After 100 Cases, Bronchoscopy Robot Leads to Higher Yields with Smaller Lesions
Tuesday, October 11, 2022
Michael Nead, M.D., Ph.D., associate professor of Medicine in Pulmonary Diseases & Critical Care, answers questions about the advantages of the bronchoscopy robot, lessons learned after completing over 100 cases, and what the future may hold with interdepartmental collaboration.
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Researchers Receive $2.5 million NIH Grant to Study Potential Sepsis Drug Therapies
Tuesday, July 5, 2022
Every year, nearly 11 million people around the world die of sepsis, and there is currently no FDA approved drug to treat the condition. URMC researchers are out to change that.
When Anthony Pietropaoli, M.D., first met Minsoo Kim, Ph.D., over 15 years ago, they found they had common scientific and clinical interests, and started a fledgling translational research project combining a small cohort of septic patients with preclinical investigations using a mouse model of sepsis. In 2014, they earned a $4 million grant from the National Institutes of Health to study how immune cells would penetrate blood vessels. Fueled more recently by a URSMD Scientific Advisory Committee Faculty Pilot Incubator award, they have continued to build on that work and grow their collaborative sepsis research program.
This new grant from the NIH is for $2.5 million over four years, and will allow Pietropaoli, a professor of Medicine in Pulmonary & Critical Care Medicine, and Kim, the Dean’s Professor of Microbiology and Immunology, to conduct research for their ambitious proposal: determining whether a specific blood complement factor could be used as a drug treatment for sepsis.
With funding from previous grants and their intense study of blood markers, they discovered that the complement protein C1q, which occurs naturally in our blood and is one of the bacteria fighting molecules, has other functions, such as promoting resolution of inflammation. They aim to do a deep dive into C1q to see if harnessing its functions can lead to a new therapeutic treatment.
Drug therapies for sepsis have been difficult to obtain so far because the patient population is so diverse. There is no one treatment for the wide variety of situations of septic patients.
“The goal of this new research,” said Pietropaoli, “is to determine whether the production of C1q by neutrophils in septic patients is an important prognostic marker in our cohort of critically ill patients with sepsis. If we can show this is true, independent of other things like age, and comorbidities, then we have something that might be a relevant target for therapy. Our preliminary work suggests that when neutrophils don't or can't produce C1q, they can't be effectively cleared, and thus they continue to promote organ failures and sepsis. We want to both prove that it's prognostically significant, and further investigate the reasons why neutrophil C1q is so important.”
Their work is also a very timely topic as we continue to see COVID cases in hospitals. “A lot of COVID patients,” said Kim, “they don’t really die because of the virus, they die because of the overall inflammation response. It’s not the virus that kills them, it’s what it does to their bodies, and a lot of COVID patients are dying of sepsis.”
Pietropaoli and Kim stress that all of this work is made possible by the enthusiastic assistance of the clinical ICU teams of nurses, respiratory therapists, and providers, and the selfless generosity of their patients and their families.
For the time being, their treatment studies will be conducted with lab mice, providing pre-clinical data that will be used to build rationale for potential human clinical trials down the road. Should their work prove successful, URMC may present the world with a new drug treatment for sepsis.
A Generous Gift from a Grateful Family Establishes Pulmonary Education Endowed Fund
Tuesday, July 5, 2022
Ellen and Donald Bilgore have donated $500,000 to the divisions of General Medicine and Pulmonary & Critical Care Medicine to establish the Donna Bilgore Robins Research, Education & Clinical Innovation Endowment. The fund will support education initiatives for junior faculty. The Bilgores are lifelong Rochester residents, and are extremely grateful for how Strong Memorial Hospital has cared for their daughter, Donna, all her life.
At only six months old, Donna was diagnosed with severe asthma. She is now in her 60s, and as she points out, “I never have a day that’s asthma free.” During her childhood, her parents were very involved in her care, which included many trips to the hospital.
Don had already developed a great patient/doctor relationship with his primary care doctor, Marc Berliant, M.D., who is now division chief of General Medicine. Together with Paul Levy, M.D., professor of Medicine in Pulmonary & Critical Care Medicine, and Augusto Litonjua, M.D., M.P.H., chief of Pediatric Pulmonology, they have worked with the Bilgore family for many years.
The endowed fund will also establish the Donna Bilgore Robins Teaching Day, for updates on education, training, treatment, and management of asthma and other airway diseases, to and by providers for patients, patients’ families, and their caregivers.
To honor the Bilgore family and their generosity, the Pulmonary clinical care suite has been named after Donna Bilgore Robins, where a new plaque has recently been installed that includes the phrase “to breathe is to be free.” There is a similar plaque in her honor at the Mary Parkes Asthma Center.
