INTRODUCTION

In 1999 the Nobel Prize in Physiology or Medicine was awarded to Gunter Blobel for the discovery that proteins have intrinsic signals that govern their transport and localisation in the cell. It was based on this research into how cells use these signals that the functions of glycoproteins were discovered.

Glycoproteins are molecules that have a sugars and protein bonded together. The sugar chains of glycoproteins play a role in determining their destination in the cell or body. The bonding of sugars to proteins to form glycoproteins significantly alters the properties of these proteins.

There are eight sugars that predominantly bond with proteins to form glycoproteins, these are: xylose, galactose, glucose, mannose, fucose, N-acetylgalactosamine, N-acetylglucosamine and N-acetylneuraminic acid.

WHAT ARE THE FUNCTIONS OF GLYCOPROTEINS?

Glycans contain biologic information and are the specific sequence of sugars in a glycoprotein that determine its recognition and interaction with other molecules in the cell, often resulting in a biologic effect or response. These impart their function to glycoproteins.

Glycoproteins have many functions in the human body. A few functions of interest is that they are used structurally in the body to form some types of collagen; or are involved in cell-cell interactions, such as in the proteins involved in sperm-egg interactions during fertilisation or how cells stick together to form tissues and communicate with each other. They also function in cell signalling.

Cell signaling is the related study of how healthy cells respond appropriately in health to various stimuli e.g., hormones, growth factors, drugs, cell-cell contact, etc. Glycoproteins on the surface of one cell bind to glycoprotein receptors on another cell, which allows the cells to communicate with one another. These communications then result in other cellular events, such as secretion of bioactive substances, killing of bacteria and cell debris, inhibition of adherence necessary for bacterial infection. Conversely, the responses may be inappropriate in certain diseases, such as cancer and cancer cell metastasis.

Lectins, for example, are proteins that selectively bind glycans. One lectin will recognize and bind mannose at the end of a glycan, whereas others will recognize and bind to glycans containing fucose, galactose, or other sugars. A class of lectins called selectins helps white blood cells to sites of inflammation.

WHAT IS GLYCONUTRITION?

Glyconutrition is the supplementation the 8 principal sugars that are needed by the body to from glycoproteins. They are considered essential nutrients, much the same as essential amino acids or essential fatty acids, which means you have to get them from your diet.

WHY IS GLYCONUTRITION CONSIDERED ESSENTIAL?

Metabolic pathways exist for synthesis of non-glucose sugars from glucose, and it has long been thought that glucose is the most important dietary sugar; it has recently been shown that glycoprotein formation actually prefer to utilize non-glucose essential sugars (e.g. mannose) provided in the diet as substrates. In fact, if only glucose is supplied, the liver severely malfunctions, due to a lack of the other essential sugars, indicating that the body simply cannot synthesize all the other essential sugars from glucose to the extent that they are needed.

WHERE ARE THE 8 SUGARS OBTAINED FROM IN THE DIET?

These 8 sugars will only appear in fruit and vegetables that are vine ripened; this essentially means the fruit or vegetable ripens on the plant. However this is a process that no longer happens in modern agriculture. Much of our fruit and vegetables are picked when green, and artificially ripened prior to being put on the shelves at the supermarket. This means sadly that we have to supplement with them to obtain the eight necessary sugars essential for health.

HOW MAY CORRECT GLYCOPROTEIN FORMATION CONTRIBUTE TO DISEASE MANAGEMENT?

As can be seen from the preceding paragraphs, glycoproteins are vital in the health and maintenance of the human body; so much so, that extensive research has been conducted on them in relation to certain diseases.

Implications for cancer. Research has shown that there are changes to the sugars in glycoproteins of cancer cells. These changes relate to adhesion properties of the cancer cell and their ability to adhere to other cells in the body or to metastasize. These altered glycoproteins may also relate to the ability of the tumour to avoid the responses of the immune system. Altered glycoproteins have been found in intestinal, pancreatic, liver, ovarian, prostate, and lung cancers.

