1 "Bacteria versus Antibiotics: a Time-Honored Battle"

by

Michele Seipp

Carlos Rios' bronchial infection just wouldn't get better. Why, though? Carlos, a 37-year-old bookkeeper, obeyed all of his doctor's orders: he got enough sleep, "took it easy," and finished up the 10-day prescribed dosage of the antibiotic clarithromycin. For good measure, Carlos even regularly sudsed his hands with antibacterial liquid soap -- to ward off possible influx of any other nasty germs. Yet, Carlos' weeks-long infection lingered and even worsened. What went wrong? Medicine is supposed to make you better....right? So goes the theory. But, the bacterium -- an incredibly resilient, adaptable, mutable, and resourceful little creature that lingers in the fascinating world between plant and animal -- has other ideas.

2 Or would have other ideas if it only had a brain. For a single-celled organism, it's awfully clever. With the advent of antibiotics penicillin, streptomycin and tetracycline in 1941, hospital doctors were thrilled and relieved to be able to directly treat the bacterial infections in World War II's many wounded soldiers. And, although mortality from infections did decline once penicillin and these other antibiotics were employed -- antibiotic resistance almost immediately went up. To begin to understand this phenomenon, it's important to get a good look at a bacterium's innate characteristics. Like all life forms (even the more complicated ones), the bacterium fights to stay alive, seeks fuel, has a drive to reproduce, and competes for territory and resources. Star Trek's Dr. Spock's Vulcan philosophy "live long and prosper" -- could just as easily be bacteria's credo, too. As one of Earth's most ancient and abundant organisms, (some scientists argue that they are the beginning kernel of all life), bacteria, thus, have had the longest time to develop the hardiest survival tactics. Indeed, the more than 2,500 variations of this singlecelled microbe first came into existence at least 3.5 billion years ago.

3 Whether they're helpful, hindering or harmless, bacteria are a vital part of all life. The scavengers of the species facilitate ongoing, natural cycles by breaking down the useful matter in dead animals and plants. From these corpses, important nutrients -- such as carbon, nitrogen and sulfur -- are then returned to water and soil ... providing essential food for higher organisms. And, yes -- Charles Darwin's "survival of the fittest" schemata comes into play, even for the bitsy bacterium: the reason antibiotics penicillin, erythromycin, streptomycin and tetracycline even exist in medical practice is because they first thrummed in Nature. Crafty bacteria created these antibiotics as a chemical arsenal in their ongoing battle against their bacteria rivals. Urban street gangs war over primacy; Iraqis and Kurds fight for ethnic dominance; bacteria vs. bacteria? They tussle over their version of territory: soil and water and space in a body. Human enemies might use guns and bombs to kill each other off. Bacteria get more complicated: they either murder their rivals outright by damaging their cell walls,

4 or they halt enemy growth by interrupting the opposing microbes' internal chemical processes. If human war victims under physical attack defended themselves with a shield or a fortress, warring bacteria stymie assault by creating a resistance gene called betalactamase. Do certain soldiers in a bacterium's troop lack this protective gene? That's not necessarily a problem: the bacterium, that remarkably resourceful and adaptable little entity, can pass its resistance gene (and whatever else it darn well feels like) to bacteria it's not even related to. Through the wonders of passed-down DNA (deoxyribonucleic acid) and filial genetic traits, you may have inherited your mother's dazzling smile and father's twinkling blue eyes. The bacterium doesn't need such formalities. One bacterium connects with another completely unrelated bacterium by extending a thin strand called a pilus. Then, during a process called conjugation, it transfers a copy of its plasmid (a plasmid is a nifty ring of extra genetic material, including, in this case, a resistance gene, which exists separately from a microbe's chromosome -- and all of its essential genes) to the second bacterium.

5 Ta-da! The resistance to antibiotics is now doubled. In human terms, this is comparable to a bald man passing on his genetic predilection for "male pattern baldness" to some stranger on the street. One bald man equals one bald man. Two bald men equal -- bald power. But, that's not all. The bacterium, that wily cell, doesn't even always need a pilus to transfer its resistant material. Hence, if a virus invades a bacterium, that bacterium's resistance gene might use the transposen (or jumping gene) from the virus to jump on to the DNA of a second bacterium -- thus making the second bacterium resistant to a particular antibiotic. Bacteria aren't above grave-robbing, either. Sure, bacteria release viable nutrients from dead matter to create food for higher organisms. They also pillage the microbe cemeteries of their own fallen comrades, snatching up a dead bacterium's still-alive DNA, especially if it pulses with a fabulously useful resistance gene. The live bacterium then incorporates the dead bacterium's DNA into its own system. If that reminds you of a surgeon plucking out a deceased organ donor's healthy kidney to implant in a dialysis patient, then it just continues to show how the

