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Quality of Life With Busulfan and Fludarabine Compared With Busulfan and Cyclophosphamide – Hematology Advisor

Posted: November 15, 2019 at 3:44 pm

Myeloablative conditioning with busulfan and fludarabine (bu/flu) may produce similar clinical outcomes and quality of life (QOL) compared with conditioning with busulfan and cyclophosphamide (bu/cy) for allogeneic hematopoietic cell transplantation (alloHCT) in acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS), according to research published in Hematology/Oncology and Stem Cell Therapy.

Although bu/cy and bu/flu are both standard myeloablative conditioning regimens for alloHCT, they have not yet been studied with a focus on quality of life. Researchers conducted a single center, retrospective analysis of adult patients who received a first T-cell-replete human leukocyte antigen-8/8 matched related or unrelated donor alloHCT. The study included 126 patients with AML and 84 patients with MDS. All patients were 18 years or older and were treated between 2008 and 2017.

Quality of life was measured using the Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale (FACT-BMT) questionnaire.

The researchers found no significant differences in FACT-BMT scores between patients receiving bu/cy and patients receiving bu/flu in both the AML and MDS cohorts. No significant difference was found to for mucositis severity either.

When patients with AML were analyzed separately, the researchers found that those receiving bu/flu had more rapid neutrophil and platelet recovery compared with patients receiving bu/cy, as well as a shorter median hospital stay. No differences were found in other post-transplant outcomes.

In the MDS cohort, the researchers found that patients receiving bu/flu had more rapid platelet recovery and a shorter median hospital stay as well as greater risk for cytomegalovirus infection compared with patients receiving bu/cy. However, patients receiving bu/flu experienced decreased risk for nonrelapse mortality. There were no significant differences in other outcomes.

Previous studies examining these 2 regimens have found no differences regarding hematopoietic engraftment kinetics, risk for grade 3 or 4 mucositis, graft-versus-host disease, relapse, and nonrelapse mortality. The current study suggests quality of life may also be similar between the regimens. Future formal cost-effectiveness analyses of these regimens would be appropriate to better assess the implications for resource utilization, wrote the authors.

Reference

1. Patel SS, Rybicki L, Pohlman B, et al. Comparative effectiveness of busulfan/cyclophosphamide versus busulfan/fludarabine myeloablative conditioning for allogeneic hematopoietic cell transplantation in acute myeloid leukemia and myelodysplastic syndrome [published online October 11, 2019]. doi:10.1016/j.hemonc.2019.09.002

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Fife pupils hope to save lives by taking part in stem cell recruitment event – Fife Today

Posted: November 15, 2019 at 3:44 pm

Senior pupils from Balwearie High are hoping to save lives after taking part in an Anthony Nolan Trust stem cell recruitment drive recently.

The event was held at the school last Friday and saw 125 potential donors sign up by giving cheek swabs.

S6 pupil Emily Greig explained how the recruitment drive came about: The school was approached by the Scottish Fire and Rescue Service to hold the event and we immediately thought it was a brilliant way to help people, she said.

In addition it was a great way to involve pupils in the wider community and allow some sixth year pupils a voluntary opportunity to become a SFRS champion.

The champions were mostly Advanced Higher Biology pupils who are seeking a career in science and were interested in the donation process, however it wasnt directly linked to the curriculum.

Through organising the event there was an opportunity to learn or develop skills for work and further education.

We thank the Scottish Fire and Rescue Service for giving us the opportunity to run the event in our own way.

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She said SFRS arranged to come into the school and facilitate the swabbing but stressed the event was pupil led with the SFRS champions organising things on the day.

Emily said the fire service delivered an assembly about the donation process along with a former pupil from Kirkcaldy High who was a donor to tell pupils more if they are a match.

She added that Balwearie High pupil Amy Dall who lost her dad to blood cancer was also involved in the stem cell drive.

While Amys mum Jen was involved in recruiting pupils to take part.

Emily said: A fifth year pupil, Amy Dall lost her father, Gary to blood cancer. Amys mum, Jen Dall, was involved in recruiting pupils at assembly to sign up and on the day by working with the fire fighters doing swabs.

I had the opportunity to speak to her on Friday about why she felt it was so important for Anthony Nolan and the SFRS to recruit in schools.

She said stem cell donation doesnt get spoken about enough and she herself had never heard of it before her husbands diagnosis. Jen wanted to emphasise to the pupils and readers that signing up and donating affects peoples lives.

Jen is now working on spreading the message to young people 16+ to put themselves on the register for the chance to save someone.

When reflecting on her own experience, Jen said: You never think its going to be you and your family thats affected. We didnt have a happy ending as Gary became too ill to receive his transplant but we are working towards helping other people receive theirs.

Amy joined the register on Friday with many of her peers also joining her.

Rector Neil McNeil said: I am delighted to report that the final number of potential life saving donors from the event was 125, which is the record for Fife schools.

I am proud of our seniors who participated in this worthy cause as they are a credit to the school and their families.

Amy Bartlett, regional register development manager for Anthony Nolan in Scotland, said: SFRS have been working in partnership with Anthony Nolan for the last ten years to recruit young people to the Anthony Nolan stem cell register.

Most SFRS partnership activity now takes place in schools across Scotland.

Its a great way of reaching our target audience as Anthony Nolans research indicates that younger donors provide better survival rates for patients.

Friday was a fantastic day and 125 potential donors signed up from Balwearie High in Kirkcaldy and any one of these pupils could give a second chance of life to someone with blood cancer.

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Taiwan Announced the Application of Cell Therapy, The Value of The Medical Industry was Improved – Yahoo Finance

Posted: November 15, 2019 at 3:44 pm

Taiwan has top cell technology, and Guang-Li Biomedicine and Taipei Medical University Hospital have passed legal review in November, 2019.

TAIPEI, TAIWAN / ACCESSWIRE / November 15, 2019 / In September last year, Taiwan announced the application method for cell therapy. Up to now, 27 medical institutions and 80 cell therapy applications are awaiting review, which is expected to increase medical output. Among them, Taipei Medical University Hospital and Guang-Li Biomedicine applied for CIK immune cell therapy for 12 solid cancers through the Cancer Treatment Application Program, all of which were approved attracting many domestic and foreign patients to come to receive treatment.

