MUSC Catalyst 11-07-2014

Nov. 7, 2014

MEDICAL UNIVERSITY of SOUTH CAROLINA

Vol. 33, No. 12

Inside a superherO hallOween 2014 emerging COmpany award

6

Nanoscale technology makes big gains.

researCh disCOvery

11 Popular drug linked to birth defects.

2 President’s Letter 4

Salute to Vets

5 Meet Geraldine T h e C aTa ly s T Online http://www. musc.edu/ catalyst

photos by Helen Adams, Public Relations

On Halloween, members of the Mount Pleasant SWAT team put on costumes instead of bulletproof vests and rappelled past the windows of a play area at Children’s Hospital. Afterward, the officers stayed in character and went inside the Atrium to spend time with the children.

Spiderman (aka Mount Pleasant SWAT team member Justin Hembree) wishes a Children’s Hospital patient a happy Halloween.

Study targets helping veterans use fewer pain pills

By Helen AdAms Public Relations Researchers at MUSC will be part of a $21.7 million federal initiative aimed at finding alternatives to addictive painkillers for thousands of veterans suffering from pain related to their military service.

MUSC will seek volunteers for its study in January, specifically veterans whose doctors have prescribed opiates to treat their chronic pain. Those veterans will sit with electrodes strapped to their heads for 20 minutes per session while an electric current flows to a targeted area of the brain. Researchers hope the treatment called transcranial direct current stimulation will help reduce their pain and their cravings for opiates.

Borckardt

Jeffrey Borckardt, Ph.D., director of the Biobehavioral Medicine Division at MUSC, will lead the trial. He specializes in researching treatments for chronic pain. “We think that by helping them manage their pain better non-pharmacologically, with the electricity and the combined psychotherapy, the pain will be under better control,” he said. “They’ll be less likely to misuse their medications.”

His idea is that tDCS, a form of neurotherapy, can prime the veterans’ brains, reducing their pain and making them more receptive to cognitive behavioral therapy, which is also part of his study.

Cognitive behavioral therapy is a form of talk therapy aimed at controlling and changing negative thoughts and behavior. By itself, this form of therapy has been shown to help people better manage chronic pain, but it is hoped that combining it with tDCS will provide even greater pain relief.

“We’re building on some techniques that are reasonably well established,” Borckardt said of the brain stimulation techniques MUSC has been instrumental in pioneering. Borckardt said there is

READ THE CATALYST ONLINE - http://www.musc.edu/catalyst

See pain on page 9

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A letter from the president: New travel policies relating to Ebola To the MUSC Family: Since my Oct. 16 letter pertaining to the Ebola epidemic in West Africa, much has emerged in the news media regarding travel to and from that region.

The Medical University leadership has been closely monitoring information and recommendations by state and federal government agencies, and by other universities and medical centers, to ensure necessary steps are taken to protect the health and safety of the MUSC community.

To that end, the following travel policies Cole will now apply across the MUSC enterprise (MUHA,University, and MUSC Physicians).

1) Travel is restricted for all MUSC related purposes to Guinea, Liberia, and Sierra Leone. These restrictions align with the U.S. Centers for Disease Control and Prevention’s issuance of the Level 3 Travel Warning (the highest level of warning) urging all U.S. residents to avoid non-essential travel to these countries. Other countries may be added to this list if conditions change.

2) Exemptions will be considered on a case-by-case basis and will require the approval of the appropriate MUSC authority. Please contact Kathleen Ellis at ellisk@musc.edu in the MUSC Center for Global Health for more information

Editorial of fice MUSC Office of Public Relations 135 Cannon Street, Suite 403C, Charleston, SC 29425.

843-792-4107 Fax: 843-792-6723 Editor: Cindy Abole catalyst@musc.edu Catalyst staff: Mikie Hayes, hayesmi@musc.edu Helen Adams, adamshel@musc.edu

on how to apply for an exemption.

3) Personal/volunteer travel to Ebolaaffected countries to deliver health care or other services is discouraged but recognized as an individual choice. You must use PTO or leave, and you should provide advance notification of your plans to your direct supervisor and to the MUSC Center for Global Health. We urge anyone considering going to one of these three countries to carefully evaluate the substantial risks. Medical evacuation is extremely limited, as private carriers are not currently allowed to bring medical evacuees into the U.S from Ebola–affected countries. While the CDC and the U.S. Department of State are assisting with medical evacuations out of the affected areas, you should be aware that individuals who show any signs of fever, whether exposed to the disease or not, face significant challenges leaving these countries and risk being quarantined together with potential Ebola patients.

4) Those returning from travel — whether university-sponsored or personal travel — to any Ebola–affected country are required to contact their supervisor and Employee Health Services (7922991) or Student Health (792-3664) to report their return. This should be done immediately upon returning home and prior to returning to campus in order for MUSC to provide the necessary support and clinical guidance to monitor the individual’s health and to protect others.

Returning travelers should also strictly adhere to any requirements imposed by the state of South Carolina.

5) Anyone considering hosting visitors who have been in affected countries in The Catalyst is published once a week.

Paid adver tisements, which do not represent an endorsement by MUSC or the State of South Carolina, are handled by Island Publications Inc., Moultrie News, 134 Columbus St., Charleston, S.C., 843-849-1778 or 843-958-7490. E-mail: sales@moultrienews.com.

the previous 21 days must first consult with Employee Health Services who will help develop plans that will assure safety for the host and others.

