Multiple myeloma patients display weakened antibody responses to mRNA COVID vaccines

Weakened antibody responses to COVID-19 mRNA vaccines among most patients with multiple Read more

Precision medicine with multiple myeloma

“Precision medicine” is an anti-cancer treatment strategy in which doctors use genetic or other tests to identify vulnerabilities in an individual’s cancer subtype. Winship Cancer Institute researchers have been figuring out how to apply this strategy to multiple myeloma, with respect to one promising drug called venetoclax, in a way that can benefit the most patients. Known commercially as Venclexta, venetoclax is already FDA-approved for some forms of leukemia and lymphoma. Researchers had observed that multiple Read more

Promiscuous protein droplets regulate immune gene activity

Biochemists at Emory are achieving insights into how an important regulator of the immune system switches its function, based on its orientation and local environment. New research demonstrates that the glucocorticoid receptor (or GR) forms droplets or “condensates” that change form, depending on its available partners. The inside of a cell is like a crowded nightclub or party, with enzymes and other proteins searching out prospective partners. The GR is particularly well-connected and promiscuous, and Read more

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From the Predictive Health Symposium

Predictive Health logoEmory and Georgia Tech kicked off their fifth annual predictive health symposium, “Human Health: Molecules to Mankind,” Dec. 14-15. Researchers, physicians, health care workers, and interested community members were treated to some intriguing and provocative findings and commentary.

Emory President James Wagner and Georgia Tech President Bud Peterson introduced the symposium, along with Fred Sanfilippo, MD, PhD, CEO of Emory’s Woodruff Health Sciences Center. Sanfilippo emphasized that predictive-personalized health is one of the most innovative and promising solutions to our current health care crisis. Medicine today stands at the brink of an achievable goal to tackle the most serious issues facing the health of humans – the ability to predict, reduce, and in many cases eliminate the specific illnesses we each face.

To achieve this goal, he said, we must understand why each of us has a different risk and response to diseases and their treatment, based on our unique differences in biology, behavior and environment. And then we have to use that knowledge to determine the right treatment at the right time for each individual.

Keynote speaker Penny Pilgram George, president of the George Family Foundation and co-founder of the the Bravewell Collaborative, said, “We currently have a disease management system based on episodic care, which means we treat symptoms instead of problems…True healing can only begin when we correctly diagnose the problem and treat the root cause.”

We know we could prevent half of chronic illness, said George by simply teaching people to eat nutritionally, adopt health habits such as nonsmoking, build positive relationships, live and work in nontoxic environments, practice stress reduction, stay fit through some form of exercise, and be purposely engaged in life. If we only treat disease after it occurs and do not promote health, we will have missed the whole point. We need to create a culture of health and well being.

And this from W. Andrew Faucett, director of the genomics and public health program at Emory, who cautioned that although many personalized genetic tests are now available through numerous sources, individuals and clinicians have to weigh the benefits, risks, and usefulness of this evolving technology. People may not even want to know some things revealed by genetic testing, and not everything revealed may be clinically useful or related to disease risk. For example, matters such as one’s true ancestry or revelations concerning one’s paternity may unexpectedly come to light. Furthermore, the accuracy of personalized genetic testing should be carefully considered. Also, a negative result is never truly negative, because there are so many factors involved and some of them can change.

Faucett also spoke about the differences between relative risk and absolute risk. “Anytime you’re talking about genetic risk for disease, you have to present risk in multiple ways,” Faucett said.

Kenneth Thorpe, chair of health policy and management at Emory, talked about the elements of health reform that may be getting lost in the reform process– redesigning the delivery system to prevent and avert the development of disease. Thorpe focused on Medicare because he says, it’s “the most acute offender of the system.” That is, it encompasses some of the most difficult problems that health care reform faces. The typical Medicare patient, he said, is an overweight hypertensive diabetic with back problems, high cholesterol, asthma, arthritis, and pulmonary disease. And that typical patient sees two different primary physicians, a multitude of specialists, and fills 30 different medications. Yet, Medicare does nothing to coordinate the patient’s care. As a result, preventable admissions and readmissions rates are “off the charts,” he says. But, data show that coordination could cut those rates in half.

Because today’s patients have chronic health care conditions that require medical management, said Thorpe, the hope is to develop a preventive and personalized health plan that identifies problems before they manifest and employs care coordinators to guide patients while they’re at home.

