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FOCUS TOPICS HIPAA • PEDIATRICS • AUTOIMMUNE DISORDERS

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St. Jude, Mayo Researchers Lead Discovery Of Fundamental Pathology Behind ALS A team led by scientists at St. Jude Children’s Research Hospital and Mayo Clinic has identified a basic biological mechanism that kills neurons in amyotrophic lateral sclerosis (ALS) and in a related genetic disorder, frontotemporal dementia (FTD), found in some ALS patients. Read the story on page 3.

PhysicianSpotlight

West Tennessee Kids Benefit From Specialist Dr. Joe Gleason brings wide range of expertise to UT Le Bonheur Pediatric Specialists By SUZANNE BOyD

West Tennessee hit the jackpot when Joe Gleason, MD, decided to leave Canada for a warmer climate. From cancer to general urologic problems to robots, Gleason brings a wide range of expertise and technology to his patients, the area and to his pediatric urologic practice with UT Le Bonheur Pediatric Specialists/St. Jude. Growing up in Minneapolis, Gleason knew he liked math and science but had no affinity for medicine until he took an anatomy class in high school. “An ER doctor made a presentation to the class one day and at the end he said anyone who wanted could come hang out with him in the ER,” said Gleason. “I took him up on it and got to spend a couple of nights in the ER and found it fascinating. I even aspired to be a trauma surgeon, so when I applied to college, I did so with pre-med as my plan.” (CONTINUED ON PAGE 2)

Some HIPAA Processes May Need Significant Updates

HealthcareLeader

Another Feather in Her Cap

Providing patients with copies of their medical record is not a new concept for medical practices. However, processes in place for doing so may need some significant updates based on guidance issued by the U. S. Department of Health and Human Services (HHS) in 2016. In this guidance, which is based on 45 CFR § 164.524 of the Health Insurance Portability and Accountability Act of 1996 ...

West Tennessee Healthcare executive, Lisa Piercey, heading regional organization By SUZANNE BOyD

While her day job has its own set of demands, West Tennessee Healthcare’s Executive Vice President Lisa Piercey has added President of MidSouth Healthcare Executives to her resume for 2017. With nearly 250 members from across West Tennessee, the regional chapter of the American College of Healthcare Executives is helping healthcare executives network, obtain continuing education and further develop their leadership skills. The American College of Healthcare Executives (ACHE) is the premier society for healthcare executives in the nation. Membership in chapters is open to all healthcare

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West Tennessee Kids Benefit From Specialist, continued from page 1 At Notre Dame, Gleason decided that he would pursue biochemistry just in case he changed his mind about medical school. Graduating Magna Cum Laude, Gleason headed to the University of Minnesota for medical school where he found an interest in pediatric urology. “I went into medical school thinking I wanted to be a trauma surgeon based on my time in the ER in high school,” said Gleason. “When I went to do my first subspecialty elective, a friend recommended a two-week rotation in pediatric urology because the doctor in charge of it would let you really ‘get your feet wet’ in the op-

erating room which could really be beneficial down the road. I followed his advice and had an amazing two weeks with the pediatric urologist and the residents. My fourth year I changed my schedule to do adult urology since I would have to do that before I could pursue pediatric urology.” Toward the end of medical school, Gleason got married. With a wife that wanted to live in Los Angeles, his choices for a residency were somewhat narrowed. He completed his internship and residency in general surgery followed by a residency in urology at Kaiser Permanente Health System in Los Angeles. During his fourth

year of residency he spent six months in pediatric urology, which rekindled his desire to pursue pediatric urology. Upon completion of his general urology residency, Gleason headed to Canada to complete a two-year clinical and research fellowship in pediatric urology at The Hospital for Sick Children in Toronto, a place that would become close to his heart. “In my fifth year of residency, my brother died of brain cancer. At the Hospital for Sick Children, I would have the chance to be heavily involved in urology oncology which was a draw for me,” said

