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By Nancy Lapid, Health Science Editor

Welcome to Health Rounds! A minimally-invasive endoscopic procedure is helping patients with type 2 diabetes eliminate their need for insulin, as we describe below. We also report on a multi-pronged pre-surgery wellness program in Canada that benefits women with a new breast cancer diagnosis, and a new approach to gene editing that holds the promise of making it more efficient. .

In breaking news, see these stories from our Reuters journalists:

One-third of U.S. nurses plan to quit profession; Australia to ban recreational vaping; and the U.S. is ending its COVID vaccine requirements for foreigners and federal workers.

In industry updates, we have first-quarter results from Pfizer, Incyte, Amplifon, Stryker and AmerisourceBergen, plus reports on Gilead’s HIV drug patent trial and Elanco's new parvovirus antibody.

An experimental minimally invasive upper-GI procedure has allowed people with type 2 diabetes to stop taking daily insulin injections and switch to once-weekly injections of semaglutide. Reuters/George Frey.

An experimental minimally invasive procedure that resurfaces the first 8 or 9 inches (23 cm) of the small intestine is allowing some patients with type 2 diabetes to stop taking insulin, according to findings from a small study.

The treatment destroys cells in the mucosa, or lining, of the duodenum. When the mucosa regenerates with healthy new cells, the body's response to its own insulin from the pancreas improves, researchers found.

At Amsterdam University Medical Center, 14 patients underwent an hour-long endoscopic procedure during which alternating electrical pulses were delivered to the duodenum using equipment manufactured by study sponsor Endogenex Inc.

Patients went home the same day and followed a calorie-controlled liquid diet for two weeks, after which they began taking Novo Nordisk's once-weekly Ozempic (semaglutide).

One year later, 86% were still maintaining good blood-sugar control with weekly semaglutide and without insulin, senior researcher Dr. Jacques Bergman said at a news conference. His team will present the data at the Digestive Disease Week conference in Chicago next week.

Another company - Fractyl Health - is already testing its duodenal ablation equipment in later-stage trials. Its Revita DMR System is commercially available in Germany.

Bergman said Fractyl's technology uses heat and results in patchy, uneven resurfacing of the mucosa, whereas the Endogenex procedure is non-thermal and achieves a more homogenous effect. He expects a randomized control trial with the Endogenex tools to begin soon.

Duodenal ablation "improves patients' sensitivity to their own insulin," Bergman said.

Insulin resistance is the root cause of type 2 diabetes, he noted. As type 2 diabetes becomes more advanced and the pancreas produces less and less insulin, the procedure is less likely to work, he added.

Dr. Loren Laine of the Yale School of Medicine, who moderated the news conference, said controlling diabetes with a single endoscopic treatment "is going to be incredible, if it does pan out in clinical trials."

Women with a new diagnosis of breast cancer who must undergo chemotherapy before surgery may benefit from a pre-operative "prehabilitation" program, researchers reported at the annual meeting of the American Society of Breast Surgeons in Boston.

At Sunnybrook Health Sciences Center in Toronto, 72 women undergoing chemotherapy before planned surgery for stage 1, 2 or 3 breast cancer were randomly assigned to receive usual care, or to participate in a program involving aerobic and resistance exercises, nutritional counseling sessions, smoking cessation counseling with free nicotine replacement therapy, and stress management with guided meditation and help from a psychologist.

At the end of their chemotherapy course and during six months of follow-up, patients in the prehabilitation group reported significantly less fatigue, better walking capacity, and better quality of life, study leader Dr. Frances Wright said at a news conference.

The main aim of the study was to assess the feasibility of such a program, and a larger study is needed to determine efficacy, she said.

Meanwhile, a nonprofit organization is going to offer the program virtually throughout Canada for women who wish to participate, she said.

Read more about breast cancer on Reuters.com

• Novartis buoyed by trial success in early-stage breast cancer
• FDA mandates breast density information with mammography results

A new approach to genetic engineering of cells will allow for improved treatments for cancers and other diseases, scientists predict.

The CRISPR-Cas systems, for which the 2020 Nobel Prize in Medicine or Physiology was awarded, are already used for editing genes. But their use in modifying patients' cells to make cell-based therapies has been limited, in part because CRISPR-Cas gene-editing molecules can be hard to get into cells and then into their DNA-containing nuclei.

At the Perelman School of Medicine at the University of Pennsylvania, researchers have found that protein fragments, or peptides, used by some viruses to help them infect cells can also be used to carry CRISPR-Cas molecules into cells and their nuclei with nearly 100% efficiency and low cellular toxicity, according to a report in Nature Biotechnology.

The scientists say they expect their new "Peptide-Assisted Genome Editing (PAGE) CRISPR–Cas system" to be particularly useful for modifying cells from a patient's body to make cell therapies. They hope, for example, to be able to more efficiently remove T cells from a patient's blood and reprogram the immune system components to find and attack cancer cells when reintroduced to the bloodstream.

The researchers say their PAGE approach could see wide application in basic scientific research, helping "foster the next wave of genome engineering."

Read more about CRISPR on Reuters.com

• Vertex/CRISPR's gene editing therapy cost effective at $1.9 million
• Sherlock Bio to buy UK firm in quest for CRISPR-based handheld diagnostic tests

This newsletter was edited by Bill Berkrot.

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