Dr. Myles Wolf

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  www.asn-online.org/education_and_meetings/renal_week/20 - [Cached Version]
  Published on: 1/1/2009    Last Visited: 8/8/2009  

  Myles S. Wolf, MD, MMSc

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  www.eurekalert.org/pub_releases/2008-08/mgh-hlm080108.p - [Cached Version]
  Published on: 8/1/2008    Last Visited: 8/7/2008  

  "FGF-23 helps regulate serum phosphate levels; and we know that, among patients with kidney failure, elevated phosphate is associated with more rapid progression to renal failure and earlier death," says Myles Wolf, MD, MMSc, who led the study when he was with the MGH Renal Unit,.
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  "This is the first report of racial and ethnic differences in FGF-23 levels, and we are now investigating whether such differences are also seen in healthy patients and those with earlier stages of kidney disease," Wolf says."We expect those differences may relate to previous observations of calcium, phosphorous and vitamin D metabolism differences among racial groups.We also need to investigate whether FGF-23 elevations are toxic in themselves or if they are simply a biomarker for abnormal phosphate balance.
  
  "Incorporating FGF-23 levels into the management of kidney failure may have its greatest potential for treatment of the millions of patients with early-stage kidney disease who do not yet require dialysis, who usually have normal phosphate levels but quite high FGF-23," he adds."Routinely monitoring FGF-23 may help determine which patients need to begin therapies that control phosphate levels, which may reduce mortality in this very high-risk group."As of August 1, Wolf has joined the University of Miami Miller School of Medicine as director of Clinical Research in the Nephrology Division.

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  www.kidneydialysis.org.uk/news.htm - [Cached Version]
  Published on: 3/29/2008    Last Visited: 10/16/2008  

  One-year mortality risk for patients starting dialysis with the highest serum fibroblast growth factor 23 (FGF-23) levels was 5.7 times higher than for those with the lowest levels and 20% higher than for those with normal levels, reported Myles Wolf, M.D., of the University of Miami, and colleagues, in the Aug. 7 issue of the New England Journal of Medicine.

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  www.hdcn.com/symp/08asn/05/08asn05.htm - [Cached Version]
  Published on: 6/16/2009    Last Visited: 6/16/2009  

  Myles S. Wolf, MD
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  Myles S. Wolf, MD University of Miami, Miller School of Medicine
  
  This group of talks is accredited for up to 1.5 AMA PRA Category 1 credits™.

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  www.asbmr.org/meeting/program/Symposia.cfm - [Cached Version]
  Published on: 8/19/2007    Last Visited: 4/15/2008  

  Myles Wolf, M.D., MMSc, Massachusetts General Hospital (USA)

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  www.asn-online.org/application/omniconference/public/oc - [Cached Version]
  Published on: 9/15/2008    Last Visited: 9/15/2008  

  Myles S. Wolf, MD

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  www.accessmedicine.com/amed/public/amed_news/news_artic - [Cached Version]
  Published on: 4/5/2002    Last Visited: 11/13/2002  

  "This study showed that a risk factor that can be detected many weeks before symptoms appear may be able to predict who will develop preeclampsia," says Myles Wolf, MD, of the MGH Renal Unit, the paper's first author."Our study raises the possibility of developing new approaches to diagnosis and intervention, which eventually could lead to preventive treatments."
  
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  "We know that obese women are at higher risk for preeclampsia and tend to have insulin resistance," Wolf says."The fact that the association of preeclampsia with reduced first-trimester SHBG is also seen in lean women suggests that insulin resistance may be the true risk factor.It also may provide the only clue that a lean woman is at elevated risk."
  
  Wolf adds that the possibility of being able to identify at-risk women earlier in their pregnancies could lead to advances in the search for preventive therapies."One reason why the studies of possible treatments have failed could be that we can't predict who might develop preeclampsia until symptoms begin, which can be 20 to 25 weeks into pregnancy.There might be a window of opportunity in the first trimester when preventive treatment could be successful, but until now we did not have a simple way to identify high-risk women."
  
  Related Chapters:Harrisons Chapter 7: Medical Disorders during Pregnancy

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  AACOM | About - [Cached Version]
  Published on: 1/14/2005    Last Visited: 4/17/2006  

  Myles Wolf, MD, MMSc Massachusetts General Hospital

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  ASH - [Cached Version]
  Published on: 1/1/2004    Last Visited: 3/11/2009  

  Myles Wolf, MD, MMScInstructor in MedicineHarvard Medical School
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  In those with early-stage CKD, progression of disease to renal failure is common, but not as common as death," said Myles Wolf, MD, MMSc, Instructor in Medicine, Harvard Medical School, and Assistant Program Director, Department of Internal Medicine Residency Program, Massachusetts General Hospital, Boston (Table 1).According to Dr. Wolf, "Vitamin D deficiency plays a key role in the pathogenesis of CKD-associated hyperparathyroidism,and perhaps also CVD-related mortality in these patients."
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  Emerging evidence suggests a potential association between vitamin D deficiency and CVD complications in persons with CKD," Dr. Wolf explained.
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  "In another study, patients on dialysis who received intravenous calcitriol therapy showed a significant reduction in left ventricular mass as well as decreased renin, angiotensin II, and ANP levels with active vitamin D therapy, suggesting a link between the vitamin D and cardiovascular systems," Dr. Wolf explained (Park et al. Am J Kid Dis 1999;33:73).
  
