10 Ways Pittsburgh's Medical Community is Changing the World
Pittsburgh has been a center for medical research for decades. As the region’s university and hospital communities continue to grow and collaborate, the work being done here is changing — and saving — lives around the world.
Doctor photos by Martha Rial
Jan Scheuermann looks at a piece of chocolate held by the metal fingers of a robotic arm. She imagines that the chocolate is moving toward her, coming close enough for her to take a nibble — and it does.
The robotic arm responds to small implanted electrodes in her brain, reading the signals and bringing the chocolate to her mouth. For the first time in nine years of living as a quadriplegic, she is feeding herself.
Across town, Dr. Masahiro Yoshida is folding up his custom-made Gore-Tex heart valve, fitting its leaflet design into a child born with congenital valve defects.
These are but two examples of recent medical research in Pittsburgh that have come to life — and are changing lives. The relentless innovations envisioned in area hospitals and laboratories echo the city’s past; it was 60 years ago at the University of Pittsburgh that Dr. Jonas Salk was testing a vaccine against polio, rounding up 1 million school children for the trial. He would announce its success the following year. A little more than 10 years later, Dr. Peter Safar — best known for developing CPR — would team with Philip Hallen to pioneer Pittsburgh’s Freedom House ambulance service, training the first class of those who would become the nation’s first paramedics and launching the profession of the emergency medical technician.
Pittsburgh is a city that, decade after decade, churns out groundbreaking research that both improves and saves lives, and the factors at play in that continuing reality go beyond the students and doctors who call the region home.
Financial support is imperative. Physicians and researchers work nights and weekends writing grants to support their research; during the 2013 fiscal year, they were rewarded with more than $474 million in grants from the National Institutes of Health. That’s not counting other sources of funding: For example, America Makes, a Youngstown-based network of organizations focused on the growth of 3-D printing, recently selected the University of Pittsburgh to explore the use of 3-D printers in creating biodegradable structures, helping surgeons sidestep the disease-transmission problems of bone grafting and allowing the body to heal more safely. That 18-month contract comes with $438,000.
The wide breadth of topics researched is another constant. Beyond the developments spotlighted in the reports that follow, Allegheny Health Network is exploring new treatments for ovarian cancer and studying drugs that can help to reduce the number of breast cancer cases in high-risk women. At UPMC, studies are underway on concussion patients from elementary school children to NFL players, and a social worker is trying to reduce retaliation shootings — which can account for up to one-third of Pittsburgh’s homicides — by bringing an interventional program to gunshot victims.
But the bedrock of the region’s research culture is its strategic partnerships — between the hospitals and universities, between scientists and physicians and between experts and community members willing to volunteer. Without collaboration, the work done here simply wouldn’t be possible — and the amount of cooperation across institutional lines and disciplines found in Pittsburgh is atypical, overcoming bureaucratic hurdles that hinder projects elsewhere.
The presence of long-standing, world-class institutions can lead to those collaborations, often in unprecedented ways. While Scheuermann, a volunteer participant, works with her team in Oakland to use the robotic arm, scientist Andy Schwartz is nearby doing related work with monkeys; he’s previously had them interacting with virtual reality and operating cursors with their brains. Also nearby, you’ll see the lab of Peter Strick, Ph.D. and distinguished professor and chair of the Department of Neurobiology at the University of Pittsburgh, studying how the brain controls stress and the immune system.
Welcome to the Brain Institute, which merges teams from the University of Pittsburgh, Carnegie Mellon University and UPMC to study the brain and seek cures for brain disorders. With the multiple-Nobel-Prize-winning Bell Labs as its inspiration, the institute is using its resources to support new and creative ideas in research.
“We have open architecture, so you may interact with someone in the psychology department, neurology or mathematics — or run into someone from CMU in robotics or statistics,” says Dr. Strick, the institute’s founding scientific director. “Our job is to make the bridge between the two universities.”
