FLASH radiotherapy is a brand-new model of radiation therapy that may be administered to a cancer patient in as little as a single, complete treatment. The therapy lasts much less than one second and has a duration of up to six weeks. Comparatively, conventional radiation therapy takes several minutes to administer the same dose.

Introduction

Radiotherapy is one of the predominant scientific remedies for tumors. The goals of radiotherapy are twofold; the first of which lies in successfully killing tumor cells with ionizing radiation, and the second is, at the same time, minimizing regular tissue damage that negatively influences the affected person’s care and quality of life. It is estimated that up to 65% of tumor patients go through radiotherapy at one point during their treatment. The first thing to do to reach these goals is to deposit a high amount of powerful ionizing radiation onto a tumor while at the same time avoiding irradiating regular tissue. Recent decades have seen a rise of new, superior technology consisting of intensity-modulated radiotherapy, stereotactic body radiotherapy, proton, and carbon particle radiotherapy. These new devices and techniques have converted radiotherapy into a particular and effective therapy routine for most cancer sufferers with the aid of using enhanced spatial dose administration. Nevertheless, the therapy of radiation-resistant tumors continues to be confined with the aid of using dose-proscribing regular tissue complications.

The second thing to do to achieve successful radiation is to grow the differential reaction among regular tissue and tumors to ionize radiation with the aid of using, for instance, a hyper-fractionated therapy strategy. Conventional radiotherapy (CONV-RT) contains fractions of two Gy (or “gray”; a measurement used for radiation) per day for five days (Monday to Friday) every week for numerous weeks, permitting regular tissues to get over radiation-precipitated damaging results to an extra quantity than tumors, whose radiation reaction is dictated with the aid of using the whole dose introduced as opposed to with the aid of using the dose given at every fraction. Recently, a third method to for precise aiming, known as FLASH-RT, emerged as a promising new device in presenting temporal administration of a single dose of high dose rate ionizing radiation.

What is new in Radiation Therapy?

Conventional RT has developed significantly over time. However, the harm precipitated to healthy tissues at some point of the radiation therapy continues to be a vital task for traditional RT.

FLASH RT represents an entire archetypal shift as opposed to an improvement upon the present era of radiotherapy technology. The variety of research is continuously growing to an accumulation of promising outcomes. FLASH RT is perhaps one of the most promising technologies for tumor therapy, imparting vital views for preclinical studies.

Advantages of Flash radiation therapy compared to conventional radiation therapy

FLASH RT complements the differential impact among tumors and healthy tissues. FLASH RT provides doses in an extraordinarily brief irradiation time as a quick “flash” of radiation. FLASH RT is iso-powerful whilst in comparison to standard dose rate RT, thus decreasing regular tissue toxicity and side effects.

Conventional radiotherapy (RT) is significantly confined by radiation-precipitated toxicities. If those could be decreased, an extra dose of radiation might be given thus facilitating a higher tumor reaction.

The ultra-speedy administration of radiation therapy (i.e., electrons, photons/x-rays, and protons) at dose rates numerous orders-of-importance extra than the ones presently utilized in scientific exercise reduces radiation-precipitated toxicities. This permits regular tissue tolerance stages to be substantially exceeded, thereby growing the healing index over traditional radiation administration.

In traditional external beam radiotherapy (EBRT), the affected person is irradiated for 1-2 minutes, 5-days/wk, for 1-2 months. In FLASH-RT, the affected person might be irradiated in < 0.1 second for 1 to four days thus substantially decreasing side-effects, regular tissue toxicity, and cost.

Tissue toxicity

It was first discovered in the 1960’s that non-cancerous cells that were subjected to ultra-high dose rates of radiotherapy had been much more likely to be viable than the ones subjected to standard dose rates. This has been currently supported with the aid of using research in mice, and was validated that there was much less harm in the lungs of mice treated with FLASH-RT in comparison to the ones treated with CONV-RT. In every other examination, mice subjected to complete brain irradiation at traditional dose rates were worse in recognition checks in comparison to the ones treated at ultra-high dose rates. Radiation-precipitated pores and skin reactions can encompass reddening and breakdown and have been proven to be greatly decreased in rodents being treated with FLASH-RT in comparison to CONV-RT. FLASH-RT additionally compared favorably in a single examine evaluating the pores and skin response of a mini-pig to distinctive dose rates of radiotherapy. Another examination related to the therapy of nasal cancers in cats with FLASH-RT confirmed the entire remission of tumors with minimum trauma to surrounding tissues. Researching the FLASH impact is of importance to set up how it could be utilized in a scientific situation to deal with most cancer patients.

Many research studies show that further to decreasing tissue toxicity, FLASH-RT additionally produces an identical tumor reaction as CONV-RT.

Influencing elements

There is an array of elements that could have an effect on the efficacy of FLASH treatment which includes dose rate, general dose, pulse rate, fractionation, and modality of radiation. The dose rate used for the FLASH impact may additionally range relying upon the affected tissue and the administration approach. Many studies vary in the general dose of radiation used, or use doses inconceivable in scientific scenarios, which complicate the findings. The supply of radiation is likewise an aspect because FLASH impact has been primarily discovered by using electron linear accelerators. More currently, the success of FLASH treatment has additionally been visible following usage of proton and X-ray radiation. Pulsing the radiation at a high frequency can result in FLASH therapy at an appropriate dose-in line with-pulse. Furthermore, the examination is wanted to verify the important parameters for inducing the FLASH impact, as there are a wide variety of variables at work.

Oxygen depletion

Exactly why the FLASH impact happens is not absolutely understood but has been hypothesized. Hypoxic tissues (tissues which might be disadvantaged of oxygen) are greatly immune to radiation (and are consequently much less likely to be damaged) than well-oxygenated tissues. It is therefore conceptualized that the distinction in tissue toxicity among FLASH-RT and CONV-RT can be because of the extent of hypoxia at ultra-high dose rates and ensuing radioresistance transferred to irradiated tissue.

Changes in immunity

Another proposed idea for FLASH treatment to have a greater impact is a changed immune reaction. Since it utilizes a shorter therapy time, much fewer lymphocytes (white blood cells concerned within the immune gadget) suffer from the radiation. One examination mentioned much less immune gadget activation in mice following FLASH-RT in comparison to CONV-RT. It has to be referred to that it’s far doubtful if any immune reaction following FLASH-RT is contributing to the FLASH impact or because of it. Other organic responses consisting of DNA harm and infection can also be contributing, and greater research is needed for clarification.

Conclusion

FLASH-RT provides a single burst of high dosage rate ionizing radiation in milliseconds and achieves near perfect tumor control and, at the same time, spares regular tissues from extreme aspect results. The result is the presentation of fascinating imaginative and prescient of enhancing scientific results for tumor sufferers with the aid of using the use of dose-rate modulation of radiotherapy. The FLASH impact gives advanced tissue safety in comparison to CONV-RT without compromising on tumor therapy. It has been studied throughout numerous species and now a single human case has been documented. While its mechanism of motion is likely to contain oxygen depletion, it isn’t always absolutely understood and consequently calls for similar examination. The doses required to acquire the FLASH impact make it unsuitable for many patient studies. Furthermore, the provision of radiation sources to generating appropriate beams for the therapy of each superficial and deep tumor is a proscribing aspect in scientific trials. If future studies yield greater know-how of the organic mechanisms of the FLASH impact, it will be viable to acquire it at decreased doses, growing its scientific viability.

References

1. https://www.mdpi.com/1422-0067/21/18/6492
2. Jonathan R. Hughes and Jason L. Parsons.: “FLASH Radiotherapy: Current Knowledge and Future Insights Using Proton-Beam Therapy”. Int. J. Mol. Sci. 2020, 21(18), 6492; Cancer Research Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool L3 9TA, UK And  Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Bebington CH63 4JY, UK.
3. https://www.sciencedirect.com/science/article/pii/S26665557203000833 4. Guangming Zhou. : Mechanisms underlying FLASH radiotherapy, a novel way to enlarge the differential responses to ionizing radiation between normal and tumor tissues. Radiation Medicine and Protection. Volume 1, Issue 1, March 2020, Pages 35-40
4. https://isensors.net/flash-rt/5.
5. https://researchoutreach.org/articles/flash-radiotherapy-what-how-why/#:
6. J. D. Wilson, E. M. Hammond, G. S. Higgins, K. Petersson (2020) Ultra-High Dose Rate (FLASH) Radiotherapy: Silver Bullet or Fool’s Gold? Frontiers in Oncology 9, 1563.

The motion of the stars and celestial bodies result in inaudible sounds, reflecting the mathematical harmony of the macrocosm. In the animal kingdom, we see that music emerged long before humans did. Archaeologists have uncovered what they think were ancient flutes as old as 43,000 years and musical notations as old as 4,000 years. Music has always played a part in humankind’s development (Andrews 2018). There is not one place in the world that does not have some kind of musical culture. This scheme of cosmic music suggests that music is a universal language. However, many have questioned why, “as neither the enjoyment nor capacity of producing music notes are faculties of the least use to man… they must be ranked among the most mysterious with which he is endowed (Darwin 1871).”

Why is it that whale and human music have so much in common? How is it that music reaches deeper, past our auditory cortex, to activate our limbic system, which our emotions are connected to? One can thus ponder the biological purpose of music since it does not contribute directly towards our survival. Some people, such as Dr. Steven Pinker, suggest that music is merely “auditory cheesecake,” a by-product of our motivational systems that give us pleasure and release dopamine; “as far as biological cause and effect are concerned, music is useless … it could vanish from our species and the rest of our lifestyle would be virtually unchanged” (Leutwyler 2001).

Looking back at history allows us to see that music was implemented as a healing tool for centuries. Hippocrates played music to treat mental health patients as early as 400 BC. In the Bible, David played the harp to heal King Saul of a bad spirit. Physicians such as Al-Farabi (Alpharabius), Al-Razi (Rhazes), and Ibn Sina (Avicenna) passed on their ideas of music therapy that Ottoman physicians developed further into therapeutic systems. Muslim scientists traced ancient musical theories of the Hellenistic sources (borrowed mainly from Sumerian, Babylonian, and Egyptian concepts and perspectives) as well as the Chinese and Indian sources, and melded western and far eastern ideas to introduce a new and innovative approach. Patients suffering from a certain physical or psychological illness were expected to be influenced by certain makams, or specific musical modes, and were prescribed these makams for therapeutic purposes. These effects were systematically applied as preventative and curative means. For example, sciatica (a type of back pain) was expected to be treated with the neva makam, which also brings a person pleasure and contentment and is most effective in the evening. Hüseyni makam, most effective at dawn, was used to treat fever; zengule and irak were for meningitis (referred to as sersam) (Sari 2009). Native American communities still practice religious healing ceremonies consisting of prayer, dance, and chanting to help members of their tribe heal and find harmony. The earliest proponents of music therapy, whether they be from the East or West, engaged in scientific debate with each other, curious as to why they observed improvements in their patients with music therapy. One theory was that music, humans, and cosmology were in harmony with the physical elements of water, air, fire, and soil. Others approached sound from a physicist’s point of view and discussed the nature of sound, its subdivisions, and the process of perceiving sound. They also debated what these therapies could be used for, some argued they were only suitable for treating mental disorders, whereas others supported its expansion for other physical ailments.

