Connecting the dots
Veterans of the Afghanistan and Iraq wars who sustained mild traumatic brain injuries (TBIs) were 28 percent more likely to have epilepsy than those with without TBIs, Health Science Center researchers found.
They studied the medical records of veterans from both wars who sustained traumatic brain injuries. Similar to prior studies, this research also showed that veterans who suffered penetrating or severe TBIs had the highest risk of developing epilepsy.
"We saw that 24 percent of the veterans who had epilepsy also had experienced a TBI. That is compared to 11 percent of people without epilepsy," said Mary Jo Pugh, Ph.D., RN, associate professor in the Department of Epidemiology and Biostatistics who is also a research health scientist with the South Texas Veterans Health Care System and a veteran of the U.S. Air Force.
Funded by the VA Health Services Research and Development Administration, the research was based on the records of 256,284 Afghanistan and Iraq veterans who received inpatient and outpatient care in the Veterans Health Administration (VHA) in fiscal years 2009 and 2010.
Of the more than 2 million returning veterans, 15 to 19 percent of them have suffered a TBI with either loss of consciousness or altered mental state.
"The high prevalence of TBIs has raised concerns for the long-term consequences of neurotrauma in this population. Based on data from previous wars, there is a particular concern for the risk of post-traumatic epilepsy," Dr. Pugh said, adding that studies of veterans from World War II and the Korean War showed a link between combat-related head injury and epilepsy.
"This study shows us that we need to be prepared as a health care system," she said. "Given the large number of individuals who have sustained deployment-related TBIs, a substantial increased burden of epilepsy in this population is possible. The long-term consequences on the patient and the health care system includes increased risk of medical and social complications, including accidents, social stigmatization, loss of employment, inability to drive and even death. These veterans should be followed closely, and systems of care, such as the VHA Epilepsy Centers of Excellence, should be prepared to provide epilepsy specialty care for these individuals."
Two for one: Drug kills cancer cells and blocks pain
An anti-pain agent has been found to also dramatically shrink human oral cancer tumors in mouse models. The agent, capsazepine, caused no damage to surrounding tissues, researchers from the School of Dentistry and School of Medicine found.
"That’s the beauty," said Cara B. Gonzales, D.D.S., Ph.D., assistant professor of comprehensive dentistry and an investigator with the Cancer Therapy & Research Center. "Capsazepine kills cancers selectively, leaving normal tissues unharmed, and also acts on neurons to block pain, a desirable combination in a potential medication."
Oral squamous cell carcinoma is the eighth most common cancer in the U.S. with 40,000 new cases and nearly 8,000 deaths reported annually. Typically, tumors develop on the side of the tongue, and 60 percent of patients have large tumors before seeking help. The five-year survival rate is 30 percent.
But if caught early, the disease is curable, said Randal A. Otto, M.D., FACS, professor and chairman of the Department of Otolaryngology-Head & Neck Surgery in the Long School of Medicine.
"Anything that selectively attacks the tumor while not injuring the normal tissues can only help the patient," he said.
Capsazepine was developed to block TRPV1, a calcium channel found in pain-sensing neurons. When TRPV1 is activated, a pain signal is sent to the brain. Capsazepine may reduce oral cancer pain because it blocks tumor-secreted factors from stimulating TRPV1 on these neurons. Dr. Gonzales found that capsazepine also has anti-cancer activity that may be linked with its ability to increase oxidative damage in tumors. Enhanced oxidative stress leads to auto-destruction of the tumor cells, the researchers theorize.
So far, only local administration of capsazepine, directly into the primary tumors, has been tested.
"We would like to be able to deliver this therapy systemically to target metastatic disease," Dr. Gonzales said. "Our laboratory is working with the Center for Innovation in Drug Discovery, a partnership between the Health Science Center and The University of Texas at San Antonio, to develop novel drugs that are similar to capsazepine, with improved efficacy for the purpose of systemic administration to treat tumors that are inaccessible to local injection or that have metastasized."
The Health Science Center has claimed intellectual property on results of the study, which is described in the journal Oral Oncology.
A good combination: Dual-drug combo can cure hepatitis C
More than 90 percent of hepatitis C patients were cured in three months using a combination of pills already approved by the FDA.
When taken together, the drugs sofosbuvir and simeprevir resulted in nine out of 10 patients being cured. They were also well tolerated by patients, according to a study published in The Lancet.
