Emory Health Digest - Summer 2022

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THE ROAD TO 1,000 HEART TRANSPLANTS

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COFFEE REGIONAL MEDICAL CENTER BARIATRICS | 17 DRUG DISCOVERY | 20 SUMMER
2022

That’s Why They Call it ‘Re’search

20 Trial and error in scientific research paves the way to success, and Emory has built a drug development nexus thanks to a rare confluence of institutions and expertise.

contents
PHOTO KAY HINTON

Tyronne and Edna Baldwin find joy in tasks around the home after his heart transplant.

Baldwin’s transplant was Emory’s 1,000th heart transplant.

Early detection of medical problems, illnesses, and diseases helps your doctor provide proactive care and treatment.

Injury Prevention Research 42 The Injury Prevention Research Center at Emory focuses on a communal approach to reducing the harm of injuries.

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PHOTO JACK KEARSE ILLUSTRATION JOEY GUIDONE

Ridge Report

A Lifetime of Service to Public Health 9 James Curran’s career spans decades of public health milestones, many of which his insight and vision helped launch.

Emory Health Digest

Jonathan Lewin Executive Vice President for Health Affairs, Emory University, Executive Director, Woodruff Health Sciences Center, CEO and Chair of the Board, Emory Healthcare

Vincent Dollard, Editor

Peta Westmaas, Art Director

Jack Kearse, Photography Director

Coffee Regional Medical Center and Emory Healthcare 14

Jim Auchmutey, Sherry Baker, Quinn Eastman, Stacey Jones, Contributors

Stacey Jones Copy Editor

Deanna Altomara Editorial Intern

John Mills Online Communications, Senior Director

Stuart Turner Production Manager

Jarrett Epps Advertising Manager

Wendy Darling Web Specialist

Nikki Troxclair Assistant VP, Communications

the well

To Our Readers 4 A message from Jonathan Lewin, executive VP for health affairs, executive director of WHSC, and CEO of Emory Healthcare.

The Well 5 Parkinson’s research into balance. Molecular glue in cancer research. WHSC’s Office of WellBeing, Elite TAVR status. New TB research. The Lone Star tic.

and more Policy Wise 46

CRMC’s innovative bariatrics program is a regional success story. 7

All of Us is a research initiative aimed at building one of the largest, most diverse research databases to create a detailed picture of health and health disparities to help speed research breakthroughs.

Jennifer Checkner Executive Director of Content

Cover Illustration Paul Oakley

Emory Health Digest is published twice a year for patients, donors, friends, faculty, and staff of the Woodruff Health Sciences Center. © 2021 Emory University

Emory University is an equal opportunity/ equal access/affirmative action employer fully committed to achieving a diverse workforce, and complies with all applicable federal and Georgia state laws, regulations, and executive orders regarding nondiscrimination and affirmative action in its programs and activities. Emory University does not discriminate on the basis of race, color, religion, ethnic or national origin, gender, genetic information, age, disability, sexual orientation, gender identity, gender expression, or veteran’s status. Inquiries should be directed to the Office of Equity and Inclusion, 201 Dowman Drive, Administration Bldg, Atlanta, GA 30322. Telephone: 404-727-9867 (V) | 404-712-2049 (TDD).

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contents
“Just as the best care for patients is achieved through teamwork and support, addressing burnout and advancing the wellness of health care providers will require leadership and institutional commitment.”
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--Blue
44 ILLUSTRATION JON KRAUSE ILLUSTRATION
JOYCE HESSELBERTH

INNER VISION

Emory’s WHSC Office of Well-Being will implement programs that address stress among clinicians and health providers.

SUIMMER 2022
PHOTO STEPHEN NOWLAND

The Importance of Communicating Research

In today’s complex media environment, trusted and consistent information on scientific research and its impact on our lives is critical. That is why Health Digest magazine plays such an important role in the Woodruff Health Sciences Center’s strategic plan for the advancement of scientific research and knowledge for the greater good. Health Digest magazine has worked to tell the stories of so many discoveries and the people’s lives who have been positively impacted by this work.

In this issue, we feature the story of Emory’s long history of drug discovery (p. 20). We examine the twists, turns, and pauses that are essential in breakthrough discoveries that save people’s lives. Our goal is to help readers gain a clearer understanding of the research process and its importance in our society.

In our cover story, Tyronne Baldwin didn’t realize his heart transplant would land him in the news (p. 30). He has graciously told his story as Emory’s 1,000th heart transplant patient, so others might learn about the stunning progress in cardiology and dedicated team work

that have benefited so many. The story also highlights our continuing efforts to advance the body of knowledge in heart and vascular care.

As I prepare to move into a new role, and the search for a new EVPHA moves forward, I want to thank the team that has worked so diligently over the years to make this publication an important educational vehicle. Mary Loftus served as it’s dedicated and inspired founding editor since the first issue in 2017. Vince Dollard has recently assumed the editor role for Health Digest, and Peta Westmaas continues to lead its innovative graphic design, which is critically important in conveying complex information.

The team includes writers, editors, photo, video, print and digital production professionals, all working to tell the stories of the dedicated men and women of Emory University and Emory Healthcare. From their efforts we move toward our goal of improving lives and providing hope.

Please direct questions and comments to evphafeedback@emory.edu.

Jonathan Lewin, Executive Vice President for Health Affairs, Emory University, Executive Director, Woodruff Health Sciences Center, CEO and Chair of the Board, Emory Healthcare
to our readers 4 EMORY HEALTH DIGEST

INSIGHTS INTO PARKINSONS BALANCE PROBLEMS

Loss of balance and falls are big concerns for people living with Parkinson’s disease and their caregivers. Researchers at Emory and Georgia Tech recently published a paper in PLOS ONE providing insights into how sensory and motor information are misrouted when people with Parkinson’s are attempting to adjust their balance.

When the researchers examined 44 people with Parkinson’s, their history of recent falls correlated with the presence and severity of abnormal muscle reactions. This could help clinicians predict whether someone is at high risk of falling and possibly monitor responses to therapeutic interventions.

both a muscle promoting a motion and its antagonist muscle are recruited. It’s like stepping on the gas and the brake at the same time, says J. Lucas McKay, associate director of Emory’s Neuromechanics Laboratory and first author of the paper.

“Disorganized sensorimotor signals cause muscles in the limbs to contract, such that both a muscle promoting a motion and its antagonist muscle are recruited. It’s like stepping on the gas and the brake at the same time.”

People with Parkinson’s tend to lose their balance in situations when they are actively trying to control their center of mass, such as when they are getting up from a chair or turning around. Disorganized sensorimotor signals cause muscles in the limbs to contract, such that

Physical therapists are sometimes taught that balance reactions in Parkinson’s patients are slower than they should be. “We show this is not true,” McKay says. “The reactions are on time but disorganized.”

McKay says that sensorimotor problems may be a result of degeneration of regions of the brain outside of and after the dopaminergic cells in the basal ganglia.

“We have to speculate, but the sensory misrouting would be occurring in brain regions like the thalamus—not usually the ones we think about in Parkinson’s, such as the basal ganglia,” he says. “This suggests that future therapies involving these areas could reduce falls.” EHD

SUMMER 2022 5
balance well
Lucas McKay, associate director of Emory’s Neuromechanics Laboratory. ILLUSTRATION KEN ORVIDAS

Back Together Again

As Star Trek’s Spock once observed: “As a matter of cosmic history, it has always been easier to destroy than to create.”

The same is true inside human cells, explaining why Emory researchers’ recent accomplishment—finding a small-molecule compound that corrects a defective protein-protein interaction—is so significant for cancer research.

Xiulei Mo, Haian Fu, and colleagues have identified what they call a “mutation-directed molecular glue.” The glue restores a regulatory circuit that when defective, is responsible for acceleration of colorectal and pancreatic cancer. The results are reported in Cell Chemical Biology.

Restoring protein-protein interactions disrupted by an oncogenic mutation is like putting Humpty Dumpty back together again.

“It is very exciting, because this is a clear example of a protein-protein interaction stabilizer that can reactivate the lost function and reestablish tumor-suppressive activity,” says Fu, who is chair of Emory’s Pharmacology and Chemical Biology department and leader of Winship Cancer Institute’s Discovery and Developmental

EMORY SAINT JOSEPH’S HOSPITAL EARNS ELITE ‘TAVR’ PROCEDURE STATUS

Emory Saint Joseph’s Hospital has earned a distinguished three-star rating from the Society of Thoracic Surgeons (STS) and the American College of Cardiology (ACC) for its patient care and outcomes in transcatheter aortic valve replacement (TAVR). The threestar rating, which denotes the highest category of quality, places the hospital among an elite few for the TAVR proce-

HEALTH DIGEST

Therapeutics program.

Scientists are very good at finding inhibitors for enzymes that are overactive. But they have meager results as far as strengthening interactions that are weak or absent. There are existing examples of drugs that stabilize protein-protein interactions (transplant drugs rapamycin and cyclosporine), but they inhibit the function of the proteins they target, as intended —Quinn

“It is very exciting, because this is a clear example of a protein-protein interaction stabilizer that can reactivate the lost function and reestablish tumor-suppressive activity.”

dure in the United States and Canada.

During a TAVR procedure, a doctor uses a catheter inserted into a patient’s blood vessel to deliver a prosthetic heart valve, replacing the patient’s impaired valve.

“This threestar rating affirms Emory Saint Joseph’s Hospital as a leader in quality for the TAVR procedure, which is increasingly becoming a

top-choice method to treat valve dysfunction in a minimally-invasive way, leading to faster recoveries and better outcomes for our patients,” says George Hanzel, interventional cardiologist and director of the cardiac catheterization lab at the hospital. EHD

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ILLUSTRATION CARTOON RESOURCE ILLUSTRATION
PEPERMPRON

WHSC Establishes Office of Well-Being

Emory University’s Woodruff Health Sciences Center has established the WHSC Office of Well-Being. The office will be a central resource for the entire Woodruff Health Sciences Center, which includes Emory Healthcare. The focus will be the design, direction, and implementation of programs that address environmental stressors among clinicians, health professionals, faculty, and staff in clinical, research and academic health sciences areas.

The goals of the office include facilitating systemwide changes that prioritize and promote wellness and professional fulfillment while establishing a robust well-being research foundation.

“We are excited to begin this initiative and to announce our co-leadership structure,” says Jonathan S. Lewin, Emory’s executive vice president of health affairs and CEO of Emory Healthcare. “Health care and academic research, while integral to the health of our nation, are stressful careers. Our strategy is to build an integrated program in which our employees throughout Emory’s health sciences enterprise benefit from work that is collaborative and built around physical and emotional health and compassion, so that our employees can continue to improve lives and provide hope to those we serve.”

Wellness or well-being is not a new concept in corporate or academic environments. According to the Harvard Business Review, more than nine in 10 organizations across the globe offer employees at least one kind of wellness benefit, and more than three in five have dedicated “wellness budgets,” which are expected to expand by 7.8% in the coming years.

A 2018 Blue Ridge Academic Health Group report addressed the issue of stress among health care providers and the need for research and programs on well-being. Among its conclusions: “It is clear that the ‘healing’ of care-

givers cannot be accomplished solely through ‘self-help.’ Just as the best care for patients is achieved through teamwork and support, addressing burnout and advancing the wellness of health care providers will require leadership and institutional commitment.”