Cell therapy is targeted at patients with stage I to III cancer who are not responding to standard therapy, as well as patients with stage 4 of solid cancer. Taiwan Cell Therapy Project:

Beginning in May, the General Hospital of the Three Armies used "autoimmune cell CIK" to treat malignant lymphoma and multiple myeloma. The Hospital of China Medical University uses "autoimmune cell DC" to treat pancreatic cancer, prostate cancer, liver cancer, and breast cancer. The Hospital of Taipei Medical University uses "autoimmune cell CIK" to treat colorectal cancer, breast cancer, lung cancer, cervical cancer, ovarian cancer, kidney cancer, liver cancer, pancreatic cancer, nasopharyngeal cancer, stomach cancer, esophageal cancer, and cholangiocarcinoma. A total of 12 solid cancers is the largest number of indications.

Guang-Li Biomedicine, Dr. Yi-Ru Chen, said that the Guang-Li Research Center meets the stringent specifications of various cell therapies and uses top-notch technology to produce Cytokine-induced killer cells (CIK) to provide a strong immune system for cancer patients. At present, there are many related cases to be applied in succession. In the future, Guang-Li Biomedicine will continue to study clinical cases and improve cell quality in cooperative hospitals to alleviate pain and create happiness for the majority of cancer patients.

Taiwan's top cell therapy technology has enabled the medical community to make more progress in the use of cell technology, accelerate the formation of the cell therapy industry chain, and prioritize the opening of other countries to make Taiwan more marketable. In the near future, it has helped many cancer patients stabilize their disease, prolong life, and even be cured. The output value of cell therapy is TWD$16.5 billion. The international medical service multiplication plan estimates that the medical output value will double to TWD$40 billion in 2023, and it is expected that more foreigners will be attracted to Taiwan for medical treatment in the future.

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Taipei Medical University Hospital has passed the JCI evaluation of American International Hospital and the JCI CCP-CKD clinical care certification for chronic kidney disease twice. It has passed the ISO9001:2008 certification and is the second in Taiwan. One of the American AAHRPP Subject Protection Assessments, and won the National Quality Award of the Executive Yuan, and the quality assessment of cancer A-level diagnosis and treatment.

Guang-Li Biomedicine laboratory was established in 2009. The laboratory team consists of Doctoral and Master researchers. It is the first in Taiwan to have cord blood, umbilical cord mesenchymal stem cells, adipose stem cells, peripheral blood stem cells, and immune cell storage services. The omni-directional storage center has many patents for cell culture in Taiwan and the mainland.

CONTACT:

Guang-Li Biomedicine Inc.Ting-Cheng LinE-mail: alic@guangli.com.twPhone: +886-2-2694-9880Website: https://guangli.com.tw/

SOURCE: Guang-Li Biomedicine Inc.

View source version on accesswire.com: https://www.accesswire.com/566745/Taiwan-Announced-the-Application-of-Cell-Therapy-The-Value-of-The-Medical-Industry-was-Improved

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Allogene allies with Notch to make CAR-T production more scalable – BioPharma-Reporter.com

Posted: November 14, 2019 at 12:46 pm

Last year, Arie Belldegrun and David Chang, fresh from selling chimeric antigen receptor (CAR)-T pioneer Kite Pharma to Gilead Sciences, launched Allogene with $300m (271m) and a deal with Pfizer to access off-the-shelf cell therapies. The focus then, as now, was on taking CAR-T therapies mainstream by eliminating factors that could restrict them to niche status, such as the complex, costly production process.

Allogenes founding allogeneic technology moves it some way toward that goal, by enabling therapies to be made from donor cells rather than having to engineer cells taken from the patient themselves.

However, even if the allogeneic approach works as Allogene hopes, it will still require a steady supply of donor cells. When Allogene launched, it set its sights on making up to 100 doses from one donor sample.

The finite nature of donated T cells has spurred interest in induced pluripotent stem cells (iPSC), which could serve as a renewable source of materials for off-the-shelf CAR-T therapies. Notchs work to realize that potential caught the attention of Allogenes CEO, David Chang.

Chang said, We believe [it] to be a scalable and potentially more [good manufacturing practice] amenable manufacturing process. It might be amenable for large-scale manufacturing.

The early stage nature of the iPSC technology Notch is yet to enter the clinic means it is unclear whether the approach can live up to those expectations. An inability to show CAR-T doses are free from undifferentiated iPSCs and failure to generate functioning T cells from iPSCs are two potential stumbling blocks.

Allogene has seen enough potential to bet on Notch, though. The deal will see Allogene pay Notch $10m upfront, take a 25% stake in its new partner and commit to a package of milestones.

Notch will take iPSC AlloCAR T cells through preclinical development before Allogene steps in to test them in humans. Allogene will have global rights to any products resulting from the collaboration.

Other companies are also working to develop oncology cell therapies based on iPSCs. Fate Therapeutics is trialling an engineered natural killer cell therapy created from a clonal master iPSC line, while Bayer-backed startup Century Therapeutics recently raised $250m to take iPSC-derived treatments for blood cancers and solid tumors into the clinic. Takeda is also active in the space.

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Gene Editing Tool in Ongoing Sickle Cell Trial of BIVV003 Supported by Early Study – Sickle Cell Anemia News

Posted: November 14, 2019 at 12:46 pm

A technique called zinc finger nuclease (ZFN) gene editing technology can be used to modify immature red blood cells called precursor cells to boost the production of fetal hemoglobin and help ensure red blood cells maintain a normal shape in people with sickle cell disease (SCD), a study shows.

Sanofi has launched a Phase 1/2 trial (NCT03653247) evaluating the safety, tolerability and efficacy of a BIVV003, a gene editing therapy using the ZFN technology (by Sangamo Therapeutics) in adults with severe SCD. This trial, taking place at four U.S. sites, is currentlyrecruiting eligible patients.

ZFN technology findings will be presented by Samuel Lessard, PhD, a researcher at Sanofi, in the poster, Zinc Finger Nuclease-Mediated Disruption of the BCL11A Erythroid Enhancer Results in Enriched Biallelic Editing, Increased Fetal Hemoglobin, and Reduced Sickling in Erythroid Cells Derived from Sickle Cell Disease Patients, (abstract No. 974) at the 61st Annual Meeting of the American Society of Hematology (ASH), December 710 in Orlando.

Sickle cell is caused by mutations in the HBB gene, which provides instructions for making part of hemoglobin, a protein responsible for transporting oxygen in the blood.

