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VOLUME 11, NUMBER 2

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Partners for Discovery

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Alumni Collaborate on NIH Study

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New Recruits

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From Ancient Egypt

Advanced Molecular Imaging Opens Window to Study Diseases C o n t i n u e d o n Pa g e 2 . . .

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Research Notes

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Man’s Best Friend

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THE TWO PET/CT HYBRID IMAGES, TAKEN SIX MONTHS APART, SHOW THAT A B-CELL STAGE IV LYMPHOMA PATIENT IS RESPONDING WELL TO CHEMOTHERAPY. THERE’S BEEN A SIGNIFICANT REDUCTION IN TUMOR CELLS IN THE SHOULDER AND PELVIS AREAS. THE SAME APPROACH MIGHT HAVE DIFFERENT RESULTS IN A DIFFERENT PATIENT, HIGHLIGHTING THE NEED TO MONITOR DISEASE ON AN INDIVIDUAL PATIENT BASIS. THE CENTER FOR MOLECULAR IMAGING IS WORKING WITH A NUMBER OF VCU SCIENTISTS AND PHYSICIANS TO ADVANCE OUR UNDERSTANDING OF DISEASE AND THE WORKINGS OF THERAPY. IMAGE COURTESY OF MELVIN FRATKIN, M.D., DEPARTMENT OF RADIOLOGY.

Dean’s Discovery Initiative School of Medicine Development Office VCU’s Medical College of Virginia Campus P.O. Box 980022 Richmond, VA 23298-0022 ADDRESS SERVICE REQUESTED

NONPROFIT ORGANIZATION U.S. POSTAGE PAID PERMIT NO. 869 RICHMOND VA


... CONTINUED FROM COVER

“In the era

of molecular medicine, each individual has what amounts to a unique disease,” said Jamal Zweit, Ph.D., D.Sc., professor of radiology and director of the Center for Molecular Imaging. “It comes with an individualized scenario for how it will progress, if it will be aggressive or if it will respond to therapy. In addition, each individual is different because their molecular and genetic make-up is at work within the specific environment in which they live.” The environment within the patient’s body, Zweit said, is key: it surrounds, influences and interacts with the diseased cells. And that interaction is the thing that excites Zweit when he talks about the potential of molecular imaging and nanotechnology to advance molecular medicine. “Currently, we study disease by taking it outside the body, with invasive biopsies for example,” Zweit said. “That carries inherent disadvantages: it doesn’t take into account the environment in which the disease sits. In the era of molecular medicine, we can use new technologies of molecular imaging and nanotechnology to study disease at the molecular and cellular level, in a live subject, in an intact environment.” Equally important, we can better understand how a therapy is working by measuring direct changes in the disease rather than relying on indirect blood tests. In doing so, Zweit said, there’s the potential to tailor treatment to what will work best for each patient. Along the way, we will build a more diverse knowledge of how a unique environment creates an individual disease, and begin to understand how cells move from a benign state to a diseased state. The VCU center and others like it are distinguished by what’s known as multi-modal molecular imaging. Molecular imaging is different from the conventional imaging many are familiar with, like X-rays or CT scans that simply show anatomical structures. Recent technological advances have created hybrid systems that deliver

{ SPECT/CT }

a single image revealing information on the biology and function underlying organ anatomy. In this regard, the advent of PET/CT and PET/ MRI are rapidly contributing to treatment decisions and patient care.

NANOTECHNOLOGY makes those molecular imaging advances possible. Scientists produce various nanoparticles, compounds such as quantum dots. The tiny cocktails are packed with a tracer to home in on a targeted tumor, an imaging agent that flags the tumor’s location for the scanner and, on occasion, a therapeutic medicine. Researchers have even coined a term for this mixing of modalities, theranostic: part therapy, part diagnostic, entirely futuristic. A good example of this approach is a study currently underway at the center. Taxol is commonly used in breast and other cancer treatments, but can become useless. Used alone, the drug is vulnerable to tumor resistance. In addition, because current therapy can not target the tumor directly, it ends up damaging healthy normal tissues but not saturating cancer tissues as effectively as needed. Researchers think they may be able to improve the overall efficacy of Taxol by creating a nanoparticle that packages the drug along with a tumor-specific compound. The packaging shields healthy tissue while the attached compound speficially seeks out the tumor, avoiding toxic effects on normal tissues and delivering a higher dose to the tumor. By incorporating imaging agents into the package,

