School of Medicine

Wayne State University School of Medicine
Dr. Drewlo wins $1.25 million NIH grant to study diabetes drug's role in reversing preeclampsia
In Headlines on July 7, 2015
Sascha Drewlo, Ph.D.

Sascha Drewlo, Ph.D.

Sascha Drewlo, Ph.D., assistant professor of Obstetrics and Gynecology for the Wayne State University School of Medicine, has secured a $1.25 million grant from the National Heart, Lung and Blood Institute to study the role of approved drugs to improve placental function.

The R01 grant (1R01HL128628) will fund Dr. Drewlo’s research into the effectiveness of the drug rosiglitazone, sold as the diabetic medication Avandia, in stimulating a placental signaling channel to halt severe preeclampsia.

Dr. Drewlo is exploring a novel signaling pathway within the placenta that, when altered with rosiglitazone can restore normal vascular function, preventing preeclampsia in pregnant mothers.

Preeclampsia, a sudden increase in blood pressure after the 20th week of pregnancy, is the leading cause of fetal and maternal death worldwide. Women not killed by preeclampsia can suffer lifelong health problems from the condition. Indicated by a sudden increase in blood pressure and protein in the urine, preeclampsia warning signs, in addition to elevated blood pressure, can include headaches, swelling in the face and hands, blurred vision, chest pain and shortness of breath. While the condition can manifest within a few hours, some women report few or no symptoms.

The condition is responsible for 76,000 maternal deaths and more than 500,000 infant deaths annually, according to estimates from the Preeclampsia Foundation. The condition occurs only during pregnancy. Some mothers develop seizures (eclampsia) and suffer intracranial hemorrhage, the main cause of death in those who develop the disorder. The babies of preeclamptic mothers may develop intrauterine growth restriction or die in utero.

Severe preeclampsia, Dr. Drewlo explained, is believed to stem from the placenta since the only available “cure” is delivery of the fetus. In severe cases, early fetal delivery is necessary, leading to preterm birth, which carries a host of long-term complications for the infant.

At the molecular level, Peroxisome proliferator-activated receptor-gamma, or PPAR-γ, a transcription factor and a nuclear receptor, is primarily known for its role in lipid metabolism. Researchers have shown that PPAR-γ also regulates lineage differentiation in trophoblast stem cells in mice through the control of glial cell missing-1, or GCM-1, a protein-coding gene in the placenta. The trophoblast stem cells provide nutrients to the embryo and develop into a large portion of the placenta. The expression of GCM-1 has been shown to affect the formation of new blood vessels in embryos, which can result in preeclampsia.

Dr. Drewlo has found that when PPAR-γ in placental development in mice was stimulated by rosiglitazone, preeclampsia-like symptoms were reduced. At the same time, inhibiting PPAR-γ induced preeclampsia-like features. Rosiglitazone, when used in diabetics, binds PPAR receptors in fat cells, making them more responsive to insulin.

“We hypothesize that human trophoblast differentiation is regulated by the PPARγ – GCM1 axis, which can be pharmacologically activated to improve placental and, in turn, maternal endothelial function,” Dr. Drewlo said. “The ultimate goal of the proposed research program is to improve pregnancy outcome by restoring placental and maternal vascular function in severe preeclampsia.”

Dr. Drewlo said that in pregnancy, PPAR-γ oversees the release of factors that inhibit the growth of new blood vessels through a GCM-1-dependent pathway. Preliminary studies in human placental explants suggest that PPAR-γ directly controls trophoblast differentiation by regulating the expression of GCM-1. PPAR-γ activation with rosiglitazone significantly decreased the secretion of blood vessel growth inhibitors.

According to the Preeclampsia Foundation, the condition, also known as toxemia or pregnancy-induced hypertension, affects 5 percent to 8 percent of pregnancies. Approximately 13 percent of all maternal deaths worldwide – the death of a mother every 12 minutes – have been attributed to eclampsia. The foundation reports that preeclampsia is responsible for nearly 18 percent of all maternal deaths in the United States.

Even if treated successfully, preeclampsia can bring future health problems for mothers. Women who have had preeclampsia have double the risk for heart disease and stroke over the next five to 15 years after they are treated. The condition can cause blindness in some mothers.

The Preeclampsia Foundation estimates that in the United States about 10,500 babies die annually as a result of preeclampsia. The cost of the condition in the U.S., according to the foundation, is $7 billion annually, split between $3 billion a year in treating mothers and $4 billion a year for the cost of treating infants born prematurely.

Dr. Smitherman named interim vice dean of Diversity and Inclusion
In Headlines on July 6, 2015
Herbert Smitherman Jr., M.D., M.P.H.

Herbert Smitherman Jr., M.D., M.P.H.