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Gleason. “It just so happened that the head of the program there had also been touched by glioblastoma and we really bonded over that. During my second year of my fellowship, I started looking to come back to the United States as that was what the plan was with my wife as she wanted a warmer climate than Canada. Los Angeles and the South both fit that bill. A pediatric surgeon who was a year ahead of me called me and invited me to come look at UT Le Bonheur Pediatric Specialists, a multi-specialty group owned and managed by Le Bonheur Children’s Medical Hospital.” One of the things Gleason found most attractive was the affiliation Le Bonheur has with St. Jude because it would give him the opportunity to continue to work with cancer patients and the fact that it was St. Jude, the leader in childhood cancer research and treatment. “St. Jude has a huge referral base which allows you to see more complex cases as well as some of the rarer tumors,” he said. “That and having access to the latest technology were definitely a huge draw for me to come to Memphis.” In addition to working with Le Bonheur Children’s Hospital, Gleason would become the Chief of the Pediatric Urologic Surgery at St. Jude as well as an Assistant Professor of Pediatric Urology with UT Health Science Center. “I had also done a lot of training in the field of robotic surgery and in 2014, it was a relatively new field and a hot topic in medicine,” said Gleason. “Le Bonheur Children’s Hospital did not have a program at the time and coming here would give me the opportunity to start one, which was also very appealing to me. Within a year of my coming to LeBonheur, we started the robotic surgery program and I was named Medical Director of Robotic Surgery for Le Bonheur.” Gleason does not limit his time to patients in Memphis; he also spends time at the Le Bonheur Clinic in Jackson seeing patients from across West Tennessee. “We treat the same things in Jackson that we do in Memphis; we just do not do any surgeries in Jackson. Those are all done in Memphis. We also would see any patient with cancer at St. Jude,” he said. “There is definitely a need for a clinic in Jackson because it saves 40 or more patients and their families from having to come to Memphis to be treated.” One other area of interest that Gleason brought with him from Canada, is a program of fertility preservation in prepuberty boys. “For patients with testicular cancer, we want to give them a chance to have children in the future even though they cannot give a sample to freeze,” he said. “We had a program in Toronto and when I came here, I said we needed to start one since there are few centers in North America. We have partnered with a program at the University of Pittsburg and it is in the pipeline to be rolled out in the next few months.”

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St. Jude, Mayo Researchers Lead Discovery Of Fundamental Pathology Behind ALS A team led by scientists at St. Jude Children’s Research Hospital and Mayo Clinic has identified a basic biological mechanism that kills neurons in amyotrophic lateral sclerosis (ALS) and in a related genetic disorder, frontotemporal dementia (FTD), found in some ALS patients. The researchers were led by J. Paul Taylor, MD, PhD, chair of the St. Jude Cell and Molecular Biology Department and a Howard Hughes Medical Institute investigator; and Rosa Rademakers, PhD, of the Mayo Clinic in Jacksonville, Florida. The findings appeared last month in the journal Neuron. The disease-causing mutation identified is the first of its kind, Dr. Taylor said. Unlike in other genetic diseases, the mutation does not cripple an enzyme in a biological regulatory pathway. Rather, the mutation produces an abnormal version of a protein involved in a process called phase separation in cells. Phase separation is a mechanism by

J. Paul Taylor, MD, PhD, chair of the St. Jude Cell and Molecular Biology Department and a Howard Hughes Medical Institute investigator

which proteins assemble into organized assemblies, called membrane-less organelles, necessary for orderly cell functions. The researchers found that the ALS/FTD mutation produces an abnormal version of a protein called TIA1 that is a building block of such organelles. As a result, in ALS, the proteins within the organelles accumulate and kill neurons that control muscles. In FTD, the accumulation kills neurons in the brain. The researchers noted that abnormal

