medical Association,
could have a big impact on the treatment of heart disease.
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- "This is extremely intriguing and exciting,"
said Jean-Claude Tardif, director of clinical research at the Montreal
Heart Institute.
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- "The notion that we could bring about disease regression
in just six weeks is truly revolutionary," he said, while cautioning
repeatedly that the study, with only 47 patients, is too small to be definitive.
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- "This isn't going to change clinical practice tomorrow,
but it is going to change our thinking about cardiovascular disease in
the years to come," Dr. Tardif said.
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- In an editorial accompanying the study in JAMA, Daniel
Rader of the Center for Experimental Therapeutics at the University of
Pennsylvania in Philadelphia expressed a similar mixture of excitement
and caution.
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- "This study provides the best example to date that
directly targeting HDL in humans can have an impact on atherosclerosis,"
he said.
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- Most heart drugs are designed to lower low-density lipoproteins,
also known as LDL, or bad cholesterol.
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- Dr. Rader, too, cautioned that with only 47 patients,
36 of whom received the drug and 11 a placebo, the study needs to be replicated
on a much larger scale.
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- Plans are already under way to do that research in a
number of countries, including Canada, but researchers said yesterday they
cannot discuss the details because they are bound by confidentiality agreements.
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- The new drug is called recombinant ApoA1 Milano. It is
a synthetic version of a naturally occurring alolipoprotein collected in
the Italian village Limone sul Garda.
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- Residents of the village gained near mythical status
after researchers stumbled onto a family there whose HDL was incredibly
low but who, paradoxically, suffered virtually no heart disease. It turned
out that their HDL was exceptionally efficient at clearing plaque.
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- Animal studies using the protein from their blood showed
dramatic results, but because the idea was in the public domain, there
was no economic incentive for pharmaceutical companies to develop a drug.
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- What researchers did instead is create a synthetic version
that can be patented.
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- The study was funded by Esperion Therapeutics Inc. of
Ann Arbour, Mich., a small biotechnology company that makes the product.
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- Dr. Rader said the drug is likely just the first of many
that will target HDL.
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- "The next two decades may be to HDL what the past
two decades were to LDL: an era in which the development of new therapies
may permit the unequivocal demonstration of the clinical benefit of targeting
HDL to reduce the burden of atherosclerotic heart disease," he said.
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- Atherosclerois, or hardening of the arteries, is a condition
that occurs when cholesterol builds up in the bloodstream, forming fatty
deposits or plaque on artery walls. This decreases blood flow to the heart
and, if the plaque breaks away, can provoke a heart attack or stroke.
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- © 2003 Bell Globemedia Publishing Inc. All Rights
Reserved.
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- http://www.globeandmail.com/servlet/story/RTGAM.200311
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