Bridging health care
Both functional and symbolic, a bridge was constructed between two Health Science Center clinical homes—the Medical Arts & Research Center and the new Center for Oral Health Care & Research. A ceremonial ribbon cutting merged the two practices in October.
The bridge will facilitate referrals, enhance educational experiences and promote dental research as a component of good overall health, officials said.
“This walkway is a reminder that oral health is an important part of overall health,” said Health Science Center President William L. Henrich, M.D., MACP. “As is occurring now, the connection of the two buildings will further interdisciplinary work among our medical and dental students, clinicians and researchers.”
The Center for Oral Health Care & Research opened in September and is a clinical training site for dental and dental hygiene students. It is also home to clinical trials and features laboratories where faculty and trainees conduct research on oral health care.
“This is, of course, a symbolic as well as a real connection,” Dr. Henrich said. “We recognize oral health more and more is the key to good general health. And now our practices are joined in these two magnificent buildings.”
Broccoli for life
The world’s longest-lived rodents don’t eat broccoli, but they have the protection of a protein that, in humans, is activated by consumption of steamed broccoli.
The protein is called Nrf2, and it was connected with the maximum life span in 10 rodent species tested by the UT Health Science Center’s Barshop Institute for Longevity and Aging Studies. But its signaling is highest in the naked mole rat, which boasts a maximum life span of 32 years—eight to 10 times longer than the oldest mice of comparable size. Naked mole rats don’t just live longer, however. They also don’t develop cancer, and they remain healthy almost to the end of their extraordinarily long life span.
In the naked mole rat, Nrf2 is well regulated by several other proteins, which work to degrade the protein. Unregulated gene expression of certain protective molecules leads to diminished signaling and shorter life span.
Graduate student Kaitlyn Lewis is the lead author on the study that suggests targeting negative regulators of Nrf2 could yield interesting results in longevity and life span-extending drugs.
So, do you want to live longer? Changing your diet and adding more broccoli, Brussels sprouts and cabbage can increase your Nrf2 activity, and just may provide some of the same protective mechanisms seen in healthy long-lived rodents.
Staying in balance after stroke
Strokes affect nearly a million Americans each year, but an already-approved drug used for epilepsy could dramatically reduce their debilitating impact.
New research shows one dose of the anti-epilepsy drug retigabine given hours after a mouse experienced a stroke preserved brain tissue and prevented the loss of balance and motor coordination.
In the study, both treated mice and untreated mice were placed on a balance beam after a stroke. The untreated mice showed a marked loss of coordination with repeated slips and falls, while treated mice had no difficulty with balance, ambulation or turning around on the beam.
“You couldn’t even tell they had a stroke,” said Mark S. Shapiro, Ph.D., professor of physiology. “They ran across the balance beam like gymnasts.”
Brain tissue of the treated mice showed significantly reduced damage to the tissue, compared to untreated mice. The protective effects of the medication were seen up to five days after the stroke, said Sonya Bierbower, Ph.D., postdoctoral fellow. The study was published in The Journal of Neuroscience.
Future studies will assess how long brain function can be protected after a stroke, whether injury-related seizures can be prevented and if strokes can be prevented in high-risk animal models.
A drug called tissue plasminogen activator commonly treats strokes by dissolving blood clots to restore blood flow, but there are significant limitations. It is most effective in the first hours after a stroke, but its later use may do more damage than good.
Drugs such as retigabine work on a completely different system. Instead of thinning blood, they preserve cells by putting a brake on their electrical activity, Dr. Shapiro said.
“It’s treating the first step in the sequence and stopping the more damaging secondary effects,” Dr. Bierbower added. “These agents directly affect the nerve cells themselves.”
Retigabine is approved by the Food and Drug Administration as an anticonvulsant, so physicians may use it off label in stroke patients. FDA approval for use as a stroke therapy will require a clinical trial to be conducted—something that a team of neurologists and neurosurgeons is already considering, Dr. Shapiro said.
Early detection
Having a baby is a joyous event but can be nerve-wracking, even when the baby is the picture of health.
Now imagine being the parent of an infant who has a congenital anomaly, a developmental delay or an autism spectrum disorder. Three months is the average wait time faced by parents to learn the nature of their child’s health issue, the severity of it and the help the baby needs.
The clock is ticking, precious time is lost. Anxiety abounds.
Yet this time doesn’t have to slip away. Parents now have the option of rapid-turnaround, Food and Drug Administration-approved microarray testing to diagnose genetic conditions, done at the UT Health Science Center. The Clinical and Molecular Cytogenetics Laboratory of South Texas Reference Laboratories, in the Department of Pathology, recently became certified to offer Affymetrix CytoScan® Dx Assay microarray testing.
