Black Death genetic code 'built'

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12 October 2011 Last updated at 17:02 GMT By Matt McGrath Science reporter, BBC World Service The ancient burial site is under what is now the Royal Mint The genetic code of the germ that caused the Black Death has been reconstructed by scientists for the first time.

The researchers extracted DNA fragments of the ancient bacterium from the teeth of medieval corpses found in London.

They say the pathogen is the ancestor of all modern plagues.

The research, published in the journal Nature, suggests the 14th Century outbreak was also the first plague pandemic in history.

Humans have rarely encountered an enemy as devastating as the bacterium, Yersinia pestis. Between 1347 and 1351 it sparked the Black Death, an infection carried by fleas that spread rapidly across Europe killing around 50 million people.

Now scientists have uncovered some of the genetic secrets of the plague, thanks to DNA fragments drilled from the teeth of victims buried in a graveyard in London's East Smithfield.

Professor Johannes Krause from the University of Tubingen, Germany, was a member of the research team. He said all current strains circulating in the world are directly related to the medieval bacterium.

Continue reading the main story The plague is one of the oldest identifiable diseases known to manPlague is spread from one rodent to another by fleas, and to humans either by the bite of infected fleas or when handling infected hostsRecent outbreaks have shown that plague may reappear in areas that have long been free of the diseasePlague can be treated with antibiotics such as streptomycin and tetracyclineSource: World Health Organization"It turns out that this ancient Yersinia pestis strain is very close to the common ancestor of all modern strains that can infect humans," he said.

"It's the grandmother of all plague that's around today."

Previously researchers had assumed the Black Death was another in a long line of plague outbreaks dating back to ancient Greece and Rome.

The Justinian Plague that broke out in the 6th Century was estimated to have killed 100 million people. But the new research indicates that plagues like the Justinian weren't caused by the same agent as the medieval epidemic.

"It suggests they were either caused by a Yersinia pestis strain that is completely extinct and it didn't leave any descendants which are still around today or it was caused by a different pathogen that we have no information about yet," said Professor Krause.

Tooth power

Globally the infection still kills 2,000 people a year. But it presents much less of a threat now than in the 14th Century.

DNA fragments were extracted from teeth

According to another member of the research team, Dr Hendrik Poinar, a combination of factors enhanced the virulence of the medieval outbreak.

"We are looking at many different factors that affected this pandemic, the virulence of the pathogen, co-circulating pathogens, and the climate which we know was beginning to dip - it got very cold very wet very quickly - this constellation resulted in the ultimate Black Death."

Rebuilding the genetic code of the bacterium from DNA fragments was not easy, say the scientists.

They removed teeth from skeletons found in an ancient graveyard in London located under what is now the Royal Mint.

Dr Kirsten Bos from McMaster University explained how the process worked.

"If you actually crack open an ancient tooth you see this dark black powdery material and that's very likely to be dried up blood and other biological tissues.

"So what I did was I opened the tooth and opened the pulp chamber and with a drill bit made one pass through and I took out only about 30 milligrams of material, a very very small amount and that's the material I used to do the DNA work."

From the dental pulp the researchers were able to purify and enrich the pathogen's DNA, and exclude material from human and fungal sources.

The researchers believe the techniques they have developed in this work can be used to study the genomes of many other ancient pathogens.

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Decoded DNA Reveals Details Of Black Death Germ

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Victims of the plague are consigned to a communal burial during the Plague of London in 1665.

Scientists have used DNA lurking inside the teeth of medieval Black Death victims to figure out the entire genetic code of the deadly bacterium that swept across Europe more than 600 years ago, killing an estimated half of the population.

The researchers didn't find any genetic feature that could explain why the plague was so virulent, according to a report just published in the journal Nature.

"There is no smoking gun, so to speak, to say, 'Aha, we've found the one mutation which caused this tremendous virulence and now we know why it killed 50 million people.' We don't see that," says biological anthropologist Hendrik Poinar of McMaster University in Hamilton, Canada, who was on the research team.

 

He says the most likely explanation for the plague's devastation is that this rodent-infecting bacterium changed and struck humans for the first time right when the population of Europe was dealing with a cooling climate, poor crop production and filthy, crowded conditions.

Plus, people back then had no access to modern antibiotics and were likely weakened by other infections as well.

Poinar says the ancient Black Death DNA looks so similar to Yersinia pestis that still infects people today that researchers believe the medieval strain must be the ancestor of all modern strains.

That suggests this particular disease probably wasn't around centuries earlier and couldn't have caused the Plague of Justinian, another famous epidemic that devastated the Eastern Roman Empire in 541-542.

"More likely is that it was caused by another pathogen altogether that we haven't really considered yet," says Poinar.

In the past, other research groups have produced conflicting results when they've tried to detect Black Death bacteria in skeletal remains using less sensitive genetic tools. Some experts have argued that the famous plague might have been caused by a different disease, such as an Ebola-like virus.

This study used a newer, more robust genetic technique to fish out small bits of the ancient DNA from the dried powdery pulp hidden inside teeth taken from a Black Death cemetery in London.

"This is really the first ancient complete genome from skeletonized remains," says Poinar, who notes that scientists have sequenced the genes of the deadly 1918 flu virus, but that was from preserved tissue samples.

The Natural History Museum of Denmark's Thomas Gilbert is one of the scientists who tried to find plague DNA in Black Death victims in the past without success. He says the new technique used in this study is exciting and the analysis is compelling. "It's a great result. It looks very, very convincing," Gilbert says. "There's no reason why the data shouldn't be real."

But even if this has firmly established that plague bacteria caused the Black Death, Gilbert thinks the calculations that rule out its presence during the Justinian plague are open to question.