These mutations change the structure of the protein, resulting in the production of abnormal hemoglobin fibers. These fibers tend to stiffen red blood cells, changing their shape from normal disc-like cells to those with a sickle-like shape.

BIVV003 is an investigational gene edited cell therapy being developed under an agreement between Bioverativ, a Sanofi company, and Sangamo.

It uses Sangamos proprietary ZFN gene editing technology to modify a short sequence of the BCL11Agene in red blood precursor cells acquired from the patients own hematopoietic stem cells (stem cells that give rise to other blood cells) to raise production of fetal hemoglobin, the main form of hemoglobin found in fetuses.

Fetal hemoglobin production is normally switched off in adults and largely disappears at ages 6 months to 1 year, but artificial ways of introducing fetal hemoglobin show increasing promise in treating SCD by preventing red blood cells from taking on a damaging sickle shape.

Sangamoannounced the findings from a proof-of-concept ex-vivo(lab) study aiming to validate the ZFN gene editing technology using immature red blood cell isolated from four healthy donors and one sickle cell patient.

Study findings demonstrated that more than 90% of edited donor cells incorporated genetic modifications in both copies of the BCL11A gene, leading to an increase of 27% to 38% in fetal hemoglobin levels compared to baseline (studys start).

Edited cells from the SCD patient also tended to incorporate these modifications in both gene copies. As a result, patient edited cells produced up to 28% more fetal hemoglobin compared to unedited cells.

Patient red blood cells obtained from already edited precursor cells were also less likely to change to a sickle-like shape, supporting BIVV003 as a potential cell therapy for SCD, the study reports. Further experiments in red blood precursor cells from additional SCD patients are underway.

Sangamo is also enrolling patients with transfusion-dependent beta-thalassemia (TDT) in thePhase 1/2 THALES trial (NCT03432364) to evaluate the safety, tolerability, and efficacy of ST-400, another experimental gene-edited cell therapy that uses the same gene-editing approach as BIVV003.

The companyannounced it will present data from the first three THALESpatients at the ASH meeting.

Joana is currently completing her PhD in Biomedicine and Clinical Research at Universidade de Lisboa. She also holds a BSc in Biology and an MSc in Evolutionary and Developmental Biology from Universidade de Lisboa. Her work has been focused on the impact of non-canonical Wnt signaling in the collective behavior of endothelial cells cells that make up the lining of blood vessels found in the umbilical cord of newborns.

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Margarida graduated with a BS in Health Sciences from the University of Lisbon and a MSc in Biotechnology from Instituto Superior Tcnico (IST-UL). She worked as a molecular biologist research associate at a Cambridge UK-based biotech company that discovers and develops therapeutic, fully human monoclonal antibodies.

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Todos and Amarantus JV Announces Full Enrollment for Clinical Trial of LymPro Alzheimers Blood Test Relationship with Amyloid PET – Yahoo Finance

Posted: November 14, 2019 at 12:46 pm

REHOVOT, Israel and NEW YORK, Nov. 14, 2019 (GLOBE NEWSWIRE) -- Todos Medical Ltd. (TOMDF), a clinical-stage in-vitro diagnostics company focused on the development of blood tests for the early detection of cancer and neurodegenerative disorders, and Amarantus Bioscience Holdings, Inc. a US-based JLABS-alumnus biotechnology holding company developing proprietary orphan neurologic, regenerative medicine and ophthalmic therapies and diagnostics through its subsidiaries, today announced that their joint venture company, Breakthrough Diagnostics, Inc. has completed enrollment of its ongoing clinical trial evaluating the relationship of Alzheimers blood diagnostic Lymphocyte Proliferation Test (LymPro Test) with amyloid PET neuroimaging at Leipzig University in Germany (the LymPro PET 2). Topline results are expected before the end of the first quarter of 2020.

Breakthrough completed a 20-subject clinical study (LymPro PET 1) in 2018 evaluating the correlation between LymPro scores and the diagnosis of Alzheimers disease, as confirmed with amyloid PET neuroimaging and other Alzheimers disease biomarkers. LymPro measures cell cycle dysregulation in peripheral lymphocytes. The top-line data, announced in July 2019, revealed a strong and statistically significant correlation between LymPro scores and amyloid PET neuroimaging cSUVR scores (r = -0.849; p = 0.00000216). Breakthroughs academic collaborators at the Leipzig University then expanded enrollment of that study to include an additional cohort of 20 subjects (LymPro PET 2) to confirm the strong relationship seen from LymPro PET 1. The data from both LymPro 1 and LymPro 2 will be published together in a peer-reviewed journal in 2020.

LymPro is a unique immune system-based Alzheimers blood test, said Dr. Herman Weiss, President & CEO of Todos. LymPro could prove to be a major breakthrough for Alzheimers disease diagnosis by measuring cell cycle dysregulation and amyloid, together, conveniently as part of a blood workup in routine clinical practice. The therapeutic field in Alzheimers has begun to see some renewed hope based upon recent Aducanumab data announced by Biogen that is directly related to the amyloid hypothesis, as well as conditional approval by the National Medical Products Administration in China for the first new Alzheimers drug in over 20 years, called Oligomannate from Shanghai Green Valley Pharmaceuticals, that is based on gut-brain biology of the microbiome and its effects on the immune system. We believe this renewed optimism and broadening of pathophysiological hypotheses relevant to Alzheimers disease being evaluated in the clinic significantly increases the scope for LymPro pharma services collaborations and begins to refine LymPros clinical utility profile for primary care physicians as strategies to correct cell cycle dysregulation emerge.

About Alzheimer's DiseaseAccording to the Alzheimer's Association, it is estimated that over 5.4 million people in the United States suffer from Alzheimer's disease. Over 500,000 patients are diagnosed annually, with nearly one-in-eight older Americans affected by the disease. Alzheimer's disease is the third leading cause of death in the United States. The cost of unpaid care in the United States is estimated at over $210 billion annually.Total payments for care are estimated at over $200 billion annually, including $140 billion in cost to Medicare and Medicaid. Alzheimer's expenditures in the United States are expected to exceed $1.2 trillion by 2050. There is no cure or effective treatment for Alzheimer's disease. Worldwide, about 35.6 million individuals have the disease and, according to the World Health Organization, the number will double every 20 years to 115.4 million people with Alzheimer's by 2050.

