Houston Methodist Methodology Magazine - Spring 2019

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METHODOLOGY

The Research and Education Magazine of Houston Methodist Spring 2019

Revolutionizing Stroke Recovery An Electromagnetic Cap Reveals— and Recovers—Brain Function


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Partnering to Produce New RNA Vaccines 14

Albert Huang, MD: Full Circle in the Cycle of Care

Revolutionizing Stroke Recovery 06

Mobile App Drives Healthy Habits 08

Bridging the Gap in Public Health Case Reporting

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A Flexible Approach to Breast Reconstruction 18

Teams Test a New Heart Drug 20

Patient Care Spanning Several Years

Front cover: Artist’s rendering of a concept for a design for the magnetic cap. See the current version on page 5.

NEWS HIGHLIGHTS

FEATURES

Implementing Innovation with Roberta Schwartz, PhD 22

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Collaboration within the TMC 24

News Briefs 26

Awards & Accolades 27

Faculty Recruitment & Appointments 28

Upcoming Events


Houston Methodist Institute for Academic Medicine Executive Leadership

FROM THE INSTITUTE FOR ACADEMIC MEDICINE With entrepreneurial-minded investigators, pioneering educational programs, and the best translational research technology and operations now fortifying the Institute for Academic Medicine, we approach the key challenges of innovation on the pathway to the clinic: strengthening product development and commercialization. Roberta Schwartz, PhD, provides a better understanding of Houston Methodist’s strategy to deliver innovation to our patients and accelerate commercialization in our Q&A interview.

H. Dirk Sostman, MD, FACR President, Institute for Academic Medicine MD Anderson Foundation Distinguished Chair in Molecular Imaging

Developed by Drs. Santosh Heleker and David Chiu, the electromagnetic cap for stroke patients featured on our cover was the first project to be selected for Translational Research Initiative funding and is now licensed and undergoing several clinical trials. Employing her

Houston Methodist

17 years of experience customizing patient treatment plans, Dr. Aldona Spiegel created the

Emeritus Professor of Radiology

FlexHD Pliable PRE™, a licensed product for breast reconstruction surgery. Houston Methodist’s

Weill Cornell Medical College

RNAcore, led by Dr. John Cooke, has become a leader in RNA synthesis, resulting in an exclusive license with GeneOne Life Science and VGXI to produce clinical-grade RNA. Embarking on this mission to improve medical translation was no small challenge. Through our collective efforts to innovate and educate, combined with an unrelenting patient focus, we are leading medicine into the next frontier.

H. Dirk Sostman, MD, FACR

Edward A. Jones President and CEO Houston Methodist Research Institute

President, Institute for Academic Medicine MD Anderson Foundation Distinguished Chair in Molecular Imaging Houston Methodist Emeritus Professor of Radiology Weill Cornell Medical College

Senior Vice President Houston Methodist

Board of Directors • Houston Methodist Research Institute

Timothy B. Boone, MD, PhD Director, Education Institute Chair, Department of Urology Houston Methodist

David C. Baggett, Jr.

John P. Cooke, MD, PhD

Gregory V. Nelson

John F. Bookout, Jr.

Martha DeBusk

Mary Eliza Shaper

John F. Bookout, III

Dan O. Dinges

H. Dirk Sostman, MD

Marc L. Boom, MD

Antonio M. Gotto, Jr., MD, DPhil

Douglas E. Swanson, Jr.

Timothy Boone, MD, PhD

Edward A. Jones

Andrew C. von Eschenbach, MD

Carrie L. Byington, MD

Evan H. Katz

Joseph C. "Rusty" Walter, III

Joseph R. "Rod" Canion

Edwin H. Knight

Martha Walton

David Chao

Pastor Kenneth R. Levingston

Elizabeth Wareing

Stephen Chazen

Kevin J. Lilly

Judge Ewing Werlein, Jr.

Augustine M.K. Choi, MD

Steven S. Looke

Ernest D. Cockrell, II

Vidal G. Martinez

Read more online: issuu.com/instituteforacademicmedicine

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FEATURES

Exploring the Riddle of Brain Function to

Revolutionize Stroke Recovery by LaVonne Carlson

What do songbirds, stuttering and electromagnetic stimulation have in common? A revolutionary treatment for recovery after stroke — and potential treatments for many other neurological disorders.

It all started with the riddle of stuttering, explored by Houston Methodist neurologist David Rosenfield, MD, and neuroscientist Santosh Helekar, MD, PhD. They compared the brain structures of zebra finches learning songs to those of humans learning speech and asked: How can we identify and influence brain mechanisms that affect speech? It occurred to Helekar that the answer was to develop a way to apply electromagnetic stimuli to precise, localized points in the brain — by inventing a device small enough to stimulate a songbird's brain. Helekar and Henning Voss, PhD, a physicist at Weill Cornell Medical College, worked together to invent a portable non-invasive device that uses powerful neodymium rare earth magnets, combined with tiny electric motors to produce high-speed oscillations: electromagnetic bursts that resemble the wave patterns that might occur in the brain during learning. Eventually, the researchers attached the motorized magnets, small enough to enclose in capsules, to a neoprene cap that fits snugly on the human head. Controlled by a smart phone app, the cap provides patients with an affordable and portable home-based therapy. Called transcranial rotating permanent magnet stimulation, or TRPMS, the patented technology uses multi-focal stimulation to manipulate impulses at several points in the brain simultaneously, exciting or

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“ Fifty years of research show that

the brain changes when stimulated repeatedly and often. Simultaneous repeated stimulation of two connected points in the brain enhances the connections between them — this is how learning occurs — and stimulation using oscillations might create a better effect.

