A Small Helping For Australia

There’s an awful lot of very good things in Australia. Australians for a start. They’re just so kind, open, welcoming and accommodating it makes touring round this vast land a joy. Not merely do they cheerfully find a way to fix anything you want but they’re so polite that no one’s drawn attention to my resemblance to a scientific version of those reconstructed geriatric pop groups (viz the Rolling Stones or whatever) staggering round the place on their Zimmer frames. And they say wonderful things about my talks – that’s how charming they are!!

Greater bilgy

Greater bilby

Of course, you could say of Australia what someone once said of America and Britain: two nations divided by a common language. In the case of Oz you could also add ‘and by a ferociously competitive obsession with sport.’ So it’s wonderfully not home. Even Easter’s different in that here you get chocolate Easter bilbies rather than rabbits. Bilbies, by the way, are a sort of marsupial desert rat related to bandicoots. The lesser version died out in the 1950s so only the greater bilby is left (up to 20 inches long + tail half as long again) and you have to go to the arid deserts to find those. Not the choccy versions obviously: they don’t do too well in the deserts but they’re all over Melbourne:

Easter bilby

Easter bilby

shops full of ’em – and a lot bigger than the real thing. So, together with the egg avalanche, there’s no limit to the number of calories you can consume in celebrating the resurrection of Christ. Coupled with the glorious fact that there’s scarcely any mention of wretched soccer, all these novelties mean you’re never going to be lulled into thinking you’re still in dear old Blighty (or back in the old country as they delightfully put it here).

Hors D’Oeuvres

Even so there are some marked similarities to make you feel at home. One of the least striking is that most people are overweight. That is, I scarcely notice it, coming from what I regard as the global fat capital, i.e. Cambridge. The stats say that that’s not true, of course. The USA does these things better than the UK. Of course it does. But there’s not much in it. More than two-thirds of American adults are overweight and one person in three is obese. For the UK the prediction is that one in three will be obese by 2020. Currently in Australia 63% of the adult population is overweight, a figure that includes 28% who are obese.

The essential point is that there’s stuff all difference between those countries and the really critical thing is that the rates go on soaring. In the U.S. between 1980 and 2000 obesity rates doubled among adults and since 1980 the number of overweight adolescents has tripled. By 2025 one Australian child in three will be in the overweight/obese category.

Main course

The meat in this piece is provided by a report written by a bunch of Australian heavyweights – all Profs from Sydney or wherever. It has the droll title ‘No Time To Weight’ – do I need to explain that or shall I merely apologise for the syntax? ‘Oh c’mon!’ I hear our Aussie readers protest. ‘We’re going to hell in a handcart and you’re wittering about grammar. Typical b***** academic.’ Quite so. Priorities and all that. So the boffins’ idea is to wake everyone up to obesity and get policy-makers and parliamentarians to do something effective.No Time to Weight report

Why is this so important? Probably unnecessary to explain but obesity causes a variety of disorders (diabetes, heart disease, age-related degenerative disease, sleep apnea, gallstones, etc.) but in particular it’s linked to a range of cancers. Avid followers of this BbN blog will recall obesity cropping up umpteen times already in our cancer-themed story (Rasher Than I Thought?/Biting the bitter bullet/Wake up at the back/Twenty winks/Obesity and Cancer/Isn’t Science Wonderful? Obesity Talks to Cancer) and that’s because it significantly promotes cancers of the bowel, kidney, liver, esophagus, pancreas, endometrium, gallbladder, ovaries and breast. The estimate is that if we all had a body mass index (BMI) of less than 25 (the overweight threshold) there would be 12,000 fewer UK cancers per year. Mostly the evidence is of the smoking gun variety: overweight/obese people get these cancers a lot more often than lesser folk but in Obesity Talks to Cancer we looked at recent evidence of a molecular link between obesity and breast cancer.

Entrée (à la French cuisine not North American as in Main course)

Or, as you might say, a side dish of genetics. The obvious question about obesity is ‘What causes it?’ The answer is both complicated and simple. The complexity comes from the gradual accumulation of evidence that there is a substantial genetic (i.e. inherited) component. Many people will have heard of the hormone leptin, a critical regulator of energy balance and therefore of body weight. Mutations in the leptin gene that reduce the level of the hormone cause a constant desire to eat with the predictable consequence. But only a very small number of families have been found who carry leptin mutations and, although other mutations can drive carriers to overeating, they are even rarer.

