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"THAT'S the thing about cancer; it's all yours – it's entirely, perfectly personalised." So says Kit, a character in The Quarry, the final novel by the Scottish writer Iain Banks – who himself died earlier this month from cancer. "An unwilled suicide where... one small part of the body has taken a decision which will lead to the death of the rest."

Kit is right. Outside the lab, or hospital, we continue to talk about "a cure for cancer" as though it was a single disease, with a single cure. But it's an understatement even to say that every case is different: individual tumours in the same person can be quite different, each carrying enormous numbers of distinct genomes (see "Rapid evolution of tumours may be their Achilles' heel").

That may be why cancer is so difficult to treat. Current treatments are based on the bulk, brute removal of cells – but miss even a few, and evolution will see to it that the cancer returns in a new, often more resistant, form.

Bacteriologists and virologists have long employed evolutionary biology to develop therapies aimed at thwarting adaptation. Now it seems cancer researchers must do the same if we are to find cures for our cancers.

This article appeared in print under the headline "An evolving battle"

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Editorial: "The battle to find a cure for every cancer is evolving"

IT WAS the ultimate selfless act. Knowing he had just months to live, and that any knowledge gleaned would be too late to help him, the man known as Patient Two underwent two last painful biopsies. In doing so, he is believed to be the first person to have his cancer's evolution traced from its first appearance to its last, lethal mutation.

Genomic analysis of his tumours over the span of the disease could help figure out how to stop cancer from evolving its deadliest characteristics – its ability to spread throughout the body and its uncanny knack of developing resistance to drugs.

That is the aim of several research groups around the world who are trying to understand the disease by looking at it from a Darwinian perspective. "The fundamental aspects of evolution are at play ...

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IF HUMANS lived as long relative to body size as naked mole rats, we would last for 600 years. These mouse-sized, subterranean African mammals live for over 30 years, and if that wasn't impressive enough, they don't get cancer. Now we have a clue why, which could lead to treatments for a variety of human conditions.

Vera Gorbunova at the University of Rochester in New York and colleagues have found that the extracellular matrix in naked mole rats – the gloop that supports tissues – is rich in a substance that stops cancers growing.

The magic ingredient is a polysaccharide called hyaluronan, which acts as a lubricant in the body. It is present in a unique, heavyweight form in naked mole rats known as high-molecular mass hyaluronan (HMM-HA). The animal – which spends most of its life underground – probably evolved the special form to help it squeeze through tunnels but, seemingly as a bonus, the lubricant confers cancer resistance.

By manipulating the pathways that lead to the build-up of HMM-HA in cells, Gorbunova's team showed that tumours can be grown in naked mole rat tissue prevented from making the lubricant. Regular tissue was immune to tumour formation (Nature, DOI: 10.1038/nature12234).

Unfortunately, even if HMM-HA also conferred protection against cancer in humans, you may have to manipulate all cells in the body to express it, which is impractical and potentially dangerous. However, the heavyweight version might be beneficial in other human diseases. Co-author Chris Hine of the Harvard School of Public Health says arthritis might be a target. "We could imagine engineering cells found in the joints of a patient suffering from arthritis to express HMM-HA and then placing them back, possibly alleviating the symptoms associated with the disease," he says.

It may also be possible to modify human skin, brain, eyes and blood vessels, Hine says. "As hyaluronan production decreases in these tissues with age, it would be interesting if we could slow ageing by engineering these organs to produce HMM-HA."

Chris Faulkes, at Queen Mary, University of London, says the animals are well adapted to living in tight spaces. "They can virtually turn somersaults in their skin," he says. It's possible that one day some of the cool features of the animals could be engineered into humans, he says. "But we may all end up looking like naked mole rats."

This article appeared in print under the headline "'Gloop' the secret to naked mole rats' cancer defiance"

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STAND on the shores of Wembury Bay and let nature heal you. Here on England's south-west coast, the gentle sway of the trees in the ocean breeze will lower your blood pressure, the sound of lapping waves will banish the stress hormones from your blood, and the pine scent will invigorate your immune system.

On closer inspection, you'll find that something is missing from this scene: namely, all of it. This is no shore. You're in an intensive care unit 325 kilometres inland, in Birmingham. But the illusion will fool your body into healing itself, its creator claims.

Decades of research have built a compelling case for the healing effects of nature. But because this field has been largely overlooked by medicine, it has been difficult to uncover the direct causes. At the same time, a growing body of evidence has begun to suggest that it is possible to hijack ...

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CHINA may soon breathe a little easier. The nation's State Council has announced strict measures to cut the amount of air pollution chucked out by industry by nearly a third by the end of 2017.

It's a big move, but it's only the first salvo of a lengthy battle. Much of eastern China suffers from severe air pollution due to heavy industry and enormous volumes of traffic. In early 2013, the pollution in Beijing was the worst on record. Levels of particles less than 2.5 micrometres across, known as PM2.5, were 22 times what the World Health Organization considers safe . Although the air has been much cleaner in recent months, China's pollution still regularly reaches unhealthy levels, and the country's emerging middle class has begun protesting regularly about the bad air.