It has long been argued whether or not music therapy is only useful for regulating emotions or if it can also be used to aid the treatment of physical ailments. It has also long been observed in psychology and biology that specific emotions result in well-known physiological responses. For example, when you feel sad, your skin’s conductivity usually decreases and heart’s pulse slows down, while blood pressure and body temperature rise. Fear often results in an increased heart rate, and happiness tends to make us breathe faster. We see that music can directly trigger these emotions: music with a quick tempo and major (wider interval, more open sound) key bring about the physical changes associated with happiness, whereas a slow tempo and minor (narrow interval) key result in those associated with sadness. However, newer research (Jolij & Meurs 2011) suggests that music does not only affect our moods but that it can affect our worldviews and can even change our perceptions of the world. Since emotions elicit physiological responses, music therapy may have the capacity to prevent or treat physical illnesses, in addition to emotional and psychological ones.

These debates still continue, but with the technologies of today and the evidence we record in patients, we see the potential for music therapy more than ever. Maybe the more important question isn’t how, but why this information is important and how we can properly utilize it. If music is so universal and so essential, what effects does it have on what makes us, us: our soul and body? Music therapy tries to answer this question. In western tradition, the Latin phrase “Mens sana in corpore san,” which means “a healthy mind in a healthy body” is supported with the current psychological understanding that there is a clear connection between body and psyche and how both processes react to each other. As functional MRIs allow us to see the living brain dance as individuals listen to, imagine, and even compose music, we are finding many answers and also asking new questions. We see there is no single center within the brain that responds to musical activity and that different parts of the brain light up for different people. Many current studies explore the positive effects of music therapy, meditation, and other holistic treatment options for pain management. In 1944, Michigan State University established the first academic program in music therapy and the Certification Board for Music Therapists was incorporated in 1983 to assure the competency of credentialed music therapists. Currently, in the United States, music therapy is an established profession that uses music as a therapeutic tool to address physical, emotional, cognitive, and social needs of individuals. Since 1998, the American Music Therapy Association has been the intellectual home of music therapists and has published two research journals that promote music therapy through social media streams in addition to podcasts, scholarships, and newsletters.

Contemporary music therapy comes in two forms: active and receptive. In active therapy the therapist and patient make music together, with their voice, instruments, or other objects, allowing the patient to express his or her creativity. Receptive therapy, on the other hand, is very similar to what we observed with historical musical therapists where a therapist plays music for the patient to listen to. It is used in a variety of fields, for example, individuals with special needs focus on developmental work, such as communication or motor skills. In the physical rehabilitation of stroke victims, practices include processing and relaxing via rhythmic entertainment. Alcohol and drug recovery programs, correctional facilities, medical hospitals, psychiatric hospitals, and cancer centers have also utilized music therapy in various forms. Current music therapists work with older adults to lessen dementia symptoms, children with autism to improve communication capabilities, and with premature infants to improve sleep patterns and increase weight gain.

Neurologist Dr. Oliver Sacks has done incredible research on the power of music therapy for the treatment of dementia. His curiosity was sparked in 1966 when he first saw the profound effects music had on long drifted Parkinson’s patients which he described in the book, Awakenings. With music, he saw his patients awaken, their dyskinesias diminishing, and their memories coming back into view. What may seem magical to some is simple neuroscience to others: Parkinson’s is a dysfunction of dopaminergic neurons in the brain, and the memory of music we love gives us a rush of dopamine. He also applied what he observed with his Alzheimer’s patients who couldn’t remember their own names (Sacks 2008). After being immersed in a “brain bath” of music from the patient’s past, they could now have a conversation and talk about their childhood memories. “Even if they can’t recognize loved ones and they’ve stopped speaking, they hear music and they come alive.”

In other neurological conditions such as strokes, aphasias (difficulties with expressive language due to head trauma or brain tumors), autism, and psychiatric illnesses, there is growing evidence of the difference music therapy can have on long-term outcomes. Stroke patients who choose to add music therapy, in addition to other treatments, have an overall better quality of life and are better able to regulate their emotions and communicate with fewer occurrences of depression and anxiety while also having a greater increase in muscle strength. Melodic intonation therapy (MIT) is an active therapy technique that is used to help treat communication disorders (aphasias) that were caused by brain damage (Norton 2009). It encourages patients to sing and hum in order to engage the language-capable regions of their brains. Sometimes this humming can be accompanied by physical movements such as tapping of the hand or drumming. Along with these neural activations, visual stimuli of the word to be relearned will be shown. With many repetitions, patients can eventually remember words without the musical and physical cues. With the connections that have been illustrated between music, emotion, and communication, it’s not difficult to see how music could also help patients who are autistic and having difficulty with social interactions. Research has illustrated the usefulness of music therapy in autism treatment approaches, and how it promotes healthy neurodevelopment along with honing socio-communication, interaction, speech production, language acquisition, attention, and motor skills. There is also much evidence that supports music therapy as supplemental treatment in patients suffering from psychiatric ailments such as schizophrenia, major depressive disorders, anxiety disorders, and post-traumatic stress disorder (PTSD).

We are also starting to see the emergence of music therapy research that concerns non-neurological conditions such as heart disease, cancer, and autoimmune diseases including arthritis or lupus. It is easier to wrap one’s mind around how music therapy may help someone with heart disease, but more difficult to understand how it could have any effect on autoimmune diseases, which are already a mystery for modern medicine to treat. As mentioned above, music and emotions go hand in hand; when we feel happy or relaxed our heart beats in a different way than when we feel angry or stressed. These long-term effects can reduce blood pressure and provide a healthy environment for our hearts.

Emerging research shows that listening to music can actually alter our genetic material on a molecular level. Scientists at the University of Helsinki found that music directly affects human RNA, which is the very core of one’s biological being (Kanduri 2015). A similar research project is also underway at Kyoto University. Another approach, if we remember our historical physicians’ debates, is high-intensity focused ultrasound (HIFU), which harnesses the actual physical property of sound waves and targets them toward cancer cells, which is already being used as an FDA-approved treatment to cure prostate cancer (FDA 2015).

The sensation of perceiving music is on a spectrum; it changes from anhedonia (almost no dopamine response) to synthesis (increased dopamine response). But even when we take away the dopamine rush and the element of enjoyment, there is still a benefit of music/sound waves from a purely physical point of view, as in the ultrasound treatment of cancer or in the rewriting of our DNA with post-transcriptional regulation.

As can be seen with the historical and current explorations, there is much potential in music therapy. There is still much to be uncovered about the power of sound and music, but this will require a multi-pronged, interdisciplinary approach from budding STEM enthusiasts.

References

• Andrews, Evan. 2018. “What is the oldest known piece of music?” https://www.history.com/news/what-is-the-oldest-known-piece-of-music
• Darwin, Charles. 1871. The Descent of Man, and Selection in Relation to Sex, UK: John Murray.
• Leutwyler, Kristin. 2001. “Exploring the Musical Brain,” Scientific American. http://www.scientificamerican.com/article/exploring-the-musical-bra/
• Sacks, Oliver. 2008. Musicophilia: Tales of Music and the Brain, Vintage.
• “Alive Inside: A Story of Music & Memory Featurette” (https://www.youtube.com/watch?v=8HLEr-zP3fc)
• Sari, Nil. 2009. “Ottoman Music Therapy” http://www.muslimheritage.com/article/ottoman-music-therapy#sec_2
• Norton, Andrea. 2009. Melodic Intonation Therapy: Shared Insights on How it is Done and Why it Might Help
• Kanduri, Chakravarthi, et al. 2015. “The Effect of Listening to Music on Human Transcriptome,” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4362302/
• Jolij, Jacob. 2011. “Music Alters Visual Perception,” https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0018861
• De Novo Classification Request for Sonablate 450. 2015. https://fountainmagazine.com/wp-content/uploads/2020/07/DEN150011-7a9.pdf

Our brains consist of many different types of cells, including astrocytes, microglia, and neurons. These are the cells that people are indirectly referring to when you hear someone say that hitting your head can cause permanent damage even though the initial impact was a minor one. They are the primary cells that are responsible for signaling functions, and one can see this in their shape because they resemble an electric cord. The dendrites receive signals, process them in cell bodies, and send an output signal via the axons and synaptic terminals (Figure 1). These cells cannot multiply, and our heads never get larger, so it begs the following question: how do we continue to learn and store information? The answer is long-term potentiation (LTP).

LTP is when synaptic connections between neurons become stronger with frequent activation. Neuronal activation is an electrical signal called an action potential that emerges due to a change in ion locations resulting in electrical potential that generates a nerve impulse (Figure 2). When the same neurons keep getting activated, again and again, a shortcut is created. We have two crucial receptors that play a role in this mechanism: AMPA and NMDA. AMPA is activated first because a Mg2+ ion blocks NMDA. As AMPA gets activated, the neuron becomes depolarized (due to the previously mentioned electrical changes). Now, the neuron is more positive overall, which will push the Mg2+ ion out of the channel, which is called the Law of Attraction in physics (i.e., opposites attract). With the Mg2+ ion removed, calcium ions can move freely through the NMDA receptor, and this influx of calcium initiates cellular mechanisms that cause more AMPA channels to be produced and placed on the synapse of the neuron, making the pathway activated quicker and quicker (Figure 3). These pathways become a default, and this is called long-term potentiation. The opposite of long-term potentiation is long-term depression, a decrease in synaptic strength, so if “you don’t use it, you lose it.”