  In a recent animal study, Li and colleagues created vitamin D receptor knockout mice.The results showed that knockout mice developed significantly more hypertension than wild-type mice.The knockout mice also had marked expansion of the juxtaglomerular apparatus, increased cardiac myocyte hypertrophy, and increased renin and angio- tensin levels, suggesting that vitamin D exerts a tonic inhibitory effect on the renin-angiotensin system (Li et al. J Clin Invest 2002;110:229).In addition, Zitterman and colleagues showed that low levels of vitamin D in humans may contribute to congestive heart failure and activation of the renin-angiotensin system (Zitterman et al. J Am Coll Cardiol 2003;41:105)."These findings may be of particular interest for application to persons with early-stage CKD, as this is when proteinuria is worsening and vitamin D deficiency, hypertension, and left ventricular hypertrophy are beginning to develop," said Dr. Wolf.
  
  Vitamin D TherapyNew National Kidney Foundation guidelines indicate the need to consider active vitamin D therapy not only for patients on dialysis, but also for some persons with earlier stage CKD (National Kidney Foundation.Kidney disease outcomes quality initiative clinical practice guidelines for bone metabolism and disease in CKD, 2003).First-generation vitamin D analogs, such as calcitriol, show a potent ability to inhibit PTH levels.However, their use is also associated with an increased risk for hypercalcemia and hyperphosphatemia."This observation led to the development of newer vitamin D analogs with increased selectivity for PTH suppression, and a reduced effect on calcium and phosphate absorption in the gut," Dr. Wolf explained.
  
  Indeed, one long-term study of patients on dialysis receiving third-generation paricalcitol demonstrated a sustained reduction in PTH, with an initial modest increase in calcium and phosphate levels that stabilized over time (Lindberg et al. Clin Nephrol 2001;56: 315).In another study, researchers compared calcitriol and paricalcitol in patients on dialysis.They found a comparable reduction in PTH levels, but with significantly less risk of sustained hypercalcemia or calcium-phosphate product > 75 in the paricalcitol group (Sprague et al. Kidney Int 2003;63:1483)."Importantly, compared with calcitriol, current data indicate that paricalcitol has a three-fold increased selectivity for PTH suppression, relative to its effects on calcium and phosphate," Dr. Wolf noted.
  
  Differences in survival have also been shown with the newer vitamin D analogs.In an observational study of more than 67,000 patients on dialysis at Fresenius Medical Center, patients receiving paricalcitol for secondary hyperparathyroidism showed a significant survival advantage over those receiving calcitriol."After adjusting for other variables, such as age, gender, race, and known survival factors, the survival advantage for those receiving paricalcitol was 16%, and this benefit continued to increase over time," Dr. Wolf stated (Teng et al. N Engl J Med 2003;349: 446).According to Dr. Wolf, these promising data warrant further study in randomized, controlled trials.
  
  In closing, Dr. Wolf emphasized that vitamin D is critical for the normal maintenance of mineral metabolism in patients with CKD."Emerging evidence suggests that vitamin D deficiency may contribute to the excess CVD-related morbidity and mortality in this population.While the exact mechanisms are not completely understood, active vitamin D therapy appears to confer a survival advantage in CKD patients on dialysis, and may be of benefit in those with earlier stage disease.The next research frontier is to investigate the direct impact of vitamin D therapy on CVD morbidity and mortality in those with earlier stage CKD," he concluded.

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  Am-I-Pregnant.com: Preventing Preeclampsia - [Cached Version]
  Published on: 9/17/2001    Last Visited: 6/24/2002  

  "Women who had below normal levels of SHBG in their first trimester of pregnancy went on to develop preeclampsia far more frequently than those who had normal levels, indicating to us that SHBG could act as a marker, helping to identify those at greatest risk long before symptoms occur," says study author Dr. Myles Wolf, a researcher at Massachusetts General.
  
  Other doctors involved in preeclampsia research elsewhere, however, are not so sure the finding will hold up in larger studies.
  
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  Although no one is certain what causes preeclampsia, Wolf and his team suspect it may be linked to insulin resistance, a problem that interferes with the body's ability to clear sugar from the blood and is often a precursor to Type II diabetes.
  
  Because insulin resistance is associated with obesity, and obesity is already a known risk factor for preeclampsia, Wolf believed there could possibly be a direct connection from the insulin problem to the pregnancy complication.One of the ways to find that out was to measure the levels of SHBG, which are altered by insulin resistance, so that's what the study set out to do.
  
  First, the researchers accessed medical records from participants in the Massachusetts General Hospital Obstetrical Maternal study, a large project involving 4,500 pregnant women who had given blood samples in their first trimester.All the samples had been tested, among other things, for levels of SHBG.
  
  Wolf's group then identified 45 women who developed preeclampsia, and compared the results of their SHBG blood levels to 90 randomly selected women who had a normal pregnancy.
  
  They found the women who went on to develop preeclampsia were far more likely to also have low blood levels of SHBG, the marker for insulin resistance.The surprising factor, however, was that thin women were as likely to have the low levels as heavy women -- and they were just as likely to develop preeclampsia.
  
  "This told us that with or without obesity, insulin resistance, on its own, could play a role in preeclampsia," Wolf says.
  
  Wolf now believes testing levels of SHBG as early as the first trimester would alert doctors to which women need special care, and doing so early, enough could make a difference in the outcome of the pregnancy.
  
  "There are some treatments for preeclampsia that may actually work if they could be started early enough, before symptoms develop," Wolf says."This test could help identify which women might benefit from that early treatment."
  
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  Wolf agrees: " I think there is going to be more than one factor involved.But right now, insulin resistance appears to be one of those factors."
  
  Other risk factors for preeclampsia include pre-pregnancy high blood pressure, diabetes and gestational diabetes, which develops during pregnancy.However, treatments for any of these disorders don't work for preeclampsia.Risks can also be higher in women carrying more than one baby, in mothers over the age of 35, and in those who experienced preeclampsia in a previous pregnancy.

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