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Saturday, January 15, 2011

Life Expectancy For Today's Youth Cut Short By Obesity

For the first time in history, the next generation will not live longer, or even as long, as their parents.

"Diseases such as Type II diabetes, high blood pressure, heart conditions and joint deterioration - what were once considered 'adult' diseases - are regularly being diagnosed in children, due to the prevalence of obesity," said Jessica Bartfield, MD, internal medicine and medical weight-loss specialist at Gottlieb Memorial Hospital, part of the Loyola University Health System.

"What is particularly tragic is that studies have suggested that obesity in children today may contribute to a 2-5 year decline in their life expectancy, shorter than that of their parents, due to obesity related diseases that are largely preventable," said Dr. Bartfield, who is part of Gottlieb's medically supervised weight-loss program involving physicians, nutritionists, exercise physiologists and behavioralists.

She says the causes are "multifactorial, including environment and culture." Genetics and parental weight status also plays a role.

"If one parent is obese, a child has a 50 percent likelihood of being obese, and if both parents are obese, that skyrockets to 80 percent likelihood," she said.

Research by the Center for Disease Control found that 80 percent of obese children between the ages of 10-15 continue to be obese at age 25. Furthermore, the earlier obesity develops in children, the more severe it tends to be as an adult.

In addition to health implications, there are psychological and social damages as well.

"In addition to decreasing years of life, obesity decreases the quality of life through social ostracism, bullying, social isolation, and poor self-esteem which can lead to poor performance in school, in jobs and in life," she said.

Top Five Ways We Can Reverse The Obesity Trend

1 - Parents take charge. "Focus on getting the family healthy, not putting someone on a diet," she said. "Monitor and take accountability for what the family is eating. Plan meals, set limits and take the team approach."

2 - Involve the Kids. "As a family, create a weekly meal plan, look up calorie counts, make a grocery list, read product labels, choose fresh rather than packaged and get everyone's participation," said Dr. Bartfield. "Everyone has to get on board to be successful."

3 - Add fresh fruits and vegetables. "Replace applesauce for oil in baked goods, add carrots, broccoli and kale to soups and omelettes, cut up fresh fruit as a side dish," said Dr. Bartfield. "Even if it is dipped in low-calorie whipped topping or low-calorie salad dressing (moderately) to make the fruit or vegetable more appealing to kids."

4 - Cut liquid calories. "Soda, flavored and full fat milk, fruit punches and fruit -flavored beverages are loaded in sugar and empty calories," says Dr. Bartfield. "Substitute 2 percent for whole milk, or skim for 2 percent, and try adding water, seltzer or club soda to juices to cut calories."

5 - Prioritize breakfast and keep meals consistent. "Eating within the first hour of waking up powers the brain and jump-starts the metabolism for the rest of the day," said Dr. Bartfield. "Choose protein and fiber in breakfast foods to boost endurance." Establish set meal times, and calories per meal, and stick to them, with defined healthy options for snacking.

Keeping It Real

"In overweight children with medical complications or obese children, strive for a one-pound individual weight loss per month," said Dr. Bartfield, who uses guidelines by the American Academy of Pediatrics. "Focus on weight maintenance for overweight kids without medical complications. As kids continue to grow in height, their percentage Body Mass Index (BMI) on the growth chart will decrease."

Illinois Is At-Risk

Dr. Bartfield practices in Chicago, a city whose youth population has increased in obesity. "Most recently, data from 2007 National Survey of Children's Health found Illinois to have the 4th highest rate of child obesity in the nation 1 out of every 5 children is obese. In particular, our children entering schools in Chicago (age 3-7) have about double the rate of obesity as the national average of similar aged kids."

Source: Loyola University Health System

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Feast Or Famine; Researchers Identify Leptin Receptor's Sidekick As A Target For Appetite Regulation

A study by researchers at Mayo Clinic's campus in Florida and Washington University School of Medicine adds a new twist to the body of evidence suggesting human obesity is due in part to genetic factors. While studying hormone receptors in laboratory mice, neuroscientists identified a new molecular player responsible for the regulation of appetite and metabolism.

In the Jan. 11 online issue of PLoS Biology, the authors report that mice engineered not to express the lipoprotein receptor LRP1, in the brain's hypothalamus, began to eat uncontrollably, growing obese as well as lethargic. They found that LRP1, a major transporter of lipids and proteins into brain cells, is a "co-receptor" with the leptin receptor meaning that both the leptin and LRP1 receptors need to work together to transmit leptin signals.