Long-term potentiation is thought to be a way in which the brain changes in response to experience, and thus may be an underlying mechanism for learning, retaining memory, and even overall physical health. With long-term potentiation our default pathways are formed; so if we train ourselves to be anxious and stressed individuals, then we will be at an increased risk for developing hypertension, heart disease, cancer, and almost any other physical illness. We often forget that stress itself is a risk factor along with other lifestyle choices such as diet and regular physical activity. An interesting article, “The Science of Happiness: Why Complaining is Literally Killing You,” delves into this point of view:

“When your brain is firing off these synapses of anger, you’re weakening your immune system; you’re raising your blood pressure, increasing your risk of heart disease, obesity and diabetes, and a plethora of other negative ailments… This is why it is so important to spend time with people who lift you up. Want to be happy? Surround yourself with happy people who rewire your brain towards love.” (http://www.curiousapes.com/the-science-of-happiness-why-complaining-is-literally-killing-you/)

Long-term potentiation is also the basis of cognitive-behavioral therapy, which is a form of psychotherapy treatment that is goal-oriented and takes a practical approach to problem-solving. Cognitive-behavioral therapy recognizes the underlying mechanism of long-term potentiation: neurons that fire together wire together and puts it to good use by trying to change default patterns of thinking and behavior. By changing these default patterns, the result changes how we feel. For example, a common practice in cognitive-behavioral therapy is to keep a daily gratitude journal. The therapist may ask their client to write three things they are grateful for each morning and each night, whether it be something as simple as having water to drink or a significant life event. Forcing yourself to make these connections continuously, and being in a default repetitive state of gratitude, has been scientifically proven to decrease rates of depression and other mental illnesses.

Another perspective we can approach LTP from is from the lens of faith and prayer since prayer has an element of repetition in it. In his book, Fethullah Gülen: A Life of Hizmet, Jon Pahl states that “Peacebuilders pray, and prayer is a nonviolent practice. Even more: prayer has power. The power of prayer is neither political nor miraculous. Personally, prayer builds confidence. The repetition of prayer comforts a troubled mind with the solace of the familiar. Culturally, prayer builds trust. Communing with God and others can make any challenge seem surmountable. Socially, prayer builds movements.”

Yes, if we could rewire our brains towards love and peace with each prayer, we could find comfort and peace, and build bridges with those around us. In 2019 alone, the Islamic scholar Fethullah Gülen Hodjaefendi, mentioned the word “neurons” in his weekly sermons nine times, a fascinating statistic for a scholar who is neither a neuroscientist nor psychiatrist. Some excerpts from these sermons include:

“[when recited and listened to a couple times during the day and in the Tarawih Prayer] the Qur’an will establish itself better in our minds; our neurons will open their doors like the doors of a castle to the Qur’an and say ‘enter.’ Therefore, who knows how many times a day, a reunion will be established with the Qur’an.” (Ramadan: The Month of Mercy, Hope and Abundance on May 10, 2019)

“Bediuzzaman says: ‘Even if we had four hands instead of two, they would not be sufficient to do things we need to do.’ … In this case, we must send orders to the millions of neurons in our brain at the same to dedicate them all to the same task. … God opens you a window to exit. (Means for Serenity and Talk of the Beloved on April 4, 2019)

“[‘The entire universe is a great book of God; the meaning of each letter is nothing but God.’] Just as you … use all of your neurons to see the endless possibility of bounties, lined along like a gallery as if He is to say, ‘see and think as you walk this gallery.’ (Sorrow, the Spiritual Heart and Tongue on March 29, 2019)

To return to the biological aspect of neurons, one key component that is also valuable to synthesize all the information we have just covered, and that is the concept of “mirror neurons.” When we observe another person these mirror neurons start to fire and a kind of virtual reality simulation is formed in our minds, contributing to the construction of a theory of our intentions. For example, when someone smiles, you want to smile back; when someone gets a paper cut, you feel their pain; or when someone cries, you cannot help but cry as well. These are all phenomena explained by mirror neurons. Mirror neurons explain empathy on a biological level and are present even in animals.

From a multi-disciplined approach, including biological, psychosocial, and spiritual perspectives, one lesson becomes clear: we have the free will and responsibility to carve our default pathways. To make sure these default pathways are filled with love, peace, serenity, alongside discipline, patience, and resilience is paramount to our personal and collective health. By defining our own neural pathways, we will also be building our community’s networks since neurons mirror each other.

Nooriye is a 39-year-old Iraqi female. She had a pretty normal life until a group of terrorists knocked on her door. Her two sons were killed in front of her. She was abused and tortured for days, as was her husband. Rebels eventually took her husband and left. Some neighbors helped her to bury her sons and provided her with shelter and food. She was about to kill herself when, miraculously, her husband came back 57 days later. He never told her what he went through during those 57 days. They were both in extreme pain but able to hold onto each other.

They immigrated to the U.S. a year later. Her husband found a job and is still working. They are safe now, but it has not been enough to heal them. Both still have nightmares and flashbacks. She spends all her time in her home. She stares at walls, feels numb and very fearful, and cries every day. Her speech is sparse, and she never smiles. She goes out with husband once a day but grabs his hand and won’t let him go when they are out. When faced with stress, she often passes out.

Her husband “has to be strong because she is the only thing he has,” although he also has extreme pain. He hides his tears from his wife, is unable to sleep at night, feels guilty, and misses his sons. He is afraid to make any Iraqi friends and stays away from mosques.

Obviously, providing a safe place, food, and a job is not enough to heal these people’s pain. Invisible wounds and problems are much harder to treat than visible ones.

In this article we will try to elucidate some elements of what Nooriye and thousands of other families have been exposed to all around the world.

Mass trauma

When a group of people, regardless of size, experience psychological effects after a trauma that was suffered collectively, this is called a mass trauma. Sometimes an entire society witnesses the same trauma, and this may cause a collective sentiment, often resulting in a shift in that society’s culture and mass actions.^1,2

Wars, political violence, natural disasters, exile, torture, and terrorism are examples of mass trauma. The Holocaust, the Atomic bombing of Hiroshima and Nagasaki, slavery in the United States, and the 9/11 attacks are well-known collective traumas.

Collective traumas have been shown to play a key role in group identity formation. Having the same problems, suffering from the same pain, and being under the same pressures bring individuals together. This togetherness eventually helps to build a community, a group, and sometimes a nation. Almost every nation has traumatic events in their history. Even the concept of “nation” is extensively affected by these events.

Nevertheless, despite its role in building group identity, mass trauma is still individually painful. In fact, the effects of mass trauma can be very deep and transferred through the generations. In 1966, clinicians observed that large numbers of children of Holocaust survivors were seeking treatment in psychiatric clinics in Canada. Moreover, when compared to the general population, the grandchildren of Holocaust survivors were three times more likely to seek clinical psychiatric help.³

Post-Traumatic Stress Disorder

According to the National Center for Posttraumatic Stress Disorder, the most common stress reactions in the wake of disaster may include the following:

Emotional reactions, including shock, fear, grief, anger, guilt, shame, feeling helpless, feeling numb, and sadness.

Cognitive reactions, including confusion, indecisiveness, worrying, shortened attention span, and trouble concentrating.

Physical reactions, including tension, fatigue, edginess, insomnia, bodily aches and pains, startling easily, racing heartbeat, nausea, change in appetite, and changes in other bodily desires.

Interpersonal reactions, including distrust, conflict, withdrawal, work or school problems, irritability, loss of intimacy, and feeling rejected or abandoned.⁴

Several factors present in the acute-phase recovery environment of a disaster have been found to aggravate stress reactions and therefore increase survivors’ risk of developing negative outcomes. These include:

• Lack of emotional and social support
• Presence of other stressors such as fatigue, cold, hunger, fear, uncertainty, loss, dislocation, and other psychologically stressful experiences
• Difficulties at the scene
• Lack of information about the nature and reasons for the event
• Lack of, or interference with, self-determination and self-management
• Treatment [given] in an authoritarian or impersonal manner
• Lack of follow-up support in the weeks following the exposure

Protective factors that may mitigate negative effects include:

• Social support
• Higher income and education
• Successful mastery of past disasters and traumatic events
• Limitation or reduction of exposure to any of the aggravating factors listed above
• Provision of information about expectations and availability of recovery services
• Care, concern and understanding on the part of the recovery services personnel
• Provision of regular and appropriate information concerning the emergency and reasons for action.⁵

In most cases, the symptoms of trauma eventually disappear, but unfortunately, some of the survivors of the mass trauma will eventually develop Post-Traumatic Stress Disorder (PTSD). PTSD is a mental disorder resulting from exposure to an extreme traumatic stressor.

The National Comorbidity Survey Replication (NCS-R), conducted between February 2001 and April 2003 in the U.S., estimated the lifetime prevalence of PTSD among adult Americans to be 6.8%.⁶ The lifetime prevalence of PTSD among men was found to be 3.6% and among women 9.7%. ⁷

PTSD is described in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM 5) which is published by the American Psychiatric Association, as:

Criterion A (at least one required): The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):

• Direct exposure
• Witnessing the trauma
• Learning that a relative or close friend was exposed to a trauma
• Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)

Criterion B (at least one required): The traumatic event is persistently re-experienced, in the following way(s):

• Intrusive thoughts
• Nightmares
• Flashbacks
• Emotional distress after exposure to traumatic reminders
• Physical reactivity after exposure to traumatic reminders

Criterion C (at least one required): Avoidance of trauma-related stimuli after the trauma, in the following way(s):

• Trauma-related thoughts or feelings
• Trauma-related reminders

Criterion D (at least two required): Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):

• Inability to recall key features of the trauma
• Overly negative thoughts and assumptions about oneself or the world
• Exaggerated blame of self or others for causing the trauma
• Negative affect
• Decreased interest in activities
• Feeling isolated
• Difficulty experiencing positive affect

Criterion E (two required): Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):

• Irritability or aggression
• Risky or destructive behavior
• Hypervigilance
• Heightened startle reaction
• Difficulty concentrating
• Difficulty sleeping

Criterion F (required): Symptoms last for more than 1 month.

Criterion G (required): Symptoms create distress or functional impairment (e.g., social, occupational).

Criterion H (required): Symptoms are not due to medication, substance use, or other illness.⁸

Treatment for mass trauma:

Treatment for mass trauma should be delivered at two different levels: the community level and the individual level.

1. Community level:

Dr. Frantz Omar Fanon gives the recipe for mass trauma treatment at the community level: “Mass trauma can be alleviated through cohesive and collective efforts such as recognition, remembrance, solidarity, communal therapy and massive cooperation.”

The statement above can be a topic for a separate article. Here, we would like to express the importance of the remembrance days. People comes together on remembrance days and remind the victims that they are not alone and not forgotten. This can be therapeutic for the victims and alleviate their pain.