– Santosh Helekar, MD, PhD Associate Professor of Neurology Stanley H. Appel Department of Neurology Houston Methodist

inhibiting areas responsible for specific functions. Following

additional medical conditions. Seraya also plans to design a

a stroke and its resulting lesions, the cap can stimulate nearby

commercial version of the cap, for which it will apply for FDA

healthy tissue to take over functioning in damaged areas.

marketing approval.

For example, healthy tissue surrounding lesions in the motor cortex may be stimulated to send instructions that induce muscle groups to continue functioning.

Data demonstrating the cap's ability to diminish stuttering was presented at the 2018 American Neurological Association meeting. Following a poster presentation co-authored by

An ongoing clinical trial conducted by Helekar and

Rosenfield and Helekar, their research was awarded a "blitz"

David Chiu, MD, Elizabeth Blanton Wareing Chair in the

presentation for an audience of neurologists. Rosenfield, who

Eddy Scurlock Stroke Center in the Stanley H. Appel

is the Chair in Speech and Language in the Stanley H. Appel

Department of Neurology, will be completed in March using

Department of Neurology, reported their results: When using

the TRPMS cap to attempt to promote recovery from stroke.

the cap to strengthen the connection between the Broca’s and

As the first project to be selected for funding by the Houston Methodist Translational Research Initiative, the cap is fulfilling

Wernicke’s speech areas in the brain, eight out of nine study participants showed improved fluency of speech.

the fund’s mission of promoting clinical translation. The patent portfolio for the technology underlying the cap has been licensed by Seraya Medical Systems, LLC, which has supported one

Helekar SA and Voss HU. (2016) Transcranial brain stimulation with rapidly

clinical trial in the past year and plans to extend the trials for

spinning high-field permanent magnets. IEEE Access, 4: p. 2520-2528.

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FEATURES

Mobile App Drives Healthy Habits for Breast Cancer Survivors Study participants achieved goals with real-time access to clinicians

by Gale Smith used the app, the more likely they were to lose weight. These results were published in the November 2018 issue of JCO Clinical Cancer Informatics. What sets MOCHA apart from consumer health apps is that Houston Methodist incorporated a clinical dietitian who actively communicated with patients to provide direct Tejal Patel, MD

Renne Stubbins, PhD

Stephen T.C. Wong, PhD

feedback and guidance, reviewing entries and making comments and suggestions in real time. For Houston

The link between being overweight and cancer is becoming

Methodist dietitian Renee Stubbins, PhD, the app allowed

increasingly clear. A recent meta-analysis of 82 studies including

her to interact with more patients on a daily basis,

more than 213,000 women indicated that reducing obesity

something she believes can be adapted by other registered

also reduces the risk of cancer recurrence, as well as the

dietitians and health care providers. She also helped

frequency of hospital readmission.

motivate participants to support each other via the app.

To help breast cancer survivors make healthier lifestyle choices,

“Maintaining a healthy weight is difficult enough for the

breast medical oncologist Tejal Patel, MD, clinical dietitian

average person, let alone for those who’ve survived breast

Renee Stubbins, PhD, and bioinformatics expert Stephen

cancer,” said Stubbins, “So being able to empower and

Wong, PhD, worked together to develop and test a mobile

support these women in real time made a difference.”

app that helped survivors interact with their health care team, including a clinical dietitian, especially between appointments.

MOCHA was created by Stephen T. C. Wong, PhD, John

The results proved promising: Those who used the Methodist

S. Dunn, Sr. Presidential Distinguished Chair in Biomedical

Hospital Cancer Health Application (MOCHA) consistently

Engineering, and his informatics development team as a way

lost weight—mainly due to daily, real-time interactions with

for Houston Methodist health care providers to offer continued

their health care team via the mobile app.

care beyond hospital walls. While the app is currently accessible to study participants, the goal is to broaden its use in multi-

The pilot study revealed that 56 percent of its enrolled patients

center studies and focus on changing long-term behaviors

lost an average of 3.5 pounds while using MOCHA over a

to reduce health issues most common in cancer survivors.

four-week period. It also showed that the more the participants

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One of the biggest hurdles for a survivor is finding the support needed to maintain a healthy lifestyle: Although clinicians tell patients that losing weight reduces the risk of cancer recurrence, they typically don’t provide structured tools to achieve this weight loss. This mobile application provides a link to the physician’s office so that real-time changes can be made.

– Tejal Patel, MD Assistant Professor of Clinical Medicine in Oncology Houston Methodist

Stubbins R, He T, Yu X, Puppala M, Ezeana C, Chen S, Alvarado M, Ensor J, Rodriguez A, Niravath P, Chang JC, Patel T, Wong STC. A Behavior-Modification, Clinical-Grade Mobile Application to Improve Breast Cancer Survivors’ Accountability and Health Outcomes. JCO Clinical Cancer Informatics: Nov 30, 2018. This research was supported in part by the Ting Tsung and Wei Fong Chao Foundation and the John S. Dunn Research Foundation.

