Posted on October 1st, 2013 by Admin
University of Illinois Chancellor Phyllis Wise and her administrative team attended Mayo Clinic's Individualizing Medicine Conference this week and held meetings on ongoing collaborations between the two institutions. The group from Urbana-Champaign included (l-r) Associate Vice Chancellor Jennifer Eardley; Gianrico Farrugia, M.D., director of the Center for Individualized Medicine at Mayo; Vice Chancellor Peter Schiffer; Chancellor Wise; Provost Ilesanmi Adesida; and Bryan White, Ph.D., who served as co-chair of the conference. Mayo and Illinois have been collaborating for years on medical genomic projects under the banner of the Mayo Illinois Alliance for Technology Based Health Care. Recently extensive work has been done in microbiome research and dozens of students and researchers have traveled between the campuses to work together.
Posted on October 1st, 2013 by Admin
"Getting the what in the what?" That's going to be a problem if health care professionals are asking that question in the future. Many medical centers are finding that patients have allergies or will be put at considerable risk if given the wrong drug for their genetic makeup or even the standard dose of the right drug. Pharmacogenomic screening prior to prescribing medications will one day be a normal practice. It's the mantra of giving the right dose of the right drug at the right time. One size, one standard pharmaceutical practice, does not fit all. Your genome can often provide the answer. At Mayo's Individualizing Medicine Conference today, we've been hearing about how pharmacogeneomic screens are done at St. Jude Children's Hospital (thanks Dr. Mary Relling) and how those results are immediately going into those patients' electronic medical record.
The problem comes in if patients aren't exposed to appropriate screens --- or if they don't have an EMR. With an EMR, any physician can see almost immediately through a genomic-drug alert in the record (at Mayo a red flag pops up) that a patient should not be given drug X. This avoids a trial and error system of letting the patient's physiology reject the drug while exhibiting associated side-effects. We are used to hearing the slogan "There's an app for that." Well, soon we'll be able to say "There's a test for that" -- before you take a drug, any drug. There's relevance for you.
Posted on September 30th, 2013 by Admin
Dr. Eric Green summed up his plenary talk at Mayo's Individualizing Medicine conference by sharing his vision for what we'll see (and he and his colleagues will do) in genomics research and application before 2020.
Hot Areas in Genomic Medicine:
Posted on September 30th, 2013 by Admin
Dr. Eric Green, head of the National Human Genome Research Institute, is now on the stage...explaining how "genomics is becoming increasingly relevant to the patient." He says this discipline is a marathon, that began 13 years ago with the initial mapping of the human genome. Now he talks of "base pairs to bedside" or "double helix to health"...and points to the strategic plan for his institute, published in 2011. He is now outlining advancements in our understanding of the genome, it's biology, how it impacts human biology and then how it can impact medical practice. Finally, he says, we must measure and demonstrate how genomics improves health care.
He also says we've learned much in the last decade, including the epigenomic code -- the impact of proteins on our genetic behavior based on environmental influences. He is essentially setting the stage for what will come later in the conference -- all of the knowledge thus far, he says, is a "Cliff Notes" version of the human genome and we have a lot more to learn -- including the differences in individual human genomes.
Posted on September 19th, 2013 by Admin
Mayo Clinic radiology researcher Cynthia McCollough, Ph.D., and her team were awarded a four-year grant from the National Institutes of Health that will allow Mayo to establish a national clearinghouse for CT dose reduction research. Dr. McCollough is internationally known for her work in limiting radiation exposure to patients. She is head of Mayo's CT Clinical Innovation Center.
Their NIH grant application, in response to a request for proposals to reduce CT doses to the level of background radiation, was the only one funded in a highly competitive field.
“This grant is unique in that it provides funding for Mayo Clinic to establish a national clearinghouse to share the data sets, software algorithms and imaging methods developed by our team with the entire CT imaging community,” says Dr. McCollough.
This will be the first information depository of its kind in the field of CT dose reduction, providing reference data sets for use in developing and validating the many noise reduction and iterative reconstruction methods currently under development. “Mayo Clinic will provide a tremendously valuable resource for all researchers working on dose reduction in CT,” she says.
Other investigators involved include Joel Fletcher, M.D., Shuai Leng, Ph.D., Lifeng Yu, Ph.D., David DeLone, M.D., Jeff Fidler, M.D., David Levin, M.D., Ph.D., Rickey Carter, Ph.D., and David Holmes III, Ph.D.
Posted on September 5th, 2013 by Admin
A team of researchers from the Mayo Clinic Children's Center are trying to answer that question. From what they can tell from animal studies, it may cause problems with learning and memory. They've conducted a study of records -- both medical and school records - in the area around Rochester, Minn. There was some correlation: an association with learning disabilities and attention deficit disorder for some children who'd been exposed to anesthesia multiple times at a young age.
But as we know, correlation does not mean causation. So they are now working on a much larger and detailed study to test 1000 children to see if they can better define what injury or injuries may be associated with anesthetic exposure (if any).
Ultimately they hope to find if there is a problem with how anesthesia is administered or if changes are needed to minimize potential problems. It's one more way Mayo Clinic is trying to improve safety of the medical practice and share its findings with everyone.
If you, as a parent, are interested in having your child participate in this study -- and you live in the Rochester, Minn. area, you may be interested in learning more about it from this YouTube video:
Posted on July 10th, 2013 by Admin
Mayo Clinic is among the handful of centers launching one-year fast-track studies of existing drugs to determine their value for other conditions. In Mayo's case, Jordan Miller, Ph.D., a Mayo Clinic researcher in the Departments of Surgery and Physiology, and two colleagues were awarded the grant to study the drug from pre-clinical tests through the first clinical trial, all in one year. The targeted condition is aortic valve stenosis -- a type of cardiac stenosis in which the valve area calcifies, leading to serious heart problems.