2. Individual level

PTSD treatment includes pharmacotherapy (medical treatment) and psychotherapy. Some of the medications which have been helpful combatting depression are selective serotonin reuptake inhibitors (SSRIs), such as Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), and serotonin-norepinephrine reuptake inhibitors (SNRIs) such as Venlafaxine (Effexor) and Duloxetine (Cymbalta).

There are several therapy types that have been shown to be effective at treating PTSD. Trauma-focused psychotherapies are the most highly recommended psychotherapies for PTSD. In these therapy types the treatment focuses on the memory of the traumatic event or its meaning. These treatments use different techniques to help a victim process their traumatic experience. Some involve visualizing, talking, or thinking about the traumatic memory. Others focus on changing unhelpful beliefs about the trauma. Prolonged exposure therapy, Cognitive Processing Therapy, Eye-Movement Desensitization and Reprocessing, Brief Eclectic Psychotherapy, and Narrative Exposure Therapy are the some of the therapies that have been found to be helpful for PTSD patients.

Additionally, spirituality might help treat PTSD, too. A study of Bosnia-Herzegovina war veterans suggested that veterans who prayed had significantly higher levels of incorporation, self-protection, and reactive formation and significantly lower levels of regression, compensation, transferring, lack of control, and aggressiveness than their peers who did not pray. ⁹

In brief, providing shelter, food, and a safe environment are mandatory for trauma patients, but they aren’t nearly enough. Psychological traumas are very hard to treat, and treatment may take years. It has been shown that soldiers who have somebody to share their war experience/trauma with, have a lower risk for PTSD when compared with the ones who can’t talk to anybody. Victims need professional help along with community support. Trauma can be alleviated through cohesive and collective efforts and cooperation. Praying for the trauma victims, as politicians suggested for recent hurricane victims, definitely has some social impact. It has also been shown that medication/prayers decrease PTSD symptoms ¹⁰; however, showing support and empathy, listening to victims, and acts of remembrance are the other key elements of community support.

References

1. Lisa Gale Garrigues, “Slave and Slave Holders Break Free of History’s Trauma“, Yes Magazine, August 2, 2013
2. Updegraff, Silvler, Holman, “Searching for and Finding Meaning in Collective Trauma, Journal of Personal and Social Psychology, September 2008
3. Coffey, R. (1998). Unspeakable truths and happy endings. Sidran Press. ISBN1-886968-05-5
4. https://www.ptsd.va.gov/professional/pages/handouts-pdf/Reactions.pdf
5. NSW Institute of Psychiatry and Centre for Mental Health. (2000). Disaster Mental Health Response Handbook.North Sydney: NSW Health.
6. Kessler, R.C., Berglund, P., Delmer, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6): 593-602.
7. National Comorbidity Survey. (2005). NCS-R appendix tables: Table 1. Lifetime prevalence of DSM-IV/WMH-CIDI disorders by sex and cohort. Table 2. Twelve-month prevalence of DSM-IV/WMH-CIDI disorders by sex and cohort. Accessed at: http://www.hcp.med.harvard.edu/ncs/publications.php
8. American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders, (5th ed.). Washington, DC.
9. Pajević I, Sinanović O, Hasanović M. Association of Islamic Prayer with Psychological Stability in Bosnian War Veterans. J Relig Health. 2017 Dec;56(6):2317-2329. doi: 10.1007/s10943-017-0431-z.
10. Gallegos AM, Crean HF, Pigeon WR, Heffner KL. Meditationand yoga for posttraumatic stress disorder: A meta-analytic review of randomized controlled trials. Clin Psychol Rev. 2017 Dec; 58:115-124. doi: 10.1016/j.cpr.2017.10.004.

Gastro-esophageal reflux disease (GERD) is among the most common chronic diseases in the Western world, affecting up to 30% of the general population in Europe and the US. It is a condition which develops when the acidic contents of the stomach flow backwards into the esophagus and cause what’s known as heartburn. While most patients respond well to the standard therapy of proton pump inhibitors which block acid-secreting cells in the stomach, we are still trying to understand the molecular reasons why 30-40% of reflux patients do not respond adequately to acid-suppressant therapy. Not only does GERD have a significant negative impact on health-related quality of life, but the over-subscription of ineffective drugs causes a significant economic burden on healthcare.

Heartburn is the most noticeable and troublesome symptom of GERD. From what we currently understand about the pathophysiology of the disease, we know that the reflux of acid evokes different types of pain, but the basic mechanisms and pathways by which this pain is generated is incompletely understood. The junction between the esophagus and stomach is structurally and functionally designed in a way to ensure that any acid secreted in the gastrointestinal tract flows towards the stomach, and not up onto the lining of the esophagus. This function is served by the muscle structure sitting at this junction, called the lower esophageal sphincter (LES), which ensures that the ingested food following a meal does not reflux. However, there are several factors which can make the LES’s job more difficult. One of the most obvious factors includes the excessive consumption of food, particularly during the later hours of the day. There is convincing evidence that 90% of reflux episodes occur post-prandially, due to minor elevations of intragastric pressure which causes the LES to relax and therefore allow the reflux of acid. In more advanced cases of reflux disease, acid pockets form at the gastroesophageal junction where unbuffered acid collects into a reservoir. When the LES fails in this setting, there is reflux of a higher volume of acid.

Focusing on the microscopic structure of the esophagus and stomach, we can see a minute yet essential difference between the linings of these two gastrointestinal organs. The esophagus has a stratified squamous epithelial lining, which acts as a tight protective barrier against food but is readily damaged when exposed to a chemical environment. On the other hand, the stomach is lined by tall columnar epithelium, which is designed to withstand very low pH and high levels of proteolytic activity. Our gastrointestinal tract (and the human body in its entirety) is perfectly designed to carry out the specific role of transporting food from the oral cavity from the esophagus to the stomach, where it is digested for our nourishment. It is oftentimes our greediness and overindulgence which disrupt the perfect order of our anatomy at a molecular level, resulting in the macroscopic changes we see at endoscopy and the symptomatic discomfort we feel from the painful circumstances of reflux. 

The stomach is our center of nourishment. Given that every food particle has the purpose of nourishing the cells of our body, why do we so commonly make the mistake of eating excessively, nocturnally, and quickly? Fatty foods influence the relaxation of the lower esophageal sphincter, along with alcohol, coffee, and acidic drinks. Large meals and rapid food intake distend the stomach, increase intragastric pressure and facilitating the reflux of acid from the stomach. Given these, it is plain to see that, in most cases, simple lifestyle changes can prevent the development of such chronic and discomforting diseases. The following verse in the Holy Qur’an offers a short but very effective prescription: “Eat and drink, but do not be wasteful” (7:31).

The philosopher and physician Ibn Sina (Avicenna) summarized the science of medicine as follows: “Eat little when you eat, and after eating do not eat again for a certain period of time; health lies in digestion. There is nothing heavier for the body to tolerate than putting food after food in the stomach.” Frugality in eating is also echoed in the teachings of Prophet Muhammad, peace be upon him, who famously said “There is no vessel which the son of Adam can fill more evil than his stomach, for it is sufficient for him to take a few mouthfuls in order to straighten his back; but if he must, then fill one-third with food, one-third with drink, and one-third with air” (Tirmidhi).

The lifestyle factors that are strongly associated with GERD are obesity and smoking. In the 30-40% of GERD patients who do not respond to acid-suppressant therapy, simple lifestyle changes such as cutting out acidic drinks and eating more slowly, and not after 7 pm have been effective alternative treatments. While our understanding of molecular pain mechanisms of the esophagus need further improvement, the simple act of making minor changes in our eating habits can ensure that the anatomy and function of our gastrointestinal tract remains optimal.

The fascinating aspect of these materials stems from the fact that when certain particles or devices are manufactured on the nanometer size region by means of special chemical and physical methods, they start showing distinct properties dependent on size, shape, and elemental compositions (such as huge amount of light absorption/emission, plasmonic resonance, high surface area, ability to convert light into heat, desirable magnetic properties, etc). Each of these features have found many applications in technology and they provide superior properties when compared to conventional materials. This article will not cover each technology based on nanomaterials but rather focus on the medical aspects and applications of nanotechnology and the direction it is heading.

Nano-medicine is a novel branch of nanotechnology seeking to deliver medically relevant drugs and imaging agents to the desired sites of the body. Biomedical imaging and drug delivery fields are benefitting from nanotechnology to a greater extent because not only do nanomaterials provide unprecedented results in diagnosis and therapies, considerable amounts of incentives in the form of governmental and private funding also drive topnotch institutions and scientists to study these materials around globe. For instance, iron oxide—when designed and manufactured on the nanometer order—can compete with, if not replace, most of the commercial magnetic resonance imaging (MRI) contrast agents due to some of its attributes, (i.e., being much more sensitive) requiring a less amount compared to other contrast agents, non-toxic to humans, and easy to manipulate in terms of its chemistry (1). Nanometer-sized spherical and rod-shaped Cadmium/Tellerium/Lead sulfides and selenides, also known as “Quantum Dots,” can absorb and emit light from ultra-violet (UV) to infrared region (IR) and this phenomenon could be utilized to construct biomedical sensors capable of detecting biologically relevant species (such as blood glucose, tumor markers, hormones, and etc.) with great accuracy and speed (2). Even by using multiple colors emitting “Quantum Dots,” one can, in principle, detect more than one biological entity simultaneously. Furthermore, their superior emissive properties could be harnessed to develop sensitive and selective fluorescence imaging techniques and assays which can lead to simple and early diagnosis of diseases. Gold nanorods, if irradiated with IR lasers, can generate extreme local temperatures in the surrounding medium owing to “plasmonic resonance of surface electrons,” and this feature could be directed to killing of localized tumor tissues known as “Photothermal Theraphy” (3).

Another class of nanomaterial called liposomes (4) can actually mimic lipid bilayer of the cell membrane which gives rise to a protective layer around organelles and nucleus, and maintains the transport of ions and molecules in and out of the cell. Synthetic liposomes, strikingly, can accommodate various cargoes extending from drugs to imaging agents in their inner cavity and render controlled release of its cargo as it circulates in the body, thereby providing longer bio-availability.

One of the most alluring uses of nanoparticle formulations in cancer therapy is their dimension. Certain sizes of nanoparticles can permeate into tumoral sites and be retained in that region longer than small particles or molecules. This extraordinary feature of nanoparticles, called “enhanced permeability and retention effect” (5), was utilized with liposomes to deliver chemotherapeutics to cancerous tissues effectively in a slow and controlled manner. In addition, chemical malleability of nanoparticles give rise to smart formulations which could respond to external stimuli in drug delivery applications. For example, the fact that cancer cells have lower pH values as compared to normal cells has been used to trigger release and delivery of drugs on site (6).