The Woodruff Health Sciences Center and Emory Healthcare employ more than 34,000 individuals, including 7,000 nurses who serve as expert clinicians and an essential surveillance system for hospital care.

“This novel interprofessional approach to improve well-being for all clinicians, health sciences faculty, and researchers will accelerate improvement for individuals and the systems they use to care for patients, while building community with their colleagues,” says Sharon Pappas, chief nurse executive, Emory Healthcare.

The office will initially be led by co-chief well-being officers Tim Cunningham and Chad Ritenour, both of whom will dedicate their time, energy, and creativity to establishing the office.

Cunningham is currently the vice president for practice and innovation for Emory Healthcare and adjunct associate professor in the Nell Hodgson Woodruff School of Nursing. Ritenour is chief medical officer of Emory University Hospital and professor of urology in Emory University School of Medicine. Cunningham and Ritenour will report directly to Lewin in this capacity and began their appointments on Jan. 1, 2022.

“We wanted to ensure this important initiative got off the ground and started on a positive trajectory right away,” says Lewin. “This leadership appointment illustrates a holistic approach, bringing together two established leaders whose backgrounds in nursing and medicine ensure the creation of a collaborative and balanced strategy that focuses on support for individuals.” EHD

SUMMER 2022 7 stay well
ILLUSTRATION DAN PAGE

USING ARTIFICIAL INTELLIGENCE TO UNRAVEL THE MYSTERIES OF SEPSIS

In the United States, more than a quarter of a million people each year succumb to sepsis, and around the world it’s one in five. Sepsis is a condition in which the immune system responds to an existing infection such as COVID-19 by turning on itself instead of fighting the germs.

Infections that lead to sepsis most often start in the lung, urinary tract, skin, or gastrointestinal tract. Without timely treatment, sepsis can rapidly lead to tissue damage, multi-organ failure, and death.

The National Institute of General Medical Sciences of the National Institutes of Health recently awarded Emory researchers $2.6 million to study the use of artificial intelligence (AI) to predict treatment effectiveness and outcomes for patients with sepsis.

“The hope is to use AI in a new way so we can better see in an area where traditionally we have flown blind,” says Rishikesan Kamaleswaran, the assistant professor in Emory’s biomedical informatics department who leads the research.

Typically, AI approaches have largely focused on predicting sepsis from electronic medical records, which Kamaleswaran says suffer from many problems. “The data are not timely, significant portions are missing or wrong because of the manual process of entry, and the information often reflects individual and institutional biases, which all make it difficult to devise a treatment plan that can be replicated someplace else.”

The five-year study will tap into expertise from different disciplines at Emory including mathematics, computer science, and medicine to develop sophisticated tools that can analyze the data, identify patterns, and prescribe a course of action.

“The use of AI and machine learning here are powerful mathematical constructs that when placed in the hands of a capable clinician, can become an efficient resource for improving patient care,” Kamaleswaran says. EHD

8 EMORY HEALTH DIGEST predict well ILLUSTRATION ELENABSL
Rishikesan Kamaleswaran, assistant professor in Emory’s biomedical informatics department

A Lifetime of Service to Public Health

years old when Curran was tapped to lead it.

James Curran led US efforts in HIV/AIDS prevention for 15 years at the Centers for Disease Control and Prevention (CDC) before joining Rollins School of Public health as its dean in 1995. Last year, Curran announced his retirement. He will be succeeded by M. Daniele Fallin, an internationally regarded researcher and educator, who comes to Emory from Johns Hopkins Bloomberg School of Public Health and was named the new James W. Curran Dean of Public Health at Rollins.

“Jim Curran’s extraordinary vision and leadership helped establish the Rollins School of Public Health as a world leader in public health education and research,” says Jonathan Lewin, CEO of Emory Healthcare. “It’s humbling to reflect on the extraordinary impact of Jim’s leadership and his groundbreaking and lifesaving decades of work.”

In 1981, Curran accepted a leadership role on a CDC task force charged with determining what was behind the first cases of what is now known as AIDS. Reflecting on that time, Curran says, “The most important thing we did was come out with prevention recommendations before the cause was found. If you read those recommendations today, they sound pretty good.”

Emory’s School of Public Health was just five

Under his strategic leadership, Rollins has grown steadily over the past two decades, with six academic departments and an executive MPH program for working professionals among its academic programs. As of 2020, Rollins employs more than 200 full-time faculty as well as 250 adjunct faculty from the CDC, CARE, the Task Force for Global Health, the Carter Center, and state and local health departments. The school is home to more than 22 interdisciplinary centers and 10 dual degree programs that bridge students to related fields such as business, medicine, nursing, law, and theology.

Annually, Rollins enrolls cohorts of approximately 600 public health master’s students from all 50 states and more than 40 countries, with nearly 20 percent originating from outside the US. With Laney Graduate School, Rollins offers seven PhD programs. Today, more than 10,000 Rollins alumni are contributing to public health in 104 countries.

Rollins is ranked No. 4 among accredited schools and programs of public health by US News & World Report and has a reputation for being a collaborative work and learning environment. Curran can be credited for fostering a strong sense of community among faculty, staff, and students through his personal approach as dean.

At the time he announced his retirement, Curran was the longest-serving dean at Emory and among schools of public health in the United States. “We have much to be proud of at Rollins and should be very confident about the future,” he says. EHD

SUMMER 2022 9 serve well
PHOTO BRYAN MELTZ PHOTO JACK KEARSE James Curran joined the Rollins School of Public Health as dean and professor of epidemiology in 1995 following his 25-year career of leadership at the CDC. PHOTO JACK KEARSE

Grant Provides Training for Sexual Assault Nurse Examiners

The US Department of Health Resources and Services Administration has awarded $1.2 million to the Nell Hodgson Woodruff School of Nursing to increase the number of sexual assault nurse examiners in Georgia. The school is using the grant to create the Georgia Forensic Nursing Network (GFNN), which will work with partners across the state.

Associate Professor of Nursing

Trisha Sheridan leads the effort, which will provide training and certification opportunities to 140 nurses over the next three years. She is board certified as a women’s health nurse practitioner and a board-certified sexual assault examiner for adults, adolescents, and children.

The Georgia Forensic Nursing Network works to create partnerships between academic institutions, private practice, and other stakeholders to improve health care to survivors of sexual violence. The network will offer classroom and clinical training opportunities through Emory’s School of Nursing—the only clinical skills training in Georgia approved by the International Association of Forensic Nurses. EHD

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10 EMORY HEALTH DIGEST
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Trisha Sheridan, Associate Professor of Nursing

An Ounce of Prevention. . . well,

you know the rest

Anannual preventive exam identifies potential health issues in the early stages when they may be easier and less costly to treat. Early detection of medical problems, illnesses, and diseases helps your doctor provide proactive care and treatment. Your primary care provider also can help you coordinate which tests and vaccinations are right for you. The exam generally includes:

n Checks of vital signs such as temperature and blood pressure

n Heart and lung exams

n Head, neck, and abdominal exams

n Muscle strength, balance, and reflex checks.

Pamela Briggs, service-line manager in Emory’s Diagnostic Treatment Center, has learned the value in making time for an annual preventive exam and following the advice of her providers.

Briggs has had high cholesterol levels for many years. After her annual preventive exam, she began taking medications prescribed by her physician assistant (PA). She also began drinking more water and reducing some of her stressors. Making these changes helped Briggs lower her cholesterol level by more than 100 points.

“Being able to discuss concerns with my provider and knowing that someone is an advocate to help you stay healthy is really a gift,” Briggs says. “I have to give a huge shout-out to my PA, Heather Prusik. She is amazing and really does want the best healthy outcomes for her patients.”

Emory family medicine physician Tina-Ann Thompson says, “The annual preventive exam is a time to review the health concerns that have come up over the last year. It is a time to be sure that immunizations, routine health screenings, and physical and mental health concerns are addressed. It is best to find out if there have been any changes in family history, because certain routine screenings need to be done earlier if there is a family history. It needs to be annual because recommendations change, our bodies change, and early detection of illnesses is best.” EHD

Rock-Solid Rankings

Review: For the 10th year in a row, US News & World Report ranked Emory University Hospital the No. 1 hospital in Georgia; Emory Saint Joseph’s Hospital ranked No. 2 for the sixth consecutive year; and Emory University Hospital Midtown ranked No. 5 for the third consecutive year. Emory Healthcare was also named one of the 10 most trusted health system brands in the US—the only health system in Georgia—based on a recent survey conducted by the American Hospital Association (AHA), the Society for Health Care Strategy and Market Development (SHSMD) of the AHA, and Monigle.

SUMMER 2022 11 check well
ILLUSTRATION ELENA PIMONOVA

WASTE MATTERS

Christine Moe, professor in the Rollins School of Public Health, is collaborating with CERES Nanosciences to test wastewater for COVID-19. The $3 million NIH grant will allow for rapid detection of the virus and enable municipalities to detect virus concentrations in specific geographic areas.

test well
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PHOTO KAY HINTON
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New Emory TB Research Center to Help Draw Attention

to an Old but Still Deadly Disease

A century ago, tuberculosis was the equivalent of COVID-19 today: a respiratory disease that was everywhere, killing men and women across all strata of society. Once the world discovered an effective antibiotic treatment for TB, it became mostly relegated to the margins. And yet, until the arrival of SARS-CoV-2, more people died of TB every year than any other infectious disease, especially in poorer countries.

A new grant from the National Institute of Allergy and Infectious Diseases (NIAID) will support scientists at Emory and three other institutions in the US to further research TB, which in 2020 killed approximately 1.5 million individuals and was responsible for an estimated 10 million new cases world wide.

The goal of the Emory/Georgia Tuberculosis Research Advancement Center (Emory/Georgia-TRAC) will be to expand collaborative multidisciplinary TB research in the US and internationally; diversify TB research in new directions; and identify, train, and mentor the next generation of TB researchers and scientific leaders.

Emory/Georgia-TRAC will include colleagues from the University of Georgia, Georgia State University, Morehouse School of Medicine and Georgia Tech. It will also work closely with public health professionals in the Fulton and Dekalb county health departments and the Centers for Disease Control and Prevention.

Principal investigators Neel Gandhi, professor of epidemiology at the Rollins School of Public Health, and Jyothi Rengarajan, professor of medicine at Emory Vaccine Center and the School of Medicine, say the initiative will harness Emory’s deep infectious diseases expertise and tap into the complementary strengths of other institutions in the state.

Like COVID-19, TB disproportionately affects those in underresourced settings—people who live in poverty, have little access to health care, sanitary facilities, and education, and are malnourished.

“If there’s one thing we have learned from the pandemic, it’s that a dangerous infectious disease anywhere is a dangerous infectious disease everywhere,” says Gandhi.

“The impact of a respiratory pathogen such as TB being present in the world is a big reason to ensure we find ways to end this disease.” EHD

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Neel Gandhi, professor of epidemiology at Rollins School of Public Health
Animage showi n g accu m ul a t i o n o f t u b e r uc solsi airetcab ni t eh gnul.s
Jyothi Rengarajan, professor of medicine at Emory Vaccine Center and Emory School of Medicine

Practical Goals for Weight Loss

Weight-loss scams, crazed fashion diets, and countless pills have promised fast and simple ways to lose weight. In reality, the true foundation for successfully losing weight is developing a realistic and healthy program that fits your body and lifestyle. Here are five simple tips that can help you create practical weight loss goals for yourself.