Glycoproteins that have mannose in their structure has been shown to activate macrophages (an immune system cell), one of the most important cells involved in fighting cancer. Also, the release of substances from the macrophage is stimulated, which activates natural killer cells (another immune system cell involved in the elimination of cancer cells).

Implications for chronic fatigue syndrome and fibromyalgia. The principle symptoms of these conditions include muscle and joint pain, chronic fatigue, non-restorative sleep, chronic tension, migraine headaches, and bowel and bladder irritability. The immune, endocrine (e.g. hormones), nervous (e.g. neurotransmitters, sleep pathways, psychological stress), and muscular (e.g. tender points) systems of the body are all intimately involved in these syndromes. Glycoproteins all play important roles in maintaining the health and normal functioning of these systems. Therefore supplementation with the 8 simple sugars may positively impact on these syndromes.

Implications for inflammation. Inflammation in itself is not a disease, but rather occurs as result of tissue injury, such as in bacterial infection. Inflammation is usually beneficial to the individual. However, this process can get out of hand, as many diseases that affect us are inflammatory in origin. As noted earlier, glycoproteins help guide immune cells to sites of inflammation, as well as they are involved in the process of allowing the immune cells to traverse the wall of blood vessels and enter the tissues at the site of inflammation.

Implications for peptic ulcers induced by Helicobacter pylori bacteria. Helicobacter pylori attach to 2 specific glycans on the cell surfaces of stomach and duodenum. Once attached, the bacteria release various enzymes that along with the acidic content of the stomach, results in ulceration. Glycans are the first molecules encountered by bacteria as a means to attach to cells. The 8 sugars compete with bacteria for attachment to the glycans, and is one way of blocking bacterial adherence.

Implications for stress. Research has shown that the formation of glycoproteins is significantly altered in various types of stress, such as in infection, inflammation and trauma.

Stress exists in many forms, whether it is psychological (as in nervous system dysfunction), environmental (as in extreme heat or chemical toxins) or physicochemical (such as in exercise). Glycoproteins prevent and repair damage to cells as a result of these stresses.

Implications for Rheumatoid Arthritis. Rheumatoid arthritis (RA) is an inflammatory condition, and glyconutritions are known to positively affect inflammation.

RA is an autoimmune condition, meaning that antibodies are produced against the body’s own tissues; this implies that there is a miscommunication between the immune system and the joint tissue. The abnormal antibody produced is IgG, which has less than normal amounts of galactose in its structure, and during remission this reduction of galactose is reversed.

It has also been found that fucose is markedly reduced in RA patients. The greater the deficiency of fucose in RA patients, the more severe the symptoms will be.

Supplementation of the necessary sugars, i.e. galactose and fucose, needed by the body to combat this illness.

On the topic of auto-immune conditions I would like to share a case of mine successfully treated with the ise of these 8 essential sugars. Mrs T. presented to me with discoid lupus, which is a milder case of lupus which predominantly affects the skin, causing hard ‘scar-like’ lesions. She had these lesions spread throughout the body. I prescribed the sugars in a powder, 5g/day. After using them for a period of 3 months, all of her skin lesions were completely healed, as well as her anti nuclear factor had dropped right down to normal blood levels.

In my personal experience with these sugars I have found that they are the best in treating auto-immune conditions such as lupus, rheumatoid arthritis, multiple sclerosis etc. If you have any questions regarding the use of the 8 sugars for your health condition/s, feel free to contact me.

CONCLUSION

As can be seen from the above article, proper glycoprotein formation plays an important role on the maintenance of health and combating of disease. Sadly six of the eight sugars no longer appear in our food supply, and it has become necessary to supplement with these sugars in order to maintain optimum health.

