Advancing the Science

Mayo Clinic Medical Science Blog – an eclectic collection of research- and research education-related stories: feature stories, mini news bites, learning opportunities, profiles and more from Mayo Clinic.

About

Member has chosen to not make this information public.

Posts (51)

Thu, Feb 7 6:00am · Eva Galanis, M.D.-Bitten by the virotherapy bug

Every day more than 1,600 Americans die from cancer. Most of them have cancer that can’t be cured with traditional methods — surgery, radiation and chemotherapy. The father of Evanthia Galanis, M.D., was one of them.

He died in the late 1990s from melanoma when his daughter was a junior faculty member at Mayo Clinic.

“My father would have better treatment options today,” says Dr. Galanis, chair of the Department of Molecular Medicine at Mayo Clinic in Rochester and the Sandra J. Schulze Professor. “Research has led to the availability of very effective melanoma treatments, including immunotherapy. My father always encouraged me to be the best I could be. Every time I see a patient with cancer for whom we can’t offer good options, I think of him, and my commitment to decreasing the burden of cancer and eliminating it altogether is re-energized. I’m more determined to find answers as a result of that very difficult personal experience. I know my father’s legacy makes me a better oncologist and researcher.”

From fellow to virotherapy P.I.

Dr. Galanis’ research is focused on developing viral gene and cell therapies to treat cancer. She has been the principal investigator in multiple phase I and II gene therapy and virotherapy trials in solid tumors (ovarian cancer, glioblastoma, renal cell carcinoma, colorectal cancer, melanoma and pancreatic cancer).

She believes that ongoing trials could result in viral therapy products being approved for cancer treatment in the next several years. Many viruses are drawn to cancer cells, which grow and replicate more quickly than normal cells. Virotherapy harnesses viruses’ cancer-cell-killing ability to attack cancer cells while sparing normal cells. Mayo Clinic has explored treating cancer with gene therapies and viruses for about 25 years, making it one of the oldest cancer gene therapy and virotherapy programs in the country. Dr. Galanis was there from the start — as a hematology/oncology fellow.

“When you understand what’s wrong with a cancer cell, you can design a gene-based treatment to repair the defect or convert the abnormally behaving cell to one that behaves like normal cells,” says Dr. Galanis. “That led to my interest in gene therapy — using genetic material to treat disease — and trials to introduce genes in tumors. Today we have much better ways to deliver genetic material to cells; we also can use viruses to deliver genetic material that replicates and kills cancer cells. This is a welcome alternative to chemotherapy, which isn’t selective and can be crude for and highly toxic to patients.”

The measles virus is one of the most promising viral platforms. It has shown to be safe, generates good immune response from the tumor, and can be engineered to carry genes and retargeted to be more specific against certain types of cells. In the early 2000s, Mayo Clinic researchers delivered a weakened strain of the measles virus to laboratory mice with ovarian cancer. Their tumors shrank by 80 percent. To test that approach in humans and more quickly move ideas to the clinic, Mayo Clinic created a vector production facility — one of the only academic sites in the world capable of manufacturing clinical-grade engineered viruses for patient use.

First-in-human measles virus trials

Dr. Galanis led the first-in-human clinical trials in which 36 patients with recurrent ovarian cancer were treated with homegrown measles strains. Patients treated with higher doses of the viruses achieved a median overall survival of 27 months — more than twice as long as the expected median survival in these heavily pretreated patients who had failed multiple chemotherapy regimens. The vaccine provided remarkable results on other cancers in the lab, eliminating tumors in almost every model tested.

A five-year, three-site randomized phase II trial is now comparing measles virus treatment for ovarian cancer with the treating physician’s chemotherapy of choice. In addition to efficacy, the virotherapy is much less toxic than chemotherapy, resulting in better quality of life for patients.

More recently, Dr. Galanis led the first human trial of stem cell delivery of a cancer-killing virus. The phase I/II trial uses a small amount of a patient’s fat tissue to generate stem cells at Mayo’s Human Cellular Therapy Laboratory that are then infected with measles virus. The cells are subsequently infused back to the patient. The infected stem cells help lead the virus to tumor sites. With a grant from the National Cancer Institute, the trial recently expanded the number of patients to assess efficacy and treatment impact on survival. If the trial succeeds, the way physicians deliver viruses to cancer patients could change drastically.

