Experimental drug may prevent development of multiple sclerosis in mice

The experimental drug laquinimod may prevent the development or reduce the progression of multiple sclerosis (MS) in mice, according to research published in the September 21, 2016, online issue of Neurology® Neuroimmunology & Neuroinflammation, a medical journal of the American Academy of Neurology.

"These results are promising because they provide hope for people with progressive MS, an advanced version of the disease for which there is currently no treatment," said study author Scott Zamvil, MD, PhD, of the University of California, San Francisco and a Fellow of the American Academy of Neurology.

In a proper immune response, T cells and B cells help the body develop immunity to prevent infection. But in MS, an immune and neurodegenerative disorder, those cells can help create antibodies that attack and destroy myelin, the protective, fatty sheath that insulates nerves in the brain and spinal cord.

For this research, the investigators studied mice that develop a spontaneous form of MS. Mice were either given daily oral laquinimod or a placebo (water). The number of T cells and B cells were then examined.

In one study of 50 mice, only 29 percent of the mice given oral laquinimod developed MS as opposed to 58 percent of the mice given the placebo, evidence the drug may prevent MS. Plus, there was a 96-percent reduction in harmful clusters of B cells called meningeal B cell aggregates. In people, such clusters are found only in those with progressive MS.

In a second study of 22 mice, researchers gave laquinimod after mice developed paralysis and observed a reduction in progression of the disease. When compared to the control, mice given the drug showed a 49-percent reduction in dendritic cells that help create special T cells called T follicular helper cells, a 46-percent reduction in those T cells and a 60-percent reduction in harmful antibodies.

"This study has given us more insight into how laquinimod works," Zamvil said. "But because this was an animal study, more research needs to be done before we know if it could have similar results in people."

Oral antidiabetic drug modulates the body's nitrogen and urea metabolism

In continuation of my updates on metformin

The most frequently prescribed oral antidiabetic drug metformin significantly affects metabolic pathways. This was reported by scientists from the Helmholtz Zentrum München together with colleagues from the German Diabetes Center (DDZ) in Düsseldorf. The underlying study was conducted with further scientists of the German Center for Diabetes Research (DZD). These results have now been published in the journal 'Diabetes'.

Metformin is a widespread oral medication to increase insulin sensitivity in patients with type 2 diabetes (T2D). According to a number of studies, it additionally reduces the risk of cardiovascular complications. Last year, a team led by Dr. Rui Wang-Sattler discovered that metformin intake lowers the levels of the harmful LDL cholesterol by activating the AMPK protein complex. Dr. Wang-Sattler is head of the "Metabolism" research group in the Research Unit of Molecular Epidemiology at the Institute of Epidemiology II at the Helmholtz Zentrum München. Her group aims to understand the molecular mechanisms that underlie the activity of metformin.

Metformin intake changes metabolite profiles in population-based KORA study

In the present work, the interdisciplinary team of scientists was able to explain a further feature of the drug: "Our results show that metformin also modulates the body's nitrogen and urea metabolism," first author Jonathan Adam summarizes.

In close collaboration with Dr. Stefan Brandmaier and other colleagues, he examined the metabolite profiles (353 small molecules) of KORA participants. The researchers compared T2D patients treated with metformin (a total of 74) with those not being treated with metformin (115) and looked for differences in the distribution of metabolites in the blood. They subsequently confirmed the findings in samples of more than 1500 participants.

Amino acid levels provide a crucial hint

Changes in the amino acid citrulline concentration caused by metformin intake were particularly significant. The amino acid citrulline (named after Citrullus vulgaris, the watermelon, where it is found in large quantities) showed significantly lower levels in samples of T2D patients treated with metformin than in untreated ones. The researchers propose that this is a further consequence of metformin's AMPK activation. "Our analysis indicates that the activation of the AMPK pathway by metformin affects nitrogen and urea metabolism through a further enzyme, which thus lowers the citrulline levels", reports Rui Wang-Sattler.