However, aside from mutations, everyone’s DNA is subtly different (see Policing DNA) – about 1 in every 1000 of the units (bases) that make up our genetic code differs between individuals. All told the guess is that in  90% of the population this type of genetic variation can contribute to their being overweight/obese.

Things are made more complicated by the fact that diet can cause changes in the DNA of pregnant mothers (what’s called an epigenetic effect). In short, if a pregnant woman is obese, diabetic, or consumes too many calories, the obesity trait is passed to her offspring. This DNA ‘imprinting’ activates hormone signaling to increase hunger and inhibit satiety, thereby passing the problem on to the child.Preg Ob

So the genetics is quite complex. But what is simple is the fact that since 1985 the proportion of obese Australians has gone up by over 10-fold. That’s not due to genes misbehaving. As David Katz, the director of Yale University’s Prevention Research Center puts it: ‘What has changed while obesity has gone from rare to pandemic is not within, but all around us. We are drowning in calories engineered to be irresistible.’

Desserts

We might hope that everyone gets theirs but for obesity that’s not the way it works. The boffos’ report estimates that in 2008 obesity and all its works cost Australia a staggering $58.2 billion. Which means, of course, that every man, woman and child is paying a small fortune as the epidemic continues on its unchecked way. The report talks formulaically of promoting ‘Australia-wide action to harmonise and complement efforts in prevention’ and of supporting treatment. It’s also keen that Australia should follow the American Medical Association’s 2013 decision to class obesity as a disease, the idea being that this will help ‘reduce the stigma associated with obesity i.e. that it is not purely a lifestyle choice as a result of eating habits or levels of physical activity.’ Unfortunately this very p.c. stance ignores that fact that obesity is very largely the result of eating habits coupled to levels of physical activity. The best way to lose weight is to eat less, eat more wisely and exercise more.

In 2008 Australian government sources forked out $932.7 million over 9 years for preventative health initiatives, including obesity. This latest report represents another effort in this drive. Everyone should read it but, clear and well written though it is, it looks like a government report, runs to 34 pages and almost no one will give it the time of day.

The problem is that in Australia, as in the UK and the USA, all the well-intentioned propaganda simply isn’t working. As with tobacco, car seat belts and alcohol driving limits, the only solution is legislation, vastly unpopular though that always is – until most folk see sense. Start with the two most obvious targets: ban the sale of foods with excessive sugar levels (especially soft drinks) and make everyone have a BMI measurement at regular intervals, say biannually. Then fine anyone over 25 in successive tests who isn’t receiving some sort of medical treatment.

Amuse bouche

I know: I’ll never get in on that manifesto. But two cheers for ‘No Time To Weight’ and I trust the luminaries who complied it appreciate my puny helping hand from Cambridge. In the meantime, not anticipating any progress on a national front, I’m going to start my own campaign – it’s going to be a bit labour-intensive, one target at a time, but here goes!

The other evening I had dinner in a splendid Italian restaurant (The Yak in Melbourne: very good!). And delightful it would have been had I not shared with two local girls at the next table. One was your archetypal tall, slender, blonde, 25-ish Aussie female – the sort you almost feel could do with a square meal. Her companion of similar age was one of the dirigible models. (You’ll understand I wasn’t looking at them at all: I was with my life’s companion so no chance of that – but I do have very good peripheral vision. Comes from playing a lot of rugby). Each had one of the splendid pasta dishes on offer – but, bizarrely, they also ordered a very large bowl of chips. No prizes for guessing who ate all the fries. Miss Slim didn’t have one – not a single one! (OK, by now I was counting). Her outsize friend had the lot. How could she do that with a shining example of gastronomic sanity sitting opposite?

So c’mon Miss Aussie Airship: you know who you are. Let’s have no more of it. Obesity is not a personal ‘issue.’ Regardless of your calorie intake in one meal, your disgraceful behavior ruined a delightful dining experience for me, and quite possibly several other folk within eyeshot, upset the charming waitress and insulted The Yak’s excellent chef. Just think in future: there’s a place in life for chips – but it’s not with everything.

