"This laboratory-based study demonstrates the depth and severity of what has been observed clinically for some time, namely, that after measles infection, but not measles vaccine, the ability of the immune system to respond to other pathogens is significantly diminished, leading to increased risks and complications from other infections," says Dr. Poland. "This study is a further important step in understanding the underlying scientific basis for the long-lasting harm that measles virus infection can cause."

Immune memory

"Immune memory develops after we are exposed and infected with various pathogens, allowing the body to "'remember'" what it has previously been exposed to and allowing very rapid production of protective immune responses after reexposure," says Dr. Poland. "Measles virus infection significantly harms the body's ability to maintain that immune memory and rapid response."

Study significance

"The significance of this is that measles infection harms the body's ability to recognize, remember and fight off other infections besides measles virus.  This leads to an enhanced risk of infection with other viruses and bacterial, and an increased risk of complications," says Dr. Poland. "These findings reinforce the importance of vaccination."

Measles symptoms and complications

Measles is a highly contagious viral infection that spreads through coughing or sneezing. Complications may include ear infection, pneumonia and encephalitis, which can result in permanent brain damage. In the U.S., 3 of 1,000 people infected with measles will die. In developing countries, 1 of 100 people will die from complications of the virus.

Measles can be prevented with the measles, mumps and rubella (MMR) vaccine. The Centers for Disease Control and Prevention recommends that MMR be given to children at 12–15 months of age. A second dose is recommended before a child starts school, around ages 4–6. If children receive an early dose of MMR vaccine between 6 and 11 months of age because of international travel or a local outbreak, they still will require both routine doses after 1 year of age for full protection.

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"Measles is a vaccine-preventable disease that is highly contagious," says Dr. Pritish Tosh, a Mayo Clinic  infectious diseases specialist. "Once it gets introduced into a susceptible — usually unvaccinated —population, most people will get infected quite quickly."

Watch: Dr. Pritish Tosh discusses measles

Journalists: Broadcast-quality sound bites with Dr. Pritish Tosh are in the downloads at the end of the post. Please 'Courtesy: Mayo Clinic News Network.'

The measles, mumps and rubella (MMR) vaccine is an effective and safe way to prevent the spread of the childhood illness. Dr. Tosh says vaccines have been a victim of their own success. "When they rolled out, especially for measles in the '60s, at that time hundreds of thousands of kids were dying every year in the world. As we've been able to increase the amount of vaccination in developing countries, that number is down to about 150,000 a year — still an unfathomable number."

Symptoms

It may take up to two weeks after exposure to the virus to develop symptoms. Those symptoms frequently include:

• Fever
• Dry cough
• Runny nose
• Sore throat
• Inflamed eyes (conjunctivitis)
• Tiny white spots with bluish-white centers on a red background found inside the mouth on the inner lining of the cheek
• A skin rash

Along with symptoms, Dr. Tosh says the virus can cause more severe complications, including pneumonia and encephalitis. About 1 in 4 people in the U.S. who get measles will be hospitalized. And for every 1,000 children who get measles, one or two will die from it, according to the CDC.

While there is an effective vaccine to prevent the virus, there's no anti-viral treatment for it. "It's just supportive care," says Dr. Tosh. "And the best way to prevent these complications is not to get it at all. Thankfully, there's a very safe and very effective vaccine that’s been available for decades. We just have to use it."

The CDC recommends all children get two doses of MMR vaccine, starting with the first dose at 12 to 15 months of age and the second dose at ages 4 to 6. Adults may need a third booster vaccine in settings where outbreaks are occurring, such as college campuses and military settings.

Related posts:

• More about measles
• Infectious Diseases A–Z: Importance of childhood vaccines
• Infectious Diseases A–Z: Measles in North America

The post Infectious Diseases A-Z: Measles outbreaks continue in the US appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Induced pluripotent stem cells, the workhorse of many regenerative medicine projects, start out as differentiated cells that are reprogrammed to pluripotent stem cells by exposure to a complex set of genetic cocktails. Mayo researchers now report that using the measles virus vector; they’ve trimmed that multi-vector process with four reprogramming factors down to a single “one cycle” vector process. They say the process is safe, stable, faster and usable for clinical translation. The findings appear in the journal Gene Therapy.

