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.


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Thu, Sep 3 6:00am · Largest pharmacogenetics clinical trial in cardiology shows potential benefit in individualized approach to anti-platelet therapy

Heart patients who undergo percutaneous coronary intervention (PCI) or stent placement― nonsurgical procedures to improve blood flow to the heart ― are typically prescribed anti-platelet therapy to avoid blood clots that can lead to a heart attack or stroke. New research from the international TAILOR-PCI trial, the largest pharmacogenetics clinical trial in cardiology, suggests that genetic testing could potentially be a useful tool to help select antiplatelet medication. Pharmacogenetics is the use of a patient’s genetic makeup in prescribing treatments that are likely to be most successful.

The trial, led by Naveen Pereira, M.D., and Michael Farkouh, M.D., is published in JAMA. Dr. Pereira is a cardiovascular disease specialist at Mayo Clinic and Dr. Farkouh is a cardiologist from the Peter Munk Cardiac Centre, University Health Network. The trial originated from a Mayo Clinic study catalyzed by Mayo Clinic’s Center for Individualized Medicine and Department of Cardiovascular Diseases in 2012.

Naveen Pereira, M.D.

Clopidogrel is the most commonly used antiplatelet drug, but about 30% of Americans carry variants in the CYP2C19 gene, which interfere with the metabolism of clopidogrel. These patients are in a high-risk category due to their genetic makeup, but they can be identified with a simple point-of-care genetic test. Patients who have the CYP2C19 gene variants may be good candidates for alternative anti-platelet therapy.

The trial focused on people with the loss of function CYP2C19 gene variants who underwent percutaneous coronary intervention to see if genotype-guided therapy in that group would be more beneficial than giving clopidogrel to all. Mayo Clinic was the clinical coordinating center and data coordinating center for the five-year clinical trial, which spanned 40 centers in Canada, Mexico, South Korea and the U.S. The data coordinating center was led by Kent Bailey, Ph.D., a Mayo Clinic statistician, and the chair of the steering committee was Charanjit Rihal, M.D., a Mayo Clinic interventional cardiologist.

“Although these results fell short of the effect size that we predicted, they nevertheless provide a signal that offers support for the benefit of genetic testing, with approximately one-third fewer adverse events in the patients who received genetically guided treatment, compared with those who did not.”

Dr. Pereira

The trial enrolled 5,302 patients who had been treated for artery blockage with one or more stents, and followed them for one year. Half of the group was randomized to be tested for the CYP2C19 gene variation and the carriers (35%) were treated with the alternative anti-platelet medication, ticagrelor. The remainder of the group was given clopidogrel, as was the entire other randomized half that consisted of the control group of patients who did not receive genetic testing.

The results showed a statistically not significant 34% reduction in blood clotting events in the loss of function CYP2C19 gene carrier patients assigned to ticagrelor in the genotype-guided group. The loss of function CYP2C19 gene carrier patients that received clopidogrel showed a 5.9% event rate versus a 4.4% event rate in those who received genotype-guided ticagrelor treatment. The study narrowly missed its statistical goal, which was a 50% reduction in blood clotting events.

“Although these results fell short of the effect size that we predicted, they nevertheless provide a signal that offers support for the benefit of genetic testing, with approximately one-third fewer adverse events in the patients who received genetically guided treatment, compared with those who did not,” says Dr. Pereira.

Dr. Pereira explains that the standard of care following coronary angioplasty and stent placement has evolved and greatly improved since the study was designed in 2012. The advent of drug-coated stents and other medical treatments improved care by reducing the expected rate of adverse events for patients in a year, but at the same time made it more difficult for the trial to reach its goal. The National Heart, Lung and Blood Institute has funded an extended follow-up study of TAILOR-PCI to determine if genetic-guided treatment will benefit longer-term outcomes.

“TAILOR PCI represents an important public-private partnership in advancing science and therapeutics for the benefit of patients. We will continue to seek more follow-up data and ascertain clinical endpoints.”

Dr. Rihal

The trial was positioned for patient evaluation at one year and just missed statistical significance. However, data at the three-month mark hold important implications for pharmacogenetics. In the first three months after the procedure, TAILOR-PCI showed an 80% risk reduction in patients with the CYP2C19 gene variation who were given ticagrelor. Furthermore, when evaluating the total number of events experienced per patient, genetic-guided treatment showed a statistically significant 40% reduction in events, compared to those who received standard treatment.

“Clopidogrel offers many advantages, but for those who can’t metabolize the drug, this trial demonstrates the potential effectiveness of a personalized medicine approach,” says Dr. Farkouh. “For patients who do not have a loss of function variation, it may be cost-effective to use clopidogrel, as it’s widely available and has a favorable safety profile. We plan to report a cost-effective analysis in a separate manuscript.”

“TAILOR PCI represents an important public-private partnership in advancing science and therapeutics for the benefit of patients. We will continue to seek more follow-up data and ascertain clinical endpoints,” says Dr. Rihal.   