About Dr. Arendt's Research at Leipzig UniversityDr. Thomas Arendt is Professor of Neuroscience at Leipzig University where he runs the Paul Flechsig Institute of Brain Research. He has a 30-year record in R&D of therapeutic and diagnostic strategies of neurodegenerative disorders and made several seminal contributions to therapeutic concepts of Alzheimer's disease, including stem cell therapy and modulating tumor suppressor genes. In the early 1980's, he was involved in identifying the degeneration of the cholinergic system in Alzheimer's disease laying the basis for today's only available treatment. He is one of the pioneers of the "cell-cycle theory" of Alzheimer's disease, which he developed towards a diagnostic and therapeutic concept.

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About Breakthrough Diagnostics, Inc.Breakthrough Diagnostics, Inc. is a joint venture owned by Amarantus Bioscience Holdings, Inc. (AMBS) (80.01%) and Todos Medical Ltd. (19.99%). Breakthrough has been assigned the intellectual property and other rights to the LymPro Test, a diagnostic blood test for Alzheimers disease, as well as rights to other neurological diagnostics testing intellectual property. Todos Medical has provided Amarantus with notice of Todos decision to exercise its exclusive option to acquire the 80.01% of Breakthrough Diagnostics that it currently does not own.

The Lymphocyte Proliferation Test (LymPro Test) determines the ability of peripheral blood lymphocytes (PBLs) and monocytes to withstand an exogenous mitogenic stimulation that induces them to enter the cell cycle. It is believed that certain diseases, most notably Alzheimer's disease, are the result of compromised cellular machinery that leads to aberrant cell cycle re-entry by neurons, which then leads to apoptosis. LymPro is unique in the use of peripheral blood lymphocytes as surrogates for neuronal cell function, suggesting a common relationship between PBLs and neurons in the brain.

About Todos Medical Ltd.Todos Medical Ltd. is an in-vitro diagnostic company engaged in the development of blood tests for the early detection of a variety of cancers, and also has initiated the development of blood tests for neurodegenerative disorders such as Alzheimer's disease through Breakthrough Diagnostics, Inc., its joint venture with Amarantus Bioscience Holdings, Inc. Todos has developed two cancer screening tests based on TBIA (Todos Biochemical Infrared Analyses), a method for cancer screening using peripheral blood analysis. The TBIA screening method is based on the cancers influence on the immune system, which triggers biochemical changes in peripheral blood mononuclear cells and plasma. This proprietary and patented method incorporates biochemistry, physics and signal processing. The companys two cancer screening tests, TM-B1 and TM-B2, have received the CE mark. Breakthrough Diagnostics is developing the LymPro Test, a blood test for diagnosing Alzheimers disease.

For more information, the content of which is not part of this press release, please visithttp://www.todosmedical.com

About Amarantus Bioscience Holdings, Inc.Amarantus Bioscience Holdings (AMBS) is a JLABS alumnus biotechnology company developing treatments and diagnostics for diseases in the areas of neurology, regenerative medicine and orphan diseases through its subsidiaries. The Companys 80.01%-owned subsidiaryBreakthrough Diagnostics, Inc.,currently a joint venture with Todos Medical, Ltd., has licensed intellectual property rights to the Alzheimers blood diagnostic LymPro Test from Leipzig University that was originally developed by Dr. Thomas Arendt, as well as certain rights to multiple sclerosis diagnostic MSPrecise and Parkinsons diagnostic NuroPro. Amarantus entered into a joint venture agreement withTodos Medical, Ltd. to advance diagnostic screening assets and Todos has exercised its exclusive option to acquire Amarantus remaining ownership in Breakthrough in exchange for approximately 50% ownership of Todos. The transaction is expected close before the end of the first quarter of 2020. Amarantus also owns approximately 30% of the common shares of Avant Diagnostics, Inc., a healthcare data-generating technology company that specializes in biomarker assay services that target multiple areas of oncology. Avant provides precision oncology data through its TheraLink assays to assist the biopharmaceutical industry and clinical oncologists in identifying likely responders, initially for breast cancer, to over 70 FDA-approved drug treatments.

AMBS 50%-owned subsidiaryElto Pharma, Inc. has development rights to eltoprazine, a Phase 2b-ready small molecule indicated for Parkinson's disease levodopa-induced dyskinesia, Alzheimers aggression and adult attention deficit hyperactivity disorder, commonly known as ADHD. AMBS acquiredCutanogen Corporationfrom Lonza Group in 2015. Cutanogen is preparing for pivotal studies with Engineered Skin Substitute (ESS) for the treatment of pediatric life-threatening severe burns. ESS is a regenerative medicine-based, autologous full-thickness skin graft technology originally developed by the Shriners Hospital that can be used to treat severe burns, as well as several other catastrophic and cosmetic dermatological indications. AMBS wholly-owned subsidiary,MANF Therapeutics Inc.owns key intellectual property rights and licenses from a number of prominent universities related to the development of the therapeutic protein known as mesencephalic astrocyte-derived neurotrophic factor (MANF). MANF Therapeutics is developing MANF-based products as treatments for ophthalmological disorders such as Wolfram Syndrome, Retinitis Pigmentosa and Glaucoma, as well as neurodegenerative diseases such as Parkinsons disease. MANF was discovered by the Companys Chief Scientific Officer John Commissiong, PhD. Dr. Commissiong discovered MANF from AMBS proprietary discovery engine PhenoGuard, and believes several other neurotrophic factors remain to be discovered. Amarantus has entered into a binding letter of intent to license the therapeutic assets from Elto Pharma, Cutanogen and MANF Therapeutics to Emerald Organic Products.

Forward-looking StatementsCertain statements contained in this press release may constitute forward-looking statements. For example, forward-looking statements are used when discussing our expected clinical development programs and clinical trials. These forward-looking statements are based only on current expectations of management, and are subject to significant risks and uncertainties that could cause actual results to differ materially from those described in the forward-looking statements, including the risks and uncertainties related to the progress, timing, cost, and results of clinical trials and product development programs; difficulties or delays in obtaining regulatory approval or patent protection for product candidates; competition from other biotechnology companies; and our ability to obtain additional funding required to conduct our research, development and commercialization activities. In addition, the following factors, among others, could cause actual results to differ materially from those described in the forward-looking statements: changes in technology and market requirements; delays or obstacles in launching our clinical trials; changes in legislation; inability to timely develop and introduce new technologies, products and applications; lack of validation of our technology as we progress further and lack of acceptance of our methods by the scientific community; inability to retain or attract key employees whose knowledge is essential to the development of our products; unforeseen scientific difficulties that may develop with our process; greater cost of final product than anticipated; loss of market share and pressure on pricing resulting from competition; and laboratory results that do not translate to equally good results in real settings, all of which could cause the actual results or performance to differ materially from those contemplated in such forward-looking statements. Except as otherwise required by law, Todos Medical does not undertake any obligation to publicly release any revisions to these forward-looking statements to reflect events or circumstances after the date hereof or to reflect the occurrence of unanticipated events. For a more detailed description of the risks and uncertainties affecting Todos Medical, please refer to its reports filed from time to time with the U.S. Securities and Exchange Commission.