Designer virus

When viruses destroy cancer cells, they release hundreds of infectious virus particles to kill the remaining tumor. The infected cells also secrete chemicals that trigger the anti-tumor immune response. This ability to kill cancer cells and recruit immune cells to join the fight makes viruses a potentially potent treatment for advanced cancers that don’t respond to other therapies.

Dr. Galanis is exploring ways to strengthen this immune response to cancer by combining the measles virus with an antibody that unleashes the immune system — a combination of virotherapy and immunotherapy. In mice with malignant brain tumors, this combination therapy significantly increased survival, leading to cures in 60 percent of the animals.

In further exploration of these encouraging results, Dr. Galanis’ laboratory has modified the measles virus to express genes that significantly enhance the immune response to the tumor, which Dr. Galanis describes as a form of vaccination against cancer. The first-ever phase I clinical trial with one of these designer viruses is about to launch in patients with metastatic breast cancer in partnership with Mayo Clinic’s Specialized Program of Research Excellence (SPORE) in breast cancer.

A new standard of care

With the first-in-human testing of the measles vaccine for ovarian cancer, first-in-human stem cell delivery of a virus and novel combination virotherapy-immunotherapy approaches under her belt, Dr. Galanis remains laser-focused on rapid translation of lab work to trials.

“Viruses represent an innovative way to treat cancer, and clinical activity is very promising,” says Dr. Galanis. “Some of the leading efforts in the world in virotherapy are happening at Mayo Clinic. We believe our trials will lead to viruses becoming incorporated to the standard of care. I’m honored to be part of a team in the Department of Molecular Medicine and the Cancer Center that can bring clinical and lab work together and move science forward to help our patients and change lives.”

###

This article was originally published in Mayo Clinic’s Alumni Magazine, Issue 4, 2018.

NOTE: The composite image is from the Mayo Clinic Viral Vector Production Laboratory.

 

SAVOR, SUBSCRIBE, SHARE:  Advancing the Science

  • If you enjoyed this article, you might want to subscribe for regular updates.
  • If you want to share this story with friends, social media links are at the top of the article.
  • And if you want to see other recent stories on the blog, the index page is a great place to start.

Tue, Jan 29 6:00am · The Newbies Weigh In - Women in cardiology

Four of the 39 women cardiologists at Mayo Clinic: Shannon Dunlay, M.D., Marysia Tweet, M.D., LaPrincess Brewer, M.D., and Rehka Mankad, M.D.

Diversity and inclusion are integral to Mayo Clinic’s mission to provide excellent, culturally relevant care in a welcoming environment to patients from a wide variety of backgrounds and creating an inclusive work environment where differences are valued, allowing individuals to achieve and contribute to their fullest potential.

The women featured in these profiles represent a small – but representative – sample of the talents and dedication of the more than 63,000 diverse individuals who make up Mayo Clinic.

Women in cardiology at Mayo Clinic are blazing trails for the next generation rather than fit a traditional mold. Their backgrounds and accomplishments are varied, adding layers of diversity that extend well beyond the obvious.

Meet LaPrincess Brewer, M.D.

‘There is strong mentorship at Mayo, and I knew I would be trained to be among the next leaders in academic cardiology.’

LaPrincess Brewer, M.D. (@DrLaPrincess), Division of Preventive Cardiology, says she’s always had female role models in cardiology although representation varied. “I thought, ‘Wow, she did it. Maybe I can, too.’”

She says the representation at Mayo Clinic was inspiring. “I saw many female cardiologists on staff and in leadership positions. I saw women from Mayo leading professional organization meetings. I felt I would be embraced and my skills and talents would be fostered at this institution. I wanted to take the baton and pass it on. But before you can do that, you have to receive the baton. There is strong mentorship at Mayo, and I knew I would be trained to be among the next leaders in academic cardiology.”

Dr. Brewer has a master’s degree in public health, and her research focuses on cardiovascular health disparities. “In the church community where I grew up in North Carolina, so many people lost their lives prematurely to cardiovascular risk factors,” she says. “So much potential was lost. That drove me to focus on preventive cardiology and health disparities research. I want to make the strongest impact possible from a public health standpoint on the No. 1 killer in the world.”

Dr. Brewer faces unique challenges as an underrepresented minority woman in medicine, who account for less than 5 percent of cardiologists. Dr. Brewer is the first African-American woman cardiologist on the Mayo Clinic Rochester staff.

“Don’t let perceived barriers deter you from pursuing cardiology,” she says. “I’m early in my career and have had so many opportunities I wouldn’t have imagined as a medical student, and I’ve been fostered by my mentors and professional organizations. If the culture of your institution supports what you do professionally and personally, this will lead to your success. Mayo Clinic has been supportive of my career development and has been an incredible place to work and pursue my unique research interests.”


