Warren symposium follows legacy of geneticist giant

If we want to understand how the brain creates memories, and how genetic disorders distort the brain’s machinery, then the fragile X gene is an ideal place to start. That’s why the Stephen T. Warren Memorial Symposium, taking place November 28-29 at Emory, will be a significant event for those interested in neuroscience and genetics. Stephen T. Warren, 1953-2021 Warren, the founding chair of Emory’s Department of Human Genetics, led an international team that discovered Read more

Mutations in V-ATPase proton pump implicated in epilepsy syndrome

Why and how disrupting V-ATPase function leads to epilepsy, researchers are just starting to figure Read more

Tracing the start of COVID-19 in GA

At a time when COVID-19 appears to be receding in much of Georgia, it’s worth revisiting the start of the pandemic in early 2020. Emory virologist Anne Piantadosi and colleagues have a paper in Viral Evolution on the earliest SARS-CoV-2 genetic sequences detected in Georgia. Analyzing relationships between those virus sequences and samples from other states and countries can give us an idea about where the first COVID-19 infections in Georgia came from. We can draw Read more

American Heart Association

Before the cardiologist goes nuclear w/ stress #AHA17

Exercise stress testing to diagnose heart disease has a long history. This year, cardiologists can celebrate the 50-year anniversary of a study connecting abnormal stress test results and obstructive coronary artery disease (CAD).

The basic stress test procedure can involve walking on a tilting treadmill as the heart is monitored via electrocardiogram. A variant called the nuclear stress test involves introducing a radioactive tracer into the body to visualize alterations in blood flow within the heart.

Some stress tests are considered inappropriate, leading to additional medical costs. Arshed Quyyumi and colleagues from Emory Clinical Cardiovascular Research Institute presented research on Sunday at the American Heart Association Scientific Sessions meeting on the use of a blood test along with an exercise stress test. First author Bryan Kindya is a 2017-18 internal medicine resident.

The blood test detects troponin, a sign of recent damage to the cardiac muscle. Very high levels indicate that someone is having a heart attack. As testing for troponin has become more sensitive in recent years, the implications of lower but still detectable troponin levels need to be backed up by follow-up outcomes. That’s what the Emory data can provide.

Quyyumi’s team found that more than 25 percent of CAD patients will have troponin levels below a certain cut-off (2.45 picograms per milliliter), predicting that they have a low risk of having heart problems during a stress test or adverse events (hospitalization/heart attack/death) over the next three years.

The researchers conclude that measuring troponin in CAD patients before embarking on stress testing “may provide major cost-savings.” Disclosure: the research was done in cooperation with Abbott Labs, the maker of the high-sensitivity troponin test.

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#AHA17 highlight: cardiac pacemaker cells

At the American Heart Association Scientific Sessions meeting this week, Hee Cheol Cho’s lab is presenting three abstracts on pacemaker cells. These cells make up the sinoatrial node, which generates electrical impulses driving our heart beats. Knowing how to engineer them could enhance cardiologists’ ability to treat arrhythmias, especially in pediatric patients, but that goal is still some distance away.

Just a glimpse of the challenge comes from graduate student Sandra Grijalva’s late breaking oral abstract describing “Induced Pacemaker Spheroids as a Model to Reverse-Engineer the Native Sinoatrial Node”, which was presented yesterday.

Cho has previously published how induced pacemaker cells can be created by introducing the TBX18 gene into rat cardiac muscle cells. In the new research, when a spheroid of induced pacemaker cells was surrounded by a layer of cardiac muscle cells, the IPM cells were able to drive the previously quiescent nearby cells at around 145 beats per minute. [For reference, rats’ hearts beat in living animals at around 300 beats per minute.] Read more

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Emory clinical research highlights for #AHA16

Clinical research presentations at 2016 American Heart Association Scientific Sessions: telomeres + circulating progenitor cells, food deserts, and troponin as risk marker for atrial fibrillation.

 

Telomere Shortening, Regenerative Capacity, and Cardiovascular Outcomes Nov. 13, 4:45 pm, Room 346-347

Aging, in general, depletes our bodies’ regenerative capacities. Arshed Quyyumi, MD and colleagues at Emory Clinical Cardiovascular Research Institute have shown how circulating progenitor cells or CPCs, which regenerate blood vessels and correlate with outcomes in cardiovascular disease, are a finite resource.

Working with Quyyumi, research fellow Muhammad Hammadah, MD is presenting data on how telomere length interacts with the levels of CPCs, in a study of mental stress ischemia in 566 patients with stable coronary artery disease. Telomeres tend to shorten with ageing and cellular stress, and their length has been a widely studied biomarker.