Todos Investor and Corporate Contact:Kim Sutton GolodetzLHA Investor RelationsSenior Vice President (212) 838-3777kgolodetz@lhai.com

Todos Corporate ContactDaniel HirschTodos MedicalInvestor RelationsEmail:Dan.h@todosmedical.comPhone: (347) 699-0029

Amarantus Investor and Media Contact:Gerald CommissiongPresident & CEOOffice: 650-862-5391Email: gerald@amarantus.com

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From inspiration to innovation | UDaily – UDaily

Posted: November 14, 2019 at 12:45 pm

Article by Karen B. Roberts Photos by Evan Krape November 11, 2019

The Merriam-Webster Dictionary defines an inventor as one who creates or introduces something new.

Thomas Edison is one. So is Emily Day.

Edison created the incandescent light bulb and the typewriter, among dozens of other things.

Day, an assistant professor in biomedical engineering at the University of Delaware, is working on technology that may one day replace bone marrow transplants by enabling nanoparticle carrier systems to deliver medication and cargo directly to stem cells without the need to remove them from the body.

The University recognized more than 225 inventors, including Day, on Tuesday, Oct. 29, for their remarkable contributions to UD and to society at large.

The event, held at the Roselle Center for the Arts and coordinated by the UDResearch Office, celebrated researchers with discoveries in engineering, health care, energy, agriculture and many other fields.

You, our inventors, have taken nuggets of ideas, of discoveries that youve made and developed them through hard work, trial and error, failure and success. Youve shown tenacity and drive, patience and persistence, and the results are what were celebrating today, said UD Provost Robin Morgan.

Enriching the environment for entrepreneurship

Since 2008, UD researchers have generated more than 500 inventions.

Working in collaboration with its partners, the University has made a concerted effort to enrich the environment for these types of efforts in Delaware, contributing to the states economic prosperity and positively impacting the greater good.

UD research expenditures for fiscal year 2019 totaled $161 million, a record-setting 10% increase over 2018, to explore pressing topics across the sciences, engineering, humanities and social sciences.

During this same time frame, UD researchers generated 33 patent applications and secured 11 patents, with the support of the Universitys Office of Economic Innovation and Partnerships (OEIP). OEIP has licensed six UD-developed technologies to outside companies and evaluated numerous other potential inventions currently under development.

Several UD-developed technologies are now featured in the Association of University Technology Managers Better World Project, which highlights successful examples where academic research and technology transfer combine to benefit the broader world. One of these is the UD-patented microbe UD10-22, a unique strain of Bacillus subtilis that helps plants grow stronger, developed by Harsh Bais, associate professor of plant and soil sciences, and Janine Sherrier, a former UD faculty member. UD licensed the technology to BASF, a global chemical company, in 2013. After completing successful trials and regulatory clearances, the technology is now available in the market as a key component of BASFs Velondis and Nodulator Duo product lines in Canada and the United States. Trials are ongoing for the product to be available in four additional product lines and for a range of crops to be sold in several countries in South America, Europe and Asia.

We are building a dynamic and rich ecosystem to support this type of activity, now and in the future, said Charles G. Riordan, UD vice president for research, scholarship and innovation.

Continued growth of UDs Science, Technology and Advanced Research (STAR) Campus through strategic partnerships and infrastructure development is one example that firmly positions the University as an innovation powerhouse for the community, state and region. The Delaware Innovation Space, the business incubator that is a public-private partnership between the state of Delaware, DuPont and UD, is another.

Riordan reported that Delaware Innovation Space, with its 130,000 square feet of lab-based tech space for startups, already is 90% occupied, hosting 13 companies including UD startups W7energy and MCET along with serving an additional dozen companies through its virtual program. The result more than 240 jobs created or retained.

Other resources available on campus to support innovators and entrepreneurs include, but are not limited to, OEIP, competitive funding opportunities, seed funding and training programs at UDs Horn Entrepreneurship,and new and existing core research facilities.

Other UD technologies that have had success in the marketplace during the past year include Avkin, a leading manufacturer of sensor-enabled, high-fidelity, wearable technology for health care simulation education founded byAmy Cowperthwait, director of Healthcare Theatre for the College of Health Sciences.The patented devices are used for training health care workers and caregivers to perform clinical procedures, such asdrawing blood, tracheostomy care or catheter insertion. Designed to be worn by a live actor, Avkin products provide a realistic, patient-centered simulation.

Today, the UD-developed products can be found in select medical and nursing schools and health systems.The company now has five products in the market, and recently launched a new package aimed at equipping todays practitioners with the knowledge and skills necessary to prevent hospital acquired infections and to improve patient outcomes.

Isao Noda, UD affiliated professor in materials science and engineering, said it is particularly important to foster innovation and invention among students. An inventor himself, Noda is named on more than 60grantedU.S. patents.

One of Nodas inventions is abio-basedplasticmade from vegetable oilsknown asNodax, which can be used to make eco-friendlyproductsranging from biodegradable plastic straws topiezoelectricnanofibers forsensors and other electronics. Nodainventedthe material while a research fellow atProcterand Gamble. Today, UDscientistsare part of theexploratorywork onNodax, collaboratingon fundamental research to see just what elsethisnovelmaterialcan do.

In industry, invention is required. If you dont invent, you will be fired. But many graduates get jobs in industry without any of the training on how to invent, so this is amazingly important, said Noda.

Day agreed and said her approach to innovation shifted in recent years, particularly when speaking with students.

In the beginning of my academic career I was more focused on publishing papers, Day said. As my group has become more established, I now tell my students, Hey, before you go present this or publish, its important for you to submit your invention disclosure to protect your ideas.

