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UR Alum Seeks Solutions to the Problem of Strep

1/22/2018

About James Musser, MD, PhD

Dr. James Musser
Career – Joined Baylor College of Medicine and Houston Methodist Hospital (1991-99). He then led the Laboratory of Human Bacterial Pathogenesis for the National Institute of Allergy and Infectious Diseases, NIH, at Rocky Mountain Laboratories in Montana (99-03), and returned to Texas to work at Houston Methodist Hospital and Research Institute (2004-present).
Current - At Houston Methodist Hospital he is the Fondren Presidential Distinguished Endowed Chair, Chair of the Department of Pathology and Genomic Medicine, and Director, Center for Molecular and Translational Human Institute.
Hometown – Originally from Bellefonte, PA and now lives in Houston, TX.
Family – Wife, Dr. Camille Leugers, a family physician (also a University of Rochester graduate and former resident). They have two daughters, Sophie, 23, and Grace, 23, and one dog, Biscuit.
Education – Earned his MD, PhD from University of Rochester (1988). He spent the following year doing a postdoctoral fellowship at Penn State University, continuing research on bacterial pathogenesis and population genetics with Robert K. Selander, previously of the UR Department of Biology. His residency training was at the Hospital of the University of Pennsylvania.

Dr. James Musser is a distinguished pathologist who got his start at the University of Rochester as a medical student. To this day, he is quick to give credit to the University for putting him on the right career path.

“One of the crucial themes in my career—and I really think in large part it is because of the University of Rochester—has been the desire to work across traditional academic boundaries to weave together seemingly disparate biomedical research areas,” he said. 

His laboratory uses molecular pathology, microbial pathogenesis, and population genomics in its approach to important infectious disease problems. Chief among these problems is Group A Streptococcus, the culprit behind strep throat and so-called “flesh-eating” disease (necrotizing fasciitis).

There is currently no licensed vaccine for Group A Strep, which can lead to life threatening illnesses if left untreated. The World Health Organization reports that 700 million cases of infections are caused by the pathogen every year worldwide. These range from common infections like strep throat to more severe infections like necrotizing fasciitis or rheumatic fever.

Musser has devoted much of his career to understanding how Group A Strep causes human infections at the molecular level. He and his research colleagues aim to lay the groundwork for a licensed vaccine for strep throat and its more serious iterations. This is easier said than done.

Group A Strep has many genetic variations that Musser likens to different makes and models of cars; there are different kinds of Fords or Toyotas, and each is built differently. And in the same way some models can go faster than others, the Group A Strep pathogen contains different combinations of genes that allow more severe diseases to spring forth under certain conditions. These genetic varieties have made it difficult for a reliable vaccine to be developed despite decades of research.

“We have a lot of unfinished business,” Musser said. “We still really need to understand all aspects of how the organism causes human epidemics. These are long term problems that are likely to persist well into the future.”

Musser’s early career began at Baylor College of Medicine and Methodist Hospital in Houston, where he moved up through the traditional academic ranks from assistant to full professor. In 1999 he was hired by the NIH’s National Institute of Allergy and Infectious Diseases (NIAID). There, he was tasked with significantly upgrading and developing new areas of research at Rocky Mountain Laboratories, in Hamilton, MT.

One of his contributions at RML was the introduction of genome-scale investigative strategies and helping to plan a biosafety level 4 laboratory, a so called “hot zone” laboratory.” This Integrated Research Facility houses scientists that study infectious microbes with the goal of finding new ways to treat diseases like ebola, zika, flu strains, and so forth.

Musser resumed working for the 8-hospital Houston Methodist Health System in 2004 where he wears many hats. As chair of Pathology and Genomic Medicine, he divides his time between clinical responsibilities, research, and overseeing a department of 65 faculty.

“Everyone is very busy in academic medicine these days,” he said of his workload. “I don’t think that I’m doing anything especially unique in that regard.”

He was first drawn to the UR because of its signature biopsychosocial model of disease.
“I knew that the UR was the right place for me because it had its head on right about how medical students should be taught, and emphasized the critical importance of biopsychosocial factors in human illness and daily interactions,” said Musser.

UR is also where he met his future wife, Dr. Camille Leugers, and the two remain active in the UR alumni organization in Houston, recently hosting 35 UR graduates at their home. 

Musser has returned to the UR since walking the halls as a student. He recently came back to give the Whipple lecture, named after the Medical Center founder and Nobel Prize-winning pathologist. He was also bestowed the Rous-Whipple Award by American Society for Investigative Pathology. This award, whose name is also a nod to his alma mater, is given to a scientist who has worked to advance the understanding of disease.

Looking back, Musser is thankful for the many mentors he encountered at UR along the way, including Ron Yasbin (Microbiology), Marilyn Menegus (Pathology), Bernard Panner (Pathology), and Frank Young (Dean of the School of Medicine), to name a few.