Accordingly, the scientists suspect that the additional intake of citrulline could have a positive effect on the cardiovascular system in patients being treated with metformin. As a follow-up study, the team plans to analyze the metformin-associated effects on other central metabolic pathways, such as the citric acid cycle.

Supplement of polyunsaturated fatty acids may improve reading skills in children

Supplement of omega-3 and omega-6 fatty acids may improve reading skills of mainstream schoolchildren, according to a new study from Sahlgrenska Academy, at the University of Gothenburg, Sweden. Children with attention problems, in particular, may be helped in their reading with the addition of these fatty acids.

The study included 154 schoolchildren from western Sweden in grade 3, between nine and ten years old. The children took a computer-based test (known as the Logos test) that measured their reading skills in a variety of ways, including reading speed, ability to read nonsense words and vocabulary.

The children were randomly assigned to receive either capsules with omega-3 and omega-6, or identical capsules that contained a placebo (palm oil) for 3 months. The children, parents and researchers did not learn until the study was completed which children had received fatty acids and which had received the placebo. After three months, all children received real omega-3/6 capsules for the final three months of the study.

"Even after three months, we could see that the children's reading skills improved with the addition of fatty acids, compared with those who received the placebo. This was particularly evident in the ability to read a nonsense word aloud and pronounce it correctly (phonologic decoding), and the ability to read a series of letters quickly (visual analysis time)," says Mats Johnson, who is chief physician and researcher at the Gillberg Neuropsychiatry Centre at Sahlgrenska Academy, University of Gothenburg.

No children diagnosed with ADHD were included in the study, but with the help of the children's parents, the researchers could identify children who had milder attention problems. These children attained even greater improvements in several tests, including faster reading already after three months of receiving fatty acid supplements.

Polyunsaturated fats important for the brain

Polyunsaturated fats and their role in children's learning and behavior is a growing research area.

"Our modern diet contains relatively little omega-3, which it is believed to have a negative effect on our children when it comes to learning, literacy and attention," says Mats Johnson. "The cell membranes in the brain are largely made up of polyunsaturated fats, and there are studies that indicate that fatty acids are important for signal transmission between nerve cells and the regulation of signaling systems in the brain."

Previous studies in which researchers examined the effect of omega-3 as a supplement for mainstream schoolchildren have not shown positive results, something Mats Johnson believes may depend on how these studies were organized and what combination and doses of fatty acids were used. This is the first double-blind, placebo-controlled study showing that omega-3/6 improves reading among mainstream schoolchildren.

"Our study suggests that children could benefit from a dietary supplement with a special formula. To be more certain about the results, they should also be replicated in other studies," says Mats Johnson.

Supplement of polyunsaturated fatty acids may improve reading skills in children

Liquid crystal technique could be new way to control drug delivery process

In continuation of my update on liquid crystals..

Liquid crystals are strange substances, both fish and fowl. They can flow like a liquid, but have the orderly molecular structure of a crystalline solid. And that internal structure can be changed by small cues from outside.

A group of scientists at the University of Chicago's Institute for Molecular Engineering has found a way to exploit this property to turn liquid crystals into a tool to manipulate the shape of synthetic cell membranes. The technique has potential for use in biology, medicine, and advanced materials development. The team reported its findings in the Aug. 10, 2016 edition of Science Advances.

"What we've done is reproduced the beginnings of cell division in a synthetic system," said Juan de Pablo, Liew Family Professor in Molecular Engineering, who headed the group. When a cell divides, the spherical cell membrane stretches into an elliptical form, develops a waist in the middle, and then splits into two spherical cells. The scientists built sophisticated models that produced this behavior on the computer and then reproduced it in the real world, testing the model's predictions.

"It's the first time that this has been done," said de Pablo. "It's a system that has been engineered at the molecular level using computer models."

