- Pioneering study shows disease that causes sudden cardiac death in children can be prevented with new drug therapy
In Headlines on January 28, 2015
Steven Lipshultz, M.D.
A recently published study with major implications for ameliorating or preventing gene-triggered hypertrophic cardiomyopathy, a chronic form of heart muscle disease characterized by abnormal thickening and enlargement of the heart muscle that may also interfere with the function of the heart, suggests that pediatric cardiologists may soon be able to use drug therapy to block the onset of these abnormalities.
Hypertrophic cardiomyopathy can cause heart failure by stiffening the heart muscle and interfering with normal heart function. The condition sometimes causes sudden cardiac death when abnormal muscle cells and scar tissue lead to dangerous heart rhythms. Hypertrophic cardiomyopathy is the most common genetic disease of the heart, affecting one in 500 children. It is the most common cause of sudden cardiac death in young people and athletes.
The new study – the first of its kind and co-written by the Children’s Hospital of Michigan DMC Pediatrician-in-Chief Steven Lipshultz, M.D. – showed that in many patients carrying these genes the abnormalities did not develop, or if they did develop they improved if treated for one to three years with a calcium channel-blocking drug called diltiazem. The drug helps block the effect of the gene mutations on the growth of heart muscle fibers.
“With this study, we are opening a new chapter in the book about heart care,” said Dr. Lipshultz, who also chairs the Department of Pediatrics at the Wayne State University School of Medicine. “For the first time, we now have convincing evidence that drug therapy can protect patients from genetic mutations that lead to the abnormal heart development found in hypertrophic cardiomyopathy, a set of diseases that place affected children at increased risk for heart failure and sudden death.
“This study shows that if someone is carrying a mutated gene for hypertrophic cardiomyopathy but hasn’t yet developed the disease – in other words, a patient who is ‘genotype-positive but phenotype-negative’ – we can prevent or delay the onset of the disease later in life by administering the drug therapy during the patient’s earlier years. Further, the drug may also reduce the severity of associated diseases.
“This proof-of-concept study, funded by the United States National Heart, Lung, and Blood Institute of the National Institutes of Health and published in the Journal of the American College of Cardiology: Heart Failure, is an important milestone in the development of genetically-based therapies aimed at reducing the harmful effects of cardiac mutations,” Dr. Lipshultz said.
The study, “Diltiazem Treatment for Pre-Clinical Hypertrophic Cardiomyopathy Sarcomere Mutation Carriers”, looked at the effectiveness of diltiazem in reducing the development of heart muscle abnormalities in 38 children and young adults with genetic mutations that can lead to eventual heart failure. The study found that after these patients were treated daily with the drug for periods ranging from 12 to 42 months, “... left-ventricular end-diastolic diameter improved toward normal” – a key step in preventing heart muscle abnormality or left ventricular hypertrophy with possible scar tissue formation, which can cause heart failure and sudden death.
The authors of the study, led by Carolyn Ho, M.D., of Harvard Medical School and including investigators from Wayne State University School of Medicine, Johns Hopkins University School of Medicine, Sydney Medical School, University of Navarra and the Howard Hughes Medical Institute, concluded: “Pre-clinical administration of diltiazem is safe and may improve early left ventricular remodeling (preventing heart muscle growth abnormality) in hypertrophic cardiomyopathy. This novel strategy merits further exploration.”
Describing the breakthrough, Dr. Lipshultz said, “The gene mutations that cause the growth of too much heart muscle (hypertrophy) in children or young adults contribute to the leading cause of sudden death in young adults in the United States. But this study tells us that if you can prevent the onset or ameliorate the course of cardiomyopathy in a child with a gene mutation you may be able prevent or reduce the risk for heart failure and sudden death that will occur in some affected children.
“The first thing we aim for in pediatrics is prevention, and this study describes a truly exciting prospect – the likelihood that we will soon begin treating children with a heart failure-causing gene mutation long before the development of the muscle abnormality that causes the failure.”
Dr. Lipshultz, an internationally recognized expert on pediatric cardiac care who 25 years ago led the effort to found the nation’s only NIH-funded registry of pediatric cardiomyopathy and who has published numerous studies in pediatric cardiology and pediatric oncology, described the study as “a compelling example of how clinical research can help children. Such advancements continue to create a better future for our patients.
