Blood rebirth: Over time, blood stem cells (shown in green) lose their ability to replenish blood. Researchers have discovered that exposing old mice to circulating blood from younger mice restores this ability.  Credit: Amy Wagers

A mysterious substance in blood rejuvenates blood-forming stem cells

MIT Technology Review, February 17, 2010, by Emily Singer  —  The antiaging power of blood might not be just the stuff of vampire stories. According to new research from Harvard University, an unspecified factor in the blood of young mice can reverse signs of aging in the circulatory system of older ones. It’s not yet clear how these changes affect the animals’ overall health or longevity. But the research provides hope that some aspects of aging, such as the age-related decline in the ability to fight infection, might be avoidable.

“At least some age-related defects are reversible, and the factors to reverse them are carried in blood,” said Amy Wagers, a researcher at the Harvard Stem Cell Institute and Joslin Diabetes Center, in Boston, at a press conference on Tuesday. Identifying those factors could lead to new strategies to boost resistance to infection, and perhaps a decrease in some cancers, she said.

In the experiment, Wagers and team surgically connected the circulatory systems of two mice, allowing older animals to be exposed to blood–and all the molecules and cells it carries– from young animals. They found that the procedure made the blood-forming stem cells in older animals act young again; the overall number of these cells decreased, and the cells generated different varieties of blood cells in more appropriate ratios. “In aged animals, many of the changes we see normally that are associated with age were reversed,” said Wagers.

The findings, published today in the journal Nature, and which follow similar results with muscle stem cells, also suggest that the regenerative capacity of stem cells is highly influenced by their environment, which could have both positive and negative implications for regenerative medicine.

As we age, our body loses its ability to regenerate different tissues. The circulatory system reflects this decline clearly–the number of blood-forming stem cells, which reside in bone marrow and generate all types of blood cells, increases. But these cells paradoxically lose their ability to repopulate the blood and generate cells in inappropriate ratios, creating too few immune cells, called B lymphocytes, and too many inflammatory cells.

One theory for aging is that our stem cells eventually wear out, thanks to intrinsic changes within the cells. While previous research supports this idea, findings from Wagers and others show that the age-related decline in stem cells is also influenced by external forces. For example, exposing skeletal muscle to blood-borne factors from young mice can restore the regenerative capacity of muscle stem cells.

The regenerative power of young blood appears to be mediated by osteoblasts–bone-forming stem cells previously shown to play a role in regulating blood-forming stem cells. Researchers found that osteoblasts from old animals can make blood-forming stem cells from young mice act old. And conversely, surgically exposing old mice to young blood rejuvenates aged osteoblasts, restoring their capacity to properly regulate blood-forming stem cells.

Researchers haven’t yet identified the mysterious molecule in blood that controls these aging effects. But insulin-like growth factor 1 (IGF-1), a hormone that has been shown to regulate longevity in a number of organisms, may play a key role. Researchers found that they could partially correct aging defects in osteoblasts by suppressing IGF-1. On the other hand, suppressing IGF-1 in muscle cells has the opposite effect, highlighting the complex role this molecule probably plays in aging.

It remains to be seen just what effect rejuvenating the circulatory system will have on the animals long-term. For example, scientists haven’t assessed whether older mice surgically exposed to young blood are more resistant to infection than their normal aged counterparts. “But there are lots of reasons to link changes in [the circulatory system] with changes in the immune system,” said Wagers. Older mice produce fewer lymphocytes, which respond to viruses and other pathogens. And they produce more myeloid cells, which tend to promote inflammatory conditions. “In a lot of tissues, you see an increase in inflammation that occurs with age,” said Wagers.

The research also has important implications for regenerative medicine, such as stem cell transplants. “Most effort has focused on how to make [replacement] cells,” says Linheng Li, a researcher at the Stowers Institute for Medical Research, in Kansas City, MO, who was not involved the study. “But we need to focus on making cells that function properly.” Blood-forming stem cells, for example, are made in great quantities with age. But those cells don’t work as well as younger ones. “It highlights the importance of the environment into which you transplant them,” said Wagers. “If you take young healthy cells, and put them into an old environment, you might not get the full regenerative benefit of the cells.”

© Andy Crump / Photo Researchers, Inc.

