The Well

INSIGHTS INTO PARKINSONS BALANCE PROBLEMS

ILLUSTRATION KEN ORVIDAS Lucas McKay, associate director of Emory’s Neuromechanics Laboratory.

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.

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

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. Physical therapists are sometimes taught that balance reac“Disorganized sensorimotor signals tions in Parkinson’s patients are cause muscles in the limbs to slower than they should be. “We show this is not true,” McKay contract, such that both a muscle says. “The reactions are on time promoting a motion and its antago- but disorganized.” McKay says that sensorimonist muscle are recruited. It’s like tor problems may be a result of stepping on the gas and the degeneration of regions of the brain outside of and after the brake at the same time.” dopaminergic cells in the basal —J. Lucas McKay 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

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 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 Eastman

“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.”

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 re-

placement (TAVR). The threestar rating, which denotes the highest category of quality, places the hospital among an elite few for the TAVR procedure 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

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 caregivers 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 ILLUSTRATION DAN PAGE 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

ILLUSTRATION ELENABSL

USING ARTIFICIAL INTELLIGENCE TO UNRAVEL THE MYSTERIES OF SEPSIS

Rishikesan Kama-

leswaran, assistant professor in Emory’s biomedical informatics department

In the United States, more than a quarter of a million people each year suc-

cumb 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