“The TAILOR-PCI trial is an example of the rigorous testing needed to explore personalized, genetic-guided treatment and whether it can improve patients’ outcomes,” says Yves Rosenberg, M.D. “The results suggest potential value of a personalized, pharmacogenomic approach to the management of patients with heart disease undergoing coronary stenting.” Dr. Rosenberg leads the National Heart, Lung, and Blood Institute’s Atherothrombosis and Coronary Artery Disease Branch and is a co-author on the study.

The study was funded by Mayo Clinic, Mayo Clinic Center for Individualized Medicine and the National Heart, Lung and Blood Institute, which is part of the National Institutes of Health. Spartan Bioscience Inc. supplied the point-of-care genetic tests used.


Mon, Aug 24 6:00am · Second Language Learning Linked to Brain Surgery Recovery

By Lynda De Widt

Researchers at Mayo Clinic in Florida report differences in clinical outcomes between “late bilingual” and monolingual glioblastoma patients undergoing awake brain surgery for tumor removal — information that could help guide surgeons in the operating room. Their findings, published in the Journal of Neuro-Oncology, suggest that bilingual patients who have learned a second language after around age 6, called late bilinguals, had fewer complications and an improved surgical recovery than patients who spoke one language.

“Our study results highlight that there are differences between the monolingual and bilingual patient populations, which inform our surgical decision making,” says Mayo neurosurgeon Alfredo Quinones-Hinojosa, M.D., senior author of the study and the William J. and Charles H. Mayo Professor. “Based on this information, we can involve the patient to give them a choice on which language they prefer to preserve and use for daily life.”

For the study, researchers analyzed data from 56 patients who had undergone a left-sided awake craniotomy between September 2016 and June 2019. This is a type of surgery that allows surgeons to ask patients questions during surgery to help preserve movement and speech. Of these patients, 14 were bilingual, with second languages of English, Spanish, French, Arabic, German, Estonian and Lithuanian, and 42 were monolingual controls. All participants had tumors that invaded areas of the brain responsible for language. Patient demographics, education level and the age of language acquisition were documented and assessed. All patients had received the equivalent of a college education or higher, and self-reported their second language proficiency, which was evaluated by certified translators.

close in of faces in surgery, one full headshot in center is Dr. Alfredo Quinones-Hinojosa
Alfredo Quinones-Hinojosa, M.D., concentrating in the midst of surgery.

The patients acquired their second language after the age of six and were considered “late” bilinguals. “Early” bilinguals, according to research cited in the paper, are people who learn a first and second language simultaneously before the age of six, and who are more similar to monolingual people in terms of language center location in the brain.  

“In a simple analogy, if you consider these language centers as cities, and the roads connecting them as neurons, the early bilinguals are like one big city,” says Karim ReFaey, research fellow and first author of the study. “The late bilinguals would be considered two neighboring cities with many connecting roads in-between. Recognizing the differences in these spatial areas of the brain controlling language can help guide surgical approach.”

When neurosurgeons perform awake brain surgery, they can “test” these areas of the brain to know which ones to avoid and preserve. This is done through during brain mapping. The process involves the use of direct electrical cortical stimulation. The neurosurgeon energizes surrounding structures of the brain with electrical currents, and by observing the patient’s response, can tailor the surgery plan and determine areas not conducive to tumor removal.

The study showed that none of the bilingual patients experienced seizures during brain surgery, a potential complication of the procedure, while 7% of the monolingual patients did. The bilingual patients tolerated more electrical stimulation and higher levels of electric current; however, these patients also had less of their tumor removed (as measured by volume) than monolingual patients due to their tumors having less defined boundaries. The study noted that the bilingual patients scored higher post-surgery on the Karnofsky Performance Status Scale, a standard index for measuring a cancer patient’s ability to perform ordinary tasks (84.3 score for the bilingual patients, versus 77.4 for the monolingual patients). A higher score indicates a patient is better able to carry out daily activities.

The Mayo team plans to extend these findings with a prospective study involving more patients, with the ultimate goal of creating a guide for surgical approach and intervention in the bilingual patient population.

Other researchers on the study include Shaswat Tripathi, Adip Bhargav, Sanjeet Grewal, M.D., Eric Middlebrooks, M.D., David Sabsevitz, Ph.D., Mark Jentoft, M.D., William Tatum, D.O., Anthony Ritaccio, M.D., and Kaisorn Chaichana, M.D., all of Mayo Clinic; and Peter Brunner, Ph.D., Albany Medical College, and Adela Wu, M.D., Stanford University School of Medicine.

This research was supported by the Mayo Clinic Professorship and a Clinician Investigator award, the Florida State Department of Health Research Grant, the Mayo Clinic Graduate School of Biomedical Sciences, and a National Institutes of Health grant.

Conflict of interest statement: Drs. Tatum, Quinones-Hinojosa, and ReFaey filed a patent disclosing a circular grid device and technology. The other authors listed on the paper report no conflict of interest.


