Ukrainian scientists urge restarting trials, some things improve with age, & a universal antivenom gains proof of principle

"Clinical research is alive. We've proved we are robust," said Ivan Vyshnyvetskyy of the Ukrainian Association for Clinical Research.

February 22, 2024 Check out STAT+

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By Elizabeth Cooney Reporter, Morning Rounds Writer

Good morning. Today we consider wisdom in the debate on cognition and aging, look to Ukraine for clinical trials, and see CAR-T therapy in a new light. Also, snakes.

aging Some things improve with age. Cognitive skills are among them Adobe "Older but wiser" is a saying with scientific backing, flying in the face of heated rhetoric about our two age 75+ candidates for the U.S. presidency. We're all familiar with mental skills fading among elderly adults, scrutinized as predictors of dementia every time the car keys or a name goes missing. But less often heard in the current debate is the body of evidence showing that older people are better at recognizing multiple perspectives, encouraging compromise, and acknowledging the limits of their knowledge, STAT's Olivia Goldhill tells us. Yes, working memory for details might fade, but a few different studies point to increased wisdom and calmer decision-making, and a series of studies shows less emotional volatility as people age. "The elderly brain has a lot of knowledge," said MIT's Earl Miller. As people tend to lose their working memory, they develop other skills that make up for these deficits. Read more. health CAR-T shows promise for autoimmune diseases  If you've heard of CAR-T, you know it's a novel cancer therapy enlisting a patient's genetically modified immune cells to attack malignant cells. Now researchers in Germany report progress in expanding CAR-T outside cancer: to correct autoimmune disorders, in which the immune system goes after its own healthy cells. In a NEJM paper published yesterday, they describe how 15 patients saw their symptoms and disease biomarkers eliminated or reduced after a single infusion of CAR-T cells. Those cells were designed to target B cells, immune cells that play a key role in driving autoimmunity. Early in the trial, it wasn't clear whether the chemotherapy required before CAR-T was responsible for the improvement, but the effects have lasted longer than that explanation would hold. It's still not known why the CAR-T therapy seems to work so much better than previous monoclonal antibody treatments. STAT's Theresa Gaffney has more. insurance Stacking up Medicare vs. Medicare Advantage plans Commonwealth Fund Medicare Advantage plans have been in the headlines at STAT, particularly when it comes to how decisions are made on covering care. That's why it's interesting to see what survey respondents thought about Medicare Advantage and traditional Medicare plans. In a Commonwealth Fund report released today comparing enrollees' experiences, almost two-thirds said they were satisfied with their plans, whether traditional Medicare or Medicare Advantage, the name for private plans that typically offer dental and vision benefits, unlike the traditional plan. Another similarity: More than a third in each plan said they had to wait more than a month to see a doctor.  There were differences: More Medicare Advantage beneficiaries (22%) than traditional Medicare beneficiaries (13%) reported delays in care because they needed insurance approvals. More Medicare Advantage (62%) than traditional Medicare beneficiaries (27%) said they were asked to undergo health assessments that "rarely led to changes in care plans or availability of more services or benefits."

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closer look 'Clinical research is alive': Ukrainian scientists urge restarting trials Roman Minchyn / Wikimedia Commons  Before Russia invaded Ukraine in February 2022, the country had been a hotbed of clinical trials, particularly in cancer. Its organized, digitized health system was a draw for running trials that cost less than in Western Europe. Participants were eager to sign up, hoping to gain access to treatments otherwise not available in their country. Ukraine was second only to India —whose population is 30 times bigger — among lower middle-income countries in terms of oncology clinical trials participation, according to a 2022 study. While starting up a clinical trial is a hard sell in a war zone, proponents say not all of Ukraine is off-limits. "Clinical research is alive. We've proved we are robust, we are trustable," said Ivan Vyshnyvetskyy, the head of the Ukrainian Association for Clinical Research. STAT's Andrew Joseph has more, including how the Swedish company InDex Pharmaceuticals is making it work and how  researchers at Dnipro State Medical University (above) hope to. in the lab Universal antivenom might be a step closer Full disclosure: I have a phobia about snakes. Either because or in spite of that, I have never considered how antivenom is made. The answer, STAT's Jason Mast tells us, is the old-fashioned, "vampiric" way: Inject a horse or a cow with sub-lethal doses of venom from various local snakes, wait for an immune response to develop, tap their blood, purify out antibodies, bottle, and freeze. That's the standard because venoms and their targets vary too much — even in the same snake — to beat with specific antibodies.  "Snake venom is one of the most complex things you can come across," said Karitk Sunagar, head of the Evolutionary Venomics Lab in Bangalore, India. Enter a proof-of-concept paper by Sunagar and others for creating a universal antivenom, published yesterday in Science Translational Medicine. The scientists built on tools to fight other deadly foes, Jason explains, including HIV. vaccines October was the best month for kids to get flu shots, study says What do birthdays and flu shots have to do with each other? A new BMJ study of children 2 to 5 years old suggests timing matters for how likely they are to get vaccinated or to get infected with flu. Among more than 800,000 kids, the average flu diagnosis rate was 3% but was 2.7% for children born in October and 2.9% for those born in December. Children with October birthdays may be more likely to get their shots at an annual pediatrician's visit in that month, when seasonal flu vaccine is available and it's neither too early nor too late to get the shots (though birthdays aren't the only reason kids see their doctors). Young children face a higher risk of flu and severe infection requiring a hospital stay. The CDC recommends no sooner than September and October for flu shots so they provide protection throughout the winter flu season.

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Thanks for reading! More tomorrow,

elizabeth.cooney@statnews.com

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