1. Commit to Your New Lifestyle

In order for you to successfully lose weight, you must be willing to devote your time as well as your effort. Changing your daily habits and sticking to a set plan takes a significant amount of energy, so make sure you are willing to commit yourself. Once you feel prepared and motivated, choose a date to start your program, and then begin!

2. Establish Realistic Goals

One of the most important parts of dieting is to create attainable goals. First, determine a realistic target weight that you want to reach. Second, be sensible about the time frame you have given yourself. According to experts, a realistic goal is losing 1 to 2 pounds a week to stay healthy. By planning to lose weight slowly and healthily, you will develop new lifestyle habits and be more likely to maintain them.

3. Make Healthier Food Choices

Now that you have set realistic goals for yourself, you can begin your weight loss program. Start by evaluating your style of eating and determine what you can change. As you begin to alter your eating habits, keep in mind that you should lower your

daily caloric intake, but still eat foods that you find satisfying. One tip is to increase your intake of fruits, vegetables and whole grains, and make sure to eat a hearty breakfast every morning.

4. Get Active!

Along with eating right, exercising is another key component to weight loss. In order to effectively shed pounds, you must burn more calories than you consume. While it is possible to lose weight without physical activity, exercising can burn some calories that simply can’t be dissolved by dieting. Try thinking of new ways to be active rather than just hitting the gym. Creativity counts!

5. Stay Motivated

Losing weight can be a long process, but the most important thing is to stick with your new lifestyle. Find different ways to motivate yourself, whether it is through a supportive group of friends or an exciting reward at weight loss checkpoints. Staying positive is essential, and having compassion for yourself is key. Tell yourself you can, and will, obtain your weight loss goals and create a new lifestyle for yourself through hard work and perseverance. EHD

SUMMER 2022 15 live well

You Know You Need to do This…Here’s Why

Turning 50 is a big milestone for many people—a lot happens in a half century, after all, including major medical and technological advancements. And for some time, reaching age 50 has been associated with having your first colonoscopy.

Recent guidelines have changed.

In 2018, the American Cancer Society revised its guidelines to recommend a first screening for colon cancer at age 45—or earlier if you have a family history. In 2021, the US Preventive Services Task Force (USPSTF) updated its recommendations to match the American Cancer Society’s guidelines, lowering the age of first screening to 45.

Sonali Sakaria, MD, clinical chief of gastroenterology (GI) at Emory Decatur Hospital, says the main reason for the updated guidelines “is that colorectal cancer is the third leading cancer in men and women equally and the second leading cause of cancer death. Recent studies have highlighted an increased incidence of colorectal cancer in individuals younger than age 50.”

But colorectal cancer is preventable—and it’s treatable when caught early. Colon cancer screening is one of the most effective early detection and prevention services available in medicine today.

Since 2011, Sakaria explains, the rate of colon cancer has increased by roughly 1% each year in patients both under and over age 50. Modeling stud-

ies, which are simulations run using available data to make predictions, have shown that starting colonoscopies at age 45 would help save lives. During screening, it’s possible to remove polyps early—if precancerous polyps are removed, they won’t turn into colon cancer later.

“It’s a screening test that’s as important as getting pap smears, mammograms, and prostate cancer screening. It truly does save lives,” Sakaria says. “I think educating patients on how the procedure is done alleviates a lot of their concerns. And the more educated patients are, the more likely they are going to be willing to undergo the screening procedure.”

Is a colonoscopy the only screening option?

A colonoscopy is a one-step test, Sakaria explains. “Not only does it screen for colon cancer, but it is also a therapeutic procedure, meaning during colonoscopy, we remove any polyps that could potentially turn into colon cancer in the future.”

Screening is particularly important for Black men and women.

“We do know that African Americans have roughly a 20% higher incidence of colorectal cancer and are more likely to develop colon cancer at a younger age,” says Sakaria. “They also have the lowest five-year survival rate for colorectal cancer of any other racial group. So, it’s critical for us to be screening the African American population, men and women alike.”

Request an Appointment

To make an appointment, call 404778-7777 to speak with a HealthConnection registered nurse or representative. EHD

16 EMORY HEALTH DIGEST screen well
Sonali Sakaria, clinical chief of gastroenterology at Emory Decatur Hospital
“It’s a screening test that’s as important as getting pap smears, mammograms, and prostate cancer screening. It truly does save lives.”

Coffee Regional and Emory Healthcare Build Better Bariatrics for South Georgia

ment tools available as well as the most advanced surgical techniques,” says Royals. “With the support of Dr. Lin and the entire Emory Healthcare team, our team is now able to give our patients all the tools they need to overcome challenges and be successful in their weight loss journey.”

Lin has led Emory Healthcare’s participation in the initiative with CRMC. “Coffee Regional has a visionary leadership team, a talented staff, and solid infrastructure that contributes to a successful initiative like this,” he says.

Coffee Regional Medical Center has been serving south Georgia residents since 1935, and innovation and strategic growth have been hallmarks of CRMC’s commitment to its community.

One recent example is CRMC’s Bariatric and Metabolic Center, a comprehensive weight loss center established in 2020 in collaboration with Emory Healthcare’s Regional Affiliate Network. Chet Royals, a CRMC general surgeon, leads the Bariatric and Metabolic Center along with Edward Lin, Emory’s chief of gastrointestinal and general surgery.

Vicki Lewis, president and CEO of CRMC, points out the benefits of the collaboration with Emory Healthcare. “As a member of Emory Healthcare’s Affiliate Network, we are able to continue to explore and expand expertise across both existing and new clinical services, ad-

vancing our mission of exceptional care and wellness close to home. Our relationship with Emory helps CRMC develop and deliver the right services to the residents of Coffee County and South Georgia. In addition to bariatrics, Emory assisted CRMC with our successful Percutaneous Coronary Intervention program, and we are collaborating on an eICU telehealth program, providing consultation from Emory physician in the care of our ICU patients.”

The bariatric program’s multidisciplinary approach addresses nutritional, medical, physical, and behavioral obstacles to achieving each patient’s weight loss goals. Patients have access to nutrition counseling, exercise classes, and, for those for whom it is appropriate, various surgical options.

“We provide each patient with the best weight manage-

Lin further explained, “The affiliation between Emory and Coffee Regional is one of several we have throughout Georgia. The idea is to help places homegrow advanced care and therapeutics, making care accessible to people in the community,” he says. “We believe a healthy community leads to a healthier Georgia, and that’s good for everyone.”

“We are confident that our commitment to strengthening access to quality, affordable care in communities across the region will benefit the Coffee County community and surrounding areas,” says Jonathan S. Lewin, CEO of Emory Healthcare and executive vice president of health affairs for Emory University.

To learn more about Coffee Regional Medical Center, visit them online at coffeeregional.org. To learn more about CRMC’s new Bariatric & Metabolic Center, visit CoffeeRegionalBariatrics.com. EHD

SUMMER 2022 17 serve well
PHOTO SARAH BROWN, CRMC Emory’s Ed Lin performs a GI proceedure with the Coffee Regional surgical team

If This Doesn’t ‘Tick You Off’

Heartland virus identified in lone star ticks in Georgia

Emory University scientists have confirmed that the Heartland virus is circulating in lone star ticks in Georgia. The journal Emerging Infectious Diseases recently published the findings, which include a genetic analysis of the virus samples, isolated from ticks collected in central Georgia.

The research adds new evidence for how the tick-borne Heartland virus, first identified in Missouri in 2009, may evolve and spread geographically and from one organism to another.

different specimen samples of lone star ticks— collected in different locations and at different times—and including both the nymph and adult stages of the ticks.

the wild

“Heartland is an emerging infectious disease that is not well understood,” says Gonzalo Vazquez-Prokopec, associate professor in Emory’s Department of Environmental Sciences and senior author of the study. “We’re trying to get ahead of this virus by learning everything that we can about it before it potentially becomes a bigger problem.” Vazquez-Prokopec is a leading expert in vector-borne diseases—infections transmitted from one organism to another by the bite of a vector, such as a tick or mosquito.

The study detected Heartland virus in three

The Heartland virus was discovered in 2009 in northwest Missouri after two local men were hospitalized with high fevers, diarrhea, muscle pains, low counts of white blood cells and platelets, and other symptoms similar to known tick-borne diseases. Researchers soon realized the men were infected with a novel virus, which was christened Heartland and later traced to lone star ticks. Further studies found antibodies to the virus in blood samples from deer and some other wild mammals.

The Centers for Disease Control and Prevention currently recognizes 18 tickborne diseases in the United States, many of them newly emerging. One of the most well-known tick-borne illnesses is Lyme disease, which in recent decades has grown into the most common vector-borne disease in the country.

giving well 18 EMORY HEALTH DIGEST
In
PHOTO BY JOHN GRATON

While the complex transmission cycle for Lyme disease is well understood, many questions remain about how the Heartland virus moves among different species.

Since it was first discovered, more than 50 cases of Heartland virus have been identified in people from 11 states in the Midwest and Southeast, according to the Centers for Disease Control and Prevention.

To better assess the risk, Vazquez-Prokopec wanted to learn whether lone star ticks are currently carrying Heartland virus in central Georgia. Members of his field research team collected ticks from the rural landscape near the Piedmont National Wildlife Refuge. The lone star tick, named for a distinctive white spot on its back, is the most common tick in Georgia and is widely distributed in wooded areas across the Southeast, eastern, and Midwest United States. They are tiny, about the size of a sesame seed in the nymph stage, and barely a quarter-ofan-inch in diameter as adults.

The team collected nearly 10,000 specimens from sites in Georgia’s Putnam County and Jones County. The results suggested that about one out of every 2,000 of the collected specimens carried the Heartland virus. Additional collection initiatives are underway.

“We want to start filling in the huge gaps in knowledge of the transmission cycle for Heartland virus,” Vazquez-Prokopec says. “We need to better understand the key actors that transmit the virus and any environmental factors that may help it to persist within different habitats. Tick-borne diseases are a real and growing threat and the best way to deal with them is not to panic, but to do the science needed to learn everything we can about them.”

Funding for the work was provided by a grant from the Emory University Research Council. EHD

Teamwork Tackles C. diff Infections

A team of nurses, infection preventionists and other specialists at Emory Saint Joseph’s Hospital found that multidisciplinary teamwork is key to reducing Clostridioides difficile (C. diff), a common hospital-onset bacterial infection, in health care facilities.

“Our project showed that interprofessional collaboration and continuous improvement can profoundly impact C. diff incidence and sustain reductions over years,” says Cherith Walter, first author on the published study and clinical nurse specialist at Emory Saint Joseph’s. “We hope our findings will help other health care teams to improve patient safety and reduce associated costs.”

Their research, was published in May 2022, in the American Journal of Infection Control.

According to the Centers for Disease Control and Prevention, an estimated 500,000 cases of C. diff occur in the United States annually, making it one of the most prevalent health care associated infections in the country.

To address the C. diff incidence at ESJH, Walter and colleagues created an interprofessional team consisting of a clinical nurse specialist, a physician champion, a hospital epidemiologist, an infection preventionist, a clinical microbiologist, unit nurse champions, an antimicrobial stewardship pharmacist, and an environmental services representative.