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Serving those who serve – The Hub at Johns Hopkins

Posted: November 14, 2019 at 12:43 pm

ByKristin Hanson

This article was originally published on Nov. 8 on giving.jhu.edu

Between 2001 and the beginning of 2018, more than 1,500 U.S. military service members lost limbs in the line of duty. Although technology has improved the prosthetic devices these people can use, a stubborn obstacle remains: the fragility of human skin.

"Skin was never meant to hold this kind of pressure," says Lee Childers, the senior scientist for the Extremity Trauma and Amputation Center of Excellence at Brooke Army Medical Center in San Antonio, Texas.

"Think about it like a blister on your foot. It's painful, but you can still get by," he continues. "In an amputation, it's a blister on your residual limb. You can't use your prosthesis until the blister is completely healed. If it's your leg [that is affected], you can't walk for two or three weeks. Think about how that would impact your life."

What if there were a way to make the skin at an amputation site tougher, like the palm of your hand or the sole of your foot? Luis Garza, an associate professor of dermatology at Johns Hopkins and leader of the Veteran Amputee Skin Regeneration Program, is developing a cell therapy that could enable prosthetics wearers to use their devices longer.

"This is an example of personalized medicine," Garza says. "We're taking each person's own cells, growing them up, and inserting them back in."

Garza's postdoctoral research focused on skin stem cells. In 2009, he and his department chair, Sewon Kang, began having conversations about how that work could help the increasing numbers of veterans coming back from war with amputations. Garza and his team received grants from the U.S. Department of Defense, National Institutes of Health, and Maryland Stem Cell Fund that have moved the program forward in the past decade.

Garza's team spent the summer of 2019 testing "normal" subjectsthose without amputationsto perfect the procedure, including the dose, content, method, and frequency of the injections. During one appointment, members of Garza's team took biopsies of skin from a subject's scalp and sole. The cells went to a lab where they were grown under an FDA-approved protocol and passed through quality control tests.

In a second appointment, subjects completed a questionnaire and underwent baseline measurements of their skin's thickness and strength. Garza's team then injected a site on the subjects' skin with the stem cells grown from their cells in the lab.

Image caption: Luis Garza, associate professor of dermatology at Johns Hopkins, leads the Veteran Amputee Skin Regeneration Program.

"We're hoping that these stem cell populations will engraft in the new skin," Garza says.

The subjects returned to Hopkins several months later to go through the questionnaire and measurements once more, and Garza's team documented changes.

Confident in the results they gleaned from the normal subjects, Garza's team enrolled its first subject with an amputation in August. Moving from the normal population to the amputation-affected population quickly unearthed some aspects of the therapy Garza didn't anticipate.

"When we talked with him, he said 'I don't want to mess with my one remaining footdo you have to take skin from there?' And we said, 'Actually, no, we could do your palm,'" Garza says.

His team then tested the biopsy and growth of palm cells from subjects in the normal population. "We're moving away from having our product informed purely by biology to letting our therapy development be shaped by the user."

Although federal grants have supported much of the program's progress, private philanthropy has played a role, too. Corporations like Northrop Grumman, foundations like the Alliance for Veteran Support, and grateful patients with and without ties to the armed forces have contributed nearly $300,000. Those gifts have enabled the program to persevere through gaps between federal grants.

Private funds will be increasingly important as the project enters its next phase: extension to military medical centers around the country. Garza's team must prove that the safeguards to protect cells on their round-trip voyage from a test site to Hopkins are effective. They also must secure approval by local institutional review boards for clinical studies.

"Soldiers are used to getting orders, but you can't order someone to be part of a [medical] study," Garza says. "There are hard medical ethics questions around how to make this open to them but ensure they don't feel obligated. We've been working on that for a year, and we probably have another six months or so to go."

Childers stands ready for whenever the program's extension is a go. He will lead the study at Brooke Army Medical Center and feels motivated by the prospect of helping many of the veterans he works with every day.

"We do everything we can to serve those who serve us. This can enable people to return to duty and be redeployed if they choose," he says. "This is game-changing technology that will have an impact for our service members, but also others who live with amputation."

That population includes the hundreds of thousands of Americans who've undergone amputations for complications of diabetes, who must use a wheelchair, or who wear ankle or foot orthoses for help with walking, among others.

"Having the ability to transform skin anywhere you want to target on the body will have gigantic implications across the entire spectrum of our society in many ways," Childers says.

There's a lot of work to be done before such benefits reach the public, Garza cautions. With continued support from donors and the military community, though, he's optimistic about the program's future.

"The challenges are pretty big, but I think within five years, it could happen," he says. "That's the hope."

Disclaimer: The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of the Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, the Department of the Air Force and Department of Defense or the U.S. Government.

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Do Acupuncture and Acupressure Help With Asthma? – Everyday Health

Posted: November 14, 2019 at 12:41 pm

People living with asthma use a variety of methods to keep their condition under control. Common methods include taking daily medicine to lower inflammation in the airways, and using inhalers for quick relief when an asthma attack strikes, according to theNational Heart, Lung, and Blood Institute.

RELATED: Everything You Need to Know About Asthma

For some people, complementary treatment options can boost the effectiveness of conventional treatments and help keep symptoms under control. Two such complementary options include acupressure and acupuncture.

Acupressure is a form of massage (also known as bodywork) thats been used in traditional Chinese medicine for thousands of years as a treatment for illness and pain, according to theUCLA Center for East-West Medicine. Its based on the same ideas as another type of traditional Chinese medicine: acupuncture.

Both forms of therapy involve stimulating pressure points on the body, but in acupressure the practitioner uses the hands and elbows to apply physical pressure, and in acupuncture he or she inserts very thin needles in the skin; the needles are activated through gentle movements of the practitioners hands or with electrical stimulation, according toJohns Hopkins Medicine.

The idea is that by stimulating various pressure, or acupoints, on the body, you can work on bringing about therapeutic effects for a given condition, according to Malcolm B. Taw, MD, the director of the UCLA Center for East-West Medicine in Westlake Village and an associate clinical professor in the UCLA Department of Medicine in Los Angeles. A review published in 2015 in the journal Pain Medicinelooked at current research and evidence on the definition and function of acupoints and concluded that they may release certain substances or sustain certain changes in ways that adjust the function of specific organs, maintain homeostasis in the body, or affect symptoms of various diseases.