“If we’re going to successfully use reprogrammed stem cells to treat patients in the clinic, we need to ensure that they are safe and effective, that is, not prone to the risk of mutation and potential tumors,” says Patricia Devaux, Ph.D., Mayo Clinic molecular scientist and senior author of the article. “The measles virus vector has long been used safely at Mayo for treating cancer, so it is very safe. Now that we’ve combined a multiple-vectors process into one, it’s efficient as well.”

Previously, the four reprogramming factors – proteins OCT4, SOX2, KLF4 and cMYC – had to be introduced individually to the cells to induce them to change in the proper fashion for the desired outcome. That led to potential partially reprogrammed cells, as not all cells received the four factors required for reprogramming. The new Mayo process combines those factors within the measles virus vector so the process happens in one step and all targeted cells have the potential to reprogram. It should be noted that this measles virus is attenuated, that is all dangerous aspects of the virus have been removed, as they are in a vaccine, and the virus becomes a vector or carrier for other genetic material. The measles virus vaccine strain is often used today because it is safe, fast and targetable.

The researchers say a clinically applicable reprogramming system free from genomic modifications will go a long way to making widespread use of induced pluripotent stem cell therapies feasible. These are therapies in which an individual’s own cells are reprogrammed can then be use to work in a particular diseased organ, thus avoiding risk of cell rejection.

Additional co-authors of the article include first author Qi Wang, Alanna Vossen, and Yasuhiro Ikeda, D.V.M., Ph.D., all of Mayo Clinic. The research was supported by the National Institutes of Health, including the National Institute of Allergy and Infectious Diseases, National Center for Advancing Translational Sciences, Mayo Clinic Graduate School of Biomedical Sciences, and Mayo Clinic Center for Regenerative Medicine.

###

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“You can't predict when you’ll be exposed to measles,” says Gregory Poland, M.D., a Mayo Clinic vaccine researcher. “If you get on an airplane, visit Disneyland, go to a mall, or frequent any place where there are other people, you're at risk.”

Once contracted, a measles infection is not trivial. The virus causes fevers over 104°F, a hacking cough, runny nose, enflamed eyes, and a full-body rash. It can trigger severe complications, such as pneumonia, brain swelling, and blindness. For every 1,000 children infected, three will die. And every new infection creates another opportunity for the potentially fatal virus to spread. Essentially anyone who is not nonimmune and is exposed to an infected measles patient will end up getting the measles themselves.

Roberto Cattaneo, Ph.D., a Mayo Clinic molecular biologist who has been studying the virus that causes measles for three decades, is the scientist who discovered what makes it so contagious (Nature, 2011). Unlike other respiratory viruses that settle in the lungs, measles replicates in the windpipe, which it uses like a trampoline to bounce millions of infectious particles into the air.

"The measles virus has developed a strategy of diabolic elegance," said Dr. Cattaneo. Once inhaled, the virus hijacks immune cells patrolling the lungs to get into the host’s system. Then it multiplies in lymph nodes and in the organs producing new circulating immune cells. Those circulating immune cells deliver the infection to cells lining the trachea. There, the virus multiplies again before inducing spasms of coughing to launch itself out of the patient and possibly onto its next victim.

Dr. Cattaneo is now investigating how the virus, known to inhabit the immune and respiratory systems, also manages to find its way into the brain to cause a rare and deadly brain disorder called subacute sclerosing panencephalitis (SSPE) that appears years after infection.

“It is another unsolved mystery of measles virus spread, but I think we have the answer,” said Dr. Cattaneo. “We’re still working out the details now, but it appears to get into the brain by a completely different mechanism than it uses to get into immune cells and out of the host.” Understanding how the measles infiltrates different organ systems could lead to new ways to prevent its most dangerous complications.

Of course, there is already a pretty effective way to prevent those complications: vaccination.

And getting vaccinated is more important than ever. The disease still kills more than 100,000 people a year, most under the age of five. To be protected from the virus, people need two doses of the MMR vaccine. The first dose is given to infants after their first birthday, and a booster is given between four and six years of age. Those two doses are about 97 percent effective against infection.

Impressive, but not perfect.

To protect the remaining three percent – as well as babies or people with compromised immune systems who are also not immune to the virus – requires something known as herd immunity. When a critical proportion of the community is immunized against the disease, then most members will be protected because there is little opportunity for an outbreak.