The team reviewed C. diff events at ESJH to determine causative factors, then identified appropriate, evidence-based infection prevention interventions.

After the first year, the team recorded a 63% decrease in C. diff as compared to the two years prior (4.72 per 10,000 patient days vs. 12 per 10,000 patient days). This number improved further to 2.8 per 10,000 days three years after implementation of the selected interventions (a 77% decrease from baseline).

Interventions also improved C. diff testing practices, increasing testing for appropriate patients in the first three days of hospital admission from 54% in 2014 to 81.1% in late 2019, to support prompt treatment of infected patients. EHD

SUMMER 2022 19 giving well
“Tick-borne diseases are a real and growing threat and the best way to deal with them is not to panic, but to do the science needed to learn everything we can about them.”

Failure is Frequent Success is Sweet

EMORY’S DRUG HUNTERS AND THE ROAD TO DISCOVERY

Jim • Illustration by Mark Allen Miller

It is a rare honor to meet someone whose life you have saved.

Emory drug hunters Dennis C. Liotta, Raymond F. Schinazi, and Woo-Baeg Choi, however, know the feeling. The drugs they developed for HIV— Epivir and Emtriva—have saved countless lives.

At conferences, in restaurants, those who are still here because of the work of these scientists, or love someone who is, often step forward to express their thanks. It doesn’t get old. How could it?

Though rightly celebrated for the magnitude of their discoveries, Schinazi and Liotta, who remain at Emory, rub elbows with a host of colleagues whose work is also groundbreaking. During the past two decades, Emory scientists and clinicians have developed medications to treat influenza, cancer, hepatitis, hemophilia, measles, heart disease, dry eye, hot flashes, and other disorders.

In that time, a brass bell outside the Emory Office of Technology Transfer (OTT) has gotten a workout. Whenever the office signs a deal to license an Emory researcher’s invention to a company wanting to develop it as a new product or drug, Todd Sherer, associate vice president for research and OTT’s executive director, rings the bell outside his office, and everyone within earshot applauds.

SUMMER 2022 21
Dennis C. Liotta, professor, Department of Chemistry; executive director, Emory Institute for Drug Developmemt Raymond F. Schinazi professor, Emory School of Medicine; senior career Scientist, Atlanta VA; researcher, Emory National Primate Research Center Woo-Baeg Choi former Emory researcher

In 2013, Sherer sounded the bell for an obscure drug called EIDD2801, which Emory scientist George Painter developed as a countermeasure against Venezuelan equine encephalitis. Painter later found that it worked against respiratory viruses such as influenza and, eventually, a disease no one had heard of until two years ago: COVID-19.

EIDD-2801 evolved into molnupiravir, the first oral antiviral pill approved in the world to treat symptoms of the novel coronavirus that has killed more than five million people worldwide. The medication received Emergency Use Authorization from the US Food and Drug Administration on December 23, 2021, and its manufacturer, Merck, rushed to make the red capsules available to high-risk patients.

26 FDA-APPROVED DRUGS AND COUNTING

But none of that was foreseeable when Painter synthesized the precursor of the drug and Sherer clanged his bell. “It was but a glimmer in the eyes of us all,” Sherer says. “This is standard fare for universities, where discovery occurs

years before success becomes obvious.”

Molnupiravir is the 26th FDA-approved drug born at Emory. Thirteen others are in clinical testing, and six more are in preclinical trials.

Given the flurry of work by Emory researchers in response to the pandemic, molnupiravir isn’t even the first approved COVID-19 drug credited to Emory. That distinction goes to baricitinib, an arthritis medication marketed by Eli Lilly that Emory researchers discovered could be used to treat the complications of severe COVID-19.

Emory has become a drug-development nexus because of a rare confluence of institutions and expertise. The presence of the Emory Healthcare system, the Centers for Disease Control and Prevention, Emory National Primate Research Center, and research partners such as Georgia Tech, Georgia State University, the University of Georgia, and Morehouse School of Medicine have created a hothouse of drug innovation and attracted a growing number of renowned scientists to the university.

“We have a very broad-based faculty with interest in immunology, vaccinology, and drug discovery and development,” says Schinazi, a medical chemist who has helped generate some of Emory’s biggest drug breakthroughs.

The university counts more than 2,500 scientific researchers who received almost $900 million in funding from the US government, private foundations, and other sources in the past fiscal year. They carry out their discovery in a matrix of schools, centers, institutes, and

22 EMORY HEALTH DIGEST
Todd Sherer associate vice president for research and OTT’s executive director George Painter CEO, Drug Innovation Ventures at Emory; professor, Pharmacology and Chemical Biology David Stephens vice president for research, Woodruff Health Sciences Center

laboratories across campus and beyond. Some of the entities specifically target drug creation, such as the Emory Institute for Drug Development (EIDD), Emory Vaccine Center, Alzheimer’s Center for the Discovery of New Medicines, and DRIVE (Drug Innovation Ventures at Emory), the university’s own nonprofit biotech company, which first licensed the discovery that became molnupiravir.

“Emory’s innovative model has accelerated the discovery of life-saving drugs,” says President Gregory L. Fenves. “It’s an interdisciplinary approach that begins with asking what scientific advances are required to address urgent needs, then turning discoveries into safe and effective therapeutics and vaccines that have the power to save lives and improve the health of communities.”

NOT THAT MANY YEARS AGO, HARDLY ANY OF IT EXISTED

It takes guts.

When David S. Stephens, vice president for research in the

Woodruff Health Sciences Center, was considering his career options in the early 1980s, he interviewed at Emory. His colleagues at Vanderbilt University advised him not to go.

“Emory at the time was not known as a place of innovation or discovery,” he remembers. “We were known for clinical medicine, education, teaching. But we were not known for translational research. I think we’ve changed that paradigm.”

One of the early landmarks in that transformation, he believes, was the 1979 gift of $105 million from Coca-Cola magnate Robert W. Woodruff and his brother George W. Woodruff. That commitment continues. A 2018 pledge of $400 million from the Woodruff Foundation is helping to create a new home for drug discovery in the Health Sciences Research Building

II, an eight-story tower scheduled to open in 2022.

Emory was first recognized for drug development in the

early 1990s when Liotta, a chemistry professor, resolved to focus on the HIV/AIDS epidemic. “I made it my personal goal to create a safe and effective AIDS drug. It is so gratifying that it became part of a series of combination therapies that transformed AIDS from a death sentence to a manageable chronic disease,” he says.

Liotta partnered with Emory researchers Schinazi and Choi, and they patented an HIV drug in early 1990, just seven days ahead of their competition. It took a decade of laboratory refinement, testing, and patent prosecution and litigation before the compound could reach the market. “[The university] ended up spending over $20 million in legal fees,” Liotta says.

“It took guts.”

The resulting medication, Epivir, became the first Emory-developed drug to win FDA approval in 2001. Emtriva, a second drug created by the same team, followed two years later. More than 90 percent of HIV patients in the United States

SUMMER 2022 23
Emory University Health Sciences Research Building II

have taken or are taking the drugs, as they became part of a once-a-day pill regimen that prevents the withering disease. Epivir is also widely used for the treatment of HBV, an infection affecting more than 400 million people that often leads to hepatocellular (liver) cancer. Schinazi also discovered telbivudine, a drug highly effective and specific for HBV infections.

The collaboration that the three scientists demonstrated is a staple of the Emory program. When the overriding goal is the health of patients, every source of insight and expertise is welcome. Jonathan Lewin, Emory’s executive vice president for health affairs and CEO of Emory Healthcare, believes the culture of collaboration across schools and disciplines is one of the university’s strengths.

“The fact that our scientists work together—people across medicinal chemistry, the School of Medicine, and our other schools—has enabled us to tackle some of the most challenging diseases around,” he notes.

The success of the HIV medications helped secure the future of drug development at Emory. In one of the largest intellectual property deals ever struck by a university, Emory in 2005 sold rights to future Emtriva royalties for $525 million. It reinvested most of the proceeds into research, in accordance with federal law, while Liotta gave millions from his lab’s share of earnings from the sale to create EIDD and DRIVE. The two entities work hand-in-glove—EIDD concentrating on science, DRIVE focusing on antivirals that address critical treatment gaps—and were instrumental in the discovery of molnupiravir.

Painter, DRIVE’s CEO, started working on what would become molnupiravir in 2013 after the Defense Threat Reduction Agency put out a call to develop countermeasures against equine encephalitis, a tropical infection that it feared could be used as a bioterrorism weapon. He learned that the drug could suppress a wide variety of viruses, especially coronaviruses, by stunting their ability to reproduce.

The promise of an oral medication against COVID-19 drew global attention. Painter found the glare distracting. “I have spent my career as a drug developer, nose down, getting things done,” he says.

When he heard the trial results from Merck confirming that molnupiravir could help treat COVID-19 patients at high risk for severe disease, he admits that his scientific detachment melted. He started weeping.

And then he got back to work.

“Our continuing mission is to search for other antiviral agents that are usable by the general public to address other tough diseases,” Painter says. “So we are on it. That’s our job.”

SKIRTING THE MANY ROADS TO FAILURE

As medications go, molnupiravir’s development—propelled by the pandemic—was rapid. It took only eight years from the time Painter started developing the drug to the time the FDA issued emergency authorization. Most drugs are tortoises, taking an average of 10 years or longer to reach the public. The vast majority don’t finish the race.

“Most drug discoveries never go to market,” says Deborah Watkins Bruner, Emory’s senior vice pres-

24 EMORY HEALTH DIGEST
Deborah Bruner senior vice president for research, Emory University Jon Lewin executive vice president for health affairs, Emory University; CEO Emory Healthcare Pete Lollar, professor, Department of Pediatrics; director of hemostasis research, AFLAC Cancer and Blood Distorders Center Louise Hecker, associate professor, Department of Medicine, Pulmonary

ident of research. “It’s only a very small percentage that make it through that entire pipeline, from animal trials to human trials to licensing to FDA approval to commercialization.”

Pete Lollar, an Emory hematologist, recalls seeing a cartoon that illustrated the long odds; thousands of pills were pouring into the open end of a huge funnel, while one measly survivor made it out of the bottom. The image resonated with him because he lived through the process with a drug he invented to treat acquired hemophilia A, a rare condition that usually strikes older people.

Lollar started investigating Factor VIII, a protein that helps blood clot, four decades ago. In 1992, he and his lab partners at Emory discovered a way to synthesize the substance to treat hemophilia patients. After failing to find a pharmaceutical company to license the technology, Lollar co-founded a company with the university to license the technology and develop a medication.

Twenty years later, after several pharmaceutical firms had licensed or sublicensed the technology, the drug still had not won federal approval. It was in the wilderness between research and commercialization, what people in drug development call “the valley of death.” Lollar blames economics. The market for the medication was relatively small— in pharmaceutical parlance, it was an “orphan drug”—so none of the successive companies felt an urgent need to spend the money to finish testing. Lollar kept at it. Finally, in 2014—22 years after Lollar disclosed his invention to Emory—Baxter International won FDA approval for

his hemophilia drug, obizur.