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FEATURES

Bridging the Gap Houston Methodist is first to pilot Digital Bridge for public health case reporting by Gale Smith

In November 2018, Houston Methodist became the first hospital system in eight U.S. pilot sites to successfully test and launch an approach for electronic case reporting that automatically sends case reports directly from a hospital to public health agencies. Houston Methodist worked in collaboration with the Houston Health Department and Epic, the electronic medical records company, to implement the innovative process. Reporting cases of certain communicable or infectious diseases

and alleviate inconsistencies that have allowed a gap in public

is critical for disease surveillance and detection of possible

health case reporting across the nation. Additional locations

outbreaks and trends. Local and state health departments

that partnered with Digital Bridge to pilot electronic case

require hospitals to report cases of these diseases, which

reporting are in California, Kansas, Massachusetts, Michigan,

are regularly tracked. The Centers for Disease Control and

New York and Utah.

Prevention (CDC), in collaboration with members of the Council for State and Territorial Epidemiologists, chose five initial

Prior to electronic case reporting, communication between

conditions for the pilot sites to report electronically: chlamydia,

hospital systems and various levels of health departments

gonorrhea, pertussis, salmonella and Zika.

was not as timely or streamlined as the system now in place. Having successfully implemented the pilot system, Houston

The electronic case reporting approach was designed by key

Methodist will continue to use the electronic case reporting

stakeholders in health care, public health and health information

approach, adding other reportable conditions as recommended

technology. Called the Digital Bridge collaborative, they shared

by the CDC.

the common goal of finding an efficient way to align systems

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worked tirelessly with city health officials and our electronic “ We medical records vendor to improve public health surveillance. Digital Bridge partners created an innovative approach that allowed our hospital system to reduce the burden on our health care providers for meeting public health reporting requirements.

CASE REPORTING SITES

– Roberta Schwartz, PhD Chief Innovation Officer and Executive Vice President Houston Methodist

Massachusetts

Michigan

New York

California Utah Kansas

CDC Headquarters (Atlanta)

Houston

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QA FEATURES

&

Implementing Innovation A conversation with Roberta Schwartz, PhD, Chief Innovation Officer and Executive Vice President by Gale Smith

Houston Methodist has excelled in medical and clinical innovations for nearly 100 years. As we prepare to enter our second century, Roberta Schwartz, PhD, shares her vision for the Houston Methodist Center for Innovation, and explains why focusing on the business side of health care innovations will facilitate the organization’s long-term success.


Q: What is your vision for the Houston Methodist Center for Innovation?

A: The Houston Methodist Center for Innovation is transforming

Q: How will advances in telemedicine, artificial intelligence and big data improve care for our patients?

A: When asked, 75 percent of consumers say they would like

the way we do business and the way we serve our patients.

to see their doctors on camera, equal to seeing them in

There are better and different ways to provide health care

person. When you have an industry that’s transforming so

to consumers. Our goal is to do research and development

quickly, it’s astounding to see.

on new technologies and bring those technologies to our consumers and our business partners to make their lives better.

We recognize that our role is to make practitioners available to communities all over the southern part of the United States

We’re not afraid to innovate, to try and possibly fail with new

and, in some cases the world, because we have particular

technologies. We’re not afraid to try things that have been

expertise that not everyone can travel here for, but we want

used in other industries and are considered fairly new in

them to be able to see our specialists.

health care. We are going to bring change and expand our reach to patients. Of that I have no doubt.

Q: Houston Methodist has a history of clinical innovation. How do you see the Center for Innovation building on this history?

A: If you look at Dr. DeBakey, you look at the Dacron graft, and see historically how we solved problems differently. Or what our scientists are doing in the laboratory, and they iterate over and over again until they get it correct. Those in health care have been apprehensive to do that in the world of technology. We tend to think we have to get it right the first time and it has to be perfect. What we’re recognizing is that we’re not going to get it right the first time. We have to try it, not be afraid to fail, iterate, make it better, try it out again, get it better, and get it to where it works for either a business purpose or a clinical purpose.

Q: How will digital innovations transform safety, quality and service at Houston Methodist?

A: As we really look at opening up avenues for texting or video, both for business purposes and direct to consumer, we’re looking at new avenues for patients to access us. There are so many technologies that are available today to help us make our jobs easier, give us more time at the bedside. We’re looking at how to put the technology where we may not want to have people deployed, and then put people where we need them. We understand that health care is too expensive and

We want to catch people at a very early stage of illness so that we can treat them early, or manage chronic conditions more seamlessly, thereby not only doing better by them but also reducing costs to the health care system.

Q: What are we doing at Houston Methodist that truly sets us apart from other health care organizations across the country?

A: At Houston Methodist, we’ve taken a different approach than most health care organizations. A lot of health care organizations are setting up independent companies that are almost not linked to their hospital or leaving digital innovation to IT. We’ve pulled in our high level business experts, clinical informatics as well as IT to talk, and we’ve also set up smaller innovation committees all over our system. The ideas from each of those innovation committees are bubbling up to the parent group. In putting all of those individuals in the room together, we’ve created a research and development engine that is really unparalleled.

Q: We are celebrating 100 years this year. As chief innovation officer, what do you want the next century to look like at Houston Methodist?

A: In the next 100 years, I’m hoping that people across the world are able to access Houston Methodist from wherever they are. I see Houston Methodist as an institution that’s not afraid to take advantage of every technology to make life easier for both the people working here and the patients we serve.

we’re going to have to reduce costs. For us, we want to get more people at the places where we need them through transforming our industry.