Any MUSC individual — whether on university-approved or personal travel — who fails to adhere to these guidelines may be subject to disciplinary action.

Please be advised that travel to other parts of West Africa should be carefully evaluated due to local country restrictions on incoming and outgoing visitors, even if those areas are not presently at risk of Ebola virus disease.

We will continue to provide updates about the evolving situation, countries under current CDC travel advisories, and links to resources.

Yours in service,

David J. Cole, M.D., FACS MUSC President

2014 Cooking Well Invitational event set for Nov. 7 Cheer on MUSC/Sodexo chefs as they compete among 10 statewide teams of hospital dietary and nutrition professionals preparing nutritious meals in a healthy culinary competition.

The event is scheduled from 9 a.m. to 3 p.m. at the Culinary Institute of Charleston at Trident Technical College, 7000 Rivers Ave. in North Charleston. Tickets are $35 and includes lunch.

The event will feature live demos and dialogue with Chef Marvin Woods.

For tickets information, visit http://www.cookingwellsc.com.

THe CATAlysT, Nov. 7, 2014 3

First-year MSTP student selected for MUSC Physicians scholarship

By JAne mA Public Relations

W

inston Plunkett, a first–year student in the Medical Scientist Training Program, was named the 17th recipient of the MUSC Physicians MSTP scholarship. This scholarship was originally established in 2003 during the presidency of Bruce Elliot, M.D., senior associate dean for clinical affairs, when the group was known as University Medical Associates. It is awarded annually to one of the first– year MSTP students based in large measure on overall undergraduate academic performance.

Perry V. Halushka, M.D., Ph.D., former dean of the College of Graduate Studies and MSTP director, noted, “As with all of the awardees, Plunkett was an outstanding choice. The MSTP admissions committee rated him very high on our list of applicants and was quite pleased that he chose to attend our program. He personifies what the scholarship stands for, and we expect great things from him in the future.”

A native of Williamsburg, Virginia, Plunkett attended the University of Virginia as an undergraduate before being accepted into the M.D./Ph.D. dual degree program at MUSC. He was a chemistry major and was inspired by his undergraduate research experiences to pursue a career in research.

photo provided

MSTP student Winston Plunkett, second right, receives a certificate and plaque from Dr. Bruce Elliott, from left, Interim VP for Medical Affairs; Dr. Scott Reeves, MUSC Physicians president; and Dr. Perry V. Halushka, MSTP director.

As he pursues his Ph.D., his interests lie in certain aspects of ophthalmology and bioinformatics. Having worked in a drug discovery lab during the previous summer, that line of research holds a great deal of interest for him as well. In terms of his medical

specialty, he is undecided.

“Luckily, one of the great things about the program here at MUSC is that it encourages its MSTP students to explore,” Plunkett said. He added that he was drawn to MUSC because of the strong support system in place for the students; this scholarship is absolute proof of that for him. He said, “The scholarship is just one example of the great support the physicians here at MUSC have extended to MSTP students.”

The MSTP scholars are known for being extremely talented and accomplished students and professionals: Four were inducted into the Alpha Omega Alpha medical honor society, two were named Distinguished Graduates of the Year in the College of Graduate Studies and six were awarded the highly competitive National Institutes of Health National Research Service Awards. The first recipient of the scholarship, Loretta Hoover Jophlin, M.D., Ph.D., returned last year to MUSC as a gastroenterology fellow slated to work with Don Rockey, M.D., chairman of the Department of Medicine. Jophlin had been voted outstanding Intern of the Year at Mount Sinai Medical School.

The future looks bright and filled with exciting possibilities for Plunkett as he moves forward into his graduate studies and professional career.

pa week: serving and eduCaTing The COmmuniTy

Above photo: Members of MUSC’s Physician Assistant Class of 2016 assisted in a health screening at the Oct. 4 Hope for Healing Event sponsored by the Dream Center clinic in North Charleston. Left: The team set up a tent and conducted screening exams for more than 100 underserved people and educated the public about the PA profession using a brief questionnaire at time of registration. The students also provided educational and take–home materials for participants.

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MUSC celebrates its military-serving employees E The Veterans Day Celebration ach day MUSC employees are valued for their efforts and contributions in educating health care professionals, conducting research and providing patient care. MUSC employees and students also share an important dual role as citizen–soldiers, working with the National Guard, active duty or reserve troops.