“What I learned,” Lollar says, “is that getting a drug to market is an idiosyncratic process. There are no easy formulas and there are many routes to failure. Once you disclose an invention, the university has to like it well enough to spend money to prosecute the patents. And then it has to try to find a company to license it. The company has to be willing to spend the money to perform preclinical work and do clinical trials. The longer it goes, the more expensive it gets.”

Even when a drug is approved, the struggle isn’t over.

Christian P. Larsen, professor of surgery in Emory’s Department of Transplantation, co-developed a drug called belatacept that reduces the chance of kidney transplant rejection. After 19 years of development, Bristol Meyers Squibb secured FDA approval for the medication in 2011, and Larsen and his co-discoverer, Thomas C. Pearson, executive director of the Emory Transplant Center, marked the triumph by performing the first kidney transplant using the drug.

BUT THAT WAS JUST THE BEGINNING

“We tell the story of belatacept like it was linear,” Larsen says, “but it wasn’t. There were so many fits and starts, peaks and valleys, other candidates that we decided not to pursue. And then when you get the drug approved, there really isn’t a moment when you get to declare victory.”

He continues. “That was a big revelation for me. It’s never over. You have to do follow-up studies, keep investigating the best way to use it,

SUMMER 2022 25
“The fact that our scientists work together—people across medicinal chemistry, the School of Medicine, and our other schools—has enabled us to tackle some of the most challenging diseases around.”
—Jon Lewin
“That was a big revelation for me. It’s never over. You have to do follow-up studies, keep investigating the best way to use it, find the most effective companion drugs. If you take the long view of solving problems for patients, drug discovery is an ongoing process.”
—Christian P. Larsen

find the most effective companion drugs. If you take the long view of solving problems for patients, drug discovery is an ongoing process.”

A NEW GENERATION OF ‘ACADEMIC ENTREPRENEURS’

One of the biggest changes in drug development has been the role of private industry. Research universities used to think their work had ended after scientific discovery; it was the job of pharmaceutical companies, not academia, to develop innovations into medications. Now institutions such as Emory embrace partnerships with biotech and pharmaceutical companies.

“Ultimately, a lot of the ideas we’ve had only move forward if someone in the for-profit sector wants to move them forward,” says Vikas P. Sukhatme, dean of the Emory School of Medicine.

“Most drugs are developed by industry. And most devices are developed by industry. So, we do have to keep an eye on how we can best commercialize things.”

Pulmonologist Louise Hecker left the University of Arizona to join Emory as an associate professor of medicine in 2020, in part because she believed Emory understood the role of private enterprise.

“They brought me here to be an academic entrepreneur,” she says. “To translate any science into something that helps people, you have to think of it as a product. I felt like this was a place where that mind-set is valued. Even the dean has a company. You don’t see that everywhere.”

Hecker studies regenerative biology and the body’s declining ability to heal scar tissue as it ages. In a major discovery, she identified

NOX4, an oxidizing agent that can go into overdrive and result in fatal organ damage after traumas like a heart attack. She set her sights on finding a compound that would curb NOX4 and allow organs to regenerate themselves.

She and her lab screened 35,000 compounds to find candidates that looked likely to control NOX4. It was a long, difficult search that took years and was filled with disappointment. “Things fail all the time,” she explains. “It’s a key part of being successful. I always try to fail as quickly as I can, because you’re not going to find out what works until you find out what doesn’t work. Each failure brings you a step closer to success.”

Now that she is ramping up her lab at Emory, she hopes to be filing “a lot” of invention disclosures in the coming years as new applications for her research are discovered. In continuing her work on a new campus, Hecker is inspired by pioneer Emory drug hunters such as Dennis Liotta, whom she asked to be on her academic advisory board.

“To have people like Dennis around is fantastic,” Hecker says. “I mean, he’s done it.” When it comes to drug discovery, history seems to be repeating itself at Emory. EHD

26 EMORY HEALTH DIGEST
“It’s a key part of being successful. I always try to fail as quickly as I can, because you’re not going to find out what works until you find out what doesn’t work. Each failure brings you a step closer to success.”
—Louise Hecker

Walkin’ on Sunshine thanks to a 3D printed ankle joint

When Natasha Bass survived a severe car accident in September 2016, she wondered if she would be able to walk again. With both legs and ankles broken in multiple places, she joked that “my surgeon had to put me back together again like Humpty Dumpty.”

After the accident, Bass had to stop working as a security officer in a hospital while she began to heal. It wasn’t long before Bass noticed one of her feet started tilting. X-rays confirmed that she had developed talar avascular necrosis due to her bone break, which meant her ankle bone was losing blood supply and dying.

In 2017, Jason Bariteau, an orthopedic surgeon at Emory Orthopaedics & Spine Center, started with non-surgical treatments such as bracing, using a boot, modifying activity and stimulating the bone to heal. When that didn’t work and Bass’s talus

SUMMER 2022 27

bone continued to soften, he presented her with a surgical option: ankle and subtalar joint fusion, which involves fusing three bones together. But even that treatment had limitations. Because the subtalar joint is what gives your ankle its basic rotation, permanently fixing Bass’s ankle at a 90-degree angle and eliminating movement in the joint, the fusion procedure would reduce her pain but seriously limit her mobility and change her gait.

“I would have to walk with a cane for the rest of my life,” said Bass, who’s in her 40s and enjoys an active lifestyle that includes biking, daily nature walks, and dancing for fun.

Since fusion was the only surgical option available to her at the time, she decided to wait and check in with her doctor to make sure the bone was still getting some blood supply. “It was painful to walk partially on the side of my foot. I took pain relievers and arthritis pills.” Yet Bass remained determined. “I kept going every day and I still did things I needed to do. But if I was on my foot for too long, I would have to take a break and sit the next day.”

A few years later, she was offered a new solution involving 3D printing that could be the answer she was looking for.

3D Printing Provides an Innovative Surgical Option

Bariteau referred Bass to another surgeon at the Emory Orthopaedics & Spine Center’s Brookhaven office (located inside the Emory Musculoskeletal Institute building) who had recently gained experience with 3D-printed implants. Rishin Kadakia, assistant professor of orthopaedic surgery, suggested they try a new, innovative procedure to address her condition, relieve pain, and keep her ankle range of motion: a 3D-printed talus implant

coupled with an ankle replacement and the surgical fusion of several bones.

Emory Orthopaedics & Spine Center is one of the largest orthopaedics centers of excellence in the Southeast and provides innovative solutions to help patients fully recover faster with better results. Bass was excited at the thought of the suggested treatment.

“What enticed me the most was that he knew what he was doing because he had done a few before. It was new and inventive,” said Bass. “I’m not afraid to try something new. I think God put him in my path.”

Bariteau and Kadakia collaborated on Bass’s procedure. “We both have a clinical interest in complex reconstructive cases,” said Kadakia. “It helps to have two surgeons working together to bounce ideas off each other.” They decided Bass was a good candidate for the procedure based on her condition, medical history and treatment goals.

In August 2021, Bass received a custom, 3D-printed cobalt chrome talus implant and the procedure was completed. “I was really excited to have something so new,” said Bass. “And it was going to give me the best quality of life so I can go back to work and be able to do things I used to do.”

The day of her procedure, Bass was nervous. She remembered one of the surgeons whispering into her ear, “Everything is going to be fine,” after which she felt a sense of calm. “I put my faith in them,” she said. “I would do it all over again.”

Outstanding Outcomes—Inside and Out

While there is limited data on 3D-printed implants, Kadakia explained that “early results are good, and our patients are doing well. Careful patient selection and counseling is key. The 3D-printed implants are not for every case—but in some instances they

28 EMORY HEALTH DIGEST
A custom, 3D printed implant replaced the talus— the bone in the ankle joint that connects the leg and the foot—in Natasha Bass’s ankle. The procedure, coupled with surgical fusion of several bones, has enabled Bass to resume her active lifestyle. PHOTO JACK KEARSE

can provide an innovative option when there are limited surgical solutions.”

That’s the case for Bass, who has been dedicated to her rehabilitation and recovery since day one.

Six months out from her surgery, Bass felt 70 percent back and expects to

and made sure I understood, had a quick response time and always kept in touch with me throughout the process.”

To honor her care team, Bass decided to express her thanks through her favorite form of writing, a poem. EHD

So it begins the writing on the wall

Dr. Kadakia and Dr. Bariteau had advised me on a new life,

The positivity all anew, the patient care inviting

My response out of the blue, Yes! I declared I am happy to take this journey with you,

It took some time, patience is key

reach 100 percent soon. “I’m walking fine, and I feel stronger and ready to tackle each day.” She’s getting back to visiting her friends and family and taking daily walks. She enjoys riding her bike and being in nature “to have that peaceful time for myself and calm my nerves. Nature makes you realize you’re alive.”

Bass’s attitude also has received a boost. “The surgery has made me feel more confident about myself.”

Expressing Her Gratitude

Bass has more than enough words to express her gratitude. “I’m thankful and privileged to get this surgery. It makes me feel like I could conquer the world again.”

She’s especially thankful for her care team. “These doctors care more about the welfare of the patient. They gave me choices, explained everything to me

Truly blessed hands are these Dr. Kadakia and Dr. Bariteau,

I owe you my gratitude, special you are, everyone needs to know,

You gentlemen are the epitome of satisfaction,

You both deserve all accolades

Your care and patience for me outstanding,

For you gentlemen, Dr. Kadakia and Dr. Bariteau, I thank you from the bottom of my heart

Dr. Kadakia and Dr. Bariteau, your kindness and character,

What wonderful doctors you are, thank you again for taking me on this wonderful journey, This new life because of you

So it begins the writing on the wall.

SUMMER 2022 29
Natasha Bass PHOTO PROVIDED BY NATASHA BASS

THE ROAD TO 1,000 HEART TRANSPLANTS

While heart transplant procedures don’t make news the way they once did, Tyronne Baldwin’s marked an important milestone— the one thousandth heart transplant performed at Emory.

30 EMORY HEALTH DIGEST
SUMMER 2022 31
Tyronne Baldwin and his wife, Edna, walk the halls in Emory University Hospital after his heart transplant. Baldwin’s transplant was Emory’s 1,000th heart transplant, by far the most by any hospital in Georgia. PHOTO JACK KEARSE

As the Douglasville, Georgia, resident is quick to point out, he feels great. “I’m 50 but I feel like I’m about 30 or 35 now.” His health and chances for an active life were very different in 2015, when he was diagnosed with heart failure and tests showed his heart’s ability to pump was failing dramatically.

Initially, Baldwin didn’t qualify for a heart transplant due to his weight. Tipping the scales at more than 300 pounds, and in no shape to exercise, he received an implanted left ventricular assist device, commonly known as an LVAD, to help his heart pump blood more effectively so he could undergo a gastric sleeve weight loss procedure.

By February 2021, he’d lost enough weight to be in Emory University Hospital, awaiting a heart. He exercised by walking the halls and spent time talking to and encouraging other heart patients who needed LVADs but were afraid of the surgery.

Baldwin received his new heart

in May and was home three weeks later. He’s taking the year off to further recuperate, but he’s active and making plans for a future that just a few years ago didn’t seem possible.

“I’ve learned a lot about medicine from my experience. I previously worked in engineering, and the robotic aspect of this technology is intriguing,” he says. “I will also continue to speak up and urge people to become organ donors.”