"I'm not completely convinced by that," says Gilbert. "The only way to find out what caused the Justinian plague is to do the same analysis on the Justinian samples, and I guess that's going to be the next attempt."

He says other groups have been working to use this same technique to probe for other diseases of historical interest. "What was unique about this paper is that they basically finished first and they did it on plague," says Gilbert. "But I know for example, people are doing it on tuberculosis, and people are doing it on all sorts of other things."

He says the insights that come from these studies will be of interest not only from a historical perspective, but also to help scientists understand how deadly epidemics have emerged in the past so that they can get ready for what might come in the future.

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Death Toll From Listeria in Cantaloupe Rises to 21

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Federal health authorities say a nationwide outbreak of listeria in Colorado cantaloupes is now responsible for 21 deaths and the number may continue to grow.

The Centers for Disease Control and Prevention on Friday reported new deaths in Indiana and New York. The CDC also confirmed a death in Wyoming that state officials reported last week. CDC said 109 people have been sickened in the outbreak — including the 21 dead — in 23 states from California to the East Coast.

The agency previously reported five deaths in Colorado, five in New Mexico, two in Texas, two in Kansas and one each in Maryland, Missouri, Nebraska and Oklahoma. CDC said it is also aware of one miscarriage associated with the outbreak.

The number of illnesses and deaths is expected to grow. Louisiana has said it is investigating two listeria deaths possibly related to the outbreak that aren't included in the CDC's count.

CDC officials have said the symptoms of listeria can take up to two months to show up and that they expect more illnesses through October.

MORE: Listeria and Cantaloupe: 6 Things You Need to Know

The death toll in the cantaloupe outbreak is now tied with a 1998 outbreak of listeria in hot dogs and possibly deli meats made by Bil Mar Foods, a subsidiary of Sara Lee Corp. That outbreak was also linked to 21 deaths. The deadliest outbreak in the United States before that is believed to have been listeria in Mexican-style soft cheese in 1985, which was linked to 52 deaths.

Jensen Farms in Holly, Colo., recalled the tainted cantaloupes earlier this month after they were linked to listeria illnesses. They were shipped all over the country but should be off store shelves by now. The last cases of cantaloupes were shipped Sept. 10, and its shelf life is about two weeks.

The Food and Drug Administration has said state health officials found listeria in cantaloupes taken from Colorado grocery stores and from a victim's home that were grown at Jensen Farms. Matching strains of the disease were found on equipment and cantaloupe samples at Jensen Farms' packing facility in Granada, Colo.

The company has said they shipped the cantaloupe to around half of U.S. states, but added that they aren't sure where the cantaloupe went because it has been sold and resold. Thus, many companies may not even know if they bought or distributed the fruit. Fruit Fresh Up, Inc. of Depew, N.Y., issued a recall Thursday of 4,800 individual packages of cut cantaloupes, three weeks after the original recall and several days after the melons surpassed their freshness date.

MORE: California Farm Recalls Lettuce Over Listeria Fears

FDA Commissioner Margaret Hamburg said this week that the agency is still investigating the cause of the outbreak. Officials have said they are looking at the farm's water supply and possible animal intrusions among other things to figure out the source of the problem. Listeria bacteria grow in moist, muddy conditions and are often carried by animals.

Officials from the CDC and the Food and Drug Administration say that any cantaloupes not from Jensen Farms are safe to eat. The recalled cantaloupes may be labeled "Colorado Grown," ''Distributed by Frontera Produce," ''Jensenfarms.com" or "Sweet Rocky Fords." Not all of the recalled cantaloupes are labeled with a sticker, the FDA said.

Government health officials said this is the first known outbreak of listeria in cantaloupe. Listeria is generally found in processed meats and unpasteurized milk and cheese, though there have been a growing number of outbreaks in produce.

Listeria is rare but more deadly than well-known pathogens like salmonella and E. coli. While most healthy adults can consume listeria with no ill effects, it can kill the elderly and those with compromised immune systems. It is also dangerous to pregnant women because it easily passes through to the fetus. The CDC said the median age of those sickened is 77, and most ill people are over 60 years old.

Symptoms include fever and muscle aches, often with other gastrointestinal symptoms.

MORE: What's Lurking in Your Meat and Poultry? Probably Staph

The CDC has reported illnesses in Alabama, Arkansas, California, Colorado, Idaho, Illinois, Indiana, Iowa, Kansas, Maryland, Missouri, Montana, Nebraska, New Mexico, New York, North Dakota, Oklahoma, Oregon, South Dakota, Texas, Virginia, West Virginia, Wisconsin, and Wyoming. Colorado has the most illnesses, with 32 sickened. Texas has 16 reported illnesses, New Mexico has 13 and Oklahoma has 11.

—By MARY CLARE JALONICK

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The death of a friend

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Marci Smith "just wanted to enjoy every minute she had left," said her husband, Tim. Their son is Joshua. Marci Smith was one of the first people featured in this columnThe ultimate empowered patient, she diagnosed her own cancerCohen: She beat cancer in how she lived the last 4½ years

(CNN) -- It's never easy when you get that phone call, even when you've known for years that it might be coming. But on Friday, I got the call that someone I loved had died.

Just five days earlier, my friend Marci and I had been making plans for our kids to go trick-or-treating together, and now she's gone. I can't write that Marci Smith lost her battle with brain cancer, because Marci hated that phrase. Her husband, Tim, thinks she just didn't like the concept of losing at anything.

Actually, in my book, she beat cancer. Her disease was diagnosed when she was 43, when her son Joshua was 3 years old. Her doctor told her that statistically speaking, she had three to six months to live. That was in February 2007.

She beat cancer not just in the length of the time she survived, but in how she lived these last 4½ years. As the cancer invaded Marci's brain and the chemotherapy poisoned her body, her spirit remained clean. She never expressed anger to me that she got cancer at such a young age and with such a young child, even though she certainly would have been entitled to.

