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Tue, Oct 3 8:00am · Alzheimer’s Researcher Receives MERIT Award

Dr. Guojun Bu in his Florida laboratory.

Neuroscientist Guojun Bu, Ph.D., Mary Lowell Leary Professor of Medicine, on Mayo Clinic’s campus in Florida, has been selected to receive the prestigious Method to Extend Research in Time (MERIT) Award. Granted by the National Advisory Council on Aging, the award provides long-term research funding to outstanding principal investigators who have demonstrated success on projects supported by the National Institute on Aging (NIA). The NIA MERIT award is given to fewer than a handful of researchers annually and offers up to 10 years of NIH support.

“This is an honor that recognizes excellence in research and helps to ensure the continued success and productivity of his research program,” says Tushar Patel, M.B., Ch.B., dean for research on Mayo Clinic’s campus in Florida.

Dr. Bu’s lab has a two-decades-long track record teasing apart the neurobiology of Alzheimer’s disease.

Alzheimer’s medical illustration of amyloid plaques

His team has made headway understanding the mechanisms of the Alzheimer’s gene, APOE, and its high-risk variant, APOE4. In recent studies, Dr. Bu described the role of APOE4 in impaired insulin signaling in the brains of Alzheimer’s patients.

His team has also been focusing on understanding the cerebrovascular effects of Alzheimer’s, in particular determining how the disease reduces the brain’s ability to clear out deposits of the sticky protein known as amyloid peptide. His group recently identified “clean-up” cells in the healthy brain, responsible for removing toxic amyloid deposits, the main pathological component of Alzheimer’s brains. Funding from the MERIT Award will further his investigations of the brain’s natural clean-up mechanisms, as he focuses on the brain’s vasculature. Studies will investigate the cerebral blood vessels, which remove accumulating amyloid protein, as well as drainage pathways that run alongside the blood vessels, and will look at the role APOE plays in the effectiveness of these amyloid clearance systems.

“I’m grateful to have the opportunity to advance what we’ve begun as we look deeper into these mechanisms and collectively try to find a cure for Alzheimer’s disease,” Dr. Bu says. “And I’m also grateful the award provides lengthy protected time, where you don’t have to spend too much time writing grant applications and can focus on doing science.”

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Wed, Sep 6 8:00am · Access to clinical trials-- focus of Florida policy forum

Health care organizations from around the state of Florida came together on Mayo Clinic’s Jacksonville campus Aug. 29 to raise awareness about clinical trials research taking place in the state. The Florida Policy Forum on Clinical Trials also focused on strategies for recruiting more diverse participants and the important role clinical trials play in providing improved treatment options for patients.

“It is crucial for patients to have access to high-quality, innovative clinical trials that may open doors to new treatments, and it is particularly important to ensure clinical trials are accessible to all, including minorities,” says Tushar Patel, M.B., Ch.B., dean for research at Mayo’s Florida campus. ”The Office of Health Disparities Research at Mayo supports the recruitment of diverse populations into our research studies. We have also made dramatic improvements in how quickly we can activate a clinical trial so that patients have faster access to clinical trials and treatments that may benefit them.”

Dr. Patel opened the program in Kinne Auditorium with welcoming remarks to about 100 people in the audience, consisting of major cancer centers and health systems in Florida, state government and policy makers, patient advocacy organizations and consumers. Florida State Representative Jason Brodeur (House District 28), chair of the House Health Care Appropriations Subcommittee, served on one of the panels, explaining how the state of Florida funds clinical trials.

Panel discussions included a focus on the importance of clinical trials and how to close the disparity gap, as well as the future of cancer clinical trials. Asher A.Chanan-Khan, M.D., chair of Hematology/Oncology, and Sikander Ailawadhi, M.D., vice chair, clinical practice, Hematology/Oncology, represented Mayo on the panels. Dr. Ailawadhi emphasized that more can be done to provide patients the access they need to clinical trials. He told the audience that Mayo Clinic is working to develop clinical trial pathways for clinicians so that “clinicians can decide when patients walk in the door, what clinical trial they are eligible for. As long as patients get the right treatment at the right time, we can make a difference.” He stated that he believes clinical trials should become the standard for cancer care across the country. That comment earned him applause.

Dr. Chanan-Khan commented that “we’ve developed an extensive resource and infrastructure on campus for novel clinical trials” at Mayo Clinic. “We look at the science first and bring it to the patient.” He called for action in seeking legislative solutions to remove financial barriers so that every patient could have access to clinical trials.

The event was hosted by the American Cancer Society Cancer Action Network. Other participating health care organizations included Moffitt Cancer Center; UF Health Shands Hospital; Baptist MD Anderson Cancer Center; University of Miami Sylvester Comprehensive Cancer Center; 21st Century Oncology, UF Oncology and Infusion Center; and PhRMA.

Find out more about clinical trials on Mayo’s clinical trials website.