Herbert Smitherman Jr., M.D., M.P.H., F.A.C.P., the assistant dean of Community and Urban Health for the Wayne State University School of Medicine, has been appointed interim vice dean of Diversity and Inclusion.

Dr. Smitherman will serve in the new position on an interim basis while a search for a permanent vice dean of Diversity and Inclusion is conducted. He will continue in his role as assistant dean of Community and Urban Health.

Jack D. Sobel, M.D., dean of the School of Medicine, announced the appointment June 6, noting that the vice dean of Diversity and Inclusion is a new office that was recommended by the Wayne State University School of Medicine Diversity and Inclusion Task Force. The task force submitted its findings to Dean Sobel in May.

“I established this task force, co-chaired by Dr. Smitherman, to develop recommendations to help rectify the decade or so decline in the enrollment of under-represented minority medical students,” Dean Sobel said. “I am committed to rectifying this problem and returning our School of Medicine to its position as the nationally recognized leader that it once was in recruiting qualified minority medical student candidates. Dr. Smitherman will help us do that, and help us define the role of this new position while we search for candidates.”

“We will need everyone’s help to improve diversity within our institution,” said Dr. Smitherman, noting that the task force’s report was shared with faculty, staff and students at the School of Medicine. “It is the right thing to provide opportunity for all. As interim vice dean of Diversity and Inclusion, I will begin to consolidate under one School of Medicine office all pipeline and diversity-based programs and assist the school in increasing the number of underrepresented minorities, not only at the medical student level, but also at the resident, fellowship, faculty and staff levels. I look forward to working with the entire School of Medicine community in assisting bringing the school back to its historic prominence related to diversity.”

Elected in May as president of the Wayne County Medical Society of Southeast Michigan and chair of the Detroit Wayne Mental Health Authority, Dr. Smitherman has been a member of the School of Medicine faculty for 25 years. He is an associate professor of Internal Medicine for the School of Medicine and for the Barbara Ann Karmanos Cancer Institute.

He also serves as president and chief executive officer of Health Centers Detroit Foundation Inc., a Federally Qualified Health Center Look-Alike that operates three health centers in Detroit under the name Health Centers Detroit Medical Group.

Dr. Smitherman has devoted himself to working with diverse communities to develop urban-based primary-care delivery systems that integrate the health, social goals and concerns of the community. He has committed more than two decades to providing quality medical care to underserved populations. In 2007, he and four co-authors published “Taking Care of the Uninsured: A Path to Reform,” which detailed the 10-year path of the Voices of Detroit Initiative. The project, launched in 1998 with a $5 million grant from the W.K. Kellogg Foundation, sought to ease the strain on emergency rooms relied upon by the uninsured as primary care facilities by providing access to true primary care. Originally tasked with addressing the primary care needs of 27,500 patients, the initiative surpassed that goal by assisting 33,093 uninsured Detroit residents in receiving access to basic primary care services.

He also served as co-chair of the $16.2 million U.S. Department of Health and Human Services Southeast Michigan Beacon initiative launched in 2012. That program used mobile phone text messaging and IT Healthcare Exchanges to engage diabetic patients to take better control of the self-management of their condition.

He has spoken nationally on health care disparities and has been invited to the White House several times to speak on that issue and others.

“Shifting U.S. demographics means we need to have a greater understanding of a variety of different cultures. In the 21st century, knowing how to work within our culturally diverse society is essential to meeting the health care needs of the nation, improving health outcomes, reducing health disparities and eliminating health inequities, especially among underserved populations,” Dr. Smitherman said. “Recently there has been a sharp decline in the number of underrepresented minority students admitted to and graduating from the School of Medicine. These diversity deficits were also identified by the Liaison Committee on Medical Education during its recent site visit not only at the medical student level but also at the resident, fellowship, faculty and staff levels.”

The WSU Center for Peace and Conflict Studies honored Dr. Smitherman with its annual Peacemaker Award in 2008, recognizing him for “monumental achievements and contributions to multicultural awareness and constructive conflict resolution.” The Michigan State Medical Society, in 2009, presented him with its Community Service Award for his efforts to battle health care disparities. In May, Michigan Gov. Rick Snyder appointed him to serve as a member of the state’s new Human Trafficking Commission.

Dr. Smitherman received his undergraduate degree in chemical engineering from Northwestern University in Evanston Ill., and his medical degree from the University of Cincinnati College of Medicine in 1987. He completed an internal medicine internship and residency in 1990 at the Wayne State University School of Medicine, and was named chief medical resident of the Veterans Administration Medical Center in Allen Park in 1990. He received his master’s of public health degree in health service administration from the University of Michigan in 1994. He also completed the National Health Care Forum Creating Healthy Communities Fellowship and is an International Salzburg Healthcare Fellow, where he was invited to spend time in Salzburg, Austria, to participate with health care experts from around the world in 2002 at the Salzburg Center. He has completed special course work in international economics and U.S. macroeconomics at Amherst College, in Amherst, Mass., and health care economics and conflict resolution at Harvard University.