It's not that Marci sugar-coated her illness: Tim remembers she was scared when she got the diagnosis, and she talked to me and her other friends about the brain surgeries and the awful side effects of the chemo. But Marci lived full speed ahead until she couldn't live anymore. She knew cancer would ultimately end her life, but she didn't let it ruin the life she had left.

"She was such a happy, positive person," Tim told me after her death. "She just wanted to enjoy every minute she had left. She never wanted to talk about 'what happens if I die.' "

Instead, Marci planned for life. She'd always wanted to visit all 50 states, and so over the past four years, she and Tim and Joshua visited the states she hadn't been to yet. She wanted to see Israel and Scotland, too, and the three of them took trips there. When a teenage family member needed her help, she took him into her home, since helping family and friends meant everything to her.

Marci taught me so much about living, and so much about being a smart patient. She was one of the first people I wrote about when I started the Empowered Patient column shortly after her diagnosis, and our frequent discussions about doctors and hospitals and treatments and choices have informed my writing since. Marci was the ultimate empowered patient, as she diagnosed her own cancer.

When her cancer was first diagnosed, doctors told Marci she had leiomyosarcoma, a particularly rare and aggressive form of cancer. A licensed practical nurse, Marci looked up the diagnosis online and called to tell me that something sounded strange -- she had the leiomyosarcoma only in her brain and nowhere else, and such leiomyosarcoma cases are so rare, they get written up in medical journals. Plus, people with leiomyosarcoma often have had diseases like HIV, or have had lots of radiation earlier in life. Marci had neither.

Her oncologist wanted Marci to start chemo right away, but she refused. Instead, she and Tim flew to a hospital in Florida that specialized in sarcomas, where they confirmed she didn't have leiomyosarcoma, but rather a much more common type of tumor, a glioblastoma multiforme.

If Marci had simply accepted her first diagnosis, she would have received the wrong treatment and most likely would have died quite quickly. She lived for 4½ years -- she lived to see her son's seventh birthday -- because she was smart and she trusted her gut, the most important part of being an empowered patient.

Marci was in her kitchen the last time I visited her, surrounded by Tim, Joshua, her mother, and aunts, uncles, cousins and friends. The weekends at her house were like that, as she sustained a community for herself, her husband and son. I'd never seen a house so full of life in the face of death, but that's because Marci embraced all that was good no matter what horrible things lay ahead.

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Scientist wins Nobel 3 days after cancer death

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Family members of Nobel prize winner Ralph Steinman walk in front of a picture of Steinman during a ceremony honoring him at Rockefeller University in New York, Monday, Oct. 3, 2011. From left to right are daughter Lesley Steinman, wife Claudia Steinman and son Adam Steinman. Canadian-born Ralph Steinman, a cell biologist, was awarded the Nobel Prize in medicine on Monday for his discoveries about the immune system, but hours later his university said that he had died three days earlier. The Nobel committee had been unaware of his death. (AP Photo/Seth Wenig) Family members of Nobel prize winner Ralph Steinman walk in front of a picture of Steinman during a ceremony honoring him at Rockefeller University in New York, Monday, Oct. 3, 2011. From left to right are daughter Lesley Steinman, wife Claudia Steinman and son Adam Steinman. Canadian-born Ralph Steinman, a cell biologist, was awarded the Nobel Prize in medicine on Monday for his discoveries about the immune system, but hours later his university said that he had died three days earlier. The Nobel committee had been unaware of his death. (AP Photo/Seth Wenig) FILE - This is a Tuesday, Oct. 5, 2010 file photo of Professor Andre Geim, left, and Dr Konstantin Novoselov are seen outside Manchester University, Manchester, England. The scientists won the 2010 Nobel Prize for Physics. (AP Photo/Jon Super, File) FILE - In this April 24, 2009 photo, Dr. Bruce Beutler of the Scripps Research Institute in La Jolla, Calif., speaks during a news conference in Albany, N.Y., The Nobel committee says American Bruce Beutler and Luxembourg-born scientist Jules Hoffmann have shared the 2011 Nobel Prize in medicine with Canadian-born Ralph Steinman on Monday, Oct. 3, 2011. Beutler and Hoffman were cited "for their discoveries concerning the activation of innate immunity." (AP Photo/Mike Groll) FILE - In this April 24, 2009 file photo, Dr. Ralph Steinman of Rockefeller University speaks during a news conference in Albany, N.Y. Rockefeller University in New York says Ralph Steinman, co-winner of this year's Nobel Prize in medicine, has died. The university says Steinman was diagnosed with pancreatic cancer four years ago and died on Sept. 30, three days before the announcement. (AP Photo/Mike Groll, File) Nobel prize winner Ralph Steinman's family, from left to right, daughter Lesley Steinman, wife Claudia Steinman, son Adam Steinman and daughter Alexis Steinman, speak at a ceremony honoring him at Rockefeller University in New York, Monday, Oct. 3, 2011. Ralph Steinman, a cell biologist, was awarded the Nobel Prize in medicine on Monday for his discoveries about the immune system but hours later his university said that he had been dead for three days. The Nobel committee had been unaware of Canadian-born Ralph Steinman's death. (AP Photo/Seth Wenig)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); NEW YORK (AP) — Ralph Steinman, a pioneer in understanding how cells fight disease, tried to help his own immune system thwart his pancreatic cancer.

Steinman survived until Friday. Three days later, he was awarded the Nobel Prize for medicine.

The Nobel committee, unaware of his death, announced the award Monday in Stockholm. Steinman's employer, Rockefeller University in New York, learned of his death after the Nobel announcement.

Steinman's wife, Claudia, said the family had planned to disclose his death Monday — only to discover an email to his cellphone from the Nobel committee.