Pressing acupoints via acupressure, for example, can help release muscle tension and promote blood circulation, according to theMemorial Sloan Kettering Cancer Center. More specifically, applying pressure to acupoints can signal to the body to turn on self-healing or regulatory mechanisms, sending vital energy (known as qi, pronounced chee) through natural pathways in the body called meridians. Research suggests that once the pressure point is stimulated, the qi flows from the pressure point through the meridian and into the target area. Similarly, stimulating pressure points with needles via acupuncture is thought to stimulate the central nervous system to release chemicals into the muscles, spinal cord, and brain, which may kickstart the bodys natural healing abilities, according to Johns Hopkins Medicine.

There are many acupoints that may be used to treat asthma symptoms. A few include bladder 13 (located on the back), conception vessel 17 (located on the chest), as well as lung 1 and kidney 27, which are located along the front of the torso, according to Dr. Taw.

Acupuncture has been shown to be effective for relieving allergic asthma, according to Maeve OConnor, MD, the chair of the Integrative Medicine Committee for the American College of Allergy, Asthma, and Immunology and an allergist in private practice at Allergy Asthma & Immunology Relief in Charlotte, North Carolina. Allergic asthma is a type of asthma where symptoms are caused by allergens like dust, mold, pollen, and food, she notes.

RELATED: What Type of Asthma Do I Have?

In one study published in April 2017 in theJournal of Alternative and Complementary Medicine, patients with allergic asthma who added 15 acupuncture sessions to routine care over the course of three months saw greater improvements in disease-specific and health-related quality of life compared with patients who received only routine care.

Another study found that patients with allergic asthma who received 12 acupuncture sessions that targeted the pressure points thought to be connected with asthma over four weeks reported a greater improvement in general well-being compared with a control group of individuals who received the same number of acupuncture treatments, but ones that didnt necessarily target pressure points linked to asthma.

Plus, blood tests of those individuals who received asthma-specific acupuncture showed reductions in inflammatory cytokines (small proteins that influence how other cells communicate) after four weeks. Why does this matter for people with asthma? Well, asthma is a condition that leads to inflammation of the airways. The study shows that acupuncture can influence the physiological processes found in asthma by lowering levels of specific mediators involved with inflammation, Taw says.

In addition, a review and meta-analysis published in the January 2019 issue of Evidence-Based Complementary and Alternative Medicine found that using acupuncture in addition to conventional asthma treatments led to a statistically significant improvement in symptom response rates, and resulted in lower levels of interleukin-6 (IL-6), a protein your body produces in response to infections and injuries. Too much IL-6 can contribute to chronic inflammation, according to research published in the October 2014 issue of Cold Spring Harbor Perspectives in Biology. And as weve already seen, chronic inflammation is a hallmark of asthma. Therefore, the review and meta-analysis suggests that acupuncture may help lower inflammation in people with asthma by lowering levels of pro-inflammatory proteins like IL-6.

Ultimately, acupuncture is a good add-on to conventional asthma treatments, according to Taw. But acupuncture shouldnt replace your usual asthma treatments. We wouldnt advise patients to stay away from conventional treatments, Taw says. But if they wanted to add it on, we have no problem adding acupuncture to help with the symptom response.

While several studies have looked at acupunctures effects on asthma (including the aforementioned ones), few have investigated the effectiveness of acupressure for helping with asthma. And while acupressure and acupuncture are therapies that follow similar principles, we cannot conclude with certainty that acupressure will create the same effects shown in acupuncture research studies, according to Taw.

But Taw adds that there are few safety concerns for acupressure for asthma when it is done correctly, and may be worth trying for some despite the lack of evidence behind it. Acupressure is very safe, with minimal to no risk overall, Taw says.

But its always a good idea to check with your doctor before beginning acupressure or any other complementary treatment. You should be especially cautious with acupressure if youre pregnant, as stimulating certain pressure points such as the large intestine 4 (known as he gu) may induce labor and could cause harm, according to the UCLA Center for East-West Medicine.

Its possible to perform acupressure on yourself (the UCLA Center for East-West Medicine offers this handy guide to locating the various pressure points), but you may want to seek help from someone whos trained in this form of bodywork to better learn how to do it safely and effectively. Ask your doctor and people you trust for recommendations.

Studies have mostly focused on asthma and acupuncture, and so far, the research suggests that adding acupuncture into your asthma treatment plan may improve your quality of life, boost your immune system, and ease symptoms.

Unfortunately, the research on asthma and acupressure is lacking, so we cant know how effective it is. While acupressure and acupuncture are therapies along a similar continuum, we unfortunately cannot conclude that acupressure will also lower inflammatory mediators, improve quality of life, and reduce symptoms, Taw says.

That said, acupressure may help with symptoms, and there are very few safety concerns. But again, its a good idea to talk with your doctor or healthcare provider about adding any new complementary therapy whether acupuncture, acupressure, or another modality to your care.

If youve talked to your doctor and have decided its a good idea to try acupuncture or acupressure, find a practitioner you trust. Receiving acupuncture treatment in particular from an unqualified practitioner may result in complications, mainly through the use of nonsterile needles or improper delivery of treatments, according to theNational Center for Complementary and Integrative Health. Though relatively few complications have been reported, improper delivery of acupuncture treatments can lead to serious health effects, including infections, punctured organs, collapsed lungs, and central nervous system damage.

Ask your doctor and trusted friends for referrals, or find a practitioner through the National Certification Commission for Acupuncture and Oriental Medicine.

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Q&A: Deepak Chopra on Bentonville, health and well-being – talkbusiness.net

Posted: November 14, 2019 at 12:41 pm

The nonprofit Chopra Foundation in California is bringing its Sages and Scientists Symposium to Bentonville this weekend beginning Thursday. Itll be held at Crystal Bridges Museum of American Art.

Deepak Chopra, the foundations namesake and the co-founder of the Chopra Center for Wellbeing in Carlsbad, Calif., is the organizer of the conference. Chopra moved from India to the U.S. in his early 20s to continue his study of Western medicine. Following a residency in New Jersey, he landed in Boston, where he quickly rose to chief of medicine at New England Memorial Hospital.

Now 73 years old, Chopra is considered a pioneer of integrative medicine, which recommends mixing mainstream Western medicine with alternative treatments. He has written nearly 90 books on the topic, many of them The New York Times bestsellers.