Eric Lawitz, M.D., clinical professor in the Long School of Medicine and vice president of research and scientific development at the Texas Liver Institute, led the clinical trial conducted in the United States and funded by Janssen Pharmaceutical Companies.
Encouraging people to take a blood test to diagnose hepatitis C could result in their being treated with an oral regimen that could prevent serious liver diseases such as cancer, cirrhosis or liver failure. Hepatitis C is the leading cause of liver transplants in the U.S.
An estimated 3.2 million people nationwide have hepatitis C, and most do not know they are infected. Cure rates for hepatitis C patients with cirrhosis are historically lower than 50 percent, and the treatment has had numerous adverse effects. The previous standard of care with the drug interferon involved a complicated regimen of shots and up to 18 tablets a day for up to 48 weeks, and six months of follow-up care to determine if the therapy was successful. Side effects included rash, anemia and depression.
"We are now in the midst of a paradigm shift of moving away from complicated injection regimens," Dr. Lawitz said. "This trial provides a glimpse into the outcomes of sofosbuvir and simeprevir for treatment of hepatitis C. Both drugs are approved by the FDA but are not yet approved together for this treatment."
All-oral regimens hold promise for a hepatitis C cure rate of more than 90 percent of patients, including those with liver scarring, or cirrhosis. Study participants had the most common form of hepatitis C, called genotype 1, and were difficult to treat due to either failing a previous course of interferon and ribavirin, or having cirrhosis.
More than 150 million people worldwide have chronic hepatitis C, a major cause of liver cirrhosis and liver cancer. Annually 350,000 to 500,000 deaths are reported.
According to the U.S. Centers for Disease Control and Prevention, 75 percent of U.S. residents with chronic hepatitis C were born from 1945 through 1965. For this reason, the CDC recommends that people born during these years have a one-time test for hepatitis C to prevent the risk of more serious health problems.
Fat be gone
What if you could flip a switch and start burning your excess fat? That could lead to more energy, and a lower risk of obesity and diseases such as type 2 diabetes. It sounds like a miracle switch, but researchers from the Long School of Medicine believe they have found it in the protein Grb10.
The body is made up of white and brown adipose tissue, also called fat tissue. White tissue stores fat, while brown tissue releases it through energy. Both are important for regulating metabolism, but having too much white adipose tissue could lead to weight and health problems.
"We know that if we want to keep our body lean, we have to get rid of extra nutrients in the body, which means burning more energy," said Feng Liu, Ph.D., professor of pharmacology at the Health Science Center and director of the Metabolic Syndrome Research Center at Second Xiangya Hospital, Central South University in Changsha, China.
Converting the white tissue to brown, or "beigeing" the fat, could lead to this increase in energy. The researchers discovered the molecular pathway called mTORC1 that controls this beigeing, and Grb10 acts as the on-off switch. This protein is stimulated by cold stress, which causes the body to burn energy.
"Understanding how beigeing is controlled is so very important because, if we can improve energy expenditure, we can reduce obesity," Dr. Liu said.
The discovery has other implications, too. The mTORC1 pathway is also involved in aging, cardiovascular disease and cancer.
It's in your gut
A high-fat diet may cause changes in people’s gut bacteria, leading to an increase in bacterial byproducts called endotoxins in the bloodstream. In older people and those with type 2 diabetes, the level of endotoxin is higher.
Nicolas Musi, M.D., director of the Barshop Institute for Longevity and Aging Studies at the Health Science Center, recently received $600,000 from the American Diabetes Association to lead a clinical research study into the issue.
"We all have a little bit of endotoxin in our body coming from the bacteria that live in our gut," Dr. Musi said. "But usually endotoxin does not come through the intestinal barrier into the blood, or very little does. We question whether the higher level of endotoxin in the blood of diabetics is caused by a high-fat diet that makes the intestinal barrier leaky, allowing endotoxin to spill into the blood."
The study will also explore how the level of endotoxin might affect insulin sensitivity and the body’s ability to metabolize sugar.
It’s official. CTRC retains national elite Cancer Center designation
In September, the National Cancer Institute renewed the Cancer Therapy & Research Center’s official Cancer Center designation. An NCI Cancer Center designation is given to elite cancer centers, of which there are only four in Texas.