“I believe there are mentors all around us,” he said. “I firmly believe that if we talk less and listen more, they will appear.”

Alumni Q&A: Former Pathology Resident & Fellow, Brooke Koltz, M.D.

1/4/2018

We recently caught up with Dr. Brooke Koltz, a former Pathology resident at the University of Rochester (2008-2012) and Cytopathology fellow (2012-2013).

Dr. Brooke KoltzAfter training and working in Rochester, she and her family moved to the Philadelphia, PA area for a year and recently moved to Perrysburg, OH, near Toledo. This is a homecoming of sorts for Koltz, who grew up in nearby Whitehouse, OH.   

She will start a new role this month at the University of Toledo Medical Center (where she also attended medical school). Her clinical responsibilities will include surgical pathology, cytopathology, and resident education. Here, she shares more about the experiences that led her to this moment in her career.

Tell us about your family.

I am married to Peter Koltz, who was also a resident at University of Rochester in Plastic and Reconstructive Surgery. We have four children, Eleanora (9), Henry (7), Cecilia (4), and Simon (2).

What first sparked your interest in pathology?

I went into medical school thinking I would become an emergency medicine physician, but I am so glad that I didn’t. I was one of those rare students that was fascinated by histology and pathology labs in the first and second year of medical school.

Even so, I was still set in pursuing clinical medicine until I took an elective pathology rotation on a whim late in my third year. In about a week, my whole outlook changed. As I sat across the multi-headed scope from the attendings and residents, I realized that what they did was ‘medicine’ to me. From then on I pursued a career in pathology. So far, I have no regrets.

When you look back on your time here, is there a particular person or experience that made a great impact on you professionally or personally?

The entire Cytopathology department had an impact on me both professionally and personally.  Not only did the department educate me and prepare me for my future career, but I truly enjoyed being a small part of the talented team for a few years.

I often find myself repeating things that Dr. Giampoli, Dr. Zhou, and Dr. Yao taught me when I sit down with residents. The entire team of cytotechnologists, including Donna Russell, Mary Ann Rutkowski, and Michael Facik, accepted me into their offices, the occasional inside joke, and gave me the benefit of their years of experience and knowledge.  I couldn’t have asked for a better fellowship. 

Aside from the Cytopathology department, many of the surgical pathology attendings, especially Dr. Hicks and Dr. Whitney-Miller, encouraged me and gave me a solid experience to pursue my career goals. My co-residents were fun and supportive as well. There are too many people to name, but I appreciated my time in Rochester and felt that I received a positive educational and personal experience.

How do you like to spend your free time? Do you have any hobbies/interests?

Like most mothers, my free time is often spent chasing my kids around and getting them to their various activities. But I do love to read books, and I read often.  I am happy to read almost anything: fiction, non-fiction, poetry.  I also enjoy playing and watching sports, including soccer.

What’s next for you career wise? 

I am looking forward to spending more time teaching residents, medical students, and student fellows in my new position.  I have always enjoyed teaching, and am happy that I have found a position that puts a large emphasis on education.

What advice would you give up-and-coming pathology trainees looking to start their careers?

Because I am one half of a two physician household, I have had to change jobs frequently in the last four years as my husband’s training has taken him to various hospitals. While I haven’t always wanted to leave positions, the benefit has been that I have gained experience in a lot of different practice settings. 

My advice would be to learn as much as you can from each place you end up, even if it isn’t necessarily your dream job. Seek to find what you can take away from each place or experience that will grow your knowledge. Each place (and person!) has something unique to teach you that will contribute to your success as a physician, a pathologist, and a person.

HLA Lab Team Makes Organ Transplants Possible

12/1/2017

Organ recipient

Organ recipient, Janine Cassata, right, with HLA lab supervisor, Angela Busacco.

On December 16, Janine Cassata will celebrate the one-year anniversary of her organ transplant.

The 50-year-old realtor from Chili was diagnosed with Type 1 diabetes when she was just 2 years old. It wasn’t until after she suffered an e-coli infection as an adult and her kidneys began to fail that her doctor told her she would need a kidney transplant. He suggested a pancreas transplant as well.

Just six months after being added to a waiting list, Cassata was woken up by an early morning phone call. It was the organ transplant coordinator at Strong Memorial Hospital.

“He said, ‘We have a kidney and a pancreas for you and you need to come in right away if you’re interested,” recalls Cassata. “I had to collect my thoughts,” she said. “I was in shock.”

An hour later, she went in for the procedure, which was a success. Months later, she got the rare chance to meet someone who played a part in her transplant behind the scenes.

Cassata was at a graduation at her neighbor’s house when the host introduced her to a fellow party guest, Angela Busacco.