Friends and colleagues were stunned by his death.

"For the last five years, I've gotten up in the morning of the Nobel Prize announcement and rushed to the computer to see his name," said Olivera J. Finn of the University of Pittsburgh.

"And this morning I saw it, and I just totally shrieked with joy," she said. Then she heard the bad news from a friend in Singapore.

"I have been this whole morning ... out of breath like somebody punched me in the stomach," Finn said.

Experts disagree whether Steinman's research helped him live for 4½ years after he was diagnosed. A colleague in his lab thinks it did. The odds of making it even a year with his type of cancer are less than 5 percent.

Nobel officials said they believed it was the first time that a laureate had died before the announcement without the committee's knowledge.

"It is incredibly sad news," said Nobel Foundation chairman Lars Heikensten. "We can only regret that he didn't have the chance to receive the news he had won the Nobel Prize. Our thoughts are now with his family."

Since 1974, the Nobel statutes don't allow posthumous awards unless a laureate dies after the announcement but before the Dec. 10 award ceremony. That happened in 1996 when economics winner William Vickrey died a few days after the announcement.

However, the committee said Monday that Steinman's award would stand and that his survivors would receive his share of the $1.5 million prize.

The Canadian-born Steinman, 68, was awarded the prize along with American Bruce Beutler and French scientist Jules Hoffmann. They were honored for discoveries about the body's disease-fighting immune system.

Steinman discovered so-called dendritic cells in 1973. These cells regulate the activity of other cells — Steinman called them the conductor of the immune system.

"When he got sick, he realized he needed to call upon these cells to induce a strong enough immune response to fight his tumor, and that is what he did," said Dr. Sarah Schlesinger, clinical director for his lab.

Steinman tried eight to 10 experimental therapies approved by the federal government, focusing in various ways on revving up his immune system to fight his cancer, she said.

Colleagues came forward with their best approaches for other kinds of cancer, and Steinman analyzed what seemed the most promising for him.

In one approach, for example, samples of Steinman's own dendritic cells were loaded with protein markers from his tumor, and then reinjected into his body. The idea was that this would "teach his immune system how to respond to that tumor," said Rockefeller colleague Dr. Michel Nussenzweig.

Although he also underwent chemotherapy, "he didn't really want to take it because he wanted to be cured," Nussenzweig said. "And he felt the immune system would be the best way to effect a cure, as opposed to just living with the disease."

Dozens of scientists around the world pitched in on the effort, Nussenzweig said. "Ralph was a special person, and they were all eager to do anything to try to cure him."

The experimental therapy continued until just recently, he said, but "there's no way of knowing whether it worked or not."

Steinman was the only patient, with no control group — other patients with the same cancer for comparison, a scientific must for convincing evidence. "It's not the kind of experiment Ralph would have liked to have done."

Rockefeller University said "his life was extended" using the therapy of his own design. Schlesinger believes that, pointing to the poor survival odds for his tumor and his good quality of life during his treatment. Noting that he also got chemotherapy, she said, "I think it all worked together."

But Dr. Alan Venook, a pancreatic cancer specialist at the University of California, San Francisco, cautioned against drawing conclusions about the impact of the treatments.

He said surviving four years with pancreatic cancer "is a long time," but not out of the question, depending on the type and how advanced it was when it was found.

"It's a disservice to the field for anyone to say that his immune therapy prolonged his life," Venook added.

"The phones will be ringing off the hook" with desperate patients who mistakenly believe that these experimental treatments have been proved safe or effective when in fact they have not, he said.

Finn said Steinman used several experimental therapies based on the immune system "because he believed in that as a solution to the problem of cancer." She said she believed the approach prolonged his life.

Nussenzweig said Steinman was working on his laboratory research until just a week ago.

He was open and honest about his cancer and "talked about it with a lot of people," Nussenzweig said.

"He was incredibly heroic in how he handled his disease," Finn said. "It was something important to fight. He continued his science, his publications, his experiments. He appeared at all the meetings. He received multiple prizes. He traveled.

"He wasn't delusional in any way, but he was not going to let the disease change his life. Science was his life, and he stayed with it until the end."

Hoffmann, 70, headed a research laboratory in Strasbourg, France, between 1974 and 2009 and served as president of the French National Academy of Sciences in 2007-08.

Beutler, 53, holds dual appointments at the University of Texas Southwestern Medical Center in Dallas and as professor of genetics and immunology at the Scripps Research Institute in San Diego. He will become a full-time faculty member at UT Southwestern on Dec. 1.

Beutler and Hoffmann were cited for their discoveries in the 1990s of receptor proteins that can recognize bacteria and other microorganisms as they enter the body, and activate the first line of defense in the immune system, known as innate immunity.

The work of the three men has enabled the development of improved vaccines against infectious diseases, and in the long term could yield better treatments of cancer, rheumatoid arthritis, Type 1 diabetes, multiple sclerosis, and chronic inflammatory diseases, Nobel committee members said.

The work could also help efforts to make the immune system fight cancer, the committee said. A new treatment, Provenge, uses this concept to attack advanced prostate cancer.

"I am very touched," Hoffmann said. "I'm thinking of all the people who worked with me, who gave everything. I wasn't sure this domain merited a Nobel."

Beutler said he woke up in the middle of the night, glanced at his cellphone and realized he had a new email message.

"And, I squinted at it and I saw that the title line was 'Nobel Prize,' so I thought I should give close attention to that," Beutler said in an interview posted on the Nobel website.

When he opened it, he saw that it was from Nobel committee member Goran Hansson, "and it said that I had won the Nobel Prize, and so I was thrilled."

The medicine award kicked off a week of prize announcements, with the physics prize on Tuesday, chemistry on Wednesday, literature on Thursday and the Nobel Peace Prize on Friday. The winners of the economics award will be announced Oct. 10.