Meet Shannon Dunlay, M.D.

‘I wanted to be a cardiologist and knew I could make the rest of it work.’

Shannon Dunlay, M.D. (@ShannonMDunlay), Division of Circulatory Failure, was interested in cardiology as far back as college when she worked with a hypertension basic scientist. “I knew I’d have the opportunity to save lives and help patients feel better and live longer,” she says. “I didn’t let the perceptions about cardiology and work-family life balance affect my decision. I wanted to be a cardiologist and knew I could make the rest of it work.”

She says she noticed that some programs where she interviewed lacked a female presence. “I knew programs without women weren’t a good fit for me,” she says. “When I interviewed with Dr. Hayes at Mayo Clinic, it had a big impact on me. Dr. Roger was my research mentor during my fellowship. Seeing women doing what I wanted to do at Mayo Clinic was a big factor in my decision-making. I saw that I could follow in their footsteps.”

Now associate program director for the Cardiovascular Training Program, Dr. Dunlay is interested in attracting even more women to Mayo Clinic. “The biggest thing we can do to attract women to cardiology is to have more women cardiologists,” she says. “Seeing us being successful and happy is impactful to those considering cardiology positions. Dr. Hayes and others have been good at helping women get in leadership positions and achieve academic promotion.”


Meet Rekha Mankad, M.D.

‘I didn’t think it mattered to me if there were females cardiologists on staff. I realized then how much I may have missed out on.’

Rekha Mankad, M.D. (@RMankadMD), Division of Cardiovascular Ultrasound, came to Mayo Clinic in 2007 after having been in two private practices in Pittsburgh. Her husband, Sunil Mankad, M.D., Division of Cardiovascular Ultrasound, was recruited to the department, and they came as a “package deal.”

When Dr. Mankad joined the Mayo Clinic staff, she was used to working among primarily male colleagues. “I didn’t think it mattered if there were female cardiologists on staff,” she says. “However, when I saw the female cardiologists and dual-physician couples here at Mayo, I said to myself, ‘These are individuals who have traveled the same road as me.’ I realized then how much I may have missed out on by not having female mentors and colleagues. The men I’d worked with were really great, but I have a deeper connection with the women I have had the privilege of working with here.”

Dr. Mankad’s career changed at Mayo Clinic. “I hadn’t had an academic career with research because I was also raising children and was in private practice,” she says. “And I didn’t see any women doing it. My male colleagues who had academic careers had stay-at-home wives. I had never envisioned myself doing research. However, the environment at Mayo Clinic is conducive to academia, and there are so many people to help you along the way. I’m so happy that I have been able to do some research and publish papers; these activities have enhanced my career as a cardiologist.

“As a woman, when you see mostly men in a specialty, you identify it as a male specialty and have trouble picturing yourself in that role. When female trainees come to me today for advice, I tell them to do what they love. It’s always difficult for everyone, men and women alike, to balance work and family life. If you are passionate about a career choice, even if it is ‘male-dominated,’ you should go for it. You don’t want to look back and have regrets. Life is difficult, and there are always choices to be made. Do what makes you happy.”


Meet Marysia Tweet, M.D.

‘Women here are so visible, approachable and involved with trainees and mentoring others. There’s a strong spirit of helping each other.’

Marysia Tweet, M.D. (@marysia_tweet), Division of Ischemic Heart Disease and Critical Care, says she is privileged to have had women in cardiology at Mayo Clinic pave the way for her.

“Mayo Clinic is a great place to work, and leaders are trying to make it an even better place to work for everyone,” she says. “Even though our department is a bit higher than the national average for women on staff, it feels like it’s even higher because the women here are so visible, approachable, and involved with trainees and mentoring others. There’s a strong spirit of helping each other.”

When Dr. Tweet interviewed for a fellowship, some institutions had an obvious lack of women. “That was concerning,” she says. “One place said it was because they didn’t offer part-time status. It was very uplifting to see so many women in cardiology at Mayo Clinic.”

Dr. Tweet, who has been on staff for two years, has five children. Before she accepted a staff position, she asked if she could work part time. “Some others told me not to dare to ask for it,” she says. “I hesitated asking because the answer could have been no, but it was a deal-breaker for me at the time.” Dr. Tweet returned to full-time status after a year and receipt of a BIRCWH scholar grant to study women and heart disease.