{ OPTICAL }

VCU’S OFFICE OF TECHNOLOGY TRANSFER ASSISTS SCIENTISTS IN PROTECTING DISCOVERIES THAT HAVE COMMERCIAL POTENTIAL. FOR EXAMPLE, A PATENT APPLICATION HAS BEEN FILED ON AN APPROACH THAT COMBINES SPECT, CT AND FLUORESCENCE IMAGING METHODS IN ONE NANOPARTICLE PLATFORM. THESE UNIQUE PROBES ARE CURRENTLY BEING INVESTIGATED IN APPLICATIONS SUCH AS IMAGE-GUIDED THERAPY AND IMAGE-GUIDED SURGERY. UNDER A BLACK LIGHT, A SURGEON IN THE OPERATING ROOM WOULD BE ABLE TO EASILY VISUALIZE THE BORDERS OF THE TUMOR.

JAMAL ZWEIT, PH.D., D.SC., LEADS THE CENTER FOR MOLECULAR IMAGING.

the strategy’s ultimate success or failure can be tracked over time, with molecular imaging providing a window for watching the tumor cells’ response. The Center houses a diverse range of scientists, in radio-chemistry, nanotechnology, biology and imaging. Together they bring expertise to translate basic science discoveries to clinical trials and ultimately improved patient care. As a result, the center is growing into a hub for collaboration, with the potential to impact cancer, the neurosciences, cardiology and all sorts of diseases that are plagued by inflammation. “We were fortunate to recruit Jamal Zweit, one of the world’s leading imaging scientists and radio-chemists,” said Dean of Medicine Jerry F. Strauss, III, M.D., Ph.D. “He’s assembled scientists and resources that will allow us to look at biology in a way that no one else can. This type of innovation is the backbone of our research infrastructure.” Learn more at: http://www.molecularimaging.vcu.edu/

{ MICRO-CT } IMAGING LIVE ANIMALS YIELDS VALUABLE DATA IN IDENTIFYING DEVELOPMENTAL ABNORMALITIES ASSOCIATED WITH GENETIC DEFECTS. WHILE DIFFERENCES IN OVERALL SIZE ARE IMMEDIATELY VISIBLE IN TWO MICE PUPS FROM THE SAME LITTER, IT IS ONLY VIA MICRO-CT IMAGES THAT DIFFERENCES IN BONE DENSITY ARE EVIDENT. THE LESS DENSE BONES OF THE GENETICALLY MODIFIED MOUSE ON THE BOTTOM ARE VISIBLE AS DARK BROWN AREAS ON THE SCAN IN COMPARISON TO THE NORMAL MOUSE ON THE TOP. IMAGE COURTESY OF: JERRY F. STRAUSS, M.D., PH.D., DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

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PARTNERS FOR by Nan Johnson

Gift Puts Research in the Fast Lane

discovery

Privately funded endowments support faculty, new discoveries

Bruce Rubin, M.D., would like nothing more than to be out of a job. NASCAR driver Denny Hamlin is giving him a hand.

Professor and chair of the Department of Pediatrics and physician-in-chief of Children’s Hospital of Richmond at VCU, Rubin has been caring for children and adults with cystic fibrosis (CF) for 32 years. He is also a noted CF researcher and biomedical engineer. “I’m working to get out of the cystic fibrosis business,” he said. In Hamlin, he’s found an unlikely partner to help put an end to CF through a $150,000 donation to help fund his research.

annually to support CF research in Rubin’s lab through the establishment of the Denny Hamlin Foundation Summer Scholars Program and to support clinical trials in CF research at the Children’s Hospital of Richmond at VCU. Private gifts, such as this generous donation, provide much-needed flexibility for labs like Rubin’s. “New ideas come from collaborations, pilot studies and information sharing,” he said. “The funding that comes from these types of gifts is the most precious thing to a researcher. It opens up opportunities for us that wouldn’t be available otherwise. It’s huge beyond measure.” Maybe one day, Rubin will be out of his job. With Denny Hamlin’s help.