“What’s very promising here is the idea that if you know you carry the gene, and you know you can get treated for it early, then you have a good chance of winding up with a more normal heart in spite of the genetic mutation,” he said. “More science here may be capable of transforming life with less fear and disease because hypertrophic cardiomyopathy changes the lives, routine and future of affected children and their families, and also the way the world thinks about it.
“As a pediatrician who’s treated many children with heart abnormalities that can have tragic consequences, I can’t think of a better example of how cutting-edge research is helping establish innovative care with new therapies to create better outcomes for patients right here at the Children’s Hospital of Michigan.”
- Exhibit celebrates history of African-Americans at the WSU School of Medicine
In Headlines on January 23, 2015
Joseph Ferguson, M.D.
Chester Cole Ames, M.D.
Marjorie Peebles-Meyers, M.D.
Thomas FLake Sr., M.D.
“Celebrating Diversity: An Exhibit and Lecture Series on the History of African-Americans at the Wayne State University School of Medicine” will explore the rich history and the significant contributions of African-Americans during the school of medicine’s 147-year history.
The exhibit, which kicks off with an opening reception from 4 to 6 p.m. Jan. 29, will be on display all February in the atrium of the Shiffman Medical Library, 320 E. Canfield St. At 2 p.m. each Saturday in February, guest speakers will present histories of their personal and family experiences.
“The Wayne State University School of Medicine has a rich and diverse history,” said Anita Moncrease, M.D., clinical associate professor of Pediatrics and a Class of 1984 graduate. “This exhibit will help inform the school of medicine family about the important role the school played -- and still plays -- in educating African-American physicians. It will also tell some of the stories of the people whose photos they may see on the wall or names they may overhear in passing. Over time, African-Americans who have made major contributions to the school of medicine are being forgotten. This exhibit will remind those of us who knew some of them and will introduce others just coming along to them.”
Visitors will find included in the exhibit a timeline of African-Americans’ involvement with the school of medicine. Historic points along that timeline include:
* The 1869 graduation of Joseph Ferguson, M.D., who graduated from the Detroit Medical College and became the first African-American in Detroit -- and most likely in Michigan -- to earn a medical degree. Dr. Ferguson also was instrumental in the Underground Railroad and in the movement to integrate Detroit’s public schools.
* The 1893 graduation of Albert Henry Johnson, M.D., the third African-American graduate from the Detroit College of Medicine. A century later, his twin great- granddaughters, Kimberly and Kelly Colden, graduated from the Wayne State University School of Medicine. Dr. Johnson was one of the founders of Dunbar Hospital, the first African-American non-profit hospital in Detroit.
* In 1917 Drs. Daisy and David Northcross opened Mercy General Hospital, the first African-American hospital in Detroit.
* In 1926 Chester Cole Ames, M.D., graduated from the Detroit College of Medicine and Surgery. He was the first African-American to obtain an internship in urology at a white hospital in Detroit, but was never allowed on staff. He was Detroit’s first African-American intern, resident and member of the Wayne University medical faculty. He cofounded three African-American hospitals in Detroit, but was never granted hospital privileges to practice his specialty.
* In 1943 Marjorie Peebles-Meyers, M.D., graduated from Wayne University College of Medicine, the school’s first African-American female graduate. She became the first African-American female resident and chief resident at Detroit Receiving Hospital.
* In 1960 African-American physicians Thomas Flake Sr., M.D., Class of 1951; Addison Prince, M.D.; William Gibson, M.D.; and James Collins, M.D., were appointed to the staff at Harper Hospital staff, thereby integrating the Detroit Medical Center hospital staff.
Dr. Moncrease said visitors will find that many of the same barriers that African-Americans seeking careers in medicine faced a century ago continue to be roadblocks. At one time, she said, with the exception of Howard University College of Medicine and Meharry Medical College, two historically African-American universities, the school of medicine graduated more African-American physicians in the country than any other college.
