BU Today Robert Stern, PhD, neurology, neurosurgery, CTE Center Julie Stamm, PhD candidate As the...
By Lisa Brown
As if the fourth year of medical school is not busy enough, Brian Honeyman, (MED’15) chose to spend October interning at the editorial office of the New England Journal of Medicine (NEJM).
This four-week elective, offered by NEJM for medical students from Massachusetts medical schools, exposed Honeyman to the world of medical publishing and allowed him to learn how editorial decisions are made. Honeyman wanted to get a sense of how novel and innovative medical findings are reviewed and disseminated to the medical community.
During his internship Honeyman supported individual NEJM editors, worked on a number of pieces including a letter to the editor, summaries and critiques of potential articles, and a decision letter. He also prepared a piece for NEJM’s online blog “Vaccination and Pneumococcal Disease in South Africa,” which reviewed the importance of vaccination in US communities through the lens of pneumococcal vaccination in South Africa.
Submitted by Adil Yunis, MD
A new study has found it is possible to distinguish between different hemorrhagic fevers, including Marburg (Ebola cousin) and Lassa before the person becomes symptomatic.
The study, which appears in the journal BMC Genomics, will allow for the development of better diagnostics, especially during the early stages of disease, when treatments have a greater chance of being effective.
Hemorrhagic fevers include Lassa, which is endemic in Western Africa and Marburg, which causes sporadic outbreaks in Africa associated with high rates of mortality. The early symptoms of these viruses (fever, flu-like symptoms) are not unique, making it difficult to diagnose properly. More disease-specific symptoms and the ability to spread the virus from person to person, do not begin until virus has accumulated in the blood. Current diagnostics detect the virus after it spills out of primary sites of infection into the blood. The ability to identify the infection prior to this point would significantly aid early intervention and containment, and could improve outcomes.
Researchers from Boston University School of Medicine (BUSM) approached the diagnostic dilemma by trying to “see” infection prior to the point where viruses enter the blood stream. Collaborating with researchers at the U.S. Army Medical research Institute (USAMRIID), they used two experimental models: one that had involved Lassa virus, and one that involved Marburg virus infection. The researchers extracted genetic material (RNA) from a sample of white blood cells from each infection group at multiple times after the models were infected. Using next-generation sequencing techniques, gene expression changes in hosts cells that “recognize” early stages of infection were identified. This was seen prior to clinical symptom onset and before the models became infectious.
According to the researchers, distinguishing between these viruses early can guide treatment and containment efforts. “The ability to distinguish between different types of infection before the appearance of overt clinical symptoms has important implications for guiding triage and containment during epidemics,” explained corresponding author Nacho Caballero, a PhD candidate in the Bioinformatics Program at Boston University. “We hope that our study will help in the development of better diagnostics, especially during the early stages of disease, when treatments have a greater chance of being effective,” he added.
As exciting as the prospect of this testing is, the research team is setting a realistic time line. “We want to stress that this is not a finding that can be translated into a test tomorrow. This study supports the idea that early markers of infection are there, but significant work will still need to be done to extend these findings,” said Caballero.
This work was supported by the United States Army contracts W81XWH 100-02-0008 and 11-02-0130. NC was supported in part by the Fulbright Commission Spain and the Regional Government of Andalusia.
This year marks the 26th Evans annual research celebration, which was established in 1985 to acknowledge and foster the research activities of the Evans Department of Medicine. This two-day event features distinguished clinical and basic science lectures (Ingelfinger Visiting Professor and Wilkins Visiting Professor respectively), and poster and oral presentations of ongoing research. Faculty, students and staff are invited to attend these events.
Thursday, Oct. 16
Research Poster Session, 9 a.m.- noon, Hiebert Lounge
Wilkins Visiting Professor Lecture, 3:30 p.m., Keefer Auditorium
“Genetic Determinants of Idiopathic Pulmonary Fibrosis”
David A. Schwartz, MD
Professor of Medicine and Immunology, Robert W. Schrier Chair of Medicine
University of Colorado
Friday, Oct. 17
Ingelfinger Visiting Professor – Grand Rounds, noon, Keefer Auditorium
“Joy in Practice: Innovations in Ambulatory Care”
Christine Sinsky, MD, FACP
Medical Associates Clinic and Health Plans
The Kripalu Institute for Extraordinary Living (IEL) of the Kripalu Center for Yoga & Health in Stockbridge, Mass., selected Jennifer Johnston, PhD, clinical psychologist and Kripalu Yoga instructor, as the first recipient of the Samuel B. Hanser Visionary Award for her research on the effects of yoga on people with epilepsy, a stress-aggravated disease. Dr. Johnston will be conducting her research under the guidance of Chris Streeter, MD, associate professor of Psychiatry and Neurology at BUSM.