The coveted prizes were established by wealthy Swedish industrialist Alfred Nobel — the inventor of dynamite — except for the economics award, which was created by Sweden's central bank in 1968 in Nobel's memory. The prizes are always handed out on Dec. 10, the anniversary of Nobel's death in 1896.

___

Associated Press writers Karl Ritter, Louise Nordstrom and Malin Rising in Stockholm and chief medical writer Marilynn Marchione in Milwaukee contributed to this report.

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Scientist wins Nobel for medicine days after death

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Nobel prize winner Ralph Steinman's family, from left to right, daughter Lesley Steinman, wife Claudia Steinman, son Adam Steinman and daughter Alexis Steinman, speak at a ceremony honoring him at Rockefeller University in New York, Monday, Oct. 3, 2011. Ralph Steinman, a cell biologist, was awarded the Nobel Prize in medicine on Monday for his discoveries about the immune system but hours later his university said that he had been dead for three days. The Nobel committee had been unaware of Canadian-born Ralph Steinman's death. (AP Photo/Seth Wenig) Nobel prize winner Ralph Steinman's family, from left to right, daughter Lesley Steinman, wife Claudia Steinman, son Adam Steinman and daughter Alexis Steinman, speak at a ceremony honoring him at Rockefeller University in New York, Monday, Oct. 3, 2011. Ralph Steinman, a cell biologist, was awarded the Nobel Prize in medicine on Monday for his discoveries about the immune system but hours later his university said that he had been dead for three days. The Nobel committee had been unaware of Canadian-born Ralph Steinman's death. (AP Photo/Seth Wenig) FILE - In this April 24, 2009 photo, Dr. Ralph Steinman of Rockefeller University speaks during a news conference in Albany, N.Y., Friday, April 24, 2009. The Nobel committee says American Bruce Beutler and Luxembourg-born scientist Jules Hoffmann have shared the 2011 Nobel Prize in medicine with Canadian-born Ralph Steinman on Monday, Oct. 3, 2011. Beutler and Hoffman were cited "for their discoveries concerning the activation of innate immunity." Steinman was honored for "his discovery of the dendritic cell and its role in adaptive immunity." (AP Photo/Mike Groll) FILE - In this April 24, 2009 file photo, Dr. Bruce Beutler of the Scripps Research Institute in La Jolla, Calif., speaks during a news conference in Albany, N.Y. The Nobel committee said Monday, Oct. 3, 2011 that American Bruce Beutler and Luxembourg-born scientist Jules Hoffmann have shared the 2011 Nobel Prize in medicine with Canadian-born Ralph Steinman.(AP Photo/Mike Groll, File) Nobel prize winner Ralph Steinman's family, from left to right, daughter Lesley Steinman, son Adam Steinman, wife Claudia Steinman and daughter Alexis Steinman, speaks to the media after a ceremony honoring him at Rockefeller University in New York, Monday, Oct. 3, 2011. Ralph Steinman, a cell biologist, was awarded the Nobel Prize in medicine on Monday for his discoveries about the immune system but hours later his university said that he had been dead for three days. The Nobel committee had been unaware of Canadian-born Ralph Steinman's death. (AP Photo/Seth Wenig) The microscope that Ralph Steinman used in the early 70's to make his discovery about dendritic cells is displayed in his lab in New York, Monday, Oct. 3, 2011. Steinman, a cell biologist, was awarded the Nobel Prize in medicine on Monday for his discoveries about the immune system, but hours later his university said that he had been dead for three days. The Nobel committee had been unaware of Canadian-born Ralph Steinman's death. (AP Photo/Seth Wenig)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); STOCKHOLM (AP) — A pioneering researcher was awarded the Nobel Prize in medicine Monday, three days after dying of pancreatic cancer without ever knowing he was about to be honored for his immune system work that he had used to try to prolong his own life.

The Nobel committee said it was unaware that Canadian-born cell biologist Ralph Steinman had already died when it awarded the prize to him, American Bruce Beutler and French scientist Jules Hoffmann.

Since the committee is only supposed to consider living scientists, the Nobel Foundation held an emergency meeting Monday and said the decision on the 10 million kronor ($1.5 million) prize will remain unchanged.

"The Nobel Prize to Ralph Steinman was made in good faith, based on the assumption that the Nobel laureate was alive," the foundation said.

Steinman, 68, died Sept. 30, according to Rockefeller University in New York. He underwent therapy based on his discovery of the immune system's dendritic cells, for which he won the prize, the university said.

"He was diagnosed with pancreatic cancer four years ago, and his life was extended using a dendritic-cell based immunotherapy of his own design," the university said.

Beutler and Hoffmann were cited for their discoveries in the 1990s of receptor proteins that can recognize bacteria and other microorganisms as they enter the body, and activate the first line of defense in the immune system, known as innate immunity.

Nobel committee members said the work by the three is being used to develop better vaccines, and in the long run could also help treatment of diseases linked to abnormalities in the immune system, such as rheumatoid arthritis, Type 1 diabetes, multiple sclerosis and chronic inflammatory diseases.

The work could also help efforts to make the immune system fight cancerous tumors, the committee said.

No vaccines are on the market yet, but Nobel committee member Goran Hansson told The Associated Press that vaccines against hepatitis are in the pipeline.

"I am very touched. I'm thinking of all the people who worked with me, who gave everything," Hoffmann said by telephone to a news conference in Paris. "I wasn't sure this domain merited a Nobel."

Beutler said he woke up in the middle of the night, glanced at his cellphone and realized he had a new email message.

"And, I squinted at it and I saw that the title line was 'Nobel Prize,' so I thought I should give close attention to that," Beutler said in an interview posted on the Nobel website. "And, I opened it and it was from Goran Hansson, and it said that I had won the Nobel Prize, and so I was thrilled."