At Carnegie Mellon, one new initiative has faculty members at work solving the problems of making health care cheaper and more effective. Some have suggested developing video analytics for colonoscopies to lower the amount of missed polyps. Others are working on new methods of discovering mistakes in medical claims data.
Their research was prompted by the newly formed Disruptive Health Technology Institute, a union of the Allegheny Health Network and CMU that uses science and engineering to solve problems in the health-care system.
Allegheny Health Network approached CMU to launch the institute, headed by Dr. Alan Russell. “They had a huge amount of knowledge about the core problems in health care,” says Dr. Russell, chief innovation officer at Allegheny Health Network. “CMU had a huge amount of knowledge about how to solve problems.” The institute announces different rounds of problems to solve throughout the year, and faculty submit proposals to receive funding.
CMU is in a unique position in that it collaborates with its research with both UPMC and the Allegheny Health Network. As a protracted legal and public-relations battle over business operations continues between those two institutions, researchers and doctors nevertheless have found ways to make important work continue.
“A university that doesn’t have a medical school isn’t going to be wrapped up in [conflict],” Dr. Russell says. “We have a history of being Switzerland. Research and innovation should be Switzerland as well.”
As hospitals, universities and research groups collaborate, so, too, must individuals in different disciplines. Dr. Ngoc Thai, a surgeon with the Allegheny Health Network Center for Abdominal Transplantation, was trying to keep liver cancer patients healthy enough to receive transplants. He was intrigued by a radiation therapy technique developed by radiation oncologist Dr. Alexander Kirichenko.
“We were forming a multidisciplinary liver group, and I thought, ‘Let’s have Alex here.’ His research was so simple, so elegant that we felt it was a no-brainer to use the technology for the treatment of liver cancer,” Dr. Thai says.
Dr. Kirichenko, for his part, defers the praise. “The surgeon is the commander-in-chief,” he says. “When you have a good commander, everyone listens.”
The feeling of mutual admiration between the region’s scientists and physicians is palpable. When Dr. Peter Rubin, chairman of the Division of Plastic and Reconstructive Surgery at UPMC, came to Pittsburgh from Boston 12 years ago, he says he was pleasantly surprised by the open-door culture.
“People are so amenable to forming collaborations here. Some of the best things happen when I sit down in a room with someone in a completely different field who has nothing to do with what I’m doing, and we start sharing ideas. A lot of synergy develops,” he says.
Dr. Ernesto Marques, too, is in the business of collaborations; he splits his time between Pittsburgh and Brazil and has built a partnership with a Brazilian blood bank to test blood samples for antibodies to the dengue infection.
He says he was impressed by the cooperative nature he encountered at the University of Pittsburgh.
“It starts with the leadership — they had the vision to select a team of people [who] complement each other. That is very important. It’s not just a random selection of scientists that are doing great work but not connected to each other,” says Dr. Marques. “You can have very successful departments in Ivy League schools that are very well-funded and published very well, but they can be excellent in one thing and forget everything else.”
As one of those leaders, Arthur Levine, M.D., senior vice chancellor for the Health Sciences and the John and Gertrude Petersen Dean of the School of Medicine at the University of Pittsburgh, has a black-and-white attitude toward the necessity of collaboration.
“Within the health sciences, there is the recognition that contemporary medical and behavior research is interdisciplinary because no one scientist has mastered all the disciplines of science. It has to be collaborative and interactive,” says Dr. Levine. “One can no longer be productive in science and have a productive career if one is not able and willing to be collaborative and interactive.
“The days of one human being looking in a microscope and saying ‘Eureka!’ are probably in the past.”
One of the touchiest lines, of course, may be between UPMC and the Allegheny Health Network themselves. Anthony Mannarino, Ph.D. and professor and vice chair of the Department of Psychiatry at Allegheny General Hospital, is proud that his development of posttraumatic cognitive behavioral therapy with partner Dr. Judith Cohen was able to happen across those sometimes-contentious lines.