The paper:
M. Laflamme et al., “Cardiomyocytes derived from human embryonic stem cells in pro-survival factors enhance function of infarcted rat hearts,” Nat Biotech, 25:993–94, 2007. (Cited in 140 papers)

The finding:
Charles Murry and his colleagues at the University of Washington demonstrated that cardiomyocytes derived from human embryonic stem cells (hESCs) can help repair an infarcted rat heart. Murry’s team developed a novel protocol to guide all the hESCs to differentiate into cardiomyocytes, then exposed the cells to a prosurvival cocktail (PSC). “Our method worked 50-fold better than previous efforts at forming cardiac muscle,” says Murry. Ten percent of these cardiomyocytes survived, where none had survived in previous experiments.

The impact:
“This is the first study to demonstrate improved function following an infarct,” Dan Rodgers, a molecular biologist at the University of California, Berkeley, writes in an email.

The details:
To ensure hESCs differentiated into mature cardiomyocytes, the team treated the cells with two proteins (activin A and BMP4) that promote cell differentiation. The PSC consisted of six key ingredients, including use of a hydrogel called Matrigel and enhanced activity of a caspase inhibitor to prevent apoptosis.

The future:
The team recently started working on strengthening the approaches they’ve established with the PSC technique, such as creating better hydrogel agents to support cell survival.

Read more: Reviving hearts – The Scientist – Magazine of the Life Sciences http://www.the-scientist.com/2010/2/1/47/1/#ixzz0fjhKmgSL

The-Scientist.com, February 15, 2010, by Kai Simons MD/PhD   —  The picture of the lipid bilayer of cell membranes as a boring solvent for proteins has given rise to one that is much more dynamic, and which is revealing new mechanisms and targets for drug delivery.

When I was 11 years old, I stood with my brother outside the Institute of Advanced Study in Princeton waiting for Albert Einstein to come to work so that I could take his picture. My father, a professor of physics at the University of Helsinki, was spending a sabbatical at the Institute. There was Einstein, on the picture that still hangs in my office in Dresden, with his umbrella as always, even though the sun is shining.

I saw several famous physicists in our home in Helsinki. My dream was to become a physicist myself. But fortunately my father, a farmer’s son, was a practical man and when I asked him for advice concerning my career choice, he pointed out to me “Kai, I think you are not up to it. Why don’t you study medicine instead? Then you can do research and if you don’t like it, you at least have a profession!”

I followed his advice and have never regretted it. I began to study medicine, but inspired by the physical laws that define molecular interactions, I soon moved into biochemistry research. My MD/PhD research project in 1964 was concerned with vitamin B12 absorption. I purified intrinsic factor, the protein required for vitamin B12 uptake from the intestine, from a pool of 30 liters of human gastric juice. The real mystery was how the protein binding could facilitate vitamin B12 passage across the intestinal cell membranes. This work started my obsession with cell membranes that has persisted to this day.

During my postdoc in New York at the Rockefeller University, I met Finnish virologist Leevi Kääriäinen, who told me about the virus that he was studying, the Semliki Forest virus. This was exactly what I had been looking for—a simple membrane model. This virus stole its envelope from the plasma membrane of the host cell, in the process excluding all host membrane proteins and replacing them with the viral spike glycoprotein. After coming back to Helsinki, Leevi and I were joined by a lipid biochemist, Ossi Renkonen, forming a troika to study this virus membrane. What was absolutely unique at that time was that we included both lipids and proteins in the analysis. We demonstrated that the virus membrane contained the lipids of the host cell plasma membrane and embedded the viral spike protein in the lipid membrane so that the virus could exit from the host cell. The study not only gave us insight into basic viral biology, but offered an experimental system to study plasma membrane biogenesis in general.

That research gave me the entrance ticket to an international career. In 1975, I was invited by Sir John Kendrew to join the newly founded European Molecular Biology Laboratory (EMBL) in Heidelberg. We again formed a troika, this time with my two graduate students, Henrik Garoff and Ari Helenius . We continued the studies on Semliki Forest virus, now using the virus as a tool to study endocytosis and exocytosis in the host cell.1 This research became a textbook classic and explained how a membrane virus gets into and out of a host cell.

I left Semliki Forest virus to Ari and Henrik, and turned to a new experimental system—one with unique features that I thought could give us a better picture of how the cell membrane functioned. Some differentiated cells, like intestinal or kidney cells, are polarized. This means that they have two plasma membrane domains, apical and basolateral, with different proteins and different properties. How could a cell with freely moving lipids divide its surface and direct proteins—which were continually replenished and recycled—to the right place on the cell’s surface?

My obsession with cell membranes began when I was purifying intrinsic factor from 30 liters of human gastric juice.