On 14 June, the State Council announced that heavy industries like steel manufacturing will have to replace outdated technologies and publish data on pollutants. The council also wants to cut the use of coal-fired boilers, which heat many apartment buildings.

If all goes as planned, major industries will cut their pollutant emissions by 30 per cent by the end of 2017.

Owen Cooper of the National Oceanic and Atmospheric Administration in Boulder, Colorado, calls the target ambitious. In developed countries like the US that have a track record for cutting air pollution, cuts have taken much longer than that.

The challenge, Cooper says, will be to cut pollutants fast enough to outpace China's rapid economic growth, which drives up pollution. China made cuts on emissions between 1990 and 2005, but the economy grew so fast that pollution still rose, albeit at a slower pace (Atmospheric Chemistry and Physics, DOI: 10.5194/acp-11-931-2011).

China's decision is a good start, says Cooper. "But it's not going to make a difference if their economy continues to grow."

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Say hello to Heath (pictured). He's the first baby in the world to be born using a new IVF technique that researchers hope will be safer for would-be mothers.

During IVF, a woman's ovaries are stimulated to boost ovulation and harvest eggs. This is usually done by an injection of human chorionic gonadotropin (hCG), a hormone involved in progesterone secretion.

But sometimes this leads to ovarian hyperstimulation syndrome. OHSS is mild in a third of women having IVF, causing abdominal bloating, but for one woman in 20 it also causes vomiting and diarrhoea. In extreme cases it can be fatal. Women with polycystic ovary syndrome – a leading cause of infertility – are at greater risk of OHSS.

The problem with hCG is that it is too potent, says Waljit Dhillo at Imperial College London. His team hypothesised that another hormone, called kisspeptin, may be gentler. Its effects are short-lived and during pregnancy it naturally increases to 7000 times the usual level, so should have minimal side effects.

Dhillo tested the hormone in 30 women having IVF. Suzannah Kidd became the first to give birth as a result – Heath, a healthy boy, was born on 26 April. Dhillo thinks that IVF success rates will be as good with kisspeptin as they are with current methods. "We'll know in six months," he says.

Dhillo presented his results to the Endocrine Society in San Francisco this week.

Simon Fishel at CARE Fertility in Nottingham, UK, thinks the results are exciting. "It's an opportunity that needs to be studied," he says. "It could be very important if it eliminates OHSS."

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SIXTY years after Edmund Hillary and Tenzing Norgay became the first people to climb Everest, the world's highest mountain is a busy place. When the weather is good in mid to late May, the upper slopes are crowded with hundreds of climbers. With every step available to view on YouTube, you might think there is nothing left to explore on the roof of the world. You would be wrong.

A team from the Centre for Altitude, Space and Extreme Environment Medicine (CASE) at University College London recently spent several weeks on Everest studying hundreds of trekkers, climbers and Sherpas. The findings from their work and that of others is radically changing our understanding of how our bodies adapt to altitude, particularly the low oxygen levels experienced there.

Don't assume this revolution only affects a few groups of people around the world. Anyone with anaemia, heart failure and a wide ...

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More than 20 years ago, geneticist Mary-Claire King discovered BRCA1 – the first known gene with mutations related to heritable breast and ovarian cancer. Last week, the US Supreme Court ruled against patenting the gene, and the story of her initial discovery is the subject of a forthcoming Hollywood film. She tells Sara Reardon just how far her field has come

You discovered the BRCA1 gene in the early 1990s. Soon afterwards, Myriad Genetics determined and patented the sequence of the gene. At the time, were you surprised by that?
Genes had been patented before; the cystic fibrosis gene was patented. But I don't think anyone – from the US National Institutes of Health or anywhere else – anticipated the level of patent protection Myriad has engaged in.

What was different about Myriad was its insistence that it was the only entity that could do the test and its aggressive efforts to shut down anyone else. That's why in 2009 the American Civil Liberties Union filed the suit that has gone all the way to the US Supreme Court. They brought the case on behalf of people who needed tests and were not able to get a second opinion.

On 13 June, the US Supreme Court ruled that genes occurring in nature cannot be patented. What is your reaction to the ruling?
I am delighted. This is a fabulous result for patients, physicians, scientists and common sense. When I was working on it from 1974 to 1994, it did not cross my mind that a legal case that would end up in the Supreme Court would be the consequence of my work. But it did and sometimes that's what happens when you start in a new area of science. It is a relief to have a decision after so many years, and I'm so gratified that it was a unanimous decision.

What's next for genetic testing, now that we have this ruling?
Developing multi-gene panels – one-stop shops for testing for susceptibility to breast and ovarian cancers on many genes – has been a very high priority. The multi-gene test we developed, called BROCA, has been used for months, but until today we had to mask BRCA1 and BRCA2. The Supreme Court ruling removes the illogical situation of being able to test all genes but having to mask some. Multi-gene tests can now be made available to people by many firms. In fact, I think they were on the market straight after the ruling.

