Multiple myeloma (MM), also known as plasma cell myeloma and simple myeloma, is a cancer of the plasma cells, a type of white blood cell that normally produces antibodies. Often, no symptoms are noticed initially. As it progresses, bone pain, bleeding, frequent infections, and anemia may occur. Complications may include amyloidosis.The cause of multiple myeloma is unknown. Risk factors include obesity, radiation exposure, family history, and certain chemicals. Multiple myeloma may develop from monoclonal ...

multiple myeloma

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Author: Rositsa Tashkova, Master of Molecular Biology and Microbiology

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Photo by <a href="https://unsplash.com/@freestocks?utm_source=unsplash&amp;utm_medium=referral&amp;utm_content=creditCopyText" target="_blank" rel="noopener">freestocks</a> on <a href="https://unsplash.com/s/photos/suspicion?utm_source=unsplash&amp;utm_medium=referral&amp;utm_content=creditCopyText" target="_blank" rel="noopener">Unsplash</a>

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<a href="https://www.bioseek.eu/bg/eng/research/search?q=Capgras%20delusion&amp;p=1&amp;st=1&amp;tp=9&amp;s=0" target="_blank" rel="noopener">Capgra</a> syndrome [ref. 1] is a rare but very interesting psychiatric condition, received its name from its discoverer - the French psychiatrist Jean-Maries Joseph Capgra Jean Marie Joseph Capgras; 1873—1950).

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The sufferer of the syndrome begins to think that his relative, relative, husband, child or even a pet has been replaced with another - that it is no longer his close person, but is someone who impersonates him, an alien or a robot. The patient admits that his targeted doppelganger really "looks" or is even "identical" to his relative, but is sure it is not the same person. Logically, this worsens relations and puts the targeted in a complex situation, and he can also be subjected to aggression on the part of the diseased.

Who-is-at-risk-of-developing-Capgra-syndrome

Who is at risk of developing Capgra syndrome

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The condition is most commonly seen in patients suffering from paranoid <a href="https://www.bioseek.eu/bg/eng/research/pubmed/Schizophrenia_and_monothematic_delusions_17372282" target="_blank" rel="noopener"></a> schizophrenia [ref. 2], neurodegenerative diseases or dementia, as well as after brain injuries. Women are more often affected.

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Capgra syndrome often manifests itself in a state of psychosis, but in a third of cases it is a brain injury, which suggests that the cause of the disease probably has an anatomical basis.

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Photo by <a href="https://unsplash.com/@franckinjapan?utm_source=unsplash&amp;utm_medium=referral&amp;utm_content=creditCopyText" target="_blank" rel="noopener">Franck V.</a> on <a href="https://unsplash.com/s/photos/robot?utm_source=unsplash&amp;utm_medium=referral&amp;utm_content=creditCopyText" target="_blank" rel="noopener">Unsplash</a>

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An overview of cases of the syndrome shows a link between it and the following conditions: paranoid schizophrenia, schizoaffective disorder, affective disorder, Alzheimer's disease, dementia with Levi's calf, multi-infarction dementia, head trauma, epilepsy, cerebrovascular disease, pituitary tumor, multiple myeloma, multiple sclerosis, viral encephalitis, frontal lobe pathology and AIDS [<a href="https://www.bioseek.eu/bg/eng/research/pubmed/A_review_of_the_phenomenology_and_cognitive_neuropsychological_origins_of_the_Capgras_syndrome_10029936" target="_blank" rel="noopener">ref. 3</a>].

What-are-the-likely-mechanisms-behind-Capgra-syndrome

What are the likely mechanisms behind Capgra syndrome

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The disease should be distinguished from prosoppagnosia, a condition in which patients cannot distinguish faces. But <a href="https://www.bioseek.eu/bg/eng/research/pubmed/Autonomic_recognition_of_names_and_faces_in_prosopagnosia_a_neuropsychological_application_of_the_Guilty_Knowledge_Test_6483172" target="_blank" rel="noopener"></a>at the sametime, the electrical activity of their skin increases when they see pictures of loved ones, even though they do not realize that they know them.