emplOyees & sTaff Beau Adams, Claude Allande, Richard R. Anderson, Teresa Lopez Anderson, Thomas P. Anderson, Michael G. Andrews, James R. Atkins, Kenneth Bachewicz, Larry V. Banks, Andrew Barrett, Christopher S. Barrett, Harold Wayne Barron, John M. Barry, Barbara A. Bell, Greg Bellamy, Dionne L. Bennett, Frederick L. Bennett Jr., Leonel R. Bersamina, Connie Lee Best, Robert Partridge Bethea, Rob Black, Jeff Blice, LaRonda Boddie, Wallace T. Bonaparte, John R. Boolen, Alice Bova, Pamela D. Bowens, Timothy Brabbs, Hazel Lavelle Breland, Frank Joseph Brescia, Mary M. Brigman, Rob Britt, Jeff Brittain, Ron Brown, Walter Adam Brzezinski, James C. Bundo, Timothy H. Bussey, David E. Callahan, Sr., Desiree E. Case, Rudolph A. Chapman, Ed Cheeseman, Stephanie F. Chomos, Theodore Vincent Clark, Coury Clements, Alfred Cox, Fred A. Crawford, Jr., Elise A. Cromwell, Howard Shawn Crowley, Paul Croy, Arthur Jackson Crumbley, III, William J. Crummer, Michel Cuenin, James Cummins, Josh Dakin, Charles A. Davis, Jr., Sharon DeGrace, Angienita Deveaux, Samuel C. Deveaux, Alexandra Dillon, Leroy Dingle, Joseph M. DuRant, Raymond D. Edwards, Andrew Eiseman, Bruce M. Elliott, Dallas Ellis, Jill Evans, Jo Lynn Evans, Julius P.L. Fielding II, Tom Flathmann, Shaune L. Flournoy, Jacob Fountain, Dennis J. Frazier, Melissa Ann Freeland, Geoffrey A. Freeman, Calvin M. Gathers, Sr., Pat Gaylor, Greg Gischia, Joseph Cole Good, Jr., William J. Graham, Brett Green, Rickey A. Greene, Susan Ann Greene, Robert Gregowicz, Jennifer Hart Griffin, Edward Griles, Brent Grimball, David Guarino, Jr., David A. Guarino, Sr., James E. Guest, Polly Bramblett Guffin, Brande Guillory, Greg Hackworth, Jason S. Haney, Russell Harley, Tina Harris-Johnson,

2-3 p.m., Monday, Nov. 10 Drug Discovery Building Auditorium MUSC Provost Dr. Mark Sothmann along with the Veterans Day Task Force invite MUSC employees, students, faculty and staff to the Veterans Day Celebration.

Guest Speaker Col. (Ret) Dick Sula U.S. Air Force MUSC Public Safety Color Guard Video in Celebration of MUSC Veterans Presentation of Lapel Pins to All Veterans Reception to follow in the Drug Discovery Building lobby

Robert C. Hedin, James E. Hensley, Jr., Kenton R. Holden, Kevin Holsapple, Jennifer Hooks, Lee T. Howard, Cindy Beisler Hylenski, Gabriel B. Ingraham, III, David W. Ivey, Kara Jackson, Paul F. Jacques, James F. Johnson, Karen E. Johnson, Lance H. Johnson, Laureen R. Johnson, Rodger A. Johnson, Floyd P. Jones, Kimberly Jones, Joyce Justice, Paula Lajeunesse Kersey, Tammy Lamont, John T. Lancaster, Kristin Land, Lori W. Langston, David A. Lee, Edward H. Lee, Lawanda Levell, Christina M. Linthicum, Joanne Liu, Paul M.P. Locicero, III, Karla K. Locklear, Christopher T. Long, Leanna Loud, Scott M. Luedtke, Martin Maddox, Ceferino G. Magpantay, Jr., Lucinda Magwood, Robert J. Malcolm, Jr., Stephen W. Malley, David Marcum, Barbara Martin-Ayers, Randy Massingale, Barry Mathis, Brandon Matthews, Clearo Mattox, Kammy L. Mauldin, Tommy L. Maw, Shareen McCoy, Allen G. McCreary, Clifton L. McDonald, Marshall McFadden, Karen L. McGee, Ronald E. McKinnie, Darin McNeal, Jay McNealy, David W. Menendez, Lawrence C. Mohr, Joaquin Antonio Molina, David Moses, Paul Moss, Kelly Mullen, Steve Naert, Tyler Nance, Dave Neff, Robert F. Neuner, Pamela C. Nevill, Donald Thomas Newburn, Ronald O. Nickel, Shawn Nimons, Jack

Nolen, Matt Nutaitis, Lisa O’Donnell, Jeffery D. Osmer, Henry B. Othersen, Jr., Donna Padgette, Lyndsey Palumbo, Lloyd R. Pate, Jr., Steve Paterniti, Monica L. Peeples, Charles H. Pegram, Robert H. Peiffer, David Penick, John Pigott, Randy Pilch, Joe Pizarro, Jr., Cassandra A. Poole, Mansle Raines, Carlos Angel Ramirez, Jon B. Rampton, Susanne Ratzlaff, James G. Ravenel, Michele C. Ravenel, Archie L. Reid, William J. Rentz, Russell Rine, David E. Rivers, Laura L. Roberts, Jacob G. Robison, Christian Romanchek, Phyllis Deneen Ross, George M. Rossi, Roger D. Rowell, Timothy S. Roylance, Mike Ruth, Robert M. Sade, Charlie Sander, John J. Sanders, Michael Schaupp, Charles Schleich, Howard Schomer, Bradley A. Schulte, John Bayne Selby,