Hamlin, who grew up in Chesterfield, Va., made the donation through the Denny Hamlin Foundation, which he created to help raise awareness and funds for CF research and treatment. Hamlin’s cousin has the disease. Affecting approximately 30,000 children and adults in the United States, CF causes chronic lung infections and inadequate digestion of nutrients. In a significant discovery, Rubin’s research showed that excess pus fills the lungs of CF patients, not excess mucus as was originally thought. In contrast, Rubin’s lab showed, mucus helps protect the lungs. The discovery led the team to identify promising new opportunities for treatment. “Our focus has been on helping people clear the pus that builds in the lungs and airways,” Rubin explained. “As an engineer, I’ve been interested in how oil moves – I’m now studying how mucus moves. CF is an engineering problem. We’re working to regulate the inflammation and infection in the lungs.” Each year for the next three years, the Denny Hamlin Foundation will give $50,000

student Fries’ Legacy ForAubreedoctoral Shay, balancing Continues to Inspire family and career is an important part of life. A work-life balance was also important to Elizabeth Fries, Ph.D., a psychology professor at VCU who was also director of research for the university’s Women’s Health Center of Excellence and co-director of cancer control research for the Massey Cancer Center. Though Fries died in 2005 of complications following breast cancer treatment, she continues to inspire and assist students through a scholarship established in her honor. Shay is the 2012 recipient of the Elizabeth Fries Memorial Scholarship and a doctoral student in the Department of Social and Behavioral Health. She shares similar interests with the much-admired professor and researcher who worked to reduce cancer-causing behaviors among those who were at risk for cancer. “Dr. Fries focused on prevention and cancer control studies from a psycho-social point of view. She was really interested in mentoring new researchers and cared for her family at the same time,” Shay said. “I hope that my career will mirror hers in that way.”

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A member of the department’s first class of Ph.D. students, Shay’s research interests focus on decision making and doctor-patient communication across the cancer control continuum, ranging from prevention to end-of-life care. “It’s overwhelming to have cancer,” she said. “There are thousands of decisions to be made, especially during the end of life stage. We can help doctors help their patients be informed and engaged throughout the process. One way to help improve the quality of care is to improve decision making.” In her doctoral program, Shay explained, she’s had the opportunity to learn more about cancer prevention and about helping people change their behavior, two areas that were important to Fries in her own work. “I’m very excited and honored to have received the Fries scholarship award. I wish I could have met Dr. Fries to thank her for her example and her service. I hope to follow in her footsteps, pursuing excellence both in my research and family life.”


by Kristen Coulter

n o e t a r o b a ll o C i Alumn es k a M t a h T y d u t S NIH s e n li d a e H l a n io t a N First-time mothers, today, take 2.6 hours longer to deliver babies than mothers in the 1960s, according to a study whose authors include two School of Medicine alumni. The researchers suggest that, because guidelines for normal labor were defined 50 years ago, this discrepancy may lead to unneeded cesarean sections. Their study findings appear in the April issue of the American Journal of Obstetrics and Gynecology. “We may need to revisit the definition of abnormal and normal labor. As long as the mother and baby are ok, we may not need to intervene as quickly,” said S. Katherine Laughon, M.D., a member of the Class of 2000 and the study’s lead author. Laughon is an Investigator at the Eunice Kennedy Shriver National Institute of Child Health & Human Development, NIH, which sponsored the study. She collaborated on the research with the Class of 1979’s D. Ware Branch, M.D. Though average mothers today are older and have a higher body mass index, physical differences did not fully account for longer labor, Laughon said. And while there have been changes in practice that contribute to longer labor times such as the use of epidural anesthesia, those do not explain all of the differences

either. While the study did not explore other factors associated with longer labor times, researchers hypothesize mothers’ inactivity after arriving at the hospital may contribute. Regardless of the reasons, in current practice doctors sometimes intervene when labor fails to progress by starting oxytocin, a medication to speed up labor, or performing a cesarean delivery. The new findings on labor progressing slower indicate those practices may need to be re-evaluated. Branch hopes the findings motivate the medical community to consider how to alter labor processes to maximize efficiency while providing safe outcomes. A professor of obstetrics and gynecology at the University of Utah, Branch led a team at Intermountain Healthcare in Salt Lake City in a study of labor and labor outcomes within the Intermountain system. Branch and his colleagues have estimated keeping the national cesarean rate as low as 21 percent, the rate of the Intermountain Healthcare system, could save the U.S. $3.5 billion annually. C-sections currently account for 32 percent of births nationally.

S. Katherine Laughon, M.D. C L ASS O F 20 0 0

Laughon and Branch were initially surprised to learn about their shared connection to the School of Medicine after the study was published. “I loved my experience at MCV,” Laughon said. “It doesn’t surprise me that Ware is also a graduate. It’s that warm feeling that once again MCV is such a great school.”