“The sooner you identify the underlying cause of these children’s medical conditions, the better the outcomes for the children in the long run,” said Veronica Ortega, B.A., CG (ASCP)CM, manager of the laboratory. “We can confirm the common abnormalities within 24 hours, which is a relief for families because conditions are diagnosed sooner so that the parents can pursue better care options for their children.”
Gopalrao Velagaleti, Ph.D., FACMG, professor of pathology, pediatrics and clinical laboratory sciences and director of the cytogenetics laboratory, said microarray testing is the first line of testing for children with these conditions. It is widely used already, he said, but the Health Science Center is the only institution offering an FDA-approved assay within a region including Texas, Oklahoma and Mississippi.
“It is a tremendous benefit to some of these families to know the underlying cause of their child’s condition, and what the typical outcome is for other babies with similar diagnoses,” said Steven Seidner, M.D., professor of pediatrics at the Health Science Center and the medical director of the Neonatal Intensive Care Unit at University Hospital. “Occasionally this knowledge will also change our management of the baby, including the timing of needed surgeries.”
Testing also tells families whether the child has a new mutation that likely will not recur, or whether there is a strong pattern of inheritance in the family.
“We can often learn whether this is something of major concern to parents in future pregnancies,” Dr. Seidner said.
Dental implants for diabetics
Diabetics heal slowly and often face high infection rates. For some 20 years, these reasons have kept dentists from placing dental implants in patients with diabetes.
But a new study shows that with some accommodations, diabetic patients—even those with poorly controlled diabetes—had as high a success rate with implants after one year as patients with healthy sugar levels.
When a tooth is lost, a dental implant, usually made of metal or another material, can be permanently implanted in the jawbone to become the base for a false tooth.
“The most striking thing to me about the study is that we are not only able to see that dental implants can be successful for patients with diabetes, but that the patients are truly benefiting from them,” said Thomas Oates, D.M.D., Ph.D., interim associate dean for research and assistant dean for clinical research in the School of Dentistry, who led the study published in the Journal of the American Dental Association.
The study evaluated 110 patients, including those without diabetes, and those with both controlled and poorly controlled diabetes. Each patient had two implants placed in the lower jaw followed later by a full set of dentures anchored to the implants. After the implants were placed, patients were followed for at least one year. Diabetics, like nondiabetic patients, had nearly 100 percent implant success rates.
“The study findings showed no significant differences between the nondiabetic and well-controlled diabetic groups. The group with poorly controlled diabetes required a longer time for the implant to heal before placing the dentures,” Dr. Oates said. For this reason, there was a four-month healing time following implantation for all groups instead of the usual two months. All patients were prescribed antibiotics and a chlorhexidine gluconate mouth rise following implantation to guard against infection.
Drug cocktails increase risk of death
It’s been seven years since actor Heath Ledger, 28, was found dead in his Manhattan apartment. The New York medical examiner ruled that Ledger died of “acute intoxication” from six kinds of painkillers, sleeping pills and anti-anxiety drugs.
Most drug overdoses are unintentional, said Barbara J. Turner, M.D., M.S.Ed., MACP, professor of medicine and director of the Center for Research to Advance Community Health. “People with chronic pain don’t mean to end their lives,” she said. “But they’re taking a lot of drugs with substantial risks.”
These painkillers include prescription opioids, such as hydrocodone, that are often prescribed along with sedative-hypnotics, such as alprazolam (Xanax) and zolpidem (Ambien). Many patients are prescribed antidepressants, as well, to treat their pain and mood disorders.
Two new studies authored by Dr. Turner and Yuanyuan Liang, Ph.D., also of the School of Medicine, found that a morphine equivalent dose of 100 milligrams or more daily significantly increased the risk of drug overdose, and even lower doses of 50 to 99 milligrams daily were dangerous over an extended time. Patients prescribed more than four to six weeks of moderate doses were at higher risk. The findings are in a recent issue of The Journal of Pain.
“If you take moderately high daily doses of opioids and exceed a total dose of about 1,800 milligrams, you are almost at the same risk of drug overdose as somebody who is taking a very high daily dose,” Dr. Turner said.
Physicians should take into account how much opioid a person has been prescribed over a period of time, in addition to the daily dose, she said.
The doctors also examined the increase in drug overdose risk for patients with mental health disorders who are taking opioids, hypnotic-sedatives and antidepressants in combination—the type of cocktail that killed Ledger.
“We found that if a patient is taking benzodiazepines (one class of hypnotic-sedative) on top of the narcotics, the risk is multiplicative,” Dr. Turner said of the study published in The Journal of General Internal Medicine. “If you are at fourfold greater risk of overdose from higher-dose opioids, and then there is more than a twofold greater risk from being on benzodiazepines for 90 days or more, the risk of drug overdose using both together becomes eight times greater.”