“We have collaborators at UPMC, at Children’s [Hospital of Pittsburgh of UPMC] and at [UPMC] Mercy. We don’t let higher-level politics get in the way of forging the collaborations,” he says.
And since parents and children lined up for Dr. Salk’s vaccine, Pittsburgh researchers and institutions have been able to count members of the community as powerful, essential allies as well. When Dr. Cohen teamed with Dr. Mannarino to think through a new type of therapy for children of trauma, she says she knew what they would need — the children themselves. It started with interested parents of Pittsburgh preschoolers bringing young volunteers; afterward, local agencies streamed forward to help.
“We could not have done it without the collaborations in the community,” she says. “Pittsburgh has a lot of nice people, and the children have contributed to our knowledge and have helped kids around the country and the world.”
Blair Jobe, M.D., director of the Institute for Treatment of Esophageal and Thoracic Disease at Allegheny Health Network, agrees with Dr. Cohen’s assessment of the value of locals’ friendliness.
“There’s a spirit of cooperation that is unique to Pittsburgh,” he says. “Pittsburghers are adventurers — they have refined and renewed that spirit of can-doism.”
Michael Bell, M.D., director of the Pediatric Neurocritical Care and Neurotrauma at Children’s Hospital of Pittsburgh of UPMC’s Brain Care Institute, credits his success in Pittsburgh to the city’s rich medical history and particularly to Dr. Safar. Along with Dr. Safar’s many accomplishments — and being nominated for the Nobel Prize in medicine three times — he would go on to hire many of Bell’s mentors.
“I’m standing on the shoulders of some relatively large giants and trying to see the next hill,” says Dr. Bell.
Perhaps that’s the best argument for Pittsburgh’s brand of collaborative innovation: Progress can be cumulative. The more doctors and researchers combine their talents to solve the medical dilemmas of the present and future, the more a community fostering those advancements can grow. As the region continues to establish itself as a global powerhouse for medicine and research, the introduction of life-changing breakthroughs here will remain business as usual.
10 Tales Illustrating the Importance of Pittsburgh's Collaborative and Innovative Medical Community:
From world-changing technological developments to patient-focused rethinking of care, doctors, researchers and institutions in Pittsburgh are making novel advancements with the potential for immediate impact. Here are 10 examples of revolutionary work born in local hospitals and labs.
Fighting Liver Cancer with New Treatments
For patients with liver cancer, the best treatment lies in a transplanted organ. As a patient lingers on the transplant wait-list, however, cancer can spread until surgery no longer is an option.
Enter Alexander Kirichenko, M.D., Ph.D., radiation oncologist with the Allegheny Health Network. If tumors grow during the waiting period, he can employ stereotactic body radiotherapy, which can either downsize or kill those tumors. He partnered on this research with transplant surgeon Ngoc Thai, M.D., Ph.D. and director of the Allegheny Health Network Center for Abdominal Transplantation.
Until a few years ago, radiation treatment was beamed down on the patient in a less-precise manner. SBRT tightened the focus; Drs. Kirichenko and Thai can see the tumor in 3-D view, thus targeting only the tumor and sparing the healthy parts of the liver from radiation treatment.
This technique has been successfully implemented in the brain, says Dr. Thai, because it’s easier to operate on the head. “The hard thing is that the liver moves in space,” he says, because internal organs can’t be physically stabilized on the operating table in the same way that a head can. The new SBRT guidance technology helps him to work closely with Dr. Kirichenko to track the tumor even while the liver is in motion. In 2006, when they first started applying this technique, only 10 percent of doctors were trying a similar approach; now, Dr. Kirichenko says, 40 to 50 percent of doctors are following their lead. “We are definitely pioneers in the field,” he says.
While helping their current patients stay qualified for a transplant, Drs. Thai and Kirichenko may be creating a new method of treating tumors that will help some patients recover from cancer without needing surgery.
“If we’re able to deliver a killing dose in a liver tumor and we’re able to ablate that tumor, then maybe you won’t need surgery. You can go in and have an outpatient procedure that will kill liver tumors without having to operate,” says Dr. Thai. “That’s the progress that can be made.”