The model that I was looking for to test this question was provided by the now famous epithelial MDCK cells that Enrique Rodriguez-Boulan and David Sabatini from New York University had shown to display polarized budding of viruses. They demonstrated that MDCK cells infected with influenza virus would release the viral progeny from the apical plasma membrane, while cells infected with vesicular stomatitis virus (VSV) would release viral particles from the opposite, basolateral side. This result was extremely exciting. Now I had a system where I could study how the cell sorted its proteins by tracking the movement of two viral transmembrane glycoproteins. Other researchers had shown that cells could not only sort proteins differentially, but lipids as well: for example, the apical membrane in intestinal epithelial cells was enriched in glycolipids. Perhaps this system would also shed light on lipid interactions during the membrane trafficking process—a totally unknown area at that time.

Lipid Raft Traffic
The components of a lipid raft, some of which are produced in the endoplasmic reticulum, begin to coalesce in the trans Golgi network. Raft membranes are enriched for cholesterol and sphingolipids and also contain clustering proteins and trans membrane proteins. Raft vesicles extruded from the Golgi traffic to the surface where they can separate into smaller raft compartments.

I geared up my laboratory for MDCK work and was joined by two fantastic postdocs, Karl Matlin and Gerrit van Meer. Karl was to study protein sorting and Gerrit would go for the lipids. However, setting up the cell cultures we discovered a major problem. We were growing the MDCK cells on plastic supports as Rodriguez-Boulan and Sabatini had done, but with precise assays we found that the cells were only partially polarizing. This meant that no quantitative biochemistry could be done, which was necessary if we wanted to understand the polarization process molecularly. I thought that I had embarked on a path leading nowhere. What a misery!

But then we struck gold. When we tried to grow the epithelial cells on porous nitrocellulose filters instead of plastic or glass, they took up their nutrients on the basal side—the side that is exposed to blood supply in the body. If the cells were to form a tight and fully polarized epithelial cell layer on plastic, they would starve to death. Instead, when cultured on plastic, the cells simply adjust their plasma membrane organization, and do not polarize their nutrient uptake mechanisms.

With the system finally set up, my two postdocs attacked the trafficking question. Karl showed that sorting of HA—an influenza membrane protein—occurs in the Golgi apparatus and the protein is directly delivered from there to the apical surface.2 Gerrit worked out quantitative methods to analyze lipid traffic to the polarized cell surface and demonstrated that a fluorescently labeled glycolipid was delivered with higher efficiency from the trans Golgi to the apical, than to the basolateral membrane.3 For the first time we had shown that polarized delivery of both proteins and lipids is initiated at the Golgi complex.

Pieces of the puzzle had come together: Not only proteins, but different classes of lipids were sorted at different concentrations to the apical or basolateral side of a polarized cell, and they were kept from mingling by tight junctions that created a belt around the cell and formed a gated seal between neighboring cells. We had discovered that this sorting occurred in the layer of the Golgi apparatus that was farthest from the endoplasmic reticulum. We named it the trans Golgi network.4 In 1988, we published an article postulating that glycolipids and apical proteins were linked to each other within the trans Golgi network.5 Together they would form transport carriers for delivery to the apical membrane. The concept that specific lipids called sphingolipids and proteins would associate with one another to function in membrane trafficking was totally new, and formed the basis of the raft concept that came to dominate my research.

Ten years later, with Elina Ikonen from the National Public Health Institute in Helsinki, I brought together all of the elements of the raft concept in a review in Nature in 1997.6 It drew from our observation of sphingolipid–protein assemblies in the Golgi as well as from other sources. Biophysicists using simple lipid model systems had demonstrated that cholesterol plays a key role in regulating how lipids within membranes separate into phases, or rafts, rather than diffusing evenly across the surface. We coined the term “raft” for the assemblies of specific lipids, proteins, and cholesterol, and summarized the evidence for their role as platforms for membrane trafficking, signaling and polarization. We proposed three major tenets: 1) the lipid bilayer was not just a homogenous solvent or carrier for membrane proteins, but that the make-up of the lipids regulates lateral cell membrane heterogeneity; 2) rafts are not fixed in size but have the capability to coalesce to form larger functional rafts with scaffolding proteins holding them together; and 3) rafts serve to dynamically compartmentalize the membrane into different “reaction chambers” that allow completely independent processes to occur side by side.

It was difficult to get this review published. One reviewer was vehemently against acceptance, stating that these ideas would set the field back for at least a few thousand person-years. I felt almost proud of my commanding influence. Fortunately, editor Annette Thomas overruled the objections.