D. Ware Branch, M.D. C L ASS O F 1 979

Egidio G. Del Fabbro, M.D. Associate Professor of Internal Medicine LAST POST:

MD Anderson Cancer Center

Egidio Del Fabbro first became interested in palliative care as a practicing internist, when he recognized certain deficiencies in his training. “I wanted to become more accomplished at treating pain symptoms,” he said. He felt managing patients’ symptoms in a supportive way was crucial to caring for them. So Del Fabbro, who earned his medical degree in South Africa and did residencies in the UK and the U.S., headed to MD Anderson Cancer Center in Houston for a palliative care fellowship. “Six months into the fellowship, I realized there was a real gap in knowledge with regard to palliative care,” he said. “There was an opportunity to do pioneering work.” He stayed on as faculty, helping to direct the palliative care program and co-founding a clinic for patients with cachexia, also known as wasting syndrome. His research studies have included testosterone replacement for fatigue and melatonin treatment for patients whose lack of appetite results in weight and muscle loss.

by Jill U. Adams

Del Fabbro became program director of palliative care at the Massey Cancer Center last May. Initially drawn to the MCV Campus for its comprehensive palliative care center, he’s since been impressed by the knowledge and integration of palliative care both in and outside of oncology. Del Fabbro says that’s a great setting in which to do meaningful research.

Adam Rosenblatt, M.D. Professor of Psychiatry LAST POST:

Johns Hopkins University

At Johns Hopkins University, Adam Rosenblatt customized his practice and research in psychiatry to focus on patients with major neuropsychiatric disorders. On the MCV Campus, he’ll direct the VCU Medical Center’s Geriatric Psychiatry Program and co-direct the Huntington Disease Program at the VCU Parkinson’s and Movement Disorders Center. Rosenblatt loves to teach and will also focus on developing a geriatric neuropsychiatry fellowship in collaboration with the McGuire VA Medical Center. Of his unusual mix of disciplines, Rosenblatt said, “Many people don’t have enough experience working with geriatric populations, for example, as an on-call psychiatrist at a nursing home.” These patients may have medical issues such as multiple diagnoses and greater sensitivity to medications and their side effects. In addition, they may not have a strong support network or have trouble communicating. On the Huntingdon’s disease front, Rosenblatt is interested in its long-course treatment as a neurological disease that also has a psychiatric component. “It’s a fairly uncommon disease, but it’s devastating and fatal,” he said. “And it strikes in the prime of life.” He says while the genetics of the disease are straightforward, the treatment of affected patients has plenty of room for improvement. He’ll team up with neurologist Claudia Testa, M.D., Ph.D., to focus on Huntingdon disease, offer a regional center for patient care and begin clinical studies.

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THE UNIVERSITY OF RICHMOND’S RESIDENT MUMMY, TI-AMENY-NET, ON THE CT TABLE. IN JUST SECONDS, THE STATEOF-THE-ART SCANNER ACQUIRED 25,000 IMAGES.

Modern Day Revelations from Ancient Egypt “as recently as the 1970s, scientists performed mummy autopsies that entailed not only unwrapping the mummies but cutting through their bones and tissues,” said Ann Fulcher, M.D., chairman and professor of the Department of Radiology.

But with modern-day CT scanners and software, Fulcher had the chance to study – rather than destroy – a 3,000-year-old mummy known as Ti-Ameny-Net housed at nearby University of Richmond. “These images let us electronically unwrap the mummy’s linen to reveal her skeleton.” The 64-detector, all-purpose scanner is usually used to answer a specific clinical question. For human patients, focused exams keep the radiation dose to a minimum as doctors seek information for diagnosis or treatment. But in the case of Ti-Ameny, a full-body scan delivered 25,000 images. Fulcher was surprised at the “exquisite” level of detail captured and attributes it to the unusual effort taken to preserve the body. “I could identify all the muscle groups because all her muscles were perfectly intact.” She determined Ti-Ameny was probably about 30 years of age when she died, and while there were signs of scoliosis of the spine, there was no evidence of trauma or of metabolic bone disease. The CT scan confirmed what is known about Egyptian mummification practices. The bones at the base of the skull and the back of the nose had been broken, providing a route to access and remove the brain. Abdominal organs were also removed before preservation but, Fulcher pointed out, the heart was left in place. “They saw it as the seat of the soul.” And that’s where Fulcher found her most telling finding: signs of atherosclerosis. The resulting heavy calcifications in the vessels of Ti-Ameny’s heart are one likely cause of death. Her diagnosis was independently supported by DNA analysis. A bone marrow biopsy showed no indication of common and deadly infections like malaria or tuberculosis, but there was a clear correlation for hereditary coronary artery disease.