phase separation may also underlie Alzheimer’s disease. There is currently no effective treatment for ALS/FTD. However, the researchers believe their finding offers a promising pathway for developing treatments to restore neurons’ ability to disassemble the organelles when their cellular purpose has ended. The TIA1 mutation was discovered when the scientists analyzed the genomes of a family affected with ALS/FTD. Tracing the effect of the mutation on TIA1 structure, the researchers found that it altered the properties of a highly mobile “tail” of the protein. This tail region governs the protein’s ability to assemble with other TIA1 proteins. Taylor and his colleagues previously

identified such unstructured protein regions, called prion-like domains, as the building blocks of cellular assemblies and as hotspots for disease-causing mutations. In further studies, the researchers found that TIA1 mutations occurred frequently in ALS patients. The scientists also found that people carrying the mutation had the disease. When the investigators analyzed brain tissue from deceased ALS patients with the mutations, the scientists detected a buildup of TIA1-containing organelles called stress granules in the neurons. Such granules form when the cell experiences such stresses as heat, chemical exposure and aging. To survive, the cell sequesters in the granules’ genetic material that codes for cell proteins not necessary for survival-critical processes. The granules also contained a protein called TDP-43, another building block of stress granules, whose abnormality has been implicated in causing ALS. In test tube studies and experiments with cells, the researchers found that the TIA1 mutation causes the protein to become more “sticky,” delaying the normal disassembly of stress granules, trapping TDP-43. “This paper provides the first ‘smoking gun,’ showing that the disease-causing mutation changes the phase transition be(CONTINUED ON PAGE 6)

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Another Feather in Her Cap, continued from page 1 executives but there are member subsections for niche groups such as physician executives, early careerists, and women/ minorities. “We enjoy support and close collaboration with our parent society,” said Piercey, who currently serves as the organization’s president. “ACHE has over 40,000 members and is led by a distinguished Board of Governors.” Midsouth Healthcare Executives (MHCE) serves the needs of West Tennessee’s healthcare leadership community. The chapter generally meets eight times per year, with at least one event in Jackson. While the bulk of its membership resides in the Memphis metropolitan area, MCHE’s membership is open to professionals from hospitals and health systems, consulting firms, healthcare associations, managed care companies, pharmaceutical companies and other organizations that provide and support the delivery of health services across West Tennessee. “For me, the initial benefit of becoming a member was to begin my path to board certification in healthcare management,” said Piercey. “It is an arduous process that takes several years, but being certified as a Fellow of the American College of Healthcare Executives (FACHE) is a distinguished honor, allowing me to join an elite group across the nation, in the widely recognized highest level of certification available for healthcare executives.” While the chapter follows the lead of the ACHE and focuses on diversity and ethics in healthcare, Piercey says her personal goal for the chapter is more membership directed. “I want to see our membership grow, especially outside of the Memphis metropolitan area. We have a wide variety of healthcare facilities throughout rural West Tennessee, and our local leaders can make significant contributions to the organization, especially as it pertains to management of small and/or independent hospitals, medical group practices, nursing homes, etc.,” she said. “Networking – really building relationships, not just exchanging business cards – with other local healthcare professionals is crucial to sharing best practices and discovering the nuances of various settings, such as for-profit, not-for-profit, academic, and philanthropic.” With its close tie to the University of Memphis’ Master of Healthcare Administration (MHA) program, MHCE affords graduate students and faculty the opportunity to interact with, and learn from seasoned healthcare executives.  In fact, MHCE was recently recognized by ACHE as having the nation’s highest year-over-

Keep your finger on the pulse of West TN’s healthcare industry...