One of the biggest problems of studying the molecular interaction of lipid membranes is that they are fickle and susceptible to the slightest changes. When using different microscopic methods on membranes in living cells, researchers have had to contend with the fact that, akin to the Heisenberg’s uncertainty principle, we can change the bilayer simply by observing it. For example, biochemical analysis requires that the membrane be solubilized before one can analyze its constituents by the usual analytical tools. This implies breaking many of the interactions that define membrane function. Nevertheless, technological advances have allowed the field to pick up speed in recent years.

In 2001, I moved from EMBL to found a new Max Planck Institute of Molecular Cell Biology and Genetics (MPI-CBG) in Dresden. With Joe Howard, Tony Hyman, Wieland Huttner, and Marino Zerial—a great team—as directors we have managed to build up a research environment that has attracted worldwide attention. One major focus of MPI-CBG is membrane research, a demanding area that depends on technological innovation. One approach we have taken is the development of lipidomics technology based on modern mass spectrometry that can quantitatively sample the thousands of lipid species making up our cell membranes. Another is imaging. This area has undergone a revolution in recent years and we have tried to capture it within our superb core facilities. A third is membrane biochemistry, including new methods to reconstitute membrane activities in the test tube, and technology to purify transport vesicles. This has allowed us to isolate a transport carrier involved in the raft pathway from the trans Golgi network to the cell surface. Together with Andrej Shevchenko we have characterized the lipidome and shown that raft lipids are enriched in the carrier vesicles.

Raft Targeting Drugs
We have developed a therapeutic approach that targets raft-bound proteins. The drug inhibits the activity of β-secretase, an enzyme that activates beta-amyloid, which plays a major role in Alzheimer’s disease. We designed the inhibitor with a sterol tail that is chemically attracted to cholesterol rich rafts, where it can inhibit amyloid cleavage directly at the vesicle.

When the raft concept was introduced, the idea that a multicomponent cell membrane might contain phases composed of different concentrations and combinations of lipids—that is, phase separation—was met with outright skepticism. Our lab recently demonstrated that lipid phases can indeed separate out within a plasma membrane. Daniel Lingwood developed a method to blow up the plasma membrane of A431 cells into “balloons” similar to giant unilamellar vesicles produced from simple lipid mixtures. These plasma membrane balloons, which contain thousands of protein and lipid species, separate into two types of micrometer-scale phases at 37°C. This separation is cholesterol dependent. One phase is enriched in raft proteins, whereas the other includes non-raft proteins. It was a totally unexpected finding, highlighting the inherent capability of the plasma membrane for phase separation,7 and raising questions about the evolutionary origins of phase separation.

It is my contention that a phase-separating capability was introduced early in evolution. It would have given primordial cells an easy way to generate organization within membranes. Since then, evolutionary pressure would have developed the complexity of this organizing principle, reflected in the capability for phase segregation. The Gibbs phase rule, proposed in the 1870s, states that the number of different phases should be close to the number of chemically independent components in the system. In an artificial three-component lipid system set up in the lab, two phases can be seen, as predicted by the rule. Actual plasma membranes include hundreds of different chemical components. However, instead of having hundreds of possible phases in our plasma membrane balloons, we only observe two! Membrane lipid and protein species appear to have coevolved to behave as a collective, single entity. This suggests that we should be able to unravel the design principles of the heterogeneity underlying the raft concept. In studying collective behavior of this type, membrane research is showing the way for other areas of biology in which we ultimately have to come to grips with collectives, not simply with protein A interacting with protein B.

Membrane lipid and protein species appear to have coevolved to behave as a collective, single entity.

Membrane biology has gained prominence in basic biology and disease research. Highly pathogenic membrane viruses such as influenza and HIV employ rafts to exit from the cell by scaffolding a raft domain around their nucleocapsids when they exit from the host-cell plasma membrane. And in Alzheimer’s disease, the cleavage of the amyloid precursor protein (APP) into β-amyloid takes place in specific raft platforms, localized intracellularly in endosomes (see figure on p. 28).

We at MPI-CBG, with the University of Technology Dresden, have launched JADO Technologies, a biotech company focusing on developing lipophilic small molecules for inhibiting membrane raft targets. While the company is currently focused on specifically targeted raft inhibitors for applications to allergy, we have been investigating a β-amyloid raft inhibitor. To deliver the inhibitor to its cellular target, we have synthesized a membrane-anchored version of the inhibitor by linking it to a sterol moiety that embeds into a lipid membrane. The membrane bound-inhibitor is routed to the rafts in the endosomes, where it inhibits β-secretase, efficiently preventing the production of amyloid.8 The challenge now is to find ways to overcome the blood–brain barrier, because it is in the brain that the inhibitor has to do its job.