Customizing Heart Valves for Young Patients
Many know Gore-Tex as a material found in camping gear and outdoor wear. Now, Masahiro Yoshida, M.D., Ph.D., cardiothoracic surgeon at the Heart Institute at Children’s Hospital of Pittsburgh of UPMC, has used the material to create a conduit for children with congenital valve defects. For the roughly 3,200 children born each year with these defects, the new valve can be put in the place of a defective one, and its leaflet design directs blood to flow in the right direction.
Dr. Yoshida developed the valve while in his home country of Japan as an alternative to homograft (human) and allograft (bovine) valves. The Japanese government did not approve of the use of homografts, and the spread of Mad Cow disease took allografts off the table. Children born with defects often have multiple open-heart surgeries as the heart grows, and Dr. Yoshida’s Gore-Tex valves also had a benefit of calcifying less than other materials, thus extending the patient’s time between surgeries. Gore-Tex also is less costly than homograft valves and now is FDA-approved for surgical use.
When he joined Children’s six years ago, Dr. Yoshida partnered with biomedical engineers from Carnegie Mellon to build a new version of the valve, which since has gone through several iterations. Dr. Yoshida chooses the right size of valve and custom fits it during surgery. To date, he has implanted a valve in 93 patients. He has instructed surgeons from Mexico, Colombia and Argentina on the use of the valves in their home countries and will be presenting a paper this summer showing the results from all three generations of his valves.
Dr. Yoshida already is thinking about the next version he can create, which will use a different material — something biodegradable. Now in the basic research phase, his team is testing on a rat to see which materials have better growth potential, further reducing the number of surgeries children will need.
Treating Trauma in Children with Novel Therapy
Anthony Mannarino, Ph.D., vice chair of the Department of Psychiatry at Allegheny General Hospital, compares his research subjects to the soldiers from Iraq and Afghanistan. He describes their hyper-arousal, nightmares and concentration problems.
His research subjects are children, however — a particularly vulnerable yet resilient population. Today, 60 to 70 percent of all children have been exposed to a traumatic life event, including abuse, domestic violence or the death of a family member by age 16, says Dr. Mannarino. When he started research 25 years ago with his partner, Judith Cohen, an M.D. and medical director for the Center for Traumatic Stress in Children and Adolescents, therapists generally didn’t ask children to discuss their trauma directly.
Drs. Cohen and Mannarino designed a treatment that became the scaffolding for their Trauma-Focused Cognitive Behavioral Therapy. They then started running clinical programs, beginning with a study with preschool children who had been sexually abused.
“The treatment is all about helping kids and parents talk about the traumatic experience and take what’s inside of them — the feelings, thoughts and shame — and have them talk about it so they can move forward,” says Dr. Cohen.
The therapy follows a series of phases. The first focuses on skills and stabilization, where children and their caregivers explore the impact of the trauma, such as emotional outbursts or ADHD-like symptoms. Next, they’ll construct their narrative, meaning that the children will be able to tell the story in detail, share it with their caregivers and develop safety skills.
“Many come in not able to say the words ‘sexual abuse’ or ‘domestic violence,’” says Dr. Cohen. “They take pride in mastering their fears.”
The therapy has gone through 13 randomized trials, which demonstrated its efficacy; it then was shared via Web-based courses — one launched eight years ago and has trained 150,000 therapists — and clinical training sessions. In the last four years, 25,000 therapists around the world have received in-person training.
Moving a Robotic Arm with the Mind
It was in an Oakland bar that Andrew Schwartz, Ph.D., and Michael Boninger, M.D., decided that moving a robotic arm with the human mind was possible.
“Mike, if we could do this experiment, I could get someone to play the piano with a neuroprosthetic,” said Dr. Schwartz, a professor of neurobiology at the University of Pittsburgh School of Medicine who had been researching how animals’ brains responded to movement and sent impulses to manipulate a robotic arm.