“The personal stories of Drs. Joseph Ferguson, Marjorie Pebbles-Meyers and Charles Whitten are very interesting,” said Dr. Moncrease, an alum of the Black Medical Association and member of the Post Baccalaureate Program Admission Committee. “Their contributions to medicine in the face of racism, segregation and discrimination are lessons that everyone can take something away from. It is my hope that these personal stories will inspire visitors to want to learn more about them, other African-American alumni and African-American health care in Detroit, especially through attending the Saturday lecture series.”
Dr. Moncrease said the exhibit could not have been developed without the contributions of many people, including school staff, and especially Dedra Seay-Scatliffe, a member of the Office of Diversity and Inclusion.
“So many times people don’t know their history, so others will come along and lay claim to the positive aspects of it,” said Dr. Moncrease, who describes history as one of her passions, after God and family. “Because you don’t know your histories, others make you think you have not made a contribution in order to make you feel small. Knowing your history puts everyone on a level playing field, not because you can change the past but because you can learn from it and determine your own future.
“Learning history helps me respect others because I have a better understanding of what they have gone through in order to be where they are today, added Dr. Moncrease, who serves as the historian of her church, Hartford Memorial Baptist. “A physician can only truly know what is wrong with his or her patient by taking a good history. If they do not, they have an excellent chance of misdiagnosing and mistreating their patient. The physician can do a lot of tests to assist them with making the right diagnosis, but they could have saved themselves and the patient a lot of time and money by just taking a good history.”
The “Helping Hands: The African-American Health Care Experience in Southeastern Michigan” exhibit will also be on display, courtesy of the Kellogg African American Health Care Project and the University of Michigan. The exhibit provides a historical context for understanding the African-American experience with health care, the health professions and the health sciences in southeastern Michigan.
- CMMG's Leonard Lipovich talks RNAs in second Australia guest teaching stint
In Headlines on January 23, 2015
Drs. Kevin Morris, left, and Leonard Lipovich in Sydney, Australia.
The University of New South Wales in Sydney, Australia, hosted Wayne State University School of Medicine faculty member Leonard Lipovich, Ph.D., in September and October for the second installment of an instructional collaboration with the university’s School of Biotechnology and Biomolecular Sciences’ Associate Professor of Biological Sciences Kevin Morris, Ph.D.
Dr. Morris works on the role of non-coding RNA in epigenetic regulation of gene expression in human cells, and has two affiliations bridging the Pacific Dr. Morris’ primary laboratory is at The Scripps Research Institute in La Jolla, California, and more recently he acquired a joint affiliation at the UNSW, where he hosts a burgeoning and highly productive group of honors and graduate students.
Dr. Lipovich, an associate professor at the WSU Center for Molecular Medicine and Genetics and the School of Medicine’s Department of Neurology received UNSW’s Visiting Faculty Fellowship in 2013, teaching a two-week, hands-on practical in UNSW’s undergraduate core molecular biology and genomics course that year. In his 2014 visit, he taught three half-day computational labs and three related one-hour theory lectures for the same undergraduate genomics course.
During his 2014 visit, he also guest-lectured about his research in a freshman course on gene regulation and epigenetics, and, together with researcher Marianne Farnebo, Ph.D., of the Karolinska Institutet in Sweden, who was visiting the Morris laboratory during her sabbatical, spoke as part of the university’s popular Friday biological sciences seminar series for faculty, postdocs and students. Dr. Lipovich had additionally given a fellowship guest seminar at UNSW in 2013, and delivered two invited lectures at The Garvan Institute of Medical Research, also in Sydney, over the course of his two recent academic visits to Australia. Faculty, postdocs, and graduate students comprised most of the audiences.
The stints all spotlighted Dr. Lipovich’s work on primate-specific long non-coding ribonucleic acids, or lncRNAs, in human breast cancer and the three major international post-genomic consortia in which he is a co-investigator.
One, ENCODE (Encyclopedia of DNA Elements; www.encodeproject.org), is an international consortium that serves as the official successor to the original Human Genome Project. Dr. Lipovich also is in his second decade of working with the Japan-based Functional Annotation of the Mammalian Genome (FANTOM) Consortium, and in early 2014 he joined the CHARGE (Cohorts for Heart and Aging Research in Genomic Epidemiology) Consortium, singlehandedly bringing all three major international efforts to Wayne State through his laboratory.