Thu, Jun 18 6:00am · Crisis inspires innovation

Mayo Clinic has successfully navigated many challenges over our 150-plus year history, including two world wars, the 1918 influenza pandemic and the Great Depression. Our visionary leaders were able to use these inflection points of crisis to catalyze transformational change.

Mayo Clinic has an unparalleled resource to lead the response to COVID-19: our organizational values — the living legacy of the Mayo family and the Sisters of St. Francis, who established the foundation of Mayo Clinic.  

Addressing employees, who face major challenges in the COVID-19 pandemic, Gianrico Farrugia, M.D., president and CEO, pledged on behalf of institutional leaders to “ensure that every action that Mayo Clinic takes is aligned with our values and secures our ability to serve patients through our three-shield mission.”

In many ways, COVID-19 has been disruptive on a global scale. In other respects, however, it is the latest example of a timeless truth: At Mayo Clinic, crisis inspires — and accelerates — innovation and generosity.

Guided by Our Values

“Throughout our history, times of crisis have consistently called forth some of the best qualities of Mayo Clinic,” says Robert Brown, Jr., M.D., the John T. and Lillian Mathews Professor of Neuroscience and director of the Mayo Clinic Program in Professionalism and Values.

Sister Tierney Trueman, coordinator of the Mayo Clinic Values Council, describes values as a thread of continuity: “Particular circumstances vary widely over time, but the way that the people of Mayo Clinic respond to crisis, working in trust and teamwork, caring for patients and each other, has been a constant throughout the generations.”

The COVID-19 pandemic struck at a critical time in the history of Mayo Clinic. Arriving just months after the Board of Trustees approved the “cure, connect and transform” vision for the path to 2030 and beyond, the pandemic has greatly accelerated the revolution in health care that Mayo is strongly positioned to lead.

The future has arrived, and the care models of tomorrow have become the expectations and essential services of today. Guided by our values, Mayo Clinic will lead a revolution in health care in a time when it’s needed most.

Today, as throughout its history, the record shows that at Mayo Clinic crisis is a catalyst.

After the tornado, Rochester, MN, 1883

Born in a storm – One could say that Mayo Clinic as we know it today was born in a storm: the 1883 tornado that devastated Rochester, Minnesota, and brought the Doctors Mayo – Dr. William Worrall Mayo and his sons, Drs. William J. and Charles H. Mayo — and the Franciscan sisters together as partners in healing. Their collaboration — sealed with a handshake — led to the founding of Saint Marys Hospital, a revolutionary innovation in methods as well as philosophy.

Saint Marys was one of the first hospitals to use the new antiseptic theory in surgical practice. In contrast to many hospitals of the time, it was neither an asylum for the poor nor a convalescent home for the well-to-do. Rather, Saint Marys Hospital set a new model in providing high-quality, compassionate care for all, regardless of race, creed or financial means. Saint Marys became the incubator of Mayo Clinic’s greatest innovation, the Mayo Clinic Model of Care, an integrated, multispecialty practice focused on the patient.

This dynamic model of care has driven Mayo’s expansion far beyond the original “clinic in a cornfield” to become the No. 1 hospital in the United States — and the world.

World War I – In the spring of 1915, Mayo Clinic and the University of Minnesota established the first comprehensive, academically affiliated program in postgraduate medical education, transforming the specialized training of physicians. This concept received almost immediate validation when the British ocean liner R.M.S. Lusitania was torpedoed and sank on May 7 that year. Most civilians ceased traveling to Europe for the duration of the war, and physicians who would have gone abroad for advanced training went instead to Mayo Clinic. In the mass mobilization of American society and economy to meet wartime demands, Mayo Clinic led the systemization in medical education.

Other innovative contributions to health care occurred when the United States entered the conflict in 1917.

Mayo Clinic developed concentrated, high-quality training programs for physicians and nurses who served in the military.

Louis Wilson, M.D.

Mayo Clinic’s Dr. Louis B. Wilson established pathology laboratories in close proximity to military surgical units in Europe, improving care for soldiers and strengthening the postwar linkage of pathology as data for care decision-making.

Mayo Clinic and the University of Minnesota co-sponsored a base hospital and mobile surgical units close to the fighting on the Western Front in France.

1918 influenza pandemic – In contrast to the chaotic and makeshift conditions in many hospitals during the influenza outbreak, the Franciscan sisters opened an isolation unit at Saint Marys Hospital. Their knowledge of illness transmission led to the high standards of cleanliness and safety that saved many lives. Mayo Clinic advocated for measures that echo the COVID-19 response today: masks, social distancing and suspension of elective procedures as a public health safety measure.

Great Depression – Following the stock market crash of 1929, patient registration fell by 40%. Of the patients who did come, 25% could not pay their bills. Despite unprecedented financial hardship, Mayo Clinic continued to support research and education, leading to innovations such as the nation’s first hospital-based blood bank, early forms of organ transplantation, and ultimately the Nobel Prize for discovery of cortisone.