In a world where some research findings take a decade or more to surface in the world of patients, the National Institutes of Health is trying to whittle that time of translation down to a single year. That includes several rounds of preclinical studies and then a phase one clinical trial to determine efficacy by the end of the twelve months.
“This is highly significant, not only because of the speed of the process, but the impact that it may have on prolonging lives,” says Dr. Miller. “We have a year to determine if there’s a positive change in experimental models and in patients. If so, we move on with more studies.”
Mayo Clinic is one of only nine awardees of a new type of research grant, one that takes an existing but unused drug from a participating pharmaceutical company and studies it for a different disease or condition. In this case the drug is supplied by Sanofi and Mayo’s team led by Dr. Miller, will see if it will work to slow the advance of aortic valve stenosis, in which calcification keeps the heart valve to the aorta from opening fully.
While only three percent of Americans of retirement age develop aortic valve stenosis, calcium can be seen (using x-ray or CT scanning) on the valves of approximately half of the population over 65. As baby boomers continue to live longer, the actual numbers of patients expected to progress to aortic valve stenosis are expected to grow dramatically, and less than 40 percent survive beyond five years from diagnosis. Right now there is no effective treatment for advanced stenosis, other than replacing the heart valve – a surgical procedure that carries its own risk.
Dr. Miller says this new application of the drug may not remove existing calcification, but it may slow the progression or stop it from getting worse. “Even slowing progression of valve calcification by 50 percent will greatly reduce or delay the need for surgical intervention in these patients.” The first steps of the study are already underway.
Posted on July 9th, 2013 by Admin
Trials and Fibrillations is a blog on the Heart.org, by Kentucky physician John Mandrola. He happens to be an electrophysiologist, thus the blog title. We wanted to offer up here one of his recent posts -- for reasons very apparent you'll if you read it -- in which he outlines his recent experience at a presentation by Mayo Clinic cardiologist and long QT expert Michael Ackerman, M.D., Ph.D.
The talk is titled Five Reasons To Not Do Genetic Testing. It seems counterintuitive, but there are instances when testing isn't the best approach -- including when there's no one around to properly interpret the results. But we'd rather that you hear Dr. Mandrola's take on the talk...and on Dr. Ackerman. In any case, we're glad he's in the house.
Posted on June 3rd, 2013 by Admin
Edith Perez, M.D., an internationally known breast cancer researcher, and deputy director at large of the Mayo Clinic Cancer Center, is fond of finding simplicity in treatment where possible. Her recent study has done just that. Published in the Journal of Clinical Oncology, a national team of researchers, including investigators at Mayo Clinic in Florida and Minnesota, found it is not necessary to test for presence of tumor suppressor PTEN protein in the HER2-positive subset of breast tumors.
“Many people hypothesized that this marker would be very important for treatment decisions — that it could predict resistance to trastuzumab, which is standard therapy. It almost became something people took as a fact,” Dr. Perez says. “Several small studies gave conflicting results, but people still paid more attention to the positive results.”
The study was the first to thoroughly test for this protein marker in the setting of long-term follow up of 1,802 patients with early stage HER2-positive breast cancer. The results conclusively showed that there was no difference in disease-free survival between PTEN-positive and PTEN-negative tumors, Dr. Perez says. Clinically, then, patients with HER2-positive early breast cancer with or without PTEN benefit from treatment with trastuzumab.
“This will help many investigators now and in the future because we can focus our attention on evaluating other markers that predict effectiveness of trastuzumab treatment in the adjuvant setting, instead of continuing to test for PTEN protein,” she says.
Posted on May 30th, 2013 by Admin
A change has occurred in medicine. Just wanted to make note.
A couple of years ago, on the 10th anniversary of the mapping of the human genome, the national media issued a number of stories lamenting what they saw as the irrelevance of that achievement for medical patients. I won't list the bylines here, but there were a number of these stories, all quick to conclude that little was being done in the field and that the public hadn't benefited. Well, I guess you have to be a little more patient with science... it doesn't happen on a timetable and things don't fit into nice little decade-sized packages. Now, less than three years later, Mayo Clinic announced today that its Individualized Medicine Clinic was open for business. That it was taking referrals -- from physicians, from other institutions, and self-referrals from patients themselves. What do I mean? I mean 20 physicians, plus dozens of other team members -- technicians, bioinformatics specialists, genetic counselors, and others -- are working up patient cases on all three Mayo campuses. Actually over 30 patients have already been seen, so there's a bit of a track record.
How is this different from what other institutions are doing? A number of centers are doing genomic screening, yes, but if you look into it, they are doing this under a research protocol, perhaps as a clinical trial. In other words, as experimental medicine. This is not that. The Individualized Medicine Clinic has standardized genomic medicine - full individualized sequencing and analysis - as a regular program of Mayo's clinical practice. The Individualized Medicine Clinic is currently seeing two types of cases: hard to diagnose and treat cancer patients; and "diagnostic odyssey" cases - patients who have a set of symptoms, but no diagnosis and there is some indication the problem may be heritable. (Mayo will continue to conduct a range of genomic research as part of its Center for Individualized Medicine and you'll be seeing plenty of news about that as well.)
The Doctor Is In. So -- my point at the start of this post, was that something had changed in medicine. Genomics is now part of the practice of medicine. It's not just part of research and it's certainly not science fiction. We are beginning to regularly treat people based on their individualized genomic differences. So while it's still reasonable to say genomics is part of medicine's future -- please pass the word that it's also part of the present.