Leptin decides whether fat should be stored or used, resulting in lethargy or energy. When working properly, the hormone, which is made when body cells take in fat from food, travels to the brain to tamp down appetite.

"If a person is born with too little gene expression in the leptin pathway, which includes its receptors, or the circuitry is not functioning well, then leptin will not work as well as it should," says the study's lead investigator, neuroscientist Guojun Bu, Ph.D., of Mayo Clinic. "Appetite will increase, and body fat will be stored."

Given these results, Dr. Bu says it may be possible to develop a treatment that increases gene expression in one or both of the protein receptors, which then increases the messages meant to decrease appetite sent to the brain.

The serendipitous findings were born out of Dr. Bu's primary research focus, Alzheimer's disease. He has been studying how cholesterol, essential to the smooth functioning of neurons, is carried from star-shaped astrocytes to the surface of neurons by apolipoprotein E (APOE). There are two major receptors for APOE on brain neurons, and LRP1 is one of them.

Inheriting one version of APOE APOE4 is a known risk factor for development of Alzheimer's disease, and Dr. Bu has found that APOE4 is less effective at transporting cholesterol. To understand what role LRP1 plays in bringing APOE4 into neurons, he created a knockout mouse model with no expression of LRP1 in its forebrain neurons; the rest of its body expressed the receptor normally.

He found neurons lacking LRP1 had even less ability to absorb cholesterol, and that they lost synaptic contact with other neurons, impairing their ability to retain memory.

But Dr. Bu was surprised to find the mice suddenly gained weight. "This is the opposite of what had been observed in mice who did not have the receptor in their body fat cells," he says. "Those animals became skinny because they couldn't absorb enough lipoproteins."

The knockout mice were indistinguishable from control mice for the first six months of life but then gained weight rapidly, a phenomenon that correlated with a decrease in LPR1 expression in the central nervous system. At 12 months old, the genetically engineered mice had twice as much body fat as control mice, lacked energy, and were insulin resistant. "Together, these results indicate that LRP1, which is critical in lipid metabolism, also regulates food intake and energy balance in the adult central nervous system," Dr. Bu says.

The study was funded by the National Institutes of Health and the Alzheimer's Association.

Source: Mayo Clinic

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Compulsory Nutritional Information In Menus Makes No Difference To Calorie Intake

You would have thought that forcing restaurants to list nutritional information in their menus would make people more careful about what they ate - apparently it makes no difference at all. In January 2009, King County, Washington, USA, made it compulsory for fast food outlets with 15 or more locations to disclose nutritional data on their menus, including calorie information.

Authorities at King County, which includes the city of Seattle, said their intention was to try to address the rise in obesity rates in the area.

Scientists from the health department of Seattle and King County, as well as some from Duke-National University of Singapore gathered information on purchasing behavior of Taco Time customers in the area. They found that after 13 months of mandatory menu labeling, people's purchasing habits had not changed at all.

Sales value and average calories for each transaction were not affected by the measure, the authors wrote.

Lead author Eric Finkelstein, Ph.D., said:

"Given the results of prior studies, we had expected the results to be small, but we were surprised that we could not detect even the slightest hint of changes in purchasing behavior as a result of the legislation. The results suggest that mandatory menu labeling, unless combined with other interventions, may be unlikely to significantly influence the obesity epidemic."

Federal authorities are planning to make all fast-food chains with at least 20 outlets include nutritional data on all their menus. The researchers wonder whether this may be a mistake.

Coauthor Kiersten Strombotne of Duke-NUS, said:

"However, it may be that detailed nutritional information is not the best way to convey the health content of fast foods. For example, if you know a store offers diet and regular soda, does showing how many calories are in regular soda really offer any relevant information? Those who want a lower calorie drink already know to drink the diet soda."

Before mandatory labeling was introduced, Taco Time already had a "Healthy Highlights" logo option on its menu, something which may have undermined the impact of the county's health drive, Finkelstein suggested.

Finkelstein said, said:

"A simple logo identifying which foods are healthiest may be all it takes to convey that information to those consumers who wish to choose a healthier alternative. The additional information appears not to have made a difference."