Cellular stand-ins

Standing in for cells in the experiments were capsules, or "vesicles," a few microns in diameter (a fraction the width of a human hair) made of some of the same phospholipids that make up real cell membranes. These were immersed in a bath of liquid crystal oil whose molecules are slightly elongated rather than round. At temperatures above about 97 degrees Fahrenheit the oil behaves like any other oil. But when the temperature is lowered slightly, the molecules of the oil pack tightly against one another like cigarettes and align along a single direction.

"When that happens, the liquid crystal presses on the vesicle more in one direction than in the other, so the vesicle becomes elongated," de Pablo said. "If you squash it more and more, it becomes an ellipsoid and the two ends become pointier and pointier. There is a point when the molecules around those points separate from one another and create a little gap in the membrane through which things could be squeezed out."

Lipid vesicles are in current use for drug delivery. De Pablo envisions using the liquid crystal technique as a cunning way to control that process.

"What we find intriguing is that we have a mechanism that will allow us to take vesicles loaded with something interesting, and by changing the temperature a little bit, we could deform the vesicle and have it squeeze out whatever it has inside without our ever touching the vesicle. And then as we restore the temperature to the original value, the vesicle becomes spherical again."

Calculations indicate that squeezing more or less would alter the size of the gap, allowing for the release of contents of varying sizes. "But that's something that we still have to demonstrate," said de Pablo.

Ref : http://advances.sciencemag.org/content/2/8/e1600978

Cone snail venom could hold key to efficient therapies for diabetes

New research has found that venom extracted from a species of marine cone snail could hold the key to developing 'ultra-fast-acting' insulins, leading to more efficient therapies for diabetes management.

Researchers from Australia and the US have successfully determined the three-dimensional structure of a cone snail venom insulin, revealing how these highly efficient natural proteins called Con-Ins G1 can operate faster than human insulin.

The teams also discovered that Con-Ins G1 was able bind to human insulin receptors, signifying the potential for its translation into a human therapeutic.

Associate Professor Mike Lawrence from Melbourne's Walter and Eliza Hall Institute of Medical Research led a collaborative study between the University of Utah, the Monash Institute of Pharmaceutical Sciences, La Trobe University and Flinders University in Australia.

Associate Professor Lawrence, a specialist in the structure of insulins and their receptors, said the teams utilised the Australian Synchrotron to create and analyse the three-dimensional structure of this cone snail venom insulin protein with exciting results.

"We found that cone snail venom insulins work faster than human insulins by avoiding the structural changes that human insulins undergo in order to function -- they are essentially primed and ready to bind to their receptors, " Associate Professor Lawrence said.

Associate Professor Lawrence said human insulins could be considered 'clunky' by comparison.

"The structure of human insulins contain an extra 'hinge' component that has to open before any 'molecular handshake' or connection between insulin and receptor can take place.

"By studying the three-dimensional structure of this snail venom insulin we've found how to dispense with this 'hinge' entirely, which may accelerate the cell signalling process and thus the speed with which the insulin takes effect." Associate Professor Lawrence said.

Published today in Nature Structural and Molecular Biology, the team's findings build on earlier studies from 2015, when the University of Utah reported that the marine cone snail Conus geographus used an insulin-based venom to trap its prey. Unsuspecting fish prey would swim into the invisible trap and immediately become immobilised in a state of hyperglycaemic shock induced by the venom.

Dr Helena Safavi-Hemami from the University of Utah said it was fascinating to uncover how the cone snail insulin was able to have such a rapid effect on its prey and, furthermore, that the peptide had therapeutic potential in humans. "We were thrilled to find that the principles of cone snail venom insulins could be applied to a human setting," Dr Safavi-Hemami said.

"Our Flinders University colleagues have shown that the cone snail insulin can 'switch on' human insulin cell signalling pathways, meaning the cone snail insulin is able to successfully bind to human receptors," Dr Safavi-Hemami said.