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Upcoming MidSouth Healthcare Executive Events September 9 – University of Memphis – Topic “Health Equity” October 5 – Tower Center Memphis – Topic “Cybersecurity” You do not have to be a member to attend Registration information is available at www.mhce.org

year chapter membership growth (over 15 percent), something Piercey attributes to the engagement of students who transition to membership after graduation. Not one to not be involved, Piercey jumped into leadership in MHCE after just a few years of membership. “I joined the board in the progressive ranks of education chair, treasurer, vice president. In December of 2016, I was installed as chapter president for the 2017 year” she said. “Due to my chapter work locally, I was appointed in 2015 to the Management Series Editorial Board for the Health Administration Press, and I currently serve as the chairman of that group. We frequently review and offer input on manuscripts of proposed healthcare publications, which allows me to stay current on industry theories and commentary, on the national level.” Much as it is across the nation, Piercey says the issue most pressing for members, as well as all healthcare executives, is healthcare reform. “Today’s healthcare leaders must remain educated and flexible on alternate payment models,” she said. “As well as the changing management techniques required to implement these paradigm shifts.” While MHCE as a group does not necessarily have a specific political platform, it does uniformly and consistently advocate for affordable access to healthcare for all, as well as sustainability of healthcare organizations. “We educate policymakers and business leaders on the complexity of healthcare and remind them that the provision of medical services in our current system is not always amenable to free market capitalism,” said Piercey. “It is not as simple as flipping a switch and changing laws to meet either party’s agenda. When the intricacies of practicing and administering healthcare are ignored, people die.” As her time as president of MHCE enters its last quarter, Piercey is thankful for the opportunity to serve the organization. “While, this leadership role requires additional time and effort outside of my traditional job duties at West Tennessee Healthcare, the meaningful relationships and national exposure gained far outweighs the costs,” she said.

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Some HIPAA Processes May Need Significant Updates By LORETTA DUNCAN, FACMPE

Providing patients with copies of their medical record is not a new concept for medical practices. However, processes in place for doing so may need some significant updates based on guidance issued by the U. S. Department of Health and Human Services (HHS) in 2016. In this guidance, which is based on 45 CFR § 164.524 of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), HHS reiterates the importance of providing individuals with timely access to their protected health information (PHI) in the form and format requested and, if a fee is imposed, it must be reasonable and costbased. This guidance was issued in large part due to the number of complaints from patients who could not obtain timely access to their PHI or who could not afford the fees charged for copies.

Form, Format and Manner of Access

HIPAA requires covered entities (medical practices, hospitals, health plans, etc.) to provide individuals access to their PHI in whatever form and format they chose, if the covered entity can produce a copy in that specific form and format. This means that practices must be prepared to handle requests for access in a number of ways, such as saving files on a CD, emailing PHI to the patient or simply providing the patient with a paper copy. The point made in the guidance is that covered entities must accommodate the patient’s request unless the PHI cannot be produced readily in the requested format. According to HIPAA rules, covered entities that maintain PHI electronically must be able to provide an electronic copy at the request of the patient. For practices that maintain PHI in paper charts, there is a requirement to provide an electronic copy, at the patient’s request, if it is readily producible in electronic form. For example, if a patient requests that the practice scan their lab results and save them as a PDF on a USB drive, the practice would be required to do so if they have that ability. When an individual requests a paper copy of PHI maintained in either paper or electronic form, HHS expects the covered entity to provide a paper copy.

Requiring a Written Request, Verification, and Unreasonable Measures

Many practices have a written process for patients to request copies of records. HIPAA states that a covered entity may require an individual to make their request for access in writing, but HIPAA does not require a written request. HIPAA does require covered entities to take reasonable steps to verify the identity of the individual making the request for access, but this can be done in a number of different ways. Verification may be done orally WESTTNMEDICALNEWS

.COM

or in writing, in person, over the phone or through a patient portal. The guidance states that the covered entity must not impose unreasonable measures on the individual that could create barriers or unreasonably delay access. For example, a practice may not require an individual who wants a copy of their PHI mailed to their home to physically come into the office to complete a medical records release and provide a photo ID. This would be considered an unreasonable measure and could result in potential penalties. In order to reduce the risk of imposing unreasonable measures, covered entities are encouraged to have multiple options for patients to obtain access to PHI.