6 reactive survivalism of this wee creature parallels that of most life-forms. Just look at what happens when certain bacteria lack adequate resources: food, water and oxygen. These bacteria sustain themselves by creating a new, thicker cell membrane inside their old one. Without fuel, the old cell membrane deteriorates, and the ever-impressive bacterium, now protected by its new cell membrane, renders itself inactive -- thus turning itself into a dormant bacterial spore. Think of a bear going into energy-reserving hibernation once chilly Winter depletes the ursine of his or her usual resources. When Spring blooms with food, the bear roars back into action. Likewise, that resilient bacterial spore (it can survive, dormant, for decades!) quietly reactivates itself when its necessary resources increase -- once again becoming a bodacious, full-functioning bacterium. Rev up the flagellum! Now that we see how antibiotic resistance and bacteria adaptability and resourcefulness are as ancient as the tiny organism itself, is it, then, any surprise that antibiotic resistance continues to be a challenge?

7 Patients such as bronchial infection sufferer Carlos Rios actually impair themselves when they use antibacterial-infused products -- like that pesky liquid hand soap. It only fosters more antibiotic resistance, priming Carlos' innate bacteria to resist when it doesn't need to. "Dear, don't encourage them," might be a useful refrain. And, although innovative new studies point to the natural disease-fighting microbes in frog skin and cockroach brains as possible antidotal solutions, the bacteria-antibiotic war, as observed by retired surgeon Lawrence D. Stern from Palo Alto, "is a battle in which there will never be one clear winner."

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The Eyes Have it!

See into the Future of Beauty, with HA Injections

By Michele Seipp Look out -- sagging, aging eyes are about to see a fountain of youth...and it's burbling up in the form of hyaluronic acid injections. In the dark old days, plastic surgeons tried to firm sagging eyelids by excising the excess skin or, sometimes, by elevating the brow. Unfortunately, those blepharoplasty procedures actually made the eyes look more skeletal and hollow. Patients came off as gaunt and severe, rather than youthful and revitalized. Now, hyaluronic acid (or HA) injections into the brow are a safe, exciting way to restore soft tissue volume. They plump up the eye area and smooth wrinkles, giving women a younger-looking, more refreshed appearance. "For years, we've avoided injecting the brow area for fear of complications," says New York plastic surgeon Dr. Tracy Pfeifer. "Now it can be done safely and the results are excellent. It's definitely the future of beauty -- it's only going to get more popular." HA injections are easier to control than fat injections: they're more manageable and predictable, take less time to recover from (just a few days, with mild

9 swelling and bruising, as opposed to a few weeks of that) and result in a more natural, organic look. This beautifying effect typically lasts about six weeks. Costs range from $75.00 to $350.00. Ask your certified board dermatologist or plastic surgeon how setting your sights on HA brow injections can be a gorgeous, eye-opening experience for you, too!

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"A Change of Heart"

by

Michele Seipp Forty-one-year old Robert Wolfstein did everything right: he kept his 5'9" frame lean and wiry, ate a low-

fat, healthy diet of fruits, fish, vegetables and whole grains, and briskly walked every morning before bicycling to his job as picture editor for Catch All Productions. Despite all that, he was still knocked senseless by a massive heart attack in August, 2008. "I started sweating and shaking during a production meeting at Junior's Deli," he later said from his hospital

10 bed at Cedars Sinai. "I thought it was food poisoning. It wasn't." Sure, Robert's father and older brother both died prematurely (42 and 46, respectively) of heart disease, but he thought he could stave off his family's fierce genetic legacy through care and vigilance. Unfortunately, heredity launched a brutal battle that fateful August 30th -- three of his arteries were blocked. Luckily, however, modern medicine had made strides, and Robert's doctors, Dr. Parveem Shawarmi, surgeon, and Dr. Eldon McKinley, cardiologist, were able to fight back. Otherwise young and healthy, Robert was a prime candidate for a new, experimental surgery program at Cedars Sinai. His doctors rebuilt his damaged pulmonary artery, left ventricle and left coronary artery with delicately removed and transferred stem cells from his own back tissue. They also cleaned and stabilized his weakened descending aorta and superior vena cava -- and started him on a schedule of anticoagulants and beta-blockers. "I've had a change of heart...literally," Robert says, grateful to Drs. Shawarmi and McKinley for giving him the second chance at life that his father and brother weren't lucky enough to enjoy.

11 "I'm patient number 27 in this experimental program," Robert says. "I wear a t-shirt with that number on it every morning when I go to the gym."