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FEATURES

Partnering to Produce

New RNA Vaccines and Therapies Licensing agreement leads to manufacturing GMP-grade RNA by LaVonne Carlson

Only 75 years ago, molecular biologists were just beginning

To be able to study—and ultimately implement—gene therapies,

to grasp the basics of genetic structure: DNA, found in the

researchers and clinicians must have a steady source of RNA

cell nucleus, establishes the genetic code, while RNA, found

that is pure and stable. Houston Methodist's RNAcore has

in the cytoplasm, is responsible for carrying it out, helping

developed a process for producing RNA that is reliable and

in the creation of basic proteins to build molecules and cells.

reproducible on a large scale. Directed by John Cooke, MD, PhD, the RNAcore has become a leader in RNA synthesis, generating

As recently as the 1960s, scientists were still struggling to

RNA constructs including mRNA, modified mRNA, microRNA

understand RNA, due to its tendency to transmute so rapidly.

cassettes, and noncoding RNA for scientific and medical collaborators.

But persistence paid off and today their understanding of

In addition to its manufacturing methods, the RNAcore also has

RNA is crucial to the fields of gene therapy and epigenetics,

developed exceptional technologies for improved stability of RNA

as it focuses on changes in gene expression rather than

products and enhanced delivery of nucleic-acid-based therapies.

altering the genetic code itself. In September 2018, Houston Methodist entered into an exclusive license with GeneOne Life Science and its subsidiary, VGXI, to produce clinical grade RNA. The agreement will encourage development of new RNA vaccines and therapies by combining the design capabilities of the RNAcore with the manufacturing capabilities of VGXI, an industry leading plasmid DNA contract manufacturer, which has expanded its facility in The Woodlands, Texas, in anticipation of the collaboration. VGXI has a successful track record of supplying preclinical through cGMP-grade DNA plasmids for vaccines, gene therapies and viral vector production. The addition of RNA manufacturing services will make it the world’s first dedicated contract manufacturing organization to encompass both DNA VGXI held a ribbon-cutting ceremony on November 2, 2018, to celebrate the opening of its Woodlands-based facility, which includes purpose-built GMP production areas for RNA synthesis. It brought together Houston Methodist’s John Cooke, U.S. Congressman Kevin Brady, VGXI President and CEO Young Park, and VGXI COO Dorothy Peterson.

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and RNA biopharmaceuticals.


RNA based therapeutics and vaccines are developing rapidly, with an expected market value of $1.2 billion by 2020. The pairing of the RNAcore and VGXI fills a critical product development gap with a GMP manufacturing solution that enables biotechnology companies and academic consortia to drive novel mRNA therapies through FDA approval pathways to market.

– John P. Cooke, MD, PhD Joseph C. “Rusty” Walter and Carole Walter Looke Presidential Distinguished Chair in Cardiovascular Disease Research Houston Methodist

GENE THERAPY DELIVERS RNA INTO CELL FOR IMMUNOTHERAPY

Antigen

Activation

RNA

Antigen-Presenting Cell

Immunized Cell

The RNAcore received initial funding as a core group for the Progenitor Cell Biology Consortium of the National Heart, Lung, and Blood Institute; it now also receives support from the Cancer Prevention Research Institute of Texas to further the development of cutting-edge RNA technologies.

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FEATURES

Turning Full Circle in the

Cycle of Care From student to inventor to teacher, Albert Huang, MD, is a model of med tech innovation in Houston by LaVonne Carlson

Albert Huang, MD, holds the StimSite device he designed to help identify the ureter during surgery.

Over 3 million operations in the U.S. each year involve cutting close to the ureter, risking damage to the fragile tubes that are vital to kidney function. The ureter is notoriously difficult to locate and identify during surgery, requiring time-consuming dissection and even impromptu consults from urologists. Seeing the long-standing challenge to surgeons, former Houston Methodist surgical resident and research fellow Albert Huang, MD, wondered "Why do we do it this way? Is there an alternative? If not, why not?" It was during a difficult surgery—facing the challenge of avoiding the ureter—when Huang had the idea of using an electrical current to locate the ureter. As the only smooth muscle structure in that part of the body, the ureter is easily identified when stimulated with a small current in a device developed by Huang. It produces a wormlike movement that has proven 100% effective in identifying the ureter, offering

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surgeons greater confidence when performing procedures and documenting that every precaution was taken to ensure accuracy. Called StimSite, the device can be plugged into the operating room wall and powered by a foot pedal. Huang also is planning to integrate it into robotic operating systems, such as the DaVinci.

ANNUAL FACTS HOUSTON METHODIST

Currently, it is undergoing a clinical pilot with a private practice Ob/Gyn group, whose physicians flew in from Dallas to train

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on using the device at the Houston Methodist Institute for Technology, Innovation & Education (MITIESM). Huang continues to refine the technology before submitting the final version of the product for FDA clearance. His top priority is documenting the methodology and manufacturing process to ensure the product’s greatest safety and efficacy. Ultimately, he hopes his device will lay the foundation for a thriving ecosystem of innovation in Houston. “I want people to see success here, to see that the ecosystem

I would love to set the stage in the Texas Medical Center, for that doctor who comes up with that billion-dollar idea, which ultimately will help improve health care for millions of patients.”