On Display:

CT IMAGES OF THE HEAD CREATED A 3D ROTATIONAL IMAGE THAT FORENSIC ARTIST JOSHUA HARKER USED TO RENDER AN ILLUSTRATION OF HOW TI-AMENY MAY HAVE LOOKED IN LIFE.

University of Richmond student Caroline Cobert invited Fulcher to

participate in the research project. Colbert is now continuing her work with mummies at a

graduate program in England. The exhibition she created with Fulcher remains on display through Nov. 16, 2012, at the University of Richmond. For information on the exhibition and on Fulcher’s findings, go to http://go.vcu.edu/ddrMummy.

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by Jill U. Adams

NEJM EDITORIAL ON SEPSIS FAILURES In a May 31 editorial published in The New England Journal of Medicine, two medical school physicians take a long, critical look at the body of research seeking an effective treatment for severe septic shock. Richard P. Wenzel, M.D., professor and former chairman of WENZEL EDMOND the Department of Internal Medicine, and Michael B. Edmond, M.D., M.P.H., chair of the Division of Infectious Diseases, highlight the fact that some 20 drugs — adjuvants designed to bolster to antibiotic treatment of infection — have failed in trials of sepsis in the last two decades. Severe septic shock is a devastating sudden illness, easily missed until it’s too late, and can lead to major organs shutting down and death. If sepsis is recognized early, appropriate antibiotic treatment has a better chance to prevent this tragic spiral. Many different treatment strategies have been tested over the years to interrupt the trajectory of severe septic shock in its later stages. The latest of these — drotrecogin alfa — looked promising in an early study, but later failed to protect against death in a larger study. Wenzel and Edmond critique study methodologies and the lingering appeal of certain biologic hypotheses — such as the role of Human Activated Protein C — in the face of hard data and re-emphasize early recognition in septic shock. AUTOINJECTOR PEN FOR ANTISEIZURE MEDS One problem in treating prolonged seizures is the difficulty of starting an IV in a seizing patient. Joseph P. Ornato, M.D., chair of the Department of Emergency Medicine, looked at the problem as part of a nationwide, multicenter study of an Epi-Pen-like autoinjector to deliver anticonvulsant medications more easily. The VCU Medical Center is one of 17 Neurological Emergencies Treatment Trials sites in a consortium examining potential new therapies for the most common and devastating neurological emergencies. Researchers evaluated whether intramuscular administration of an anticonvulsant drug was safe and effective and how it compared to the standard intravenous administration. The study was performed in the field by paramedics and compared how well delivery by each method stopped patients’ seizures by the time the ambulance arrived at the emergency department. The results proved that the autoinjector mode of delivery stopped more seizures and resulted in fewer patients needing to be admitted to the hospital compared to the standard IV route of injection. “This study has the strong potential to change the standard of care nationally with respect to how we treat seizure patients,” Ornato said. The results of the Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART) was published in the Feb. 16 issue of The New England Journal of Medicine. GRANT TO STUDY PREMATURE BIRTHS Research on the problem of premature births, and in particular the disparity in incidence in minority populations, was awarded a five-year, $6.2 million grant from the National Institute of Health’s Institute on Minority Health Disparities. Jerome F. Strauss, III, M.D., Ph.D., dean of the School of Medicine and professor of obstetrics and gynecology, serves as the principal investigator. The funding is a renewal for the VCU Center on Health Disparities and supports research, training and community outreach. The high rate of premature births in the United States remains a public health concern. Preterm or premature birth is the leading cause of neonatal mortality and morbidity in African Americans. The causes and mechanisms explaining preterm birth — and especially the disparity in African Americans — are poorly understood.