Chopra organized the first Sages and Scientists in 2010 in Carlsbad, where it was held annually through 2014. The most recent Sages and Scientists was in Beverly Hills in 2016.

In a recent interview, Chopra discussed his rationale for choosing Bentonville for this years event, which will attract thought leaders from around the world. The interview has been edited slightly for brevity and clarity.

Paul Gatling: How did you decide on having Sages and Scientists in Arkansas? Whats the appeal of having the event here?

Deepak Chopra: We decided to do it at Crystal Bridges for two reasons. One is Alice Walton was very gracious to give us the venue to do the conference. I have been to Bentonville several times over the years and to Crystal Bridges. And of course Northwest Arkansas has a great tradition of various things: food, culture, music, film and so on. I have a special proclivity to be enchanted by this kind of culture, so we decided to come to Bentonville, Ark., and people are coming from all over the world.

Gatling: Whats your take on Bentonville versus maybe what your preconceived idea of Bentonville was before visiting? I cant imagine youve been to Arkansas too many times.

Chopra: I have, actually. I have been there several times. Over the course of a year I come out at least three or four times. I love the atmosphere. Bentonville, particularly, has grown over the years. I remember it from the late 1980s, and it keeps getting even more culturally, unusually attractive to me. People are unaware of the fact there are direct flights from New York and Los Angeles. Once they come there, they find it very enchanting.

Gatling: How long have you known Alice Walton?

Chopra: I have known her since 1988. I knew Sam [Walton] as well. And I have known the [Walton] family for several years.

Gatling: Sages and Scientists, in general, what was the goal when you first began to organize these events?

Chopra: To bring together luminaries and thought leaders in academia, and also entrepreneurs from Silicon Valley, and also thought leaders in business and philanthropy in three areas. No. 1, well-being; No. 2, humanitarianism; and No. 3, a deeper understanding of the nature of reality or what we call the cosmos. We have thought leaders in every field, from machine learning to deep learning to understanding genetics and neuroscience and cosmology. We have the professor from MIT who created the VR for the landing on Mars. She very kindly accepted the invitation to speak about virtual reality and how that will have immense applications, not only for exploring intergalactic space but right here at home with the treatment of illness and disease.

Its going to be amazing, and every time weve done this conference, it has evolved to a new level of understanding. We have 3.5 days. The first day is the future of well-being and then the future of humanity and the future of the cosmos. Its a very ambitious program.

Gatling: You have said Sages and Scientists Symposium is a catalyst for your work to improve global well-being trends? Which trends need the most work? What is most concerning to you as a thought leader in that space?

Chopra: Right now, we know that only 5% of disease-related gene mutations are fully penetrant, which means they predict the disease. So if somebody has the BRCA gene for breast cancer, its almost 100% likely they will get breast cancer. But that applies to only 5% of all chronic illness, including cancers. For those kinds of mutations, there are new technologies emerging.

You may have heard of CRISPR, which is basically gene editing and splicing. Just like you can read a barcode of an item at the grocery store or cut and paste an email, you will soon be able to its already being done you can actually read the barcode of a gene and delete the defective gene and insert the healthy gene. Even that only helps 5% of chronic illness.

So 95% of chronic illness is related to inflammation in the body low-grade inflammation in the body, low-grade depression, anxiety, stress. If you pay attention to things like sleep, stress management, exercise, movement, yoga, deep breathing, healthy emotions and relationships, nutrition and the connection with nature that is why we also chose Northwest Arkansas then you can actually prevent a lot of chronic illnesses.

So the future of well-being is predictable. It requires your participation. Its preventable, and in many cases even reversible. We want to highlight what the future of health and well-being is. Right now, the discussions around health are not really about health. Theyre about insurance. Everybody needs to be covered, but I think people need to realize that a lot of disease is preventable, and they can participate in their own well-being.

Gatling: You are a proponent of alternative medicine. Whats your definition of alternative medicine? An alternative to what?

Chopra: So I dont use that word, even though I have been given that designation. Its integrative medicine, which means you use whatever works. Pharmaceuticals, surgery, radiation they all work in selective cases, and also particularly in acute illness. Integrative medicine means mostly lifestyle and stress management and nutrition and healthy emotions. Even things like good sleep. We have been doing studies on aspects of well-being, and we were among the first to be published in peer-reviewed journals how you can change the activity of your genes toward health and well-being or self-regulation, instead of inflammation.

Gatling: Whats the single biggest barrier thats keeping integrative medicine from the mainstream?

Chopra: There are special interest groups that have a vested interest in maintaining the status quo, and thats not going to change unless theres public awareness of what it means to be healthy.

Gatling: How would you say you spend the majority of your time these days? Writing, speaking, traveling, advising, podcasting? What occupies most of your time?

Chopra: Writing and public speaking, but also at the Chopra Foundation. We collaborate with other researchers at places like Harvard and Duke and Scripps [Health] and UCLA on looking at integrative modalities. And we publish a lot of research in peer-reviewed journals.

Gatling: Suicide prevention is something that you are specifically focused on through some of your podcast work. Why are those rates so high in America or around the world?

Chopra: This is an epidemic that has reached a proportion that we never envisioned, and a lot of attention has been brought to it recently because of very successful people, celebrities, committing suicide. It is the second most common cause of death in younger people as well, between the ages of 10 and 30.

We need to do something about it. If you bring awareness to people, if you help them create social networks, both online and offline much in the way of Alcoholics Anonymous without the stigma then we can actually do something about the epidemic. And we need to, for the next generation.

Gatling: What are your thoughts on technology today a necessity versus a necessary evil? Smartphones for example. Good or bad?

Chopra: I actually am a big fan of technology. I also think its part of our human evolution, and by itself its neutral. Neither good nor evil. Its up to us how we use it. You can use it to hack elections. You can use it to create a better world. Its all up to us. We should schedule technology time, just like we schedule other times for exercise, sleep, relationships.

Gatling: How old are you?

Chopra: I am chronologically 73, but biologically I feel very young.

Gatling: Still a practicing physician?

Chopra: I have a group practice in California, and I maintain my license in Massachusetts and also California. But I mostly consult with other physicians who are part of our group practice. Once in a while when I am in California I will see patients that are intriguing to our group. Our group practice [Mind-Body Medical Group] in San Diego has lots of physicians internists, oncologists and others who are trained in internal medicine and in some specialties, but also have expertise in integrative medicine.

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