Insight into the mechanisms by which 13-cis RA combats acne has now been provided by Diane Thiboutot and colleagues, from Pennsylvania State University College of Medicine, Hershey, who analyzed skin biopsies from patients with acne before and after 1 week of treatment with 13-cis RA. The authors suggested these data might lead to the development of new treatments for acne, which are badly needed as the use of 13-cis RA is limited by its severe side effects.

Initial analysis confirmed previous observations made using cultured cells that 13-cis RA induces a form of cell death known as apoptosis in sebaceous glands, the parts of the skin that are affected in individuals with acne. Further studies revealed that the gene responsible for making the protein NGAL was highly upregulated in human sebaceous glands by 13-cis RA. As NGAL was found to mediate apoptosis of human sebaceous glands and to be essential for 13-cis RA to mediate apoptosis of human sebaceous glands, the authors suggested that agents that selectively induce NGAL expression in human sebaceous glands might provide a new approach to treating individuals with acne.

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According to the guidelines, it is important for people with VWD to avoid over-the-counter medicines that can affect blood clotting, including aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs). Those with VWD should talk to their dentist to determine if medicine is needed before dental work to reduce bleeding. Anyone over two years of age with VWD should be immunized against hepatitis A and B to decrease risks of complications from blood transfusions. It is important to exercise regularly and maintain a healthy weight. Safe exercises include swimming, biking, and walking. Football, hockey, wrestling and lifting heavy weights are not recommended for people with VWD.

The NHLBI von Willebrand Disease Expert Panel was established in spring 2004 in response to a recommendation from the FY 2004 Congressional appropriations conference committee. The committee urged NHLBI to work with medical associations and experts in the field to develop a set of treatment guidelines for VWD.

In addition to the guidelines, the NHLBI has developed a pocket guide for physicians to provide concise information from the full guidelines report as well as a fact sheet for patients and the public.

To interview Dr. Nichols, Dr. James, or another VWD expert, contact the NHLBI Communications Office at (301) 496-4236.

Resources:

Guidelines for the Diagnosis, Evaluation and Management of von Willebrand Disease nhlbi.nih/guidelines/vwd Von Willebrand public education materials nhlbi.nih/health/dci/Diseases/vWD/vWD_WhatIs.html

Part of the National Institutes of Health, the National Heart, Lung, and Blood Institute plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at www.nhlbi.nih.

The National Institutes of Health (NIH) ” The Nation's Medical Research Agency ” includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.

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