As the nation’s financial system neared collapse, Mayo Clinic made every effort to protect its employees, using its own reserves to back bearer notes that staff could cash if the local banks failed. Dr. Charlie Mayo and Mayo Clinic donated funds for the construction of Mayo Civic Auditorium to provide employment and a much-needed public amenity. Dr. Will Mayo and his wife, Hattie, gave their home to Mayo Foundation as a meeting place “for the good of mankind.” They also sold the North Star, their beloved riverboat, and contributed the proceeds to pay for the care of patients in financial need. Saint Marys Hospital not only fended off bankruptcy but was able to use this time to pioneer a new form of hospital design that aligned medical research with patient care.

1939: “The Year of Greatest Crisis” – Amid the lingering effects of the Great Depression and the gathering storm of World War II, the Mayo brothers and Sister Joseph Dempsey, longtime superintendent of Saint Marys Hospital, died within four months of each other.

Thanks to careful succession planning, there was a smooth transition to new leadership. At the end of his life, Dr. Will Mayo told his associates that their natural inclination would be to become cautious and conservative after his death. In the strongest terms, he urged them to resist that inclination and be bold — particularly by expanding the Rochester airport, because he foresaw the future significance of air travel for both civilian and military transportation. As a result, the Rochester airport became one of the largest and best-equipped private airports in the country, which set the stage for Mayo Clinic’s landmark innovations in aeromedical research and as a future destination medical center.

Charles Lindbergh wears a Mayo-developed high-altitude mask to test bail-out techniques for the P-47 pursuit aircraft.

World War II – Along with sponsoring two military hospitals in the Pacific theater, Mayo Clinic conducted top-secret research on the Home Front, including development of the G-suit, high-altitude mask and other aviation discoveries. Willy Messerschmitt, the famed German aviation expert, saw a G-suit on a downed American flyer, and knowing the Germans had nothing to match it, he concluded, “The war is over.”

These collaborative innovations proved to have significant ripple effects in the postwar era, leading to the development of open-heart bypass surgery, military/civilian jet aviation and the space program. For its wartime contributions, Mayo Clinic charged the U.S. government $1 per year.

Cold War – In the 1950s and ‘60s, Mayo Clinic was a leader in planning the national health care response in the event of an atomic or nuclear attack. Mayo Clinic and the Sisters of St. Francis created an emergency hospital below the basement level of Assisi Heights, the motherhouse of the sisters’ congregation in Rochester. It had two operating rooms and more than 1,000 army cots to accommodate mass casualties. Mayo Clinic became one of the first hospitals to use the computer in anticipation of processing huge amounts of medical data for a civil disaster. As a result, Mayo Clinic scientists and physicians discovered other innovative ways to augment their practice with the use of computers.  

2001 – The attacks of 9/11 were soon followed by the worst bioterrorism event in American history: Letters containing anthrax poisoning were sent via the U.S. mail, killing five people, sickening 22 and causing widespread public anxiety. Standard testing to detect anthrax took days. In an intensive effort, Mayo Clinic developed a test that provided confirmation in less than an hour, earning national and global recognition.

Stronger together

COVID-19 specimen testing

The COVID-19 pandemic has brought the importance of supporting health care to the forefront. It has identified where the health system soars and where it fails. The pandemic has accelerated Mayo’s path toward a model of care that is more digital, consumer-friendly and responsive — elements set forth in our strategic plan to cure, connect and transform health care by the year 2030. The vision is bold and ambitious, building on Mayo’s ability to revolutionize medicine to meet the changing needs of patients.  

During the pandemic, Mayo Clinic has demonstrated significant leadership on a national level, leading important efforts to improve and expand testing capabilities and conducting research for treatments and vaccines to stop the virus.

Throughout history, Mayo Clinic has answered the call of the nation — and the world — in need. Guided by our values, Mayo Clinic has inspired cures, accelerated connectivity and transformed generosity into innovation. Today, together with visionary benefactors, Mayo Clinic is prepared to advance its vision for the future.

Dr. Will Mayo always maintained a long-term perspective. His words resonate across the arc of Mayo Clinic’s history and in Mayo’s response to COVID-19: “The ills of today must not cloud the horizons of tomorrow.”

This article originally appeared in Mayo Clinic Magazine.

Mon, Jun 8 6:00am · Learning tools to manage current times: Capacity Coaching

Kasey Boehmer, Ph.D.

Kasey Boehmer, Ph.D., is a health services researcher at Mayo Clinic

As a society amidst the COVID-19 pandemic, we continually hear of the struggle to embrace a “new normal.” For some, this new normal is at the front lines of health care. Clinicians caring for those with chronic illnesses are pivoting quickly to check in on patients through telehealth technology. Others are shifting their duties to identify and treat those acutely ill with the virus. In many other cases, those not in health care are still interacting with the public as they provide essential services like groceries, plumbing repair, or transportation services. However, the physical environment or other aspects of their work may have changed.  

For those not in essential service categories, new normal likely includes a homebound reality that many have never experienced before. They, along with their housemates, are learning to work and attend school from home — or to occupy their time without formal employment. Many are facing these new realities with reduced or no income. People who live together have been thrust into 24-7 contact, while becoming physically distant from the other people in their social circles. None of these situations feel normal, but at least for right now, they are.