Reference

“Obesity: A National Epidemic and its Impact on Australia”

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A Very Odd Coincidence

UntitledOne of the great pleasures of swanning round giving talks on biology and stuff to anyone who’ll listen is meeting an amazing range of wonderful folk with a seemingly limitless number of interesting and clever questions, asked either at the end of a lecture or, quite often, when they queue up afterwards to raise personal points or chat about their own experiences. Wide-ranging though the topics are, there’s one word I can’t recall coming up even once. No surprise really. It’s a very rare disease, even though it’s a kind of sub-group of the lung cancers that kill more people every year than any other type – over one and a half million world-wide in 2012 when there were 23 new cases in every 100,000 people. In the USA the incidence is 38 per 100,000, in Australia it’s 27. The very rare form is called mesothelioma – that’s the one where there’s almost always a history of exposure to asbestos. Rarely mentioned though it is, mesothelioma came up after a lecture I gave last week in the sumptuous premises of the Union, Universities & Schools Club, just up the road from Circular Quay in Sydney, when a gentleman from the audience revealed that his wife had contracted the disease and described how he was seeking the next round of treatment options for her. He was kind enough to say that he was a follower of my blog but he hadn’t trawled sufficiently far back to track down a piece I wrote about a lady called Heather Von St. James. To my considerable embarrassment, I couldn’t on the spur of the moment recall what I’d called it (What’s it all about?  Serves me right for trying to be clever with titles: the idea of this one was convey Heather’s determination to have a life with her children and husband in spite of being dealt the really rough hand of mesothelioma). What is it all about? In contrast to the overall incidence figures for lung cancer, mesothelioma afflicts just under one white American in every 100,000, so it is indeed pretty unusual. The UK has the highest rate (top of something then!) but Australia comes second with 2.9 new cases of mesothelioma per 100 000. Since the early 1980s over 10,000 Australians have died from the disease and the rate is still rising. It’s predicted to start falling after 2020 but, even so, a further 25,000 Australians are expected to die from it over the next four decades, the majority being men. Now Sydney, as you may recall, is the largest city in Australia and it’s in New South Wales, so you might predict that, if you were going to run into mesothelioma anywhere outside the UK, Sydney would be the spot. But why? Well, NSW was the first state in Australia to mine asbestos and it produced the bulk of the chrysotile (white) and amphibole forms. Asbestos of whatever type is now classed as carcinogenic but it was not until the end of 2003 that the use of all forms of asbestos was banned in Australia. The hazard remains, however, because of the widespread use that had been made of asbestos for construction, both residential and commercial. The risk can be seen from the near doubling of mesothelioma incidence in NSW between 1987 and 2006, with an even bigger increase being seen in women – attributed largely to second-hand exposure. And the freaky happening? The very next day after my conversation at the Universities Club, and completely out of the blue, I received an email from Heather about what she describes as her ‘life’s mission to educate people about this deadly disease’. Having told the story, perhaps the most helpful thing I can do by way of supporting this remarkable lady is to spread the word of her initiative by advertising the web site.

A New Review!

Any author will tell you how incredibly difficult it is to get your books reviewed. When Betrayed by Nature came out I was lucky because it received a number of very good write ups (and no critical ones!). Even so, it’s still a case of the more the merrier and I’m delighted to include this recent one from Professor Richard Christopherson in Sydney – not least because new recruits to this blog may find it helpful if, for some inexplicable reason, they are hesitating about stumping up the trivial sum required to secure their very own copy!!

Review: The War on Cancer: Betrayed by Nature

There are not enough books written on Cancer, for the educated layman, as an undergraduate text, or as a review at the cutting edge for researchers.  The book written by Robin Hesketh caters to the first group and should increase community understanding of Cancer, a diverse collection of hundreds of different diseases caused by large numbers of mutations in different combinations.  We have all seen the headlines in newspapers and magazines, ‘Cancer Breakthrough’, and may have become tired of the way that journalists use this phrase.  Hesketh’s book provides excellent coverage of most of the basic issues that relate to Cancer, and should enable laypersons to assess what may be exaggerated claims by journalists.