Hammadah concludes that low leukocyte telomere length is associated with decreased regenerative capacity, independently of age and cardiovascular risk factors. However, telomere length and CPC levels are independent and additive predictors of adverse cardiovascular outcomes (such as death, heart attack, stroke, or hospitalization for heart failure), he finds. Hammadah is a finalist for the Elizabeth Barrett-Connor Research Award for Young Investigators in Training. Read more

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Emory basic research highlights for #AHA16

Basic research presentations at 2016 American Heart Association Scientific Sessions: cell therapy for heart attack (mesenchymal stem cells) in animal models and role of CD73, gradual release drug for atrial fibrillation, how particles from stored blood affects blood vessels.

Mesenchymal Stem Cells Require CD73 Activity to Reduce Leukocyte Associated Inflammation Following Myocardial Ischemia-Reperfusion Injury

Nov.13, 1:30 pm, Science and Technology Hall- Basic Science Theater

Cell therapy, using the patient’s own cells to reduce damage to the heart after a heart attack, has been a hot topic. Mesenchymal stem cells are derived from the bone marrow and can’t replace heart muscle. But they do exert anti-inflammatory and anti-oxidative effects, Eric Shin, MD, Rebecca Levit, MD and colleagues show in a rat model of heart attack.

The researchers use the gel material alginate to encapsulate the cells, in a way previously described by Levit. They say this is the first study to demonstrate that mesenchymal stem cells reduce reactive oxygen species production in the heart. and that the molecule CD73, which degrades ATP/ADP into adenosine, is needed for the anti-inflammatory effect. CD73 is also a cancer immunotherapy target. Read more

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Trio with Emory roots probing PTSD-hypertension links

This grant announcement from the American Heart Association caught Lab Land’s eye. All three of the scientists involved in this project, examining the connections between hypertension, inflammation and the sympathetic nervous system in PTSD, have Emory connections:

*Kerry Ressler, previously Emory Psychiatry/HHMI-supported/Yerkes-based lab/Grady Trauma Project, who moved this summer to Harvard’s McLean Hospital

Related finding that emerged from the Grady Trauma Project: Blood pressure drugs linked with lower PTSD symptoms

*Paul Marvar, who worked with both David Harrison and Kerry Ressler at Emory, and is now at George Washington University

Related item on Marvar’s work: Immune cells required for stress-induced rise in blood pressure in animals

*Jeanie Park, kidney specialist who is here now! The grant is exploring the relationship between the sympathetic nervous system, regulation of blood pressure and PTSD.

2015 TV interview with Park on her chronic kidney disease research

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AHA meeting highlights — an Emory-centric view

Poring over the abundance of information presented at major scientific meetings is like trying to drink from a firehose.  Imposing an Emory-centric filter on this year’s American Heart Association Scientific Sessions meeting in Los Angeles, here are three highlights, with a shoutout to the AHA journal Circulation, which provides a database of meeting abstracts.

Alginate encapsulation, a therapeutic delivery tactic to get stem cells to stay in the heart

Presenter Rebecca Levit, MD, a postdoc in cardiology division chair W. Robert Taylor’s laboratory, was a finalist for an Early Career Investigator Award.

 Stem cell therapies for myocardial repair have shown promise in preclinical trials, but lower than expected retention and viability of transplanted cells. In an effort to improve this, we employed an alginate encapsulation strategy for human mesenchymal stem cells (hMSCs) and attached them to the heart with a biocompatible PEG hydrogel patch in a rat MI model. Encapsulation allows for diffusion of pro-angiogenic cytokines and growth factors made by the hMSCs while maintaining them at the site of implantation…Alginate encapsulated hMSCs attached to the heart with a hydrogel patch resulted in a highly significant improvement in left ventricular function after acute myocardial infarction. The mechanism for this markedly enhanced effect appears to be increased cell survival and retention.

 Note: alginate already has a wide variety of uses, for example in culinary arts and to make dental impressions.

suPAR, a biomarker connected with depression, inflammation and cardiovascular outcomes. Step back, C-reactive protein

Depression, inflammation (Manocha, Vaccarino)

Cardiovascular outcomes (Eapen, Quyyumi)

Coronary microvascular dysfunction (Corban, Samady)

Predicting mental-stress myocardial ischemia via a public speaking test

A study probing myocardial ischemia (a lack of blood flow to the heart) induced by psychological stress, described in this Emory Public Health article. The presentation by Ronnie Ramadan examines physiological responses to a public speaking test as a way of predicting more severe problems.

