May 2007

New Clinical and Translational Sciences Initiative Fuels Expansion

Clinical and Translational Sciences Institute

Less than six months after the University of Rochester Medical Center announced a $40 million National Institutes of Health (NIH) grant to establish a major new expansion in research and education, it was back in the limelight again, this time with the news of building what will become an "academic home" for the new Clinical and Translational Sciences Institute (CTSI).

"The new facility will establish the University as a national leader in clinical and translational science, and will spark growth in research and jobs here in Rochester," said David S. Guzick, M.D., Ph.D., dean of the School of Medicine and Dentistry and director of the CTSI.

In October 2006, URMC was named one of a dozen leading academic medical centers to receive the NIH award. All 12 institutions are charged with one overarching purpose: to accelerate the transformation of medical breakthroughs into new ways to diagnose, treat, prevent, and cure diseases. URMC's CTSI will build the necessary infrastructure to streamline and coordinate all clinical and translational research efforts, including acquiring new technology, training personnel and developing other operational support systems.

Current plans call for construction to begin on the new 150,000-square-foot, four-story research and education building next year. It will be located adjacent to Helen Wood Hall in the area currently occupied by the south visitor parking lot off Crittenden Boulevard. The new facility will enable the University to bring together necessary scientific disciplines, support operations, education and training programs, and specific clinical research programs under one roof. It will not only serve as the academic home of clinical and translational research at the University, but as a hub for research being conducted elsewhere on campus and in collaboration with partners throughout Rochester and upstate New York.

Leadership is currently working on solutions to address both short- and long-term implications the facility will have on faculty, staff and patient parking (see sidebar below).

In addition to the new facility, it is expected that this new initiative will have a substantial regional economic impact. A report by the Center for Governmental Research has concluded that, by the end of five years, the immediate and catalytic impacts of the project will total nearly $30 million annually, will result in $43 million in labor income, the creation of approximately 550 permanent jobs at the University (including the hiring of 30 to 50 new clinical and research faculty), as well as hundreds of other support jobs. The building of the new facilities will create 830 construction jobs.

For more information on the CTSI, please visit www.urmc.rochester.edu/ctsi.

$5M Gift by Alumnus to Wilmot Cancer Center Helps Expand Cancer Research

University of Rochester School of Medicine and Dentistry alumnus and former chairman and CEO of Aetna John Wallis "Jack" Rowe, M.D., has generously donated $5 million to support the James P. Wilmot Cancer Center's comprehensive campaign to expand cancer care and research.

It is the largest single gift from a living alumnus of the School and one of the largest private donations to a University of Rochester Medical Center (URMC) program in its 86-year history.

"My own family, like many others, has experienced the fear and triumph of a diagnosis of cancer. Advances in diagnosis and therapy have made survival with cancer an expectation for many types of cancer. Our gift will enable research in novel areas such as cancer immunology that hold promise for all cancer patients," said Rowe, a 1970 Rochester graduate.

The Wilmot Cancer Center is raising $42.5 million to construct a new facility to double clinical and research space, consolidate outpatient cancer care and research laboratories in a single location, recruit additional scientists and build translational research programs to find cures. Rowe's donation brings the five-year campaign total to $30 million.

"This tremendous gift is a testament to the confidence that our alumni have in the quality clinical and research programs at the Medical Center and Wilmot Cancer Center," said Joel Seligman, president of the University of Rochester. "Jack Rowe's gift furthers the University's commitment to provide the highest quality cancer care and research. I am most grateful for his inspirational gift."

Rowe was president and CEO of Aetna Inc., from 2000 to 2006. Before joining Aetna, he was president and chief executive officer of Mount Sinai New York University Health. Internationally recognized for his research and health policy efforts for the care of the elderly, Rowe was a founding director of Harvard Medical School's Division on Aging.

The Wilmot Cancer Center has adopted an ambitious plan to capture the National Cancer Institute designation as one of the country's top cancer centers. Over the past four years, more than 20 scientists and clinicians have been recruited to bolster research and patient care programs.

A key element of the plan is the construction of a new state-of-the-art, four-story, 163,000-square-foot facility at the corner of East Drive and Crittenden Boulevard, which began a year ago. This new building, set to open in spring 2008, was designed with patient comfort at the forefront and will offer unprecedented levels of privacy, educational opportunities and ease of access. The research laboratories dedicated to translational research in the new Wilmot Cancer Center facility will be named in recognition of Rowe's gift.