Emory’s Heart Transplant Program is recognized as the foremost in the Southeast. No other heart transplant program in Georgia has done as many procedures as Emory’s. The story of Emory’s success in this life-saving field is far more complex than it may seem at first glance—and also more hopeful.

As Baldwin’s experience illustrates, the story behind each heart transplant involves an integrated team with multiple specialties, technological advances, and specialized patient care.

The path to Emory’s success in heart transplantation also points to the future of cardiology, with ongoing research into technologies that can help people awaiting heart transplants live better quality lives.

“I had a mentor in medical school who was a heart transplant surgeon and, very early on, he exposed me to the miracle that heart transplant really is,” says cardiothoracic surgeon Mani Daneshmand, director of the Emory Heart and Lung Transplantation program.

“A heart transplant is one of those few things that we as humans can do that so effectively and quickly impacts the lives of those around us for the better,” he says. “You take somebody who has less than a year

32 EMORY HEALTH DIGEST
Mani
Daneshmand
“YOU TAKE SOMEBODY WHO HAS LESS THAN A YEAR OR SIX MONTHS TO LIVE AND WHO IS MISERABLE AND YOU GIVE THEM 15 TO 20 YEARS OR MORE TO LIVE— GOOD QUALITY YEARS.”
Mani Daneshmand, director of the Emory Heart and Lung Transplantation program PHOTO JACK KEARSE

or six months to live and who is miserable and you give them 15 to 20 years or more to live—good quality years. There’s really not anything else in society that can do something like that.”

THE BEGINNING

The first heart transplant procedure took place more than a half a century ago. On December 3, 1967, 53-year-old Louis Washkansky received the first successful human heart transplant in Cape Town, South Africa. Because little was then known about how to suppress the immune system to prevent rejection, the surgery was a huge gamble and Washkansky survived only 18 days. By the l970s, the rejection problem proved daunting—too many patients were dying—and heart transplants were mostly stopped.

In the early l980s the drug cyclosporin, which lowers the odds of organ rejection and boosts survival rates, again made heart transplantation a potentially viable option for people with severe heart failure, sparking renewed interest and hope for the procedure in medical centers, including Emory University Hospital.

Douglas Murphy was a young Emory cardiothoracic surgeon in 1984 when he found himself at a meeting of senior surgeons discussing the launching of a heart transplant program at Emory University Hospital. Called away briefly to answer a page, Murphy returned to find he’d been chosen to be Emory’s new and, at the time, only heart transplant surgeon.

Murphy made arrangements to visit and observe surgeons with whom he’d trained who were then performing heart transplants at Stanford Univer-

This undated photo is from one of Emory University Hospital’s first heart transplants. Emory’s pioneering work in heart transplantion has led to innovative solutions now widely utilized in cardiac surgery. Douglas Murphy, medical director of surgical robotics at Emory Saint Joseph’s Hospital
SUMMER 2022 33
Andrew Smith, clinical chief of cardiology, Emory University Hospital PHOTO BILLY HOWARD

Emory’s heart transplant program began in 1985. In 2008, the hospital celebrated its 500th heart transplant. From 2008 to 2021, transplant surgeons completed an additional 500 transplants in just 13 years.

sity Hospital. “I went with them on the run to pick up a donor heart, watched the surgeons sew it in, and then came back to Emory and started organizing,” he recalls.

In 1985, a young man from South Carolina was in the hospital with severe heart failure. The newly launched Emory Heart Transplant team was notified of a donor heart in south Fulton County, Georgia. They rapidly retrieved the heart, and the transplant went well. And although the young man eventually suffered rejection of the heart, he received a second successful transplant at Emory. Other heart transplants followed, most with good outcomes.

Murphy is now medical director of surgical robotics at Emory Saint Joseph’s Hospital, but occasionally he still hears from former heart transplant patients, including his third, Harry Wuest, who is one of the longest living heart transplant patients in the world (see sidebar).

TODAY’S HEART TRANSPLANT TEAM

In recent years, the national one-year survival rate for heart transplant patients has climbed to 90 percent, according to Emory Clinical Chief of Cardiology Andrew Smith, a specialist in heart failure and transplantation cardiology. “At Emory, that survival rate is 94 percent. For each year after the first year, there is over a 96 percent chance of ongoing survival. So, the outcomes are very promising,” he says.

J. David Vega, current director of Emory University Hospital’s Heart Transplant Program, has performed more than half of Emory’s heart transplants. He credits collaboration for the remarkable success of Emory’s program. “We

34 EMORY HEALTH DIGEST
David Vega, director of Emory University Hospital’s Heart Transplant Program Divya Gupta, medical director for Emory’s Advanced Heart Failure and Transplant program PHOTO BILLY HOWARD

Making the Most of His SECOND

CHANCE

Living and working in Florida in the mid-1970s, Harry Wuest experienced some unusual pains in his side but was unaware he had a serious heart condition. “You mentally and physically compensate as your heart decreases its ability to work. I sort of adjusted my life to it and didn’t realize what was going on,” he recalls.

Wuest was eventually diagnosed with cardiomyopathy, a disease of the heart muscle that makes it increasingly difficult for the heart to pump blood throughout the body. His condition deteriorated, and his doctor at Florida Hospital (now Advent Healthcare) was Andrew Taussig, who had been chief resident and cardiology fellow at Emory University Hospital. Taussig was familiar with Emory’s then new heart transplant program and sent his patient to Emory cardiothoracic surgeon Douglas Murphy for evaluation. Wuest’s condition was so bad he was flown by air ambulance to Emory, and shortly after his consultation with Murphy, he was in the hospital awaiting a transplant—and miserable. “I was so sick, bedridden, on an IV. I didn’t think about the difficulty of the transplant,” he says. He only knew was the surgery was his best chance at life.

The donor heart of a 19-year-old accident victim was located in May 1985, and Wuest became Emory’s third heart transplant patient. “When I woke up from my surgery, I just knew somehow I was going to be fine,” he says.

The heart turned out to be a remarkably good match, and Wuest is now the longest living heart transplant patient in Georgia—and one of the longest living in the world.

Murphy is now the chief of cardiothoracic surgery and medical director of surgical robotics at Emory Saint Joseph’s Hospital. He is recognized as one of the world’s leading expert in robotically assisted heart surgery.

Almost 37 years later, Wuest, now in his late 70s, lives in Atlanta. He works as a CPA during tax season and plays golf frequently. “I have a great wife and, with 15 grandchildren, I’m always looking forward to something,” he says. EHD

SUMMER 2022 35
Harry Wuest occasionally visits with Douglas Murphy, who transplanted his heart in 1985. The two have remained close friends PHOTO COURTESY OF HARRY WUEST
“When I woke up from my surgery, I just knew somehow I was going to be fine.” —Harry Wuest

work as a team. Everyone’s input is valuable, and the patient and their family come first. We keep that focus,” he says.

Emory’s heart transplant surgeons, who along with Murphy, Vega, and Daneshmand include Tamer Attia and Jeffery S. Miller, work with transplant cardiologists both before and after the procedure to optimize patient care.

The team includes a host of other medical specialists, including transplant infectious disease specialists, arrhythmia experts, transplant coordinator nurses, nutritionists, physical therapists, imaging experts, and others, all working to bring collaborative and individualized care to patients before, during, and after their transplants.

COMBINED EXPERTISE

A patient’s diagnosis of heart failure does not mean someone is necessarily headed for a transplant, says Divya Gupta, medical director for Emory’s Advanced Heart Failure and Transplant program. Medication, diet, and lifestyle changes can often help prevent progression of the disease.

“Approximately five percent of heart failure patients develop end-stage heart failure, and that can happen at any point within their disease trajectory,” says Gupta. “We don’t have a great way of predicting who is going to progress and how quickly they are going to progress. However, with adherence to current guideline-based recommended medications, there is a greater chance of feeling better and living longer with this disease.”

When a heart failure patient

at Emory is a potential transplant candidate, Gupta and her colleagues do an assessment to make sure the person is able to survive a transplant. They also ensure the patient has no other health problems that would likely worsen with the transplant.

Heart failure patients waiting for transplants are supported with medication and, if needed, temporary mechanical devices to help their heart. Throughout the entire process, from evaluation through post-transplant follow-up, heart transplant coordinators—nurses with extensive specialized training in the field—are key.

They manage the wait list for heart transplants, follow transplant patients in the period immediately following their surgery, and coordinate care after patient discharge and throughout the patients’ lives.

Virtually all patients who reach advanced cardiac failure will have arrhythmias, sometimes dangerous irregular heart rhythms. Doctors on the transplant team, like Anand Shah, an electrophysiologist, or heart rhythm specialist, treat these patients to help optimize their cardiac function and help keep them healthier as they await transplant.

“We coordinate our approach with other members of the transplant team to understand where the patient is on their heart journey and what therapies might be most appropriate and what therapies the patient can tolerate,” he says.

A LIFEGIVING MEASURE

“Heart transplant is the ultimate gift,” says Anurag Sahu, who leads the adult congenital heart disease imaging program at Emory. “With ev-

36 EMORY HEALTH DIGEST
Anurag Sahu
“WITH EVERY TRANSPLANT, SOMEWHERE A FAMILY GOING THROUGH THE DARKEST OF TIMES HAS DONATED THE GIFT OF LIFE, A LOVED ONE’S HEART, TO SOMEONE ELSE THEY DON’T EVEN KNOW.”

After pioneering Emory’s heart transplant program, Douglas Murphy turned to another groundbreaking surgical proceedure: robotic cardiac surgery. He is recognized as one of the most experienced robotic heart surgeons in the world.

SUMMER 2022 37
PHOTO JACK KEARSE

ery transplant, somewhere a family going through the darkest of times has donated the gift of life, a loved one’s heart, to someone else they don’t even know. It is not to be taken lightly, and we work toward making sure we honor that gift by taking excellent care of the patient who will receive that organ.”

Rachel Moore’s heart transplant took place in January 2009. “Never in a million years can I say enough thanks to the donor family for that precious gift,” she says. Her story also illustrates the complex, team-based process involved in transplant surgery.

Moore was a 42-year-old cardiac nurse in Chicago in the mid-2000s when she noticed simply walking a short distance made her short of breath. She was diagnosed with cardiomyopathy, and tests showed her heart was weakening. Her doctors implanted a defibrillator to protect her from a potentially deadly irregular heart rhythm and prescribed medication, gentle exercise, and a special diet, but nothing improved her condition.

When a problem with a heart valve was discovered, doctors placed Moore on an LVAD to strengthen her heart for valve surgery to no avail. With her options diminishing, her doctor referred her to Emory and David Vega.

It wasn’t until January 2009, more than two years after being placed on the transplant list, that a donor heart became available.

“The heart transplant changed my philosophy of life. I was given a second chance to live and that’s what I want to do—really live,” Moore says. “I tell people to not be so busy that you don’t look at the sky today, hug your family. When you wake up today, enjoy your life.”

CHALLENGES AND COMMITMENTS

The financial and emotional costs for prospective transplant patients can be overwhelming. The Emory Heart Transplant program is working to find ways to help people with failing hearts, regardless of their financial situation, receive appropriate care and assistance.