Class of 2018 student's research appears in Arthritis and Rheumatology journal
In Headlines on July 2, 2015
Nathan Wood, Class of 2018.

Nathan Wood, Class of 2018.

Nathan Wood finished his first year at the Wayne State University School of Medicine in May, and the Class of 2018 student has already published his first academic paper.

“Characteristics of Fibromyalgia Independently Predict Poorer Long-Term Analgesic Outcomes Following Total Knee and Hip Arthroplasty” was published in the May issue of Arthritis and Rheumatology.

The paper comes out of work Wood performed as an undergraduate at the University of Michigan. The work earned him third place in the Clinical Studies Oral Presentations category at the WSU School of Medicine’s 2015 Medical Student Research Symposium in January.

“This is my first published work, and I feel very grateful to have been a part of it. I gained invaluable experience working with the orthopaedic surgeons and Chad Brummett, M.D. (assistant professor of Pain Medicine for U-M), who was as much of a mentor and friend as he was a preceptor,” Wood said. “It’s always satisfying to see your hard work pay off,but even better when you can celebrate it with people with whom you’ve worked so closely and for so long.”

Despite being a linguistics major, Wood applied as a 17-year-old freshman to work as a research assistant on Dr. Brummett’s research team in the school’s Department of Anesthesiology. “As the story goes, he gave me a pity interview at the request of his study coordinator, with no plans of ever hiring me. Apparently something went well in the interview, though, because I was hired that day,” Wood said.

Wood hopes to continue his involvement in clinical research in pain medicine and surgery, both now in medical school and in his prospective career as an academic physician.

He is conducting research this summer through the Henry Ford Health System’s Department of Plastic Surgery in Detroit, and hopes to continue being involved in his undergraduate mentor’s research.

“I am excited to see what future works this research might inspire and where the field of pain medicine and arthritic treatments goes from here,” he said.

The Brummett lab set out to see whether it could predict in advance which patients would “fail” their knee or hip replacement, and found that patient answers to a four-question “2011 Fibromyalgia Survey Questionnaire” predicted with statistical significance how they would respond to a total knee or hip replacement. The survey quantifies how fibromyalgia-like a patient’s symptoms are. The more fibromyalgia-like features a patient has, the more likely he or she is to derive little to no reduction in pain from a knee or hip replacement.

“With these findings, we argue two things. One is that a large proportion of the patients who ‘fail’ their lower limb joint replacement do so because of their preexisting fibromyalgia-like symptoms; we believe these symptoms are indicative of something called ‘augmented centralized pain processing,’ meaning their bodies process pain differently,” Wood said. “Our second argument is that this short survey could be used in orthopaedic surgery offices to help patients considering a knee or hip replacement develop realistic goals in regards to their expected pain relief.”

Dr. Kuhn honored for advancing women in emergency medicine
In Headlines on July 2, 2015
Gloria Kuhn, D.O., Ph.D.

Gloria Kuhn, D.O., Ph.D.

Gloria Kuhn, D.O., Ph.D., professor of Emergency Medicine for the Wayne State University School of Medicine, received the Advancement of Women in Academic Emergency Medicine Award from the Society for Academic Emergency Medicine.

Dr. Kuhn, vice chair of Academic Affairs for the WSU Department of Emergency Medicine, received the award in May during the society’s annual meeting in San Diego.

“Having been involved with the Academy for Women in Academic Emergency Medicine and been chosen to be the lead author of the manuscript ‘Recommendations from the Society for Academic Emergency Medicine Taskforce on Women in Academic Emergency Medicine’ has been one of the most satisfying experiences of my career,” said Dr. Kuhn, an attending physician at the Detroit Medical Center. “This recognition and honor is something I will treasure all of my life.”

The Farmington Hills resident has served on several SAEM committees and served as president of the AWAEM in 2012. She is known for her commitment to advancing careers for women in medicine.

“Women have a great deal to contribute to medicine, and supporting the recruitment and retention of these bright and dedicated physicians is crucial,” Dr. Kuhn said. “When I entered medicine there were few women in the field and some of my male colleagues sincerely questioned whether women had the intellectual capacity and strength that would allow them to practice medicine effectively. Those questions would never be asked today.

“Women have demonstrated their competencies and capabilities as physicians,” she added. “Almost 50 percent of medical classes are made up of women. They work side-by-side with their male colleagues, as equals. They have arrived and earned their place in the profession of medicine. If I have helped in some small way, I am grateful for having had the opportunity to advocate for them.”