"The next step in our research, which is already underway, is to apply these findings to the design of new and better treatments for diabetes, giving patients access to faster-acting insulins," she said.

Ref : http://www.nature.com/nsmb/journal/vaop/ncurrent/full/nsmb.3292.html

Study provides insight into how weight-loss drug acts in the brain

In continuation of  my update on lorcaserin

A weight-loss drug dampened the response to food cues in regions of the brain associated with attention and emotion, leading to decreases in caloric intake, weight and body mass index (BMI), a team led by scientists at Beth Israel Deaconess Medical Center (BIDMC) reported. In the first study of the drug lorcaserin in the human brain, the research revealed the mechanism underlying the drug's efficacy and provides insight into which individuals may benefit most from the medication. The paper was published today in the journal Diabetes, the journal of the American Diabetes Association.

"Human feeding behaviors involve areas of the brain responsible for cognitive control and decision-making," said Christos S. Mantzoros, MD, Director of the Human Nutrition Unit in the Division of Endocrinology, Diabetes and Metabolism at BIDMC and Professor of Medicine at Harvard Medical School. "We wanted to find out if lorcaserin was acting on these brain regions and, if so, where and how. One-third of the U.S. population is obese, and another one-third is overweight. This is a huge burden on individuals and the health care system. In addition, it increases the risk of diabetes, cardiovascular disease and many types of cancer. We need to continue to develop safe and effective therapies to combat this epidemic."

Approved by the FDA in 2012, the generic drug lorcaserin is a medication prescribed for obese or overweight adults who also have weight-related health complications such as diabetes. Several studies have shown the drug helps about half of the people who take it lose more than 5 percent of their body mass within a year, but there's a great deal of variability in individual results, and the mechanism underlying its effect was previously unknown.

To determine how the drug works in the human brain, Mantzoros and colleagues observed 48 obese men and women - half taking the drug, half taking a placebo - over the course of a four-week experiment. Participants came into the clinic on four occasions for blood work, physical exams, measurements and weight-loss counseling with a registered dietician. They were also expected to keep records of the food they ate during the study.

On three visits - before receiving any medication (Week 0), after a week of medication (Week 1), and after four weeks of medication (Week 4) - exams were followed by two brain scans: one after the patients had fasted for at least 12 hours, the other after they had eaten a meal. The scans were taken using functional magnetic resonance imaging (fMRI) to measure changes in blood flow in an active brain, which suggests which regions play a role during a given task. During each scan, participants were shown 150 images of foods generally considered highly desirable, such as cake and onion rings; foods generally considered less desirable like vegetables; and nonfood items like rocks and trees.

At Week 1, the fMRI scans in the fasting state revealed that people taking the drug showed decreased brain activity in response to images of highly desirable foods in the attention-related parietal and visual cortices. At Week 4, the lorcaserin group in the fed state showed less activity in the parietal cortex - which is responsible for integrating sensory information - when looking at any of the food images.

The data also revealed that subjects who had the strongest brain responses to food prior to taking lorcaserin saw the most success with the weight-loss medication.

"Decreases in caloric intake, weight, and BMI were linked to strong responses to food cues in the areas of the brain related to emotion, pleasure and attention prior to taking the weight-loss drug, which suggests that lorcaserin could prove to be of particular benefit to 'emotional eaters,' " Mantzoros said.Lorcaserin targets only a very specific serotonin receptor (known as 5-HT2c), shown in animal studies to play a role in abnormal food consumption. A previous generation of weight loss drugs was linked to this receptor, but because their scope was broader, those products also had dire cardiac side effects including pulmonary hypertension and valve problems. Lorcaserin could produce weight loss without these cardiac risks, the authors noted.

"In addition, the different mechanism of action in comparison to other drugs for obesity creates an opportunity for combination drugs for the treatment of obesity," Mantzoros said. "This might create more powerful solutions and is something that remains to be explored."