The more contagious the disease, the more people that need to be vaccinated to protect the herd. Dr. Poland says that for measles, that threshold is 95 percent. According to the Centers for Disease Control, only 91.5 percent of children received the MMR vaccine in 2014, the last date such data was available.

As head of Mayo Clinic’s Vaccine Research Group, Dr. Poland is studying why the vaccine works better in some people than in others in the hopes of building a better vaccine. In an approach he calls “vaccinomics,” He and his team are searching for genetic signatures of people who have abundant, luxuriant protective responses to the current vaccine and will use that data to reverse engineer novel vaccine candidates.

The ultimate goal is to design a vaccine that is more effective, easily administered, biodegradable, cheap, and storable indefinitely. Poland says vaccinomics could also be used to develop types of vaccines that are tailored to each individual’s genetic profile. For example, an individualized genetic screen might identify who is at risk for a serious adverse side effect, who might need multiple doses, as well as those who are already immune to the disease and therefore can skip the shot altogether.

For now, two doses of the MMR vaccine remain the best shot at avoiding a measles infection. Convincing parents to make that decision requires an entirely different kind of personalized medicine – one that takes into account each individual’s biases and belief systems.

“I have come to believe that a wise clinician understands where the patient is coming from in their decision-making process and then adapts their education method to the cognitive style of that patient,” said Dr. Poland. “I find there are very, very few people that I ever see as a clinician who don't end up getting their vaccines. Maybe not at the first meeting or the second, but eventually they do.”

- Marla Vacek Broadfoot, June 2017

The post Discovery’s Edge: Mayo experts on the measles outbreak appeared first on Mayo Clinic News Network.

Rene Maleski knew it was bad news when the young ultrasound tech who was scanning her abdomen suddenly stopped and left the room, crying. The technician returned a few minutes later to tell Maleski she would need to see the radiologist that day, and she should probably bring her husband with her. That afternoon, Maleski came face to face with her new reality: the pelvic scan showed tumors covering her ovaries, climbing up her aorta, and invading her lymph nodes. She had stage-three ovarian cancer.

Within days, the mother of five was on the operating table, as doctors laboriously removed every tumor. She endured 18 rounds of chemotherapy, and for a time that was enough. But within two years, the cancer was back. “It was very disappointing,” said Maleski. “I realized that I was probably going to die from cancer.”

Then her doctor suggested they try something outlandish – an injection of the measles. Maleski didn’t hesitate. A healthy eater, she had struggled mentally with chemotherapy and the thought of purposely “dumping major toxins into your body.” She was willing to try anything to avoid more chemo.

Maleski is one of hundreds of patients who have received cancer-killing viruses in over 25 different clinical trials at the Mayo Clinic. When she was first diagnosed, her CA125 levels -- a standard biomarker of ovarian cancer – were 1600. While she was on the measles trial, those levels dropped to 4 (anything below 35 is considered normal). The dramatic results stem from almost a quarter of century of studies at Mayo, one of the oldest virotherapy programs in the world.

Reloading the virus

Scientists first suspected a connection between cancer remission and viruses in the early 1900’s, when they noticed that some cancer patients unexpectedly went into remission after a bout of the flu or chicken pox. But taking a potentially deadly virus -- which clinicians have made every effort to eradicate -- and turning it into a therapy has not been easy. In the 1950’s and 60’s, researchers made several attempts, injecting patients with a wide variety of wild type viruses, occasionally with promising results. By the 1970’s and 80’s, however, advances in radiation and chemotherapy made the search for such alternative cancer treatments seem unnecessary.

Decades later, scientists now realize that while there are some cancers that can be cured by conventional methods, there are many others that cannot. This year more than 600,000 Americans are expected to die of cancer – more than 1,600 people a day.

“We know that in order to do better we need to think outside the box, and one way to accomplish that is by revisiting the old concept of viruses as cancer killers,” said Eva Galanis, M.D., who heads Mayo’s molecular medicine department. “Viruses have been around for millennia. They have survived evolution by mastering the ability to kill human cells very effectively. The principle behind virotherapy is to take this destructive power and harness it to specifically attack cancer cells while sparing normal cells.”

