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Phlebotomy Gaining Acceptance as HCV Treatment
http://www.hepatitis-central.com/mt/archives/2007/11/phlebotomy_gain.html
Last episode of House he got a suprise biopsy from one of the angry job candidates. Man, I didn't look when they did mine, but that needle sure looked long and thick!! Ai Ai Ai!!
Now back to your normally scheduled program.
Can't speak to escapted mutants (except maybe the turtles) but there are several studies that suggest low pre-tx viral load is positively associated with SVR. That was my first thought when I first read about this machine -- that if it could bring the virus count below <600,000 IU/ml prior to treatment, then indeed it could increase the chance of SVR. Using it during treatment is another idea, but only if it could selectively remove the virus without disturbing all that lovely Peg and Riba floating around :) The other thought I had, was that since viral load can dramatically fluctuate over time (I was around 30 million IU/ml, then two years later 100,000, then three months later 1.5 million) one strategy for those who can afford to wait would be monthly VL tests with the idea to start treatment immed but only if the VL dropped to within a pre-determined limit.
But again, more bucks required for either approach. Stil, when you look at the agressive (and costly) treatments some cancer patients receive -- and are reimbursed by their insurance company for -- one can only conclude that HCV are still second class citizens in terms of the kinds of treatment we're allowed.
Now think of how the SVR rate might change if a geno 1 was admitted to a hospital, pre-dosed with high-dose riba (IV) whose levels were monitored by HPLC, concurrent with pre-dose Epo, and then started on the best antivirals of the moment with twice weekly CBC's and viral load tests so doses could be tweaked. And, yes, maybe hooked up to that machine initially to get the viral load down as low as possible. I mean, don't they do it on "Dr. House"? Four doctors to one patient who never seems to have to share a room with anyone.
-- Jim
But again, more bucks required for either approach. Stil, when you look at the agressive (and costly) treatments some cancer patients receive -- and are reimbursed by their insurance company for -- one can only conclude that HCV are still second class citizens in terms of the kinds of treatment we're allowed.
Now think of how the SVR rate might change if a geno 1 was admitted to a hospital, pre-dosed with high-dose riba (IV) whose levels were monitored by HPLC, concurrent with pre-dose Epo, and then started on the best antivirals of the moment with twice weekly CBC's and viral load tests so doses could be tweaked. And, yes, maybe hooked up to that machine initially to get the viral load down as low as possible. I mean, don't they do it on "Dr. House"? Four doctors to one patient who never seems to have to share a room with anyone.
-- Jim
MEDICAL PROFESSIONAL
You have indeed experienced personally the dramatic effects of too much iron and also the only proven way (phelebotomy) to eliminate substantial quantities to get the body iron stores in the right position, that is
low, but not too low best assessed by Ferritin levels.
Iron function, metabolism and storage needs to be well understood because of its enormeous importance.
The Japanese machine that you are referring too is simply a method to use plasmapheresis, then pump the plasma over a filtration membrane of proper pore size
THIS MEMBRANES ARE USED IN THE PLASAMPRODUCT INDUSTRY AT INDUSTRIAL SCALES
to clean olasma from viral contamination, but leaving its protein content intact.
There is a Japanese publication (cant find it at this moment for quotation) that showed that daily plasmapheresis of HCV patients combined with viral filtration will reduce the circulating virions by two logs or more, all depending on the frequency and duration of the filtration process. This is obviously not going to reduce the hepatic infection size initially, but, if used in combo with antivirals, at the start / the first 2 weeks of a combo therapy, it could catch the majority of viral escape mutants eg from Telaprevir, those mutant viruses ending up in the filtration membrane instead of reinfecting a hepatocyte.
The downside are the high cost and the inconvenience to the patients, but there is no toxicity, so for the ones who could afford it, it most likely would mean a substantial upping of their SVR chances about as big as adding another potent HCV antiviral to their combo cocktail, with no toxicity attached.
Please note that this is not the same as UV radiation or Ozone exposure of the blood as sometimes mentioned here. These prooxidative treatments are likely to have negative effect on the reinfused blood components. This is a pure mechanical filtration process with a filter material that has been tested in huge industrial plasma protein preparation plants. (NFI)
low, but not too low best assessed by Ferritin levels.
Iron function, metabolism and storage needs to be well understood because of its enormeous importance.