Still, he was a "little disbelieving" until he checked his laptop, "and in a few minutes I saw my name there and so I knew it was real."

Since 1974, the Nobel statutes don't allow posthumous awards unless a laureate dies after the announcement but before the Dec. 10 award ceremony. That happened in 1996 when economics winner William Vickrey died a few days after the announcement.

Before the statutes were changed in 1974 two Nobel Prizes were given posthumously. In 1961, U.N. Secretary-General Dag Hammarskjold was awarded the Nobel Peace Prize less than a month after he died in a plane crash during a peace mission to Congo. Swedish poet Erik Axel Karlfeldt won the Nobel in literature in 1931, although he had died in March of that year.

"The Nobel Foundation thus believes that what has occurred is more reminiscent of the example in the statutes concerning a person who has been named as a Nobel Laureate and has died before the actual Nobel Prize Award Ceremony," the foundation said following its meeting.

Nobel officials said the situation was unprecedented, and that Steinman's survivors would receive his share of the prize money. It wasn't immediately clear who would represent him at the ceremony in Stockholm.

Nobel Foundation chairman Lars Heikensten, who started his job in June, said he was stunned when he found out that Steinman was dead.

"My first thought was: 'Wow, this is a remarkable thing to happen now that I'm involved in this for the first time. How do we handle this now?'" he told AP.

Hansson said the medicine committee didn't know Steinman was dead when it chose him.

"It is incredibly sad news," he said. "We can only regret that he didn't have the chance to receive the news he had won the Nobel Prize. Our thoughts are now with his family."

Beutler, 53, holds dual appointments at University of Texas Southwestern Medical Center in Dallas and as professor of genetics and immunology at the Scripps Research Institute in San Diego. He will become a full-time faculty member at UT Southwestern on Dec. 1.

Hoffmann, 70, headed a research laboratory in Strasbourg, France, between 1974 and 2009 and served as president of the French National Academy of Sciences between 2007-08.

Steinman had been head of Rockefeller University's Center for Immunology and Immune Diseases.

"We are all so touched that our father's many years of hard work are being recognized with a Nobel Prize," Steinman's daughter, Alexis Steinman, said in the Rockefeller University statement. "He devoted his life to his work and his family, and he would be truly honored."

Hoffmann's discovery came in 1996 during research on how fruit flies fight infections. Two years later, Beutler's research on mice showed that fruit flies and mammals activate innate immunity in similar ways when attacked by germs.

Steinman's discovery dates back to 1973, when he found a new cell type, the dendritic cell, which has a unique capacity to activate T-cells. Those cells have a key role in adaptive immunity, when antibodies and killer cells fight infections. They also develop a memory that helps the immune system mobilize its defenses next time it comes under a similar attack.

The medicine award kicked off a week of Nobel Prize announcements, and will be followed by the physics prize on Tuesday, chemistry on Wednesday, literature on Thursday and the Nobel Peace Prize on Friday. The winners of the economics award will be announced on Oct. 10.

The coveted prizes were established by wealthy Swedish industrialist Alfred Nobel — the inventor of dynamite — except for the economics award, which was created by Sweden's central bank in 1968 in Nobel's memory. The prizes are always handed out on Dec. 10, on the anniversary of Nobel's death in 1896.

Last year's medicine award went to British professor Robert Edwards for fertility research that led to the first test tube baby.

___

Associated Press writer Malin Rising contributed to this report.

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CDC reports additional listeria death in Colorado

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WASHINGTON (AP) — The Centers for Disease Control and Prevention has reported a third Colorado death linked to listeria in cantaloupes, bringing the nationwide death toll in the outbreak to as many as 17 people.

The CDC said Friday that 84 people in 19 states have become ill after eating Colorado cantaloupes. That number includes 15 deaths, the CDC said. Health departments in Wyoming and Kansas have said they are investigating additional deaths that may be connected to the outbreak.

Jensen Farms in Holly, Colo. recalled its cantaloupes Sept. 14 after the farm's melons were linked to the outbreak. CDC officials have said they expect the death toll to rise because the symptoms of listeria can take several weeks to show up.

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VIDEO: Death plea case rejected by judge

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28 September 2011 Last updated at 21:57 GMT Help

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Death plea case rejected by judge

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28 September 2011 Last updated at 21:00 GMT Yogi Amin representing M's family, said they were "deeply disappointed with the judgement"

A High Court judge has ruled that a brain-damaged woman should not be allowed to die, in what is being seen as a landmark case.

The woman, who is 52 and can be referred to only as M, is in what is known as a "minimally conscious state".

Her family argued she was in pain and that artificial feeding and hydration should be withdrawn.

The Official Solicitor and the health authority responsible for her care opposed the application.

Mr Justice Baker, who heard legal argument during a Court of Protection hearing in London in July, said the case was unique and raised "very important issues of principle".

Edge of awareness

M had "some positive experiences", he said, and there was a "reasonable prospect" that those experiences could be extended.

Mr Justice Baker said: "The factor which does carry substantial weight, in my judgement, is the preservation of life. Although not an absolute rule, the law regards the preservation of life as a fundamental principle."

Continue reading the main story

Those on both sides of this argument can draw comfort from the judgement”

End Quote Fergus Walsh Medical correspondent, BBC News A spokesman for the law firm representing M's family said the law had been clarified.

Yogi Amin, a partner with the law firm Irwin Mitchell, said: "This is a very important judgment. The law has been clarified and, going forward, in all such cases of patients who are in a minimally conscious state, the High Court does now have the power to decide on whether it is in that patient's best interests for treatment to continue, or whether the patient should be allowed to die naturally, with dignity."