After speaking at an off-campus bioinformatics club in Sydney about lncRNA datasets in the UCSC Genome Browser, Dr. Lipovich was interviewed about lncRNA and primate-specific genes in human evolution for two episodes of Diffusion Radio, a podcast and radio show that airs throughout Australia. The episodes were broadcast by four radio stations in New South Wales and along the Victoria/South Australia border, and were also made available as a podcast online.
(Listen to the interview here).Next, Dr. Lipovich will use his five-year, $2.3 million National Institutes of Health New Innovator Award, which he received in September 2014, to test a hypothesis that could lead to breakthrough methodologies to improve health. The project will identify primate-specific lncRNAs that are functional in cell growth and cell death, within the framework of human estrogen receptor positive breast cancer. The goal of the project, which has broad relevance to other nuclear hormone receptor pathways in human disease, is to reveal the extent to which non-conserved RNA genes contribute to cancer pathogenesis in humans.
- March 21 5K run/walk benefits Student-Run Free Clinic and Street Medicine Detroit
In Headlines on January 23, 2015
Just as they combine to assist the homeless and underinsured, the Robert R. Frank Student-Run Free Clinic and Street Medicine Detroit have teamed up this year to host a 5K run/walk to raise funds to support the efforts of both student organizations.
Proceeds from the March 21 run/walk will benefit Michigan’s first student-run free medical clinic and the Street Medicine Detroit mobile clinic.
The event will begin with registration and check-in at 7:30 a.m. in the Visitor’s Center at Fort Wayne in Detroit. The run/walk will begin at 9 a.m. with the run, followed by the walk starting at 9:15 a.m. An awards ceremony for the top three men and top three women taking part in the 5K run will be held at 11 a.m.
The registration fee is $25. Those registering by March 1 will be guaranteed an event T-shirt and medal. All participants will be provided with snacks following the 5K. To register for this year’s Street Run 5K Run/Walk, visit www.frankclinic.org/streetrun5k or register the morning of the event at the registration/ check-in table.
“The Robert R. Frank Student-Run Free Clinic and Street Medicine Detroit both appreciate the value of providing primary health care services to Detroit's medically uninsured and those otherwise unable to obtain health care,” said Cara Crawford-Bartle, a second-year medical student involved with the clinic. “We are excited to team up with a like-minded organization, and by doing so, we hope to reach a larger number of people with which we can share our visions and garner support. Funds raised by the event will be split evenly between the groups and utilized to further our endeavors. By working together we also hope to set the stage for future collaborative efforts allowing both groups to provide the best possible care to patients.”
“From our perspective, we were fortunate enough to be asked and welcomed by the Student-Run Free Clinic to jointly host this 5K,” said fourth-year Jonathan Wong, founder and president of Street Medicine Detroit. “Ever since we started Street Medicine Detroit, the clinic was a model organization for us as we began to think about our mission and how we might carry out that mission at an operational level. So it's particularly meaningful for us to partner with the clinic for this event.”
While organizers have not yet mapped out the course, there is a paved path through Fort Wayne that likely will be used for as much of the run/walk as possible. Organizers selected the Fort Wayne location after holding the run/walk for several years on Belle Isle to offer a change of scenery for participants.
“We are excited to bring this event back after a brief hiatus and look forward to implementing new ideas, like the option to participate as a four-person team,” Crawford-Bartle said. “We are confident that the SRFC-SMD Street Run 5K will be enjoyable for runners and walkers alike and we look forward to seeing everyone there.”
The Robert R. Frank Student-Run Free Clinic and Street Medicine Detroit serve the needs of the medically underserved in Detroit. With the help of Wayne State University School of Medicine and Mercy Primary Care, the student-run free clinic offers a high-quality, non-emergent, primary care resource to the medically uninsured in the city while providing an opportunity for medical students to gain experience in cultural, competent medicine in an atmosphere of mutual respect and dignity.