The health care fraud, bank/mortgage fraud and securities fraud practitioner should be aware of 18 U.S.C. § 1345, a law which permits the federal government to file a civil action to enjoin the commission or imminent commission of a federal health care offense, bank-mortgage offense, securities offense, and other offenses under Title 18, Chapter 63. Otherwise known as the federal Fraud Injunction Statute, it also authorizes a court to freeze the assets of persons or entities who have obtained property as a result of a past or ongoing federal bank violations, health care violations, securities violations, or other covered federal offenses. This statutory authority to restrain such conduct and to freeze a defendant’s assets is powerful tool in the federal government’s arsenal for combating fraud. Section 1345 has not been widely used by the federal government in the past in connection with its fraud prosecution of health and hospital care, bank-mortgage and securities cases, however, when an action is filed by the government, it can have a tremendous effect on the outcome of such cases. Health and hospital care fraud lawyers, bank and mortgage fraud attorneys, and securities fraud law firms must understand that when a defendant’s assets are frozen, the defendant’s ability to maintain a defense can be fundamentally impaired. The white collar criminal defense attorney should advise his health and hospital care, bank-mortgage and securities clients that parallel civil injunctive proceedings can be brought by federal prosecutors simultaneously with a criminal indictment involving one of the covered offenses.

Section 1345 authorizes the U.S. Attorney General to commence a civil action in any Federal court to enjoin a person from:

• violating or about to violate 18 U.S.C. §§ 287, 1001, 1341-1351, and 371 (involving a conspiracy to defraud the United States or any agency thereof)

• committing or about to commit a banking law violation, or

• committing or about to commit a Federal health care offense.

Section 1345 further provides that the U.S. Attorney General may obtain an injunction (without bond) or restraining order prohibiting a person from alienating, withdrawing, transferring, removing, dissipating, or disposing property obtained as a result of a banking law violation, securities law violation or a federal healthcare offense or property which is traceable to such violation. The court must proceed immediately to a hearing and determination of any such action, and may enter such a restraining order or prohibition, or take such other action, as is warranted to prevent a continuing and substantial injury to the United States or to any person or class of persons for whose protection the action is brought. Generally, a proceeding under Section 1345 is governed by the Federal Rules of Civil Procedure, except when an indictment has been returned against the defendant, in which such case discovery is governed by the Federal Rules of Criminal Procedure.

The government successfully invoked Section 1345 in the federal healthcare fraud case of United States v. Bisig, et al., Civil Action No. 1:00-cv-335-JDT-WTL (S.D.In.). The case was initiated as a qui tam by a Relator, FDSI, which was a private company engaged in the detection and prosecution of false and improper billing practices involving Medicaid. FDSI was hired by the State of Indiana and given access to Indiana’s Medicaid billing database. After investigating co-defendant Home Pharm, FDSI filed a qui tam action in February, 2000, pursuant to the civil False Claims Act, 31 U.S.C. §§ 3729, et seq. The government soon joined FDSI’s investigation of Home Pharm and Ms. Bisig, and, in January, 2001, the United States filed an action under 18 U.S.C. § 1345 to enjoin the ongoing criminal fraud and to freeze the assets of Home Pharm and Peggy and Philip Bisig. In 2002, an indictment was returned against Ms. Bisig and Home Pharm. In March, 2003, a superseding indictment was filed in the criminal prosecution charging Ms. Bisig and/or Home Pharm with four counts of violating 18 U.S.C. § 1347, one count of Unlawful Payment of Kickbacks in violation of 42 U.S.C. § 1320a-7b(b)(2)(A), and one count of mail fraud in violation of 18 U.S.C. § 1341. The superseding indictment also asserted a criminal forfeiture allegation that certain property of Ms. Bisig and Home Pharm was subject to forfeiture to the United States pursuant to 18 U.S.C. § 982(a)(7). Pursuant to her guilty plea agreement, Ms. Bisig agreed to forfeit various pieces of real and personal property that were acquired by her personally during her scheme, as well as the assets of Home Pharm. The United States seized about $265,000 from the injunctive action and recovered about $916,000 in property forfeited in the criminal action. The court held that the relator could participate in the proceeds of the recovered assets because the relator’s rights in the forfeiture proceedings were governed by 31 U.S.C. § 3730(c)(5), which provides that a relator maintains the “same rights” in an alternate proceeding as it would have had in the qui tam proceeding.