The Japanese machine that you are referring too is simply a method to use plasmapheresis, then pump the plasma over a filtration membrane of proper pore size
THIS MEMBRANES ARE USED IN THE PLASAMPRODUCT INDUSTRY AT INDUSTRIAL SCALES
to clean olasma from viral contamination, but leaving its protein content intact.
There is a Japanese publication (cant find it at this moment for quotation) that showed that daily plasmapheresis of HCV patients combined with viral filtration will reduce the circulating virions by two logs or more, all depending on the frequency and duration of the filtration process. This is obviously not going to reduce the hepatic infection size initially, but, if used in combo with antivirals, at the start / the first 2 weeks of a combo therapy, it could catch the majority of viral escape mutants eg from Telaprevir, those mutant viruses ending up in the filtration membrane instead of reinfecting a hepatocyte.
The downside are the high cost and the inconvenience to the patients, but there is no toxicity, so for the ones who could afford it, it most likely would mean a substantial upping of their SVR chances about as big as adding another potent HCV antiviral to their combo cocktail, with no toxicity attached.
Please note that this is not the same as UV radiation or Ozone exposure of the blood as sometimes mentioned here. These prooxidative treatments are likely to have negative effect on the reinfused blood components. This is a pure mechanical filtration process with a filter material that has been tested in huge industrial plasma protein preparation plants. (NFI)
what a funny but absolutely fiction concept. good grief blood letting? I read the page and there were no numbers given as to how much...I mean do you just drain dry and eat some jello and orange juice>>>>lol sorry but blood letting went out with king henry
-----------------------------------
Actually, phlebotomy is a widely used chelation therapy for iron overdoses. I had too much circulating blood iron and iron deposited in my liver by the first quack of a hematologist I had five years ago who unfortunately misdiagnosed my anemia of chronic disease as iron deficiency anemia. Many many IV iron infusions later, my body was crippled under the toxic effects of too much iron. I had horrible symptoms, including profound "montezuma's revenge" that would not go away and resulted in about a forty pound weight loss. I was quite ill for a while there. I was chelated using blood letting, then pumped up on the other side with procrit to make new blood. My case was complicated because we had to use procrit since I had ongoing anemia but needed to get the iron levels down.
It was hugely successful, the iron levels were lowered over a matter of time by removing a half a nuit to a unit of blood at a time, and my symptoms alleviated.
Liver dialysis is being used now by some hospitals, and other chelation methods of using liver dialysis machines perhaps in addition to items that bind to HCV, or using them along with combo therapy, are in the works, and the Japanese have a patent on a machine of this nature which looks quite interesting as well.
-----------------------------------
Actually, phlebotomy is a widely used chelation therapy for iron overdoses. I had too much circulating blood iron and iron deposited in my liver by the first quack of a hematologist I had five years ago who unfortunately misdiagnosed my anemia of chronic disease as iron deficiency anemia. Many many IV iron infusions later, my body was crippled under the toxic effects of too much iron. I had horrible symptoms, including profound "montezuma's revenge" that would not go away and resulted in about a forty pound weight loss. I was quite ill for a while there. I was chelated using blood letting, then pumped up on the other side with procrit to make new blood. My case was complicated because we had to use procrit since I had ongoing anemia but needed to get the iron levels down.
It was hugely successful, the iron levels were lowered over a matter of time by removing a half a nuit to a unit of blood at a time, and my symptoms alleviated.
Liver dialysis is being used now by some hospitals, and other chelation methods of using liver dialysis machines perhaps in addition to items that bind to HCV, or using them along with combo therapy, are in the works, and the Japanese have a patent on a machine of this nature which looks quite interesting as well.
There are many publications supporting the influence of iron levels. Here are some links.
Iron should be low, but in a normal range, becuase it is needed for the erythropoesis and low levels could cause or increase anaemia, especially if low iron is combined with low folic acid & B12 and SOC.
http://tinyurl.com/2pgg24 : many links to papers about iron and hepatitis
1: J Gastroenterol. 2007 Oct;42(10):830-6. Epub 2007 Oct 15.
Long-term phlebotomy with low-iron diet therapy lowers risk of development of hepatocellular carcinoma from chronic hepatitis C.
http://tinyurl.com/2tsz9b
http://tinyurl.com/3azqua
http://tinyurl.com/32b33b
http://tinyurl.com/3avj5t
Iron should be low, but in a normal range, becuase it is needed for the erythropoesis and low levels could cause or increase anaemia, especially if low iron is combined with low folic acid & B12 and SOC.
http://tinyurl.com/2pgg24 : many links to papers about iron and hepatitis
1: J Gastroenterol. 2007 Oct;42(10):830-6. Epub 2007 Oct 15.