Presented with the plaque, Donna said “I want to thank the University of Rochester Strong Memorial team who have helped to develop the focus of this fund. In particular, I want to recognize Dr. Levy, Dr. Berliant, Joe Lynch and Michael Fahy from Advancement. This is definitely one of the most memorable days of my life. I am humbled by the naming of this gift that recognizes my personal struggle.”
You, too, can donate to the division of Pulmonary & Critical Care Medicine.
Faculty from URMC Have Large Presence at ATS Conference
Wednesday, May 25, 2022
The American Thoracic Society (ATS) is the world's leading medical society dedicated to accelerating the advancement of global respiratory health through multidisciplinary collaboration, education, and advocacy. M. Patricia Rivera, M.D., division chief of Pulmonary & Critical Care Medicine, is currently the president-elect of ATS and will assume the role of President in May 2023.
From May 13 – 18, 2022, the ATS held its annual conference in San Francisco, California. URMC had an exceedingly large presence with many faculty presenting talks, symposia, and research projects. Faculty were present from the division of Pulmonary & Critical Care Medicine, as well as Pediatric Pulmonology, Neonatology, and Environmental Medicine.
View the full list of presenters.
The Department of Medicine and Wilmot Cancer Institute Welcome Patricia Rivera
Friday, April 1, 2022
M. Patricia Rivera, M.D. joins us as division chief of Pulmonary, associate director of Diversity, Equity & Inclusion at Wilmot, and as director of the Clinical Lung Cancer Screening Program.
Read the full story.
New Bronchoscopy Robot Enhances Patient Care, Opens Doors for Collaborative Research
Wednesday, February 16, 2022
Biopsies are critical in the diagnosis and management of cancer, and Michael Nead, M.D., Ph.D., associate professor of Medicine in Pulmonary Diseases & Critical Care, was on a quest to make them more effective and easier to perform. After careful consideration of the options, Nead landed on the Ion Endoluminal System, by Intuitive, for robotic bronchoscopies. URMC is the first hospital in New York outside of New York City to acquire an Ion, which will enhance our ability to offer care in the region and is in line with our lung screening programs, which help us identify cancers at earlier stages.
This new technology has many benefits for both physicians and patients. URMC has been using the Medtronic Illumisite system for navigational bronchoscopies, but while an improvement over the prior Medtronic system, high yields on smaller lesions remained elusive. The Ion uses a robotic-assisted platform with a Vision Probe, and uses shape-sensing technology to stabilize the catheter, enhancing accuracy. Because of this increase in accuracy, the Ion enables smaller nodules to be biopsied with greater confidence. The catheter is ultra-thin and ultra-maneuverable, able to articulate in 180 degrees, which means it can reach even difficult-to-navigate to airways, complete with tight bends if needed to reach all areas of the lungs. Another benefit is that, unlike the Illumisite, the Ion does not use electromagnetic fields, so there is no worry about interference from metal in stretchers or from cell phones or pagers in proximity to the patient.
Nead and fellow pulmonologist Aaron Lampkin, D.O. began performing biopsies with the Ion in early December 2021. While only Nead and Lampkin drive the robot, it takes a larger team to perform the procedure, including anesthesiologists, nurses, and patient care techs. They have performed over 20 cases so far, and with each new patient they learn more about the system and are able to improve upon the workflow. URMC continues to use the Medtronic Illumisite system as well, and Nead and Lampkin assess which system to use on a case-by-case basis.
One case already stands out to Nead: a patient had multiple pulmonary nodules, and they decided to biopsy two of them. One of the nodules was in the lung away from an airway, requiring a hard turn to even get close, and Nead says “there was no way we could have gotten that with the Medtronic system.”
In addition to improving patient care, there is great research potential with this new technology. Beyond primary lung cancer, it can be used to biopsy lesions potentially from other cancers that spread to the lungs, such as breast cancer, melanoma, and colon cancer. The catheter is currently used for deploying biopsy needles, but collaborative research with thoracic surgery and radiation oncology at Wilmot Cancer Institute could open pathways for other uses. Future research could explore use for immunotherapy injections or ablation, such as by cryotherapy, radiofrequency, or microwave. Inter-departmental collaboration within the Thoracic Oncology Working Group will be key to answering these questions.
The Ion comes to URMC thanks to the efforts of a large number of people, including the support of associate professor of Orthopaedics and associate chief medical officer for Value Analysis, Catherine Humphrey, M.D., M.B.A., chief operating officer Kathy Parrinello, Ph.D., and chief medical officer, Mike Apostolakos, M.D.