Jr., Warren L. Sholl, Jr., Cephus E. Simmons, Christine M. Skope, Sabra C. Slaughter, DeBorah R. Smalls-Brown, Eric Smathers, Christina Smith, John D. Smith, Jr., David E. Soper, Charles E. Stevens, Robert T. Stickney, Russell J. Stillwagon, Joseph M. Stocking, Valerie Sutton, Marvin Michael Swindle, Lonnie Taylor Jr., Jeffrey Bruce Taylor, II, Anthony Thomas, William A. Thomison, Anita D. Thommes, Joseph F. Thompson, Jr., Vernell Threat, Elonda T. Threat-Seabrook, Lori Tisdale, David P. Tobin, Ron Treiber, Ed Trudo, Edwin Tufts, Paul B. Underwood, Jr., Bruce Warren Usher, Mark Harold Van Horn, Michael L. Vanderhurst, Kenneth N. Vanek, Matthew J. Wain, John A. Walker, Marion H. Watson Jr., Edgar J. Weiss, Helen Wells, David L. Wendorf, Scot P. Wetzig, Olivia Whitehurst, Floyd Whittington, George D. Whitton, Mark A. Wilberding, Miya T. Wilburn, Nicole Williams, Raymond G. Williams, Ruthel F. Williams, Ed Wilson, Danny M. Woodard, Annabel Woodman, R. Andrew Young, Susan Lee Zayac, Patrick Baker, Julio Chalela, Samuel Cooper, Alexei Decastro, Gregg Dwyer, James Fox, John Gnann, L. Manaker, David Ploth, Jacob Robison, John Waller, Sharlene Wedin Leclerc, Thomas Anderson, Rebecca Benesh, Sherry Blackwell, Laronda Boddie, Debra Brewer, Desiree Case, Steve Chattin, Marion Floyd, Tiffany Griles, Brande Guillory, Kevin Heis, Catherine Burns, Terri Mizner, David Neff, Gregory Perron, Rosalyn Peterson-Hale, Pamela Polite, Christine Schaub, Leanne Shattuck, Desha Simkpson, Bryan Smith, Ed Sookikian, Tonia Stoney, Edwin Tufts, Linda Washington and Edward Wilson

THe CATAlysT, Nov. 7, 2014 5

Meet Geraldine

Geraldine Torres Department Interpreter Services How you are changing what’s possible at MUSC By making good communications possible How long at MUSC 9 years Family and pets Husband, Luis; sons, Adam and Matthew; daughter-in-law, Kristin; two grandchildren, McKenzie and Shawn; and our pet pug, Chichi Valentino Hometown I was born in the Bronx, New York, but raised in Puerto Rico for 18 years.

Favorite fall activity Trick or treating Best thing about being a medical interpreter Seeing patients’ faces light up when they understand what their doctor says Favorite dish you can cook Arroz con gandules (rice and pigeon peas), it’s a traditional Puerto Rican dish

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Researchers make big wins on nanoscale By dAwn BrAzell Public Relations

C

ompared to more established research companies, ToleRaM Nanotech, LLC is the proverbial new kid on the block. But this company, with a potent mix of MUSC researchers, took home top honors in the 2014 BioProcess International Awards last week in the category of Emerging Companies.

In her typical effervescent style, researcher and nanotechnologist Ann-Marie Broome, Ph.D., had the perfect analogy. “You put us all together and shake us up and wait for someone to yell, Yahtzee!”

It’s a word being said frequently by the company’s founders whose slogan on thecompany website reads ‘small solutions to big problems.’ The company focuses on expediting research for the focused delivery of drugs via specifically targeted nanoparticle devices. The goal is a big one: to decrease rejection of transplanted organs and lower the debilitating side effects that transplant patients may experience.

The three founders of the company are: Broome, a biomedical engineer who has her MBA in bioscience entrepreneurship; Satish N. Nadig, M.D., Ph.D., a transplant surgeon who also has a Ph.D. in immunology; and Carl Atkinson, Ph.D., an expert in immunology and the innate immune system.

Nadig, the company’s chief medical officer, said it was an honor to be recognized. “We’re the infant company of the three finalists in that category that were chosen. The idea is novel and the need is so high that they felt it was something they wanted to highlight.”

That need is what motivated the group to form its company Image provided last January, he said. “What ails our transplant patients is that Researchers hope nanotechnology will revolutionize drug delivery for transplants and other all of them are susceptible to infections, and cancers, diabetes conditions. Above, TRaMs (shown in red) are targeted to endothelial cell surface markers and general systemic consequences of their very powerful and internalized into the cell. immunosuppressant medications. It’s a double-edged sword One of the because they need these medications to keep them from company’s secrets rejecting their organs.” to success is the THe reseArCH great chemistry Broome, who works on a nanoscale at dimensions that of the team, say are just tiny fractions of the width of a human hair, studies Drs. Anne-Marie different drug delivery constructs that mimic biological Broome and membranes, such as micelles and liposomes, to build a bubble– like structure that has ‘special ingredients’ added. These Satish Nadig. ingredients control how and when the nanoparticle homes in MUSC News or ruptures within a region.

Center has this “We take FDA–approved drugs that have chemical story’s online characteristics ideal for packaging but that have significant sidepackage at www. effects associated with them thereby limiting their widespread musc.edu/pr/ use,” she said. “We encapsulate the drugs to put them in stealth newscenter/2014/ mode and deliver them specifically to a localized region. They nanotechnology. are released only to that area, eliminating the adverse side effects.”

Nadig said their research could revolutionize the way doctors

See Nanoscale on page 7

photo by Sarah Pack, Public Relations

THe CATAlysT, Nov. 7, 2014 7

nAnosCAle

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deliver medications in transplantation.

“A major hurdle for us is something called operational tolerance. It’s the Holy Grail of transplantation,” he said.

“Operational tolerance is defined as tolerance to the organ while keeping your global immune system intact. That is something this delivery system would potentially achieve.”