Viruses are deceptively simple – just a tangle of genetic material encased in a protein shell. To survive, they must latch onto the surface of living cells, push their way in, and hijack the cell’s machinery to replicate themselves, before bursting out of that cell to infect others. As a result, many viruses are naturally drawn to cancer cells, which grow and replicate more quickly than normal cells. Cancer cells also frequently overexpress receptors that viruses use to hack into cells, making them an even more attractive host.

Nevertheless, the Mayo Clinic’s molecular medicine team didn’t want to infect cancer patients with potentially dangerous, wild type versions of virus. Thankfully, years of research have greatly increased the understanding of viral biology, and advances in various laboratory techniques have made it possible to engineer kinder, safer, but also more effective viruses.

The measles virus was selected, along with ovarian cancer as a target over a decade ago by Stephen Russell, M.D., Ph.D., who came to Mayo from Cambridge University to establish the Molecular Medicine Program, which later became a department. Preclinical findings were published by Kah Whye Peng, Ph.D., of Mayo, and Dr. Galanis was in charge of the subsequent clinical trials. In its natural form, the measles virus can cause serious damage – high fever, hacking cough, full-body rash, and in rare cases, death. But the longer it is grown in the laboratory, the less adept the virus becomes at causing disease. One domesticated form of the virus, the Edmonston B strain, has been used to safely vaccinate millions of children against the measles.

Dr. Russell designed the next generation measles virus (with the help of then Ph.D. student David Dingli). To see if the engineered versions of this weakened strain was still strong enough to target and destroy cancer cells, it was injected it into cancer avatars – mice with patient’s ovarian tumors growing inside them. The tumors shrank by 80%.

But to move this approach to the clinic in order to benefit patients, they would need vats of virus, far more than the researchers could routinely generate in the laboratory. Dr. Russell designed Mayo’s own vector production facility, and recruited Mark Federspiel, Ph.D., to run the established facility.  To this day it remains one of the only academic sites in the world capable of manufacturing clinical-grade engineered viruses for patient use. Dr. Russell also created a toxicology and biodistribution laboratory, led by Kah Whye Peng, Ph.D., to convincingly demonstrate safety in relevant animal models prior to human testing.

“It was a huge, expensive, and tedious team effort, but it demonstrated that this approach had promise,” said Dr. Galanis. “Because we had established a vector production facility as well as a viral toxicology laboratory in house, we were able to move from the clinical discovery to a first-in-human clinical trial in a fraction of the time that it would take even industry to do. For our first study, it was just three years from proof of principle to the first patient being treated.”

In that first ovarian clinical study, 21 patients with heavily pretreated recurrent cancer were given varying doses of the Edmonston strain of the measles virus. Patients in the study achieved a median overall survival of 12 months, which is twice longer than the expected median survival of 6 months. What’s more, among 37 patients with resistant ovarian cancer treated with the virus, the median overall survival in patients who received the highest doses was an extraordinary 26 to 38 months. The researchers tested the measles virus on other cancers in the lab, again with remarkable results.

“Ovarian cancer, glioma, multiple myeloma, hepatocellular cancer, breast cancer, mesothelioma, head and neck cancer, sarcoma –- the virus eliminated tumors in pretty much every model the molecular medicine teams have tested,” says Dr. Galanis.

Recently Dr. Galanis’ group hit another important milestone by activating the very first human trial of stem-cell delivery of a cancer-killing virus. In this study, the researchers in collaboration with the Mayo Clinic’s Cell Therapy laboratory, led by Allan Dietz, Ph.D., use a tiny amount of the patient’s own fat tissue to generate stem cells that they then infect with measles virus before administering to ovarian cancer patients. “This represents an important breakthrough,” says Dr. Galanis. “Infected stem cells help the virus to “hitchhike” to tumor sites, improving delivery and protecting them from the immune system. If successful, it could drastically change the way we deliver viruses to cancer patients”.

More Ammunition

Many researchers believe that cancer-killing viruses – formally known as oncolytic viruses –could represent one of the most important advances in cancer treatment. When these viruses destroy cancer cells, they release hundreds of new infectious virus particles to annihilate the remaining tumor. At the same time, the infected cells secrete chemicals called danger-associated molecular pattern molecules that trigger the antitumor immune response. The ability to both directly kill cancer cells and recruit immune cells to join the fight means that viruses have the potential to successfully treat advanced cancers that have failed other therapies.

