Gossip, Ozempic, sex in the brain, evolution of snakes, and a major clinical trial for autoimmunity

Issue #6 of American Journalist

Friday, February 23, 2024

What an odd week in the world of science. First there was the news of the Alabama Supreme Court’s decision impacting IVF (and the clinical closures and would-be parents left holding the bag). Next the first U.S. moon landing in 52 years and the first private company landing ever. Finally the sad reminder of how measles will take advantage of vaccine hesitancy by spreading in places where not enough people are vaccinated—and, with the Florida Surgeon General’s announcement, the even sadder reminder that politics thoroughly trumps public health in our country today.

The stories we share this week are not about those headlines. Rather they are simply good reminders of why we love science in the first place—JSB.

1) Immunotherapy for autoimmune diseases?

In what’s being billed as a potential major breakthrough that will open up new horizons for treating people with autoimmune disorders, doctors at Friedrich-Alexander University in Erlangen, Germany, are reporting the results of a small but hugely significant clinical study that seems to have had outstanding results.

The study looked at a new immunotherapy approach to treating autoimmunity that involves genetically modifying a type of white blood cells known as chimeric antigen receptor T cells (CAR T cells). Already approved by the FDA for several types of leukemia, CAR T therapy is actively being explored for other indications, including for aging. This new clinical trial looked at its safety and efficacy for treating 15 people suffering from three different autoimmune diseases: eight with severe lupus, three with idiopathic inflammatory myositis, and four with systemic sclerosis. These are severe, serious, and life-threatening conditions.

The results seem impressive. After a single infusion of the CAR T cells, all 15 people had such favorable remissions of their autoimmunity that they were able to completely stop taking immunosuppression drugs to control symptoms. The therapy was also deemed safe, “providing rationale for further controlled clinical trials,” the doctors write.

An old boss of ours used to say the punchline of a story should never be more research is needed. But in this case, he’s wrong. This is a promising treatment, and we look forward to more studies as it finds its way from the laboratory to the clinic. The only downside we can see is cost. CAR T therapy requires your cells to be removed from your bloodstream, carefully isolated, kept alive, genetically modified, and then infused back into your body. A 2023 WebMD estimate projected the cost of CAR T therapy (for cancer) somewhere between $500,000 and $1 million. How widely available could it be at that price? New England Journal of Medicine

2) AI spots replicable and “behaviorally relevant” sex differences in the brain

Psychiatry knows both cis genders—that much is certain. Women are more likely to experience depression, anxiety, and/or eating disorders in their lifetimes, and men are more likely to fall on the autism spectrum, exhibit attention-deficit hyperactivity disorders, and suffer schizophrenia. What isn’t clear, though, is what specifically distinguishes male and female brains on a physiological level. Understanding those differences may help better define what constitutes normative behavior and psychopathology, according to experts.

Now researchers at Stanford University say they have found replicable and “behaviorally relevant” sex differences in the brain. They used AI to examine MRI brain scans of about 1,500 young men and women aged 20–35 and found gender differences in several brain regions—including the default mode network, the striatum, and limbic network. “Our findings underscore the crucial role of sex as a biological determinant in human brain organization,” the researchers write. PNAS

3) The coming flood of direct-to-consumer weight loss drugs

An interesting op-ed this week by doctors at Seattle’s Puget Sound Health Care System and the University of Washington calls attention to the rise of direct-to-consumer marketing and sales of semaglutide GLP-1 receptor agonists like Ozempic and Wegovy for weight loss. This follows the Washington Post’s report last week that some weight-loss spas as well as drugmaker Novo Nordisk are targeting body-positive plus-sized influencers to promote these drugs. That’s just the tip of the iceberg, apparently.

Despite well-publicized shortages, possible side effects, and whopping, often unreimbursed are-you-kidding me price tags of over $1,000 a month, demand for these drugs is so high that people were already conferring blockbuster status to Wegovy even before it was FDA approved. Now that the wellness spas, traditional mail-order pharmacies, and weight-management companies like WeightWatchers and Noom are starting to get in on the action and incorporate these drugs into their services, there are LOTS of questions that come up.

Will easier access through these direct-to-consumer platforms translate into better care? That’s the million-dollar question (sorry, billion-dollar question since these are blockbuster drugs). There are possible complications for people with pre-existing chronic conditions like hypertension and diabetes. There are potential drug interactions that need to be taken into account. And a huge red flag in general is the prospect of having your weight management integrated into your primary care not at all at all. Still, if that can be done, and your weight management company does talk to your primary care docs, then better outcomes may be possible, according to the Seattle doctors. “We believe that better access will in fact translate into better care,” they say in New England Journal of Medicine.

Getting your insurance companies to pay for the drug? That’s another matter!

4) Did you hear what a certain so-and-so said about a certain something called the evolution of gossip?

One of our old bosses used to say that the only thing worse than being talked about was not being talked about. Evolutionarily speaking, that may be true according to researchers at the Chinese University of Hong Kong and Stanford University.

They hypothesize gossip evolved in ancient human societies and has persisted for thousands of years to the present day because of advantageous cooperation between the gossiper and those who are gossiped about. Gossipers proliferate information about other people to third parties, both establishing and sustaining a person’s reputation. That causes people to behave more favorably toward gossipers because they selfishly seek to improve their own reputations.

“As a result,” say researchers, “gossiping has an evolutionary advantage that leads to its proliferation.” PNAS

5) The evolution of snakes

Journalists love stories about snakes! We could not wind down the week without sharing a few of the absolutely amazing photos of our distant vertebrate cousins the squamate reptiles (snakes and lizards). These images accompanied this week’s big news out of Stony Brook University, Indiana University, and the University of Michigan.

Looking at the genomes of 1,018 snake and lizard species and comparing the information to dietary data on 68,547 individual animals from 1,314 species, they describe a point of origins for the incredible reptiles’ diversity—something they call “spectacular innovations in locomotion, feeding, and sensory processing.” It came into being following “a pulse of evolutionary innovation” (LOVE that phrase), which occurred around the time snakes emerged 128 million years ago.

We feel there is more to this story to come. As the researchers note, “snakes engage with human emotions in a visceral manner unmatched by almost any other group of organisms.” Science