As a Cancer researcher, I have freely provided interviews about my work and more general issues.  If the journalist does not offer to send me the proof of an article for checking before publication, I start to worry.  Books such as ‘The War on Cancer’ will help to provide balance in the community’s understanding of the significance of advances in Cancer research.  The book has simple diagrams that illustrate basic mechanisms that operate in Cancer, and some black and white photographs.  These historical pictures would have been better in colour, but the low cost of the book (US$28) ensures that the information is available for many readers.  Cancer is a major cause of death, and patients who wish to gain understanding of their disease could read this book.  The level of presentation is relatively simple, but the basic concepts as presented remain correct because Hesketh has been a Cancer researcher.

Prof Richard I. Christopherson

School of Molecular Bioscience

University of Sydney

Sydney, NSW 2006

Australia

A Visit to Bywong Road

Regular readers (how freely we use that expression!) will know we were due to depart for the Southern Hemisphere and so might guess from the title of this piece that we’ve at least got as far as Singapore. But actually we’re not as unworldly as you might suppose and in fact we’ve made it to beautiful Brisbane and even given the Global Leadership lecture that was the prime mover for the trip. And jolly good it was to be able to speak in The Customs House, a wonderful building that in 1889 when it was opened must have looked a bit like a cathedral – albeit dedicated to mercantile trade and the enlargement of the British Empire. Today it’s Corinthian columns are dwarfed by the constellation of fantastic skyscrapers that now make up downtown Brisbane – which makes it a really special place to step into. It was also a great privilege for me to talk to a full house that was so appreciative I think I was still answering questions two hours afterwards when the staff were on the point of carrying us outside to continue our discussions on Queen Street while they went home.

Customs House from the Brisbane RiverCustoms House from the Brisbane River

Even if you’ve never been to Australia you’ll know it’s a land of surprises and while I was still thinking nothing could upstage my evening in Customs House, next morning I found myself in front of 200 students at the QASMT school in Toowong, a delightfully hilly and leafy suburb of Brisbane. The somewhat daunting plan was to talk to them for an hour, persuading them that biology is fantastic and telling them a bit about cancer. Daunting hardly does it justice in that I’d never tried to keep that many school kids entertained before (not even when, for a mercifully short time, I was actually a teacher in Liverpool did I get confronted by classes of that size [as an historical aside, the first time I walked into a school classroom as a teacher I found before me 50 (exactly) nine year olds, of mixed ability and desperate backgrounds. So nowadays, with even the biggest UK class size being seemingly 30, the teaching game must be a doddle].

 4QASMT School, Bywong Road, Brisbane

My teaching experience could hardly be more different to what greeted me at the school on Bywong Road. Entry is via the school’s exam and they follow the International Baccalaureate (IB) Diploma Programme which means they teach a broad curriculum, albeit with a strong emphasis on science (their acronym stands for Queensland Academy for Science, Mathematics and Technology). The buildings are extensive, new, include (as their blurb puts it) university-standard science laboratories and, all told, provide a wonderfully attractive environment. However, what made my visit the highlight of Australia so far were the pupils. Favourable impressions are certainly helped by the Australian predilection for school uniforms and at QASMT all students are required to wear the Academy’s uniform. And very smart they look too. Without being regimented, they appear comfortable, neat and completely professional. I know that probably sounds like an old fogey talking but, if so, we have to conclude that there are a few of those determining school policy in Australia – and long may they prevail!

I’m not sure whether my 200 were entertained but boy were they attentive and full of great answers as we went along. After my main talk the head girl and boy made a delightful presentation after which – perhaps the best bit of all – I sat for an hour or so in the sunshine chatting to a charming and wonderfully polite group of boys and girls who were just full of interesting, thoughtful and clever questions.

I arrived at Bywong Road in a state of some trepidation but left marvelously uplifted, feeling much privileged to have spent a few hours in the world of these inspiring young Australians.

 

What Took You So Long?

A long, long time ago – 25 years to be precise – I was lucky enough to work for a few months at The University of New England in Armidale, up on the Northern Tablelands of New South Wales. And jolly wonderful it was too. You could see grazing kangaroos from my lab window and I got to play grade cricket! To anyone who’ll listen I can still describe in vivid detail the scoring of my first run in Oz. We’d won the toss and … (that’s quite enough cricket, Ed).

Equally wonderful is the fact that, in part courtesy of The University of Queensland, I’m going again to Oz – this time to do what I didn’t manage then: visit all the major cities. We begin in Brisbane this week giving a lecture in the U of Q’s Global Leadership series (yes really!), explaining the biology of cancer to an audience of largely non-scientists – at least I hope I’ve got the right brief! We end up in Perth in May having, in between if I can stick the pace, given a variety of talks and seminars to the general public, to schools and to cancer research institutes in Sydney, Melbourne and Adelaide. How good is that? Being invited to warble on about one of your favorite subjects whilst touring Oz? Wow!