Timeliness of Access

Timeliness of providing access is also important. Under HIPAA, the covered entity must provide access no later than 30 calendar days from the date of the request. However, HHS prefers that access be provided as soon as possible. If state law requires a shorter period to provide access, then that time frame must be followed.

Charging for Copies

One of the major points of clarification from HHS is the limitation on fees that can be charged for PHI provided directly to the patient or directed to a third party by the patient. HIPAA states that a reasonable, cost-based fee may be charged for providing individuals a copy of their PHI. Reasonable, cost-based fees may include only: • Labor for creating and delivering the electronic or paper copy • Supplies for creating the copy (e.g., paper, toner, CD or USB) • Postage, if the patient requests that the PHI be mailed Labor does not include costs associated with reviewing the request for access, searching for and retrieving the PHI, or segregating or preparing the PHI to be copied. Even if state law allows a retrieval fee, it may not be included in the reason-

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able, cost-based fee to the patient. Many medical practices, who choose to charge patients for copies of their PHI, have based fees on those allowed by state law, which are typically set at a per page rate. According to the guidance, most state authorized fees are higher than the reasonable, cost-based fees allowed by HIPAA and therefore may not be used. HHS would prefer that covered entities provide patients with free access to their PHI, but if a covered entity chooses to charge patients for copies they are limited a reasonable, cost-based fee. Fees must be provided to patients in advance of their request for access. HHS states that, in lieu of calculating the actual cost, a flat fee of $6.50 may be charged to patients for electronic copies of records maintained electronically. If this method is used, it is all-inclusive of labor, supplies and postage.

Third Party Access and Copies

Third parties that request PHI based on a signed authorization by the patient are not subject to the cost-based fee limitations and may be charged based on what state law allows. However, if the patient requests their information be sent directly to a third party, the fee limitations do apply. The patient will be responsible for

paying for copies in this case, based on the reasonable, cost-based fee or flat fee rate. If a patient requests that their PHI be sent to a third party, the request must be made in writing and include the patient’s signature, the name of the third party, and where the information should be sent (mailing address, email, fax number, etc.). In order to ensure compliance with HIPAA and the patient’s right to access PHI, practices are encouraged to review existing policies and procedures pertaining to access as well as the HHS guidance in its entirety. The guidance may be found at http:// www.hhs.gov/hipaa/for-professionals/ privacy/guidance/access/index.html. © 2017 SVMIC. Reprinted with permission. This article is intended for educational/ informational purposes only and is not intended to constitute legal advice.

For questions regarding patient rights to access and charging for copies of PHI, please contact Loretta Duncan at LorettaD@ svmic. com.

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St. Jude,

continued from page 6 havior of proteins,” Dr. Taylor said. “And the change in the phase transition behavior changes the biology of the cell.” More broadly, he said, “These findings are part of an emerging theme that there is a whole spectrum of diseases that includes ALS, and some forms of dementia and myopathy, that are caused by disturbance in the behavior of these structures that perturbs cellular organization.” The findings offer a highly promising pathway to the first effective treatments for ALS/FTD, Dr. Taylor said. Current drugs, which are only minimally effective, seek to improve the function of already damaged neurons. However, the new findings suggest the possibility of treatments that would prevent neuronal damage by restoring the healthy balance of phase separation in the cells of people with ALS/FTD mutations. “We know that these material properties are under tight regulation, so perhaps we don’t have to target the disease-causing mutation itself,” Dr. Taylor said. “Perhaps we can restore balance by targeting any of a large number of regulatory molecules in the cell. There are already therapeutic approaches in laboratory testing that seek to do just that.” In further studies, Dr. Taylor and his colleagues will seek to understand the basic process of phase transition. They will also map the regulatory machinery for stress granules, to seek potential therapeutic targets. He also noted that the same basic pathology of phase transition may also underlie other neurodegenerative diseases, including Alzheimer’s disease, and he is aiding researchers in applying the same research approach as in ALS/FTD to Alzheimer’s. The paper’s joint first authors are Ian Mackenzie of Vancouver Coastal Health and the University of British Colombia; Alexandra Nicholson of Mayo Clinic Jacksonville; and Mohona Sarkar of St. Jude. Other St. Jude co-authors were Jamshid Temirov, Hong Joo Kim and Tanja Mittag. The research was funded in part by Mayo Clinic for Individualized Medicine; the Arizona Alzheimer’s Consortium; CREATE, the Canadian Institutes for Health Research; the National Institutes of Health and ALSAC, the fundraising and awareness organization of St. Jude.