"Cancer is one of the most prevalent diseases that we face as individuals and physicians, and providing outstanding cancer care and cutting-edge research is a top priority for the Medical Center," said Bradford C. Berk, M.D., Ph.D., CEO of URMC. "The Wilmot Cancer Center is key to the future growth of the Medical Center and we are pleased to see Jack Rowe's gift support our efforts."

"Expanding our programs will let people of the Finger Lakes region stay close to home for the very best cancer care," said Richard I. Fisher, M.D., director of the Wilmot Cancer Center and vice president for Clinical Services at URMC. "The new facility will allow us to better serve the growing number of patients from outside the region coming to Rochester for our expert, multidisciplinary cancer care."

The Wilmot Cancer Center has one of the largest clinical programs for lymphoma and leukemia in the northeast and leads the nation in shaped-beam stereotactic radiosurgery to destroy tumors that were once considered untreatable.

Pediatric Heart Surgery Division Expands with New Surgeon, Research

Much is changing in Pediatric Cardiac Surgery. Not only is the Pediatric Cardiac Intensive Care Unit creating its own dedicated staff, but the program is pursuing more research and has hired a second pediatric cardiac surgeon, Jay Gangemi, M.D., to keep up with the increasing patient volume.

According to George Alfieris, M.D., chief of Pediatric Cardiac Surgery, Gangemi, who is the first pediatric heart surgeon trained at the Medical Center, "has tremendous potential."

"I have every confidence he will blossom into a nationally regarded pediatric cardiothoracic surgeon," said Alfieris, who is regarded as the driving force behind the program's phenomenal growth over the past decade.

A McQuaid Jesuit High School graduate, Gangemi attended medical school here. He did his residency at the University of Virginia, where he developed his interest in heart surgery. Through a mentor connection he maintained with Alfieris after medical school, Gangemi eventually decided to focus on pediatric congenital heart surgery. Alfieris and the Division of Cardiac Surgery and Department of Pediatrics jumped at the chance to provide Gangemi with a fellowship, which he completed in the summer of 2006.

Gangemi now assists Alfieris with many surgeries, and he takes on some cases of his own.

"Pediatric heart surgery is unlike any other specialty. It takes three to five years to be comfortable to do the most complex cases," Gangemi said. "It's such a nice transition to stay with the same team I worked with during my fellowship."

Gangemi plans to pursue pediatric cardiac research, starting with years of data from the Pediatric Cardiac Surgery program that has yet to be analyzed for publication. In addition, he hopes to tap into his training with implants and heart transplants to eventually add new services to the program.

George Hicks Jr., M.D., chief of Cardiac Surgery, is thrilled about the growth of the program.

"With the program growing from 75 to 100 cases a year 15 years ago to now 250 to 300 cases, it's become a much larger entity; you need more than one surgeon," Hicks said. "Jay (Gangemi) is instrumental and critical to the success of the program."

Another large piece of the growing success of the program is the dedicated staff working on the Pediatric Cardiac Intensive Care Unit (PCICU). Until recently, staff for the pediatric heart surgery patients often worked in the adjoining Pediatric Intensive Care Unit as well. But because of how complicated and special these cardiac surgery patients are, Pediatrics Chair Nina Schor, M.D., Ph.D., approved a dedicated staff to ensure consistency and the highest quality of care. The new chief of the unit is Karen Powers, M.D., a pediatric critical care specialist.

"The PCICU faculty will be a mixture of new people recruited nationally and internal people attracted to this sub-sub-specialization," Schor said. "We also are currently recruiting additional nursing staff."

Schor added that Golisano Children's Hospital at Strong will be nationally recruiting staff for cardiac echo or cardiac electrophysiology to round out the dedicated cardiac staff on the inpatient and outpatient sides.

"Having a group of people who only take care of these kinds of patients is very helpful," said Alfieris, who has hand-selected the entire operating room staff, "It's also very comforting to the families."

School of Medicine Makes the Grade

The School of Medicine and Dentistry moved up two slots to 34th best research medical school and up eight slots to 13th best primary care medical school in the U.S.News & World Report's 2008 listing of top graduate schools in the country.