In 2012, Dr. Kuhn received the School of Medicine’s inaugural Women in Medicine and Science Leadership Award. The awards is presented to an individual who has supported and brought recognition to women faculty members or activities for women faculty, and was created to recognize those who, by their leadership, have specifically promoted the advancement of women faculty members.

National Multiple Sclerosis Society funds grant to explore new model of MS pathology
In Headlines on July 1, 2015
Alexander Gow, Ph.D.

Alexander Gow, Ph.D.

The National Multiple Sclerosis Society has provided a grant to a Wayne State University School of Medicine professor to explore a new model of MS pathology.

Alexander Gow, Ph.D., the Charles H. Gershenson Distinguished Fellow Professor and associate director of the WSU Center for Molecular Medicine and Genetics, will use the three-year, $663,959 grant for his study, “Neurodegeneration associated with metabolic stress in oligodendrocytes.”

From the early-mid phases of MS, Dr. Gow said, the clinical symptoms are caused by considerable damage to the brain in the forms of autoimmune lesions, atrophy in the white matter and gray matter of the brain and cognitive deficits. Most studies to date have focused on finding disease-modifying therapies for the autoimmune component of MS, but have tended to ignore the cognitive changes, which can be the most debilitating and frustrating aspects for patients and caregivers.

Several important findings have come to light in recent years, he said, including the revelation that strong immunosuppression of patients for several years only modestly slows MS progression while damage to cortical brain regions continues and is widespread.

“In this study, we tackle both of these issues using a new model of MS pathology that does not involve autoimmune stimulation to generate disease symptoms,” said Dr. Gow, who also is a professor of Pediatrics and of Neurology for WSU. “Rather, we activate metabolic stress in oligodendrocytes to cause dysfunction and death of these cells, which is a potential disease mechanism that has gained experimental support from several laboratories.”

Oligodendrocytes are a type of cell that produce a membrane called myelin that coats axons, the pathways by which the brain sends messages to the muscles.

Dr. Gow will seek to determine whether this nonimmune-mediated animal model can recapitulate MS pathology and whether he can find evidence for behavioral changes and cognitive decline. He also will test a drug treatment designed to protect oligodendrocytes and neurons from the degenerative changes associated with inducing primary metabolic stress.

There is increasing evidence, Dr. Gow said, to indicate that autoimmune attacks on the central nervous system may be a secondary event rather than the primary cause of MS. This indicates that researchers must cast a broader net to test new ideas and develop alternative models that could shed fresh light on MS etiology.

Alliance selects WSU Graduate Medical Education, partner Crittenton, for national health equity initiative
In Headlines on June 30, 2015
Tsveti Markova, M.D.

Tsveti Markova, M.D.

Kimberly Pierce-Boggs

Kimberly Pierce-Boggs

The Wayne State University School of Medicine’s Office of Graduate Medical Education and hospital partner Crittenton Hospital Medical Center in Rochester, Mich., were selected to participate in a national health initiative sponsored by the Chicago-based Alliance of Independent Academic Medical Centers.

In “National Initiative V: Improving Community Health and Health Equity through Medical Education,” resident physicians will lead multidisciplinary teams in quality improvement projects aligned to their institution’s strategic goals.

The WSU-sponsored residency programs of Family Medicine, Internal Medicine, Transitional Year and Otolaryngology, championed by the WSU GME office, were selected based on a demonstrated commitment to better understanding and reducing health disparities in the community. When reviewing the application, the selection committee noted that WSU, partnering with Crittenton, has strong previous national initiative involvement and has identified the gap in GME understanding how disparities impact patient care and how they contribute.

Associate Dean of Graduate Medical Education Tsveti Markova, M.D., F.A.A.F.P., will lead the WSU-Crittenton team. She was honored in 2013 with the AIAMC Innovation Award for model educational practices on quality improvement and safety, leading to improved patient outcomes.

“The time is right for forward-thinking academic medical centers to proactively address community health needs while at the same time reforming residency training by involving trainees directly in community-based initiatives designed to improve health and reduce disparities,” said Dr. Markova, who also chairs the Department of Family Medicine and Public Health Sciences.

A leadership team will collaborate with select teaching institutions from across the United States to engage community partnerships that aim to provide better care for at-risk populations. Participants will attend four on-site learning sessions and monthly networking teleconferences and educational webinars during the initiative’s 18 months.

“Health disparities in the United States are well documented, and academic medical centers play a critical dual role in addressing this national problem because they train medical residents and fellows, the future physician workforce, and because many academic medical centers are key safety net providers,” said Kimberly Pierce-Boggs, AIAMC executive director.

Fifty-five hospitals and health systems and more than 450 individuals have participated in AIAMC National Initiatives since 2007. The initiatives have driven change that resulted in meaningful and sustainable outcomes that improved the quality and safety of patient care. The School of Medicine and Crittenton are among 29 AIAMC-member hospitals and health systems selected to participate.

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