Regardless of what category you fall into, life has shifted rapidly in the past several weeks in a way that we could have scarcely imagined a year ago. This rapid shift has left people from all facets of life feeling completely overwhelmed. People are saying on telephone calls and on social media that they are struggling. I recently reflected in another blog post as to why this is occurring. Peoples’ capacity (i.e., their abilities and resources to respond to new work) is currently being challenged on all fronts. Now, as people are beginning to recognize the struggle, more are looking for coping strategies. Some lessons in coping may be found in a program developed at Mayo Clinic called “Capacity Coaching.” While Capacity Coaching was originally developed for patients living with multiple chronic conditions, this intervention’s underlying principles contain tools that are applicable to the overwhelming nature of what has become everyday life. I discuss a few of these principles below.

One principle of Capacity Coaching is that of achieving “workload-capacity” balance. Briefly, everyone has a set “workload” for which they are responsible. This includes paid employment, caregiving activities, volunteer work, household chores, general self-care, and for those living with chronic health conditions, doing what is necessary to maintain their health. When we consider our current situation amidst the pandemic, most of us have experienced changes on some or all of these fronts.  The ability to accomplish and maintain a given level of work, or “workload,” relies on our capacity. When workload exceeds capacity, people struggle to act.

Contributing to our capacity is our:

  • Sense of biography or abilities to author our own stories (e.g. how one perceives themselves as a person and in relation to others) ,
  • Resources (e.g., finances, transportation, education, self-efficacy),
  • Environments (e.g., home, work, healthcare),
  • Successful accomplishment of work (e.g., managing to accomplish the tasks one has set out for themselves), and
  • Our social networks (e.g. those we interact with such as colleagues, family, friends) .

(You can read more about BREWS: Biography, Resources, Environment, Work, Social in BMC Family Practice.)

These are all in a state of upheaval right now. In the case of patients living with multiple long-term conditions, this workload-capacity balance affects their abilities to access and use healthcare and enact self-care, which in turn, affects their health outcomes. In the current situation, we might consider that this workload-capacity balance affects our abilities to manage uncertainty, care for ourselves and our loved ones, and continue our life’s goals and dreams. Ultimately, the ability to do those things will affect how we emerge from this pandemic.

Therefore, to remain healthy and resilient during these trying times, we must attend to our workload-capacity balance. To do so, we have limited options. We must: reduce workload, increase capacity, or do both.

A patient participating in a Capacity Coaching program would work through these activities with a coach during a long-term partnership. However, in the current situation, it is important to arm as many people as possible with ideas of how to cope.

Defining your workload

In order to define your workload, it is useful to conduct a brainstorming exercise to identify all the tasks that you are current doing  — or feeling required to do. Consider paid or volunteer employment, managing unemployment if unemployed right now, caregiving activities, household chores, etc. Write down everything you’re doing on a daily or weekly basis.

For each task, note next to it if the activity feels “helpful,” “burdensome,” or “both.” It is important to note that these are simply reflections for your personal use. There is no judgement in saying something is burdensome.

In Capacity Coaching, we use the ICAN Discussion Aid, which provides a helpful visual, even for people without chronic conditions.

Once you have done this, some questions to consider:

  • What stands out to me from this brainstorming activity?
  • What activities could be delayed or delegated?
  • What activities could be modified to feel less burdensome?
  • Which activities are giving me joy at the moment?
  • Which activities do I have gratitude for being able to do right now?

Ultimately, removing or modifying workload that is burdensome right now  — even if temporarily  — can be helpful. For activities that feel burdensome, but cannot be removed, brainstorming how to break them down into smaller, more doable actions can also decrease workload while contributing to your own self-efficacy. Adding mindfulness around the activities that are enjoyable right now is another option to reduce one’s overall sense of workload.

circular diagram of appreciative inquiry process: define/consider, discover/appreciate, dream/envision, design/co-create, deliver/implement

Adding appreciation and inquiry

Another principle of Capacity Coaching — used to increase capacity — is that of Appreciative Inquiry. This is an approach that focuses first on appreciating the situation at hand, what is currently working well in that situation, and past learnings and strengths from similar situations. From that, you can work to envision what an ideal future looks like and co-create a plan for arriving there. After implementing the plan, assess what is working well, and what might need reevaluation.

While this process works best with the support of a coach or others, one can use the diagram and its associated questions to work through this process individually. Appreciation and Inquiry is intended to be a continual process of appreciating, designing, implementing, and evaluating experiments in one’s own life.

During this unprecedented time, it may be helpful to use appreciative inquiry on new and emerging situations to build one’s own capacity. For example, if in a situation where current demands are particularly stressful or overloaded, one might consider past instances where this has occurred independent of the pandemic.

In my own life, due to social distancing, I have switched to teleworking and simultaneously homeschooling a 7-year-old. I am constantly reflecting back on strategies I used previously when I was pursuing my graduate degrees fulltime, while working fulltime and adjusting to motherhood.