New drug holds potential for treating advanced mastocytosis

In continuation of my update on Midostaurin 

Most people have never heard of mastocytosis. It's a rare, sometimes deadly, immune disorder. Now new research may help those with advanced mastocytosis and possibly many more people, too. "This is the first drug that's shown to be effective in this very rare disease," says Tracy George, MD, at the University of New Mexico Comprehensive Cancer Center. George was part of the international team that recently published the results of its study on mastocytosis in the New England Journal of Medicine.

"Mast cells are normal cells in the body that mediate the body's allergic and inflammatory responses," says George. "But people with mast cell disease have too many mast cells and they're abnormal." Too many abnormal mast cells can cause allergic reactions and inflammation. Different subtypes of the disease differ in the how serious these responses are.

People with indolent mastocytosis may have mild symptoms and lead normal lives. Others with indolent mastocytosis may have flushing and diarrhea and other symptoms severely enough that they can't hold a job or do things that most people can do. People with other subtypes of the disease can have life-threatening reactions, such as anaphylactic shock and organ damage. And people with advanced mastocytosis — the most deadly subtype is called mast cell leukemia — live less than six months after their diagnosis.

The Food and Drug Administration has approved only one drug, called imatinib, to treat advanced mastocytosis. Imatinib blocks the action of a cellular protein called a tyrosine kinase receptor. But people with a mutation in a gene called D816V KIT do not respond to imatinib. The D816V KIT gene codes for a tyrosine kinase receptor, says George. And, she says, most people with advanced mastocytosis have the D816V KIT mutation.

Research on the new treatment began at Stanford University, where George worked with a colleague, Jason Gotlib, MD, whose patient had mast cell leukemia. They gave that woman a drug called midostaurin under the FDA's compassionate use policy. "Midostaurin is a multi-kinase inhibitor," says George. "Midostaurin was being evaluated in a clinical trial for a different disease, acute myeloid leukemia. And this lady with mast cell leukemia remarkably improved within weeks, within days."

 Midostaurin 

Gotlib and George began a small clinical trial to test midostaurin in people with advanced mastocystosis. That clinical trial expanded into an international clinical trial after Gotlib and George shared their preliminary results at an international conference. George brought the clinical trial to UNM when she joined the Pathology department and the UNM Comprehensive Cancer Center.

The clinical trial included treatment for three subtypes of advanced mastocytosis. Still, it took years to enroll enough people because the disease is so rare. Mastocytosis affects only about one person in 10,000. In comparison, breast cancer affects more than 12 times as many people and prostate cancer affects more than 13 times as many, according to the American Cancer Society. But even though the clinical trial was small, the results were astounding.

People with advanced mastocytosis on the clinical trial lived an average of 28 months longer. This average includes the 40 percent of people who did not respond to midostaurin. The 60 percent who did respond, though, responded within two or three months of starting treatment. Responders had mild side effects like diarrhea, vomiting and nausea, if they had any at all.

Sixteen people in the clinical trial had mast cell leukemia. "For those patients who did respond," says George, "their median survival has not been reached. So that means [some are] still living, which is unbelievable."

The clinical trial has spurred more research. Scientists around the world are now studying how midostaurin affects mast cells and how to combine it with other drugs to create an even more potent treatment. Novartis, the maker of midostaurin, and other drug companies are investing in research on multi-kinase inhibitors. Clinical trials to test midostaurin for controlling symptoms in people with indolent mastocytosis have opened. And more research into using midostaurin to treat asthma, skin diseases and allergies is in the planning stages.

George, who is the American expert in mastocytosis pathology, says, "I do think this [mastocytosis] is under-diagnosed. Even though patients with advanced mastocytosis are rare, indolent [mastocytosis] is more common. And there are lots of diseases for which unhappy mast cells are a pathogenesis." Now, with the potential for a treatment, people with unhappy mast cells may feel better.