The pharmaceutical industry has so far mostly avoided the membrane bilayer itself as a therapeutic target. If the development of lipophilic and raftophilic drugs were possible, then a whole new field of pharmaceutical intervention would open up. Being trained as an MD, it would be tremendous if my life in rafts contributed to moving basic membrane research from the bench to the bedside.

Kai Simons is cofounder and emeritus director of the Max Planck Institute of Molecular Cell Biology and Genetics (MPI-CBG).

References

1. K. Simons et al., “How an animal virus gets into and out of its host cell,” Scientific American, 246: 46-54, 1982.

2. K.S. Matlin and K. Simons, “Sorting of an apical plasma membrane glycoprotein occurs before it reaches the cell surface in cultured epithelial cells,” J Cell Biol, 99:2131–39, 1984.

3. G. van Meer et al., “Sorting of Sphingolipids in Epithelial (Madin-Darby Canine Kidney) Cells,” J Cell Biol, 105:1623–35, 1987.

4. G. Griffiths and K. Simons, “The trans Golgi network: sorting at the exit site of the Golgi complex,” Science, 234:438–43, 1986.

5. K. Simons and G. van Meer, “Lipid sorting in epithelial cells,” Biochemistry, 27:6197–202, 1988.

6. K. Simons and E. Ikonen, “Functional rafts in cell membranes,” Nature, 387: 569–72, 1997.

7. D. Lingwood et al., “Plasma membranes are poised for activation of raft phase coalescence at physiological temperature,” Proc Natl Acad Sci USA, 105:10005–10, 2008.

8. L. Rajendran et al., “Efficient Inhibition of the Alzheimer’s Disease β -Secretase by Membrane Targeting,” Science, 320:520–23, 2008.
Read more: My Life on a Raft – The Scientist – Magazine of the Life Sciences http://www.the-scientist.com/2010/2/1/24/1/#ixzz0fjoZcYtn

Harvard Medical School, February 17, 2010

 

Q. I am 85 and have taken an 81-mg aspirin each day for decades for heart attack prevention. Recently, I noticed these words on the label: “Stop using if you get ringing in your ears or loss of hearing.” Should I be worried?

A. In a word, no.

In the body, aspirin gets converted into a chemical called salicylic acid, so the side effect that the label is referring to is sometimes called salicylism, or more simply, aspirin poisoning. Very high levels of aspirin in the blood can have toxic effects. Tinnitus — a ringing or whistling noise in the ear — and hearing loss are among them. But there’s no risk of that happening at an 81-mg dose.

People have been taking aspirin for more than a century, and I think it’s still the most widely used medicine. Like you, many people take small doses daily for cardiovascular health. But large doses used to be prescribed much more often, partly because we didn’t have nearly as many other medications to choose from. Doctors have also learned that many drugs, including aspirin, work just as well at lower doses as at higher ones, and — no surprise — lower doses are often associated with fewer side effects.

Aspirin for rheumatoid arthritis, an inflammatory condition that damages joints, is an example of what I am talking about. Today, if someone with rheumatoid arthritis is treated with medication, there are several choices among the disease-modifying antirheumatic drugs, or DMARDs. But when I was in medical school, aspirin doses of 1,500 milligrams (mg) a day or more were often prescribed for rheumatoid arthritis. Taking that much aspirin on a daily basis can have toxic effects, including tinnitus, and I saw cases of salicylism early in my medical career.

Your 81-mg dose is about one-twentieth of 1,500 mg. You really don’t have to worry about salicylism. The evidence for cardiovascular protection from small, regular doses of aspirin is solid. So congratulations on reaching 85, and I think there’s a good chance that your aspirin habit might have helped you get there.

— Anthony L. Komaroff, M.D.

Editor in Chief, Harvard Health Letter

MIT Technology Review, February 17, 2010, by Emily Singer  —  Research suggests that high altitudes suppress appetite and increase metabolism.

Researchers from Germany studied 20 obese men both at low altitude in Munich and while spending a week at 8700 feet, in a field station near the peak of Germany’s highest mountain, Zugspitze. Participants lost an average of two pounds that week and kept it off for the next month, without making any changes in diet or activity levels. During their high altitude stay, the men were given unrestricted access to food and restricted to short walks.