To qualify for the national designation, CTRC faculty and staff had to meet and exceed strict guidelines, such as continuing to make groundbreaking scientific discoveries, conducting innovative clinical trials, training the next generation of cancer doctors and reducing the burden of cancer for the people of San Antonio and South Texas.
"We are elated with these achievements—mainly because they help our patients," said CTRC Director Ian M. Thompson Jr., M.D. "Every conversation I have with a patient who is fighting cancer, or with a family member who is soaking up every word and asking questions so that person can fight alongside the loved one, is profoundly humbling. They are the real fighters, and we are so proud to serve them."
The CTRC serves a fast-growing area with a population of more than 4.4 million people in the region of Central and South Texas that includes Austin, San Antonio, Laredo and the Rio Grande Valley. With many Spanish speakers in its service area and higher rates of liver and cervical cancer along its borders, the CTRC has focused its mission on bilingual prevention education and outreach, collaboration with border physicians and cutting-edge clinical trials for cancer.
‘Zafè Kabrit se Zafè Mouton’
It was at once very familiar and all its own: a stage, caps and gowns, smiling graduates and a cheering crowd. But the setting was an off-duty nightclub just outside the Haitian capital of Port-au-Prince. Caps and gowns were often homemade and sometimes held together by duct tape. Graduates ranged from the very young to the very old.
The specific achievement being celebrated was entirely new to this part of the world and, yet, critically important: Each of the 430 graduates receiving a certificate this February day had completed a six-month curriculum through one of 17 Community Health Clubs across their city.
Developed in sub-Saharan Africa, Community Health Clubs are now bringing Caribbean communities together to prevent the spread of disease. There, they are facilitated by local community organizers in partnership with the Center for Medical Humanities & Ethics, part of the Long School of Medicine at the UT Health Science Center.
Three from the Center for Medical Humanities & Ethics traveled to Haiti for the graduation: director Ruth Berggren, M.D., FACP; Jason Rosenfeld, M.P.H., assistant director of global health; and academic and global health program coordinatorStephanie Gutierrez.
The mood was ecstatic. People traveled from muddy slums all over Port-au-Prince carefully groomed and meticulously attired, including one club of young girls in pristine white dresses, ruffled socks and patent-leather shoes. The fervent crowd broke out in call-and-response chants. Each club performed health-themed Creole skits or songs for a crowd of roughly 2,000. A candlelight ceremony was held to remind graduates not to let the light of their newfound knowledge go out.
These clubs are turning a traditional Haitian proverb on its head: "Zafè Kabrit pa Zafè Mouton" translates to "The goat’s business is not the sheep’s business." In Haiti, where a cholera outbreak has killed thousands and underscored deficiencies in water and sanitation systems, that mindset of minding your own business can be deadly. Accordingly, the health clubs have adopted a variation as their unifying slogan: "Zafè Kabrit se Zafè Mouton," or "The business of the goat IS the business of the sheep."
"Community matters everywhere, but in Haiti it’s essential," said Dr. Berggren, an infectious disease specialist. "How your neighbors deal with standing puddles of water and piles of trash, even how and where they relieve themselves, can determine whether your child gets sick. Community Health Clubs show neighbors how to look out for each other, and demonstrate the virtuous cycle that can follow."
Dr. Berggren and Rosenfeld bring together a unique combination of skills and experiences. Rosenfeld is a behavioral scientist with six years of experience in Africa, three of those in South Africa and Zimbabwe with Africa AHEAD, the organization that pioneered the approach.
The daughter of two public health physicians and an infectious disease specialist, Dr. Berggren grew up in Haiti from ages 4 to 14. She brings deep understanding of Haiti’s health challenges and culture, as well as language fluency and programmatic expertise.
In Haiti, a typical meeting begins with the club chanting its slogan: "health is wealth." There are always crowd-warming "animations": lighthearted dances, funny skits and songs. A facilitator asks whether homework is complete—perhaps changing a household practice. Then they launch into the new session, distributing picture cards and tackling a theme: sanitation, drinking water, hand washing and more.
It’s difficult to isolate the health impact of the clubs from other forces at work in a community. But Rosenfeld and Dr. Berggren are encouraged by knowledge increases and behavior changes they see, and are working on ways to better quantify the impact.