After the Nutrition Facts Panel was required nationally for pre-packaged foods, obesity continued growing in the USA regardless, Finkelstein pointed out.

Additional studies are needed to find out which sources of information might have the biggest impact on consumer decisions towards healthier eating.

Source: American Journal of Preventive Medicine (Citation to come)

Written by Christian Nordqvist
Copyright: Medical News Today
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Spanish Heart Risk Study Challenges Image Of Healthy Mediterranean Diet And Lifestyle

A Spanish study has challenged the long-held belief that people in the Mediterranean all enjoy more healthy diets and lifestyles, after discovering alarmingly high cardiovascular risk factors similar to those found in the UK and USA.

Research published in the January issue of IJCP, the International Journal of Clinical Practice, also found strong links between low levels of education and increased risk.

"Cardiovascular diseases account for 33 per cent of deaths in Spain, making it the main cause of mortality in the country" says Dr Ricardo Gómez-Huelgas from the Internal Medicine Department at Hospital Carlos Haya, Malaga.

The study was carried out on a random selection of 2,270 adults attending a healthcare centre in Malaga, Andalucia, a region with one of the highest rates of cardiovascular disease in Spain. The participants ranged from 18 to 80, with an average of just under 44 years, 50.3 per cent were female and 58 per cent had low educational levels.

More than 60 per cent were overweight or obese and 77 per cent did not get enough exercise. The researchers also found that 28 per cent smoked, 33 per cent had high blood pressure, seven per cent had diabetes and 65 per cent had high cholesterol levels.

Just under 30 per cent of the patients had three or more cardiovascular risk factors that could be modified by changes to their lifestyle or diet.

"Most of the cardiovascular risk factors increased with age, with the exception of smoking and low levels of 'good' cholestererol, and we noted some differences between the sexes" says Dr Gómez-Huelgas.

"We also found that a low education level was associated with a high prevalence of cardiovascular risk factors and this association was significant when it came to smoking, obesity, abdominal obesity and high levels of fatty molecules.

"The prevalence of obesity, diabetes, high blood pressure and high cholesterol in Spain have all risen at an alarming rate over the last 20 years and this is likely to cause future increases in bad health and death due to cardiovascular disease."

Other key findings of the study include:

* Men had a higher prevalence of smoking, high blood pressure, high levels of fatty molecules and impaired fasting glucose - which can lead to diabetes - than women.

* Women were more likely to demonstrate a higher prevalence of physical inactivity and abdominal obesity. Young female smokers with sedentary lifestyles were a particular concern.

* Obesity increased with age - 84 per cent of people over 50 were overweight or obese and 82 per cent had abdominal obesity, compared with 61 per cent and 56 per cent for the study as a whole.

"Our findings are cause for concern" says Dr Gómez-Huelgas. "We found high rates of obesity, abnormal lipid and fat levels and hypertension in the study group. And the high rates of smoking and sedentary lifestyles in young women raises fears for a large increase in cardiovascular deaths in this group in the near future. There are also issues around public health messages for people with lower education levels who tend to have higher risk factors.

"The drive to reduce cardiovascular disease by tackling these risk factors poses a real challenge for the healthcare profession. We hope that our findings can help to reduce risk factors among the most vulnerable sections of the community."

"The study by Dr Gómez-Huelgas and colleagues challenges the belief that cardiovascular disease, one of the fastest growing diseases in the developing world, is more likely to affect the chilly north than the sunny south" says Dr Anthony Wierzbicki, a London-based Consultant in Metabolic Medicine.

"In fact, the risk levels found in this study show parallels with the USA and are worse than those reported by recent UK studies.

"The myth that the Mediterranean diet and lifestyle is so healthy is based on 40-year old data from rural areas and so much has changed during those four decades. Studies like this are invaluable because they identify those people most at risk and provide valuable information that helps us to improve both screening and prevention strategies."

Paper: Prevalence of cardiovascular risk factors in an urban adult population from southern Spain. IMAP study. IJCP, the International Journal of Clinical Practice. Gomez-Huelgas et al. 65.1, pp 35-40. (January 2011). DOI: 10.1111/j.1742-1241.2010.02543.x

Editorial: Cardiovascular screening: which populations, what measure of risk? Wierzbicki A. IJCP, the International Journal of Clinical Practice. 65.1, pp 3-5. (January 2011). DOI: 10.1111/j.1742-1241.2010.02566.x

Source: Wiley-Blackwell

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Friday, January 14, 2011

Parents Are Key To Getting Children To Turn Off Television

With the U.S. national goal of ending childhood obesity within a generation, experts worldwide are looking for ways to keep children active and away from the television.