“Well, we just have to do it,” responded Dr. Boninger, the director of the UPMC Rehabilitation Institute — who for the past 20 years has been researching technologies to assist people with spinal-cord injuries. “There’s no reason not to.”
They set to work with volunteer Jan Scheuermann of Whitehall, who became paralyzed from the neck down due to a degenerative spine disease, and assembled more members for their team — UPMC neurosurgeon Elizabeth Tyler-Kabara, M.D., Ph.D., and lead investigator Jennifer Collinger, Ph.D., both also of the Pitt School of Medicine. While Dr. Schwartz dreamed of Scheuermann playing the piano, the group’s first goal was for her to be able to move a robotic arm with her mind, using brain-computer interface to help her achieve everyday motions.
The team began by watching Scheuermann’s brain respond while she watched a video of normal arm movement and imagined herself moving — specifically noting where blood flow in the brain increased. They placed two quarter-inch-square electrode grids as close as possible to this area, guided by the belief that the electrode would pick up the electric signals when the neurons fired. Those signals then are sent to a computer the team calls a “decoder,” which takes all of the signals and tries to figure out what Scheuermann’s brain wants to do.
Through her training, Scheuermann has been able to move the robotic arm, turn and bend its wrist, close its hand and feed herself a piece of chocolate. Called “a breakthrough” by “60 Minutes,” these results give Dr. Boninger hope for his other patients. “If we could perfect this, we have a device that would enable [patients] to be more independent,” he says.
Dr. Boninger says the team is looking to deepen research — they learned that as the arm approaches an object, the brain reacts differently — test a higher-tech version of the arm that includes sensory elements such as touch and pressure and continue enrolling patients in clinical trials.
Dissolving Stents to Help Heart Disease Patients
A stent that can save patients’ lives from a heart attack pulls a disappearing act six months after it’s put in. Developed by a team led by Tony Farah, M.D., interventional cardiologist and chief medical officer of Allegheny Health Network, the small stent now in clinical trials is meant to further reduce the rate of coronary heart disease, which is the top killer of men and women in the United States.
The bioabsorbable stent, made of dissolvable polylactide, is put into place inside a blocked artery and is able to push the clogging plaque to the side to allow blood flow. Unlike metal stents, however, these are absorbed gradually by the body over the next six months after they prop open the artery. The same material is used in dissolving sutures.
This approach eliminates several negative side effects of metal stents, which currently are the standard. Patients with those must take powerful blood thinners for six months to a year after the procedure because of potential blood clot formation. That regimen raises the possibility of excess bleeding from unrelated injuries and can cause problems if patients need surgery during that time. Also, depending on the placement of the stent in the artery, cardiac surgeons later may be prevented from performing bypass surgery on the patient.
European trials finished in early 2014; bioabsorbable stents there already are available for commercial use. The results are heartening for U.S. studies, which are ongoing at more than 20 sites.
As he awaits results of those studies, Dr. Farah is thinking about the future. He has set his sights on being able to predict heart attacks; patients with even minimal plaque in their arteries can be at risk. He thinks the stents can work even harder.
“What else can we place on the stent that can treat the artery that has seemingly minimal plaque?” he says. “That can modify the physiology of the coronary artery so the plaque does not lead to a heart attack.”
Testing Thyroid Nodules for Cancerous Potential
Yuri Nikiforov, M.D., grew up in the region affected by the Chernobyl nuclear accident in 1986, which was reported to have caused 5,000 new cases of thyroid cancer because of its release of radioactive iodine.
Dr. Nikiforov, vice chair of the Department of Pathology at UPMC, is working to solve one of the central problems of treating thyroid cancer: Thyroid nodules are very common in the general population, particularly in women older than 50. There’s only a 5 percent chance, however, that a nodule will be cancerous. The challenge is testing to determine if it’s malignant or benign. In the previous treatment, doctors used a needle to pull out cells, which they examined under a microscope. Using this technique, which had been in place for 25 years, doctors could determine if the nodule was malignant in only 70 percent of cases. In the remaining 30 percent of cases, doctors couldn’t report whether patients had cancer — often leading to unnecessary surgery.