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However, this is not the case for those suffering from Capgra syndrome - when they see their loved one's face, in whom they doubt, the electrical activity of their skin does not increase - just as it would if they saw an unknown person [<a href="https://www.bioseek.eu/bg/eng/research/pubmed/Reduced_autonomic_responses_to_faces_in_Capgras_delusion_9263474" target="_blank" rel="noopener">ref. 5</a>]. <a href="https://www.bioseek.eu/bg/eng/research/pubmed/Accounting_for_delusional_misidentifications_2224375" target="_blank" rel="noopener"></a>

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Photo by <a href="https://unsplash.com/@hightography?utm_source=unsplash&amp;utm_medium=referral&amp;utm_content=creditCopyText" target="_blank" rel="noopener">JØNΛS.</a> on <a href="https://unsplash.com/s/photos/suspicious?utm_source=unsplash&amp;utm_medium=referral&amp;utm_content=creditCopyText" target="_blank" rel="noopener">Unsplash</a>

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It is possible that the neuropsychological abnormality in Capgra syndrome consists in disconnecting the relationship between a proper facial recognition system and a proper autonomic nervous system [<a href="https://www.bioseek.eu/bg/eng/research/pubmed/Schizophrenia_and_monothematic_delusions_17372282" target="_blank" rel="noopener">ref. 2</a>].

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Psychodynamics or anatomical damage

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Historically, one of the hypotheses at issue is sought after in psychodynamics: according to her, conflicting feelings of love and hatred towards a close relative find a solution to the delusion, since the "doppelganger" can be hated without guilt. Closely related to this is Berson's idea (1983) that the defining event is a change in crucial interpersonal relationships, producing a sense of strangeness and provoking previously unconscious negative feelings. They, Besson argues, cause the patient to conclude that the person who induces these different feelings is a fraud.

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But psychodynamics does not provide the full explanation for the syndrome, as more and more studies have emerged in recent decades that clearly show that neurological significance matters, that is, physical disability [<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1688551/" target="_blank" rel="noopener">ref. 5</a>].

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One of the syndrome's researchers, Prof. William Hirstein, wrote in an email <a href="https://sciencedevil.wordpress.com/2012/11/16/we-all-have-capgras-delusions-they-prevent-divorce/" target="_blank" rel="noopener">to the author of the blog Science Satire Serpent</a> [ref. 7] the following:

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"My current hypothesis about Capra, which is a more specific version of the earlier position I took in the 1997 article with Ramachandrang, is that we have a hybrid idea of the people we know well, containing two parts. One part presents them externally: how they look, sound, etc. The other part presents them internally: their personalities, beliefs, characteristic emotions, preferences, etc. Capgra syndrome occurs when the idea of the inner part is damaged or inaccessible. This gives the impression that someone who looks familiar from the outside, but different from the inside, is an impostor. This provides a much more specific explanation that fits well with what patients actually say. It corrects a problem with the earlier hypothesis as it shows that there are many possible answers to the question of lack of emotion when we see someone."

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Photo by <a href="https://unsplash.com/@bernardhermant?utm_source=unsplash&amp;utm_medium=referral&amp;utm_content=creditCopyText" target="_blank" rel="noopener">Bernard Hermant</a> on <a href="https://unsplash.com/s/photos/trust?utm_source=unsplash&amp;utm_medium=referral&amp;utm_content=creditCopyText" target="_blank" rel="noopener">Unsplash</a>

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Today, Capgra syndrome is considered a neurological disorder, in which delusion is mainly due to organic brain lesions or degeneration. But this has not always been the case - when the syndrome was first identified it was thought to be a psychiatric disease only in women, associated with hystericalness.