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SEPTEMBER 2017

Father, Son Double-Team Autoimmune Disorders at UTHSC By MADELINE PATTERSON

A father and his son at the University of Tennessee Health Science Center are gaining attention for their contributions concerning autoimmune disorders. Arnold E. Postlethwaite, MD, AB, is the Goodman Chair of Excellence Professor of Medicine and director of the Division of Connective Tissue Diseases at UTHSC. He has been associated with Dr. Arnold Postlethwaite, left, and his son, Dr. Bradley Postlethwaite. the school since 1973 and with more than 150 publications on autoimmune disorders.  tered peptide ligand, APL) can “turn off” And now the Postlethwaite impact is the progression of arthritis in the animal growing, as Bradley Postlethwaite, MD, model of RA. Dr. Arnold Postlethwaite Arnold’s son, also enters the field of rheuconducted a phase 1 study funded by the matology at University Clinical Health, VA in which patients took a daily solution one of the faculty practices affiliated with of Type II collagen APL before breakfast UTHSC. While the elder Postlethwaite for four months. did indeed teach his son, he says he did The hypothesis was the APL solution not encourage him to enter the field of could halt the immune reaction to Type II medicine. Collagen, with the eventual goal of helpDr. Bradley Postlethwaite “loves to ing RA patients slow the progression of interact with people, and in rheumatology the disease. The data are still being anayou take care of patients all their life belyzed. cause most of the diseases we treat never In addition to the VA study, Dr. Arget cured,” Dr. Arnold Postlethwaite said nold Postlethwaite is studying the relationof his son’s choice to enter his same field ship between UVB light and arthritis. The of practice and research. Dead Sea beaches in Israel have been a The Postlethwaite duo is collaborathaven for RA patients who report feeling on autoimmune research, specifically ing reduced symptoms for days after time for patients with scleroderma. spent in the sun. Researchers have estabIt is estimated that 50 million Amerilished the benefits of vitamin D for RA cans suffer from some type of autoimmune patients, but the “beach effect” is actually disease, including lupus, Crohn’s disease, UVB light providing temporary relief. scleroderma, rheumatoid arthritis and ce“UVB is something different – it liac disease, to name a few. Autoimmune produces a potent and fast suppression of disease is also the top cause of morbidity the immune system,” Dr. Arnold Postlefor women in the United States. thwaite says, but he cautions the treatment UTHSC is at the forefront of rheumaposes a cancer risk. If researchers can bettology research, and particularly rheumater understand what the UV light does to toid arthritis (RA) research. RA is primarily the immune system, then a therapy could the inflammation of joints that occurs when be developed without causing melanoma.   the immune system attacks the body’s own Scleroderma occurs when there is an tissues. In the 1970s, Dr. Andrew H. Kang overproduction of type 1 collagen leadat UTHSC and the Memphis VA Mediing to hardening or “sclerosis” of the cal Center discovered and developed the tissue and organs in the body. The skin rodent model of type II collagen-induced and internal organs, such as the heart, GI arthritis, which is used worldwide as a tract and lungs, are susceptible to fibrosis, model for RA. More than 25,000 articles which impairs the function of the affected have been published on this model and the organ. There is no overall scleroderma topic, and UTHSC has continued to retreatment, but researchers are studying ceive grants from federal and private founoral tolerance to type 1 collagen from cow dations for its pioneering work. skin, which is like human type 1 collagen The elder Dr. Postlethwaite has spent as a therapy.  much of his research career studying colA new test of genetic variants called lagen, as it plays a crucial role in undersingle nucleotide polymorphisms (SNPs) is standing scleroderma or systemic sclerosis, a major breakthrough to determine how and rheumatoid arthritis, his two areas of researchers study oral collagen treatment focus under the umbrella of autoimmune in clinical trials. Drs. Arnold Postlethwaite diseases. and Weikuan Gu discovered a mutation Today, Dr. Arnold Postlethwaite that indicates a patient can’t be toleratized and other physicians at UT are studying to collagen. how changing amino acids in peptides (alThe marker is a sign that the patient