With the help of next-generation gene sequencing, Dr. Nikiforov now can help to determine the outcome for that final 30 percent of patients by looking at the entire genome of each cell. The new tool took doctors from looking at 500 units of DNA at once to looking at 10 million at once.
“When I show physicians the next technology, they are amazed. I show them the machines that we used before — a very large box. Then I take them to the next room and show them the new machine, and it’s five times smaller, looking like a toy with very bright colors,” Dr. Nikiforov says. “But it’s a million times more powerful.”
The tiny, brightly colored machine lets Dr. Nikiforov and his team search for 12 genes present in thyroid cancer. The research last year moved from research to clinical trials and recently debuted at the UPMC/University of Pittsburgh Cancer Institute Multidisciplinary Thyroid Center. Dr. Nikiforov predicts that six months from now it will be a standard of care.
Finding a Vaccine for Dengue
The key to a successful vaccine against dengue — a mosquito-spread virus that causes fever and vascular abnormalities and can be deadly — may lie in the careful study of blood. Ernesto Marques, Ph.D., M.D., of UPMC’s Center for Vaccine Research, is looking closely for proteins and antibodies that may unlock the possibility of immunization.
He’s collaborating with Swiftwater, Pa.-based Sanofi Pasteur to develop a test that can better determine the efficacy of a vaccine against dengue. The test that now exists is labor-intensive; in the years following a vaccination, close to 40,000 participants were followed, actively questioned and — if they reported any dengue-like symptoms — required to undergo a series of tests.
The new test streamlines that process, simply testing volunteers at regular intervals. The process can detect if people are infected with dengue despite not feeling sick (a time when they still can transmit the virus). The trial enrollments now are closed, and though the results haven’t yet been released, Dr. Marques says that they are initially showing promise compared to past studies.
Through the university, he also partners with Hemobras, which purifies proteins from plasma received from 80 percent of the blood banks in his native Brazil; he tests the immunoglobulins in the samples for immunity. Prior to that collaboration, blood banks were throwing away plasma because they lacked equipment to purify the proteins. With many people in this population having suffered and recovered from dengue, Dr. Marques asked that Hemobras ship antibodies to him so he could study the immunoglobulins to learn what properties are protective against dengue.
He projects that by using these antibodies, a serum could be made that would help high-risk patients — such as those with compromised immune systems or who have cardiac disease or cancer — survive a dengue infection.
Standardizing Treatment for Childhood Brain Injuries
When it comes to traumatic brain injury in children, there are quite a few treatment guidelines but not a lot of evidence on their efficacy. “The guidelines have been a big advance to tell us what’s important. But they haven’t come to completion yet — to tell us how we should treat things,” says Michael Bell, M.D., director of pediatric neurocritical care and neurotrauma in the Brain Care Institute at Children’s Hospital of Pittsburgh of UPMC. TBI, which is more severe than concussion injury, is the leading cause of death and disability in children, according to Stephen Wisniewski, Ph.D., senior associate dean and co-director of the Epidemiology Data Center at the University of Pittsburgh Graduate School of Public Health. Falls and car accidents are common causes of such injuries.
Drs. Bell and Wisniewski recently won a $16.5 million grant from the National Institutes of Health to perform an observational study on different treatments for traumatic brain injury around the world.
Drs. Bell and Wisniewski chose to focus on the most common treatments, including what nutrition to give patients, when to give them glucose and how to lower pressure in the brain by removing fluid. “Looking at our sites across the country and the world, there is wide variability in how they manage these things,” Dr. Bell says.
They are enrolling children to participate in the study; their goal is to reach 1,000 participants in the next three years. Then they will follow the patients’ treatment during the course of one year. Dr. Wisniewski hopes to keep the research going after the initial year of study and that it leads to new standard approaches for care.