In other words, it potentially will lower rejection of a transplanted organ while allowing the patient to be able to fight off Atkinson infection and go about a normal life. This is exciting to the team given that chronic rejection is one of the leading causes of graft loss in the long term, even today, he said.

“That’s 20 percent of people on the transplant list that need a re-transplant because they’ve lost their organ to chronic rejection. There are about 100,000 people on the list just for kidney transplants.”

The team’s rapamycin nanocarrier, referred to as TRaM for targeted rapamycin micelle, allows a drug that isn’t widely used around the time of the operation, because of its side effect of keeping wounds from being able to heal, to be used in a targeted fashion because it is one of the best drugs to use immunologically. It allows the suppressive T–cells to proliferate, which is good for the transplant as it allows the patient to tolerate the organ, he said.

Broome designed the TRaMs to have tracking fluorophores and various other molecules that target the organ or tissue to be transplanted so that delivery and therapeutic response can be monitored noninvasively and in real time. The nanoparticles are also created to respond to changes in the environment.

“By physiology, whenever a cell envelops the nanoparticle, pH sensitive materials in the shell of the nanoparticle allow them to rupture within the cell,” she said. “We use the cell’s own ability to regulate pH to release the drug where it

photos by Sarah Pack, Public Relations Above, cells are being cultured for an uptake experiment of TRaMs. Below, Dr. Yu-Lin Jiang in Broome’s laboratory works with the modification and purification of nanoparticle and drug constructs. as a perfusion additive for donor organs will be much faster — a 2–to–5 year timeline given no setbacks. If experimentally successful, they estimate the time to reach clinical trials for a drug delivery system administered intravenously will be on a 7–to–10 year timetable.

Nadig said that is what’s great about entrepreneurship, and that he hopes researchers who have a bias against industry will reconsider if such a model could work for them. In the basic science realm, it might take 20 years for their research to be translated to the bedside.

“Having a company and having the development go through the company in certain iterations speeds the process up. The reason we formed this company Dr. Broome and research specialist is to be able to use this technology and Kayla Miller are characterizing streamline its ability to go the bedside. micelle composition.

It’s often faster through industry.”

And this is a team that believes in fast. will benefit most.”

They are working on several ways to TeAm sCienCe deliver the payload of bio–designed Nadig came to MUSC in August nanoparticles. The first phase is to study 2013 just a few months after Broome soaking the donor organ with TRaMs arrived in the Department of Radiology. before transplant. Another approach Describing it as serendipity, Broome said is to deliver it intravenously during she was thrilled to be contacted by Nadig re–perfusion (when the blood flow is before he even arrived. Her specialty in returned) in a transplant, a process that drug delivery meshed perfectly with his the surgeons can control, Nadig said. need for targeted drug deliveries.

The company has filed three patents “The second day I got here, we were for the technology it uses. A potential running experiments,” said Nadig, who rollout for the first phase of treatment

also tapped into the impressive work of Atkinson, an established basic science researcher. “It’s allowed us to move at a breakneck speed.”

In the past year, they have won three national awards for abstracts; submitted a manuscript for publication and funding requests for 13 grants; landed the BioProcess International Award; and formed a company.

The pace isn’t slowing down. Atkinson said the potential is limitless and goes beyond transplantation. “By packaging and targeting drugs, we can protect them from the often toxic microenvironment they will encounter in the body and thus improve their efficacy,” he said.

The hope is other researchers will start exploring not only what can be formulated in nanoparticle payloads, but also how they can be given to the patient, such as in a nebulized form, Atkinson said. Changing the formulation potentially will broaden their application to a wide range of diseases of the respiratory tract, from sinusitis to emphysema — and beyond.

The three company founders meet every other week to share updates and revise experiments. Broome said the collaboration is rejuvenating because she expects patients to benefit from what she’s doing in the lab during her lifetime.

“You become so specialized that you miss the opportunities that are looking you right in the face. Between the three of us and our laboratories, we have a whole stable of thoroughbreds. We’re the Triple Crown of nanotherapeutics,” she said.

Nadig, who will be addressing the American Society of Transplant Surgeons about the concept of team science and impact on work-life balance in January, said that for many years medicine has worked in silos, but the future is team science.

“This is a clear example of team science at its best. One of the best things about MUSC is that we have various disciplines in close proximity, such as having a surgeon talk to an engineer who talks to an immunologist and we all come together to form a delivery platform that has very sophisticated immunologic and mechanistic abilities in a very sick patient population. That’s the coolest thing about this.”

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Employees drop, cover and hold on in Great ShakeOut

By AmAndA riTsemA University Risk Management At 10:16 a.m. on Oct. 16, the MUSC community joined thousands of other colleges, businesses, government agencies and families across the country as they participated in the 2014 Great SouthEast ShakeOut earthquake drill.

The ShakeOut is an annual opportunity for people to practice how to protect themselves and be prepared in the event of a major earthquake or catastrophe in their community. People were encouraged to drop, cover and hold on as part of the drill. Participants were asked to submit their photos of proper earthquake protocol for the Great Southeast ShakeOut, and winners received MUSC business card holders and movie tickets to the Cinebarre Theater in Mount Pleasant.

