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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9 hours ago · 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.”

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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.

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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). 

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

Wed, Apr 22 6:00am · Non-COVID research in the news

Mayo staff sitting together in office setting, discussing something.

These stories are a little like the fabled unicorn – hard to find, but special if you do. Mayo Clinic has a wide range of research ongoing, and continues to publish their findings. Sharing those findings in this current time of “all COVID, all the time,” is challenging. Some of our research and researchers is highlighted in the articles below.

Providers Are Inappropriately Prescribing Opioid-Tolerant Only Medications

By Samara Rosenfeld, HCP Live

Most patients who initiated in opioid-tolerant only medications did not have evidence of prior tolerance, according to new study findings.

The findings suggested that such patients were at an increased risk of opioid-related harms, including fatal overdose.

Molly Jeffery, Ph.D., was the study’s lead author. Dr. Jeffery is also the scientific director of Emergency Medicine Research at Mayo Clinic.


Fighting Vaccine Hesitancy, One Parent at a Time

By Amelia Harnish, The New York Times

Note: This article was originally published in NYT Parenting, Oct. 25, 2019. The Times republished because of the timeliness of the topic. Subscription may be required to read full article.

Most parents do vaccinate, but the effects of even a slight downturn in vaccination rates for highly infectious diseases can result in outbreaks. What’s more, roughly 30 percent of parents are “vaccine hesitant” — meaning they have significant concerns about vaccines and may spread out the timing of vaccinations against medical advice or refuse certain vaccines altogether, said Dr. Robert M. Jacobson, a professor of pediatrics and medical director for the population health science program at the Mayo Clinic Center for the Science of Health Care Delivery. This practice is perceived as a middle road and safe bet by parents, but it’s also risky — particularly if providers or the community don’t nip it in the bud.


Skin Cancer Test Reduces Need for Surgery

— Yahoo! Finance

“Typically, when treating patients with melanoma, surgeons remove lymph node(s) to check for metastasis and determine the patient’s disease stage and best treatment strategy,” explains Alexander Meves, M.D., a dermatologist at Mayo Clinic, [in Rochester, Minnesota] and senior author. “However, studies have shown these surgeries do not consistently provide additional diagnostic information.”

The study, published in JCO Precision Oncology, discusses a diagnostic test being developed by SkylineDx and Mayo Clinic which identifies patients who are at low risk of metastasis in their lymph nodes and will not benefit from surgical removal of their lymph nodes.

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Tue, Apr 21 6:00am · Celebration of student research

Mayo Clinic Graduate School of Biomedical Sciences held its annual Student Research Symposium in September, with poster sessions, oral presentations, a keynote speaker, a Three-Minute Thesis (3MT) competition and Teacher of the Year awards.

“The Alumni Association and Mayo Clinic Graduate School of Biomedical Sciences co-sponsored symposium and Teacher of the Year awards are the highlight of our diverse scientific community,” says Stephen Ekker, Ph.D., dean of the graduate school. “Representing almost 200 Ph.D. and M.D./Ph.D. students, faculty, staff and alumni, this event celebrates dedication and achievement in the lab and in our communities around each of the three Mayo Clinic sites.”

Posters and oral presentations

Posters at the symposium numbered 152 — a record number. One student from each track in the school was selected to present their research.

Keynote speaker

David Masopust, Ph.D., University of Minnesota Department of Microbiology and Center for Immunology, was the Findling Lecturer, presenting “Immune System Reconnaissance for Infection and Cancer.”

3MT

The Three-Minute Thesis, or 3MT, competition challenges Ph.D. students to describe their research within three minutes to a general audience.

  • Overall winner and People’s Choice: Tyler Bussian, “Zombie Cells — a New Target for Alzheimer’s Disease.”
  • Runner-up: Emma Goddery, “Keeping Brain Inflammation in Check.”

Teacher of the Year awards

Teacher of the Year awards for Mayo Clinic Graduate School of Biomedical Sciences were presented to:


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

Fri, Apr 3 6:00am · Science needs to guide us, says Mayo Clinic's Dr. Gianrico Farrugia on "Face the Nation"

Dr. Farrugia stands with his arms folded over his chest.
Mayo Clinic President and CEO Gianrico Farrugia, M.D.

Mayo Clinic President and CEO Gianrico Farrugia, M.D., shared his perspective on next steps to address the COVID-19 pandemic on CBS News’ “Face the Nation” program that aired March 29, 2020.