Molecules in 3-D
Imagine a suitcase on a bumpy ride. With enough jostling it opens, spilling clothes everywhere. Similarly awkward, the suitcase locks may jam and not open at the destination.
This analogy illustrates the importance of the protective capsule, called the capsid, which surrounds the HIV-1 genome. The capsid has to disassemble once the virus enters the cell, releasing its disease-causing cargo at precisely the right time and place.
“It’s still a matter of debate at what point the capsid falls apart in HIV-1 infection of cells,” said Dmitri Ivanov, Ph.D., assistant professor of biochemistry. Dr. Ivanov is a senior author on a study, published in Proceedings of the National Academy of Sciences, that offers clues about HIV-1 capsid disassembly. Akash Bhattacharya, Ph.D., was the first author on the study.
An HIV-1 inhibitor called PF74 and a host protein called CPSF6 bind to a small pocket on the surface of the capsid and prevent it from disassembling. Using the analogy, the suitcase is locked. Viral information is kept inside.
“We think that this process can be targeted for therapeutic purposes in HIV-1 infections,” Dr. Ivanov said.
In part of the study, researchers used X-ray crystallography at the UT Health Science Center to visualize the three-dimensional structure of the bound HIV-1 capsid.
“Seeing molecules in 3-D is illuminating; it tells us something about their function,” Dr. Ivanov said. “We now know how PF74 and CPSF6 interact with the adjacent building blocks of the HIV-1 capsid, thus stabilizing the entire capsid structure. It tells us that these molecules bind to the capsid before disassembly, blocking viral replication.”
‘Most hopeful’ suicide research
Short-term cognitive behavioral therapy dramatically reduces suicide attempts among at-risk military personnel, according to findings from a research study that included UT Health Science Center investigators.
The two-year study, funded by the Army’s Military Operational Medicine Research Program, was conducted at Fort Carson, Colorado. It involved 152 active-duty soldiers who had either attempted suicide or had been determined to be at high risk for suicide. The study evaluated the effectiveness of a brief cognitive-behavioral therapy in preventing future suicide attempts.
Soldiers receiving cognitive-behavioral therapy were 60 percent less likely to make a suicide attempt during the 24-month follow-up than those receiving standard treatment. The results were published by The American Journal of Psychiatry.
The findings are particularly encouraging given that rates of active-duty service members receiving psychiatric diagnoses increased by more than 60 percent during a decade of war in Iraq and Afghanistan. Rates of suicides and suicide attempts rose in comparable numbers.
“The significant increase in military suicides over the past decade is a national tragedy,” said Alan Peterson, Ph.D., a co-investigator on the study who is a professor of psychiatry and director of the military-focused STRONG STAR Consortium. “The Department of Defense has responded by investing significant resources into military suicide research, and the findings from this study may be the most important and most hopeful to date.”
Nobel laureate stresses the power of science
Peter Agre, M.D., Nobel laureate and director of the Johns Hopkins Malaria Research Institute, spoke about the power of science during the 2015 Presidential Distinguished Lecture March 26.
“We should never underestimate the power of science to open doors,” he said.
Dr. Agre shared the 2003 Nobel Prize in Chemistry for the discovery of aquaporins, a family of water channel proteins found throughout nature. Referred to as “the plumbing system for cells,” aquaporins are involved in numerous physiological processes in humans and are implicated in multiple clinical disorders including malaria.
Dr. Agre joined the Johns Hopkins School of Medicine faculty in 1981 and has served as director of the Johns Hopkins Malaria Research Institute at the Bloomberg School of Public Health since 2008. He oversees 20 faculty research groups as well as field activities in Zimbabwe and Zambia.
In a personal message to UT Health Science Center students and written in the Presidential Distinguished Lecture Series Commemorative Album, on permanent display in the Dolph Briscoe Jr. Library, Dr. Agre said his message was simple: Creative science that will shape the future is undertaken by young scientists.
“The experiences you are having right now may have profound impact,” he wrote. “And importantly, you do not have to be perfect in order to do something important.
“Please take advantage of opportunities, keep the faith and never give up. The world is counting on you.”
Biomedical research program gets additional funding
San Antonio area high school students will have the opportunity to participate in a unique, intensive, three-year biomedical research program at the Health Science Center, thanks to a $675,000 grant from The Max and Minnie Tomerlin Voelcker Fund.
Voelcker fund trustees helped establish the Voelcker Biomedical Research Academy at the Health Science Center in 2009 with an initial gift of $750,000. The goal of the Voelcker Academy is to encourage high school students to enter careers in science, technology, engineering and mathematics.
The new funds will also enable the Voelcker Academy leadership team to conduct longer-term research on the program’s effectiveness with the hope of developing a national model for other universities to replicate.