Street Medicine Detroit’s mission is to ensure access to quality medical care for Detroit’s unreached homeless population by bringing the clinic directly to patients. The chapter is run by Wayne State medical students partnering with local social service organizations to provide weekly outreach at shelters and occasionally on the street. Street Medicine Detroit is committed to a multidisciplinary approach to medicine in which patients are offered preventive and primary care, and access to local housing and health resources.
For more information on the 2015 Street Run 5K Run/Walk, contact Cara Crawford-Bartle at 313-444-5490 or srfcsmdstreetrun5K@gmail.com.
- Street Medicine Detroit honored at MLK tribute event
In Headlines on January 22, 2015
Street Medicine Detroit leaders and Jennifer Mendez, Ph.D., celebrate with the Arthur L. Johnson Community Leadership Award.
Street Medicine Detroit, a Wayne State University School of Medicine student organization, was honored at WSU’s annual Martin Luther King Jr. Tribute, held Jan. 16 at the Max M. Fisher Music Center in Detroit.
The organization received the 2015 Dr. Arthur L. Johnson Community Leadership Award from Wayne State’s Office of Government and Community Affairs. The award is named after the late civil rights leader and Wayne State administrator, and honors individuals and organizations whose contributions positively affect the community. Nominations are made by the public.
“The award is a huge honor, and certainly a reflection of not just our dedicated student volunteers, but our community partners, who do street outreach on a daily basis. We lean heavily upon Neighborhood Service Organization and Southwest Solutions, and we are forever grateful for the meaningful and inspiring work that they do,” said Street Medicine Detroit founder and President Jonathan Wong, a fourth-year medical student. “I think the award is also a win for our patients, too, because of the increased community awareness it provides and the platform for them to share their journey of getting back on their feet.”
Street Medicine Detroit delivers health care and related services directly to the city’s homeless, who are often service-resistant and staying in temporary shelters or living on the streets. The students visit the homeless twice a week with social service providers, are supervised by certified nurse practitioner Dean Carpenter, and perform basic health procedures such as checking vitals, testing blood glucose levels, answering medical questions and distributing medications as needed. The group’s goal is to improve health outcomes in the underserved population and reduce emergency department visits and costs. Street Medicine Detroit has had approximately 700 patient encounters since starting health care “runs” in 2012, including more than 200 follow-up visits, a testament to the continuity of care it’s delivering, Wong said. Student volunteers earn co-curricular credits for participation. For more information visit www.streetmedicinedetroit.org and like the organization on Facebook.
“They won the award because of their dedication to the underserved population in Detroit, despite having heavy didactic and clinical commitments. They make time outside of class to learn and serve the community in which they live and go to school,” said Jennifer Mendez, Ph.D., who directs the school’s Co-curricular Programs and attended Friday’s event with the group. “We are grateful to the faculty, residents and fellows who are a part of the team with the medical students.”
Richard Bryce, D.O., was appointed the organization’s first medical director seven months ago. “He is a humanistic and compassionate family medicine physician who is innately able to build trust and relationships with his patients. He has been a wonderful addition to our lead clinical preceptor, Dean Carpenter, who has been modeling these same characteristics for our students for years. We also have several other residents and attendings who volunteer with us semi-regularly,” Wong said.
The group continues to grow and improve, including implementing a new Electronic Medical Record provided by another Street Medicine practice based in Santa Barbara, Calif. Members also are working to improve their inpatient consult service workflow, finalizing a Street Medicine Detroit elective at the School of Medicine for third- and fourth-year students, submitting an application for nonprofit status and better integrating with partners to provide targeted multidisciplinary care, Wong said.
Since the awards ceremony last week, the organization’s leaders are receiving requests to explore potential collaborations with homeless recovery services groups and many individuals have asked to help or offer their expertise. “We think this is definitely a good thing, as no single entity can tackle the issue of homelessness alone,” Wong said. “Our patients could still benefit from some more regular residents and attending physicians. We could also use more cash flow, particularly for some of the long-term goals that we have.”
Wong is quick to thank others for their continued support, including Henry Ford Health System and the School of Medicine’s Department of Psychiatry and Behavioral Neurosciences, as well as Wayne State’s Office of Government and Community Affairs and its director of Community Relations, Victor Green, who organized and hosted the MLK Tribute Day, “plus the patients who we serve who courageously invite us into their lives in hopes that we might be able to provide comfort and healing,” Wong added.