An alternative approach to conventional treatments is gene therapy in which the malfunctioning or mutant gene has been reintroduced into cells with a properly functioning one in order to restore the malady (7). Nanoparticles, especially polymeric counterparts, have shown promising results in encapsulating, carrying and delivering the gene of interest into desired cells.

Apart from synthetic nanoparticles, naturally occurring nanoparticles, have lately received great attention due to their unique structures and properties such as biocompatibility, uniform size, as well as suitability to chemical and genetic engineering. Plant and bacterial viruses, known as viral nanoparticles (8), have been tested for imaging and drug delivery applications, and because they infect only plants and bacteria, they are considered to be benign towards mammalians. Their inner and outer amino acids could be chemically modified with drugs and imaging modalities and cleverly engineered drug release mechanism could be invoked to operate upon external or internal stimulus.

Nanomaterials are, furthermore, suitable candidates for vaccine development. The immune system normally recognizes certain chemical groups on the surface of antigens (pathogens) and develops its defense mechanism based on this recognition. Multiple copies of these chemical groups could be chemically tailored around the surface of nanomaterial, and thereby could trigger the same immune response more efficiently (9).

The future of medicine will be shaped and enhanced through a targeted delivery of drugs and imaging contrasts into desired sites. Promisingly, nanoparticles will be able to assist in this regard to a considerable extent. Today’s cancer chemotherapy rely mostly on administering a variety of cancer drugs via intravenous (injecting through the vein) or oral means which delivers drugs to cancer cells as well as a considerable amount to healthy tissues which causes major side effects. In order to accumulate higher doses of drugs in tumor cells selectively and minimize nonspecific delivery, nanoparticles loaded with drugs and chemically decorated with “smart molecules” which have the ability to recognize cancer cells and specifically bind to them have been designed and tested successfully (10). These smart groups (organic molecules, antibodies, peptides and small molecules), surprisingly, have higher binding affinities toward some receptors over-expressed in cancer cells. Furthermore, encapsulation of drugs by nanomaterials provides a protective shell which prevents leakage of drugs to other sites.

An important drawback of cancer therapy is drug resistance in which cancer cells develop mechanisms to pump chemotherapeutics out of cells and decreases the efficacy of drugs. Nanoparticles, however, invalidate these resistance mechanisms by encapsulating drugs and should therefore not be exposed directly to surrounding cell environment. When nanoparticles reach the desired destination in the cell, an engineered mechanism or stimulus augment the release and drugs are expected to show their activity without any compromise (11).

It is fascinating to see how these small nanoparticles behave cleverly and orderly even though they look like inanimate and unconscious clusters of atoms. The extraordinary art, design and engineering witnessed in macro dimensions can also be seen in nano dimensions which means that a conscious and purposeful Hand of Power is present and visible in this nanoworld.

To sum up, nanomaterials could be ideal platforms for drug delivery and imaging applications and could complement the deficiencies in conventional therapies. Loading multiple copies of these entities into nanoparticles and devising clever mechanisms to target and deliver them into desired sites would be key elements in the nanomedicine of the future. We are living in a world where each of us has someone in our families or among our friends who are going through painful cancer treatments, which is a heart-rending and traumatic experience. Hopefully, nanomaterial-based therapies would give rise to solutions and success in battling against cancer. For in one prophetic tradition the Prophet Muhammad, peace be upon him, says: “O servants of God! Search for ways for treatment of illnesses. If God gives you ailments, for sure He bestows upon you cures for those.”

And why can’t this bestowal be in the nano form?

References

• Qiao RR, Yang CH, Gao MY. “Superparamagnetic iron oxide nanoparticles: from preparations to in vivo MRI applications” (vol 19, pg 6274, 2009). J Mater Chem 2009;19:9286-9286.
• Raymo FM, Yildiz I. “Luminescent chemosensors based on semiconductor quantum dots.” Phys Chem Chem Phys 2007;9:2036-2043.
• Giljohann DA, Seferos DS, Daniel WL, Massich MD, Patel PC, Mirkin CA. “Gold Nanoparticles for Biology and Medicine.” Angew Chem Int Edit 2010;49:3280-3294.
• Jesorka A, Orwar O. “Liposomes: Technologies and Analytical Applications.” Annu Rev Anal Chem 2008;1:801-832.
• Sancey L, Barbier E, Hirsjarvi S et al. “Enhanced Permeability and Retention (EPR) effect in tumors: characterization by MRI and fluorescence imaging.” B Cancer 2011;98:S67-S67.
• Hruby M, Konak C, Ulbrich K. “Polymeric micellar pH-sensitive drug delivery system for doxorubicin.” J Control Release 2005;103:137-148.
• Waehler R, Russell SJ, Curiel DT. “Engineering targeted viral vectors for gene therapy.” Nat Rev Genet 2007;8:573-587.
• Yildiz I, Shukla S, Steinmetz NF. “Applications of viral nanoparticles in medicine.” Curr Opin Biotech 2011;22:901-908.
• Peek LJ, Middaugh CR, Berkland C. “Nanotechnology in vaccine delivery.” Adv Drug Deliver Rev 2008;60:915-928.
• Ruoslahti E, Bhatia SN, Sailor MJ. “Targeting of drugs and nanoparticles to tumors.” J Cell Biol 2010;188:759-768.
• Liang XJ, Chen C, Zhao Y, Wang PC. “Circumventing tumor resistance to chemotherapy by nanotechnology.” Methods Mol Biol 2010;596:467-88.

Music is a moral law. It gives a soul to the universe, wings to the mind, flight to the imagination, a charm to sadness, gaiety and life to everything. It is the essence of order, and leads to all that is good, just and beautiful.
–Plato

Music surrounds us. We may not always be attuned to hear it, but it is there, whether it is recorded music, the music of nature, or sounds inaudible to human ears. The ancients believed that even the stars in the heavens sang. They called it the “music of the spheres.” Pythagoras (sixth century BC) said, “there is music in the spacing of the spheres.” The Bible speaks of the heavens praising God: “Praise Him, sun and moon; Praise Him, all you stars of light!” (Psalm 148:3–4). And the Quran says, “All that is in the heavens and all that is on the earth glorifies God, the Absolute Sovereign, the All-Holy and All-Pure, the All-Glorious with irresistible might, the All-Wise” (Al-Jumuah 62:1).

Music has the power to heal or destroy. The nature of music is such that it can lift us into the heavens, or drag us down to the pit of hell, depending on what kind of music we listen to. Music can make us weep or dance with joy; it can bring us sanity or drive us mad. Music can bestow peace upon our souls and minds, or stir us up for battle. In short, music has power. Few other things touch us so deeply. We hear it with our physical ears, yet it is in our soul that it resonates.

All life resonates with and responds to sounds and rhythmic motions. Musical sounds, when combined in a certain way, can have a powerful effect upon the mind, body and emotions. The human body itself is like an instrument, humming with rhythm, vibrations and tonal frequencies. The very center of the human body, the heart, is a rhythmic instrument.

Music is a universal language. It speaks to everyone and everything. By feeling the vibrations through their hands, even the deaf can “hear” the music and feel the rhythm. It is a language that crosses the barriers of human vocal languages.

Plants and animals also respond to music. In various experiments, plants grew better when certain kinds of Western classical music and traditional Indian music were played. Dairy cows were found to prefer slow music, and produced more milk when it was played.

Because music has such power to affect us on such a deep level, it has been used for centuries to heal man’s body and soul. Many ancient civilizations, such as Greece, India, Israel, and Mesopotamia knew about and used music in their healing practices.

Ancient Greeks used music to help bring beauty and harmony, which they believed would then help the body to heal. Democritus believed that many diseases could be cured by the sound of a flute. Hippocrates used music to cure diseases. Plato, Aristotle, and Pythagoras all recognized the healing power of music, and Homer recommended music to counter negative emotions.

The priest-physicians of Egypt called music “the physic of the soul,” and used it to heal physical illnesses, nervous disorders and to lessen childbirth pain. The Ebers Papyrus (1550 BC) is the oldest preserved medical document in existence. Recorded in it are incantations that were chanted to heal the sick.

In ancient India, musicologists and mystics believed that health “is the balanced flow of energy through all the energy circuits of the mind and body.” When that flow was interrupted or hindered, the body got sick. They used sound therapy to restore harmony and rhythm to the body and mind.

The core study of Indian music/sound therapy was learning how to arrange different tones for different times of day and night, and for different seasons. In order to bring balance back to the body, therapists also had to know how all the tones affected body chemistry. In other words, they chose which melody, or raga, they played based on which particular disease they wanted to heal.

In the Middle East, during the Abbasid Caliphate (750–1257), the healing arts blossomed. Hospitals and medical schools based on Greek-Arab medicine were built throughout the Muslim world. A holistic approach was used in medicine, and included various types of therapy such as music therapy, aromatherapy, water therapy, and reading the Quran. The recitation of the Quran has been used for healing since the time of the Prophet Muhammad, and it has been referred to as a “book of healing.” Doctors found that music therapy worked especially well with patients who were depressed, or had other mental illnesses.

During this period, three brilliant men emerged who contributed much to the field of learning, including music as medicine. Abu Bakr Razi (834–932) worked with melancholy patients, most likely suffering from depression. Included in his list of beneficial activities to ease depression was listening “to songs which are sung by beautiful voices.”

Abu Nasr al-Farabi (870–950) was a man gifted with many talents. He invented and skillfully played a number of musical instruments. He also developed an Arabian tone system that is still used today. Farabi wrote in his book, Kitab al-Musiqa, “Music promotes good mood, moral education, emotional steadiness and spiritual development. It is useful for physical health. When the soul is not healthy, the body is also ill. Good music, which cures the soul, restores the body to good health.”

Ibn Sina (980–1037), who was known in the West as Avicenna, was greatly influenced by Farabi’s works. He said, “One of the best and most effective of treatments is to strengthen the mental and spiritual strengths of the patient, to give him more courage to fight illness, create a loving, pleasant environment for the patient, play the best music for him and surround him with people that he loves.”

During the Ottoman period (1299–1923), Dr. Musa bin Hamun, who was a palace doctor during the reign of Suleyman the Magnificent (1491–1566), used music therapy in treating dental problems and childhood mental disorders. Sultan Giyasaddin wrote in his book, Kitab as-Sinaat, that, “scholars of India recommend that physicians study melodies and the theory of music. This science is necessary for the doctor, just like his search to understand the subtleties of diagnosing the pulse. In addition, some illnesses may be cured when the patient listens to certain melodies.”