Photos were received from the following departments and areas: Neurosciences Research, MUSC Master’s of Health Administration Students, RT7 Endocrinology, University Finance, 5 East ART Cardiac Acute Care, 9 East Neurosciences, Engineering and Facilities, Nursing Professional Development, STNICU, Internal Medicine, Division of Neurology, Boeing Center for Children’s Wellness, Epic, 10 East Orthopaedics and Joint Replacement, Department of Surgery, University Purchasing Services, 7C Pediatrics- Infant Care Unit, ART 6 West Digestive Disease, Pediatrics, Facilities Maintenance.

The activity was coordinated by University Risk Management. For information, visit http://www.musc.edu/ shakeout.

First-year MHA program accounting students take cover Oct. 16.

photos provided

Above, ART 6West Digestive Disease Acute Care Unit employees Dawn Salem, from left, Michelle Reich, Charity Berg-Maggard and Jennifer Metzger hunker down in their conference room. Left, a U.S. Geological Survey Department of the Interior/USGS map depicts U.S. areas at risk for a major earthquake.

THe CATAlysT, Nov. 7, 2014 9

PAin

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photo provided photo by Helen Adams, Public Relations

Dr. Jeffrey Borckardt shows the tDCS equipment he’ll use to test whether using brain stimulation in conjunction with psychotherapy can reduce veterans’ reliance on pain medications. evidence suggesting that tDCS alone can reduce pain. One of his recent studies showed that using tDCS on people who have had surgery reduced their use of opiate pain medication by as much as 40 percent.

He also said tDCS itself is not considered painful. “Some patients report tingling, itching, and in a few cases, a mild burning sensation that typically subsides in about 30 seconds.”

He’s tried it on himself to understand how it might feel to patients. “It makes me a little sleepy. That might be endogenous opiates – they might do that to some people.”

Endogenous opiates are sometimes called the body’s most powerful painkillers, and Borckardt said they may be released as a result of using tDCS. The treatment also changes the brain’s concentrations of the neurochemicals GABA (gamma amino butyric acid) and glutemate. GABA can calm nervous activity, while glutamate is associated with learning and memory.

Borckardt, who also serves as assistant professor in MUSC’s Department of Psychiatry and Behavioral Sciences, hopes the federal initiative that includes his study will lead to new pain treatments for veterans and others in chronic pain.

“The trouble is, right now, there aren’t many options for treating pain, so a lot of people have to rely on medication,” Borckardt said. “A subset of those patients falls down this hole of aberrant use and misuse, and it gets out of control.”

Other research covered by the federal initiative includes a study of whether bright morning light can reduce lowback pain and post-traumatic stress disorder symptoms and a project testing whether mobile devices that show brain activity can help veterans know when to relax to reduce pain symptoms.

Read about all 13 of the projects included in the federal program here: http://nccam.nih.gov/news/press/09232014.

Members of MUSC’s inpatient transport team gather to celebrate National Patient Transport Week, Nov. 2 to 8.

Hospital patient transporters recognized Staff Reports MUSC medical center and the National Association of Healthcare Transport Management recognizes National Patient Transport Week, Nov. 2 to Nov. 8.

MUSC’s Patient Tranport Services team supports services in Rutledge Tower, Children’s Hospital, University Hospital, Clinical Sciences Building, Hollings Cancer Center and the Ashley River Tower. Internal transporters move approximately 120,000 patients a year and are on call 24/7.

Tyler Nance, Business Operations and Support Services manager, works closely with the 37–member team. For this year’s celebration, transporters will be wearing badges that say “I am National Patient Transport Week.”

The Patient Transport Services Department team are Nairobi Alston, Joan Ancrum, Michael Andaya, Lavonnia Bennett, Stevie Betros, Bernard Brown, Sheila Bryant, Jimmy Bowman, Michael Buckingham, Glennie Davis, Georgina Dukes, Bryce Ferry, Teana Franklin, Tony Gentry, Darren Gordon, Barry Green, Paulette Green, Brennan Grooms, Zach Halewood, Reggie Harney, Carolyn Jamison, Millie Jenkins, Felecia Jones, Will Kirkland, Leandra Neal, Deborah Mitchell, Marquita Mungin, Lance Orechevosky, Clara Phillips, Lee Russ, Phillip Sewell, Josiah Smalls, Fletcher Springer, Sam Williams, Barry Williams, Daniel Williams and Steven White.

To request Patient Transport Services, call 876-0411.

Waring Library presents Sawyer Lecture Nov. 13 The Waring Historical Library at MUSC announces its annual Warren A. Sawyer Lecture at 5:30 p.m. on Thursday, Nov. 13 in the Basic Sciences Building Auditorium, Room 100.

A reception will follow at the Wickliffe House.

The event is free and open to the public.

Dr. Charles S. Bryan will present his talk, “James Woods Babcock and Pellagra: Solving South Carolina’s Greatest Medical Mystery.”

Bryan’s talk is based on his recent book, “Asylum Doctor: James Woods Babcock and the Red Plague of Pellagra.” The book was published in 2014 by University of South Carolina Press, with support from the Waring Library Society.

Asylum Doctor is a biography of Dr. James

Woods Babcock (1856-1922), the superintendent of the S.C. State Hospital for the Insane from 1891 to 1914, during which time he led the American response to a mysterious and deadly scourge: pellagra. Babcock first sounded the alarm, brought out the first English–language treatise on pellagra and organized the National Association for the Study of Pellagra.