Established in the late 1990s, Wayne State’s Martin Luther King Jr. tribute brings together the metropolitan Detroit community to celebrate and honor the life and legacy of King, and has featured prominent civil rights leaders and advocates. The 2015 keynote speakers were The Three Doctors – Sampson Davis, Rameck Hunt and George Jenkins, who as teens growing up together in Newark, N.J., were surrounded by negative influences, yet made a pact that they would stick together, go to college, graduate and become doctors. The practicing physicians wrote three books about their lives and founded The Three Doctors Foundation in 2000.
- WSU/DMC name new leadership in Obstetrics and Gynecology
In Headlines on January 21, 2015
Robert A. Welch, M.D.
Wayne State University, the Wayne State University Physician Group and the Detroit Medical Center announced today that Robert A. Welch, M.D., will become DMC and WSU’s vice chair of DMC Obstetrics and Gynecology Clinical Operations – WSU chief and division director of Maternal Fetal Medicine, effective Feb. 1.
In his new role, Dr. Welch will focus on the continued growth and development of obstetrics and gynecology specialty services, and the development of strategic partnerships with physicians to provide advanced medical and surgical care for women. Dr. Welch’s additional duties will include working closely with other DMC and WSU leaders on women’s health and academic-related enterprises.
“Bringing Dr. Welch to Wayne State University and the Detroit Medical Center is quite a coup for our patients,” said Jack Sobel, M.D., interim dean of the WSU School of Medicine. “He is renowned as a leading clinical physician and researcher in the area of obstetrics and gynecology. His leadership further cements the fact that WSU and DMC are a major center for maternal-fetal medicine.”
“Dr. Welch’s expertise in women’s academic medicine, coupled with his experience in developing strategic partnerships with community hospitals and physicians, ensures that DMC and WSU are uniquely positioned to transform women’s health care in a more far-reaching and meaningful way for the communities we serve,” said DMC Chief Executive Officer Joe Mullany.
Dr. Welch received his undergraduate degree from the University of Toledo, his master’s degree in science administration with emphasis on the medical sciences from Central Michigan University in Mount Pleasant, Mich., and his medical degree at Louisiana State University Medical Center in New Orleans. His residency in obstetrics and gynecology and fellowship in maternal-fetal medicine were both completed at DMC/WSU.
After his fellowship, Dr. Welch remained as WSU faculty member for five years, during which time he completed a National Institutes of Health-sponsored faculty fellowship focused on substance abuse during pregnancy. He subsequently relocated to Providence Hospital in Southfield, Mich., where he developed the Maternal-Fetal Medicine Network, was appointed chair of obstetrics and gynecology, and promoted the development of the Divisions of Gynecology Oncology, Female Pelvic Medicine Reconstructive Surgery, and Minimally Invasive and Robotic Surgery. He also served as medical director for Women’s Services for the Western Region of St. John Providence Health System and was a residency program director.
Among his many accomplishments and accolades, Dr. Welch has published numerous refereed papers, book chapters and various monographs on topics related to high-risk pregnancy, and is a co-inventor of several commonly used medical devices. He received the Ephraim McDowell Award in research from District V of the American Congress of Obstetricians and Gynecologists, the Donald F. Richardson Memorial Prize for the best research paper presented at the ACOG annual meeting, and twice was presented the Community Hospital Award by the Central Association of OB/GYN. He chaired a five-hospital regional consortium dedicated to sharing quality assurance initiatives within St. John Providence Health Hospitals and served on the Perinatal Safety Committee of the Ascension Health System. He also was a co-chair for High Reliability for the 63 OB/GYN hospitals in Ascension Health.
Dr. Welch is a clinical professor of obstetrics and gynecology at the WSU School of Medicine, and is active in local, regional and national quality improvement activities in the field of obstetrics and gynecology. His research focuses on measurement of a specific cell-free fetal RNA in amniotic fluid and maternal circulation, and utilizing this portion of the fetal transcriptome for future clinical applications in perinatal medicine.