For centuries, in various cultures and religions, music and dance have been combined to worship God. According to the Old Testament, King David of Israel danced with all his might before the Lord as an act of worship (2 Samuel 6:14). Likewise, in the Islamic tradition Prophet David’s worship and glorification of God was so powerful that even mountains, plants and animals joined his praise and responded to his voice: “And We subdued the mountains, as well as birds, to glorify Us along with David” (Al-Anbiya 21:79.

The Sufis were well aware of the power of dance and music together, and have used both in their religious practices, as well as in healing mental and nervous disorders. Even the musical instruments they used were believed to have different healing properties. The ney, a cane or reed flute, was an important instrument. Neys have been found in excavations at Ur, and in tomb paintings in Egypt. It was believed to help relieve stress and promote healthy sleeping patterns. The oud, or ud, is similar to a lute, and was supposed to be good for relieving headaches and melancholy. The naghara is a drum that was used to ease melancholy, as well as physical and mental exhaustion.

The harp is an instrument that has long been associated with angels and heaven, as well as being a symbol of relief and comfort. The ethereal sound of the harp is indeed “heavenly.” It is one of the oldest instruments in the world. Many ancient civilizations used the harp in their healing practices. Pythagoras saw the harp strings as symbols of the nervous system. In ancient Israel, David, when he was only a shepherd boy, played his harp to ease the mental suffering of King Saul when he was afflicted with an evil spirit (1 Samuel 16:14–17, 21–23).

Europeans, before the Enlightenment, or Age of Reason, also used music in healing. The great medieval abbey of Cluny, in southern France, used chant and hymns, as well as the harp, to bring healing to the sick and comfort to the dying. In The Anatomy of Melancholy, written in the seventeenth century, Robert Burton wrote, “. . . beside that excellent power music (sic) hath to expel many other diseases, it is a sovereign remedy against despair and melancholy, and will drive away the devil himself.”

As science advanced and the belief in reason and rationality took hold in Europe, the idea of using music as medicine was cast aside. The new analytical approach to medicine meant that few physicians would use, or at least admit to using, music to treat a patient. The connection between the health of the soul and the body’s health was also largely dismissed. Music simply became a form of art or entertainment, unless it was used in the Church. The healing power of music was forgotten in the West, and would not re-emerge until after World War I.

Today, we are rediscovering what al-Farabi knew over a thousand years ago: when our body is sick, something is wrong in our soul. Music as therapy began to emerge in the United States after World Wars I and II. Local musicians, both amateur and professional, went to Veteran’s Hospitals around the country to play music for the recovering soldiers. Dr. Mehmet Oz, a world-renowned cardio-thoracic surgeon, began playing tapes of Sufi music before, during, and after surgery. He found that, as a result of listening to the music, patients were less depressed and less stressed. They healed faster, and left the hospital sooner. Dr. Oz wrote in Healing from the Heart, about the results of using Turkish makams with coma patients in his clinic. He found that 29% of the patients came out of their comas after listening to the makams.

One study found that students who played in the school orchestra had higher than average SAT scores. Learning to play an instrument has been shown to help develop the bridge (corpus callosum) between the left and right sides of the brain. Campbell says, “. . . the corpus callosum of musicians is thicker and more fully developed than in other people, reinforcing the idea that music enlarges existing neural pathways and stimulates learning and creativity.” Another study showed that “music majors and music education majors had the highest reading scores of any students on campus, including those in English, biology, chemistry, and mathematics.”

Just as an instrument out of tune in an orchestra causes disharmony, negative thoughts, events, or actions can result in a body and mind in disharmony. Ill-health – physical or mental – is the result. More research has to be done to explore music as a potential catalyst that can unlock and release buried emotions which may be making us ill.

The essence of music is an intangible thing. It can be measured by vibrations, sound waves, and resonances, yet those factors alone cannot explain music or why it affects us the way it does. Perhaps the best way is to say that music is a gift from God, meant to ease our suffering in this world, to remind us of His goodness, His mercy, and most of all, to help us connect with Him at a deeper level. It is a way for us to catch a glimpse of heaven.

Julie is a writer and musician who lives in Morgantown, WV, with her husband, Daniel, also a musician. She has grown twin sons who are also writers and musicians.

References

1. http://www.brainyquote.com

2. Roop Verma. “Nada Yoga: Sacred Music and Consciousness.” http://www.roopverma.com.

3. Rahmi Oruc Guvenc, “Music Therapy in Turkey,” Voices: A World Forum for Music Therapy, (March, 2006). http://www.voices.no.

4. Farid Alakbarov, “Music Therapy: What Doctors Knew Centuries Ago,” Azerbaijan International, 11.3 (Autumn 2003) 58-59, http://www.azer.com.

5. Pinar Somakci, “Music Therapy in Islamic Culture,” http://www.turkishmusicportal.org.

6. Alakbarov (2003), 58-59.

7. Unal, Ali, The Qur ’an with Annotated Interpretation in Modern English, NJ: Tughra Books, 2008, pp. 670–671.

8. Robert Burton, The Anatomy of Melancholy, Wikipedia. http://www.answers.com/topic/music-therapy.

9. Don Campbell, The Mozart Effect: Tapping the Power of Music to Heal the Body, Strengthen the Mind, and Unlock the Creative Spirit (New York: Avon Books, 1997), 192.

10. Ibid, 177.

Original Article: Wang, M. et al., PNAS (published online before print on March 1, 2010).

Periodic injections of insulin to manage blood sugar levels is critical for the treatment of diabetes patients. It requires continuous monitoring of glucose levels in the blood and multiple injections of insulin in order to mimic the natural balance of sugar-insulin levels in the human body. Yet, it is often difficult to maintain this extremely sensitive hormone balance without major side effects. These complications include blindness, leg ulcers and amputations, heart vessels problems, renal insufficiency, stroke, and nerve damage in the legs and arms. Moreover, the long-term use of insulin causes the increase of body fat and bad cholesterol. A new research study on non-obese diabetic mice shows that adding leptin- a hormone responsible for appetite control- to the insulin therapy results in better control of blood sugar levels and decreases the bad cholesterol and body fat of Type 1 diabetic mice. This is promising, as it could reduce heart and circulatory complications of Type 1 diabetes. However, the leptin therapy may not have an effect on type 2 diabetes, adult type, because in this type patients already have high levels of leptin. However, it has to be shown that leptin therapy is safe and effective on humans as well. There is a long way to go before we can use leptin in practical areas.

2- Re-teaching speech with music

Original Source: Schlaug G, Annual Meeting of the American Association for the Advancement of Science (AAAS), San Diego (2010).

Nearly 800,000 people in the U.S. are faced with strokes each year, and a quarter of those are affected by aphasia, a deficit in language. Using a new melodic intonation therapy, therapists treat patients by teaching them how to sing words and phrases consistent with the underlying melody of speech. As a result, the patients continue to speak in a more “sing-songy” way than a person with normal speech patterns, according to Dr. Schlaug, professor of neurology at Harvard Medical School. After 15 weeks, 1.5 hour-long daily sessions with a therapist, the patients gradually learn to piece the sung words together into organized speech. There are two separate brain networks associated with vocal output, with the one in the left hemisphere being engaged with speech and the other one in the right hemisphere strongly responding to music and melody. For the stroke patients that had damage to the left hemisphere, this therapy may help to train similar areas on the right hemisphere, helping them to initiate a speech region in the right hemisphere. Singing facilitates necessary engagement to the right hemisphere. Images of patients’ brains before and after the therapy reveal striking structural and functional changes in the right hemisphere. This study also reminds us of the brilliance of musical therapies employed in early hospitals in the Islamic world.

3- Renewable Jet-Fuels

Original Article: Bond, J.Q. et al., Science 327, 1110 (2010).

The global need for sustainable energy resources is ever increasing and the use of renewable fuels offer promising solutions. Among others, biofuels are especially important due to the presence of direct conversion routes from plant-based waste materials to conventional liquid fuels. However, high synthesis costs and complex processing steps are major hurdles to overcome before putting biofuels forward as economically viable alternatives to fossil fuels. Researchers are therefore trying to come up with more efficient methods -and one group, from the University of Wisconsin appears to have done so. Unlike commonly utilized routes involving microorganisms, they use a novel and environmentally-friendly chemical process which is easier to control and maintain. By using an inexpensive catalyst, they convert the majority of the wasted biomass to gaseous butene and carbon dioxide, with a water-based solution of gamma valerolactone as the intermediate chemical. The butene gas is then easily transformed to high-energy transportation fuels such as gasoline and jet fuel. As an added advantage, the stream of carbon dioxide can be efficiently captured, preventing the atmospheric release of this major greenhouse gas. Under optimized conditions, the system can operate uninterrupted for 90 hours with an overall efficiency of over 75%. Successful work like this will help make biofuels cheaper for mass production, pending the meticulous analysis of its economics.

4- Salt controversy: How much is too much?

Original Article: Bibbins-Domingo, K. et al., NEJM 362, 590 (2010).

Modern humans suffer from high rates of obesity (for instance, 64% of Americans are classified as either overweight or obese) and cardiovascular diseases, with the latter being the no.1 cause of all deaths. A recent study conducted by researchers at the University of California at San Francisco suggests that reducing dietary salt by half a teaspoon a day (~ 3g) would lower the annual number of new coronary heart disease, stroke and myocardial infarction cases. Strikingly, such a modest decrease is expected to decrease deaths from any cause by 44,000 to 92,000. According to the National Salt Reduction Initiative, Americans eat at least twice as much salt as they need where 80 percent of the salt in the American diet comes from processed or restaurant-prepared foods. However, eating too much salt is not a problem for people with healthy kidneys since kidneys are designed to flush out unneeded salt. However, when people have a high salt diet, then their kidneys are over-worked. Taking into account that modest salt reduction in one’s diet won’t likely cause harm and taste buds will likely adapt to this minor change effortlessly, it seems wise to refrain from using too much salt. This would trigger bigger health benefits ranging from not overworking the kidneys to reducing the risk of deadly diseases.

5- Why don’t we get thirsty during sleep?

Original Article: Trudel, E. & Bourque, C.W., Nature Neuroscience (published online before print on February 28, 2010).