The researchers found that basal metabolism increased at high altitude, though it’s not clear why. Levels of leptin, a hormone known to suppress hunger, also increased, perhaps in response to decreased oxygen. Participants ate less, even after symptoms of altitude sickness had disappeared. And they continued to eat less after returning to Munich, at least during the four week follow-up period of the study. The research was published this month in the journal Obesity.

A Probable Explanation

Metabolism goes up at high altitudes because you need to take more breaths per minute to get the same amount of oxygen. That (together with the typically drier air at high altitudes) is also why you need to drink more water at high altitudes — because you lose water vapor from your lungs each time you exhale.

Dear Bloggers, we are neither for or against this story.  It’s an interesting consideration as an addition to Western medicine.

How Leta Herman of Belchertown left a lucrative career as a systems analyst and became a practitioner of classic Chinese medicine
Thursday, February 18, 2010
By Mark Roessler

Photo By Mark Roessler

Leta Herman, former technology systems manager, now is an accupressurist in Belchertown

Leta Herman doesn’t miss her life as a systems analyst for Avaya Technologies, though it was the kind of life many an office employee dreams of.

While she worked for a corporation, her office was in her house. A Smith graduate and technology expert, she spent her workdays on the Web and the phone, not having to get out of her slippers while she worked with people in suits and cubicles across the world. At home, she was more available for her son and husband, and without a commute, she had time to report and write syndicated technical columns. Financially, she was comfortable. Prospects were good.

But she gave it up for something totally different.

She unplugged from the digital and virtual world and became interested in the metaphysical and physical ones. In her new occupation, instead of tapping at a keyboard, her fingers began pressing and probing living, breathing flesh. When she spoke to her clients, she looked them in the eye. The systems she analyzed were human, and the techniques and networks she learned were hundreds, if not thousands, of years old.

Leta Herman became an acupressurist with a practice in Belchertown. She has spent 10 years training in the Five Elements, one of several different schools of Chinese medicine. Business is good.

She has been a studying acupressure for 10 years and seeing clients for eight. After the last five years devoting herself wholly to her new practice, she’s become just as comfortable as she once was as a technology systems analyst, and prospects are even better.

*

Herman’s decision to change direction was not sudden or random, she explained to the Advocate in an interview last week.

As a young adult she had endometriosis, which gave her great muscle pain. After years of seeing medical specialists, undergoing an operation that offered no relief, and trying many suggested remedies (including giving birth), she turned to Chinese medicine. She found her symptoms eased the day she began and were gone in three months.

Curious, she signed up for a class called “Plant Spirit Medicine” given by Elliot Cowan in Colrain. Cowan combined a mastery of Eastern acupuncture with Native American shamanist traditions.

“I grew up in academia,” she said. “My parents were both academics, and I hadn’t been raised to be spiritual. I was curious, and I wanted to understand why acupuncture worked for me. I went wanting to understand better what my ‘chi’ was,” she said, referring to one of the central principles of Chinese medicine. Her acupuncturist had used the long, slender needles to remove internal blockages, she had explained to Herman, so that Herman’s chi could move more fluidly within her.

She was expecting a series of lectures and was surprised to find the class was a training. Rather than sit and absorb information, she was expected to participate. The course took a year and a half, with a series of seven-day stints of intensive training with masters, and then weeks of independent studying and practicing what had been learned. Upon graduating, though, “I felt like I’d only scratched the surface, and there was so much more to learn,” she said. “I considered going into acupuncture school at that point.”

She and a group of students from the Colrain class began working with Niki Bilton, the academic dean at Ongiara College of Acupuncture and Moxibustion in Ontario. Trained in England, she is a Master of Acupuncture and a teacher in the Five Element school of Chinese medicine, a discipline Cowan had also been trained in. Herman and her fellow students were already practitioners, but they needed more experience, and they each accompanied Bilton on client visits. While working with Bilton, Herman learned acupressure methods, applying pressure with the hands or other devices that don’t require piercing the skin.

In a few years, Herman first started treating her own acupressure clients on the couch in her living room. Then she turned a bedroom into an office, but it was awkward to have clients come through her kitchen. “It felt like we were always scrambling to clean before people came over,” she said. Now, with the help of her industrious husband, a wing of the house is devoted to her clinic.

*

Still, as much progress as Herman was making working with Bilton, she started to feel a conflict between her day technology job and this new passion.

