New intervention aims to improve treatment adherence among teen kidney transplant recipients

Innovative trial combines digital technology and coaching to improve adherence to treatment among young kidney transplant patients.

Learning to become self-sufficient and responsible is part of life's journey through the teen and young adult years. Mistakes are often made, and lessons are learned. However, for young kidney-graft patients, any mistake or failure in keeping to their strict immunosuppressive therapy can lead to tragic results. In fact, low-adherence to medication remains a major contributor to the high level of organ rejection in this age group.

Transplant specialists and researchers from eight leading pediatric medical centers have united to help make a difference. Led by a pediatric nephrologist and scientist,  the team conducted a clinical trial named TAKE-IT aimed at testing a new intervention to improve adherence to treatment among adolescent kidney transplant recipients.

"Missing your anti-rejection medicine, even only a few times, can lead to graft failure," says corresponding author of the study, who is also a researcher and a professor of Medicine. "Given the shortage of organs available for transplant, every failure is not only a loss for the patient but also a loss for the transplant community."

Medication non-adherence is a major problem in the 15 to 30 per cent of children in North America who have a chronic illness, resulting in significant morbidity and mortality. It is also believed to be responsible for millions of dollars in potentially avoidable healthcare costs.

TAKE-IT: Multiplying tactics to help young patients follow treatment

The TAKE-IT intervention used a combination of electronic medication monitoring and meetings with a personal coach every three months to encourage and develop adherence behaviour. The researchers followed 169 adolescent and young adult kidney transplant recipients (aged 11 to 24) for a year. Participants used the electronic pillbox,  to monitor their medication-taking. The cohort of patients was divided into two groups. The first group (81 patients) could customize the monitoring system to send them digital nudges like emails or text messages if they did not take their medicine on time. They also received coaching from people who were not part of or did not interact with the clinical team. Members of the second group, known as the control group (88 patients), didn't receive electronic messaging or adherence coaching.

Results of the trial show that the young kidney transplant recipients who used the digital health medication management and adherence solution in combination with coaching had a 66 per cent higher adherence to the anti-rejection medicine. Better adherence is likely to lead to better graft survival.

Reactions to the intervention program varied. "Some people loved it and didn't want to give the pillbox back, but others hated it and stopped using it for reasons such as the pillbox being unwieldy. Based on this feedback, the device is being re-designed," the Dr. says. "Most teens, however, liked meeting with the coach."

"These results are exciting because they show that a multidisciplinary approach can really help teens and young adults stick to their treatment plan, which is so important for their continued well-being," adds study co-author. "The coaching has a big impact as it does in sports and other activities - the encouragement and personal connection is important, because it's not easy to be a teen or young adult with a chronic health condition."

The Dr. also emphasizes that remembering to take meds can be difficult when a lot of other things are happening in the lives of these young patients, and points out the benefit of text message and email reminders for a population who grew up using cellphones.

"This is one of the largest clinical trials on adherence to daily medication ever conducted in the kidney transplant population. Identifying an approach that is effective in promoting adherence in patients with chronic conditions is a major advance," says the Dr. "Better adherence will lead to healthier patients and is likely to save healthcare dollars by preventing serious complications that would need treatment or hospitalization."

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Milk, beef may trigger rheumatoid arthritis

A strain of bacteria commonly found in milk and beef may be a trigger for developing rheumatoid arthritis in people who are genetically at risk, according to a study.

Researchers  have discovered a link between rheumatoid arthritis and Mycobacterium avium subspecies paratuberculosis, known as MAP, a bacteria found in about half the cows in the US.

The bacteria can be spread to humans through the consumption of infected milk, beef and produce fertilised by cow manure.

The researchers are the first to report this connection between MAP and rheumatoid arthritis in a study published in the journal.

They had previously discovered a connection between MAP and Crohn's disease.

Crohn's and rheumatoid arthritis (RA) share the same genetic predispositions and both are often treated using the same types of immunosuppressive drugs.

"Here you have two inflammatory diseases, one affects the intestine and the other affects the joints, and both share the same genetic defect and treated with the same drugs," said a infectious disease specialist.

For the study, the rheumatologist recruited 100 of her patients who volunteered clinical samples for testing.

Seventy-eight per cent of the patients with rheumatoid arthritis were found to have a mutation in the PTPN2/22 gene, the same genetic mutation found in Crohn's patients, and 40 per cent of that number tested positive for MAP.

"We believe that individuals born with this genetic mutation and who are later exposed to MAP through consuming contaminated milk or meat from infected cattle are at a higher risk of developing rheumatoid arthritis," the scientist said.

Rheumatoid arthritis is an autoimmune and inflammatory disease that causes the immune system to attack a person's joints, muscles, bones and organs.

Patients suffer from pain and deformities mostly in the hands and feet. It can occur at any age but the most common onset is between 40 and 60 years old and is three times more prevalent in women.
"We do not know the cause of rheumatoid arthritis, so we are excited that we have found this association," the scientist said.

"But there is still a long way to go. We need to find out why MAP is more predominant in these patients - whether it is present because they have RA, or whether it caused RA in these patients. If we find that out, then we can target treatment towards the MAP bacteria," she said.

THIS IS ONLY FOR INFORMATION, ALWAYS CONSULT YOU PHYSICIAN BEFORE HAVING ANY PARTICULAR FOOD/ MEDICATION/EXERCISE/OTHER REMEDIES.    

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Key proteins regulating heart's electrical communication found

Researchers at Cedars-Sinai Heart Institute in Los Angeles have found that six proteins - five more than previously thought - regulate the rapid flow of electrical communication signals, coordinating heart cells to produce a stable heartbeat.

The smallest of these proteins directs the largest in performing its role of coordinating billions of heart cells during each heartbeat.

Together, the proteins synchronise the beating heart, the researchers claimed.

"The findings advance our understanding of cell-to-cell communication at the root of healthy heart function. When there is less cell communication, which occurs in failing hearts, chances are greater of disturbances in heart rhythm that can result in disability or death," said Robin Shaw, senior author of the study.

Till date, scientists had recognised just one protein involved in cell-to-cell communication that occurs through conduits known as 'gap junctions', said the study.

"The finding adds startling diversity to a key biological process whereby, heart cells communicate with each other electrically," said Eduardo Marbán, director of the Cedars-Sinai Heart Institute.

"The implications are major for arrhythmias and heart failure," he added.

The researchers have also determined that a class of drugs known as 'mTOR inhibitors' - those already used for immunosuppression in organ transplants - can be used to prevent erratic and sometimes fatal heart rhythms.

A properly beating heart is necessary to pump blood to the brain, lungs and other organs.

Cell-to-cell communication occurs in all other organs. The same proteins that help heart cells communicate also play a role in brain function, bone development and insulin production in the pancreas, the study said.

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