According to a study entitled "Movement Skills and Physical Activity in Obese Children: Randomized Controlled Trial" published this month in Medicine & Science in Sports & Exercise®, the official scientific journal of the American College of Sports Medicine, parents who employ a physical activity and/or dietary intervention can reduce their overweight child's screen time by nearly one hour per day.

Researchers at the Universities of Wollongong and Newcastle in Australia studied the effects of three intervention strategies - a physical activity skill development program, a dietary modification program and a combination of the two - on 165 Australian children. All participants were between ages five and nine and were classified as overweight.

In addition to monitoring the children's body mass index, diet, exercise and skill proficiency during the study, researchers also tracked the children's screen behaviors, which comprise time spent watching television or DVD programs, playing electronic games and using the computer or Internet for fun.

At the end of the study period, children in all three intervention groups reduced their daily screen time by, on average, 55 minutes after six months and 39 minutes after one year. However, children in the dietary modification program were the only ones unable to maintain their screen time reduction after six months. Although this group reduced their daily screen time by 65 minutes after six months, they gained back more than half of this time after one year. One possible explanation for this, researchers suggest, could be a lack of targeted parental support related to screen time in the dietary modification group.

"In the physical activity skill development program (which was also included in the combination group), we targeted screen behaviors directly through a single behavior-change session with parents and follow-up telephone calls during the six month program," said Dylan Cliff, Ph.D., the lead author of the study. "The findings suggest that parental support could be the missing piece to help overweight children change their screen time behaviors."

A study released in 2010 by The Henry J. Kaiser Family Foundation found that U.S. youth ages eight to 18 spend an average of seven hours, 38 minutes each day using entertainment media such as a television and computer.

"It's a logical connection - the more time a child spends each day in sedentary behaviors, like in front of the computer or television, the less time they have to be active," said Cliff. "The results of our study indicate that with appropriate parental support, a physical activity and/or dietary intervention program can successfully help overweight children turn off the television, be more active and achieve a healthier weight. The ultimate goal for all of us is a healthier generation of children."

ACSM and the Physical Activity Guidelines for Americans recommend that children and adolescents participate in at least one hour of physical activity each day.

Source:
American College of Sports Medicine

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Family, Friends, Social Ties Influence Weight Status In Young Adults

Does obesity tend to "cluster" among young adults? And if so, what impact does it have on both their weight and weight-related behaviors? That's what researchers from The Miriam Hospital's Weight Control and Diabetes Research Center set out to answer to better understand how social influences affect both weight status and weight loss intentions in this difficult-to-reach age group.

According to the study, published online by the journal Obesity, overweight and obese young adults between the ages of 18 and 25 were more likely to have overweight romantic partners and best friends and also had more overweight casual friends and family members compared to normal weight peers. Also, overweight and obese young adults who reported having social contacts trying to lose weight had greater weight loss intentions.

Why is this an important issue? Forty percent of young adults age 18-25 are considered overweight or obese, and young adults experience the highest rate of weight gain per year - typically one to two pounds - of any age group. While previous research has consistently demonstrated the powerful impact of social influence on health behaviors, especially for younger individuals, no previous study has examined whether social ties influence weight status and weight loss intentions among young adults.

Lead author Tricia Leahey, PhD, a researcher with The Miriam Hospital's Weight Control and Diabetes Research Center, also points out that young adults are less likely to participate in behavioral weight loss interventions, and when they do, they tend to lose less weight than older adults. "Identifying the factors that influence both weight status and weight control in this high-risk age group can help us develop appealing and effective obesity treatment and prevention programs for this population," she said.

The study included 288 young adults between the ages of 18 and 25; 151 individuals were of normal weight, while 137 were considered overweight or obese (BMI of 25 or greater). The majority of participants were female and Caucasian. All participants completed questionnaires to determine their weight and height, number of overweight social contacts (including best friends, romantic partners, casual friends, relatives and colleagues/classmates) and perceived social norms for obesity and obesity-related behaviors.