“For the first four years of my studies,” she said, “I was really depressed.” As much as she wanted to pursue the Five Elements and acupressure, devoting herself to it would require abandoning the career that paid for—along with everything else—her training. “I felt like I was sabotaging my current career, rather than using it to get what I wanted,” she recalls. “It was like I was working against myself.”

Eventually, after training a very glum Herman for a number of years, Bilton told her, “You’ve got to stop the suffering.” She coaxed Herman to reconsider her situation.

“I thought: ‘I’ve got a high-paying job. If I sat down and made a plan for myself, and used the money I’m making to manifest this new thing, then I won’t be depressed any more,'” she said. “After I did that, in about a year, I was ready to take the plunge. I had my finances in order. I didn’t know how long it would take for me to return to the money I was making, and I was prepared to go into debt if I had to. And I did.”

*

The study of Chinese medicine is said to have started thousands of years ago, and as with all traditions and schools of thought, there are many different varieties, each with its own proponents and critics. The form most widely known today is Traditional Chinese Medicine, or TCM for short, and it’s the form that has started to gain some acceptance by Western medicine.

“The use of acupuncture experienced a gradual decline during the late nineteenth and early twentieth century,” she said, “and the Communists essentially resurrected it. They were interested in promoting all things Chinese. Acupuncture fit into that, but because they were atheists, the spiritual stuff didn’t really appeal to them. Their version focused more on symptoms—how do you get the worker back to work? So [TCM] acupuncture works really well if you have something bugging you like tennis elbow and you want it to feel better.

“The Chinese really tried to strip the language of spirit out of acupuncture,” she said. But it was difficult if not impossible. “The different points are called Blue-Green Spirit Dragon, or spirit-this or spirit-that.”

Leta Herman’s training had been with followers of the Five Element school of thought, introduced to the West over a half-century ago by British practitioner J. R. Worsley. He sought to reintroduce the philosophy back into the medicine.

“Worsley said, ‘What we want to do is a kind of older Chinese medicine. We want to go to the root of the problem, not just treat the symptom.’ That’s where I always try to come from,” Herman said. “He spent a lot of time in Asia, and he learned from some of these older practitioners who had been in China before the revolution and learned about the spiritual aspects. He taught that you always needed to treat the body, the mind and the spirit. Never just one.” In the West, he felt medicine focused too exclusively on the body and mind.

In order to practice acupuncture, Herman would have needed to train for four years to get a license that reflected the American medical-TCM school of thought; she chose to pursue acupressure instead.

“The more I’ve studied, the more I’ve learned that there’s stuff Worsley left out, too,” she said. “He felt he needed to come up with a program anyone could learn, so he was always trying to simplify his teachings. And that’s fine, but it’s almost as if he focused so much on treating the spirit that sometimes there were physical problems that weren’t getting fixed. So what I’ve discovered is, you really need to find a mixture [of philosophies that work for you]. If your arm is killing you, you can’t work on your spirit, because your arm is frickin’ killing you! So over the last five years, I’ve been focusing more and more on Classical Chinese Medicine, a third category.”

The Communists weren’t the only ones who have been interested in simplifying Chinese Medicine: over the centuries there have been several attempts to unify thinking and determine doctrine by promoting some practices and condemning others. Practitioners of Classic Chinese Medicine try to be as comprehensive as possible when studying tradition, and not just focus on one school of thought, or the latest incarnation.

To that end, Herman has begun studying with Jeffrey Yuen, an 88th-generation Taoist priest and Chinese medicine healer. In his particular tradition priests are celibate, and Yuen was chosen before his birth. His grandfather began Yuen’s training when he was only five years old, and he has access to an oral tradition that has largely gone underground in China. He now gives lessons in New York City’s China Town.

According to Herman, Yuen’s body of knowledge is so profound that he regularly introduces concepts that challenge what even life-long masters thought they knew.When she first began her training, her teachers only taught one set of meridians, but working with Yuen in China Town, she has begun to explore three others that other acupuncturists are aware of but rarely employ.

*

The chief delight Herman finds in her new-found work is seeing the transformation of her clients. Often Herman, who is also a licensed massage therapist, finds that her clients’ physical pain might be related to something spiritual that also needs her attention. Sometimes, though, she needs to work on a client’s physical complaint for a while before the client is willing to consider letting her address the problem using her techniques for spiritual healing.

She tells the story of one man who came into her office complaining of arm pain he thought might have been caused by a golf injury. He was able to achieve some temporary relief from pain using her physical therapies, but it was never permanent. After working with him for several months, Herman learned more about his recent history, which included an ugly falling-out with a business associate he had found embezzling from him.