M became severely brain damaged eight-and-a-half years ago. She is unable to talk and had been thought to be in a vegetative state, with no awareness or consciousness of her surroundings.

However subsequent tests indicated that she is in a "minimally conscious state" - on the edge of awareness.

She is now being looked after in a care home in the north of England.

Relatives wanted life-supporting treatment to be withdrawn, saying she would not want to live "a life dependent on others".

But a lawyer appointed by the High Court to represent the woman opposed their application for nutrition to be withdrawn, saying she is "otherwise clinically stable".

The local health authority responsible for commissioning her care also opposed the application, saying the 52-year-old's life was "not without positive elements".

In 1993 the House of Lords ruled that doctors need not keep someone alive if it was viewed that it was of no benefit to the patient. That case was crucial in determining that feeding tubes could be regarded as medical treatment.

Since 1993, a total of 43 patients in a persistent vegetative state, or PVS, have died after a judge ordered that treatment could be withdrawn.

This case is different because M is minimally conscious.

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The death of a friend

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Marci Smith "just wanted to enjoy every minute she had left," said her husband, Tim. Their son is Joshua. Marci Smith was one of the first people featured in this columnThe ultimate empowered patient, she diagnosed her own cancerCohen: She beat cancer in how she lived the last 4½ years

(CNN) -- It's never easy when you get that phone call, even when you've known for years that it might be coming. But on Friday, I got the call that someone I loved had died.

Just five days earlier, my friend Marci and I had been making plans for our kids to go trick-or-treating together, and now she's gone. I can't write that Marci Smith lost her battle with brain cancer, because Marci hated that phrase. Her husband, Tim, thinks she just didn't like the concept of losing at anything.

Actually, in my book, she beat cancer. Her disease was diagnosed when she was 43, when her son Joshua was 3 years old. Her doctor told her that statistically speaking, she had three to six months to live. That was in February 2007.

She beat cancer not just in the length of the time she survived, but in how she lived these last 4½ years. As the cancer invaded Marci's brain and the chemotherapy poisoned her body, her spirit remained clean. She never expressed anger to me that she got cancer at such a young age and with such a young child, even though she certainly would have been entitled to.

It's not that Marci sugar-coated her illness: Tim remembers she was scared when she got the diagnosis, and she talked to me and her other friends about the brain surgeries and the awful side effects of the chemo. But Marci lived full speed ahead until she couldn't live anymore. She knew cancer would ultimately end her life, but she didn't let it ruin the life she had left.

"She was such a happy, positive person," Tim told me after her death. "She just wanted to enjoy every minute she had left. She never wanted to talk about 'what happens if I die.' "

Instead, Marci planned for life. She'd always wanted to visit all 50 states, and so over the past four years, she and Tim and Joshua visited the states she hadn't been to yet. She wanted to see Israel and Scotland, too, and the three of them took trips there. When a teenage family member needed her help, she took him into her home, since helping family and friends meant everything to her.

Marci taught me so much about living, and so much about being a smart patient. She was one of the first people I wrote about when I started the Empowered Patient column shortly after her diagnosis, and our frequent discussions about doctors and hospitals and treatments and choices have informed my writing since. Marci was the ultimate empowered patient, as she diagnosed her own cancer.

When her cancer was first diagnosed, doctors told Marci she had leiomyosarcoma, a particularly rare and aggressive form of cancer. A licensed practical nurse, Marci looked up the diagnosis online and called to tell me that something sounded strange -- she had the leiomyosarcoma only in her brain and nowhere else, and such leiomyosarcoma cases are so rare, they get written up in medical journals. Plus, people with leiomyosarcoma often have had diseases like HIV, or have had lots of radiation earlier in life. Marci had neither.

Her oncologist wanted Marci to start chemo right away, but she refused. Instead, she and Tim flew to a hospital in Florida that specialized in sarcomas, where they confirmed she didn't have leiomyosarcoma, but rather a much more common type of tumor, a glioblastoma multiforme.

If Marci had simply accepted her first diagnosis, she would have received the wrong treatment and most likely would have died quite quickly. She lived for 4½ years -- she lived to see her son's seventh birthday -- because she was smart and she trusted her gut, the most important part of being an empowered patient.

Marci was in her kitchen the last time I visited her, surrounded by Tim, Joshua, her mother, and aunts, uncles, cousins and friends. The weekends at her house were like that, as she sustained a community for herself, her husband and son. I'd never seen a house so full of life in the face of death, but that's because Marci embraced all that was good no matter what horrible things lay ahead.

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The death of a friend

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Marci Smith "just wanted to enjoy every minute she had left," said her husband, Tim. Their son is Joshua. Marci Smith was one of the first people featured in this columnThe ultimate empowered patient, she diagnosed her own cancerCohen: She beat cancer in how she lived the last 4½ years

(CNN) -- It's never easy when you get that phone call, even when you've known for years that it might be coming. But on Friday, I got the call that someone I loved had died.

Just five days earlier, my friend Marci and I had been making plans for our kids to go trick-or-treating together, and now she's gone. I can't write that Marci Smith lost her battle with brain cancer, because Marci hated that phrase. Her husband, Tim, thinks she just didn't like the concept of losing at anything.

Actually, in my book, she beat cancer. Her disease was diagnosed when she was 43, when her son Joshua was 3 years old. Her doctor told her that statistically speaking, she had three to six months to live. That was in February 2007.

She beat cancer not just in the length of the time she survived, but in how she lived these last 4½ years. As the cancer invaded Marci's brain and the chemotherapy poisoned her body, her spirit remained clean. She never expressed anger to me that she got cancer at such a young age and with such a young child, even though she certainly would have been entitled to.

It's not that Marci sugar-coated her illness: Tim remembers she was scared when she got the diagnosis, and she talked to me and her other friends about the brain surgeries and the awful side effects of the chemo. But Marci lived full speed ahead until she couldn't live anymore. She knew cancer would ultimately end her life, but she didn't let it ruin the life she had left.