A key issue when Section 1345 is invoked is the scope of the assets which may be frozen. Under § 1345(a)(2), the property or proceeds of a fraudulent federal healthcare offense, bank offense or securities offense must be “traceable to such violation” in order to be frozen. United States v. DBB, Inc., 180 F.3d 1277, 1280-1281 (11th Cir. 1999); United States v. Brown, 988 F.2d 658, 664 (6th Cir. 1993); United States v. Fang, 937 F.Supp. 1186, 1194 (D.Md. 1996) (any assets to be frozen must be traceable to the allegedly illicit activity in some way); United States v. Quadro Corp., 916 F.Supp. 613, 619 (E.D.Tex. 1996) (court may only freeze assets which the government has proven to be related to the alleged scheme). Even though the government may seek treble damages against a defendant pursuant to the civil False Claims Act, the amount of treble damages and civil monetary penalties does not determine the amount of assets which may be frozen. Again, only those proceeds which are traceable to the criminal offense may be frozen under the statute. United States v. Sriram, 147 F.Supp.2d 914 (N.D.Il. 2001).

The majority of courts have found that injunctive relief under the statute does not require the court to make a traditional balancing analysis under Rule 65 of the Federal Rules of Civil Procedure. Id. No proof of irreparable harm, inadequacy of other remedies, or balancing of interest is required because the mere fact that the statute was passed implies that violation will necessarily harm the public and should be restrained when necessary. Id. The government need only prove, by a preponderance of the evidence standard, that an offense has occurred. Id. However, other courts have balanced the traditional injunctive relief factors when faced with an action under Section 1345. United States v. Hoffman, 560 F.Supp.2d 772 (D.Minn. 2008). Those factors are (1) the threat of irreparable harm to the movant in the absence of relief, (2) the balance between that harm and the harm that the relief would cause to the other litigants, (3) the likelihood of the movant’s ultimate success on the merits and (4) the public interest, and the movant bears the burden of proof concerning each factor. Id.; United States v. Williams, 476 F.Supp2d 1368 (M.D.Fl. 2007). No single factor is determinative, and the primary question is whether the balance of equities so favors the movant that justice requires the court to intervene to preserve the status quo until the merits are determined. If the threat of irreparable harm to the movant is slight when compared to likely injury to the other party, the movant carries a particularly heavy burden of showing a likelihood of success on the merits. Id.

In the Hoffman case, the government presented evidence of the following facts to the court:

• Beginning in June 2006, the Hoffman defendants created entities to purchase apartment buildings, convert them into condominiums and sell the individual condominiums for sizable profit.

• To finance the venture, the Hoffman defendants and others deceptively obtained mortgages from financial institutions and mortgage lenders in the names of third parties, and the Hoffmans directed the third party buyers to cooperating mortgage brokers to apply for mortgages.

• The subject loan applications contained multiple material false statements, including inflation of the buyers’ income and bank account balances, failure to list other properties being purchased at or near the time of the current property, failure to disclose other mortgages or liabilities and false characterization of the source of down payment provided at closing.

• The Hoffman defendants used this method from January to August 2007 to purchase over 50 properties.

• Generally, the Hoffmans inherited or placed renters in the condominium units, received their rental payments and then paid the rent to third-party buyers to be applied as mortgage payments. The Hoffmans and others routinely diverted portions of such rental payments, often causing the third-party buyers to become delinquent on the mortgage payments.

• The United States believe that the amount traceable to defendants’ fraudulent activities is approximately $5.5 million.

While the court recognized that the appointment of a receiver was an extraordinary remedy, the court determined that it was appropriate at the time. The Hoffman court found that there was a complex financial structure which involved straw buyers and a possible legitimate business coexisting with fraudulent schemes and that a neutral party was necessary to administer the properties due to the potential for rent skimming and foreclosures.