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Treatment of Capgra syndrome

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There is no well-established treatment of the condition, but therapy depends on the cause - if the syndrome is associated with schizophrenia, then treatment often involves the use of antipsychotics, while if the cause is brain trauma or lesion, then if possible, surgery can be performed.

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Some caring institutions also apply validation therapy, in which instead of trying to convince the sufferer that his relative has not been replaced with another, they confirm the delusion and thereby lower the level of panic and stress in the patient [<a href="https://www.healthline.com/health/capgras-syndrome#treatment" target="_blank" rel="noopener">ref. 8</a>].

Capgras syndrome: when we think someone else is pretending to be our loved one

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 Capgras syndrome: when we think someone else is pretending to be our

Rositsa Tashkova-Kacharova

Author: Rositsa Tashkova, Master of Molecular Biology and Microbiology

In recent decades, the value of stem cells and in particular - in the fight against certain cancers has been assessed. Treatment of cancer through stem cell transplantation has gained great popularity and success. In this article, we will look at when such treatment is needed and when it is even possible to perform such treatment, for which types of cancer is appropriate, what exactly is a stem cell transplant, and how it works.

In the article you will read:

<ul>
<li>What are stem cells</li>
<li>When stem cell transplantation can be used to treat cancer</li>
<li>How stem cell transplantation helps treat cancer</li>
<li>What types of stem cell transplantation are there</li>
<li>What are the risks of stem cell transplantation</li>
<li>What to expect during treatment</li>
<li>What happens during the recovery period</li>
<li>What happens if stem cell transplantation fails</li>
</ul>

What-are-stem-cells

What are stem cells

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To understand how this treatment can help patients with certain cancers, we must first <a href="https://www.bioseek.eu/bg/eng/research/pubmed/Stem_cells_19896546" target="_blank" rel="noopener"></a> understand what stem cells are [ref. 1].

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Stem cells do not specialize in performing a specific function, unlike, for example, red blood cells (erythrocytes), which carry oxygen to all parts of the body, or cells of the immune system that, in complex mechanisms, fight infections , or platelets, the only function of which is to participate in blood clotting, thereby protecting the body from major blood loss.

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The process in which a stem cell develops in a strictly specialized cell similar to those described above is called differentiation. Thus, stem cells are undifferentiated, and erythrocytes are differentiated.

When-stem-cell-transplantation-can-be-used-to-treat-cancer

When stem cell transplantation can be used to treat cancer

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Currently, stem cell transplantation is mainly used to treat blood cancer or one that affects the bone marrow - leukemia, lymphoma, multiple myeloma (also called multiple myeloma and Kaler's disease) or neuroblastoma (a disease that most often affects children).

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Clinical trials are <a href="https://www.bioseek.eu/bg/eng/research/search?q=stem%20cell%20transplant%20cancer&amp;p=1&amp;st=1&amp;tp=e&amp;s=x&amp;as=NCT00112645" target="_blank" rel="noopener">being</a> carried out [ref. 2]in search of treatment and other cancers using stem cell transplantation, but no approved therapies have yet been established.

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How-stem-cell-transplantation-helps-treat-cancer

How stem cell transplantation helps treat cancer

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Immediately before performing the transplant itself, the patient receives high doses of chemotherapy or radiotherapy for about a week. The goal is to destroy all cancer cells, including stem cells in the bone marrow, where blood cells are formed.

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Previously, healthy stem cells were taken from the patient or from a donor to be transplanted immediately after chemo or radiotherapy. This occurs by instilling stem cells back into the bloodstream - intravenously.

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After a while, they reach the bone marrow, where they occupy the place of the destroyed cells. There they begin to produce healthy blood cells, and with a successful transplant the patient is cured of cancer.

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When stem cells are taken from a donor (<a href="https://www.cancercenter.com/treatment-options/hematologic-oncology/allogenic-stem-cell-transplant" target="_blank" rel="noopener"></a> allogeneic transplant [ref. 3]) - usually brother, sister, parent, and are used to treat multiple myeloma or certain types of leukemia, an additional therapeutic effectcalled "graft vs. tumor" (GvT) may occur. With this effect, the white blood cells obtained in the transplant from the donor attack and destroy the rest after chemo- and radiotherapy cancer cells.