Recently, Dr. Galanis and her colleagues began to explore ways to strengthen this immune response to cancer. They combined the measles virus with anti-PD-1, an antibody that unleashes the immune system and is the key ingredient of drugs such as pembrolizumab or nivolumab. The researchers showed that this combination of virotherapy and immunotherapy significantly increased the survival of mice with malignant brain tumors. They went on to test a variety of different immune-boosting genes in a variety of different cancers. This fall, the group will launch the first phase I clinical trial testing one of these designer measles viruses (in this case, carrying the gene for NAP, a protein that activates white blood cells) in patients with metastatic breast cancer.

One question future trials will address is whether the immune response awakened by the virus can in turn make conventional methods more effective. “There have been case reports where patients didn’t experience much success with chemotherapy or radiation, but after they received virotherapy, those same treatments suddenly became effective,” said Dr. Galanis. “Plus, similarly to other immunotherapy strategies, we have found that even if patients progress, they can live much longer than we otherwise would have expected.”

For her part, Rene Maleski responded remarkably well to the measles virus. However, a few months after she finished the trial, her CA125 values crept back into the danger zone. “It was extremely frustrating,” she said. “I would have kept taking the virus if I could, but the FDA limited study treatment to six months in this trial.” Instead, Maleski is undergoing more rounds of chemotherapy, which are working better than ever before. At last count, her CA125 was 11.

Though it is too early to tell, virotherapy may one day serve not only as an adjunct but also as an alternative to current treatments. Compared to the ravages of chemotherapy and radiation, Maleski said the side effects of virotherapy were “nothing.” The only complaint she had was a day or two of bloating; other patients have experienced cold-like symptoms, such as a low-grade fever or headache. Thus far, most participants of virotherapy trials have had more advanced disease, but Dr. Galanis would to like test the approach in people earlier in their treatment course to determine if it could also improve their quality of life as compared to chemotherapy. The program is currently running a randomized phase II trial in recurrent ovarian cancer patients that compares the measles virus side by side with chemotherapy.

Dr. Galanis believes that ongoing virotherapy trials could result in a number of different viral therapy products being approved for cancer treatment over the next three to five years. “Our goal is, of course, to eventually increase the likelihood of cure for patients with cancer,” she said. “So, it's a long road ahead of us, but I feel we have come a long way also, and so in this context I am quite optimistic.”

The FDA has already approved the first virotherapy, the drug Imlygic, to treat late-stage melanoma on the skin and lymph nodes. The NIH’s database ClinicalTrials.gov currently lists more than 75 clinical trials, testing a menagerie of engineered oncolytic viruses including measles, herpes, vesicular stomatitis virus, adenovirus, HIV, and smallpox. Given the chance, Maleski said that she would wholeheartedly sign up for another infusion of virus.

“These trials, they offer options. They offer hope.”

- Marla Vacek Broadfoot, June 2017

The post Enemy of My Enemy appeared first on Mayo Clinic News Network.

ANSWER: Mesothelioma is a rare type of cancer, with about 3,000 new cases reported each year in the United States. It is much less common than lung cancer. Unlike lung cancer, mesothelioma does not start within the lung tissue. It arises from the mesothelium that forms the outside lining of the lung, also called the pleura; however, mesothelioma may spread into the lungs. Rarely, it can also arise from the lining of the abdominal cavity or other internal organs. The exact cause is unclear, but there appears to be a strong association between exposure to asbestos and mesothelioma. The most common treatment for mesothelioma is chemotherapy, but a combination of different therapies can be used. Research investigating possible new treatment options is underway.

The most significant risk factor for developing mesothelioma is asbestos exposure. Asbestos is a fibrous mineral that’s found naturally in the environment. Asbestos fibers are strong and heat resistant, making them useful in a wide variety of products, including building insulation and flooring.

When asbestos is broken up, such as during the mining process or when removing asbestos insulation, it can create dust. If you inhale or swallow the dust, the asbestos fibers settle in your lungs or stomach, where they can cause irritation that may lead to mesothelioma. Exactly how this happens isn’t understood. It can take up to 30 to 40 years or more for mesothelioma to develop after asbestos exposure.

Unfortunately, there is no screening test for mesothelioma at this time. Most patients seek medical attention when symptoms such as shortness of breath and chest pain develop. These symptoms often don’t appear until the disease is in its late stages. At that point, treatment options are limited. Unfortunately, people with mesothelioma are rarely cured of the disease. The goal of treatment typically is to control the disease as long as possible.