Long-term phlebotomy with low-iron diet therapy lowers risk of development of hepatocellular carcinoma from chronic hepatitis C.
http://tinyurl.com/2tsz9b
http://tinyurl.com/3azqua
http://tinyurl.com/32b33b
http://tinyurl.com/3avj5t
MEDICAL PROFESSIONAL
My first guess is that the excess ferritin content in serum reflects the disturbed balance between serum ferritin and liver ferritin, presumably because the increased hepatocyte turnover/death releases some of the ferritin in intact form. The anemia in this case is unrelated to the iron level. You can have anemia in the face of excess iron, if other factors, like the DNA synthesis in the marow precursor cells is hampered (IFN) or with riba, because a hemolytic ( increased lysis) anemia is present.
Normally the ferritin serum level is an excellent/the best indicator of the bodys iron storage.
I do not think that the virus is directly dependent on iron for its replication. Increased inflammation might indirectly help the virus, because the infected cells specific antiviral( Innate) responses might be hampered by the iron mediated increased prooxidative load/damage.
Normally the ferritin serum level is an excellent/the best indicator of the bodys iron storage.
I do not think that the virus is directly dependent on iron for its replication. Increased inflammation might indirectly help the virus, because the infected cells specific antiviral( Innate) responses might be hampered by the iron mediated increased prooxidative load/damage.
HR - Generally a pre-tx biopsy would be examined for excess iron, correct? It sounds from your comments that the phlebotomy would only be indicated when the liver showed excess iron? Often it is said here that the virus needs iron to replicate - and that excess iron puts replication in overload. That seems like a stretch to me.
I had rather sever anemia on tx, and ferrritin above 1,000. My name-brand hepatologist said it was a meaningless number - and sure enough things returned to normal once off the meds. I've heard a few reports similar to mine here, but not many. If you have a minute, do you have a theory behind a small subset of treating patients experiencing the high ferritin levels?
I had rather sever anemia on tx, and ferrritin above 1,000. My name-brand hepatologist said it was a meaningless number - and sure enough things returned to normal once off the meds. I've heard a few reports similar to mine here, but not many. If you have a minute, do you have a theory behind a small subset of treating patients experiencing the high ferritin levels?
An Introduction to Iron Toxicology
Iron - The Most Deadly Metal
By Jym Moon, PhD, CNS
2334 N. Fairmount St.
Davenport, IA 52804
Jymmoon1 AT yahoo.com
About the Author
Jym Moon is both a metal toxicologist and a
nutritionist. He is a Certified Nutrition
Specialist (CNS) and has a PhD in Biochemical
Toxicology from Simon Fraser University, Burnaby,
BC. Canada.
A couple excerpts from his book (sent to me by my iron hating friend):
chapter two
Iron Toxicology
How Much Iron is Present in Iron-Fortified Foods?
In the 2001 issue of DRIs for Iron, the Panel on Micronutrients, Food and Nutrition Board, states, "The median dietary intake of iron is approximately 16 to 18 mg per day for men and 12 mg/day for women."
Let us take a look at these estimates.
Level of Fortification
Apparently there is a great deal of freedom as to the amount of iron that can be added to food. The 2001 DRIs states, "Some fortified cereals contain as much as 24 mg of iron per 1-cup serving." (p 356). We will use this value to make an estimate as to how much iron some people are actually consuming.
The estimated intakes of iron used by the Panel on Micronutrients were based on the assumption that iron-supplemented food contains the actual amount stated on the label. P. Whittaker and colleagues from the FDA analyzed twenty-nine cereals for iron content.
When the "labeled value was compared to the assayed value for iron content, 21 of the 29 cereals were 120% or more of the label value and 8 were 150% or more of the label value. This gives us an approximate estimate that fortified cereals contain around 1.3 times as much iron as the label states.
Now let us make an estimate as to how much iron a person might consume from iron-fortified cereal. Whittaker and colleagues have already done this for us, so let us accept their findings in order to come up with some estimate of how much iron we really are consuming.
"Serving size quantities were estimated in 72 adults who regularly ate cereal. The median analyzed serving size was 47 g for females, and 61 g for males with a combined median of 56 g as compared to the label value of 30 g. For adults, the amount of cereal actually consumed was approximately 200% of the labeled serving size."