will be resistant to oral collagen therapy, therefore researchers can more selectively identify systemic sclerosis patients for research studies. This SNPs study has not been published yet, but it’s in process with arGentis Pharmaceuticals. The cost associated with autoimmune disease in the United States is around $100 billion annually, and to put that in perspective, it’s estimated that the direct medical cost of cancer is $87 billion. While research for new therapies has progressed since the breakthrough rodent model at UTHSC in the ‘70s, there is potential for growth in understanding the immune system of the GI tract, where about 70 percent of the immune system lives.

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Researchers: Zika Virus Kills Brain Cancer Stem Cells While Zika virus causes devastating damage to the brains of developing fetuses, it one day may be an effective treatment for glioblastoma. New research from Washington University School of Medicine in St. Louis and the University of California San Diego School of Medicine shows the virus kills brain cancer stem cells, the kind most resistant to standard treatments. The findings suggest that the lethal power of the virus – known for infecting and killing cells in the brains of fetuses – could be directed at malignant cells in the brain. Doing so potentially could improve people’s chances against a brain cancer – glioblastoma – that is most often fatal within a year of diagnosis. “We showed that Zika virus can kill the kind of glioblastoma cells that tend to be resistant to current treatments and lead to death,” said Michael S. Diamond, MD, PhD, the Herbert S. Gasser Professor of Medicine at Washington University School of Medicine, the study’s co-senior author. The standard treatment is surgery, followed by chemotherapy and radiation, yet most tumors recur within six months. A small population of cells, known as glioblastoma stem cells, often survives the onslaught and continues to divide, producing new tumor cells to replace the ones killed by the cancer drugs. In their near-limitless ability to create new cells, glioblastoma stem cells reminded postdoctoral researcher Zhe Zhu, PhD, of neuroprogenitor cells, which generate cells for the growing brain. Zika virus specifically targets and kills neuroprogenitor cells. In collaboration with co-senior authors Diamond and Milan G. Chheda, MD, of Washington University School of Medicine, and Jeremy N. Rich, MD, of UC San Diego, Zhu tested whether the virus could kill stem cells in glioblastomas removed from patients at diagnosis. They infected tumors with one of two strains of Zika virus. Both strains spread through the tumors, infecting and killing the cancer stem cells while largely avoiding other tumor cells. The findings suggest that Zika infection and chemotherapy-radiation treatment have complementary effects. Standard treatment kills the bulk of tumor cells but leaves the stem cells intact to regenerate the tumor. Zika virus attacks the stem cells bypassing the greater part of the tumor. To determine if the virus could help treat cancer in a living animal, researchers injected either Zika virus or saltwater directly into the brain tumors of 18 and 15 mice, respectively. Tumors were significantly smaller in the Zika-treated mice two weeks after, and those mice survived significantly longer than the controls. Zika used in people would have to be injected into the brain, likely during surgery to remove the primary tumor. Injecting a virus notorious for causing brain damage into people’s brains seems alarming, but Zika may be safer for use in adults because its primary targets – neuwesttnmedicalnews