In mammals, the “internal-standard-time” is kept by a particular subset of brain cells known as “clock-neurons” which display high activity during the day and low activity during the night. A group of scientists recently reported that the clock-neurons also function as a dimmer for water regulation, allowing bodily water content to be controlled by the body. A specialized group of cells, called osmo-sensory-neurons, detect and regulate water levels in the body, through balancing the water intake via thirst and loss via urine production. When water levels are low, the sensory-neurons communicate with some hormone-releasing cells which instruct the body to store water by ceasing urine production. By using isolated brain slices from rats, the researchers showed that the clock-neurons – when active – interfere with the communication between sensory-neurons and hormone-releasing-cells to suppress the water-storage-hormone release. In contrast, when the clock-cells are inactive (i.e., ‘sleep period’) the communication is restored, resulting in an increase of hormone levels to enable water-storage. Such regulation is the reason why we are not much disturbed during sleep by neither frequent trips to the bathroom, nor excessive thirst (that would both impair the sleep quality), and reminds us the verse from the Holy Qur’an: “..and He has made the night for rest…” (Chapter Al-Anaam, 96).

6- A passage to vegetative state through fMRI

Original Article: Monti MM et al., NEJM 362, 579 (2010).

Consciousness in medicine is defined as the patient’s alertness and responsiveness to the outside world. If a patient does not respond to external stimuli, his/her medical state is considered a “vegetative state”. Researchers from Cambridge, England performed functional magnetic resonance imaging (fMRI) experiments on 54 patients who had been previously classified as either “vegetative” or “minimally conscious”. Interestingly, 5 of 54 patients exhibited distinct neuronal activities in the corresponding regions of their brains, when they are given imaginary motor and spatial tasks. For the motor task, patients are asked to imagine playing a tennis game. For the spatial task, patients are asked to imagine navigating through a familiar location. A 22 year-old man who had been in coma for five months was further evaluated by being subjected to a simple set of yes-or-no questions such as “Do you have any brothers?” and was instructed to answer these questions using one type of mental imagery, that is a motor imagery for “Yes” and a spatial imagery for “No”. He answered 5 out of 6 questions correctly. This is the first evidence that through fMRI approach one can reach the residual cognitive activity in vegetative patients and establish functional communication, raising question marks about our current handling of these so-called vegetative patients.

Almost all of us are familiar with the fact that our bodily organs are composed of tissues, which are made of cells. The perfect machinery of the cells is controlled by our genes; i.e. DNA and RNA. Therefore, a minor defect or mutation in the genetic code may affect either partial or entire systems within the body. Some of these genetic diseases are inherited from our parents or relatives. Others may be introduced into our body through environmental mutagens, such as ionizing radiation, ultraviolet rays, or different chemicals within our food and drink; these can result in cancer or cardiovascular diseases. We can protect ourselves from the latter by using appropriate outfits, taking care with our diet, etc. However, inherited genetic disorders are usually unavoidable and sometimes have fatal consequences. Modern medicine is striving to find a way to treat these diseases. Although there are some medical procedures that may lessen the pain of patients or extend their life expectancy, there is no available comprehensive curative therapy for genetic disorders.

Gene therapy has become one of the rising stars in the field of molecular medicine during the last decade, with more than 1500 proposed or ongoing clinical trials worldwide. Gene therapy promises to provide curative therapies for a large number of inherited or acquired diseases, such as monogenic disorders, cancer, or cardiovascular disease. Gene therapy is universally defined as the replacement of an abnormal/dysfunctional gene in the cells of an individual with its correct and functional version. Mechanics use a number of tools to fix our cars for us when they give us trouble; in the same way, gene therapy can be used by doctors to alleviate or completely eradicate some diseases from our bodies.

Gene therapy is classified into two categories based on the target cells that are to be treated. The transduction of the differentiated cells of an individual, i.e. the somatic cells, is known as somatic gene therapy; the transduction of reproductive cells, i.e. gametes (sperm or ova), is known as germ-line gene therapy. Currently, there are many regulations in place that limit the likelihood of the modification of the germline in any gene therapy approach. This is because fear exists that the ability to alter the germline will result in the widespread application of gene therapy to achieve eugenic genetic enhancements, such as improvement of intelligence or physical characteristics. On the other hand, transgenic animals, which are used to detect the function of the genes within an organism, can be generated by modifying the germ-line. Furthermore, gene therapy is also classified into two groups: adult and fetal (in utero) gene therapy, according to the individual to be treated. There are several advantages and disadvantages to these methods, such as immune response, the pooling of mitotic cells, the amount of vector that is required, etc.; however, these are matters for a different article.

Gene therapy is achieved by using special exogenous genetic material transfer agents which are called vectors; these can be compared to the special tools used by auto mechanics. Over the years, a number of gene transfer vehicles, i.e. vectors, have been developed and these can be divided into two principal categories: non-viral (synthetic) and viral (virus-based) gene delivery systems.

Non-viral gene transfer can be achieved by using both physical and chemical methods. The physical methods include: i) Electroporation, in which areas of the cell membrane break down as result of an applied electric pulse, thus allowing DNA to enter the cell, ii) Ballistic gene transfer (the Gene Gun), which bombards particles coated with DNA into the cells, and iii) Microinjection, in which DNA is transferred through microcapillaries into the cells [1]. In terms of chemical gene transfer, lipofection is the most promising method; in this method negatively-charged DNA molecules bind to cationic lipid particles through electrostatic interaction and the DNA–lipid complex enters the cell through endocytosis/pinocytosis. Although these non-viral delivery systems exhibit low toxicity and can be easily produced in high concentrations on a commercial scale, in general, gene transfer using these agents is inefficient and often transient. Therefore, as a result of the viral vectors’ ability to efficiently deliver and integrate genes into the host genome, they are being engineered extensively to achieve a sustained and high-level expression of the gene of interest (transgene).

Viral vectors

Have you ever thought that one of the major pathological agents that cause catastrophic and even fatal diseases could be used to treat the same or a similar disease?

Viruses are equipped with specialized molecular mechanisms that allow them to efficiently transport the genomes into the cells they infect and use the cell’s machinery for their own reproduction. Molecular biologists first harnessed this machinery of transduction in the 1970s. Paul Berg used a modified SV40 virus containing DNA from the bacteriophage lambda to infect monkey kidney cells that were being maintained in culture. Viral delivery systems are based on replicating viruses that have the ability to deliver genetic information into the host cell, a process known as transduction [2]. Due to the fact that there are several advantages to viral vectors, these are the vehicles being employed in approximately 75% of all ongoing clinical trials worldwide. Numerous viruses are being used as the basis for the vectors, including, but not limited to, adenovirus (24%, n=377), retrovirus (20.9%, n=329), adeno-associated virus (4.3%, n=67), herpes simplex virus (3.2%, n=51), vaccinia virus (7.9%, n=124), poxvirus (5.8%, n=91), and baculovirus (more detailed information is available at www.wiley.co.uk/genmed/clinical). The first step to construct a viral vector for transferring the gene of interest involves the identification of the viral sequences that are necessary for replication and pathogenesis. Then some of the genes are removed to make room for the transgene and to render the viral vector replication-incompetent. Consequently, the vector is unable to replicate within the host, and therefore is safe for delivering genes to human cells or tissues (Figure 1).

There are advantages and disadvantages to all of the currently available vectors; the suitability of the vector, therefore, actually depends on the disease or condition that is being treated. For instance, if the goal of the gene therapy is to increase bone marrow engraftment with the transient expression of a growth factor, the use of chemical transfection or naked DNA transfer methods would suffice. However, if the objective is to provide long-term treatment for an inherited disease, then the use of an integrating viral vector is more desirable. Thus, a vector that might be ideal for treating one defect may not be ideal for another. Driven by the desire to develop the “perfect” vector, scientists are continually striving for novel forms of gene delivery that might become the “magic bullet.” Somia and Verma [3] have proposed that the ideal gene therapy vector should include all of the following properties: 1) easy production at a high titer on a commercial scale with a reasonable shelf-life for transport and distribution 2) sustained or regulated expression of the transgene product that is adjustable to the nature of the disease, 3) absence of immune response against the vector and the transgene product, 4) ability to target specific tissues and/or cell types while avoiding professional antigen-presenting cells, 5) absence of size limitations for the genetic material to be delivered by the vector, 6) site-specific integration of the transgene into the chromosome of the target cell to avoid insertional mutagenesis, or faithful division and segregation if it is to reside in the nucleus as an episome independent of local chromatin environments, and 7) an ability to infect dividing and post-mitotic cells. Unfortunately, none of the currently available gene delivery vectors carry all of these features; however, many vectors have enough of the attributes to make them promising for clinical use.

Candidate diseases

During the last 4 decades, gene therapy for many diseases has progressed from preclinical to clinical studies; these range from monogenic recessive disorders such as hemophilia and cystic fibrosis to more complex diseases such as cancer, cardiovascular disorders, human immunodeficiency virus (HIV), neurological and ocular pathologies. The prevalence of diseases that fall under the scope of gene therapy is enormous and most of them have catastrophic or fatal outcomes. Therefore, gene therapy approach for almost any of the diseases mentioned above has an obvious appeal and rationale. To date, more than 1,540 gene therapy clinical trials have been initiated, and these are continuing or have been completed in 28 countries, using more than 100 genes, including antigens, cytokines, tumor suppressors, growth factors, and deficiency genes [4].

Candidate monogenic disorders that are considered to be good candidates for treatment by gene therapy include the hemoglobinopathies, X-linked genetic disorders, amino acid metabolism disorders, and lysosomal and other storage diseases. Currently, there are more than 4000 monogenic diseases registered in the OMIM database. The ultimate aim in treating monogenic diseases with gene therapy is the correction of the disorder by the stable transfer of the functioning gene into dividing cells (stem/progenitor cells), which will ensure the permanence of the correction [5]. The first recognized successful clinical gene therapy trial involved the treatment of 11 children who suffered from SCID-X1 (Severe Combined Immunodeficiency), an X-linked inherited monogenic disorder caused due to a mutation in the common cytokine receptor gamma chain (&#947;c). In these patients, immunity was not fully developed due to the blocking of T-cell and natural killer cell development as a result of mutation. Unfortunately, the trial in SCID-X1 also exemplified one of the potentially serious side effects of gene therapy. Three of the children developed uncontrolled clonal T-cell proliferation, that is, leukemia, almost 3 years after treatment. This case was associated with the integration of the retroviral vector close to the promoter of the LMO-2 proto-oncogene. As a result, LMO-2 protein expression was up-regulated in an abnormal way and resulted in leukemia [7]. Another candidate monogenic disorder for gene therapy is cystic fibrosis (CF), in which abnormally thick mucus is produced in the lungs of the patients, causing difficulty in breathing and increasing the frequency of serious lung infections. CF is known as the most common inherited genetic disease in Europe and USA, especially within the Ashkenazi Jewish population. The average life expectancy of patients with CF is less than 40 years; hence the treatment of this disease has become one of the prime targets of gene therapy research.