Since the one-cup serving of cereal cited in the DRIs provides, according to the label, 24 mg of iron, and cereal eaters usually eat around two cups, that cereal has provided 48 mg of iron, assuming label is accurate.
Now, let us consider that the cereal may actually contain 130% of the label-stated amount, as found by Whittaker. A person eating a couple of cups of cereal could be ingesting as much as 62 mg iron!
Men and Post-Menopausal Women are the Targets for Iron Excess Diseases.
Iron is a cumulative poison, and most of its toxic effects are seen as diseases of aging. Francesco S. Facchini, M.D, referred very accurately to iron as "the aging factor". (The Iron Factor of Aging, Fenestra Books, 610 East Delano Street, Suite 104, Tucson, AZ 85705). Iron is a pro-oxidant, and contributes to all aspects of aging.
******************
and
******************
Heme Iron and Human Disease
Heme iron refers the iron that is found in red meat. Heme iron is much more efficiently absorbed than most other forms of iron. A recent article by A Tappel from the University of California, Davis presents a summary of the role of heme iron in a variety of diseases. "Dietary epidemiological studies indicate correlations between the consumption of red meat and/or processed meat and cancer of the colon, rectum, stomach, pancreas, bladder, endometrium, and ovaries, prostate, breast and lung, heart disease, rheumatoid arghritis, type 2 diabetes and Alzheimer's disease. The correlation of all these major diseases with dietary red meat indicates the presence of factors in red meat that damage biological components. This hypothesis will focus on the biochemistry of heme compounds and their oxidative processes."
Iron - The Most Deadly Metal
By Jym Moon, PhD, CNS
2334 N. Fairmount St.
Davenport, IA 52804
Jymmoon1 AT yahoo.com
About the Author
Jym Moon is both a metal toxicologist and a
nutritionist. He is a Certified Nutrition
Specialist (CNS) and has a PhD in Biochemical
Toxicology from Simon Fraser University, Burnaby,
BC. Canada.
A couple excerpts from his book (sent to me by my iron hating friend):
chapter two
Iron Toxicology
How Much Iron is Present in Iron-Fortified Foods?
In the 2001 issue of DRIs for Iron, the Panel on Micronutrients, Food and Nutrition Board, states, "The median dietary intake of iron is approximately 16 to 18 mg per day for men and 12 mg/day for women."
Let us take a look at these estimates.
Level of Fortification
Apparently there is a great deal of freedom as to the amount of iron that can be added to food. The 2001 DRIs states, "Some fortified cereals contain as much as 24 mg of iron per 1-cup serving." (p 356). We will use this value to make an estimate as to how much iron some people are actually consuming.
The estimated intakes of iron used by the Panel on Micronutrients were based on the assumption that iron-supplemented food contains the actual amount stated on the label. P. Whittaker and colleagues from the FDA analyzed twenty-nine cereals for iron content.
When the "labeled value was compared to the assayed value for iron content, 21 of the 29 cereals were 120% or more of the label value and 8 were 150% or more of the label value. This gives us an approximate estimate that fortified cereals contain around 1.3 times as much iron as the label states.
Now let us make an estimate as to how much iron a person might consume from iron-fortified cereal. Whittaker and colleagues have already done this for us, so let us accept their findings in order to come up with some estimate of how much iron we really are consuming.
"Serving size quantities were estimated in 72 adults who regularly ate cereal. The median analyzed serving size was 47 g for females, and 61 g for males with a combined median of 56 g as compared to the label value of 30 g. For adults, the amount of cereal actually consumed was approximately 200% of the labeled serving size."
Since the one-cup serving of cereal cited in the DRIs provides, according to the label, 24 mg of iron, and cereal eaters usually eat around two cups, that cereal has provided 48 mg of iron, assuming label is accurate.
Now, let us consider that the cereal may actually contain 130% of the label-stated amount, as found by Whittaker. A person eating a couple of cups of cereal could be ingesting as much as 62 mg iron!
Men and Post-Menopausal Women are the Targets for Iron Excess Diseases.
Iron is a cumulative poison, and most of its toxic effects are seen as diseases of aging. Francesco S. Facchini, M.D, referred very accurately to iron as "the aging factor". (The Iron Factor of Aging, Fenestra Books, 610 East Delano Street, Suite 104, Tucson, AZ 85705). Iron is a pro-oxidant, and contributes to all aspects of aging.