"To have climbed in both our primary care and research medical school rankings is a credit to our talented and dedicated faculty," said David S. Guzick, M.D., Ph.D., dean of the School of Medicine and Dentistry. "We are excited that our continued commitment to biomedical and clinical research and to the training of the best physicians and scientists, is being recognized across the country."

U.S.News & World Report also highly ranked four of the School's medical specialty training programs. Geriatrics placed 17th in specialty rankings; Pediatrics placed 20th; Family Medicine placed 21st; and Internal Medicine placed 24th.

The medical school rankings in primary care and research are based on a variety of subject areas, accounting for both reputation and other objective criteria such as total research dollars, faculty research productivity, mean MCAT and GPA scores, and acceptance rates. The specialty rankings are based on ratings by medical school deans and senior faculty.

SMD Appoints Two Interim Directors

School of Medicine and Dentistry (SMD) Dean David Guzick, M.D., Ph.D., recently announced the filling of two key positions at the School of Medicine and Dentistry

Harris A. "Handy" Gelbard, M.D., Ph.D., was named interim director of the Center for Aging and Developmental Biology, effective immediately. Gelbard replaces, in an interim capacity, Howard Federoff, M.D., Ph.D., who left in late March to become executive vice president for Health Sciences and executive dean of the School of Medicine at Georgetown University. Gelbard has provided crucial leadership for the center during the recent transition.

He is an internationally recognized expert on HIV-related dementia, a condition that is more prominent at a time when AIDS patients are living much longer than they did just a decade ago. He has made a series of important findings about how chronic neurodegenerative diseases like neuroAIDS damage brain cells, and he is in the vanguard of efforts to test new treatments to halt the damage. He also is developing new imaging methods to look at the activity of proteins in living neurons.

A professor of Neurology, Pediatrics, and Microbiology and Immunology, Gelbard has been a member of the Center for Aging and Developmental Biology since its founding in 1999. He received his bachelor's, medical and doctoral degrees from Northwestern University, and served as neurology chief resident at the Children's Hospital in Boston before joining the University of Rochester.

Susan Fisher, Ph.D., was appointed interim chair of the Department of Community and Preventive Medicine, effective July 1. Fisher is an associate professor in the Department of Community and Preventive Medicine, and is associate chair for Research and chief of the Division of Epidemiology. She also is a member of the faculty of the James P. Wilmot Cancer Center and the Department of Biostatistics.

Fisher's major area of interest is in the field of cancer epidemiology, with a particular interest in malignancies caused by viruses. She has extensive experience in the design, conduct, and analysis of national, multi-center clinical trials; her research has focused on the role of viruses in conditions such as lymphoma and skin cancer.

She received her bachelor's degree from Johns Hopkins University, a master's in biostatistics from Georgetown, and a doctorate in epidemiology from the University of Illinois at Chicago School of Public Health.

Fisher replaces, in an interim capacity, Thomas Pearson, M.D., M.P.H., Ph.D., who is taking a sabbatical with Francis Collins, M.D., Ph.D., director of the National Human Genome Research Institute in Bethesda, Maryland. During his sabbatical, Pearson will acquire new skills in the area of population genomics that he will then use toward improving the health of people throughout upstate New York. After the year-long sabbatical, he will return to his roles here as professor of Community and Preventive Medicine, senior associate dean for Clinical Research and co-director of the Clinical and Translational Science Institute.

Physical Medicine and Rehab Receives National Accreditation

The Division of Physical Medicine and Rehabilitation recently was awarded a three-year accreditation by the Commission on Accreditation of Rehabilitation Facilities, or CARF.

The three-year accreditation represents the highest level of accreditation that can be awarded to an organization and is a testament to the faculty and staff in the Division of Physical Medicine and Rehabilitation who provide care and treatment for a wide range of conditions including stroke, spinal cord injury and general rehabilitation.

An independent, nonprofit accreditor of a variety of human service providers including medical rehabilitation, each year CARF accredits approximately 5,000 providers at more than 17,000 locations in the United States, Canada, Western Europe, and South America.

"This marks the fifth consecutive time that our Division has achieved this prestigious accreditation," said K. Rao Poduri, M.D., chair and medical director of Rehabilitation at Strong Health. "An organization receiving the three-year accreditation has put itself through a rigorous peer review process and has demonstrated to a team of surveyors during on an on-site visit that its programs and services are of the highest quality, measurable, and accountable."