Unbeknownst to her, Busacco is the chief supervisor in the HLA Typing Laboratory at URMC. This lab performs that complex testing that makes it possible to match organ donors and recipients.

Lab employees almost never get the chance to meet the people they help. So when Busacco was introduced to Cassata, tears came to her eyes. What’s more, she remembered her by name. The women talked and embraced.
 
“These names that we see on a regular basis; they become people,” said Busacco.

The organ donation process is highly collaborative – with a team of people and organizations working around the clock to ensure the best match possible. Here we describe how the lab plays a key role in this journey from Day 1.

How it Works:

HLA team

The HLA/Tissue Typing Lab team at Strong Memorial Hospital.

When a patient needs an organ transplant, they go through an initial medical evaluation that includes blood and serum tests. 

The DNA in their blood cells is tested to identify which human leukocyte antigen (HLA) genes and antigens the patient is born with. Importantly, the recipient’s serum must also be screened for HLA antibodies that could cause a transplant to be unsuccessful.

HLAs are microscopic proteins that exist on the surface of white blood cells. They help the body’s immune system respond to foreign cells by presenting information to T and B cells that may target and attack foreign cells.

In order to be matched with a suitable donor, the recipient must not have antibodies that would actively target transplanted tissue. You can acquire HLA antibodies in different ways, such as having a prior transplant (successful or unsuccessful) or through a blood transfusion. They can also be present in women who have had multiple pregnancies.

All of this information is reported back to the clinicians before the patient gets listed in a national database (managed by the United Network for Organ Sharing, or UNOS) to be eligible to receive a deceased donor organ as it becomes available.

Each patient has their own unique profile when it comes to antigens and antibodies, so every case must be examined closely.

“Some people know you by face, but we get to know somebody by their antibody profile,” said Myra Coppage, Ph.D., Lab Director.

Kidneys are the most transplanted organ at Strong Memorial Hospital. Half of these transplants are from living donors, often relatives who closely match the recipient’s blood and HLA typing. The other half, currently about 350 patients, are waiting for kidneys from deceased organ donors.

Each month, the HLA Lab obtains a serum sample from every patient on the waiting list. The serum is tested on an ongoing basis to monitor any changes and to check for any new HLA antibodies.

A large portion of the daily work flowing through the lab is HLA typing for potential donors who must undergo the same thorough screening. Lab techs perform flow cytometry cross matching to check for compatibility. In this case, cells from the donor are mixed in the same tube with serum from the recipient to see if a rejection reaction takes place.

Becoming Batman

HLA Lab

William Femec (MT) and Helene McMurray; Ph.D. in the HLA Laboratory.

There is always a lab tech on call 24/7 to respond to a call for a deceased donor. This is when an organ donor dies and their HLA typing from DNA must be performed as soon as possible to identify a matching recipient who is willing and able to receive the organ while it’s still viable.

When a call about a deceased donor comes in, time is crucial, explains Helene McMurray, Ph.D., the HLA Lab’s director-in-training.

“It’s a little bit like being Batman,” said McMurray. “When the bat signal goes off, somebody has to show up to work.”

Oftentimes, calls for deceased donors come in late at night or in the early morning when the on-call tech must perform the HLA typing as soon as possible. The process includes manual and automated steps that follow a tight protocol. It can take up to five hours for the tech to finish each step. 

“They are juggling HLA typing on the patient, doing the cross match procedure, and potentially antibody screening at the same time by themselves,” said Busacco. “The stuff that we batch and rotate among everybody in the lab (during the day) – that person is doing it all alone.”

The tech must multitask like a chef juggling different side dishes on a tight deadline. Meanwhile, they are taking calls from doctors, nurses, and organ procurement staff checking on the status of the results.

After the HLA typing is complete, the donor’s information is entered into the UNOS database so the organ can be matched with a list of potential recipients.

Once the ordered list of matching recipients is generated, the transplant center coordinators can contact recipients like Janine Cassata and offer them a lifesaving opportunity to receive a transplant.

It is not unusual for the lab tech to get most of the way through the lengthy HLA typing process only to learn that the donation will not happen. This could either because the family of the deceased has chosen not to move forward, or the organ procurement organization determines the organs are not of acceptable quality. This is a difficult but familiar part of the job.

At the end of the day, however, the HLA team knows that each piece of their highly technical role directly impacts positive patient outcomes. 

“A transplant is not happening without our piece of it,” said Busacco. “There wouldn’t be an error where we were skipped over or weren’t needed. It just wouldn’t happen.”

Helping ‘Complicated’ Patients

As Laboratory Director, Dr. Myra Coppage has advocated for patients on a national level with the American Society for Histocompatibility and Immunogenetics (ASHI), where she has held a variety of roles, most recently, Program Director for Laboratory Accreditation.

Coppage has served on committees that changed the national rules specifically addressing transplants for immunologically complicated patients who can sit on waiting lists for years.