What-types-of-stem-cell-transplantation-are-there

What types of stem cell transplantation are there

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Stem cell transplantation is three types [ref. 4], depending on the source of the cells: <a href="https://www.cancer.gov/about-cancer/treatment/types/stem-cell-transplant" target="_blank" rel="noopener"></a>

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<ul>
<li style="font-weight: 400;"><a href="https://www.bioseek.eu/bg/eng/research/pubmed/A_Review_of_Autologous_Stem_Cell_Transplantation_in_Lymphoma_28478586" target="_blank" rel="noopener">Autologous transplantation</a> [ref. 5] - when the stem cells are taken from the blood of the patient himself, before chemo- or radiotherapy. In this case, there is no risk of rejection of the transplant, since these are the own cells of the treatee.</li>
<li style="font-weight: 400;">Allogeneic transplantation - when stem cells from a donor are used for transplantation. The donor must have similar molecules on his cells to those of the patient in order to reduce the risk of rejection. Therefore, most often a donor becomes the patient's brother, sister or parent, but a non-related donor from a registry whose cells must be compatible with the patient's organism can also be used.</li>
<li style="font-weight: 400;">Syngenta transplantation - in rare cases, when the patient has a healthy single-day twin, stem cells are taken from it.</li>
</ul>

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What-are-the-risks-of-stem-cell-transplantation

What are the risks of stem cell transplantation

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Like any treatment, stem cell transplantation for cancer treatment hides its risks and has side effects [ref. 6]. <a href="https://www.bioseek.eu/bg/eng/research/pubmed/Cytokine_serum_levels_during_post_transplant_adverse_events_in_61_pediatric_patients_after_hematopoietic_stem_cell_transplantation_26315105" target="_blank" rel="noopener"></a>

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Due to large doses of chemo- or radiotherapy that kill the patient's cells, problems with blood clotting and the immune system occur. This is because a large proportion of platelets and leukocytes have died. There is a risk of bleeding and infections.

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Contrary to the effect "graft against tumor", another effect may occur, which is highly undesirable - <a href="https://www.bioseek.eu/bg/eng/research/pubmed/Bone_Marrow_GvHD_after_Allogeneic_Hematopoietic_Stem_Cell_Transplantation_27066008" target="_blank" rel="noopener">"graft</a> vs. host" [ref. 7] (GvHD).

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This immune reaction can affect and damage many tissues and organs in the body - skin, liver, small intestine and others. In this case, it is necessary to take medications that suppress the immune system - immunosuppressants, which makes the patient susceptible to infections.

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This effect can manifest itself a few weeks after transplantation or much later. Therefore, it is important that the stem cells that will be transplanted to the patient are as close as possible to his own.

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All risks should be discussed in advance with the attending physician.

What-to-expect-during-treatment

What to expect during treatment

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Stem cell transplantation is a complex treatment and it should be taken into account that its cost can be very <a href="http://www.chernomore.bg/obshtestvo/2019-10-23/izgrazhdat-unikalen-tsentar-za-rabota-sas-stvolovi-kletki-vav-varna" target="_blank" rel="noopener"></a> high. At the moment a modern stem marrow transplant is being performed in Varna, <a href="https://nova.bg/news/view/2014/12/22/96448/%D0%BE%D1%82%D0%BA%D1%80%D0%B8%D1%85%D0%B0-%D1%86%D0%B5%D0%BD%D1%82%D1%8A%D1%80-%D0%B7%D0%B0-%D1%82%D1%80%D0%B0%D0%BD%D1%81%D0%BF%D0%BB%D0%B0%D0%BD%D1%82%D0%B0%D1%86%D0%B8%D1%8F-%D0%BD%D0%B0-%D1%81%D1%82%D0%B2%D0%BE%D0%BB%D0%BE%D0%B2%D0%B8-%D0%BA%D0%BB%D0%B5%D1%82%D0%BA%D0%B8-%D0%B2%D1%8A%D0%B2-%D0%B2%D0%B0%D1%80%D0%BD%D0%B0" target="_blank" rel="noopener"></a> in the stem cell transplant center atSt. Marina Hospital [ref. 8].