For most patients with late-stage mesothelioma, treatment involves chemotherapy. More aggressive treatment options combining surgery with chemotherapy and radiation are limited to people who have early-stage mesothelioma and who can tolerate these therapies.

For those who can tolerate it, the goal of surgery is to remove all visible disease: a complex and difficult task. In addition, the benefits of surgery depend heavily on being combined with chemotherapy and radiation therapy. Many people have trouble with that due to the side effects from those treatments. Despite using a variety of treatments, long-term survival remains low for patients with mesothelioma, with a five-year survival rate between 5 and 10 percent.

People diagnosed with mesothelioma may benefit from receiving care delivered with a team approach. Those teams often include lung physicians and lung surgeons, physicians who specialize in cancer care, pathologists who work with the lab tests and experts in imaging exams. The goal of the team approach is for the group to work together to identify the best possible treatment options for each patient.

A considerable amount of research currently is exploring possible new treatment options for mesothelioma. For example, researchers at Mayo Clinic are working on a clinical trial that uses the measles virus to fight mesothelioma, as has been done with other hard-to-treat cancers such as multiple myeloma. Although the research is still in its early stages, investigators have seen interesting responses to potential new therapies and are optimistic that treatment for mesothelioma can be improved. — Tobias Peikert, M.D., Pulmonary & Critical Care Medicine, Mayo Clinic, Rochester, Minn.

The post Mayo Clinic Q and A: Asbestos exposure a significant risk factor for mesothelioma appeared first on Mayo Clinic News Network.

Here's the podcast: MayoClinicRadio 02 07 15 podcast

Myth or Matter-of-Fact: Having my child vaccinated protects other children as well.

To listen to the program at 9 a.m. Saturday, February 7, click here.

Follow #MayoClinicRadio and tweet your questions.

Mayo Clinic Radio is available on iHeart Radio.

Mayo Clinic Radio is a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

To find and listen to archived shows, click here.

The post Mayo Clinic Radio: Measles/Women’s Heart Health/Skin Problems appeared first on Mayo Clinic News Network.

This Saturday, December 20, at 9 a.m. CT, we'll discuss a less invasive way to test for colon cancer, talk about research that led to using the measles vaccine to fight cancer and the discovery of using stem cells to unravel the mysteries of ALS. We'll also talk about robots that help diagnose patients suffering from stroke of concussion. There are a lot of wonderful medical discoveries to share from 2014 that are leading the way into the future of health care.

Follow #MayoClinicRadio and tweet your questions.

To listen to the program on Saturday, click here.

Mayo Clinic Radio is available on iHeart Radio.

Listen to this week’s Medical News Headlines:  News Segment December 20. 2014 (right click MP3)

Mayo Clinic Radio is a weekly one-hour radio program highlighting health and medical information from Mayo Clinic. The show is taped for rebroadcast by some affiliates.

For a look at future program topics, click here.
To find and listen to archived shows, click here.

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Here's the podcast: MayoClinicRadio-FullShow-12-1-14

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On Saturday, November 29, at 9 a.m. CT, we’ll rebroadcast a conversation with two of our favorite guests this year - Stacy Erholtz and  Stephen Russell, M.D..  Stacy's been involved in groundbreaking research at Mayo Clinic led by Dr. Russell, which uses the measles virus to fight cancer. Stacy shares her story about receiving 10 million doses – a seemingly lethal amount – of the measles virus to treat her multiple myeloma. It's called oncolytic virotherapy, and Dr. Russell discusses the science behind virus therapy. He talks about where future research might be headed, are there other diseases that could be cured by using viruses and where did all those doses of measles vaccine come from?  Join us. 

WATCH this video to learn more:

Follow #MayoClinicRadio and tweet your questions.

To listen to the program on Saturday, click here.

Mayo Clinic Radio is available on iHeart Radio.

Listen to this week’s Medical News Headlines: News Segment November 29, 2014  (right click MP3)

Mayo Clinic Radio is a weekly one-hour radio program highlighting health and medical information from Mayo Clinic. The show is taped for rebroadcast by some affiliates.

For a look at future program topics, click here.
To find and listen to archived shows, click here.

The post MAYO CLINIC RADIO appeared first on Mayo Clinic News Network.