In his interview with “Face the Nation” moderator Margaret Brennan, Dr. Farrugia said the focus needs to be on saving lives because “there is no direct end in sight,” and he emphasized that the multi-faceted approach has to be “driven by the science, not by conjecture.”

Dr. Farrugia also underscored that research and innovations that are happening across the country will improve the way health care providers test and track the outbreak on both macro and micro levels, to help flatten the curve of COVID-19 infections faster and help those in greatest need.

He praised health care workers and gave thanks for the heroic work they are doing around the clock to save lives and prevent further spread of the virus.

The full transcript of the interview can be found here. The latest news about COVID-19 from Mayo Clinic can be found here.


Fri, Mar 20 8:00am · Mayo Researchers Develop Unique Tool, Lab to Study Vaping

Vaping devices
Common e-cigarettes and vaping juices

Jon Ebbert, M.D., is sympathetic to the plight of the patients he sees who are struggling with addiction. “I saw a lot of addiction growing up,” he tells Rochester Magazine’s Steve Lange. “I know the damage it can do.”

Dr. Ebbert, a Community Internal Medicine physician and researcher in Mayo Clinic’s Nicotine Dependence Center, also understands why it can be so hard for his patients to stop using tobacco despite the negative effects the drug has on their bodies. “I understand that life is complicated. I understand that what drives drug addiction is the innate desire that we all have to escape pain and discomfort. I understand that we all need coping mechanisms,” he tells Rochester Magazine.

It’s that compassionate, firsthand understanding that’s driven Dr. Ebbert and fellow Mayo Clinic researcher Alexandra Ward to learn all they can about the chemical makeup of today’s ever-increasing and ever-changing vape solutions. The two also work to discover what patients are inhaling when they use cannabidiol (CBD) and tetrahydrocannabinol (THC) for the treatment of medical conditions — in hopes of figuring out, once and for all, if any are safe to inhale. “Half a million people die in this country every year from cigarettes,” he tells the magazine. “I’d love to find something safe to reduce that harm.”

And as the magazine reports, he and Ward are giving it all they’ve got. They’ve established their own Inhaled Particle Aerosol Lab within Mayo Clinic’s Nuclear Magnetic Resonance Spectroscopy lab to study the chemical make-up of vape, CBD and THC samples in a very unique, Star Wars-esque kind of way: By “force-feeding” today’s “next generation of drug delivery devices — e-cigs and vaping pens” into a literal “Cigarette Smoking Machine” (CSM) that looks and sounds like it would fit in a galaxy far, far away. “When it inhales — when the motor-driven pump sucks superheated vapor from the e-cig into a whistling-lips-sized hole in its faceplate — CSM makes an adorable electronic chirping sound, like R2D2 whenever he’s reunited with C3PO.”

Connection to COVID-19

Because it attacks the lungs, COVID-19 could be an especially serious threat to those who smoke tobacco or marijuana or who vape, says the National Institutes of Health.

More information is available on the National Institute on Drug Abuse website.

In addition, the Centers for Disease Control and Prevention have published special guidelines for people at risk of serious illness from COVID-19.

Mayo Clinic’s complete set of COVID-19 related news and information is housed in a central location online.

That’s a description that no doubt pleased Dr. Ebbert, as Lange notes the good doctor was wearing a pair of Yoda socks on the day of their interview. “We call her BB-Vape,” Dr. Ebbert tells the magazine of the Jedi Master Cigarette Smoking Machine.

While Dr. Ebbert would like to find a safe smoking alternative for his patients, what BB-Vape is showing time and time again is that vaping, in particular, remains particularly unsafe. “When you take an e-liquid, and put it in this device and heat it, you develop at least 18 new chemical compounds that didn’t exist in the e-liquid,” Dr. Ebbert tells Rochester Magazine. “This is a reaction vessel with new chemical species being created, including chemicals like formaldehyde, which can cause cancer. I can’t safely recommend any of these products to my patients right now. And I wish I could.”

Dr. Ebbert’s work with BB-vape and other addiction and tobacco cessation programs continues during the rising COVID-19 crisis. His sense of urgency is also rising because, “People who smoke or vape who already have compromised lungs,” he says, “may put them at increased risk for complications from COVID-19.” 

A version of this article was originally published on In the Loop.

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