Dr. Tweet now mentors other women cardiology trainees. “When you have great role models — both women and men — it becomes second nature to do that for others,” she says. “Recently a female trainee interested in cardiology was told to avoid this specialty if she wants to have children. I encouraged her to go for it. It’s possible, and the more women who go into cardiology, the more the culture will change.”

###

Mayo Clinic has major campuses in Rochester, Minn.; Scottsdale and Phoenix, Ariz.; and Jacksonville, Fla.; while Mayo Clinic Health System has dozens of locations in several states.

It is one of the largest not‐for‐profit, academic health systems in the U.S., with 63,000 employees across its medical practice, research and education. With a focus on caring for patients with serious, complex illnesses, Mayo Clinic operates in five states and cares for more than one million people a year, from all 50 states and nearly 140 countries. Mayo Clinic is ranked #1 in the nation by U.S. News and World Report.

Editor’s note:  These profiles accompanied a longer feature in Alumni Magazine, Issue 4, 2018, discussing Mayo Clinic’s gender balance in cardiology. They are just some of the 39 women in the cardiology practice across Mayo Clinic. Visit  the Mayo Clinic Alumni website for perspectives of additional women cardiology staff members at Mayo Clinic.

 

Tue, Jan 22 6:00am · Pharmacogenomics: finding the right drug, dose for cancer therapy

By Sharon Rosen

Robert Diasio, M.D.

Each year, nearly 300,000 patients receive the lifesaving chemotherapy 5-fluorouracil (5-FU) to treat many types of cancer, including colorectal, breast, bowel, skin, pancreatic, and esophageal cancer. While it can be an effective treatment, it doesn’t work for everyone. In fact, up to 30 percent of those who receive the standard dose can have serious, life-threatening side effects.

Robert Diasio, M.D., director, Mayo Clinic Cancer Center, has uncovered genetic variations that cause some patients to experience these serious side effects. Now using pharmacogenomics testing, which looks at how a person’s genetic traits affect their medication response, and a new gene verifier model, Dr. Diasio and his colleagues are able to test and find a safe, alternative 5-FU dose, allowing these patients to get the benefit of treatment, without harmful side effects.

“While a standard dose of 5-FU can be very effective in treating many cancers, it is challenging to predict who will have serious side effects from the therapy. That’s because genetic testing prior to therapy is not mandatory. Therefore, we’re only able to identify these patients after they’ve had therapy and experienced severe complications,” says Dr. Diasio.

A tool to identify a safe, alternative dose  

Through his laboratory research, Dr. Diasio has uncovered genetic variations in the DPYD gene that help drive how a patient processes the 5-FU therapy.

His gene verifier tool has already helped redirect care and individualize therapy for a patient with rectal cancer.

Only 5 days after starting 5-FU therapy to shrink his tumor before surgery, the patient experienced extreme fatigue, severe diarrhea and a skin rash. He was hospitalized and had to stop treatment.

Pharmacogenomics testing revealed that he had one common DPYD variant known to cause complications, along with a rare genetic mutation that may also be interfering with how he processed the medication.

Using the new model, Dr. Diasio and his colleagues were able to understand how both the common and rare variant caused the patient to process 5-FU more slowly, causing debilitating side effects.

“For this patient, the standard 5-FU dose caused an overdose of medication that was not only fighting his cancer cells, but also damaging the normal cells in his bone marrow and nervous system. Based on our model, we calculated that his dose should be reduced by 75 percent – this is a dose that physicians would never have considered without pharmacogenomics and genetic analysis,” says Dr. Diasio.

The adjusted dose allowed the patient to receive the therapy he needed after surgery to prevent the cancer from returning, with fewer side effects. Dr. Diasio and his colleagues recently published these results here.

Pharmacogenomics – helping target therapies for patients

This is just one example of how pharmacogenomics helps individualize cancer therapy for patients. It can also help physicians select from among many different therapies to target the unique genetic characteristics of a patient’s cancer.

“Our pharmacogenomics research has shown that many factors contribute to medication response and one of those is genetics. We’ve also identified how differences among ethnic groups affect response to medications like 5-FU. For example, 3 to 5 percent of Caucasians carry one DPYD gene variant that causes serious side effects, while those from African descent carry a different variant with the same risk for complications,” says Dr. Diasio.

“As new genetic variants linked to cancer and medication responses are discovered, we’ll continue to refine our individualized treatments directed at each patient’s disease.”