CARF surveyors specifically noted several strengths within the Division including a strong leadership team, dedicated and compassionate staff, a stroke specialty program, outreach education efforts aimed at preventing injuries, and interdisciplinary communication and collaboration. In addition, CARF's report commended the many advocacy efforts faculty and staff conduct on behalf of disabled persons at the local and national levels.

Over the past few years, the Division has experienced remarkable growth. Each year, more than 125 faculty and staff provide care to more than 400 inpatients, and manage over 40,000 outpatient visits.

Expert Discusses New Flu Center, Future of Flu Vaccines

David Topham, Ph.D.

In mid-April, the Medical Center was awarded $26 million from the National Institute of Allergy and Infectious Diseases (NIAID) to create the New York Influenza Center of Excellence. The center is part of a network recently established by NIAID to protect people against seasonal flu and future flu pandemics. For more information on the announcement, visit www.urmc.rochester.edu/pr/current_research/bird_flu/index.cfm.

Vital Signs spoke with David Topham, Ph.D., associate professor of microbiology and immunology, and co-director of the NYICE, about flu and the role of the new center.

Q: The flu's been around a long time. Don't we know enough about the flu already?
A: People think we know more about the flu than we do; it's amazing how little we actually do know. The perception that flu is not a major threat is mistaken. Respiratory infections caused by bugs like the flu are the leading cause of death in many parts of the world, and it's one of the leading causes of death and illness in the U.S. – 36,000 people in the United States die from flu each year, and more than 200,000 people are hospitalized. It's always been a threat.

Q: We have a vaccine that works. What more is there to learn about flu vaccines?
A: The current vaccine does work – sort of. It works pretty well if scientists are correct in their predictions and match the vaccine to the strains of flu that will be prevalent in any given year. It works if millions of people get the new shot, year after year. It works if there is no major breakdown in the fragile manufacturing process. And, it works pretty well as long as the flu virus doesn't mutate radically, allowing most people to carry some immunity forward year to year. Even so, thousands die every year, and if the flu changes radically, millions of lives would be at risk immediately. The design and manufacture of flu vaccines has changed very little in the last three decades, yet our knowledge of the immune system has just exploded in that time frame. For instance, the best paper on the role of the body's T-cells – the cells in the lungs that comprise our first line of defense against flu – was published more than 20 years ago, in 1983. Our knowledge has grown dramatically, but current vaccines haven't kept pace. We aren't tapping a crucial part of our body's immune response in the fight against flu.

Q: Just how likely is a pandemic from bird flu?
A: It's impossible to say. Flu is unique because different forms of the virus can mix and match their genomes and create whole new strains. The more that a new strain of flu that hasn't been seen before spreads in birds and in people, the more likely that it will find itself in a person or animal also infected with another strain of flu. All it takes is for two forms of the virus in a single person to swap genes in the right way to create a new type of flu the world has never seen. That's why we are all so concerned about the H5N1 strain of bird flu, which has killed more than half the people it has infected. If it interacts with another strain that passes from person to person as easily as the flu virus that sweeps through classrooms and hospitals every year, we'd have a pandemic on our hands.

Q: Pandemic flu sounds like a looming threat. Has the threat been overlooked?
A: You have to remember, we've had a vaccine against the flu, and the vaccine generally works great at protecting most people, under most circumstances. Flu doesn't change radically all that often; in the last 100 years, it's happened only three times. The last time flu took millions of lives was back in 1918. In addition, developing and manufacturing flu vaccine generally has not been lucrative for pharmaceutical companies. So there hasn't been a great deal of incentive to work on new flu vaccines. However, when the flu virus changed dramatically into what became known as the Spanish flu of 1918, more than 50 million people lost their lives. And so far, the H5N1 form of bird flu is 20 to 50 times as deadly in the people it has infected. It would be irresponsible to ignore that threat. Remember SARS – people quarantined, planes grounded, people in cities like Toronto routinely wearing protective masks? SARS was a wake-up call. Bird flu would make SARS look like child's play.