What’s new?

All of which makes you think a bit about Father Time and what has happened in the interim. Answer quite a lot, of course. Collapse of communism, collapse and resurgence of Australian cricket (that’s your last warning, Ed) and so on but we’re supposed to inform and enthuse about cancer here so how’s that faired, particularly in Australia? Well, in the year I first followed Captain Cook (watch it, Ed) onto the shore of Botany Bay about 60,000 Australians were diagnosed with cancers of one sort or another and some 30,000 died from these diseases. At that time one in three men and one in four women would be directly affected by cancer in the first 75 years of life.

A Cook

Alastair Cook

And now? This time round the estimated numbers are 128,000 and over 43,000 with one in two men/one in three women discovering they have cancer by time they’re 85. All told, cancer accounts for about three in ten Australian deaths – much the same contribution as heart disease. To add to the gloom the numbers are going up not down so the prediction is 150,000 new cancer cases in 2020.

Not a lot and no surprise

Well, you may be thinking, no change there then – or even I told you so. After all, I’m forever in these pieces elaborating on current cancer stories holding forth about how slow is the progress of science: one step forward, two back, more of a shuffle than a step really, and so on. Or as Martin Schwartz more eloquently puts it, describing science as the art of productive stupidity – being ignorant by choice. This follows almost inevitably from the nature of research because working on what we don’t understand puts us in the awkward position of being ignorant. As Schwartz has it, one of the beautiful things about science is that it allows us to bumble along, getting it wrong time after time, and feel perfectly fine as long as we learn something each time. That’s why I keep telling you to ignore the “great breakthough” newspaper headline dribble – that’s just the hacks trying anything to persuade their editors to give them space to promote themselves.

But wait a mo.

All that sounds consistent with the signs that things in Oz have been going backwards at a rate of knots over the last 20-odd years. But hang on. As ever, bare stats can be a bit misleading (remember what Disraeli said). Thus although around 19,000 more people die each year from cancer than 30 years ago, this is due mainly to population growth and aging – Australian life expectancy has gone up by over four years since 1990 (it’s now 82). The death rate from cancers has fallen by more than 16% and the survival rate for many common cancers has increased by 30 per cent in the past two decades. So that’s great: terrific ad for living in Oz and something of a triumph for medical science.

A sunny side in Oz?

What’s more you can put a positive twist on even the gloomy side of the picture by noting that, if indeed there’s strength in unity, Australia’s trends are much the same as everyone else’s in what we like to call the developed world. Well sort of but there’s a serious negative for Australia Fair, as you might put it, something that sticks out like a sore thumb (or an itchy mole) when you glance at the stats. Between 1980 and 2010 the incidence of skin cancer has shot up in Australia by around 60%. The most common type is non-melanoma skin cancer – usually treatable as it generally doesn’t spread around the body. The nasty version is malignant melanoma – which does metastasize, although is essentially curable if caught before some of its cells escape from the primary site. And the really bad news is that it is now the third most common cancer in Australians and in those aged 15-44 years it is the most common cancer. In 2012, over 12,000 Australians were diagnosed with melanoma and it killed over 1,600. This disease is usually set off by ultraviolet light from sunlight (or sunbeds) damaging DNA (i.e. causing mutations) and you will not have missed the allusion to the fact that people with fair skin (or blue or green eyes/red or blond hair) are most at risk.So the current Oz figures are a bit of a blow to Richie Benaud’s campaign of which I made great play in Slip-Slop-Slap Is Not Enough.

220px-Melanoma_vs_normal_mole_ABCD_rule_NCI_Visuals_Online

ABCD rule illustration: On the left side from top to bottom: melanomas showing asymmetry, a border that is uneven, ragged, or notched, coloring of different shades of brown, black, or tan and diameter that had changed in size. The normal moles on the right side do not have abnormal characteristics (no asymmetry, even border, even color, no change in diameter).

Meanwhile in the lab?