###

This article originally appeared on the Center for Individualized Medicine blog Nov. 5, 2018.

For more information on the Mayo Clinic Center for Individualized Medicine, visit our blogFacebookLinkedIn or Twitter at @MayoClinicCIM.

Mon, Jan 14 6:00am · New algorithms help predict diabetes treatment failure

Metformin is the recommended first line treatment for type 2 diabetes, and is often used to prevent progression of prediabetes to diabetes. Unfortunately, it will not work for over one third of patients who take it, a condition called “therapeutic failure.”

Historically there has been little way of knowing whether a patient will or will not respond to this drug, however, a recent study has identified a new way to predict the treatment failure of this widely used type 2 diabetes medication, giving the healthcare provider the opportunity to consider using metformin in combination with another medication or selecting a different medication entirely.

Researchers analyzed the treatment regimens and glycemic outcomes of 12,147 commercially insured and Medicare Advantage beneficiary adults and developed machine learning algorithms to predict which patients are not likely to achieve and maintain control of their blood glucose after one year of therapy. The most influential variables in the prediction were the patient’s baseline hemoglobin A1C level, starting metformin at a sub-therapeutic dose, and the presence of diabetes complications at the time of treatment initiation. By predicting metformin failure rates, physicians can adjust patient treatment strategies accordingly and achieve better outcomes.

An overwhelming majority of the machine learning model outperformed traditional models that used logistic regression. This research, through the use of these new methods in machine learning, highlights the potential for applying a type of artificial intelligence technology to problems in medicine.

###

Editor’s Note: Artificial intelligence (AI) is a branch of computer science which attempts to emulate human problem solving skills. Also called ‘cognitive computing,’ it includes concepts such as machine learning – including ‘deep learning,’ and natural language processing, which are especially relevant to health care.

Mayo Clinic recognizes the essence of AI as a set of techniques and technologies that serve to augment – not replace – human intelligence. Artificial intelligence and augmented human intelligence research and development activities at Mayo are overseen by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

Thu, Jan 3 6:00am · A vaccine to prevent breast cancer? It's worth a shot

Mayo researcher Keith Knutson, Ph.D., is working with colleagues on several vaccines that could not only prevent cancer from recurring, but perhaps keep it from developing in the first place.

Each fall, millions of Americans roll up their sleeves for a flu shot, grateful for the quick pinch that may save them from the misery the flu can bring.

In the not-too-distant future, there may be a poke with a much bigger payout. Scientists at Mayo Clinic and elsewhere are working on vaccines that could prevent cancer from recurring or even developing in the first place. While they’re not there yet, they hope to be soon — “probably within the next decade,” Keith Knutson, Ph.D., tells The Florida Times-Union.

Dr. Knutson, co-director of the Mayo Clinic Immune Monitoring Core and director of the Mayo Clinic Ovarian Cancer Immunotherapy Program, is working with colleagues on several vaccines designed to help women who have already been treated for breast cancer. This approach “could help stop the relapse,” reports the publication.

For example, one vaccine would work by helping the body “resist the return of Human Epidermal Growth Factor Receptor 2 (HER2) breast cancer,” according to The Atlanta Journal-Constitution. “The standard approaches to treating cancer address the existing disease,” Dr. Knutson tells the paper. “Our goal is to develop a strategy to address recurrence. We have good drugs … that can interfere with the recurrence of HER2 breast cancer. Our hope is that a vaccine that engages multiple aspects of the body’s own immune system will build on those successes.”

Dr. Knutson is also working on a preventive vaccine, which he describes as “a big game-changer.” It’s “a big blue-sky thing we’ve been working on,” he tells the Times-Union. The “we” includes experts from around the country who have “been working together for eight years” to develop a preventive vaccine. Their work, supported by the National Breast Cancer Coalition, may be put to the test in clinical trials “within 16 months or so,” according to the Times-Union.

Until then, consider taking other steps to reduce your risk of developing the disease. Exercise, maintain a healthy weight and limit the amount of alcohol you consume. And we probably don’t have to say it, but if you smoke, quit.

This story originally appeared on Mayo’s In the Loop blog.

Dec 21, 2018 · MOG antibody-associated spinal cord inflammation can mimic acute flaccid myelitis

Mayo Clinic researchers report that spinal cord inflammation associated with an antibody to myelin oligodendrocyte glycoprotein can mimic acute flaccid myelitis, a rare but serious disease linked to certain viruses that particularly affects children and can result in paralysis. The researchers show that detecting the MOG antibody has important treatment and prognostic implications. The findings appear today in JAMA Neurology.