The medical school’s approach is an interdisciplinary one, including social and behavioral scientists, epidemiologists, clinical investigators, basic scientists, educators and community representatives. Researchers will continue their investigations of genetic and environmental factors and at the same time conduct community-based participatory research. MOLECULAR SWITCH FOR PREECLAMPSIA Prenatal care for pregnant women includes monitoring for preeclampsia, a potentially serious condition that can lead to the formation of blood clots and organ failure. Researchers have discovered a molecular switch that contributes to preeclampsia and may pave the way for new treatments. In a study published in the June issue of Hypertension, Scott W. Walsh, Ph.D., professor of obstetrics and gynecology, reported that thromboxane synthase – an important inflammatory enzyme that’s also implicated in cardiovascular disease and stroke – is increased in the blood vessels of expectant mothers with preeclampsia. “The work opens up a new concept as to the cause and subsequent consequences of preeclampsia,” Walsh said, explaining that epigenetic changes — nonheredity changes to genes — are at play. “It is the first study to show that epigenetic alterations in the blood vessels of the mother are related to preeclampsia.” This work was supported by grants from the National Heart, Lung and Blood Institute and the National Center on Minority Health and Health Disparities. CIRCADIAN RHYTHM GENE TIED TO NEURODEVELOPMENTAL DISORDER A new study has elucidated the mechanism by which a circadian rhythm gene’s dysfunction gives rise to a sleep disorder. The gene is RAI1 and the disorder is Smith Magenis Syndrome. “One of the hallmarks of SmithMagenis Syndrome is severe sleep disturbance, and through our current work, we have found that alteration of the expression or function of RAI1 disrupts the expression of other molecular clock genes, dysregulating circadian rhythm,” said Sarah H. Elsea, Ph.D., associate professor in the Departments of Pediatrics and Human and Molecular Genetics. Circadian rhythms are physical, mental and behavioral changes that follow a roughly 24-hour cycle and are regulated by light and darkness in the environment. Genetics play a role too, particularly a gene named CLOCK. Earlier studies linked RAI1 to Smith Magenis Syndrome, but Elsea’s findings are the first to identify RAI1 as a key regulator of CLOCK. The findings also highlight the importance of circadian biology in neurodevelopment and behavior. “The data reported in this study lay the foundation to support SmithMagenis Syndrome as a primary circadian rhythm disorder,” Elsea said. “Better understanding of the function of RAI1 leads to better understanding of the molecular underpinnings of the syndrome, which can then lead to appropriate, targeted therapy.” The results of the current study were published in the June issue of The American Journal of Human Genetics. SCREENING FOR LIVER CONDITION SAVES MONEY Detecting and treating a late-stage liver condition called minimal hepatic encephalopathy (MHE) may reduce societal costs — including preventing car accidents — by more than $3 million over five years, according to a new study. MHE can occur in patients with chronic liver disease or cirrhosis. Toxic substances that are normally removed by the liver build up in the body and can lead to cognitive impairment and loss of consciousness. The condition, if detected, is reversible. In the study, published in the April issue of Hepatology, the team conducted a cost-effectiveness analysis to determine whether it would save money in the long run to test and treat cirrhosis patients for MHE. The control group received no testing or treatment, which is the current standard of care. The team used motor vehicle accidents as a benchmark complication of MHE

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and investigated whether different methods of diagnosing and/or treating MHE saved costs from a societal perspective. “This is the first time that cost-analysis in cirrhosis and MHE has taken into account the needs and finances of the society,” said lead investigator Jasmohan Bajaj, M.D., associate professor of hepatology at the School of Medicine and the Hunter Holmes McGuire Veterans Affairs Medical Center. NEURONAL CHANGES IN MILD HEAD INJURIES Even mild head injuries can cause significant abnormalities in brain function that last for several days, which may explain the neurological symptoms experienced by some individuals who have experienced a head injury associated with sports, accidents or combat. JACOBS

POVLISHOCK

Led by Kimberle M. Jacobs, Ph.D., associate professor of anatomy and neurobiology, researchers demonstrated for the first time that mild injury can cause subtle structural or functional disruption of the brain’s neurons — specifically their long projections known as axons — changing the way neurons fire. The team used models of mild traumatic brain injury to examine neurons in live cortical slices, using sophisticated bioimaging and electrophysiological techniques. The study, published in the May issue of the Journal of Neuroscience, should help move the field forward by providing a unique and useful approach to assess effects of mild brain injury, says co-investigator, John T. Povlishock, Ph.D., professor and chair of the Department of Anatomy and Neurobiology and director of the Commonwealth Center for the Study of Brain Injury. The novel method also can be used to assess the benefits of potential therapies or the damage from repeated injury such as that seen in the sports setting. A GENETIC MAP OF THE BRAIN Functional units of the brain have long been defined by overall structure — lobes for instance — or by neuronal pathways, such as vision pathways. An important new approach uses genetics to classify different regions of the brain. “This new map shows that there are 12 regions in each half of the brain,” said Michael Neale, Ph.D., a professor of psychiatry and human genetics who developed software to model the data. “Across the two halves, the corresponding regions are highly genetically correlated, so there is a good deal of left-right hemisphere symmetry in cortical areas.” For nearly three decades, Neale, an internationally-known expert in statistical methodology, has developed and applied statistical models in genetic studies. For this project, he wrote a software script to maximize the speed with which the very large number of genetic models could be fitted to the data. The project was led by researchers at the University of California, San Diego, and included scientists from VCU, Boston University, Harvard Medical School and Massachusetts General Hospital. The study, published in the March 30 issue of the journal Science, presented a genetic map of the brain that may allow researchers to better identify relationships between brain regions and abilities. DEEP BRAIN STIMULATION FOR DEPRESSION Deep brain stimulation has the potential to help patients with depression and movement disorders. Clinical trials are underway on the MCV Campus on a new medical device that delivers focused stimulation to an area of the brain linked to depression. PANDURANGI