Thinking back in your own life for times of successful coping can help you learn and identify strengths that can be applied to working in the current situation. From what my colleagues and I have learned in developing Capacity Coaching, it is best to establish small-scale experiments of new ways of working and coping and evaluating those often, ideally weekly.

I hope that these tools we have used with our patients in Capacity Coaching are helpful to you and your family during this time. If you have questions about the content here or Capacity Coaching in general, please contact Dr. Kasey Boehmer at


Thu, Jun 4 6:00am · Researchers target liver tumors with precision and "tiny radiation bombs"

By Lynda De Widt

image of a mass in the liver, and artery through which chemotherapy or radioactive beads are delivered

In the 1960’s, scientists discovered a form of cancer therapy called radioembolization, which utilizes microscopic radioactive spheres delivered through a blood vessel to reach a tumor and kill tumor cells. “Think of it as a tiny radiation bomb that’s delivered directly where it’s most needed,” says Beau Toskich, M.D., an interventional radiologist who specializes in interventional oncology at Mayo Clinic in Florida.

In the previous decades, radioembolization had been used as a palliative treatment option (read related patient story) to slow progression of advanced liver cancer in patients who were not candidates for curative therapies and had typically undergone chemotherapy. Now, Dr. Toskich and colleagues are conducting research to revisit this technology, finding new ways to maximize its capabilities.

For most cancer types, radiation therapy originates outside the body, penetrating through skin, bone, and adjacent organs to reach malignant cells, which can limit the amount of radiation that can be given safely. But many liver tumors have a unique property that makes radioembolization possible: they base their blood supply almost entirely on a few arteries that normally nourish portions of the liver. Thus, if radioembolization is delivered only through liver arteries that are responsible for supplying the tumor, higher doses of radiation can be safely administered. “It’s like a contained nuclear explosion that surrounds the cancer, while the untreated liver has little to no radiation exposure” Dr. Toskich says.

trio of images displaying: 4.3 cm liver tumor, the tumor lit by radioactivity, with nothing in surrounding liver, and 23 month follow-up image with no recurrence

The research of Dr. Toskich’s team centers on mapping specific liver blood supply territories, using small catheters and mini-CT scans to analyze the blood vessels responsible for nourishing an individual’s tumor.  After mapping is complete, the patient typically receives treatment during a single outpatient session. As the radiation takes effect over the course of several months, the liver uses its inherent regenerative abilities to recover from the small portion of itself that had been treated alongside the tumor. In another project, Dr. Toskich is also working with Kabir Mody, M.D., to determine whether radioembolization can stimulate the body’s immune response in order to fight liver cancer.

With higher radiation doses enabled by this more precise radioembolization approach, tumors are showing promising response in early research. As a result, the team is optimistic about its ability to increase the number of liver cancer patients who are candidates for tumor-removal surgery, either through transplantation or resection, or with radioembolization as the sole therapy in select circumstances. “We are finding that in patients who received liver transplantation after high dose radioembolization, about half of targeted tumors show complete cell death and over 95 percent show extensive treatment response,” says Dr. Toskich. “Certain tumors are being eradicated by radioembolization, which used to only be capable of slowing the progression of liver cancer when other treatments were not an option.”

“Radioembolization has an important role in controlling tumor growth in patients with liver cancer while they await a transplant,” says Tushar Patel, M.B., Ch.B., dean for research at Mayo Clinic in Florida, who is collaborating on this work. “We think that it may also be used as curative treatment in patients with very early liver cancer. Mayo’s extensive efforts in liver cancer research, combined with our comprehensive interdisciplinary care capabilities, are helping us develop unique treatment strategies.”


Wed, May 13 6:00am · Trailblazers, part 2

In the last Trailblazers article, we shared the stories of six women physicians and scientists appointed to the staff at Mayo Clinic between 1889 and 1926. These women stand out for their passion and leadership in medicine at a time when there were very few women in the field.

These early women in medicine prepared the way for more trailblazers in the decades that followed. Join us as we continue the celebration by sharing the stories of six women physicians and scientists who forged careers for themselves at Mayo Clinic from 1932 to 1956.

Today Mayo Clinic has 10,054 living female alumni (physicians and scientists) around the world.

black and white portrait
Julia Herrick, Ph.D.

Julia Herrick, Ph.D.

Dr. Herrick received a Ph.D. in biophysics at Mayo Clinic in 1932. Early in her career, she was interested in studying and measuring blood flow in mammalian blood vessels. Her studies led to important modifications to the Rein thermostromuhr. During World War II, she joined the Signal Corps Engineering Laboratories to work on radio direction finding. She returned to Mayo Clinic in 1946 to research the biologic effects of microwaves and ultrasound, physiologic thermometry, and the circulation of blood. Later in her career, she served as chair of the Institute of Radio Engineers Professional Groups on Medical Electronics and Ultrasonics Engineering.

Grace Roth, Ph.D.

Grace Roth, Ph.D.