The mimicry finding was an unexpected discovery, as the study focused on patients with transverse myelitis, a disease of spinal cord inflammation that also can lead to paralysis. MOG is a helpful biomarker of transverse myelitis, the researchers report.

Of 54 patients in the study, 19 percent with spinal cord inflammation from the MOG antibody were initially misdiagnosed with acute flaccid myelitis.

Patients with MOG antibodies may respond to steroids and additional treatments, such as plasma exchange to remove these antibodies from the blood, but acute flaccid myelitis does not respond well to such treatments.

Image A1:  “A view of the neck in sagittal plane (as if a line was drawn down the a person’s middle top to bottom between eyes).

“The cervical spinal cord is the grey structure the arrows are pointing to and it should be dark grey like it is at the top of the image. It should be dark grey throughout and this shows a bright line (arrowhead) surrounded by more hazy white signal (arrows) that we often see with MOG antibody cases.” – Dr. Flanagan


“It is important for physicians to search for this MOG antibody in individuals who present with paralysis from spinal cord inflammation because the patients with MOG antibody respond well to treatment that lowers the immune system response,” says Eoin Flanagan, M.B., B.Ch., a Mayo Clinic neurologist and senior author of the article.

The nerves of the spinal cord are covered with an insulating layer called the myelin sheath, similar to insulation of an electrical wire. MOG is a part of this insulation system. “Patients who have the MOG antibody get inflammation that damages this insulation, with loss of signaling in the spinal cord resulting in paralysis,” says Divyanshu Dubey, M.B.B.S., a Mayo Clinic neurologist and first author of the article.

Testing for the MOG antibody also helps from a prognostic standpoint, Dr. Dubey says, because its presence helps predict patients who are more likely to relapse. In 2017, Mayo Clinic developed the MOG antibody test, the first of its kind in the United States.

Image A2: “The oval grey circle is the spinal cord in transverse plane (vertical plane dividing body top from bottom through waist) depicted by the arrow.

“This should be dark grey throughout and you can see some white area that forms a “H-sign” appearance which is what we frequently see with the MOG antibody.” – Dr. Flanagan

Study limitations include the variability in treatments used, which prevented the researchers from determining which immune lowering treatment was best.

The authors note conflict of interest disclosures in the paper.

###

Dec 19, 2018 · A passion for serving underserved communities

LaPrincess Brewer, M.D., a Mayo Clinic cardiologist, has been applying an innovative, community-based participatory research model to prevent heart disease in underserved communities. Dr. Brewer’s program, called Fostering African-American Improvement in Total Health (FAITH), has been recognized nationally and internationally as making substantial improvements in the health of its participants. 

By LaPrincess Brewer, M.D 


I don’t have the classic story, where as a child, I dreamed of being a physician and went around wearing a toy stethoscope and carrying a doctor’s bag.

I discovered my love of patient care and medicine after my freshman year at Howard University in Washington, D.C. As a chemical engineering major, I completed a summer internship at 3M in Minnesota. I loved the experience and had a supportive unit supervisor. It was a direct application of all the knowledge I gained in class. But something was missing.

Combining two loves

That palpable void was human touch and having a lasting impact on people’s lives. So when I went back to college that fall, I contacted my advisers and told them I wanted to try something that would allow me to interact with people beyond a basic science laboratory. They recommended clinical research as an avenue to shadow a physician balancing clinical practice and research for the benefit of patients. I had never really thought of this as a possibility.

The next summer, I was selected into Research Experiences for Undergraduates — a summer research fellow program at the Duke University School of Medicine in Durham, North Carolina. I fell in love with it.

I was assigned as a mentee to a world-renowned cardiologist within the Center for Emerging Cardiovascular Technologies to work on a project in partnership with NASA. The aim of the project was to develop better therapeutic measures to prevent muscle breakdown and dysfunction in astronauts, which is a major limitation to long-term space missions by humans. Having the opportunity to shadow him was eye-opening. I discovered that I could combine my love of science and engineering with patient care. From that moment on, I made it my goal to apply to medical school. I was fortunately accepted into the George Washington School of Medicine & Health Sciences in Washington D.C., and the rest is history.

Losing loved ones to disease

I was really drawn to becoming a physician, given the privilege afforded to care for and learn from patients and then channel this knowledge to have a larger impact on population and public health, particularly within underserved groups. This stems back to my upbringing within the African-American church. I saw so many members of my congregation — many people I looked up to — slipping away from uncontrolled chronic diseases, predominantly heart disease and its risk factors. Not all were related to me, but they all felt like family. I wondered why they were dying so early from conditions that could have been prevented in the first place. There was so much potential loss.