Patients who have multiple antibodies, either from having many children or failed transplants, were previously stuck waiting for a match while others skipped ahead of them.

“The techs have people they’re always pulling for because they come to the top a lot and have been waiting for a long time,” said Coppage. “Those are the people who need us.” 

Video: What You Should Know About Blood Transfusions

11/14/2017

A new video produced by the Transfusion Medicine's Patient Blood Management Program highlights the importance of conservative transfusion and the initiatives aimed at providing the highest quality care and optimal patient outcomes.

It includes testimonials from esteemed URMC providers, including Peter Knight, M.D.Michael Eaton, M.D., and Anthony Pietropaoli, M.D. 

In non-life-threatening situations, the potential risks versus the expected benefits of blood transfusions must be considered. UR Medicine has strategies for:

  • Avoiding transfusions when it may not be necessary for patients
  • Approaches for those who choose to refuse blood transfusions for religious (i.e. Jehovah’s Witnesses) or personal reasons
  • Provisions for those who opt to only accept transfusions or blood component therapy in life-threatening situations

This video can help staff educate our patients and families on the benefits of blood management by highlighting strategies used to avoid transfusion, explaining why this is important. Blood transfusion should be considered a “liquid organ transplant,” and the decision to transfuse blood should always include careful assessment of the potential risks versus the expected benefits. 

More info is available at www.TransfusionSafety.urmc.edu

Staff Honored for Years of Service

10/26/2017

Staff Group PhotoThe Department of Pathology & Laboratory Medicine hosted its annual staff service awards luncheon on Wednesday, Oct. 25.

The luncheon at Helenwood Hall honored employees who recently hit milestones of 10 or more years working in the department. 

Special kudos to Tonia Howard (Courier Division) and Christina Malerk (IHC) who both celebrated their 40th work anniversaries this year.

Click here to view photos from the luncheon.

The Honorees
 

Last 

First 

Years

Division

Aiello

Cesare

15

Auto Lab

Alberty

Deborah

20

Auto Lab

Ayrhart

April

10

Auto Lab

Bucher

Brian

10

Auto Lab

Daley

Stacy

20

Auto Lab

Ryan

Kathleen

30

Auto Lab

Villone, Jr.

James

30

Auto Lab

Arena

Susan

15

Billing

Richards

Jodi

10

Billing

Taccone

Cynthia

10

Billing

Bastian

Kim

10

Blood Bank

Duttinger

Leilani

15

Blood Bank

Enfonde

Michael

30

Blood Bank

Henrichs

Kelly

20

Blood Bank

Brown

Kendra

10

Clinical Trials

Leibenguth

Laurie

10

Clinical Trials

Sage

Mark

30

CLSS

Akut

Joseph

15

Couriers

Dioguardi

Thomas

10

Couriers

Howard

Tonia

40

Couriers

Crowley

Patricia

25

Cytology

Wyatt

Tanya

15

Cytology

Catherine

Camille

10

Histopathology

Reese

Lynn

15

Histopathology

Bannister

Danielle

20

Immunohistochemistry

Malerk

Christina

40

Immunohistochemistry

Piampiano

Sandra

35

Lab Administration

Ramaswamy

Maimoona

20

Lab Administration

King

Kay

35

Lab Client Services

Calunod, Jr.

Baltazar

10

Microbiology

Colbert

Danielle

10

Microbiology

Jesien

Debra

35

Microbiology

Mscichowsk

Mariola

15

Microbiology

Noble

Sheila

35

Microbiology

Walker

Nicole

15

Microbiology

Lum

Michael

15

Outreach

Brewer

Kelly

20

Out Patient Lab

DeAlmeida

Erika

10

Out Patient Lab

Peterdy

Elizabeth

15

Out Patient Lab

Curran

Timothy

25

Pathology & Lab Admin M&D

Stark

Gwen

40

Pathology & Lab Admin M&D

Cooper

Marilyn

15

Phlebotomy

Everts

Amanda

10

Phlebotomy

Jones

Sonia

10

Phlebotomy

Long

Rebecca

10

Phlebotomy

McClary

Bridget

20

Phlebotomy

Morrell

Sandy

10

Phlebotomy

Nhong

Navy

10

Phlebotomy

Odell

Lisa

10

Phlebotomy

Smith

Gregory

25

Phlebotomy

McGorty

Bonnie

30

POCT

Simpson

Nancy

25

POCT

Hodges

Starr

15

SMS

Musial

Scott

10

SMS

Nagendra

Renuka

15

SMS

Norbut

Christina

10

SMS

Searley

Robyn

15

SMS

Somaskanda

Shanthi

15

SMS

Vasilik

Marya

15

SMS

Murray

Bruce

15

Surgical Pathology

Davis

Eric

25

Toxicology

 

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