In 1936, Dr. Roth became the first woman born in Rochester, Minnesota, to receive a Ph.D. from the University of Minnesota for work done at Mayo Clinic. She was appointed to the Mayo Clinic staff in 1937 as a consultant in physiology and taught at the graduate school. She is widely known for her research on the functional aspects of heart and blood vessels and clinical investigative physiology. She served as president of the Minnesota Heart Association in 1953 and, later, served as chair of the American Heart Association Section on Circulation.

Jane Hodgson, M.D.

Jane Hodgson, M.D.

Dr. Hodgson devoted a 50-year career to women’s reproductive health care. She attended Carleton College and the University of Minnesota and trained at Mayo Clinic, graduating in 1944. She co-founded the Duluth Women’s Health Center and was a founding fellow of the American College of Obstetrics and Gynecology. In 1994, she received the National Reproductive Health Award from the American Medical Women’s Association and, in 1995, she received the Margaret Sanger Award from the Planned Parenthood Federation of America. She was one of the first physicians inducted into the International Women in Medicine Hall of Fame in 2001.

Eva Gilbertson, M.D.

Eva Gilbertson, M.D.

In 1946, Dr. Gilbertson was the first woman to complete a radiology residency program at Mayo Clinic and, later, was the first woman to open a radiology practice in Seattle, Washington. She was a founding member of the Pacific Northwest Radiological Society. She told Mayo Magazine in 2007 that she hoped her early efforts helped pave the way for younger generations of women in medicine.

Sarah Luse, M.D.

Sarah Luse, M.D.

Dr. Luse completed a residency in neuropathology at Mayo Clinic in 1946. She made significant contributions to the fields of neuropathology, clinical neurology and neurosurgery. She was an internationally known expert on submicroscopic changes in tissues caused by disease. Her research led to the discovery that a particular kind of brain cell was damaged my multiple sclerosis. Dr. Luse left Mayo Clinic in 1954 for an American Cancer Society fellowship at Washington University School of Medicine in St. Louis, a decade later, she became the first women to be named to an administrative post there. From 1967 to her death in 1971, she was a professor of anatomy at Columbia University College of Physicians and Scientists in New York City.

Virginia Hartridge, M.D.

Virginia Hartridge, M.D.

Dr. Hartridge served as education director of the Mayo Clinic School of Nurse Anesthesia from 1956 to 1964, and director from 1964 to 1976. For more than 20 years she worked to advance the training of nurse anesthetists at Mayo Clinic. Under her direction, the school was accredited by the American Association of Nurse Anesthetists’ Council on Accreditation. Dr. Hartridge is known for developing and popularizing a technique of balanced anesthesia for cesarean section, which received widespread national acceptance and, for years, remained the preferred anesthetic technique for that operation.

This article was originally published in Alumni Magazine, Issue 1, 2020.

Wed, May 6 6:00am · Noninvasive test may help some patients with melanoma avoid lymph node biopsy

Alexander Meves, M.D., center, with colleagues from SkylineDx: Mark Luna-Vargas, Ph.D. (left) and Jvalini Dwarkasing, M.D. (right)

By Jay Furst

A Mayo Clinic-led research team has developed a test for patients who have melanoma, the most serious form of skin cancer, that shows whether they’re at risk of the cancer spreading to other areas of the body.

The research, described in the journal JCO Precision Oncology, could allow some patients at low risk of metastasis to avoid having a sentinel lymph node biopsy, an invasive surgical procedure that turns out to be negative for 80% of patients.

“The test combines genetic information from a skin biopsy with certain patient characteristics,” says Alexander Meves, M.D. , a Mayo Clinic dermatologist and researcher whose laboratory works on cutting-edge methods to diagnose and treat melanoma. “The test tells patients whether their melanoma is so low-risk of spreading to other areas of the body that they do not need to undergo a sentinel lymph node biopsy.”

Melanoma develops in the cells that produce melanin, the pigment that gives skin its color. Skin cancer is the most common of all cancers, according to the American Cancer Society. Melanoma accounts for only about 2% of skin cancers but causes a majority of skin cancer deaths, and the rate of incidence has increased markedly in recent years.

The study involved Mayo Clinic researchers in Arizona, Florida and Minnesota, with assistance from a Dutch biotech company, SkylineDx. “We sought to identify molecular tools that indicate which cancer cells are likely to spread throughout the body and determine whether we could identify their presence with a test,” says Dr. Meves, the study’s senior author. First author is Domenico Bellomo, Ph.D., head of bioinformatics-melanoma at SkylineDx.

The study involved 754 patients who were diagnosed with melanoma at Mayo Clinic campuses in Arizona, Florida and Minnesota between 2004 and 2018. The patients had thin or intermediate thickness primary cutaneous melanoma tumors. The characteristics of the tumors, as well as the patient age at the time of diagnosis, were among the clinical factors taken into account along with gene expression from the tumor.