And Paul Wolpe, director of the Emory Center for Ethics, says health care has changed as more and more aspects of ordinary life or behaviors are being redefined as medical. For example, being drunk and disorderly has become alcoholism. Now, virtually all of life is being redefined in biological terms, he says. And that has led to an increase in health care costs. We have an enormous amount of new things that we are calling illness, and we expect this health care system to treat them, he says. “We are creating a new category of disease called presymptomatic.”

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Providing complex care for individuals in need

Emory Healthcare physicians provided $48.9 million in charity care in fiscal year 2008–2009, a total that does not include uncompensated care provided by Emory physicians practicing at publicly funded Grady Memorial Hospital and other affiliate institutions.

Charity care includes two types of care. Indigent care refers to care provided to patients with no health insurance, not even Medicare or Medicaid. Catastrophic care refers to care provided to patients who have some coverage but whose medical bills are so large that paying them would be permanently life-shattering. People without ability to pay for care are not faceless statistics to Emory clinicians but patients in need of care.

In fact, Emory’s Wesley Woods Center exemplifies Emory Healthcare’s commitment to serving patients and their families who are facing issues related to aging. The majority of the 30,000 patients treated last year at Wesley Woods’ 100-bed hospital and outpatient clinic were elderly, in their 70s, 80s, 90s and older.

But Wesley Woods also is a life-saver for many younger patients who require chronic care and specialty services for which the center is known, including wound care, rehabilitation and respiratory care, such as weaning from ventilator therapy.

Patient receives care at Wesley Woods

Patient receives care at Wesley Woods

For example, patient Sherry Smith’s CT scan at Emory University Hospital showed large blood clots blocking the vessels leading to her spleen and kidneys. Over the next two weeks, she had four operations. Surgeons removed the clots and her spleen and cut out portions of her bowel that had been destroyed by lack of oxygenated blood. She required a feeding tube and a tracheotomy to help with breathing as she recovered.

Patients can move seamlessly between the two Emory Healthcare facilities for needed care. Smith moved back and forth between Emory and Wesley Woods as she improved. She also got some unexpected help in paying for her care. When she got sick, Smith lost her job. During the six months she spent moving between the two hospitals, her bill at Wesley Woods was more than $120,000, and that at Emory University Hospital, almost $130,000.

Community Benefits Report

Community Benefits Report

 

To her relief, Emory offered to pay her COBRA insurance fees to help her maintain her insurance for the time allowed. Payments would cover only part of the actual cost of care. Wesley Woods social workers also helped Smith apply for Medicaid to cover health care costs while she continues her recovery in a rehab facility closer to her home.

Read more about charity care at Emory in the Community Benefits Report 2009.

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Research match eases clinical trials participation

Research Match LogoIf you’d like to consider joining a clinical trial, a new secure website will make it easier. ResearchMatch.org will match any interested person living in the U.S. with researchers who are approved to recruit potential study volunteers.

Emory is one of 51 institutions participating in this first national, secure, volunteer recruitment registry. After registering at the website, potential volunteers can check out available trials. If a person indicates interest in a study, they are notified electronically about a possible match. Then they can decide whether to provide their contact information to a researcher.

The new website is sponsored by the National Center for Research Resources (NCRR) of the National Institutes of Health (NIH). ResearchMatch is the product of the NCRR’s Clinical and Translational Science Awards (CTSA) Consortium. The CTSA is a national network of 46 medical research institutions working together to improve the way biomedical research is conducted across the country.

Emory leads the Atlanta Clinical and Translational Science Institute (ACTSI), a CTSA partnership including Morehouse School of Medicine, the Georgia Institute of Technology and Children’s Healthcare of Atlanta.

ResearchMatch.org is a wonderful opportunity for those interested in participating in clinical research, says Arlene Chapman, MD, Emory professor of medicine and director of the ACTSI Clinical Interaction Network Program. It’s available to young and old, healthy or ill. And people with a rare disease can find out more about available research studies throughout the country.

The registry strictly protects anonymity. It also increases the chance to participate in local studies and saves much of the time typically spent finding out about eligibility for a particular study.