“Our goal is to look for ways to

38 EMORY HEALTH DIGEST
Rachel Moore
“THE HEART TRANSPLANT CHANGED MY PHILOSOPHY OF LIFE. I WAS GIVEN A SECOND CHANCE TO LIVE AND THAT’S WHAT I WANT TO DO—REALLY LIVE.”
Rachel Moore (right) a cardiac nurse, had her heart transplant at Emory in 2009, “Never in a million years can I say enough thanks to the donor family for that precious gift” PHOTO PROVIDED BY RACHEL MOORE

help patients become candidates for advanced therapies like LVAD and heart transplants, if that’s in their best interests and what they want,” Daneshmand says. “We are committed to taking care of the residents of Georgia who need our help, regardless of socioeconomic status or race.”

Heart failure leading to a need for heart transplant can be influenced by one’s genetic make-up or a predisposition to health conditions that increase risk. These factors appear to play a role in African Americans’ disproportionate rates of serious heart failure and may explain why these patients are far less likely, across the nation, to receive needed

heart transplants.

But that’s not the case at Emory, where more than 63 percent of heart transplant patients are Black, Gupta says. “It’s not due to the demographics of Atlanta [but] because our team works extra hard at creating an awareness around disproportionate outcomes, and we’ve become much more aggressive and worked very hard at trying to break these barriers,” she says. “We are dedicated to providing great care for our patients, no matter who they are, and no matter their race. There is no other program of our size that can say that.” EHD

SUMMER 2022 39
Tyronne and Edna Baldwin meet with Divya Gupta, medical director for Emory’s Advanced Heart Failure and Transplant program. Gupta is a key leader within Emory’s team of specialists who work closely with each patient before and after transplant surgery. PHOTO JACK KEARSE

Into the Future:

BREAKTHROUGHS AND TECHNOLOGY

A heart transplant is typically the last option for a person with a failing heart, if the patient can survive long enough for a donor heart to be found. The good news is many patients are now able to experience a better quality of life—and often better health—as they await a transplant, thanks to advances in the field.

There are ongoing challenges too. The possibility of the immune system’s rejection of a donor heart hasn’t been totally eliminated. “We can’t stop rejection. But it’s now manageable and usually well controlled,” says J. David Vega, director of Emory

University Hospital’s Heart Transplant Program. “And like any other aspect of medicine, with time and continued education, new technologies, new drugs, and our experience, we’ve been able to do more to improve outcomes for heart transplant patients.”

LVADs, the implanted mechanical pumps that help the bottom left chamber of a failing heart move blood to the aorta, the body’s main artery, and then throughout the body, are an example.

First used in the mid1960s, the devices were once

PHOTO JACK KEARSE

so large that they were only used in hospitals for short-term support.

Their size also meant that women were mostly excluded from being able to use an LVAD, says Wendy Book, director of the Emory Adult Congenital Heart Center. “Now they are so small they fit in the palm of your hand. In fact, they have been miniaturized enough that babies and children with heart defects who need transplants can benefit from these devices.”

Durable LVADs designed for long-term implantation are not only helping patients awaiting heart transplants, they also are used to improve heart function in people with advanced heart failure who aren’t candidates for transplant.

“We have a large of population of patients who have durable LVADs, and some people live five to 10 years with these implanted devices at home, leading relatively normal lives,” says Mani Daneshmand, director of the Emory Heart and Lung Transplantation program. Remarkably, the technologies used to support patients for transplants have resulted in some people improving so much they

no longer need new hearts.

“One of the technologies we use to support people for transplants is a temporary mechanical support device known as the Impella 5.5,” Daneshmand says. “It is a pump we put in through the axillary artery that goes into the heart. The device supports the heart without patients undergoing major heart surgery.”

Extracorporeal membrane oxygenation (ECMO) is another groundbreaking technology used by the Emory Heart Transplant team. ECMO involves pumping blood outside of the body to a machine that removes carbon dioxide and sends oxygen-rich, warmed blood back through the body, allowing the heart to rest and heal.

Emory also has participated in a research study of the TransMedics OCS (organ care system) for use with hearts for donation after cardiac death, which describes hearts removed because they stopped naturally or because the patient was taken off life support. Last fall, the FDA approved the TransMedics OCS technology for commercial use, and it is expected to make more donor hearts available.

“The TransMedics OCS heart device allows us to evaluate hearts that are good but would have otherwise not been used for various reasons,” says Daneshmand. “For example, the heart might have been too far away, or based on an initial assessment, the heart might be deemed not good enough for transplant. But on the device, the heart can get stronger and better.” EHD

Top: Durable LVADs designed for long-term implantation are not only helping patients awaiting heart transplants, they also are used to improve heart function in people with advanced heart failure who aren’t candidates for transplant. Above: ECMO involves pumping blood outside of the body to a machine that removes carbon dioxide and sends oxygen-rich, warmed blood back through the body, allowing the heart to rest and heal. PHOTO JACK KEARSE PHOTO JACK KEARSE PHOTO ZEPHYR/SCIENCE PHOTO LIBRARY

All Together Now

Prevention

Statistics show that injuries are the leading cause of death between the ages of 1 and 44. The Injury Prevention Research Center at Emory (IPRCE) works to lessen the devasting impact of injury in Georgia and the Southeast through research, education, and outreach. IPRCE focuses its efforts on addressing five leading causes of death and disability due to injury: motorized vehicle crashes, drug overdose, traumatic brain injury, falls, and violence.

In research labs and hospital settings, large numbers of Emory scientists and physicians are engaged in injury prevention research. IPRCE serves as a conduit for them, fostering collaborations that otherwise might not exist, says IPRCE’s director, Jonathan Rupp. More than 80 faculty from Emory and eight other universities, along with 380 community members including state and local public health officials, work with the center.

“This is something that contributes to Emory’s academic mission. It’s something where we are engaging with the community, and we are addressing a major societal problem,” says Rupp. “And combined, that merits the investment.”

Emory physicians treat many of the injuries IPRCE studies, says Sharon Nieb, IPRCE program director. “We have trauma injuries; we have falls,” she says, adding, “Falls are a huge problem in every emergency room. We have falls in our youngest population and in our oldest. Children from zero to four have a higher rate of emergency room visits than even 75-year-olds when it comes to falling.”

In 2020, 1,309 Georgians died due to opioid overdose, and another 1,600 people died on the

state’s roads. “The only way we are going to figure out accurately what are the causes and how we address these is with research,” says Nieb.

David Wright is an IPRCE steering committee member and chair of the Department of Emergency Medicine at Grady Hospital, one of the busiest trauma centers in the US. Most people believe injuries won’t happen to them, he says. “We are all at incredible risk for all types of injury. This is an area people need to pay attention to. The broader community needs to look for solutions.”

The pandemic exacerbated the potential for many of the types of injury IPRCE addresses. Empty roads early in the crisis encouraged speeding and reckless driving that hasn’t abated. Isolation and job losses helped drive up rates of opioid misuse and overdose. Shelterin-place orders made domestic violence victims more vulnerable. Older adults faced increased risk of falls. And many who injured themselves were reluctant to seek hospital care due to fears of contracting COVID-19.

During the pandemic, IPRCE worked with its agency partners on programs such as the virtual Falls-Free Fridays. Organizers demonstrated exercises for seniors and other ways of keeping themselves safe and preventing falls. “We also had a psychologist talk about the fear of falling, how that often increases people’s risk, and how they can overcome the fear of falling,” says Nieb.

“Our traumatic brain injury task force identified higher rates of head trauma in intimate partner violence patients than other populations,” says Rupp. “So they started implementing screening and referral to services for traumatic brain injury—in particular mild trau-

42 EMORY HEALTH DIGEST
The Injury
Research Center at Emory focuses on a communal approach to reducing the harm of injuries.

matic brain injury, or concussion—at domestic violence shelters.”

At Grady Hospital, IPRCE member Mara Schenker, Emory professor of orthopaedic surgery, and her team are studying how life-care specialists can help patients after orthopedic trauma and surgery to manage their pain appropriately using opiate and non-opiate medications to make sure these patients don’t progress from opioid use to opioid use disorder.

IPRCE’s Drug Safety task force helped Georgia develop a strategic plan for its opioid response, and the center also advocated for passage of the state’s distracted driving law. IPRCE presented its research to the Georgia legislature as members were debating the merits of the law. It’s doing the same type of research on e-scooter

injuries in Atlanta to find out whether the city’s nighttime ban on riding has had a positive impact on injury prevention.

IPRCE executive committee member and Emory School of Medicine Chief Diversity and Inclusion Officer Sheryl Heron has studied and treated the impact of violence for more than 25 years as an emergency department physician. “Teen dating violence, gun violence—these are all the unfortunate realities of violence we are trying to address through scholarship, education, and research partnerships.”

Heron worked with Randi Smith, Grady Hospital trauma surgeon and new IRPCE executive committee member on a partnership with Atlanta Mayor Andre Dickens’ office for the mayor’s inaugural Peace Week ATL. Smith pulled together the Grady Trauma Program, staffed by the Emory and Morehouse schools of medicine, along with IPRCE’s Violence Prevention Task Force to host a live Twitter discussion on the role of hospitals in implementing public health approaches to violence prevention.

“We think of injuries as a ‘throughout the lifespan issue,’” IPRCE Director Rupp says. “There’s a causal relationship between childhood trauma, or what we call adverse childhood experiences, and behavioral outcomes—both in the near term and intermediate term, and then health outcomes in later adulthood.” IPRCE is working on ways to disrupt the cycle of adverse childhood experiences that lead to poor outcomes in terms of risk-taking and antisocial behaviors as well as substance abuse and other unhealthy lifestyle choices. That’s because, in terms of injury prevention, the familiar adage proves true. An ounce of prevention really is worth a pound of cure. EHD

SUMMER 2022 43
ILLUSTRATION
JOEY GUIDONE

GIVING A KIDNEY STARTED WITH GIVING KNOWLEDGE

Roxana Chicas, a research professor in Emory’s Nell Hodgson Woodruff School of Nursing, was not confident in her nontraditional academic path until a mentor reassured her: “The teacher always arrives when the student is ready.”

That advice about timing recently resonated as she prepared to donate a kidney to her mentor, professor, and faculty colleague. Professor and biostatistician Vicki Stover Hertzberg, who directs the school’s Center for Data Science, had been waiting nine months for a transplant after being diagnosed with kidney failure.

The two professors’ personal relationship is only one aspect of their remarkable story.

Both long ago had personal experiences that made them aware of the high need for living kidney transplants and the safety of donation. At the No. 2-ranked School of Nursing, both women work on a research team that studies renal issues and other health problems related to heat exposure in farmworkers. And both say their life-giving partnership reflects their school’s caring connections.

Chicas was only one of several Emory employees who answered Hertzberg’s call for potential donors in mid-2021. While others matched enough to donate, Chicas was the closest match.

“I have no words to express my gratitude for the individuals who came forward including those who, ultimately, for one reason or another, could not be a donor,” Hertzberg said before the March

15 transplant surgery. “And for Roxana to do this is just phenomenal. I find it overwhelming and very humbling.”

Most of us only need one kidney

Chicas’ first job at a pediatric office in Atlanta, when she was 18, exposed her to kidney issues and solutions. She translated for pediatric nephrologist Stephanie M. Jernigan, an associate professor of pediatrics at Emory School of Medicine.