“ I was fortunate to be trained

at a place that recruits people

Operating beds

1.3 M

Patient encounters

$141 M

Huang, who also has taken on the new role of Innovation Strategist for TMCx. “I went to med school to help patients….

2,312 540,000

can support the doctors who are willing to take a risk,” said

$55.3 M

Hospitals

1,261 51

Sq.ft. research space

Research expenditures

Extramural funding

Clinical protocols

GME programs

who like to think differently

29,408

Total learners

and are allowed to flourish.

23,669

Employees

I was privileged to work with physicians who have the

6,973

Dave B, Gonzalez DD, Liu ZB, Li X, Wong H, Granados S, et. al. Role of RPL39 in Metaplastic Breast Cancer. J Natl Cancer Inst. 2016 Physicians Dec 31;109(6)

mindset for innovation—they

1,435

Trainees-in-residence

aren’t stuck in their ways

1,960

Credentialed researchers

and don’t push away a new idea because ‘This is the way we’ve always done it. ‘

– Albert Huang, MD Founder and CEO Allotrope Medical

681

Faculty

– Jenny Chang, M.D. Emily Herrmann Chair in Cancer Research & Director, Houston Methodist Cancer Center As of February 2019

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FEATURES

Designing a Flexible Approach to

Breast Reconstruction by LaVonne Carlson

As director of Houston Methodist’s Center for Breast Restoration, Aldona Spiegel, MD, has made it her mission to advance breast-restoration procedures in ways that help women enhance their physical and mental vitality as they heal. To that end, she has invented the FlexHD Pliable PRE™, an acellular dermal graft, which combines both the product design and step-by-step process for performing a new type of reconstructive breast surgery.

Designing the new approach led Spiegel to think differently about traditional breast reconstruction, which requires cutting through the pectoral muscle and placing an implant in the breast cavity. This typically causes a hard capsule to form during healing, which can be slow and painful, and the final result may distort the breasts’ natural shape and symmetry.

Aldona Spiegel, MD

Spiegel, whose subspecialty is breast reconstruction, applied her 17 years of experience with customizing treatment plans for patients. Keeping in mind that healing

was easier with autologous reconstruction, which uses one’s own tissue, she began to rethink implant reconstruction. First, she used tissue expanders, but found the lack of padding between the muscle and skin still allowed animation deformity, which was easily seen during movement.

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When taking on this challenge, Spiegel called upon skills she’d learned when she decided to sew her own prom dress: using a dress pattern to tailor a fitted bodice. For the innovative breast reconstruction, she conceptualized and designed a fenestrated tissue graft, including a substrate of collagen that conformed to the body as it grew into its natural shape. By placing the tissue on top of the muscle and covering it with allograft collagen, which is a layer of donated decellularized dermis, Spiegel’s procedure prevents the body from forming an overly hard capsule, allowing it to maintain flexible movement and symmetrical appearance. Spiegel eventually created a template for preparing the graft in advance, which along with her step-by-step process for insertion, greatly reduces the time required to perform the surgical procedure. Spiegel embarked on a product launch in early 2019, working with MTF Biologics (a non-profit tissue bank formerly known as Musculoskeletal Transplant Foundation) who licensed the product. Another aspect of her mission is to help explain the importance of tissue donation. Looking back at where she started, Spiegel reflects on the success stories she hears from her patients. “It’s a powerful feeling, to design something and implement it,” she said, “and to see how well it works.”

As a high-school student, Spiegel decided to sew her own prom dress. She credits her sewing skills for helping her learn to transform flat tissue into a three-dimensional shape that conforms flexibly to the body.

“ Seeing how this improves the patient’s experience — to have minimal pain and the breast reconstruction done in one day, with no need for additional surgery — is the best part of the process.

– Aldona Spiegel, MD Director, Center for Breast Restoration Houston Methodist Institute for Reconstructive Surgery Associate Professor of Clinical Plastic Surgery Houston Methodist

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FEATURES

Teaming Up to Test a New Heart Drug Critical care teams go above and beyond — on a large scale — to provide patient care for a clinical trial by Laura Niles Imagine the level of coordination necessary for a clinical trial involving a patient that requires 28-hour intervention and observation. The patient is enrolled, the date is set, and then, the patient becomes ill. One ongoing Phase IIa clinical trial at Houston Methodist illustrates the exceptional team effort that was needed to make the trial a success while providing incomparable patient care. Houston Methodist’s DeBakey Heart & Vascular Center clinical research team joined with the Post-Anesthesia Care Unit (PACU), the Coronary Intensive Care Unit (CCU), and the Investigational Drug Service to conduct a randomized trial of a drug to treat chronic stable heart failure patients. The drug has the potential to alleviate excess Teams from the Houston Methodist DeBakey Heart & Vascular Center clinical research team, the PACU and CCU exhibited exceptional collaboration for this Phase IIa clinical trial.

fluid overload caused by congestion, common in heart failure patients. This congestion may result in a hospital admission and weight gain. These teams, who do not normally interact, were working together to coordinate regular drug infusions for a trial participant when they faced an additional challenge: The participant became sick one week before the trial session began. Suddenly, resources shifted and extraordinary collaboration ensued. The trial’s principal investigator, Ashrith Guha, MD, assistant professor of cardiology, provided trial oversight, regularly checked in on the patient, and helped the team secure a bed in the CCU, outside of the planned