Overweight and obese study participants completed additional questionnaires to assess how many of their overweight social contacts were currently trying to lose weight, perceived social norms for weight loss (such as how frequently social contacts encouraged them to lose weight or whether the people closest to them would approve if they were to lose weight), and intentions to lose weight within the next three months.

Compared to normal weight young adults, those who were overweight or obese were more likely to have an overweight romantic partner (25 percent vs. 14 percent) and an overweight best friend (24 percent vs. 14 percent). "Our data suggests that obesity 'clusters' in this population. But interestingly, social norms for obesity did not differ between the two groups and did not account for the clustering," said Leahey. "Both groups reported similarly low levels of social acceptability for being overweight, eating unhealthy foods and being inactive."

The study also showed overweight and obese young adults who had more social contacts trying to lose weight were more likely to want to lose weight themselves. Social norms for weight loss, such as encouragement and approval from social contacts, account for this association, researchers say.

Leahey is also assistant professor of psychiatry/human behavior at The Warren Alpert Medical School of Brown University. The study was funded by grants from the National Institute of Diabetes and Digestive and Kidney Diseases. Co-authors included Rena Wing, PhD, Jessica LaRose, PhD, and Joseph Fava, PhD, all of the Weight Control and Diabetes Research Center at The Miriam Hospital and Alpert Medical School.

Wing is leading an innovative new study to help young adults avoid gaining the weight in the first place. The Study of Novel Approaches to Prevention (SNAP), funded by the National Institutes of Health, will compare two different behavioral approaches to weight gain prevention in 18- to-35-year-olds. One is focused on small lifestyle changes, such as walking an extra mile each day, while the other involves larger changes, like going on a periodic diet, as a buffer against future weight gain. For more information, please visit http://www.snapstudy.org.

Source:
Jessica Collins Grimes
Lifespan

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Thursday, January 13, 2011

Zafgen Announces Positive Topline Phase 1b Data For ZGN-433 In Obesity

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Main Category: Obesity / Weight Loss / Fitness
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Zafgen, Inc., a pharmaceutical company pioneering novel obesity therapeutics to help the body regain and sustain a lean, healthy state by targeting imbalances in fat metabolism, has announced positive topline results from its Phase 1b study of ZGN-433, a methionine aminopeptidase 2 inhibitor (MetAP2), for the treatment of severe obesity. The Phase 1b study met its primary and secondary objectives and showed that ZGN-433 at a dose of 0.9 mg/m2 was well tolerated and reduced body weight by a median value of 1 kg per week and 3.1 percent over 26 days relative to placebo in severely obese subjects. MetAP2 inhibitors work by re-establishing balance to the ways the body metabolizes fat, leading to substantial loss of body weight.

The results of the study also demonstrated a decline in hunger as well as meaningful changes in lipid parameters following treatment at 0.9 mg/m2. These changes included a 38 percent reduction in triglyceride levels and a 23 percent reduction in low-density lipoprotein (LDL) cholesterol levels (p<0.05). Additionally, beta-hydroxybutyrate, an indicator of fat oxidation, increased to levels seen with very low-energy diets. No treatment-related serious adverse events were observed. The data will be presented at the Keystone Symposia on Obesity in Keystone, Colo., on January 15, at 2:30 p.m. MST during the "Hot Topics in Obesity Therapy" workshop.

"These findings are significant as they show MetAP2 inhibition has the potential to drive impressive weight loss with excellent tolerability and favorable metabolic effects in severely obese individuals, and demonstrate that the preclinical pharmacology of ZGN-433 is translating well to human studies," said Thomas Hughes, Ph.D., president and chief executive officer, Zafgen, Inc. "The results show the magnitude of weight loss approaches the commonly recommended maximal rate of safe weight loss, which is exceeded only by gastric bypass surgery, duodeno-jejunal bypass liner and restrictive therapy. If sustained, the rate of weight loss would be consistent with a 6-9 month course of treatment in individuals requiring a 20-40 percent reduction in weight."