The Hanser Award is the first endowed annual research award, bestowed by IEL. It is designed to foster yoga research and further the goal of making yoga a more accessible and accepted modality for health and well-being across all facets of society. An inaugural award of $10,000 was presented in September at the Symposium on Yoga Research, the leading academic conference on yoga.
“I feel honored to have been conferred the Hanser Award, and am very excited about the work we will be doing in Samuel Hanser’s name,” said Johnston. “It is my wish that our research will not only demonstrate the potential yoga has to provide people with epilepsy an inexpensive, easily accessible treatment with few side effects for seizure control, it will also help clarify the mechanisms through which yoga can influence brain function, and inform future research, treatment, and self-care strategies.”
The Hanser Award is a mentored research award that aims to advance innovations in yoga research by fostering collaborations between creative scientist-practitioners in the early stages of their careers and experienced research mentors. Applicants are required to partner with seasoned professionals who have the resources, expertise and experience to guide and support the research process.
The award honors the spirit and vision of the late Samuel B. Hanser, a healer who believed that every person holds the wisdom and power to lead a happy and healthy life. After Sam’s death at the age of 28, his family established a memorial trust in his name and, in collaboration with the IEL, seeks to support like-minded visionaries enabling the understanding and dissemination of yoga.
Glioblastma multiforme (GBM) is one of the most lethal primary brain tumors, with median survival for these patients only slightly over one year. Researchers at Boston University School of Medicine (BUSM), in collaboration with researchers from the City of Hope, are looking toward novel therapeutic strategies for the treatment of GBM in the form of targeted therapies against a unique receptor, the interleukin-13 receptor α chain variant 2 (IL13Rα2).
In a review paper published in the October issue of Neuro-Oncology, the researchers discuss various targeted therapies against IL13Rα2 and early successes of clinical trials with these therapies in the treatment of GBM. The paper also highlights the need for future trials to improve efficacy and toxicity profiles of targeted therapies in this field.
Targeted therapies, which are drugs that interfere with specific molecules involved in cancer growth, have been successfully used in the treatment of many cancers, including breast and blood cancers. Successful targets for therapies are specific to tumor cells and not found on normal cells. Selectively expressed on GBM and absent on surrounding brain tissue, the interleukin-13 receptor α chain variant 2 (IL13Rα2) was identified as a potential target for therapy for GBM two decades ago. IL13Rα2 also plays an important role in the growth of tumors. In normal physiologic conditions, IL-13 binds to the receptor IL13Rα1 and helps regulate immune responses. In cancer cells, IL-13 binds to the receptor IL13Rα2 and, through a series of steps, prevents cancer cells from undergoing normal cell death. Increased expression of IL13Rα2 promotes the progression of GBM.
Since its discovery, IL13Rα2 has provided a target for therapies in GBM. These therapies have ranged from fusion proteins of IL-13 and bacterial toxins, oncolytic viruses, and immunotherapies. A phase I clinical trial and a phase III clinical trial have been completed for a T-cell based immunotherapy and IL-13/ bacterial toxin fusion protein respectively, both with promising outcomes.
“The field of targeted therapies in gliomas holds a lot of promise, and IL13Rα2 is in an optimal position to materialize these promises,” explained corresponding author Sadhak Sengupta, PhD, assistant professor of neurosurgery at BUSM and principal investigator of the Brain Tumor Lab at Roger Williams. “While early trials are encouraging, we need further research to achieve better targeting of the receptor and improved safety profiles of the treatments.”
Funding for this research was provided by the Roger Williams Medical Center Brain Tumor Research Fund.
Takes charge at critical moment in research into infectious diseases
Ronald Corley, whose five years as associate director of BU’s National Emerging Infectious Diseases Laboratories (NEIDL) saw the lab overcome several legal and political challenges, has been appointed NEIDL director, effective October 1. Corley will continue as a School of Medicine professor and chair of microbiology, but will no longer be Medical Campus associate provost for research.
Announcing Corley’s appointment in a message to the Boston University community, President Robert A. Brown describes the new director as “an outstanding scientist and a collaborative leader.”