“There’s not been a study this size looking at the long-term impact of brain injury and kids. Some data shows that they may have behavioral problems, like mood problems or PTSD. We could also look at the family and the parents — how does it impact their quality of life?” Dr. Wisniewski says.
Employing Fat Grafting for Trauma Victims
Plastic surgeons long have used fat grafting — the process of moving fat from one part of the body to plump up another — to help patients achieve a certain aesthetic look. J. Peter Rubin, M.D., director of UPMC’s Center for Innovation in Restorative Medicine and chair of its Department of Plastic Surgery, is using fat grafting to improve treatment for trauma victims and cancer survivors.
Previous procedures for trauma victims were invasive, often-complex procedures to move tissue from elsewhere in the body. A patient might have received synthetic implants to restore form — as in recreating the breast after a mastectomy, for example. Not only are fat grafting techniques less disruptive, but they also afford a quicker recovery time; operations on the face, neck or breast are outpatient procedures that require smaller incisions.
“Typically, patients are more bothered in the area where we took fat than where we put the fat,” says Dr. Rubin.
Fat grafting also is used to treat people who have lost limbs and have trouble fitting comfortably in prosthetics. In the past, these patients would undergo a revision operation, likely shortening the bone or bringing in tissue from somewhere else in the body. Now a minimally invasive injection of fat and stem cells (which help to grow additional tissue) helps to add padding to the amputation site.
“A lot of work is funded by the [U.S.] Department of Defense to help with vets,” says Dr. Rubin. “I’ve treated a number of military heroes.”
After conducting scientific research for more than a decade, Dr. Rubin’s team has been doing clinical research for the past five years. During the next five, he’ll be exploring how to help tissue grow even more; now after fat is injected, up to half of the tissue is lost in the healing process. He is working to add different types of cells for more effective healing, and he says he hopes fat grafting becomes more accepted as a method of reconstructive surgery.
“Fat grafting for breast reconstruction is starting to really gain a lot more attention nationally and internationally. For trauma, I’d like to see a lot more widespread use,” he says.
Shifting to Patient-Centered Care for Esophageal Cancer
Esophageal cancer, with a five-year survival rate of less than 15 percent, is experiencing an epidemic increase. Still, its total numbers are less prevalent than those of people affected with breast and colon cancer — prompting Blair Jobe, M.D., director of the Institute for Treatment of Esophageal and Thoracic Disease at Allegheny Health Network, to call it the “underfunded and unnoticed cancer.” Along with his partner, Ali Zaidi, M.D. — director of research for that institute and one of esophageal cancer’s leading researchers — Jobe is looking to change that lack of attention with a host of research initiatives, all aimed at answering one simple question: “How do we get this back to the patient?”
Drs. Jobe and Zaidi are entrenched in a range of research, from finding biomarkers that show a patient’s risk for cancer to looking for inflamed genes that can point to a specific treatment and using magnetic beads to treat gastroesophageal reflux disease. “Why you see such a wide variability in these studies is that we’ve taken the [range of] problems we encounter at the bedside and brought them back to the lab,” says Dr. Jobe.
In the case of biomarkers, Dr. Jobe has been identifying small protein markers on cell membranes or in a patient’s DNA that help him to better develop a prognosis by personalizing therapy based on unique molecular characteristics of individual tumors. Biopsies are placed under a microscope and examined by a pathologist, who places them all, as Dr. Jobe describes it, “in the same handbag.”
“The biomarkers take you from 30,000 feet to 5,000 feet,” he says of his new ability to establish the stage of cancer affecting a patient; the premalignant condition known as Barrett’s Esophagus often doesn’t develop into cancer.
In the pre-clinical research program, a team is looking at an animal study to discover a microRNA signature that differentiated tumors, which opens the door to study the disease’s progression in humans and could identify genes that respond well to treatment. The center also is enrolling patients who suffer from gastroesophageal reflux disease to undergo the Linx procedure, in which a small, magnetically drawn band of beads is placed around the esophageal sphincter.