HOLLOWAY

Ananda Pandurangi, M.D., professor and vice chair of psychiatry, and Kathryn Holloway, M.D., professor of neurosurgery, are leading the work at VCU, one of 20 study sites across the U.S. Two of their patients were the first to undergo implantation of the deep brain stimulator for the treatment of depression earlier this year. Denoted the BROADEN™ study, this is the

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first randomized clinical research study to investigate the use of deep brain stimulation in the cingulate cortex as an intervention for people with major depression. “A technology such as this has the potential to deeply impact the lives of patients with severe depression and their families,” Pandurangi said. VCU was chosen to participate in this clinical trial because of a pair of strengths: Pandurangi’s expertise in treating patients with resistant depression and Holloway’s surgical expertise implanting deep brain stimulators for the treatment of Parkinson’s Disease and other conditions. IMPROVING FIRST RESPONSE TRAUMA TREATMENT Is plasma better than saline as an early, rapid response to traumatic injury? Bruce Spiess, M.D., professor of anesthesiology, will address this question with the help of a $5.6 million grant from the U.S. Army Medical Research and Material Command, Combat Casualty Care Research Program. In severe trauma, the blood’s normal clotting ability can be impaired, leading to more bleeding. Saline, the conventional fluid of choice, actually makes the clotting problem worse. Plasma, however, contains all the proteins involved in blood coagulation, and is often given to trauma victims once they reach the hospital. Spiess’ work seeks to determine the viability and health outcomes of delivering plasma sooner, at the scene of the trauma whether a traffic accident or a battlefield. “This will be a multidisciplinary team including clinical researchers, pharmacists, engineers, mathematicians and others. Few institutions in the country have the expertise across the spectrum found at VCU,” Spiess said. “We’re also involving the community in this research and will be collaborating with blood bank staff as well as fire and rescue paramedics in the Richmond region.” The research will be done at the VCU Reanimation Engineering Science Center (VCURES), which seeks to improve survival and quality of life in critically ill patients and victims of traumatic injury.

CUTTING COSTS OF UNINSURED CARE The cost of caring for the uninsured population can be reduced by almost half if continuous coverage is provided, according to a new study from MCV Campus researchers. Previous work has shown that uninsured people make inappropriate use of health care services, such as BRADLEY GARLAND relying on emergency departments. The new finding bodes well for the Affordable Care Act. In the study, published in the February issue of the journal Health Affairs, researchers led by Cathy J. Bradley, Ph.D., chair of the Department of Healthcare Policy and Research, examined how uninsured low-income adults used the health care system once enrolled in a program to manage the care for an uninsured population — the Virginia Coordinated Care for the Uninsured (VCC), which is a collaboration between the VCU Medical Center and community-based primary care providers that utilizes managed care principles. The team observed that for people continuously enrolled in the program, emergency department visits and inpatient admissions declined, while primary care visits increased during the seven-year study period. Further, total costs fell each year for this group. During a three-year enrollment period, average total costs per year per enrollee fell from nearly $8,900 to just over $4,500 – a savings of almost 50 percent. “What we found is that the longer that a person was enrolled in the VCC program, the more their behavior changed, and the more they became engaged with their primary care provider,” said co-author of the study Sheryl Garland, vice president of health policy and community relations for the VCU Health System.


{

Worldwide Media Coverage Draws Attention

Sandra Barker, Ph.D., psychiatry professor and the Bill Balaban Chair in Human-Animal Interaction, has been thrilled to see her team’s findings on the benefits of dogs in the workplace appear in leading media outlets across the U.S. and the world in countries including Hungary, Australia and Japan. “We were totally amazed by the attention it has received,” said Barker, the director of the Center for Human-Animal Interaction, an interdisciplinary research center based in the School of Medicine. “We thought locally we might get a few interested media contacts, but Time magazine was the first interview Randy did. It snowballed from there.” She is referring to Randolph Barker, Ph.D., her husband and fellow researcher. Their academic interests have led to opportunities for collaboration including the recent study that showed the benefits of bringing pets to the workplace. The Barkers have tried to accommodate as many interview requests as possible, with Randy Barker, a management professor in the VCU School of Business, handling the majority. VCU’s media office has identified more than 500 stories mentioning the research. Barker said it is rewarding to talk about her unique team and to share research that resonates with people. “It increases awareness of the unique type of research we’re doing here, attracts collaborators and may generate donations, since we receive no direct funding from the university or hospital and operate totally on donations.”

