The title of this brief article in some ways doesn’t make sense. Usually, inflammation is helpful … in fact, very helpful … but it can also cause problems.

Suppose you get a bacterial infection when you stub your toe. The body immediately recognizes the bacteria as something that is not supposed to be there and begins to fight it until it is removed (killed). If we should cut our finger, the body immediately tries to heal the damage. Both of these processes, attacking an invading bacteria and healing a cut, occurs through a process called inflammation. In these cases, inflammation tries to protect us and helps initiate a healing process. Without it, wounds and injuries would never heal. In that sense, inflammation is good.

Inflammation is a very complex process and way too complicated for the purpose of this brief article. But we need to few additional steps to understand why inflammation can be bad. The steps in fighting invading bacteria or healing a cut occur because of acute inflammation, meaning it acts right away. It does so when cells in the area of the injury become activated and send out SOS signals in the form of proteins and other molecules. This is how one part of the body speaks to other parts, through so-called messenger or signaling molecules. These messenger molecules cause other cells, including those traveling in our blood stream as well as those in the surrounding tissue, to also become activated and produce other molecules which eventually all come together to help kill the bacteria or heal the cut. Normally this type of inflammation is over with very quickly, in days, and the problem is resolved.
Sometimes inflammation can continue for a long time and when it does it causes a completely different outcome. When inflammation is chronic (persistent), it frequently results in simultaneous destruction and healing of cells and when that occurs the result is a medical problem. Chronic inflammation is responsible for a host of diseases which we have all heard about, including the following examples:
◦ hardening of the arteries (atherosclerosis)
◦ psoriasis
◦ rheumatoid arthritis,
◦ ulcerative colitis
◦ acne
The striking thing about these conditions is that they seem so unrelated and yet the underlying cause may well be the same, chronic inflammation.

Scientists have greatly increased their understanding of how messenger (signaling) molecules communicate and how they may lead to chronic inflammation and cause medical problem. With this understanding, they are developing new medications that block the action of one or more of these signaling molecules and in many cases the results are dramatic. For example, use of one of these medications to treat people who have moderate to severe psoriasis has meant for many the complete eradication of the psoriasis or at least a great improvement. Unfortunately, these medications cost a lot of money, sometimes thousands of dollars each month, and are not completely covered by health insurance.

The medications which have been developed for these diseases are called biologics. Biologics contain man-made or natural proteins that block the action of signaling molecules. Proteins are large molecules, so large that they cannot be made into a powder and taken as a pill. Instead, they are dissolved into a water solution and are administered by injection, in much the same way that people with diabetes take insulin.

National Clinical Research-Richmond is currently working with 2 biologic medications for the treatment of psoriasis and ulcerative colitis. We just completed 2 studies of a biologic medication, one in patients with diabetes to see if it could actually modify the disease (translated, provide a bit of a cure) and one in patients with gout, who occasionally have very painful gout attacks. We have 2 more studies of biologic medications are in the planning stages, both for rheumatoid arthritis. In these studies, all medical care including the expensive biologics are provided at no charge. Of note, the biologic medication provided to patients in our psoriasis study is provided at no cost until 2015, for a saving of over $100,000 in the cost of biologic medication to the people who participate.

Call 755-2300 to learn more about biologics research at National Clinical Research-Richmond.