"She was such a happy, positive person," Tim told me after her death. "She just wanted to enjoy every minute she had left. She never wanted to talk about 'what happens if I die.' "

Instead, Marci planned for life. She'd always wanted to visit all 50 states, and so over the past four years, she and Tim and Joshua visited the states she hadn't been to yet. She wanted to see Israel and Scotland, too, and the three of them took trips there. When a teenage family member needed her help, she took him into her home, since helping family and friends meant everything to her.

Marci taught me so much about living, and so much about being a smart patient. She was one of the first people I wrote about when I started the Empowered Patient column shortly after her diagnosis, and our frequent discussions about doctors and hospitals and treatments and choices have informed my writing since. Marci was the ultimate empowered patient, as she diagnosed her own cancer.

When her cancer was first diagnosed, doctors told Marci she had leiomyosarcoma, a particularly rare and aggressive form of cancer. A licensed practical nurse, Marci looked up the diagnosis online and called to tell me that something sounded strange -- she had the leiomyosarcoma only in her brain and nowhere else, and such leiomyosarcoma cases are so rare, they get written up in medical journals. Plus, people with leiomyosarcoma often have had diseases like HIV, or have had lots of radiation earlier in life. Marci had neither.

Her oncologist wanted Marci to start chemo right away, but she refused. Instead, she and Tim flew to a hospital in Florida that specialized in sarcomas, where they confirmed she didn't have leiomyosarcoma, but rather a much more common type of tumor, a glioblastoma multiforme.

If Marci had simply accepted her first diagnosis, she would have received the wrong treatment and most likely would have died quite quickly. She lived for 4½ years -- she lived to see her son's seventh birthday -- because she was smart and she trusted her gut, the most important part of being an empowered patient.

Marci was in her kitchen the last time I visited her, surrounded by Tim, Joshua, her mother, and aunts, uncles, cousins and friends. The weekends at her house were like that, as she sustained a community for herself, her husband and son. I'd never seen a house so full of life in the face of death, but that's because Marci embraced all that was good no matter what horrible things lay ahead.

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HEALTH MANAGEMENT. Lose a baby increases risk of early death for parents, mothers in particular

Losing a child during his/her first 12 months of life can considerably raise the parents' risk of dying early, researchers from the University of York, England and Stirling University, Scotland reported in BMJ Supportive & Palliative Care.
Dr Mairi Harper and team examined 5% of UK death registrations of parents who had lost a child aged 1 year or more, as well as parents who had lost a child aged less than 12 months. They were randomly selected from data from 1971 to 2006. Stillborn babies were included in the study
The data obtained from Scotland found that parents who lost a child under 12 months of age ran twice the risk of dying early or becoming widowed compared to parents who lost no children.
The impact of child bereavement was found to be greater on mothers, although fathers had a higher risk of early death too, the authors wrote.
In England and Wales, mothers who lost a child run four times the risk of dying within 15 years of the child's death, compared to other mothers. Even 25 years after the loss of a child, the risk of early death was 1.5 higher.
Dr. Harper said that "dying of a broken heart" does not only apply to the loss of a spouse or partner, it also happens to people who lose a young child.
The investigators had not had enough data to determine what impact, if any, suicides had on the figures. They believe bereavement may have a biological effect on the parents, such as undermining their immune system.
Dr. Harper said:

"Bereaved parents may also be more likely to use maladaptive coping strategies, such as alcohol misuse."

Harper explained that alcohol misuse may raise the risk of developing alcohol-related illnesses, or accidental injuries.
The authors added that perhaps some parents whose child is stillborn or dies early may themselves have poor health.
Dr. Harper said:

"It is imperative that cause of death be further investigated in order to establish the factors leading to increased mortality in bereaved parents."

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HEALTH MANAGEMENT. Increases death risk in African-American women with obesity and waist size

According to a new study led by researchers from the Slone Epidemiology Center at the Boston University higher overweight and obesity in African-American women, will increase the risk of death. Cause of death in women, moreover, was a larger waist size with a higher risk the not obese. The relationship between body size and risk of death was strongest for deaths from cardiovascular disease.
The study, published in the New England Journal of medicine, Deborah Boggs, ScD, a researcher at the Slone led.
Researchers assessed the relationship of body mass index (BMI) and waist circumference risk of death over a period of 13 years of follow up in the black women's health study, an ongoing study of 59,000 African-American women in the United States. The Auditors focused on 33.916 women who had never smoked and were free from cardiovascular disease and cancer at the beginning of the study.
The risk of death was 18 percent, for every 5 units increase in BMI and BMI most from cardiovascular disease death was connected. The risk of death from cardiovascular disease was two times higher for obese women (BMI 25-29) and three times higher for obese women (BMI of 30 or higher) compared with women with a healthy weight (BMI below 25). The researchers also found that a larger waist size increased risk of death among women is associated with, who were not obese been classified; A waist size was over 35 inches a 55 percent higher risk of death.
Whereas BMI is one good estimate of the total body fat, waist size is a measure of the distribution of body fat, particularly abdominal fat. Previous research suggests that belly fat is more metabolically active, plays a role in the development of insulin resistance and can be especially harmful for the long-term health. In those who are not obese may be waist size a better indicator of risk for many health consequences.
Earlier results found that risk of death with higher BMI in the white population increased, but the limited data available on African-Americans out, pointed, increasing risk of death only at a very high level of BMI.
"Today's results show that increases the risk of death in black women with increasing BMI of 25 or more similar to the pattern in the white people", said Boggs, main author of the study. "Our results emphasize the importance for women of a healthy weight, and keep additional inches from the waist in order to reduce the risk of death."

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