Q: How did you become interested in the flu?
A: Before graduate school, I worked as a technician in a laboratory where we studied multiple sclerosis. There we looked at the idea that certain viruses might trigger MS, and we discovered a virus that can replicate in the central nervous system and cause paralysis. We ended up studying auto-reactive T cells, and that piqued my interest in viral immunology.

Q: Was flu research as popular then as it is today?
A: Hardly! When I was a post-doc, I worked in the laboratory of Peter Doherty, a leading flu researcher, at St. Jude Children's Research Hospital. My friends asked me why I was spending my time studying the flu. "We have a vaccine, what else do we need to do?" they'd ask. But really, there were a lot of unanswered questions then, and there still are today. There are a lot of models of the immune system that focus on organisms that are really no threat to anyone. But flu claims tens of thousands of lives each year, and it offers a useful way to gain new insights into the immune system. It's an actual human pathogen posing a very real threat.

Q: How might the research at the new center help protect us?
A: There are a number of ways. Some of the investigators will be studying how the flu actually spreads in families and in communities, and how different people's immune systems respond to the vaccine. Again, you'd think we'd know more about this than we do. We'll be following 150 families in the Rochester community for seven years, tracking their exposure to the flu and their responses to vaccination. In addition, much of our work will be on the basics of the immune system – the type of research that could ultimately result in the design of a much different, much more effective flu vaccine. It's a bit like stepping back and exploring whole new ways of making a vaccine, instead of tweaking the tried-and-true methods that work well enough most of the time, but likely wouldn't be effective in the face of a virulent new strain, such as H5N1, or against flu viruses that we simply can't predict.

Q: What's your specific research interest?
A: Here at Rochester, we have a specific strength in T-cell biology. T-cells in the lungs are our very first line of defense against the flu, fighting the virus in the first few days, until other parts of the immune system can gear up to respond effectively. When you first inhale a flu particle, you're dependent on T-cells to fight off the virus. There have been huge developments in T-cell biology in the last few decades. But current flu vaccines don't take T-cells into account very much. There are a lot of questions – for instance, why don't your lungs keep enough of these cells around constantly to repel an infection like the flu? If you have to wait for these cells to become activated and travel to the lungs, that can take a couple of days, and for some infections, that's already too late.

Q: Where does your work with T-cells stand?
A:We've shown that having these T-cells in great numbers in the lungs, where they can move in quickly to attack the virus, provides better protection than having other cells ready to attack the virus in other parts of the body. And we've shown that being inoculated with a live flu virus, instead of the inactivated vaccine that is widely used, gives better immunity, and we think that's because the live virus promotes the development of these T-cells. But we don't understand the process completely. More of these cells in the lungs would help people fight off an infection – it could keep many people from becoming infected, and for those who are infected, they wouldn't be as sick for as long. In a pandemic, they could keep you alive.

Q: Why do you think Rochester was chosen for one of these centers?
A: My guess is that there are a number of reasons. We are a community with a strong history of tackling a broad array of complex issues related to vaccines. We have developed vaccines against childhood meningitis, and our technology helped bring about the first vaccine designed to prevent a form of cancer. Every year, millions of children across the nation receive shots that rely on technology developed at our university. In addition, we have incredibly strong surveillance of infectious disease in this community – we're part of virtually every national effort to track disease and the effectiveness of vaccines. We have one of the highest rates of vaccination in the nation against a number of diseases. We also have strong research in basic immunology, through the Department of Microbiology and Immunology and the David H. Smith Center for Vaccine Biology. And we have the Vaccine Treatment and Evaluation Unit, where Dr. John Treanor – who directs this new center – and colleagues test new vaccines against flu and bird flu, as well as diseases like anthrax, pneumonia and whooping cough. That unit has led several national efforts to test bird flu vaccines, and spearheaded the nation's response to make flu vaccine more broadly available after recent shortages. When you put it all together, it's quite a combination that makes you think that we have as much a shot as any place of really contributing to protect the world against threats like flu and bird flu.

Celebrating Excellence

Five Strong Memorial social workers were recognized for their outstanding compassion and commitment during the celebration of National Social Work Month in March. From L to R: Crystol Milhaly, L.M.S.W. (clinical practice); Kelly Petzing, M.S.W. (supervision); Sharon Haynes L.M.S.W. (program innovation); Laura J. Wilson, Senior Counsel (excellent interdisciplinary collaboration); and Lori Synder L.M.S.W. (leadership).