They are also working to extend their reach. Because students can’t visit Haiti due to a State Department travel warning, Rosenfeld traveled with medical students to the Dominican Republic to introduce the Community Health Club concept and conduct needs assessments. They went house to house, speaking to residents and making observations: Did the house have a latrine? How were food and water stored?
One student, Matt Mullane, described it as a defining experience that will strongly influence his career: "One of the big drives right now is for medicine to reconnect with communities. To do that, we need to understand how to approach communities and to see how community life influences health."
From there, local partners were identified: Jude François and Marie Ruthza Flavienne Vincent in Haiti, and the nonprofit Children of the Nations in the Dominican Republic.
Rosenfeld took the African curriculum—picture-based, so it can be used when illiteracy is widespread—and, with Dr. Berggren and local artists, adapted it to its new context.
Next up: Medical student Samy Bendjemil’s plan to take the clubs to Burkina Faso, Africa, earned a prestigious Fulbright U.S. Student Award. He laid groundwork during a previous global health trip with guidance from Dr. Berggren and Rosenfeld.
And there are plans to adapt the clubs to San Antonio, where they could be used to promote healthy lifestyles or address chronic problems like diabetes and obesity.
"I think the potential is great," Rosenfeld said. "I have enough confidence in the model that, once we find the right people to implement it, I believe it will take off."
See more photos of the Community Health Club graduation in Haiti.
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Building a legacy
The Hinchey name is synonymous with health and service
Family and service are at the heart of William Hinchey, M.D., class of ’78. With his father, John, and son, John, also practicing medicine and contributing both time and talent to community organizations, the Hinchey name is well known throughout Texas.
Dr. Hinchey is a partner with Pathology Associates of San Antonio and is the laboratory medical director for CHRISTUS Santa Rosa Hospital’s Westover Hills and Alamo Heights campuses. He also is an assistant clinical professor of pathology in the Long School of Medicine.
"While he has contributed through a variety of teaching and literary presentations, I feel that his greatest contribution to the profession is the willingness to sit at the head of the table," said classmate Michael W. Brennan, M.D., ’78.
Among his many hallmarks, Dr. Hinchey has served as president of the Texas Medical Association and in numerous roles with the Bexar County Medical Society and the San Antonio Medical Foundation Board of Trustees. He has also been a driving force among national and federal legislators by advocating appropriate funding of both medical and graduate medical education in Texas, prompt pay legislation, improvements to the Texas Medicaid program and other issues.
Medicine aside, Dr. Hinchey’s local community has benefited from his volunteer work. He has served with the Texas Cavaliers, the Order of the Alamo and St. Anthony de Padua Catholic Church.
Dr. Hinchey said his heart has never left the Health Science Center. He has actively participated in the School of Medicine’s Alumni Association since its formative years and has spearheaded reunions and activities for his class. In 2013, he was awarded the Distinguished Alumni Award in recognition for his service and dedication.
"It is so important to me to remain connected to the Long School of Medicine Alumni Association," said Dr. Hinchey. "It is a joy for me to give back to the Health Science Center that has given me and my family so much."
Following in his footsteps, his son, John Hinchey ’07, serves as a class agent for his fellow graduates.
"Like grandfather and father, this is an example of legacy," said Dr. Brennan. "Expect another Dr. Hinchey to follow."
For health and hope
First capital campaign exceeds goal and makes history
Every gift makes a difference
In 2004, the vision for the UT Health Science Center San Antonio included new homes for its medical and dental practices, a signature building for biomedical research, and endowments and program support to attract and retain the best faculty and students.
Simultaneously, the state was steadily reducing its appropriations to higher education and the National Institutes of Health was trimming grant support, making research funding even more competitive. It was a good time, officials believed, to launch the university’s first comprehensive capital campaign.
What followed over the next decade surpassed even the most optimistic goals and ignited the fuel that would propel the university forward.
The original goal for The Campaign for the Future of Health was $300 million to support the university’s missions of research, education, patient care and community service. The community responded.
"We had momentum and the mission drove us to expand our goal," said Health Science Center President William L. Henrich, M.D., MACP. "We reached for the stars, and set our sights on $500 million by Jan. 1, 2014."
From 2004 to 2014, 14,123 donors contributed 42,327 gifts to reach a final tally of $607 million.
"What we saw was how invested our community was in the future of health," Dr. Henrich said. "The byproduct of their efforts is hope, and the beneficiaries are our patients and students."