ResearchMatch is available at: www.researchmatch.org/route=emory

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Inflammatory bowel disease gene regions identified

In the largest, most comprehensive genetic analysis of childhood-onset inflammatory bowel disease (IBD), Emory and Children’s Healthcare of Atlanta gastroenterologist Subra Kugathasan, MD, and colleagues identified five new gene regions, including one involved in a biological pathway that helps drive the painful inflammation of the digestive tract that characterizes the disease.

Subra Kugathasan, MD

Subra Kugathasan, MD

IBD is a painful, chronic inflammation of the gastrointestinal tract, affecting about 2 million children and adults in the United States. Of that number, about half suffer from Crohn’s disease, which can affect any part of the GI tract, and half have ulcerative colitis, which is limited to the large intestine.

Most gene analyses of IBD have focused on adult-onset disease, but this study concentrated on childhood-onset IBD, which tends to be more severe than adult-onset disease.

Kugathasan and a team of international researchers performed a genome-wide association study on DNA from over 3,400 children and adolescents with IBD, plus nearly 12,000 genetically matched control subjects, all recruited through international collaborations in North America and Europe.

In a genome-wide association study, automated genotyping tools scan the entire human genome seeking gene variants that contribute to disease risk.

The study team identified five new gene regions that raise the risk of early-onset IBD, on chromosomes 16, 22, 10, 2 and 19. The most significant finding was at chromosome locus 16p11, which contains the IL27 gene that carries the code for a cytokine, or signaling protein, also called IL27.

Kugathasan says one strength of the current study, in addition to its large sample size, is the collaboration of many leading pediatric IBD research programs, which included Emory, The Children’s Hospital of Philadelphia, the Hospital for Sick Children of the University of Toronto; the University of Edinburgh, UK; Cedars Sinai Medical Center, Los Angeles; and the IRCCS-CSS Hospital, S. Giovanni Rotondo, Italy.

The study, “Common variants at five new loci associated with early-onset inflammatory bowel disease,” was published in the November 2009 online issue of Nature Genetics.

Learn more about Kugathasan’s work at Emory.

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Sanjay Gupta shares stories on near-death experiences

Yesterday, Sanjay Gupta, MD, assistant professor of neurosurgery at Emory School of Medicine and associate chief of neurosurgery service at Grady Memorial Hospital, joined Emory and its community in a book-signing event to celebrate his newest book Cheating Death: The Doctors and Medical Miracles that Are Saving Lives Against All Odds.

Dr. Gupta signs his book

Dr. Gupta signs his book

It is hard to imagine having a busier schedule than the one Gupta has. On Wednesday he started his day as chief medical correspondent at CNN by discussing the new breast cancer recommendations issued by the U.S. Preventive Services Task Force. He, like other health reporters and doctors across the nation, had hundreds of questions pouring in about the controversial recommendations.

As the late afternoon approached, Gupta packed up for his visit to Emory where several hundred faculty, staff, students and neighbors awaited him for the book-signing event. After spending time presenting and answering questions, and then signing books for many people, Gupta again packed up and headed back to the CNN studio for a live show with Larry King.

Dr. Gupta presents

Dr. Gupta presents

During his presentation at Emory, Gupta talked about his experiences that led to his book. He notes one CNN story took him to Norway to meet the woman who had been skiing and slipped through a hole in the ice with her head caught under freezing water for an hour.

After an amazing rescue, Anna BÃ¥genholm was taken to the emergency room where the doctors did not give up. A doctor on the helicopter said there was a completely flat line. No signs of life whatsoever. But the team persevered and saved her life by warming her body very slowly. Even though BÃ¥genholm was alive, months of recovery lay ahead. Paralyzed for almost a year until her damaged nerves healed, she today is a radiologist at the hospital where she was saved. She has returned to skiing and other sports.

Read more about Gupta in Emory Magazine. Learn more about Gupta’s stories from on the road.

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ScienceWorksForUs highlights stimulus funding

Allan D. Kirk, MD, PhD

Allan D. Kirk, MD, PhD

A newly launched website, ScienceWorksForUS.org, highlights the scientific research made possible by the American Recovery and Reinvestment Act of 2009 (ARRA), also known as the stimulus bill.

Representatives of research universities joined Speaker Nancy Pelosi and other members of Congress in Washington, D.C. this week to announce the new site, which links to Recovery Act-sponsored research in all 50 states. The Association of American Universities (AAU), the Association of Public and Land-grant Universities (APLU) and The Science Coalition (TSC)spearheaded the initiative.