It’s pretty sobering for me to reflect that it was only a few years before I went to Oz that the first human cancer gene (oncogene) was discovered. That was RAS, detected in human cancer cells in 1982 by Geoffrey Cooper at Harvard, Mariano Barbacid and Stuart Aaronson at the NIH, Robert Weinberg at MIT and Michael Wigler at Cold Spring Harbor Laboratory. Between then and 2003 several hundred more cancer genes were identified in a huge frenzy of molecular stamp collecting. Then came the human genome sequencing project and in its wake analysis of tumours on a scale and level of detail that is almost stupefying and would have been unimaginable before 2003. To appreciate the mountain of cancer data that has been assembled over that period, screen the literature data base for research papers that have ‘RAS’ in the title: that is, contain significant info relating to that gene. Answer: 76,000. That’s seventy-six thousand separate pieces of research that have made it through all the peer review and editorial machinery to see the light of day in print. And RAS, massive player though it is, is not the biggest. Do the same check for a gene called P53 and the number is: over 145,000!!

Confused? The plot so far …

First up we noted that the cancer burden in Oz has got a lot heavier over the last 25 years, then we reminded you that advances in science are of the snail-like variety – so you shouldn’t be surprised when things seem to go backwards. But, flipping to the other hand, we trotted out another set of figures saying things have actually got much better (life expectancy and cancer survival rates have steadily climbed). Though, switching hands again, melanoma’s gone through the roof. However, going back to the first hand, if we can still locate it, we noted the massive explosion in the facts mountain of cancer biology for which the blue touch paper was only lit about 25 years ago.

And your parliamentary candidate is …

What with all this sleight-of-hand, flip-flopping and U-turning, it occurs to me that I’m shaping up rather well as a prospective politician. I’m quite taken with the idea, especially as if I stood as an MP in my own constituency I’d be up against Andrew Lansley who, as you’ve probably forgotten, was once upon a time Secretary of State for Health. Being a virtuous and helpful soul, when Betrayed by Nature came out I sent him a copy as a gift, a freebie, – figuring that, as a career civil servant and politician who’d become responsible for the nation’s health, he might find it useful to read a basic primer on something that was killing 150,000 UK citizens every year. Thoughtful, you’d say? Indeed. Did I expect to find him on my doorstep next day gushing gratitude and thirsting for more knowledge? Maybe not, even though he only lives round the corner and we have actually met in the dim past. But at least one might have received a note – a one line email, perhaps – from his PA, who can scarcely be too busy to be polite. But no. Nothing. Zippo. So I came up with a brief sentence that summarised my take on this example of voter wooing, or indeed plain good manners, but I can’t remember it now – for the best perhaps. What is it the Bible says about getting narked? Something along the lines of “whoever says, ‘You fool!’ shall be liable to the hell of fire.”

So thank heavens we’ve side-stepped that but nevertheless, Andrew, it really would be a joy to give you a bloody nose – electorally speaking, of course – so let’s just give those credentials one more buffing. We started by lowering your expectations of science with the reminder that things proceed at a snail’s pace {you do realise that common analogy is very unfair on snails? Scientists have shown they can bowl along at a metre an hour (yippee, we do discover things!) – not much slower than your average supermarket trolley-pusher, but here’s the thing. Snail’s pace means they can get round the garden in one night. That’s the whole of their world covered in one go – without mechanical assistance!! Not so slow after all, eh?}. But the flip side is that the genomic era has already seen the development of a number of drugs that are effective against malignant melanoma. They’re not perfect but at least they take us a step further in dealing with this cancer once it has spread around the body.

And the message?

(That’s quite enough politics, Ed). OK. Let’s abandon a promising career and go back to being a scientist with a typically punchy summary. Australia’s wonderful but when it comes to cancer it’s not much different to any other rich country (not really a flip that, just a statement of fact). Folk are living longer so, of course, more of us will ‘get’ cancer but we seem to think that longevity buys us more time to smoke, booze, burn ourselves pink and eat crappy food. Medical science is doing wonders in detection and treatment: at nearly $400 million a year on cancer research, almost a quarter of all health research expenditure in Australia, it jolly well should. But if we don’t do more to help ourselves the cancer burden is going to overwhelm health resources not just ‘down under’ but all over.

Reference

Schwartz, M.A. (2008). The importance of stupidity in scientific research. J Cell Sci 2008 121:1771; doi:10.1242/jcs.033340