Working patiently with him, she was eventually able to explain that some of the same pressure points she was working to relieve the physical pain, if worked differently, could address the emotional pain he felt at having been betrayed. This therapy is what finally brought lasting relief.

She uses a variety of techniques in her practice. For physical ailments, one technique she uses is Gua Sha—gently scraping the client’s skin with a spoon. The practice is very popular in Asia, and because it leaves bright red marks, Vietnamese immigrants to this country initially were accused of child abuse when the apparent bruises were discovered. Herman says she’s able to stop flu with her spoon if she recognizes the symptoms early enough.

Along with pressing on pain relief points, a more rigorous technique she uses is something she calls energetic massage, based on Japanese acutouch massage. “It’s an alternating of deep and light pressure,” she said.

“I do another technique called moxa,” she said. “It’s the mugwort herb. Sometimes people get a pain and it makes part of their body feel cold. You take a stick of moxa and warm the area. This brings the blood to the surface. You do this a few times and it can relieve the pain very quickly.”

These techniques she uses for body pain, but for deeper illnesses and internal issues, she focuses on pressure points. “Each organ has a meridian, and there are twelve meridians,” she said, “and there are twelve pulses.” These pulses are different from what we’re familiar with in Western medicine. Though read similarly—by touching different points on the body—the Eastern practitioner is measuring an energy pulse as opposed to the flow of blood. In Chinese medicine the different pulses can be read to understand what’s happening in each of the organs.

“Each pulse has three positions and two levels—it’s very complicated and takes years to learn. Say you have chest pain. Say it’s not asthma or a heart attack, but your energy is just blocked. You got really angry, and now your energy isn’t flowing through your chest. I’m able to press a point on the end of one meridian, then another, and get the chi to start to flow.” The effect can be sudden and dramatic when the client suddenly finds himself able to breathe again.

“It’s so cool,” Herman says with obvious delight.

While helping people with their physical pain is rewarding to Herman, the greatest transformations she sees are from her other field of expertise, something known as alchemy.

“The Chinese believe that you are already born perfect, but you just don’t know it,” she said. “Alchemy are a set of techniques to help people find that perfection. The idea is kind of, you get what you expect. There doesn’t need to be any such thing as aging; you could live forever if you don’t have that thought in your head. It’s not an idea that’s widely taught in the West.

“It’s called ‘alchemy’ in reference to the idea that your body is like silver—it needs to be constantly polished and taken care of or it tarnishes and degrades. But your spirit is like gold. You can bury it in the ground for a hundred years, but it still comes out shining and perfect. You can’t destroy it. So it’s a metaphysical idea where you’re trying to turn your physical presence into something that’s gold, like your spirit.”

While having blocked meridians is commonplace, sometimes the blockage is so deep that it can affect the spirit and actually change a person. “Your true self has somehow become perverted. I call this a ‘heart-level block.’ Some actually call it ‘evil-chi,'” she said. “There are these ancient protocols where you do this set of points that can open the heart and bring back the flow of your true self. It’s really incredible. Transformational.”

She also offers a less aggressive protocol which helps clients who generally feel well, but feel stifled by something emotional holding them back. She calls this cleaning out peoples’ skeletons, and it’s a four-hour process done to music she puts on shuffle on her iPod with a wide variety of genres. She uses the music to control the pace and intensity of her treatment.

Through these two protocols, she hopes to help her clients “clean out all the junk” and achieve a greater sense of freedom. Once this has been achieved, she offers a gradual program she calls “getting to fly” that helps clients realize their full potential.

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By learning more about chi—the movement and energy that happen between the life forces of yin and yang—Leta Herman has been able to move her own life toward its full potential. She speaks about what she’s learned with unbridled enthusiasm and good humor and says if she misses anything about that life, ironically, it’s the health insurance.

Under her care, it’s been years since her family has been sick, and while she would be happy having major medical (if she broke her leg or got in a car accident, she says she would want to be sent to the hospital), Massachusetts law requires her to pay over $700 a month for full coverage she doesn’t feel she needs.

A dream of hers is to develop an alternative health insurance system for Pioneer Valley health care workers where services can be bartered. Some of her colleagues have shown some interest, but so far nothing has gotten off the ground. Given Herman’s proven ability to plan and achieve dramatic changes in her own life, though, who knows what will happen in another five years?

Leta Herman is a Licensed Massage Therapist in Massachusetts, and also a Certified Practitioner with the AOBTA.