BRCA genes were also in the news recently when Angelina Jolie had a double mastectomy after learning she was a carrier of a harmful BRCA1 mutation. Was that welcome publicity?
It was a wonderful piece she wrote for The New York Times, she's come to understand it very well. I hope Angelina Jolie being so clear about what this involves and the development of next-generation sequencing lead to more women getting sequencing done. Most cancer isn't inherited, but there is a straightforward genetic test; if a woman is concerned, she can find out. I would like to see women in their 30s offered genetic testing more routinely at a time when something can be done about it.

Your discovery is the subject of the new film, Decoding Annie Parker. What is it like to have a movie made about your work?
I had nothing to do with it at all and did not know about it until after it was complete. I found out by accident. One of my grad students came in and said: "You never told me there's a movie about you."

"There is not a movie about me," I replied and didn't even stop what I was doing. She showed me on her laptop, and I thought "yeah, sure". But then I checked for myself, and sure enough there it was.

The film suggests you really struggled in the 1980s to convince people that some cancers have a genetic component. Was that the case?
The main experience of the period was that people completely ignored me. I was a young woman, not a physician, working on my own with modest support from the National Institutes of Health.

There was active opposition from some groups. But there was also terrific support from clinicians who had patients from families with large numbers of women who'd had breast and ovarian cancer. They wanted to know what to do about it. They knew it wasn't because of something the women had done wrong. I had a great deal of support from oncologists and couldn't have done the project without it.

Today, of course, cancer genetics is a booming field. Is that thanks to the BRCA genes?
I think it increased interest enormously. It confirmed the idea of inherited predisposition to cancer. My work showed that one could use the tools of genetic analysis to prove the existence of genes responsible for an inherited form of a major common disease, and that you can parse out the inherited portion.

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The US government has "high confidence" that the Syrian government has used chemical weapons (CW). In an apparent policy shift, it says it will now provide military support to Syrian rebels. The decision follows the finding of a breakdown product of the nerve gas sarin in urine samples from Syria.

"The Assad regime has used chemical weapons, including the nerve agent sarin, on a small scale against the opposition multiple times in the last year," declared a White House statement released yesterday. At least 100 to 150 people were killed as a consequence, it said.

Although that accounts for only a small fraction of the 90,000-plus deaths in the Syrian conflict so far, the statement said "the use of chemical weapons violates international norms and crosses clear red lines that have existed within the international community for decades". Since last August, US President Barack Obama has said CW would "change his calculus" on US involvement in Syria.

That has now happened: the statement promises more "non-lethal assistance" for the rebels – which could include medical and communications equipment, for example – and "direct support" for their Supreme Military Council.

"That includes military support," US Deputy National Security Adviser Ben Rhodes told journalists. This was not mentioned in the statement.

The US government declared in April that it suspected Syria had used CW, based partly on "physiological samples" from injured rebels. Since then, more samples have come to light.

Positive test

Last week, two reporters for the French newspaper Le Monde announced that two urine samples they smuggled out of Syria had been tested by the French Centre for Nuclear, Biological and Chemical Defence south of Paris and found to contain isopropyl methylphosphonic acid.

That is sarin with a fluoride ion removed by chemical breakdown in the body, says Alastair Hay at the University of Leeds, UK, a leading CW expert. "It can only come from sarin." Blood and urine retain traces of sarin exposure for up to six weeks, he says.

Moreover, Le Monde said blood samples smuggled by "other channels" from a battle at Saraqeb in northern Syria, where munitions and injuries suggested some kind of CW, contained 9.5 nanograms of sarin itself per millilitre. French and British officials declared last week they believed Syria had used sarin.

Such results do not indicate who released the sarin, notes the US statement, repeating calls for UN verification inside Syria. The statement said it had "no reliable, corroborated" evidence that the rebels had CW, however, and did have reports of "Syrian officials planning and executing regime chemical weapons attacks".

Small-scale use

It also said reports of symptoms in Syria were consistent with sarin exposure. CW experts have been dubious about this. Videos of what are purported to be victims of CW exposure show limited effects, with few people affected, mixed symptoms and no contamination of unprotected carers.

Now it seems possible that small amounts of sarin may have been used, perhaps alongside other CW, to create just such uncertainty. The French lab did not test for other agents such as tear gas.

"The estimated 100 to 150 fatalities would indicate very small-scale use," says Richard Guthrie, a CW expert formerly with the Stockholm International Peace Research Institute in Sweden. It is not clear, he says, why commanders would risk global censure in return for the uncertain military advantage that small amounts of sarin might give them. Release could have been accidental or not approved by Damascus – or attackers might have used sarin alongside other agents. "That would provide a confusing situation," says Guthrie, making it hard to prove CW use.

"The lack of bodies could be due to a whole range of factors such as the quantity used, number of people, [location of] buildings and wind direction," cautions Hay. "Even if only 50 per cent pure, sarin is so potent that you are still going to get some effect."

The White House statement says the US is "working with allies to present a credible, evidentiary case to share with the international community and the public".

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