Tue, May 9 8:00am · Increasing the Odds

Increasing the Odds

Mayo Clinic performs more transplants than any other organization in the country. That experience allows Mayo Clinic scientist-physicians to study stem cells and personalize drugs to fight organ rejection and increase the number of viable lungs.

Immune-Building Stem Cell Research

In the 1970s, when Cesar A. Keller, M.D., started his career in pulmonology, lung transplantation was widely considered science fiction. Now, lung transplantation is a lifesaving option for thousands of people every year, but it’s not perfect, Dr. Keller says. For adults, the five-year survival rate is about 55 percent, according to 2008–2015 lung transplant data from the Department of Health and Human Services.

With the help of philanthropic support, Dr. Keller and colleagues in the Mayo Clinic Center for Regenerative Medicine are trying to solve the most lethal imperfection of lung transplantation, a syndrome called chronic organ rejection.

Moving From Rejection to Acceptance

Chronic rejection is considerably more common in lung transplantation than in other solid organ transplants. This is most likely due to environmental factors, which “the lungs are exposed to continuously, with every breath a patient takes,” Dr. Keller explains.

To solve that challenge, Dr. Keller and his colleagues are using tools that are today’s version of science fiction becoming science fact: stem cells and regenerative medicine.

Stem cells have the ability to repair damaged cells, transform into almost any cell the body needs and temper the immune system. So, Dr. Keller’s team launched an initial clinical study to evaluate safety and dose considerations of stem cell use in lung transplant patients who have chronic organ rejection. Researchers also gathered data on whether the treatment may have potential for improving lung function or slowing the progressive decline in function that occurs with chronic organ rejection.

The study used bone marrow-derived stem cells, which were infused through an IV and circulated to the lungs. The lungs “trap all of the stem cells,” Dr. Keller says. His team is preparing for a larger clinical study that will be based on the initial study results. “It took us seven years from our concept to delivering stem cells to the first patient,” he says. “It’s going to take at least another seven or eight years to see if this is successful.”

Developing Lung Restoration Capabilities

A rendering of the lung restoration center on the Mayo Clinic campus in Jacksonville, Florida.

This research and other activities in the Center for Regenerative Medicine will be extended by another new technology that is coming to the Florida campus. In 2016, Mayo Clinic and United Therapeutics broke ground on a lung restoration center that could more than double the number of donor lungs viable for transplantation in the United States. (Read news release).

United Therapeutics is working to improve donor lungs and make them suitable for transplantation using “ex vivo lung perfusion technology.” The technology stores lungs in a specialized chamber and treats them with solutions and gases that can reverse lung injury and remove excess fluids.

Dr. Keller says the technology, which preserves lungs when they are outside the body, can be used to research the benefits of delivering stem cells to lungs before they are transplanted into a person. That strategy may help reduce immune system responses after the lungs are transplanted. “It was literally all science fiction when I began,” Dr. Keller says. “It’s interesting to think about where the field was when I started and to see these concepts become things we can apply.”

Despite the use of immuno-suppressants, a person’s body at times can recognize the transplanted organ as a foreign object and attempt to protect itself by attacking the new organ. Even with immunosuppression medications, some transplant patients experience episodes of rejection.

There are two main types of rejection:

Chronic rejection occurs over
many years because a patient’s immune system never fully accepts
the transplanted organ and slowly damages it.

Acute rejection may occur from  the first week after the transplant to three months afterward.

An Individualized Strategy for Stopping Organ Rejection

The effectiveness of immunosuppressant drugs is governed by a number of factors, but a major contributor is an individual’s genome. The genes that make up each person’s genome direct how a drug is metabolized and how it stimulates the immune system to accept the transplant.

While these drugs help a transplanted organ continue to function, they tax the rest of the body. For transplant patients, it is essential to understand the appropriate regimen of anti-rejection medications.

Mayo Clinic’s Center for Individualized Medicine is collaborating with a molecular diagnostics company to monitor patients after an organ transplant and improve the efficacy of these drugs by tailoring the treatment to an individual’s genome through the TOGETHER trial.

The initial focus is on immunosuppressant therapies for 250 kidney transplant recipients.

“Genomic analysis of blood can reveal early signs of rejection in transplanted kidneys,” says principal researcher Mark D. Stegall, M.D., the James C. Masson Professor of Surgery. “The potential clinical utility is to be able to monitor for rejection more frequently than is possible with surveillance biopsies and to individualize immunosuppression in transplant recipients.”

Among this study cohort, kidney transplant patients will have genomic testing at five intervals throughout their first postoperative year. These data points may help transplant care teams fine-tune immunosuppression drug regimens and improve patient outcomes.

“The promise of individualized medicine is  that we can now use information found in a patient’s own genetic code to provide better,  more personalized answers about their medical  care. Through important efforts such as the TOGETHER trial, we can and will make that promise more of a reality for our transplant patients,” says Alexander S. Parker, Ph.D., the Cecilia and Dan Carmichael Family Associate Director for the Center for Individualized Medicine at Mayo Clinic in Jacksonville, Florida.

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This article was originally published in Mayo Clinic Magazine, Volume 1, 2017.

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