b y K R I S T E N C O U LT E R

Research documenting the benefits of dogs in the workplace draws international news coverage. Two MCV Campus faculty members’ lasting friendship began at a Boston dog park. Read more online: http://go.vcu.edu/ddrDogs

PSYCHIATRY PROFESSOR SANDRA BARKER, PH.D., WITH HER HUSBAND AND RESEARCH PARTNER RANDOLPH BARKER, PH.D., WHO IS A PROFESSOR IN THE BUSINESS SCHOOL. THEIR INTERDISCIPLINARY COLLABORATION PROVIDES A BETTER UNDERSTANDING OF HUMAN AND ANIMAL INTERACTION.

}

Dogs Open Door to Lasting Friendship

In the early 1990s, Claudia Testa, M.D., Ph.D., watched her boyfriend’s golden retriever, Tristan, become fast friends with Kodiak, a chocolate lab. Soon after, she met the lab’s owner, a fellow physician-scientist named Steven Grossman, M.D., Ph.D. The two found common ground in their shared M.D.-Ph.D. experience. At the time, Testa was completing her Ph.D. research in the neuroscience labs at Massachusetts General Hospital, and Grossman was an internal medicine intern at Brigham & Women’s Hospital. The dogs’ friendship pushed their busy owners to get outside and relax. “My main memories are of our lives entirely revolving around these dogs even as we all were engaged in various aspects of medical and scientific training,” Grossman said. He recalled trips to take the dogs to the beach and hours spent playing fetch, swimming and sledding. But the owners had work to do. Since they were putting in long hours at the clinic and lab, they eventually set up doggie day care, alternating between Tristan and Kodiak’s apartments. Testa still pictures AND them, “gazing out the windows as their KODIAK’STRISTAN FRIENDSHIP owners headed out to lab.” LURED THEIR BUSY OWNERS FROM THE The researchers stayed in touch LAB TO EXPLORE THE as Testa moved to Atlanta and the GREAT OUTDOORS. CLAUDIA TESTA, M.D., Grossman family headed to the Boston PH.D., AND STEVEN suburbs. Over the years, communication GROSSMAN, M.D. PH.D., RENEWED became sporadic, until earlier this THEIR FRIENDSHIP 20 year when they were surprised to be YEARS LATER WHEN THEY REUNITED ON reunited on the MCV Campus. Grossman THE MCV CAMPUS. was recruited to the Dianne Nunnally Hoppes Endowed Chair in Cancer Research to lead the Division of Hematology, Oncology and Palliative Care in July 2011. Testa was named Joan Massey Chair in the VCU Parkinson’s and Movement Disorders Center two months later. The two researchers again live near one another but, a reprise of doggie daycare looks unlikely. Everfaithful to the Labrador breed, the Grossman family has a new black lab. Testa, however, currently describes herself as pet-deprived.

DEAN’S DISCOVERY REPORT | Volume 11, Number 2 The Dean’s Discovery Report is published twice a year by Virginia Commonwealth University’s School of Medicine on the Medical College of Virginia Campus. Reader comments and suggestions are welcome; please call (800) 332-8813 or (804) 828-4800, e-mail MedAlum@vcu. edu or write to P.O. Box 980022, Richmond, VA 23298-0022. The Dean’s Discovery Initiative provides an opportunity for donors to transform the research environment in the School of Medicine. Through philanthropy, alumni and friends can support the school’s research endeavor in ways that traditional funding sources do not. Dean: Jerome F. Strauss III, M.D., Ph.D. Produced by the School of Medicine’s Alumni and Development Office: Associate Dean for Development, Tom Holland; Editor, Erin Lucero. Contributing Writer: Jill U. Adams, Kristen Coulter, Nan Johnson Photographers: Allen Jones, Tom Kojcsich, Jay Paul, Kevin Schindler and VCU Creative Services Graphic Design: Zeigler|Dacus © Virginia Commonwealth University, 2012.

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Dean's Discovery Report Fall 2012  
Dean's Discovery Report Fall 2012  

Research newsletter of the School of Medicine on VCU's MCV Campus