Corley succeeds John R. Murphy, a MED professor of medicine and microbiology, who had been NEIDL interim director since 2011. Brown says he is grateful to Murphy, “who has been instrumental in bringing the laboratories through the arduous regulatory processes and the initial launch of operations.”
“Dr. Corley’s leadership and vision will allow the NEIDL to reach its potential of being one of the premier centers for research on emerging and deadly infectious diseases,” says Gloria S. Waters, vice president and associate provost for research. “His experience as the associate director over the past five years will ensure a smooth transition and has shown that he has the collaborative style necessary to run a center like this and strengthen this area of research excellence at BU.”
Corley takes the helm of NEIDL at a critical time, as the worst Ebola virus outbreak in history continues to sweep across Central Africa.
“With Ebola, you can’t diagnose somebody until they’re already symptomatic,” he says. “Think how beneficial it would be if you had a tool that could diagnose people earlier. That alone would be a game changer. It’s imperative for us to learn to understand these emerging viruses and also to develop the diagnostics, the therapeutics, and the vaccines. That’s what the NEIDL is about.”
Construction of the NEIDL, on the Medical Campus in Boston’s South End, was completed in 2008 at a cost of $200 million, with the majority of the funding—$141 million—provided by the National Institutes of Health. The 192,000-square-foot laboratory is part of a national network of secure facilities dedicated to the development of diagnostics, vaccines, and treatments to combat emerging and reemerging infectious diseases.
The NEIDL has faced opposition from community activists expressing concern over safety and security, worries heightened by recent breaches at the US Centers for Disease Control and Prevention (CDC), where scientists were accidentally exposed to potentially viable anthrax bacteria.
“The recent events at the CDC have done nothing to dampen people’s concerns,” says Corley. “Those were horrible events—they were outrageous. The first thing we do when events like that happen is review all our processes and ask, could that have happened here? And if the answer is no, we make sure everyone understands why. And if we need to change something, we change it.”
Corley says he is committed to open communication with the public regarding the lab’s operations, safety protocols, and research goals.
“One of the things that former director Jack Murphy has been adamant about—and I have absolute, full intention to continue—is to be as open, direct, and transparent with the community as possible,” Corley says. “We want to address any questions that come our way and meet with anyone who wants to meet with us. We will continue our public outreach, because communication with the public is absolutely critical.”
The lab has been approved for some Biosafety Level 3 (BSL-3) research and is currently working to secure the necessary permits and approvals for BSL-4 research from the Boston Public Health Commission and the CDC. Corley’s goal is to begin BSL-4 research in the NEIDL in 2015. He also plans to begin a significant recruitment campaign across a number of different disciplines.
“We already have a small but outstanding group of scientists here,” he says. “What we want to do is build critical mass in certain areas that will raise everybody’s game.”
One of his first tasks will be to identify the top three areas to focus recruiting efforts on. These areas are still under discussion, but zoonosis (the spread of infectious disease between species) and pathogenesis (the mechanism by which microbes cause disease) will certainly be top priorities at NEIDL, he says. Tuberculosis and other respiratory pathogens are also likely areas of focus.
“The advantage of having the NEIDL in an academic, research-intensive institution is that it gives us the ability to address broad questions about infectious diseases,” he says. “That means we are going to be recruiting people from a variety of disciplines: engineers, chemists, biologists, ecologists. Emerging infectious diseases are about humans encroaching on animal territories, and it’s about global warming and changes in habitats. We’re not just doing research on individual pathogens and how they function, but also trying to globally understand where these diseases come from and how we can model, predict, and prevent their spread to humans.”
Corley earned a BS in zoology and a PhD in microbiology and immunology from Duke University. He has been MED’s microbiology chair since 1994, a position he says taught him to work across disciplines and build broad collaborations between the Charles River and Medical Campuses.
“We want to be a premier emerging infectious diseases institute, not only in the United States, but in the world,” he says. “And I think we have the potential for doing exactly that.”
This BU Today article was written by Barbara Moran
BUSM researcher Dr. Jeffrey Samet and Dr. Carlos Del Rio from Emory University were recently awarded a five year, $5 million grant from the National Institute of Drug Abuse for their project titled: Improving Physician Opioid Prescribing for Chronic Pain in HIV-infected Persons.