A double-blind, placebo-controlled multiple ascending dose study was performed to evaluate the safety and preliminary efficacy of ZGN-433 in reducing weight in severely obese females with a body mass index (BMI) between 32-45 with co-morbidities allowed. Twenty-four people were enrolled in the core study. The primary objective of the study was to evaluate the safety and tolerability, and determine the pharmacokinetics and pharmacodynamics of ZGN-433 in obese individuals. The secondary objective was to obtain information on weight loss in obese individuals exposed to eight intravenous doses of ZGN-433 administered over a four-week period. Patients were allowed to eat normally and were not counselled to exercise. Individuals received ZGN-433 or placebo twice weekly by intravenous administration over a four-week treatment period for a total of eight doses at three different dose levels (0.22, 0.65, and 1.96 mg per administration).

"ZGN-433 has the potential to be the first drug to produce weight loss approaching that of bariatric surgery," said Steven R. Smith, M.D., scientific director of the Translational Research Institute for Metabolism and Diabetes and professor at the Sanford-Burnham Medical Research Institute in Orlando. "Given the excellent tolerability and safety seen in this four-week study, the program shows early promise to provide a positive risk/benefit proposition. While the long-term safety and efficacy of the compound remain to be established, there is nothing in the industry drug pipeline this advanced that has shown this kind of efficacy. These early results are very encouraging, and there remains a significant unmet medical need for new obesity therapeutics that are both safe and efficacious."

"While Zafgen's understanding of the compound's mechanism of action has evolved significantly since the company's early days, MetAP2 inhibition for the treatment of obesity and diabetes appears to translate well across species," said Alan D. Cherrington, Ph.D., professor of medicine and molecular physiology and biophysics, Vanderbilt University, and former American Diabetes Association president. "These positive initial clinical and preclinical findings show that MetAP2 inhibitor actions point to utility for the treatment of severe obesity, and also show intriguing potential for use in broader indications related to control of glucose, lipid and cholesterol metabolism, including hepatic glucose intolerance, fatty liver and dyslipidemia."

Zafgen is pioneering novel obesity therapeutics to help the body regain and sustain a lean, healthy state by targeting imbalances in fat metabolism. Research has shown that fat metabolism differs between obese and lean individuals. Recent studies indicate that once a person becomes obese, the body undergoes certain changes and is "programmed" to make and store more fat. These metabolic adaptations that take place in obese people impair the normal release of fatty acids from adipose tissue and restrict the ability to stimulate formation of ketone bodies (a byproduct of the breakdown of fatty acids). Simultaneously, the body becomes much more efficient in diverting calories from food and storing them as fat.

About ZGN-433

Zafgen's lead compound, ZGN-433, is being studied as a pharmacological alternative to bariatric surgery for severe obesity. The company plans to initiate Phase 2a studies with ZGN-433 administered via subcutaneous injection in 2011. Zafgen is also developing new compounds suitable for oral administration for use in broader indications as part of its second generation program. ZGN-433 was initially developed by CKD Pharmaceuticals. The molecule was originally profiled for efficacy in the treatment of solid tumors. Zafgen holds exclusive worldwide rights (exclusive of Korea) for development and commercialization of ZGN-433.

About Obesity and Fat Metabolism

Obesity continues to be one of the world's most costly and underserved health issues. As such, there exists a tremendous unmet medical need for effective drug therapies to treat obesity, which has reached epidemic proportions and is growing at an alarming rate. According to the Worldwide Health Organization (WHO), the number of obese adults had increased to at least 400 million worldwide in 2005, with more than 700 million projected by 20151. If current trends continue, 103 million American adults will be considered obese by 20182. The U.S. is expected to spend $344 billion on health care costs attributable to obesity in 2018 if rates continue to increase at their current levels with obesity-related direct expenditures expected to account for more than 21 percent of the nation's direct health care spending in 20182.

Obesity leads to serious health consequences. As BMI increases, so does one's risk for chronic diseases such as cardiovascular disease, diabetes, musculoskeletal disorders and some cancers, compounding the urgency for new and effective treatment options1. Currently available weight loss treatments function by blocking fat absorption or signalling feelings of fullness or diminished appetite in the brain. These drugs are often associated with undesirable side effects and limited efficacy that fails to provide sustainable weight loss in many patients.

1 World Health Organization, http://www.who.int/mediacentre/factsheets/fs311/en/index.html

2 The Future Costs of Obesity: National and State Estimates of the Impact of Obesity on Direct Health Care Expenses, A collaborative report from United Health Foundation, the American Public Health Association and Partnership for Prevention, Based on research by Kenneth E. Thorpe, Ph.D. of Emory University, November 2009

Source: Zafgen, Inc.

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