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PACU location, for both treatment and trial observation. In addition to their regular shifts, the PACU, CCU and clinical research teams went out of their way to ensure coverage for the overnight shifts to fulfill the trial

PATIENT INTAKE Cath lab, assignment to PACU/CCU, drug randomization, blood & urine sampling 1x per hour begins

requirements. Brandon Cook, RN, PACU acting director, and Daniel Kerr, RN, PACU managing nurse, stepped in to help organize the move to the CCU. Leonardo Feliciano, RN,

18 HOUR DRUG INFUSION

CCRN, PACU unit nurse, provided

First hour – data collection every 10 minutes After 17 hours – data collection 1x per hour

interventions every hour, although

28h

the patient had moved to a different unit.

patient care

Deborah Barr, RN, CCRP, lead

OBSERVATION – 10 HOURS

clinical research nurse for the trial,

Once drug infusion is completed, patient is observed with hourly data collection

and Enya Rentas-Sherman, MBBS, CCRC, senior research coordinator, volunteered to stay bed-side throughout the night to collect data for an additional trial patient. Timothy Delao, senior research technician, assisted with data collection and Susmitha Gadde, administrative director of Heart Center Research, were instrumental in providing resources throughout

PATIENT DISCHARGED After 28 hours of observation

the trial operations.

excited about this trial because I’ve seen a shift on “ I’m every level, where the staff have come together to champion the value of research as part of the mission of Houston Methodist. People have gone out of their way to be involved in this.

– Mohamad Ghosn, PhD Clinical Trials Manager DeBakey Heart & Vascular Center Houston Methodist

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FEATURES

Patient Care Spanning Several Years by LaVonne Carlson

When an opportunity opened up to help with a new clinical trial in the Alzheimer’s Research Therapy Clinic, Jennifer Garrett, RN, jumped at the chance. Over time, one trial grew into many. Today she is working on six Alzheimer’s infusion trials, as well as studies for other neurological disorders, under the direction of Joseph Masdeu, MD, PhD, Graham Family Distinguished Chair for Neurological Sciences. “I discovered a whole world I never even knew existed,”

Eli Lilly and Company and Biogen are among the pharmaceutical

said Garrett, who conducts cognitive assessments,

companies conducting drug trials in the clinic. Its reputation

records research data, and performs hands-on nursing

for strong recruitment skills and impressive infrastructure have

tasks, such as starting IVs and drawing blood. “Previously

helped it gain prominence as a clinical trial study site.

when patients left the hospital, I always wondered how they were doing. With my research patients, I get to see

Garrett appreciates getting to see patients improve, depending

them through the entire span of a study­—typically, over

on whether they are on medication or a placebo. She points

two-to-five years.”

out that all the patients, even those in the control group who don’t receive the medication, appreciate receiving the frequent

Garrett has seen Alzheimer’s research take a new direction

cognitive assessments they typically wouldn’t get with routine care.

in recent years, shifting from patient populations already showing symptoms of dementia to those showing minor

“All of our patients, and their families, appreciate the extra

or no symptoms. Studies with newly diagnosed patients,

set of eyes on their condition,” said Garrett. “What I love

still in the early stages, reveal significant slowing in the

about research nursing is the camaraderie with the patients,

progression of dementia symptoms.

and also with their sons and daughters: It’s like having an extended family.”

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“ I can see that our work with Alzheimer’s is changing the course of the disease. We see stability, or even a slight improvement, instead of a steady decline.

– J ennifer Garrett, RN, BSN, CCRP Senior Research Nurse Department of Neurology Nantz National Alzheimer Center Houston Methodist

Alzheimer's Disease Neuroimaging Initiative. A biomarker combining imaging and neuropsychological assessment for tracking early Alzheimer’s disease in clinical trials. Current Alzheimer Research. 2018;15(5):429-442.

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NEWS HIGHLIGHTS

Collaboration within the Texas Medical Center & Beyond

MOU with Texas Children’s Hospital

Translational Imaging Center

On August 29, 2018, Texas Children’s Hospital and the

The Translational Imaging Center at Houston Methodist

Houston Methodist Research Institute executed a memorandum

provides the Texas Medical Center research community

of understanding for preclinical and imaging services to be

with access to advanced high-performance imaging for

rendered by the Houston Methodist Research Institute for

preclinical and clinical investigative studies. Specifically,

TCH faculty-initiated projects. The memorandum grants TCH

the Positron Emission Tomography facility offers a wide

faculty access to expertise, facilities and services provided

variety of highly customizable advanced imaging services

by the Houston Methodist Research Institute including certain

in specialized facilities, including an on-site cyclotron and

imaging, core and other preclinical services as well as

a PET imaging clinic.

protocol development.

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The inaugural project was kicked off on October 29,

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2018 by Sundeep Keswani, MD, surgical director of

Alan Prossin, MD, psychiatrist and assistant professor in the department of psychiatry and behavioral sciences at The University of Texas Health Science Center

basic science research at TCH and professor of

at Houston, is working with Paolo Zanotti, MD, PhD,

surgery, pediatrics and obstetrics at Baylor College of

director of the Houston Methodist PET Imaging Core,

Medicine. The study focuses on a medical device technology

to study the expression of the translocator protein

tested in a cutaneous preclinical porcine model.