Bryan is the Heyward Gibbes Distinguished Professor of Internal Medicine Emeritus at the University of South Carolina. His publications deal mainly with infectious diseases, medical history and biography.

For information, contact the Waring Library, 792-2288 or waringhl@musc.edu.

10 THe CATAlysT, Nov. 7, 2014

MUSC Urban Farm unveils new farm-on-wheels second floor of ART. To There is a hand–pushed cart, request a particular stop flourishing with green and for the mobile farm cart, representing the MUSC Urban email urbanfarm@musc.

Farm, touring the MUSC campus. edu.

The purpose of the mobile farm cart The dietetic interns is to increase awareness about the are also asking people to half–acre Urban Farm, located at the complete a quick survey corner of Bee and President streets about the MUSC Urban behind the historic wall, which is Farm.

Complete the open to the MUSC community and survey at http://tinyurl. communities we serve. com/lb9ksl4. All are The mobile farm is operated by invited to participate at members of the MUSC Dietetic Susan Johnson farm events; the schedule Internship who, as nutrition experts, can be found at www. deliver health and wellness messages musc.edu/urbanfarm. along the way. This month, they are discussing how to use culinary herbs, Wellness Events like the ones growing in the farm, to q Mindful Combo Contest — Purchase season without added salt, as well as a Mindful Combo Meal between Oct. 20 answering questions about the mission to Nov. 14 and you’ll be entered to win and programs at the Farm. your choice of a Clemson or Carolina So far, the mobile farm has reached Fan Kit. The kit features a choice of a over 75 people at stops in the Hollings Cancer Center outpatient waiting room, Clemson or South Carolina Cut Out lobby and Healing Garden; bus stops on and team counter cooler. Combo must include Coca-Cola Zero or other Coke Jonathan Lucas and at ART; the library products or a Dasani Water. Submit portico; Children’s Hospital lobby and your receipt into the entry box (includthe GI medicine waiting room on the

Health at work

Dietetic intern Elizabeth Hesley shows off the mobile farm cart. ing name and email). A winner will be chosen Nov. 17. q SC Working Well Annual Meeting — 10 a.m., Nov. 6 at Trident Technical College. An annual one-day meeting of statewide leaders in wellness and prevention.The group will discuss trends in employee wellness and community health. Keynote speaker and author of “On Purpose,” Victor Strecher, will discuss how to influence change in your community. Event cost is $25 and

includes lunch. Visit http://tinyurl.com/ nget7je. q Cooking Well Invitational — 8:30 a.m. to 3:30 p.m., Friday, Nov. 7 at Trident Technical College. Cheer on MUSC/ Sodexo chefs as they compete against statewide teams in a healthy culinary competition. Visit www.cookingwellsc. com. q November challenge is to Release the Tension! To begin, take the first November Monthly Mindful Challenge survey at http://tinurl.com/n62q9uq.

A link to the final survey will be sent at month’s end to those who take the first survey. q Flu Shot Satellite clinics will be held — 4 to 8 p.m., Nov. 9, 2West Classroom; Noon to 3 p.m., Nov. 10 at Parkshore; and Noon to 4 p.m., Nov. 13, Rutledge Tower, Room 280J. q Farmers Markets — Fresh fruits and vegetables are available from local farmers Friday from 7 a.m. to 3:30 p.m. at the Horseshoe.

For more information about wellness events, contact johnssa@musc.edu or whela@musc.edu.

THe CATAlysT, Nov. 7, 2014 11

Researcher links citalopram use during pregnancy to birth defects By mikie HAyes Public Relations

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MUSC’s James Cray, Ph.D., who specializes in head and facial birth defects research, has associated the use of citalopram during pregnancy with birth defects such as a reduction in the size of the skull and other facial deformities.

Over the course of the 1990s, a then–new class of antidepressant drugs, known as selective seratonin reuptake inhibitors (SSRIs), became household words, and since that time, both their popularity and potency have continued to increase, according to Cray, making many of them among the most prescribed drugs today.

SSRIs work by increasing levels of a brain chemical called serotonin, which is linked to mood, sleep regulation and emotions. Dubbed “happy pills,” names like Prozac, Zoloft, Paxil, Celexa, Effexor and Lexapro went from obscurity to the subject of everyday discussion at the office and at cocktail parties.

The National Center for Health Statistics, report that approximately 10 percent of Americans take an antidepressant. And by their calculations, these antidepressants are the third most common prescription medication taken by Americans.

In a recent report, the Centers for Disease Control Birth Defects Prevention study identified the use of SSRIs in pregnant mothers as increasing the odds of having a child with a birth defect, specifically craniofacial and cardiac malformations. The drug citalopram was cited as particularly concerning, since a significant number of reports linked birth defects in babies born to mothers who were on the drug while pregnant. From a public health perspective, these findings, as well as other known related side effects, were great cause for concern for Cray, an assistant professor in the Department of Oral Health Sciences.

Cray stated that women are 2 ½ times more likely to be taking an antidepressant than men, and further,

that SSRIs are currently the most commonly prescribed drugs for the treatment of depression and routinely prescribed during pregnancy.

It is known that SSRIs pass the placental barrier, meaning the fetus is not only exposed to the drug, but accumulations can be found in the fetus’s blood stream and tissues: Effectively, the baby is born already on an anti-depressant.