Like other injunctions, the defendant subject to an injunction under Section 1345 is subject to contempt proceedings in the event of a violation of such injunction. United States v. Smith, 502 F.Supp.2d 852 (D.Minn. 2007) (defendant found guilty of criminal contempt for withdrawing money from a bank account that had been frozen under 18 U.S.C. § 1345 and placed under a receivership).

If the defendant prevails in an action filed by the government under the Section 1345, the defendant may be entitled to attorney’s fees and costs under the Equal Access to Justice Act (EAJA). United States v. Cacho-Bonilla, 206 F.Supp.2d 204 (D.P.R. 2002). EAJA allows a court to award costs, fees and other expenses to a prevailing private party in litigation against the United States unless the court finds that the government’s position was “substantially justified.” 28 U.S.C. § 2412(d)(1)(A). In order to be eligible for a fee award under the EAJA, the defendant must establish (1) that it is the prevailing party; (2) that the government’s position was not substantially justified; and (3) that no special circumstances make an award unjust; and the fee application must be submitted to the court, supported by an itemized statement, within 30 days of the final judgment. Cacho-Bonilla, supra.

Healthcare fraud attorneys, bank and mortgage fraud law firms, and securities fraud lawyers should be cognizant of the government’s authority under the Fraud Injunction Statute. The federal government’s ability to file a civil action to enjoin the commission or imminent commission of federal health care fraud offenses, bank fraud offenses, securities fraud offenses, and other offenses under Chapter 63 of Title 18 of the United States Code, and to freeze a defendant’s assets can dramatically change the course of a case. While Section 1345 has been infrequently used by the federal government in the past, there is a growing recognition by federal prosecutors that prosecutions involving healthcare, bank-mortgage and securities offenses can be more effective when an ancillary action under the Section 1345 is instigated by the government. Health and hospital care lawyers, bank and mortgage attorneys, and securities law firms must understand that when a defendant’s assets are frozen, the defendant’s ability to maintain a defense can be greatly imperiled.

Point-of-Service (POS) plans are one of the many health insurance options available to you and your family. A unique type of health plan, POS plans can be considered a hybrid of HMO and PPO plans. POS plans contain some characteristics of each of these, which some people may find advantageous. Below is a rundown of the advantages and disadvantages of a POS plan compared to other plans.

Advantages of a POS Plan

• No deductible. One of the most obvious advantages of a POS plan is its lack of deductibles for physicians in your network. This means that you do not have to make any payments towards your medical expenses on your own before your insurance begins to reimburse you. PPOs, on the other hand, have deductibles.
• Low co-payments. POS plans have lower co-pays than PPOs. When you have a medical expense, you will only have to pay for a small portion of it as a co-pay, and your POS plan will cover the remainder of the cost.
• More choices and freedom to choose. Unlike HMOs, POS plans provide partial coverage even for doctors that are not within your network. This means that if you are not satisfied with the choices available in your network for a certain medical treatment, you can see a doctor out of network and still have some coverage.

Disadvantages of a POS Plan

• Under a POS plan, you must choose a primary care provider (PCP). This physician serves as your primary doctor for all medical needs. He or she can refer you to specialists in your network if you have a specific health concern. In order for a doctor’s visit to be covered as an in-network visit, you must go through your PCP to see a specialist.
• If you visit an out-of-network physician, your only have limited coverage. You must pay a deductible and higher co-payments than you would with in-network physicians.

Choosing the Right Health Insurance Plan

If you are happy with the doctors that are in your network and do not mind having one primary care provider that you must go through to receive coverage, then a POS plan may be ideal for you. Often a PCP or the specialists he or she refers you to can cover all common medical needs. However, if you have unique medical conditions that will require you to frequently visit doctors outside of the POS network, you may be better off finding a plan that covers you with those doctors instead.

The greater choice and freedom of doctors, lower co-payments, and zero deductible for in-network physicians make the POS an attractive option that you may want to consider. For more information on POS health insurance plans and other options that are available to you, please visit the website of Texas health insurance company Option 1 Health here.