It was a $25 million lead gift from The Greehey Family Foundation that ignited the campaign. It allowed for the creation of the Greehey President’s Endowment for Excellence in Children’s Health Sciences, which supports cancer research and educational and community programs benefiting children, especially those in greatest need. As the campaign was coming to an end, the foundation announced its second gift—$5 million to establish the Greehey President’s Fund for faculty recruitment in medicine and dentistry, new endowments in pediatrics, and educational programs for students and faculty to provide patient care for those in need.
Today, the Health Science Center is home to the Greehey Children’s Cancer Research Institute and the Greehey Academic and Research Campus. The naming acknowledges the vital support from the Greehey Family Foundation, Dr. Henrich said.
"We needed a champion, and we found one in Bill Greehey," he said. "It’s only fitting that our campaign culminated with a major gift from him."
There were other standouts. In 2008, philanthropists Joe R. and Teresa Lozano Long established the largest endowment in university history. The $25 million gift established The Joe R. and Teresa L. Long Scholarship Research and Teaching Fund, an endowment that supports more than 50 students each year in medicine, nursing, graduate biosciences and physician assistant studies. It also supports endowments for faculty and research programs. The gift, which is one of the single largest cash gifts to an endowment in The University of Texas System, was recognized with the naming of the Joe R. and Teresa Lozano Long Campus at the Health Science Center.
The largest gift to the campaign was the Cancer Therapy & Research Center in 2007. The CTRC Foundation contributed an in-kind gift of CTRC facilities and equipment along with a cash gift of $24.5 million, and annual support, in perpetuity, from the CTRC Foundation endowment for the cancer program.
"The Health Science Center has earned its place as the chief catalyst for San Antonio’s $29.2 billion biosciences and health care industry," said Campaign Chair John T. Montford. "The UT Health Science Center continues to impact the city’s economy in a substantial way through the competitive jobs it creates and the biomedical research discoveries that ease suffering and improve health."
In one decade, in addition to donations and other funding raised through the campaign, the Health Science Center has secured $158 million in Permanent University Funds and $38 million in tuitionrevenue bonds for university projects. And its 2004 vision has been realized. The new facility for physician practice, UT Health San Antonio at the Medical Arts & Research Center, was opened in 2009. To attract exceptional biomedical scientists to San Antonio, the South Texas Research Facility was opened in 2011. And a new home for dental practice, the Center for Oral Health Care & Research, is expected to open in 2015.
Dr. Henrich said he is humbled by the community’s response, but "our work is not done."
"Although the path to deciphering some of our most vexing health challenges may seem daunting at times," he said, "it’s the spirit and support of our community that is the light that leads us on this uphill journey. We are San Antonio’s academic health science center, and our job is the future of health for this region and beyond."
Learn more about the Campaign for the Future of Health.
Coming home
UT System chancellor to return to HSC
After five years as the leader of one of the nation’s largest university systems, Francisco G. Cigarroa, M.D., is returning to the UT Health Science Center San Antonio.
The former Health Science Center president, who is chancellor of The University of Texas System, announced Feb. 10 that he will return full time to the Health Science Center as director of pediatric transplant surgery once a new chancellor is selected. He will be a member of the University Transplant Center, a partnership of the Health Science Center and University Health System.
During his 14 years as an executive-level administrator, Dr. Cigarroa continued taking surgical calls at least once a month at University Hospital.
"When initially approached by the Board of Regents to consider the chancellorship more than five years ago, I was inclined to say no, but I considered the similarities between health and education," Dr. Cigarroa said in a statement from Austin. "Like surgery, education saves lives on many levels, and I thought I could bring value to the UT System with that perspective in mind."
Highlights of his tenure in Austin include White House visits, the creation of an online dashboard of accountability by UT campuses and the establishment of two new medical schools for the state—the Long School of Medicine at UT Rio Grande Valley and the Dell Medical School at UT Austin. Dr. Cigarroa, a Laredo native, said the creation of the Valley medical school ranks among his proudest achievements.
"Dr. Francisco G. Cigarroa has made many impressive and lasting contributions as the chancellor of the UT System, and we are thrilled to have him back as a full-time pediatric transplant surgeon," said William L. Henrich, M.D., MACP, president of the Health Science Center. "This is a position in which he distinguished himself previously and from which he will continue to make lives better—one child and family at a time."