Cray and his team focused their work on the drug citalopram, as a result of the CDC study, which implicated citalopram as greatly increasing the odds of having a child with craniosynostosis, a condition characterized by the premature fusion of the sutures of the skull, with an estimated prevalence of 1 in 1,800 to 2,500 live births.

In the U.S., citalopram is marketed by Forest Laboratories as Celexa, which is in the same class as Prozac and Zoloft.

Celexa was approved by the Food and Drug Administration in 1998, and according to IMS Health, a global information and technology services company, Celexa was the third highest prescribed psychiatric drug in 2013 with nearly 39.5 million prescriptions having been dispensed. Zoloft, number two on the list, was the only anti-depressant ahead of Celexa.

While poorly understood, there is evidence to suggest that serotonin may play a significant role in early craniofacial development. SSRIs, which block the reuptake of serotonin, have been shown to impact overall craniofacial development. Serotonin has been detected during the earliest phases of fetal development, and it is important to the process of cell differentiation and normal bone development.

Preclinical studies report a reduction in cranial size in offspring after the administration of SSRIs to pregnant mice, and there are similar reports in humans. Given the frequency of SSRI use during pregnancy, Cray stated that more studies must be conducted. “It is imperative that any potential teratogenic

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12 THe CATAlysT, Nov. 7, 2014

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effects be investigated. There is now convincing evidence that at least some SSRIs are capable of disrupting the normal function and maintenance of the craniofacial development in the fetus, resulting in an elevated risk for specific birth defects.

However, Cray almost nothing is known about the mechanisms underlying this phenomenon.”

In his research, he and his team set out to determine what effects citalopram in particular would have on the developing craniofacial skeleton in mice. Cray’s team examined the effects of citalopram administration at two levels. First they conducted tests in vitro — a biological process which occurs in a controlled laboratory setting, using test tubes and petri dishes rather than within a living organism. To accomplish this, they used cells that are responsible for building

the skull as markers of bone formation, craniofacial development and serotonin synthesis. Subsequently, they conducted tests in vivo — studies that are conducted on living organisms such as animals or humans — after in utero administration of a clinical dose of citalopram.

The team hypothesized that in vitro exposure would result in altered expression of those biological factors related to both the serotonin and craniofacial growth pathways. They also predicted that they would see changes in craniofacial development in mice exposed to citalopram in utero, akin to those observed in humans.

Ultimately, some of the craniofacial changes observed corresponded to known craniofacial syndromes involving the genes that showed significant alterations in expression following the SSRI exposure. Excessive flattening of the midface, a depressed nasal bridge, major reduction in the prominence of the upper jaw, and inward bending of the nasal bones were evident. Other possible negative effects in the cranium and midface include altered regulation of the molecules known to be important for proper growth and cranial suture stability — the fibrous bands of tissue that connect the bones of the skull.

graphic provided

Craniofacial phenotype after in utero treatment with citalopram. A: Differences in shape variation between those exposed in utero to citalopram and those from untreated dam, at 15 days postnatal. B,D: Lateral and superior views of the shape variation associated with the untreated mice. C,E: Lateral and superior views exposed to citalopram. F–K: examples of anomalies found among the citalopram exposed mice. F: 3-D reconstruction of a citalopram exposed mouse with an ectopic suture dividing the parietal bone. G: Parietal defect from the same mouse. H: 3D reconstruction of one of two mice born with a single maxillary incisor. I: Absence of the left maxillary incisory root. J: Citalopram exposed mouse with a deviated snout. K: 45-degree frontal view of same animal shown in J. Cray said, “We observed as a pregnancy class C drug. Paxil, or morphological alterations similar to paroxetine, on the other hand, has those previously reported in human already been reclassified for pregnancy epidemiological and cohort studies, risk from a class C to a class D, such as altered cranial vault shape and indicating its potential risks to the decreased growth. There were also several developing fetus. This type of research craniofacial anomalies in the fetally aids in the proper classification of drugs. exposed mice, suggesting that clinical In addition, research is bearing use of citalopram during pregnancy has out that SSRIs have other harmful the potential to cause craniofacial birth drawbacks. Cray said, “The realization defects.” that SSRIs have more systemic effects Cray and his team appreciate the are now finally coming into focus. We implications of these findings which now have a population of long–term are being published in Birth Defects users. Data is beginning to suggest long– Research. “Our results,” he said, term SSRI use may exacerbate or even “provide confirmatory evidence that cause osteoporosis. There are also some citalopram exposure is associated with indications SSRI use may impair bone cellular and morphological alterations of healing particularly as it relates to dental the craniofacial complex, which may have implants. important implications for use during While there are clearly side effects pregnancy.” related to the use of citalopram in Cray hopes to be able to continue pregnancy, Cray is very clear that studying how SSRIs affect pregnancy. a pregnant patient diagnosed with He plans to look at other SSRI drugs, depression should not simply stop taking hone the pathways and mechanism, and her prescribed medication. He hopes in particular investigate the potential his studies will point to how best to of window of susceptibility. “The most prescribe medication during pregnancy clinical translative aspect of this research to reduce side effects. “Depression is a would be to identify a dose threshold or disorder with varied physiological effects. less safe time to be on these drugs during It is very difficult to ascertain from pregnancy. It is not likely a ubiquitous human population studies what might effect and may not affect every patient.” be an effect of depression, a drug to treat The FDA categorizes citalopram depression or a combinatory effect.”