In between my third and fourth year of medical school, I decided to take a year to pursue a master of public health degree, which stemmed from my clinical practice as a medical student. I became overwhelmed with the degree of cardiovascular disease health disparities within the communities we served in our nation’s capital. These disparities were magnified among the poor and underserved. To understand why the disparities existed, I wanted to become more equipped to tackle them head on.

Changing the culture of health and wellness

Dr. Brewer speaks at Celebration of Women’s Health Research 2018

I was honored to be accepted to the Johns Hopkins Bloomberg School of Public Health in Baltimore. One of our elective courses in health promotion charged us with developing a community-based intervention that had the potential to be sustained over the long term. My group members were interested in chronic disease prevention within the African-American community. It was only fitting that we would partner with the African-American church, given its profound impact in the lives of African-Americans from a spiritual, social, political and health standpoint.

We developed the project in partnership with a local African-American church that was a stone’s throw from the medical institution. No one had ever reached out to this church to do any sort of health program from Hopkins. And it was perfect timing for us, as the church’s pastor had a keen interest in establishing a health ministry within the church. He expressed sorrow in witnessing several of his church members passing way from heart disease, hypertensionheart attack, stroke and diabetes. He wanted a way to change the culture of health and wellness within his church.

In partnership with the church auxiliary leaders and pastor, we created a summer nutrition education program that included presentations held at the church by health professionals, an interactive cooking demonstration and multimedia video presentations. We had tons of fun and developed a genuine relationship with the church congregation. There were about 50 people in the original FAITH program, and we truly impacted the entire local faith community as the message spread throughout the congregation and the social networks of the members. 

Journey to Mayo Clinic

I continued to have a nice relationship with the church and continued to attend worship services there while I completed my medical school and residency training. I decided to pursue a cardiology fellowship, as it was a beautiful fusion of my passion for cutting-edge and innovative medicine and public health. I fell in love with Mayo Clinic and its resounding value that “the needs of the patient come first.” I was elated to be accepted into the fellowship program.

It was somewhat bittersweet to reveal the news of my life transition from Baltimore to the Midwest to the congregation. The church even threw me a very nice going-away party for my family and friends. The one common theme from the church members was to “not let FAITH go.” They expressed to me through testimonials how the program had truly impacted their church and emphasized that the program would be of benefit to others. They wanted me to “spread the word” in a sense by sharing the program. I really took their encouragement to heart, and it has really motivated me to keep going and has brought me to this moment.

Opening doors in Rochester

When I arrived at Mayo Clinic, my advisers knew from the start that my interests included a focus on addressing cardiovascular health disparities given my prior work with FAITH and other community outreach programs during my residency training. Fortunately, they aligned me with key mentors, including Yvonne Romero, M.D.Sharonne Hayes, M.D.,  and Joyce Balls-Barry, Ph.D., who helped to forge relationships with several African-American pastors here in Rochester.

The pastors were privy to my work in Baltimore and wanted to bring this to their churches. In the fall of 2013, we held town hall meetings with several churches in Rochester. After much trust-building and mutual understanding, we decided to alter the focus of the program from chronic disease prevention to heart disease prevention, given the needs of this community and my expertise in cardiology.

The approach we use for conducting research is unique and is called community-based participatory research. This approach aligns well with Mayo Clinic’s model of patient care, as it emphasizes that the needs of the community come first. We see the community as partners at every phase of the research process to meet their needs.

Together, we have forged a powerful relationship that has truly blossomed into a community-wide initiative. Our program has sparked healthy lifestyle practices among our participants, but it’s also changed their views and perspectives about participating in clinical research.

Building trust and relationships

My first meetings with the Rochester African-American church community were not always easy but were extremely revealing of my purpose in partnering with this endearing, yet somewhat marginalized population. They expressed the limited academic-community level partnerships with their churches and also questioned my intentions. That was something I totally did not expect. They truly challenged me, but I am so appreciative for our enlightening dialogues because I learned many lessons on how to better tailor my approach and be adaptable.

We broke much ground with the Rochester African-American community by building trust and relationships. Many viewed their participation in this research study ultimately as a form of social justice. They felt their participation in this study was giving back to future generations within the community. They saw our program in a way as Mayo giving back. It has been fulfilling and an honor to have the opportunity to grow personally and professionally through our work.