“ScienceWorksForUS is highlighting the way Recovery Act funds have made their way into academic laboratories, and reflects what’s possible when smart investments in the public sector are placed in the hands of our scientists, innovators, and academies of higher learning,” Speaker Pelosi said. “Through our ongoing support for researchers across the country, we will ensure that the Recovery Act was not the end of our investment in innovation, but the beginning of a sustained commitment to science.”

The stimulus contained $21.5 billion for scientific research, the purchase of capital equipment and science-related construction projects. The money represented an historic infusion of funding for research and an affirmation of the essential role scientific inquiry and discovery play in both short-term recovery and long-term economic growth.

Emory University scientists were awarded 153 grants from the National Institutes of Health for $53.6 million in the first year of two-year grants, and $417,000 for two grants from the National Science Foundation.

In addition to launching the new website, ScienceWorksForUS released a list of more than 50 ARRA-funded researchers and research projects from around the country. Allan Kirk, MD, PhD, professor of surgery and pediatrics at Emory School of Medicine, was featured for his work helping tailor post-transplant therapies to the needs of children. Kirk, who also is a transplant surgeon at Children’s Healthcare of Atlanta, is a Georgia Research Alliance Eminent Scholar, the vice chair of research in the Department of Surgery and scientific director of the Emory Transplant Center.

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Biomedical informatics impact on health care outcomes

Biomedical informatics is a multi-disciplinary field, involving the collection, management, analysis and integration of data in biomedicine used for research and healthcare delivery.

DNA double helix

DNA double helix

According to Joel H. Saltz, MD, PhD, director of Emory’s Center for Comprehensive Informatics, biomedical informatics enhances medical research via technology by making it possible to collect, weed through and analyze widespread data on patient treatments and outcomes.

Saltz is a Georgia Research Alliance Eminent Scholar and serves as chief medical information officer at Emory Healthcare and as a professor in the departments of pathology, biostatistics and bioinformatics, and mathematics and computer science at Emory.

Joel H. Saltz, MD, PhD

Joel H. Saltz, MD, PhD

A recent essay excerpted below, published by Knowledge@Emory, says advances in information technology are becoming increasingly critical to disease treatment and administrative efficiency at healthcare facilities.

Given the national debate over costs in the healthcare system, medical practitioners and IT experts say that the evolving field of biomedical informatics can provide large scale improvements in treatment processes, and ultimately, in the price tag for care.

Saltz notes in the article that biomedical informatics can be applied to any subset of medical research, giving clinicians access to “rich” or large pools of patient data and applying technological solutions and mathematical modeling to the process.

He says that the overarching goal of the Center is to foster collaboration between scientific and software systems researchers. However, the synthesis of medical information from disparate and numerous sources remains a key research effort at the Center and for other institutions and companies in the biomedical informatics field

The Center was selected recently as an In Silico Brain Tumor Research Center and will use advanced informatics tools and databases to discover more effective brain tumor treatments. Read here for more information about projects at the Center.

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Expandable implants utilize magnets for treatment

One of the most exciting areas in the treatment of pediatric extremity sarcomas is the development of expandable implants and a procedure that uses magnets to treat sarcoma of bone and soft tissue.

The latest devices allow lengthening of the bone using a non-invasive technique with a simple magnet held against the patient’s leg, which preserves the patient’s own joint. These implants can be expanded and grow with the patient as they get taller without multiple operations.

The patient’s leg is put through a round magnet every few months and, using different settings, the physician can turn the magnet on and patients can watch their leg get longer. There are only a few centers in the country performing this procedure – Emory Musculoskeletal Oncology and Limb Reconstruction Center is the only center in Georgia that offers this treatment.

David K. Monson, MD, Emory assistant professor of orthopaedic surgery, and Shervin V. Oskouei, MD, Emory assistant professor of orthopaedic surgery, lead the Emory Musculoskeletal Oncology and Limb Reconstruction Center.

Monson’s focus is on rare tumors, sarcomas of the bone and soft tissue as well as other uncommon benign bone and soft tissue tumors. He also treats metastatic cancers that have spread to areas of the bone from other primary malignancies, and often performs complex reconstructive procedures for these disorders not available in the community. Oskouei is an expert in the treatment of musculoskeletal (extremity) tumors, total hip and total knee replacements and revisions. His specialty is in orthopaedic oncology.