“Children who were born with just one kidney often lived perfectly normal lives,” she says. “Other children who had kidney transplants did very well, even though it’s a very invasive surgery.”

She also learned to see her own intellectual potential.

Having come from El Salvador at age four and undocumented, Chicas had received temporary protective status that allowed her to work for the pediatricians. She helped them communicate with families who only spoke Spanish, and thought she might be smart enough to become a medical assistant so she could help them more. Pediatrician A. Gerald Reisman, MD, urged her to try nursing instead, and at age 28 Chicas enrolled in what is now Perimeter College at Georgia State University.

That educational decision led to Bridges to the Baccalaureate, an Emory program that nurtures minority students in research. With School of Nursing Dean Linda McCauley as her advisor, Chi-

44 EMORY HEALTH DIGEST
PATIENT POV
ILLUSTRATION JOYCE HESSELBERTH

cas got a BSN and went directly into the doctoral program. She joined McCauley’s team working on farmworker health, which felt personal because her mother, Maria Chicas, farmed in El Salvador. Farmworkers are 35 times more likely to die from heat-related illnesses than any other profession, she says.

“I got lucky, because I could have been working out in the field,” Chicas says. “I’m not there because of sacrifices that my mom made, and many other Latino parents have made and by having a mentor who told me that I can be a professional.”

A mentor in need

Hertzberg became Chicas’ professor and research teammate. From Florida, to Mexico, to Brazil, Chicas was in direct contact with farmworkers while Hertzberg worked to tell the story of the collected data.

“A wonderful mentor,” Chicas, 39, calls Hertzberg, 67. “She taught me that you can be smart and be strong in your career and yet still be very kind.”

As the director of the nursing school’s Center for Data Science, Hertzberg is an internationally recognized expert on “big data” and its impact on health care. She is widely known for her work measuring the social contacts in emergency departments and disease transmission on airplanes.

In late 2020, Hertzberg’s own bloodwork showed acute kidney injury, and when a restrictive diet didn’t improve function enough, she was referred for a kidney transplant in mid-2021.

Like Chicas, Hertzberg had learned about the disease long before through a family friend and others. She reached out to her network by email and social media.

“Ideally, a living donor is best,” she wrote. “A kidney from a living donor lasts on average 25 years, while a kidney for somebody who is about to have life support turned off is on average 12 years. Obviously, the 25 years is my preference . . . the wait for a kidney from the person on life support will take three to seven years.” She didn’t expect much response.

“I’m going to match”

Chicas jumped on Hertzberg’s suggestion for potential donors to phone the Emory Transplant Center or complete an on-line questionnaire.

“I knew it’s a pretty big surgery, but I was just

like, ‘I have an extra kidney. I’m pretty healthy,’” she says. “And I called my mom and asked her what she thought and she said that if that’s what you feel you’re called to do, then go for it. And I thought, if God wants me to be the donor, then I’m going to match. So much science has gone into it, and to be able to use that science to help Dr. Hertzberg be healthier and live longer, it’s awesome. And I get to be a part of it.”

Christian Larsen, professor of surgery in the Division of Transplantation at Emory and former dean of the Emory School of Medicine, transplanted Hertzberg’s new kidney in March 2022. Larsen and Hertzberg have known each other through their collaborative research, having teamed-up on a project studying the immune system in kidney transplant patients.

“This is not a road I would have chosen for myself,” Hertzberg says. “So I’m trying my hardest to learn the lessons along the way and to keep being positive. I want to dance at my grandchildren’s weddings, and the oldest one is soon to be five years old.”

Chicas believes that her success, her mentors, and her organ donation have proved her favorite quote.

“Mother Teresa said, ‘If you can’t feed 100 people, then feed just one,’” she says. “I’m not a philanthropist. I’m not a billionaire. But I feel like there are certain things that I can do.” EHD

SUMMER 2022 45
Emory School of Nursing faculty member Vicki Hertzberg (left) received a gift of life from colleague and research collaborator Roxana Chicas. When Hertzberg needed a new kidney, Chicas was deemed a match. PHOTO JACK KEARSE

Emory program addresses health disparities

affect health, the data is often missing, incomplete, or does not include enough people or diversity to be able to draw relevant conclusions. In other cases, information about social factors may be available, but it is kept separate from health data. All this can keep researchers from seeing the big picture.

COVID-19 HAS HIT SOME COMMUNITIES VERY HARD. That has put new attention on a long-term problem in the United States— health disparities.

Health disparities are differences in health that harm disadvantaged communities. Understanding what causes these differences is key to addressing them. DNA alone does

not explain the big differences in people’s health. Researchers are looking closely at other variables, including social determinants of health such as income and environment; access to health care, healthy foods, and educational opportunities; and discrimination.

When researchers look for answers on how social factors

A National Institutes of Health program with a presence at Emory, the All of Us Research Program, is working to sign up one million participants. The goal is to build one of the largest, most diverse research databases to create a detailed picture of health to help speed biomedical research breakthroughs.

The program brings together information about people’s biology, environment, and life circumstances. This blend of data, contributed by All of Us participants, can help researchers learn more about why people develop

46 EMORY HEALTH DIGEST
POLICY WISE
ILLUSTRATION JON KRAUSE

certain conditions, the effect of different treatments, and how social factors affect health.

Martin Mendoza, the program’s director of health equity, explains that many factors can affect our health, but without data that is both inclusive and diverse, it can be nearly impossible to see patterns and common threads.

“When researchers can access the data they need, it’s like finding a treasure trove of keys,” says Mendoza. “The data can help lead researchers to unlock new ways to improve people’s health.”

All of Us is working to tackle one of the biggest obstacles in eliminating health disparities: many minority and underserved communities have been left out of research, leaving a gap in

This program has given me the chance to potentially improve the health of future generations, but that can only happen if we

“We’ve been invisible to researchers for too long. This program has given me the chance to potentially improve the health of future generations, but that can only happen if we all come to the table.”

understanding of what makes people—and their health needs—unique.

“As a breast cancer survivor and Black woman, it’s not okay that people like me are more likely to die from our disease than others,” says Joyce Brown, an All of Us participant ambassador. “We’ve been invisible to researchers for too long.

all come to the table.”

Participants like Brown are having an impact. So far, more than 435,000 adults have joined the program, more than 300,000 of whom have completed all the initial steps, including answering surveys, allowing access to electronic health records, and sharing biosamples. About 80% come from communities that

have been historically underrepresented in biomedical research.

“COVID-19 brings renewed urgency, but the need to solve the underlying causes of health disparities that exist in cancer, heart disease, stroke, diabetes, and most other disease areas isn’t new,” says Mendoza. “Those who choose to join us in this historic effort and participate in the All of Us Research Program are essential partners in opening the door to a better future, in their own health, and the health of their families, friends, and community.” EHD

Anyone interested in learning about the All of Us Research Program at Emory University can visit allofus.emory.edu or call 404-778-1284 for more information.

SUMMER 2022 47

Plan Big.

Here’s to the dreamers, the visionaries, and the planners. Like Jack and Barbara Gerlach.

They know firsthand how vital health care is to a community. Jack spent more than 35 years with Emory Decatur Hospital, eight of which were at the helm. Now the couple is on a mission to ensure that this community hospital stays strong for years to come.

Jack and Barbara’s bequest will go directly to emergency services, a lifesaving resource for people who need immediate care.

People like Jack and Barbara envision the ways they can change the world. And by making a planned gift to Emory, they do.

Rethink the future today. giftplanning. emory. edu | 404.727.8875

PUT THE LAW TO WORK FOR YOUR CAREER

LEGAL TRAINING FOR HEALTH CARE PROFESSIONALS

Gain the legal knowledge and skills to navigate complex regulatory environments,make informed decisions, and assess risk. Make an impact on your career with the Juris Master degree by enhancing your knowledge of health care law.

Online and On-Campus Options

Scholarship Opportunities Available

“As a busy Pediatric ICU doctor at a Texas University Teaching Hospital and an Emory Alumnus, Emory’s Juris Master online format was perfect to fulfill my lifelong desire for a law degree. This degree gives me a solid working legal knowledge and the ability to interact with our attorneys and legislators to advocate for my

patients.”
KERRIE PINKNEY, MD, MPH, FAAP CLINICAL PROFESSOR OF PEDIATRICS, TEXAS TECH UNIVERSITY
2019 JM GRADUATE
Learn more: law.emory.edu/jm Email: JMadmission@emory.edu

Emory University

Alumni Records Office

1762 Clifton Road Atlanta, Georgia 30322

CHICAS were friends and colleagues long before Hertzberg’s need for a kidney transplant

44
VICKI HERTZBERG (LEFT) AND ROXANA PHOTO JACK KEARSE

Emory Healthcare in Georgia

Emory Healthcare is the most comprehensive health system in the state, with locations all over Georgia, including 11 hospitals, 135 outpatient locations in 28 counties, and 13 regional affiliate hospitals in 20 counties. Winship Cancer Network has three locations.

Across
the State and Around the Corner

Clifton Corridor . . . and Beyond

1. Emory University Hospital 2. Emory Clinic (multiple buildings) 3. Winship Cancer Institute 4. Emory Rehabilitation Hospital 5. Emory National Primate Research Center 6. Emory School of Medicine (education and research buildings)
Health Sciences Center Administration
7. Woodruff
Building
8. Rollins School of Public Health 9. Nell Hodgson Woodruff School of Nursing 10. Emory University Hospital Midtown 11. Executive Park (Emory Healthcare clinics in brain health, orthopaedics, and sports medicine)
8 7 6 2 1 1 4 3 9 11 10 5
The

Articles inside

PUT THE LAW TO WORK FOR YOUR CAREER

1min
pages 51-52, 54

Plan Big.

1min
page 50

Emory program addresses health disparities

2min
pages 48-49

GIVING A KIDNEY STARTED WITH GIVING KNOWLEDGE

4min
pages 46-47

All Together Now

3min
pages 44-45

BREAKTHROUGHS AND TECHNOLOGY

2min
pages 42-43

CHANCE

5min
pages 37-42

THE ROAD TO 1,000 HEART TRANSPLANTS

4min
pages 32-37

Walkin’ on Sunshine thanks to a 3D printed ankle joint

4min
pages 29-31

Failure is Frequent Success is Sweet

10min
pages 22-28

Teamwork Tackles C. diff Infections

1min
page 21

If This Doesn’t ‘Tick You Off’

2min
pages 20-21

Coffee Regional and Emory Healthcare Build Better Bariatrics for South Georgia

1min
page 19

You Know You Need to do This…Here’s Why

1min
page 18

Practical Goals for Weight Loss

1min
page 17

New Emory TB Research Center to Help Draw Attention

1min
page 16

An Ounce of Prevention. . . well,

1min
page 13

Grant Provides Training for Sexual Assault Nurse Examiners

1min
page 12

A Lifetime of Service to Public Health

1min
page 11

USING ARTIFICIAL INTELLIGENCE TO UNRAVEL THE MYSTERIES OF SEPSIS

1min
page 10

WHSC Establishes Office of Well-Being

2min
page 9

HEALTH DIGEST

1min
page 8

Back Together Again

1min
page 8

INSIGHTS INTO PARKINSONS BALANCE PROBLEMS

1min
page 7

The Importance of Communicating Research

1min
page 6
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