We initially partnered with three churches in Rochester and have now doubled the number of churches in our expanded program to the Twin Cities in a relatively short time frame. All churches and study participants have provided us with exceptional input which has resulted in the evolution of our program from face-to-face, in-person sessions to an innovative mobile health (mHealth) intervention.

Harnessing technology for wider reach

As a study team, we learned that the churches wanted a way to share this information with their family and friends. The participants suggested that we revamp FAITH to include a digital component. We decided as a community and research team to develop a digital app. We often say: “FAITH. There’s an app for that.” The information we previously delivered during the face-to-face sessions has been translated to the app for participants to share with others, and to have as a resource and tool to foster healthy lifestyle change.

The suggestion from the community to remix FAITH to harness mobile technology was something I never would have imagined. It shows the power of community partnerships and learning through listening.

In its current form, FAITH is easily adaptable and can be easily distributed and tailored toward any community. It would be my dream for it to be a national initiative to protect heart health in underserved populations. I am extremely grateful to lead this program as a junior staff (faculty) member because it has helped me to realize my potential. It has further inspired me to be a go-getter to take my research to the next level.

It all has been fueled by the needs of the community and patients I serve.

This article originally appeared on Mayo’s Sharing Mayo Clinic blog.

Dec 18, 2018 · Study shows better outcomes for women treated for uterine fibroids with UAE

A multicenter study led by Mayo Clinic researchers shows that women who undergo uterine artery embolization (UAE) for symptomatic uterine fibroids are less likely to need a second procedure compared to women who were treated by magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS). The results are published online in the American Journal of Obstetrics and Gynecology.

While both treatments produced symptomatic improvements that lasted for several years, women who underwent UAE had greater symptom reduction. Additionally, the function of the ovaries as measured directly by antimüllerian hormone (secreted by developing eggs, and a good indicator of ovarian reserve) and indirectly by a woman’s increasing age, appeared to predict which women had the least chance of undergoing a second procedure.

“Our study findings provide important information to the patient and her doctor that will help her decide on the best treatment option for her fibroids,” says the study’s lead author Shannon Laughlin-Tommaso, M.D., a gynecologic surgeon at Mayo Clinic.

Nearly 80 percent of women will develop uterine fibroids in their lifetimes, according to the National Institutes of Health (NIH). Fibroids are common noncancerous growths of the uterus that often appear during childbearing years. They develop in many sizes, and some women may not even know they have them, but other uterine fibroids become large and can cause considerable symptoms such as heavy menstruation and severe abdominal pain.

Both minimally invasive procedures from the study provided significant relief for women with symptoms, making these viable alternatives to a hysterectomy. Uterine fibroids are the leading cause of hysterectomy in the United States, with more than 200,000 hysterectomies performed each year due to uterine fibroid symptoms.

For years, researchers at Mayo Clinic and elsewhere have researched alternative uterine-preserving treatment options for fibroids, but these are often compared with hysterectomy. Head-to-head comparative effectiveness trials of non-hysterectomy options are lacking. This study, called FIRSTT Fibroid Interventions: Reducing Symptoms Today and Tomorrow, is a randomized clinical trial led by researchers from Mayo Clinic and colleagues at  Duke University and the University of California, San Francisco,  is the first-ever study in the United States which compares MRgFUS to UAE.

“There are many treatment options for fibroids, but many women are not offered alternatives because providers worry about the long-term effects. Studies like this one demonstrate that minimally invasive procedures can have lasting effects with lower risk,” says Dr. Laughlin-Tommaso.

During the study, the participants were randomized to one of two trial arms: UAE or MRgFUS. Women declining randomization were also followed. The researchers compared the outcomes of the two procedures on 83 premenopausal women during a four year period. The study included 43 women who underwent MRgFUS with 27 randomized, while 40 were treated by UAE and 22 randomized. Among the women in the MRgFUS arm of the study, 30 percent underwent a second fibroid procedure compared to 13 percent of the 40 women who were treated with UAE.

After menopause, fibroids naturally shrink and are asymptomatic. Many fibroid treatments aim to reduce symptoms to allow women to transition in menopause. In this study, women who were older or had lower ovarian function/antimüllerian hormone levels before treatment had lower risks of needing a second procedure. These same factors may also help patients and providers make decisions about treatment options.

###

Related resources:

If you would like to receive regular updates from Advancing the Science, please register.

Contact Us · Privacy Policy