New drug holds potential for treating advanced mastocytosis

Edible ginger-derived nano-lipids could effectively deliver drugs for treating colon cancer

Edible ginger-derived nano-lipids created from a specific population of ginger nanoparticles show promise for effectively targeting and delivering chemotherapeutic drugs used to treat colon cancer, according to a study by researchers at the Institute for Biomedical Sciences at Georgia State University, the Atlanta Veterans Affairs Medical Center and Wenzhou Medical University and Southwest University in China.

Colorectal cancer is the third most common cancer among men and women in the United States, and the second-leading cause of cancer-related deaths among men and women worldwide. The incidence of colorectal cancer has increased over the last few years, with about one million new cases diagnosed annually. Non-targeted chemotherapy is the most common therapeutic strategy available for colon cancer patients, but this treatment method is unable to distinguish between cancerous and healthy cells, leading to poor therapeutic effects on tumor cells and severe toxic side effects on healthy cells. Enabling chemotherapeutic drugs to target cancer cells would be a major development in the treatment of colon cancer.

In this study, the researchers isolated a specific nanoparticle population from edible ginger (GDNP 2) and reassembled their lipids, naturally occurring molecules that include fats, to form ginger-derived nano-lipids, also known as nanovectors. To achieve accurate targeting of tumor tissues, the researchers modified the nanovectors with folic acid to create FA-modified nanovectors (FA nanovectors). Folic acid shows high-affinity binding to the folate receptors that are highly expressed on many tumors and almost undetectable on non-tumor cells.

The FA nanovectors were tested as a delivery platform for doxorubicin, a chemotherapeutic drug used to treat colon cancer. The researchers found that doxorubicin was efficiently loaded into the FA nanovectors, and the FA nanovectors were efficiently taken up by colon cancer cells, exhibited excellent biocompatibility and successfully inhibited tumor growth. Compared to a commercially available option for delivering doxorubicin, the FA nanovectors released the drug more rapidly in an acidic pH that resembled the tumor environment, suggesting this delivery strategy could decrease the severe side effects of doxorubicin. These findings were published in the journal Molecular Therapy.

"Our results show that FA nanovectors made of edible ginger-derived lipids could shift the current paradigm of drug delivery away from artificially synthesized nanoparticles toward the use of nature-derived nanovectors from edible plants," said Dr. Didier Merlin, a professor in the Institute for Biomedical Sciences at Georgia State and a Research Career Scientist at the VA Medical Center. "Because they are nontoxic and can be produced on a large scale, FA nanovectors derived from edible plants could represent one of the safest targeted therapeutic delivery platforms."

Ref : http://www.nanowerk.com/nanotechnology-news/newsid=44454.php

Vitamin A Compound Might Aid in Colon Cancer Fight

In continuation of my update on Retinoic acid

Retinoic acid, a compound derived in the body from vitamin A, might have a role in suppressing colon cancer, new animal research suggests.

"Retinoic acid has been known for years to be involved in suppressing inflammation in the intestine," said study senior author Dr. Edgar Engleman, professor of pathology and medicine at Stanford University School of Medicine in Palo Alto, Calif.

Meanwhile, the development of colon cancer has been linked to inflammation. For example, inflammatory bowel disease, such as ulcerative colitis, has been associated with colon cancer, he said in a university news release.

"We wanted to connect the dots and learn whether and how retinoic acid levels directly affect cancer development," Engleman added.

When the researchers looked at mice with colon cancer, they saw lower levels of retinoic acid in the intestines of the mice.

The researchers also found that boosting levels of retinoic acid in the intestines of mice with colon cancer slowed progression of the disease.

In humans, colon cancer patients who had high levels of a protein that degrades retinoic acid in their intestinal tissue tended to have worse outcomes than other patients, the study authors noted.

The findings suggest new ways to prevent or treat colon cancer. However, it's important to note that animal research doesn't always produce the same results in humans.

"The intestine is constantly bombarded by foreign organisms. As a result, its immune system is very complex," Engleman said.