(TSPO), a biomarker for inflammation, in various neuropsychiatric disorders.

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Swathi Balaji, PhD, assistant professor of surgery, division of pediatric surgery, Baylor College of Medicine,

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Natalia Pessoa Rocha, PhD, at the department of psychiatry

is working on a preclinical trial related to the underlying

and behavioral sciences at The University of Texas

mechanisms of cutaneous wound healing without

Health Science Center at Houston, is collaborating

scarring. With access to preclinal models through

with the PET Imaging Core to study differences in levels of

Houston Methodist Research Institute’s Comparative

TSPO-related brain inflammation, in Huntington’s Disease

Medicine program, her research aims to achieve

patients, asymptomatic carriers and controls. Rocha’s work

postnatal regenerative tissue repair in various organ

is supported by the Huntington’s Disease Society of

systems.

America Human Biology Project.


With the rapid expansion of its research facilities over the past ten years, the Houston Methodist Research Institute now offers an exceptional level of service and expertise to its long-standing TMC partner institutions.

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NEWS BRIEFS 1

Most Wired Award by CHIME In November 2018, Houston Methodist received the prestigious Most Wired Award for the 11th year. The annual award is granted by The College of Healthcare Information Management Executives (CHIME) to recognize outstanding technology implementation and adoption. Houston Methodist is on the global list of hospitals and health systems at the forefront of using healthcare IT to improve delivery of care. It was selected from a total of 647 organizations representing 2,190 hospitals from 9 countries.

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New Mathematics in Medicine Program The new Mathematics in Medicine Program, led by Program Director Vittorio Cristini, PhD, was established in fall 2018 to create innovative translational programs that combine mathematical, physical, imaging and engineering approaches with experimental, clinical and surgical research to optimize treatment strategies for patients. Using practical mathematical models and tools, physicians may better predict treatment outcomes for individuals. Learn more about the program at houstonmethodist.org/math-in-medicine.

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Real-Time Flu Tracking 3

S. Wesley Long, MD, PhD, and Paul A. Christensen, MD, pathologists in the department of pathology and genomic medicine, developed a real-time website that tracks flu cases across Houston Methodist, just in time to assist physicians, the CDC and patients for the fall 2018 flu season. News about the site was covered in Becker’s Hospital Review, Science Magazine, Today and other media outlets. View the site at flu.houstonmethodist.org.

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Making Room for Revolutionary 7T The Houston Methodist Translational Imaging Core has undergone significant renovations to make way for new state-of-the-art imaging equipment, including the Siemens 7 Tesla (7T) MRI, the Siemens 3 Tesla (3T) MRI and a PET/CT. The 3T, shown here, was installed December 16. The 7T was delivered February 23. The 7T MRI scanner will be the first of its kind in Texas and the first approved for clinical use in the U.S. Its exceptional capabilities include clear visualization of previously unseen anatomical details and also shows physiology or biological function. The 7T technology, accessible to all institutions in the TMC, is part of a Siemens Healthineers and Houston Methodist agreement.

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Postdoc Assaf Zinger Tours U.S. Postdoctoral Fellow Assaf Zinger, PhD, is touring the U.S. as one of Israel’s rising stars and exemplary scientists. He is traveling with Technion-Israel Institute of Technology President Peretz Lavie, PhD, as part of a Presidential Forum series focused on nanotechnology, engineering and innovation. Zinger is working on a biomimetic nanoparticle platform to develop therapies for diseases that share an inflammatory background, such as cancer, diabetes, and cardiovascular, autoimmune and neurological diseases. With three patent applications underway, he explains he sought his postdoctoral training at Houston Methodist because of its direct translational medicine capabilities.

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Alum Gives Keynote at APCS Houston Methodist Alum Joy Wolfram, PhD, gave the keynote address at the 2019 Annual Postdoctoral Career Symposium (APCS) on February 7. Organized jointly by several postdoctoral associations in the Texas Medical Center for doctoral students and postdoctoral researchers, it focused on career opportunities in the biomedical field and beyond. Wolfram, now assistant professor of medicine at the Mayo Clinic in Jacksonville, FL, was named to Forbes' 2019 list of 30 under 30 in health care in the U.S. and Canada.

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Health & Nature Symposium 2019 The Center for Health & Nature hosted the Health & Nature Symposium 2019 to increase awareness of the Center's research priorities, the current state of research in the field, and funding mechanisms available to its collaborative partners. Jointly hosted on February 13 by Texan by Nature, Houston Methodist and Texas A&M University, it featured a lightning round of research concept pitches centered on three themes: nature as preventative and restorative medicine, the health role of nature in cities, and nature for chronic disease management.

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Pumps & Pipes Goes Global The Pumps & Pipes 12th International Symposium, held December 3 at Houston Methodist Research Institute, was attended by more than 250 science enthusiasts and innovators from across medical, aerospace, energy and academic specialties. An additional 50 high-school students participated in its interactive STEAM (science, technology, engineering, arts and mathematics) program. In October 2018, Pumps & Pipes Norway held its inaugural conference in Stavanger, Norway, welcoming 117 professionals from energy and medicine sectors. This year, look for more Pumps & Pipes opportunities across Europe.