“This test, which incorporates key clinical and new genomic factors, outperforms all other diagnostics tools in identifying patients with a low risk of nodal metastasis and has the potential to reduce sentinel lymph node biopsy rates by up to 40% while keeping the false omission rate below 5%,” says Tina Hieken, M.D., a Mayo Clinic surgical oncologist whose specialty interests include melanoma.

The next step will be to validate the results in a larger prospective study, says Dr. Hieken, a study co-author. “We’re working on activating a registry trial to validate these results across key national and international sites,” she says.

Previous efforts to identify and validate molecular risk factors have been limited by the small number of patients and incomplete patient data. “We estimate that our test could eliminate as many as 70% of sentinel lymph node procedures for early stage melanoma and 40% of slightly more advanced melanoma, called T2 melanoma,” Dr. Meves says.

The study was funded by grants from the National Cancer Institute and the National Center for Advancing Translational Sciences, as well as the Mayo Clinic Center for Individualized Medicine, the Mayo Clinic Cancer Center and the Fifth District Eagles Cancer Telethon.

Dr. Meves reports a financial interest in the test being developed by SkylineDx. Mayo Clinic has reviewed this relationship and taken appropriate steps to protect the scientific integrity of the research.


This article was originally published on the Center for Individualized Medicine blog.

Fri, May 1 11:30am · Non-COVID research in the news, 5/1/2020

pipettes dropping liquid into tubes, artistically colored and cropped photo

Although the week’s coverage has largely consisted of COVID-19 news, closer inspection finds it peppered with Mayo Clinic research on some other topics. We’ve collected a few of the news clips for ease of review. Read on for findings in cancer, deep vein thrombosis and Alzheimer’s disease:

cfDNA Assay Shows Predictive Value in Detecting Cancer, Tissue of Origin

By Nichole Tucker, OncLive, 4/29/2020

A cell-free DNA (ctDNA) test demonstrated the potential to detect cancer and predict tissue of origin in patients with a suspicion of cancer, according to findings from the Circulating Cell-free Genome Atlas (CCGA) study presented at the 2020 AACR Virtual Annual Meeting I.

Late cancer detection is one of the contributing factors toward advanced cancer diagnoses and cancer-related mortality. In particular, 30% of patients with breast cancer present with regional or distant metastases at diagnosis, as do roughly 55% of colorectal cancers and about 75% of lung and bronchial cancers.

“Many cancers are detected too late. The large percentage of breast, colorectal, and lung cancers are diagnosed simultaneously with metastatic disease. The detection of cancer prior to the development of metastatic disease can improve 5-year survival,” said David Thiel, MD, chair of the Department of Urology at Mayo Clinic.

Safety, Efficacy of Apixaban or Rivaroxaban in Upper Extremity Deep Vein Thrombosis

By Lauren Dembeck, Ph.D., Cardiology Advisor, 4/28/2020

Treatment of upper extremity deep vein thrombosis (DVT) with apixaban or rivaroxaban appears to be as safe and effective as low molecular weight heparin (LMWH) and/or warfarin, according to study results published in the American Journal of Hematology. …

This study appears to be the first to compare clinical outcomes in upper extremity DVT for patients treated with apixaban or rivaroxaban compared with the traditional anticoagulation treatment of LMWH and/or warfarin. …

Patients with VTE who had enrolled in the Mayo Clinic VTE Registry from March 1, 2013, to December 31, 2019, were prospectively followed; clinical, demographic, and imaging data were collected.

With TREM2, Timing Is Everything

— ALZFORUM, Series – AAT-AD/PD 2020 Conference: Advances in Alzheimer’s and Parkinson’s Therapies, 4/22/2020

Certain variants in the TREM2 gene more than triple a person’s risk of AD, seemingly by sapping the protective function this microglial receptor performs. According to findings presented at the virtual AAT-AD/PD meeting, held April 2 to 5, TREM2’s protective power falters as amyloidosis kicks into high gear.

Guojun Bu of the Mayo Clinic in Jacksonville, Florida, described what happened in a mouse model of amyloidosis when he switched on expression of human TREM2 at different stages of disease. Wild-type human TREM2 stemmed Aβ deposition, but only while plaques were in their infancy. It had no effect later on. In contrast, the R47H mutant never protected against plaques, and even exacerbated their growth. Together, the findings suggest that TREM2’s protective role is limited to early stages of Aβ deposition.

Paul Taylor Wins 2020 Potamkin Prize

— ALZFORUM, 5/1/2020

In a virtual ceremony hosted by the American Brain Foundation on April 29, Potamkin Philanthropies awarded the 2020 Potamkin Prize for Research in Pick’s, Alzheimer’s, and Related Diseases to J. Paul Taylor from St. Jude Children’s Research Hospital, Memphis, Tennessee.  …

With Rosa Rademakers at the Mayo Clinic, Jacksonville, Florida, he found that mutations in another RNA-binding protein, TIA1, increase the risk for ALD/FTD and these variants also promote liquid-liquid phase separation (Aug 2017 news). 


For the collection of materials published on COVID-19 by Mayo Clinic, please visit the mini site.

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