Monson and Oskouei point to the advantages of the procedure:

  • The procedure can save the patient’s limb by avoiding amputation.
  • The procedure can be done in one operation so patients don’t have to make multiple trips to the operating room, using one implant that can be expanded as the patient grows.
  • It allows lengthening of the bones and maintains an equality in limb length.
  • The technique is noninvasive and can be done in the office using just a mild anesthetic, rather than general anesthesia.
  • The procedure can be done more frequently, allowing physicians to lengthen in much smaller increments, which is much safer and more comfortable for the patient.
  • The procedure provides patients improved function — patients are able to put their full weight on their leg immediately after surgery

Learn more from patient Ned Crystal or visit Emory Healthcare.

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Importance of flu vaccinations for pregnant women

Pregnant women are at the top of the Center for Disease Control and Prevention’s priority list when it comes to vaccinating people against the novel H1N1 flu virus this year. Not only should pregnant women receive the 2009 H1N1 vaccine, they should also receive the usual seasonal flu vaccine, say Emory experts.

Staying healthy in pregnancy

Staying healthy in pregnancy

Because pregnancy weakens the immune system, a pregnant woman who gets any type of flu has a greater chance for serious health problems. Pregnant women who contract H1N1 flu are more likely to be admitted to the hospital, compared with other people in general that get H1N1 flu. Pregnant women are also more likely to have serious illness, including pneumonia and death from this particular novel strain.

Both vaccines are made with a dead, or inactivated, flu virus and are given as an injection, usually in the arm. The other type of flu vaccine is a nasal spray and is not recommended for pregnant women. The nasal spray vaccine is safe for women after they have delivered, even if they are nursing.

A recent study by Emory researchers found that seasonal flu vaccination of pregnant women can benefit both mothers and infants, says Kevin Ault, MD, associate professor in the Department of Gynecology and Obstetrics at Emory.

Saad B. Omer, MBBS, MPH, PhD, assistant professor of global health at Emory’s Rollins School of Public Health, served as senior author on the report, published in the American Journal of Obstetrics & Gynecology. The study shows that there is substantial evidence that vaccination is not only safe for pregnant women but that it is critical for protecting women and their infants against serious complications from the flu.

Other members of the research team included Ault and Carlos del Rio, MD, professor and chair in the Hubert Department of Global Health, Rollins School of Public Health, Emory University.

The seasonal flu shot has been given to millions of pregnant women over several decades . Flu shots have not been shown to cause any harm to pregnant women or their babies. The 2009 H1N1 flu vaccine is being made in the same way and by the same manufacturers as the seasonal flu vaccine, explains Ault.

Ault also serves as principal investigator of a seasonal flu vaccine clinical trial underway at Emory Vaccine Center involving pregnant women.

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Children’s 1,000th pediatric transplant recognized

Emory University and Children’s Healthcare of Atlanta transplant surgeon Stuart Knechtle, MD, and his surgical team recently performed the 1,000th solid organ transplant on a Children’s patient. The milestone operation was performed on a child who received a liver through the Children’s Transplant Center.

Stuart Knechtle, MD

Stuart Knechtle, MD

Knechtle is chief of the Emory School of Medicine transplant division and professor of surgery, and surgical director of Children’s Liver Transplant Program. Children’s Liver Transplant program was founded in 1990 and has completed more than 300 liver transplants.

The liver transplant team is made up of many individuals who contribute to its success – liver transplant surgeons, transplant hepatologists (doctors with expertise in the treatment of the liver), and a team of gastroenterologists, anesthesiologists, pathologists, radiologists, mental health specialists, chaplains, nurses, social workers and pharmacists.

For more than 20 years, Emory and Children’s physicians have been at the forefront of pediatric transplant care, achieving several groundbreaking accomplishments, including:

  • Transplanted the world’s youngest (10 days old) and three smallest (2 to 4 pounds) liver transplant recipients
  • One of the first pediatric hospitals in the United States to perform three heart transplants in 24 hours
  • At the forefront of its field with ABO-incompatible liver and heart transplants
  • Performed more than 450 pediatric kidney transplants.
Children's kidney transplant recipient Quinn Roberts, age 8, poses with her donor Cheryl Thomas

Children’s kidney transplant recipient Quinn Roberts, age 8, with her donor Cheryl Thomas

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