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Once an appropriate medical facility has been opened, the patient may be accommodated in the hospital or not, but frequent visits may be required. The whole treatment takes several months.

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Before starting the course of chemo- or radiotherapy, it is necessary to secure the stem cells for the transplant. They are extracted from blood, bone marrow or umbilical cord and frozen. They thaw again before the transplant itself.

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Chemo- or radiotherapy (can be administered and a combination between the two) take about 1-2 weeks, after which the patient rests a few days before transplantation.

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The transplant itself takes between 1 and 5 hours, during which, with the help of a catheter, stem cells flow through a vein into the bloodstream - similar to an infusion of blood. Sometimes two insations are made at a certain interval of time.

What-to-expect-during-treatment_5_5

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The longest <a href="https://www.bioseek.eu/bg/eng/research/pubmed/Biobehavioral_influences_on_recovery_following_hematopoietic_stem_cell_transplantation_22820408" target="_blank" rel="noopener"></a> recovery process [ref. 10]. Its first phase is associated with the formation of new blood cells from the transplanted stemcells.

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Since each organism reacts differently to transplantation, doctors can not predict exactly how the patient will feel as a result of treatment. It depends on many factors. For example, what state of health he was in before the transplant, how advanced the stage of cancer is, what type of cancer it is, what doses of chemo and radiotherapy had to be imied the patient, how they are perceived by the particular organism and other factors.

What-happens-during-the-recovery-period

What happens during the recovery period

What-happens-during-the-recovery-period_6_0

During the recovery period, the patient will remain for a long time under the supervision of doctors, who will monitor how his blood indicators change in time after the stem cell transplant. For the first three weeks, the number of blood cells will need to be counted every day or at least once a week.

What-happens-during-the-recovery-period_6_1

Until the indicators return to normal, it should be vigorously guarded from infections and will feel weak and dropped. Negative and positive emotions can be intertwined in it - because of the relative isolation and physical malaise, but also in the hope of a successful outcome of the transplant.

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In <a href="https://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/stem-cell-transplant/after-stem-cell-transplant/?region=on" target="_blank" rel="noopener"></a> the first three months [ref. 11] blood or platelet insations may be required.

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After a year or two, it is necessary to give the vaccines, which are usually put into childhood, because as a result of treatment with immune cells, immunity to pathogens acquired with these vaccines has gone before.

What-happens-if-stem-cell-transplantation-fails

What happens if stem cell transplantation fails

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Transplantation can fail <a href="https://www.webmd.com/cancer/features/stem-cell-transplant-complications#2" target="_blank" rel="noopener">for two reasons</a> [ref. 12] - if our body rejects donor transplants or if the cancer returns.

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In the event that our immune system recognizes foreign cells as hostile and attacks them, a new transplant or infusion of special white blood cells (lymphocytes) from the same donor can be undertaken.

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Sometimes, years after the transplant, the cancer can return. In some aggressive cancers, when using the patient's own stem cells, relapse is observed in up to 50% of patients.

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The most common cause of relapse remained in the body or in the transplant cancer cells. In this case, the effect "graft against tumor" is relied upon, in which the donor immune cells recognize and kill cancer cells. This effect can be strengthened if, together with stem cells, immune cells from the donor are also infused during transplantation.

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In case of relapse, the condition can be treated by different chemotherapy, from the first time used, by a second transplant or both. If a re-transplant is selected and the first time the patient's own cells are used, then in this second transplant, donors can be used.

multiple myeloma

Stem cell transplantation as cancer treatment