******************
and
******************
Heme Iron and Human Disease
Heme iron refers the iron that is found in red meat. Heme iron is much more efficiently absorbed than most other forms of iron. A recent article by A Tappel from the University of California, Davis presents a summary of the role of heme iron in a variety of diseases. "Dietary epidemiological studies indicate correlations between the consumption of red meat and/or processed meat and cancer of the colon, rectum, stomach, pancreas, bladder, endometrium, and ovaries, prostate, breast and lung, heart disease, rheumatoid arghritis, type 2 diabetes and Alzheimer's disease. The correlation of all these major diseases with dietary red meat indicates the presence of factors in red meat that damage biological components. This hypothesis will focus on the biochemistry of heme compounds and their oxidative processes."
MEDICAL PROFESSIONAL
Iron is stored in the liver in the form of ferritin, a very tough hollow protein ball that contains inside about 50000 iron atoms in clusters of metallic iron and ironoxide. This is an old invention of evolution, necessary to store the oh so precious but also oh so dangerous iron for future use. This is like a safe containing iron with actually about 8 doors/pores that can open and close to retrieve just a little bit of that precious/dangerous iron when needed.
In chronic hepatitis, when hepatocytes are dying , the ferritin molecules are lysed within, popping open/releasing that huge load of iron, which now acts as a strong potent prooxidant in the vicinityof the dying cell. Thats why a high iron load in an inflamed liver is bad news and phlebotomy was often envisioned, even in the early Schering trials as an adjunct to IFN therapy.
The simplest way to reduce the ferritin content of the liver is bloodletting, the iron is then taken to remake the missing hemoglobin, shrinking the Ferritin storage.
The measurement of serum ferritin, that reflects the liver storage, is an easy way to follow phlebotomy, so that it does not exceed its useful range : before it would lead to anemia, that is about 18 or so ng/mL.
Some people have ferritin levels as high as 300 or more ng/ml, so they have an overabundant iron storage, that could be safely reduced to reduce the intensity of hepatitis by hepatic iron release.
That is the gist behind these phlebotomy stories...
.
In chronic hepatitis, when hepatocytes are dying , the ferritin molecules are lysed within, popping open/releasing that huge load of iron, which now acts as a strong potent prooxidant in the vicinityof the dying cell. Thats why a high iron load in an inflamed liver is bad news and phlebotomy was often envisioned, even in the early Schering trials as an adjunct to IFN therapy.
The simplest way to reduce the ferritin content of the liver is bloodletting, the iron is then taken to remake the missing hemoglobin, shrinking the Ferritin storage.
The measurement of serum ferritin, that reflects the liver storage, is an easy way to follow phlebotomy, so that it does not exceed its useful range : before it would lead to anemia, that is about 18 or so ng/mL.
Some people have ferritin levels as high as 300 or more ng/ml, so they have an overabundant iron storage, that could be safely reduced to reduce the intensity of hepatitis by hepatic iron release.
That is the gist behind these phlebotomy stories...
.
giggle, Satan is having mine with some chili powder and itching powder by the feel of it!!!
OMG you do like to dig for those fleas don't ya!!!
I'll take one bucket to go with my liver and onions!!!!
black slugs on the tumm tumm....sounds like some exotic TV "eat off the lady" scene.
I'll take one bucket to go with my liver and onions!!!!
black slugs on the tumm tumm....sounds like some exotic TV "eat off the lady" scene.
what a funny but absolutely fiction concept. good grief blood letting? I read the page and there were no numbers given as to how much...I mean do you just drain dry and eat some jello and orange juice>>>>lol sorry but blood letting went out with king henry.
All I see is phlebotomy the "word" it is a term for a profession, no information on the dosage and calculation as to how much, how often, I mean is it P.O.D.
I say get yourself some leeches and a bucket of alcohol, heck you could put it you tube and be a movie star...along the lines of many of the goofy nutcases already their but hey fifteen minutes.
just kidding around now don't get any feather ruffled please
Lanier
All I see is phlebotomy the "word" it is a term for a profession, no information on the dosage and calculation as to how much, how often, I mean is it P.O.D.
I say get yourself some leeches and a bucket of alcohol, heck you could put it you tube and be a movie star...along the lines of many of the goofy nutcases already their but hey fifteen minutes.
just kidding around now don't get any feather ruffled please
Lanier
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