In addition to its use in the treatment of monogenic diseases, gene therapy is also becoming a therapeutic alternative for the treatment of various forms of cancer. Indeed, almost 65% of ongoing clinical trials are related to cancer (more detailed information is available at www.wiley.co.uk/genmed/clinical), an area in which much more promise can be seen; this is also a reflection of the urgent need for new therapies to tackle the escalating incidence of this disease. Several different principles are used to treat cancer, including gene therapy that is targeted at tumor suppressor genes, such as p53, or central signaling molecules, as well as “suicide gene” therapy, in which the transgene is capable of converting pro-drugs (selectively less active drugs) into drugs that are toxic for tumor cells. Furthermore, various gene therapy protocols have been developed to strengthen the host’s anti-tumor immune responses by immunotherapy. Most of these studies have been early clinical trials designed primarily as studies of the safety, applicability, and toxicity of gene therapy. Several of these phase I and II studies have, however, shown partial remission of tumors and, in rare cases, complete remission. However, complete cure of the tumor has not yet been achieved. In some trials, including TP53 gene therapy trials, regression in tumor size has been observed in up to 50% of patients. China has become the first country to license gene therapy as a regular treatment for neck and head cancer; here Gendicine, a replication-defective Ad5 vector expressing p53 from a Rous sarcoma virus (RSV) promoter, is used for therapy [6].

In addition to its applications for cancer and monogenic diseases, gene therapy has become one of the favorite methods in cardiovascular research field. This is in step with the rise in clinical trials for cardiovascular gene therapy from 8.3% to 9.1% during the last few years, becoming the second most popular application for gene therapy. In accordance with the variety and occurrence of cardiovascular diseases, different gene therapy strategies have been developed to tackle each disease on its own terms. The expectation is that gene therapy will provide a new avenue for therapeutic applications in the growth of blood vessels, as well as the protection, regeneration, and repair of heart tissue, the prevention of the reoccurrence of constricted or narrowed arteries following cardiovascular intervention, the prevention of the rejection of a bypass, and risk-factor management [4]. Long-term therapeutic gene expression is required in some diseases, such as hypertension research, where reversal and prevention are the key targets. On the other hand, for some other types of cardiovascular diseases, such as ischemia, atherosclerosis, and restenosis, shorter-term gene control will be sufficient to prevent further progress of the symptoms. Therefore, different gene-therapy vectors have to be considered for the treatment of each specific cardiovascular disorder.

Consequently, gene therapy offers new avenues of treatment for diseases including monogenic disorders, cancer, cardiovascular diseases, infectious pathologies and many more. As we follow the tradition, “God did not send down any illness for which He did not also send a cure (Bukhari)”, gene therapy using either viral, non-viral, or any other novel methods may pave the way for the cure of many diseases that are highly prevalent in the world and which for decades have been perceived as untreatable.

Dr. Ferhat Ozturk is a postdoctoral research associate at University of Nebraska Medical Center.

References

1. Wells DJ. “Gene therapy progress and prospects: electroporation and other physical methods.” Gene Ther. 2004 Sep;11(18):1363-9.
2. Kootstra, N.A. and I.M. Verma, “Gene therapy with viral vectors.” Annu Rev Pharmacol Toxicol, 2003. 43: p. 413-39.
3. Somia, N. and I.M. Verma, “Gene therapy: trials and tribulations.” Nat Rev Genet, 2000. 1(2): p. 91-9.
4. Edelstein, M.L., M.R. Abedi, and J. Wixon, “Gene therapy clinical trials worldwide to 2007–an update. J Gene Med, 2007. 9(10): p. 833-42.
5. http://www.biomedisch.nl/en/gene_therapy_targeted_diseases.php
6. Peng, Z., “Current status of gendicine in China: recombinant human Ad-p53 agent for treatment of cancers.” Hum Gene Ther, 2005. 16(9): p. 1016-27.
7. Cavazzana-Calvo M, Fischer A, Gene therapy for severe combined immunodeficiency: are we there yet? J Clin Invest. 2007 June. 117(6):1456-65

In this treatment, radioactive iodine atoms are administered to the patient. These are absorbed only by cells of the thyroid gland which are then eliminated by the radiation; as a result of this process, the over-activity of the thyroid gland is prevented. By the divine will of God, the All-Healing, the All-Wise, iodine is absorbed only by thyroid cells but not by any other cell-a truly wonderful phenomenon. This treatment is known as the “bloodless thyroid operation.”

After he began this treatment, my brother-in-law visited us one day. As soon as she saw him, my small daughter, who loves her uncle very much, ran to him and sat on his lap where she fell asleep after a very short while. But then she woke up within half an hour and suddenly started vomiting. We later understood that the unseen radiation being emitted from the radioactive substance in her uncle’s body first caused my daughter to fall asleep quickly as if she was anesthetized and later had negative effects on her.

Then, an article in a scientific magazine attracted my attention. The concepts of atomic (or nuclear) energy and radiation are usually perceived negatively because of the atomic bombs which were dropped on Nagasaki and Hiroshima or the accident which occurred at the nuclear reactor in Chernobyl. This negative perception has been caused by the sudden deaths of living species, great destruction and the permanent devastating effects observed in the environment after these events. However, the energy within the atomic nucleus also has many potential advantages for humankind. It is just as possible, with this energy, to illuminate houses and work places everywhere as it is to exterminate all the living beings in a city.

Negative effects of radiation

Radiation energy may directly affect molecules within a cell by causing structural disorders especially in its DNA. It also causes ionization of water molecules within a cell and releases free radicals which are harmful to the cell. Damage to molecules and genetic material within a cell may consequently trigger a process that can cause the death of that cell. Thus, it is strongly advised for pregnant women especially to stay away from sources of radiation and also not to expose the body to frequent radiation even for diagnostic purposes, such as X-rays.

Positive effects of radiation

As we consider its beneficial aspects, we realize that nuclear radiation is just one of the innumerable blessings of God. In the field of medicine, for instance, radiation is used to cure diseases like cancer, a disease which, ironically, it sometimes causes. Blood products and medical equipment may be effectively sterilized by the use of radiation. It is also useful in radiological visualization techniques.

Atomic nuclei with unstable composition (radionuclides), which disintegrate without any external interference, display features of radioactivity. The diffusion of energy-bearing rays α, β, γ as a result of this disintegration is called radioactivity and the energy-bearing rays are called radiation. The radioactive substances which are used for the diagnosis and cure of illnesses are known as radioactive medicines or radiopharmaceuticals. This kind of medicine may be composed of pure radioactive nuclei, or they may be compounds which are radioactivated by synthesizing them with radioactive nuclei.

Compared with other radioactive substances, the radiopharmaceuticals used in radiotherapy must have some specific features in terms of radiation type and energy level. Radiopharmaceuticals should be fully absorbed by diseased organ or tissue to be cured and should be applied in such a way that it disseminates the least possible radiation to the rest of the body (so as not to contaminate the body with radiation). That is, the half-life of the radioactive substance should be such that it maintains the correct level of radiation in the tissues to effect the required cure. God has created radioactive substances which emit pure β-rays so that they are ideal for curative purposes.

Radiotherapy

Radioactive nuclear therapy is a treatment for diseased human tissue, usually by the intravenous injection of a suitably formulated radioactive composition. In this treatment, the radioactive composition, when diffused within the body, is held more intensely within the diseased organs, and a kind of radiotherapy at cellular level is thus achieved. The most outstanding example of this kind of therapy is radioactive iodine treatment. This therapy is most frequently applied in cases of excess activity of the thyroid gland in patients with thyroid cancer. As iodine is mostly consumed by the thyroid gland in our body, radioactive iodine (I-131 which is the radioisotope of the element iodine) is particularly suitable for this treatment. The thyroid gland’s feature of absorbing and retaining more iodine than other organs, makes it feasible to treat this organ exclusively by this method when it is diseased. Other peptides marked with particular radioactive nuclei are used in the treatment of other types of cancer and success is observed in some cases. Nuclear therapy is also used in treatment of bone cancers and of pain caused by certain joint diseases.

Radiopharmaceuticals in palliative treatment of bone pain from metastases

The spread of cancerous cells from the diseased organ of the body to other organs is called metastasis. Damage and pain originating from osseous (bone) metastases may cause losses in activity and function for the patient. Radiotherapy has long been used particularly in the treatment of limited bone lesions. However, the side effects of radiotherapy are greater since the body areas exposed to X-rays must be increased where there are widespread osseous metastases.

Radiopharmaceutical therapy is useful for patients who have painful metastases throughout multiple osseous zones. In this therapy the patient receives an intravenous injection of suitably formulated radiopharmaceuticals. In this therapy a radioactive substance is used which rapidly leaves the blood circulation system and concentrates within the skeletal system and especially within metastized zones. Radioactive phosphorus has been used for more than thirty years for this purpose.

Radiopharmaceuticals in therapy for joint disease

Rheumatoid arthritis, also known as inflammatory joint rheumatism, is one of the most widely seen (approximately 1–2 %) of connective tissue diseases.

In this disease, medication in some cases can become ineffective in the long run and can even be the cause of serious side effects. Radionuclide synovectomy (or radiosynovectomy), which is used in some advanced cases of this disease, yields results close to those obtainable by surgical intervention. It has the additional advantages of being less costly, not necessitating the patient’s hospitalization following the therapy and being repeatable.

It can be seen that the use of this blessing for either favorable (good) or unfavorable (bad) purposes depends on human choice, as is the case for all other divine blessings. Thus, it should be our top priority to use for humanitarian causes the blessing of radiation, which has been bestowed on us for our benefit, but which can seem as if it is harmful at first sight.

Notes

1. Al-Bukhari, “Tawhid,” 55; Muslim, “Tawba,” 14-16, Ibn Maja, “Zuhd,” 35.
2. Muhammad ibn Ahmad ibn ‘Uthman al-Dhahabi, Siyar ‘Alam al-Nubala’, 25 vols. (Beirut, 1992), 1:150.
3. Al-Qushayri, Al-Risala, 133.
4. In other words, one should regard Him as an All-Merciful and All-Forgiving Lord, rather than as an All-Punishing One.
5. Al-Bukhari, “Tawhid”, 15; Muslim, “Tawba,” 1; Al-Tirmidhi, “Dawa’at,” 132.
6. Al-Qushayri, Al-Risala, 134.