.com

roprogenitor cells – are rare in the adult brain. The fetal brain is loaded with such cells, explaining why Zika infection before birth produces severe brain damage, while mild symptoms occur in adults. Additional studies showed that the virus does not infect noncancerous brain cells. As an additional safety feature, the researchers introduced two mutations to weaken the virus’s ability to combat the

cell’s defenses against infection, reasoning that the mutated virus still would be able to grow in tumor cells – which exhibit poor antiviral defense systems – but would be eliminated quickly in healthy cells with a robust antiviral response. When they tested the mutant viral strain and the original parental strain in glioblastoma stem cells, they found that the original strain was more potent, but

that the mutant strain also succeeded in killing the cancerous cells. Researchers are going to introduce additional mutations to further sensitize the virus to the innate immune response and prevent the infection from spreading said Diamond. “Once we add a few more changes, I think it’s going to be impossible for the virus to overcome them and cause disease.”

Dr. Osayawe N. Odeh, Dr. Aleruchi Oleru, Dr. Keith Perkins, Jr., Dr. Evanna Proctor, Dr. Alan C. Rothrock, Dr. Bryan P. Tygart and Dr. Bradley M. Webb in the Hospitalist Depart- Dr. Heather L. Perry ment at Jackson-Madison County General Hospital. Dr. Perry received her Doctor of Osteopathic Medicine degree from Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Dr. Ashada T. Cumberland Gap, TN and Freshwater her undergraduate degree from Lincoln Memorial University, Cumberland Gap, TN. She completed her Residency at Family Medicine, Uni-

versity of Tennessee, Jackson, TN, Jackson-Madison County General Hospital. Dr. Perry is Board Eligible, American Board of Family Practice. Dr. Freshwater joins Dr. David W. Bryan, Dr. Anna “Liz” Burgess, Dr. Phillip A. Coy, Dr. David L. Garey, Dr. Eric W. Muir, Dr. Jason A. Myatt, Dr. Rebecca A. Nass and Dr. Kellie L. Wilding in the Family Practice Department. Dr. Freshwater received Doctor of Medicine degree from the University of Tennessee Health Science Center in Memphis. She received her undergraduate degree at the University of Tennessee, Knoxville. She completed her residency at Family Medicine, University of Tennessee, Jackson, Tenn. Freshwater is Board Eligible, American Board of Family Practice.

GrandRounds WTH’s Hickey Receives Prestigious Certification JACKSON — West Tennessee Healthcare is proud to announce Tracy Hickey has received certification as a Certified Professional in Health Informatics. Tracy serves as Director of Health Information Management for West Tennessee Health- Tracy Hickey care. She achieved the credential from the American Health Information Management Association (AHIMA), prestigious premier professional association for Health Informatics. Informatics is an interdisciplinary field that involves the application of data science, informational technologies, and human-technology interactions to health-related practice. The Certified Professional in Health Informatics certification is earned through a combination of education, experience, and performance on a certification exam. According to AHIMA, the certification exam was developed and validated by a panel of experts who were chosen to represent the diversity of the health informatics field, including practitioners, employers and academics. The process and the resulting exam were overseen by The Commission on Certification for Health Informatics and Information Management (CCHIIM). Hickey began her career with West Tennessee Healthcare over 28 years ago. Throughout this time, she has held various leadership positions. She began as a Prospective Payment Coordinator before moving to Assistant Director of Health Information Management. In 1998, she was promoted to Director in 1989, a role she continues to hold in addition to her other responsibilities within the West Tennessee Healthcare system. Tracy Hickey resides in Jackson with her husband David and daughter Gini.

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Jackson Clinic Announces Two New Physicians JACKSON - The Jackson Clinic has recently added two new physicians. Dr. Heather L. Perry joins the Hospitalist Department and Dr. Ashada T. Freshwater joins their Family Practice Department. Dr. Perry joins Dr. William Lofton, Dr. Natasha Mahajan, Dr. Ryan Nerland,

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September 2017 WTMN  

West TN Medical News September 2017

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