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Cardiac alliance seeks improved care and response time for heart attack patients

Approximately 250,000 people each year suffer from a particularly deadly form of heart attack known as a STEMI (ST-Elevation Myocardial Infarction), in which blood flow is completely blocked to the heart. Restoring blood flow quickly is crucial in order to save the patient’s life, yet more than 30 percent of these patients receive no life-saving intervention at all.

Michael Ross, MD

Led by Emory emergency medicine physician Michael Ross, the Society of Chest Pain Centers (SCPC) and the American Heart Association (AHA) recently announced they will be joining efforts to save even more lives. The joint agreement seeks to improve cardiac care, specifically the care of patients suffering from STEMI.

The new collaborative framework for hospital accreditation meets criteria of the AHA initiative “Mission: Lifeline,” established in 2007 to improve the processes surrounding care of the STEMI patient by eliminating the obstacles that keep patients from accessing and receiving appropriate treatments.

Mission: Lifeline systems start with the 9-1-1 call or at the point of entry in the emergency system, continue through the catheterization laboratory and through hospital discharge by promoting best practices that use the latest scientific evidence-based treatment for STEMI.

Mission: Lifeline systems currently cover more than 56 percent of the United States. Mortality rates from STEMI have decreased from 5.8 percent in 2008 to 4.8 percent in 2010.

“SCPC, through their Chest Pain Center accreditation, has already improved cardiac processes in close to 14 percent of hospitals within the U.S. and has moved this accreditation to the international setting,” says Ross, who is immediate-past SCPC president and an associate professor of emergency medicine and medical director for observation medicine at Emory.

“Collaboration between these two non-profit organizations, who share similar missions, will help bring consistency to health care delivery by providing a standard approach to the treatment of STEMI. Providing cardiac accreditation programs is in the best interest of patients, meets the needs of the health care community, and will help to significantly reduce cardiac deaths.”

Both Emory University Hospital and Emory University Hospital Midtown are not only accredited by the Society of Chest Pain Centers, but are also  the only accredited chest pain centers in metropolitan Atlanta to be accredited with PCI (percutaneous coronary intervention), which indicates a higher level of emergency cardiac care services.

Most commonly known as coronary angioplasty, PCI is a therapeutic procedure to treat the narrowed coronary arteries of the heart found in coronary heart disease. The designation is a distinguishing attribute since PCI is now the preferred treatment for heart attack patients.

For more information about heart disease and cardiac care option – from heart transplants and ventricular assist devices to imaging services and minimally-invasive interventional treatments, please visit Emory Healthcare at: http://www.emoryhealthcare.org/heart-center-atlanta/.

 

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CPR Manikins Make Training Easier

Studies have consistently found that cardiopulmonary resuscitation (CPR) performed immediately by a bystander doubles or even triples a cardiac arrest victim’s chance of survival.

To increase the rate of bystander CPR, the American Heart Association recently modified its CPR guidelines so that it is now permissible to provide continual chest compressions without mouth-to-mouth rescue breathing. If you’re interested in enhancing your CPR skills, feel free to learn more about advanced techniques and updates in life-saving practices.

Arthur Kellermann, MD, MPH

Arthur Kellermann, MD, MPH, formerly an emergency medicine physician and associate dean for public policy at Emory, and David Sanborn, a mechanical engineer at Georgia Tech, have invented a low-cost CPR manikin to help anyone learn and practice compression-only CPR. Kellermann currently is director of the Program in Public Health Systems and Preparedness and Paul O’Neill-Alcoa Chair in Policy Analysis at the RAND Corporation in Virginia.

Their work builds on Emory research that showed laypeople could teach themselves CPR at home using a 25-minute video with results that are comparable to taking a four-hour course taught by a professional instructor.

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Predicting individual risk for heart failure

Javed Butler, MD, MPH, and colleagues

Javed Butler, MD, MPH, director of heart failure research at Emory Healthcare and associate professor of medicine at Emory University School of Medicine, says heart failure is any condition in which the heart is unable to pump enough blood for the metabolic needs of the body, but that does not mean that the heart is not pumping or the heart has stopped working.

Heart disease is not a disease but a syndrome, so a whole family of different diseases can precede this condition. Diabetes, obesity, heart valve problems, lung disease, heart attack and irregular heartbeats are only some factors that can cause heart failure. “Pinning down the roots of heart failure can be confusing,” says Butler, who serves as deputy chief science advisor for the American Heart Association. “Unlike some heart problems, heart failure is not one disease. It has a few common causes, and a few less common, even rare, causes.”

Finding new ways to identify people at risk for developing heart failure—before damage is done—is his raison d’etre and primary research focus, according to Emory Medicine magazine.

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