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AWARDS & ACCOLADES

NEWS HIGHLIGHTS

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James Musser, MD, PhD, inducted into American Clinical and Climatological Association and named to Pathologist 2018 Power List James M. Musser, MD, PhD, Fondren Presidential Distinguished Chair and professor of pathology and genomic medicine, was recently inducted into the American Clinical and Climatological Association. The ACCA was organized in 1884 by physicians and scientists committed to improving medical education, research and practice in the U.S. Its members are selected on the basis of their leadership, excellence in their chosen field, and spirit of warmth, diversity and friendship. Musser also was named to The Pathologist’s 2018 Power List—his second year in a row on the magazine’s list of 100 pathologists worldwide, nominated by their peers, and selected by a panel of expert judges.

Miguel Valderrábano, MD, receives the Silver Review Recognition Award Miguel Valderrábano, MD, the Lois and Carl Davis Centennial Chair at the Houston Methodist DeBakey Heart & Vascular Center and professor of cardiology, has received the Silver Review Recognition Award, in appreciation of high quality and timely reviews of submitted manuscripts on behalf of Circulation: Arrhythmia and Electrophysiology, a journal of the American Heart Association.

Homer Quintana, MCTM, receives inaugural award as TMCx Innovation Champion Homer Quintana, MCTM, program project manager for preclinical translation in the Comparative Medicine Program, was awarded the inaugural TMCx Innovation Champion Award in recognition of his significant role as an advisor for TMCx start-up companies. He was instrumental in facilitating agreements with Houston Methodist clinicians and cores for 10 of the 22 companies in the current TMCx cohort. “Homer has done an outstanding job of championing the Center for Rapid Device Translation this year, and is very deserving of this recognition,” said Tanya Herzog, DVM, DACLAM, director of the Houston Methodist Comparative Medicine Program.


FACULTY RECRUITMENT

Yi-Lan Weng, PhD Yi-Lan Weng, PhD, joined Houston Methodist in September 2018 as a scientist in the Center for Neuroregeneration at the Houston Methodist Neurological Institute. Previously, he was a postdoctoral fellow in the department of neuroscience at Perelman School of Medicine, University of Pennsylvania. His Neuroepigenetics Lab focuses on understanding how the regenerative capacity is governed in the nervous system in order to guide therapeutic approaches for treatment of injuries, stroke and neurodegenerative diseases.

Chinnaswamy Jagannath, PhD Chinnaswamy Jagannath, PhD, joined Houston Methodist in January 2019 as a scientist in the Department of Pathology and Genomic Medicine. Previously, he was a professor in the Department of Pathology and Laboratory Medicine at McGovern Medical School, University of Texas Health Science Center in Houston. His work focuses on mechanisms of vaccine-mediated immunity and enhancing the

FACULTY APPOINTMENTS

body’s response to vaccines, particularly for tuberculosis, the leading cause of death due to infections.

Gulchin A. Ergun, MD, named the David M. Underwood Distinguished Professor of Medicine in Digestive Disorders Gulchin A. Ergun, MD, was named the David M. Underwood Distinguished Professor of Medicine in Digestive Disorders. She also is professor of clinical medicine, Institute for Academic Medicine.

Min P. Kim, MD, named the David M. Underwood Distinguished Professor of Surgery in Digestive Disorders Min P. Kim, MD, was named the David M. Underwood Distinguished Professor of Surgery in Digestive Disorders. He also is associate professor of surgery, Institute for Academic Medicine and associate clinical member, Houston Methodist Research Institute.

Howard J. Huang, MD, to lead lung transplant program Howard J. Huang, MD, is the new medical director of the lung transplant program at Houston Methodist J.C. Walter Jr. Transplant Center. Huang, a pulmonologist who previously served as director of lung transplant research and associate medical director of lung transplantation at Baylor University Medical Center in Dallas, specializes in clinical and translational research with a goal of helping lung transplant patients achieve better long-term outcomes.

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UPCOMING EVENTS

UPCOMING EVENTS

April 4-5, 2019

June 29, 2019

10 Annual Re-Evolution Summit -

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Minimally Invasive Cardiac Surgery (MICS): The Ultimate Hands-On Summit *

April 6, 2019

9th Annual ScienceDay

July 19, 2019 Functional Medicine: Approaches to Inflammation, Anti-Aging and Chronic Disease*

8th Annual Symposium on Enhancing Geriatric Understanding and Education (SEGUE): Geriatric Ophthalmology for Non-Geriatricians*

April 27, 2019 2nd Annual Hepatology Update for Primary Care: A Practical Approach*

August 10, 2019 2nd Annual Hepatology Update for Primary Care: A Practical Approach*

August 16, 2019 7th Annual Houston Methodist Cancer Symposium*

May 1 -4, 2019 18th International Ataxia-Telangiectasia Workshop

June 8, 2019

3rd Annual Cardiology for the Non-Cardiologist 2019*

* CME credit available Visit attend.houstonmethodist.org for more information.



METHODOLOGY The Research and Education Magazine of Houston Methodist

Editor-in-Chief Rebecca M. Hall, PhD Managing Editor LaVonne Carlson Design & Creative Lead Doris T. Huang Contributing Writers LaVonne Carlson Laura Niles Gale Smith

Public Relations Contact Gale Smith 832.667.5843 gsmith@houstonmethodist.org Read more online: issuu.com/instituteforacademicmedicine Office of Communications and External Relations Institute for Academic Medicine Houston Methodist news@houstonmethodist.org IAMNEWS-012 | 03.2019 | 1300