"We found that bacteria, or molecules produced by bacteria, can cause a massive inflammatory reaction in the gut that directly affects retinoic acid metabolism," he said.

He said that retinoic acid levels are normally regulated very tightly.

"Now that we've shown a role for retinoic acid deficiency in colorectal cancer, we'd like to identify the specific microorganisms that initiate these changes in humans. Ultimately we hope to determine whether our findings could be useful for the prevention or treatment of colorectal cancer," he concluded.

The study was published online Aug. 30 in the journal Immunity.

Combo Drug for Childhood Asthma Appears Safe in Study

In continuation of my update on fluticasone 

Lingering safety concerns regarding an asthma drug for children may be put to rest by new clinical trial results showing the widely used medication is safe, according to a new report.

Long-acting beta agonists (LABAs) provide short-term relief of asthma symptoms by relaxing and opening the airways. They're prescribed to child asthma sufferers in combination with an inhaled steroid drug to reduce airway inflammation, said study co-author Dr. Stanley Szefler. He is director of pediatric asthma research for the University of Colorado School of Medicine.

"Together they have a dual purpose, one to reduce inflammation and the other to open up the airways to make it easier to breathe," Szefler said.

But a 2008 analysis by the U.S. Food and Drug Administration questioned the safety of LABAs, noting that some studies had found an increased risk of asthma-related deaths in adults and asthma-related hospitalizations in children.

Based on the analysis, the FDA slapped a "boxed warning" label on the drugs, which calls attention to serious or life-threatening risks. The agency also asked GlaxoSmithKline, the manufacturer of a LABA intended for children, to perform a large-scale safety trial for its product, researchers said in background information.

The clinical trial, conducted by Szefler and his colleagues, found that children using a combination LABA/steroid inhaler -- sold as Glaxo's Advair Diskus-a powder form of fluticasone and salmeterol  ( -- did not have any greater risk of harm than children using an inhaler loaded only with a steroid.

  fluticasone   salmeterol

The results have been forwarded to the FDA, which now will decide whether to lift the black box warning, Szefler said.

"The next step is for the FDA to assemble all the available studies, make their own interpretation and determine how that would affect product labeling," he said.

The LABA/steroid combination drug is a valuable option that asthma doctors often use when inhaled steroids alone don't help kids with chronic asthma, said Dr. Alfin Vicencio, chief of pediatric pulmonology at Mount Sinai Hospital in New York City.

The boxed warning has impeded use of that option, he said.

"Not infrequently, families whose children could benefit from this medication decline on the medication specifically because of that warning," Vicencio said. "This manuscript not only gives physicians a little more reassurance, but parents as well."

In the safety trial, researchers recruited more than 6,200 children between 4 and 11 years old. They were randomly assigned inhalers containing a combination of salmeterol (a LABA) and fluticasone (a steroid), or fluticasone alone.

Of all the patients, 27 in the combination drug group had a serious asthma-related event that required hospitalization, compared with 21 in the steroid-only group. There were no deaths, and no emergencies that required insertion of a breathing tube.

The study results appear in the Sept. 1 issue of the New England Journal of Medicine.

The past safety concerns might have cropped up because patients were using an LABA without also taking a steroid alongside it, Szefler said. LABAs provide only short-term relief, and do nothing to treat the chronic airway inflammation targeted by steroids.

"In asthma, when you're using the long-acting beta agonist it should be combined with a steroid," he said.

Inhaled steroids will remain the front-line option for kids with chronic asthma, but this trial shows the combination drug is "a tool that can be used for those children that require something in addition to steroids for their persistent asthma," said Dr. Marilyn Li. She is an assistant professor of clinical pediatrics at the University of Southern California's Keck School of Medicine.

"There's been widespread fear about that kind of medication because of the long-acting beta agonist component, and unjustly so because, truthfully, for those children who have moderate to severe asthma, there is a serious unmet need," Li said.