Prescription opioids are the second most commonly abused substances in the U.S. (after marijuana), and overdose deaths related to prescription opioids now exceed deaths from motor vehicle crashes. Prescription opioid abuse appears to be even more common among HIV-infected patients, presumably a consequence of the known co-morbidity between HIV and substance use.
The grant will fund the “Targeting Effective Analgesia in Clinics for HIV” (TEACH) Study. TEACH will test the effectiveness of a collaborative care intervention to improve the management of chronic opioid therapy and reduce the misuse of prescription opioids among HIV-infected persons.
“This is a novel randomized controlled trial of a chronic disease management intervention to improve the delivery of chronic opioid therapy and reduce prescription opioid misuse among HIV-infected persons. If demonstrated to be effective, this model could be adopted by clinics nationwide, may improve physician satisfaction and confidence with this challenging aspect of patient care, and has the potential to improve the health and well-being of persons with HIV,” explained Samet, principal investigator of the grant.
The study will be conducted within the BMC HIV clinic (CID) with Dr. Meg Sullivan, as a co-investigator.
CME-Accredited Course Advances Teaching Skills of Health Care Professionals
Medical educators have an opportunity to participate in a new, first-of-its kind online medical education badge program at Boston University School of Medicine (BUSM). The BUSM+ Medical Education Badge Program (BUSM+Program) allows access to online faculty development in medical education and allows course graduates to display and share earned digital competency badges on social media, CVs and portfolio websites. The program is considered to be a form of digital micro-credentialing.
“The BUSM+ Program takes the concept of digital badging and applies it for an audience of health care providers (practicing and retired physicians, fellows, residents, medical students and healthcare teams) who may have missed educational courses in their professional career and are now teaching, or those healthcare providers who want to enhance their existing teaching skills,” explained Gail March, PhD, Assistant Professor of Medical Sciences & Education as well as Director of Instructional Design and Faculty Development at BUSM who founded the program.
According to March, the BUSM+ digital badge program is unique in that it is the first one for medical education faculty development. “There are faculty development programs available, but they are often very expensive and demand the health care provider leave their practice to attend. BUSM+ is available as an open (no application process), online, asynchronous program available 24/7 for a low cost,” she added.
This program is designed for practicing and retired health care professionals who educate other professionals, students and patients. Enrollees in the initial BUSM+Program course will review the fundamentals of teaching and learning. Three additional offerings are planned to follow the Teaching and Learning course including Curriculum Design, Academic Leadership and Medical Education Research.
BUSM+Program was funded earlier this year by an inaugural seed grant for online innovation from the Digital Learning Initiative at Boston University.
The American Society of Tropical Medicine and Hygiene (ASTMH) announced the 2014 recipients of the Benjamin H. Kean Travel Fellowship in Tropical Medicine. Through a highly competitive process, 22 Fellows from 18 medical schools were selected including two from Boston University School of Medicine Katrina Ciraldo and Daniel Silva.
This Fellowship is the only medical student award dedicated to nurturing a career path for physician-scientists in tropical medicine. It is awarded annually to full-time medical students at accredited medical schools in North America. Fellows receive airfare and up to $1,000 in living expenses for a clinical training or research project that takes place in an area where tropical diseases are endemic. ASTMH, founded in 1903, is a worldwide organization of scientists, clinicians and program professionals whose mission is to promote global health through the prevention and control of infectious and other diseases that disproportionately afflict the global poor.
“The future of global health and tropical medicine is in great hands with a group as dynamic and committed as this class of Fellows,” said Kean Fellowship Committee Chair, Chandy John, MD, MS, University of Minnesota. “Headlines and news reports remind us that diseases that affect people in the tropics can have worldwide consequences. These fellows will be part of the next generation working to alleviate the suffering and long-term disability caused by these diseases.”
“This premier award is both honorific and substantive. It makes overseas training experiences for students interested in tropical disease possible, and works to build the ranks of physician-scientists focused on diseases in low-income countries,” said ASTMH President Alan Magill, MD, FASTMH. “The Fellowship enables these future leaders to expand their scientific networks, which in turn advances their professional contributions. As a Society, our goal is guide them towards fulfilling career options allowing them to do the work that helps improve the lives of so many who suffer needlessly from tropical disease.”
The Fellowship is named to honor Benjamin H. Kean, MD, (1912-1993), an internationally acclaimed tropical medicine expert and personal mentor to many of today’s world-renowned tropical medicine experts who were inspired by him as his students in medical school. Kean is also credited with discovering the causes of several diseases, including turista or travelers’ diarrhea.