RESEARCH SHOWS THERE'S MORE TO WOMEN'S HEALTH THAN FEMALE ANATOMY
26 September 2004 - University of Chicago

It turns out that major illnesses like heart disease and lung cancer are influenced by gender and that perhaps treatments for women ought to be slightly different from the approach used for men.

University of Chicago researcher Dr. Sunanda Kane is one of a growing number of gender-based physicians realizing there's more to women's health than just anatomy that makes them female, and that the same diseases often affect men and women in different ways.

These discoveries are part of a quiet but revolutionary change infiltrating U.S. medicine as a growing number of scientists realize there's more to women's health than just the anatomy that makes them female, and that the same diseases often affect men and women in different ways.

"Women are different than men, not only psychologically (but) physiologically, and I think we need to understand those differences," says Dr. Catherine DeAngelis, editor of the Journal of the American Medical Association.

DeAngelis, who became the journal's first female editor in 1999, says she has made it a mission to publish only research in which data are broken down by sex unless it involves a disease that affects just men or women.

In recent months, two medical textbooks billed as the first devoted to gender differences in all areas of medicine, not just reproductive medicine, were published; a widely cited Journal of the AMA report re-emphasized the neglected fact that lung cancer, not breast cancer, is the No. 1 cancer killer among women; and the American Heart Association announced the first-ever heart disease prevention guidelines tailored specifically for women.

And this fall, the office of Surgeon General will issue its first-ever report on osteoporosis. The crippling bone-thinning disease disproportionately affects women, who lose the bone-protecting effects of estrogen at menopause. The report will emphasize prevention, and that it's not just a woman's disease, 20 percent of patients are men, said Wanda Jones, director of the Office on Women's Health at the U.S. Department of Health and Human Services.

The gender-based medicine movement isn't an effort to diminish the importance of breast cancer, but is meant to emphasize that "we have more than one body part, folks. Up until now ... that awareness just hasn't been there," said Sherry Marts of the Society for Women's Health Research. That organization seeks to expand the definition of women's health beyond breast and reproductive health, what some call "bikini medicine."

Until the 1990s, scientists frequently excluded women from medical research, including drug studies. It was largely out of concern over effects on reproduction but also because of a long-standing belief that men and women "were biologically the same except for their reproductive organs," Marts said.

However, recent discoveries suggest that genes, hormones and lifestyle may be behind many of the differences. For example:

• Heart attacks in women frequently don't involve chest pain and may involve more vague, flu-like symptoms.

• Women who don't smoke appear to be more susceptible to lung cancer than nonsmoking men. Women also tend to get lung cancer at younger ages than men, and they appear to metabolize cancer-causing substances differently than men.

• Women are less likely than men to get oral cancer.

• Women are more prone to autoimmune diseases, including lupus, rheumatoid arthritis and multiple sclerosis, in which disease-fighting mechanisms mistakenly attack the body's own tissues.

• Some AIDS-fighting medicines appear to metabolize more quickly in men than in women, who may require gender-specific doses.

• Women's symptoms for ulcerative colitis and Crohn's disease, debilitating intestinal diseases that affect men and women, vary considerably each month, requiring frequent medication adjustments.

Inflammatory bowel disease, which encompasses both Crohn's and colitis, is a specialty of Dr. Sunanda Kane, a University of Chicago researcher who is studying why the problem seems to be on the rise among young women.

Both diseases damage the digestive tract and in severe cases, doctors remove part of the colon and patients must wear colostomy bags.

Kane says she got interested in a gender-based approach several years ago during her training, when there were few other gastroenterologists who were women.

"Female patients were thrilled to see a woman and they started to tell me things they'd never tell their (male) doctors," including what their menstrual periods were doing to their disease, she said.

But as in many areas of gender-based medicine, many important questions remain, including how aging affects inflammatory bowel disease, Kane said.

"Anecdotally, people have told me their disease went into remission after menopause," and some women "are asking me if they can have a hysterectomy so they can go into remission," Kane said. It's an issue that could have a huge impact on patients' quality of life, but it's never been studied, she said.

The Discriminating Palate of Staphylococcus

Staphylococcus bacteria are heavy-hitting pathogens, causing illnesses such as food poisoning, meningitis, and toxic shock syndrome. But a new study identifies a stretch of DNA the bacteria need to get an essential nutrient, a breakthrough that the researchers hope will lead to drugs that stop the bugs cold.

Iron thief. New insight into how Staphylococcus extracts iron from the heme in red blood cells may lead to better infection-fighting drugs.

Like all bacteria, Staphylococcus need iron to reproduce, and researchers hope to thwart the bugs by understanding how they scavenge this essential nutrient from their hosts. Suspecting that Staphylococcus might prefer a particular form of iron, microbiologists Eric Skaar and Olaf Schneewind of the University of Chicago offered Staphylococcus aureus a choice of two isotope-labeled compounds. By detecting the isotope labels after the bacteria chowed down, the team learned that the bacteria prefer to steal iron from heme, the iron-containing part of hemoglobin, rather than from an iron-ferrying protein called transferrin. Heme iron makes up 80% of the body's total iron.

Skaar and Schneewind then analyzed the S. aureus genome and identified the span of genetic code responsible for the bacteria’s uptake of heme iron. Then they deactivated this stretch of DNA before injecting S. aureus into worms and mice. Whereas normal S. aureus killed the worms and caused abscesses on the organs of mice, the treated bacteria caused much milder infections, killing very few worms and causing no abscesses in the mice. This is encouraging, the authors write in the 10 September issue of Science. Understanding how Staphylococcus bacteria use iron could lead to drugs that block heme-iron uptake and minimize the severity of infections.

The research is a “significant” contribution to understanding how iron uptake moderates the spread of bacterial infection, says microbiologist Shelley Payne of the University of Texas, Austin.

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