Breaking down the prison walls
Individuals with post-traumatic stress disorder relive past traumas again and again, bound in a virtual prison of their memories.
Researchers in the School of Medicine now report a biological mechanism that might explain why these individuals are less able to extinguish the fear of past dangers.
The new research centers on the hormone adiponectin, which is secreted by fat cells called adipocytes. The scientists studied a mouse model of PTSD.
These mice were trained to associate a setting, such as a box, with a mild unpleasant stimulus. As expected, they showed a fear response when re-exposed to the setting.
Mice deficient for adiponectin and its receptor formed fearful memories just like healthy mice, but when placed again in the same setting minus the unpleasant stimulus, were slower to let go of the fear.
Injecting adiponectin prior to this training prompted faster learning to overcome fear, the measurements showed.
“Once the threat is no longer there, the fear should go away, but in PTSD it keeps flashing back,” said study senior author Xin-Yun Lu, M.D., Ph.D., professor of pharmacology and a member of the Barshop Institute for Aging and Longevity Studies. “In the PTSD animal model, the circulating adiponectin is low, data suggest. If the genes encoding adiponectin and its receptor are disrupted, the mice extinguish fear responses much slower. If adiponectin levels are elevated in the brain, the mice get extinction faster.”
Adiponectin impairment is implicated in metabolic diseases such as obesity and type 2 diabetes. The new research, published in the journal Molecular Psychiatry, shows the hormone has a role beyond its metabolic control, Dr. Lu said.
“To date, medication treatments for PTSD have been of limited benefit,” said Alan L. Peterson, Ph.D., ABPP, professor of psychiatry and director of the STRONG STAR Consortium and the Consortium to Alleviate PTSD. “Dr. Xin-Yun Lu’s work holds significant promise for the development of new, more effective medication treatments for PTSD.”
UT Health San Antonio has filed for patent protection on the finding because it may eventually lead to a drug to treat PTSD, which affects an estimated 8 percent of the civilian population and up to 15 percent of U.S. active-duty and retired service personnel.
New entry-point
The School of Health Professions is offering one of the country’s few entry-level master’s degree programs in medical laboratory science. It’s an opportunity for those looking to enter San Antonio’s $30.6 billion biomedical and health care industry, officials said.
Medical laboratory scientists are a critical part of the health care team who analyze medical samples in the clinical laboratory, and the job outlook is excellent, said Cheryl Burns, M.S., associate professor and director of the master’s degree program in laboratory science.
“We make a significant difference in the quality of patient care. Physicians rely on laboratory test results in diagnosing illnesses and monitoring how patients are progressing in their treatment,” she said.
Nearly 100 percent of graduates of the clinical laboratory sciences program are offered jobs after graduation.
While the 24-month bachelor’s degree in clinical laboratory sciences will continue to be offered, the new 27-month master’s program is designed to provide deeper knowledge to students who already have a bachelor’s degree in another field. It is expected to prepare students for higher-level positions and better potential for advancement, Burns said.
In her shoes
Essay by Diane Solomon, M.D.
It’s likely that every person reading this has been affected by Alzheimer’s disease, either through family or friends. I’m no exception—my grandmother had Alzheimer’s disease, and this is an excerpt from a poem I wrote about her shortly before she died almost 20 years ago:
Battered and worn,
Grandma’s shoes sit empty
on the bedside chair.
She is sleeping peacefully, breathing deeply.
Yet, she grips the bedside rail,
Holding onto life
Much as she used to hold onto the dashboard
When Grandpa drove too fast.
Her 92-year-old bones are barely covered with parchment-thin skin.
Her eyes slowly open
and there is no recognition.
She does not know me,
but she knows my love
And responds lovingly,
patting my hand
Just as she did
when I was a child.
“I love you, too, honey,” Grandma says.
I sometimes share this with the medical students I teach to emphasize the caring and compassion that are needed for people affected by dementia, whether they can remember who you are from one visit to the next or not. I’ve always had a heart for the elderly—even before I got my own AARP card!
As a geriatric neurologist, part of my job is evaluating people with memory disorders to determine the cause. About 80 percent of the time, the cause of dementia is Alzheimer’s disease. Receiving such a diagnosis is devastating, and before giving that news, I pray that God might somehow use me to be a blessing to the patient and their family. Yet, in the paradoxical way that God sometimes works, I am the one who is most blessed and inspired by the examples of love and caring I’ve witnessed.
Let me tell you some of their stories.
I think of the husband who gently and lovingly answers his wife’s question. It’s the same question that he answered five minutes ago … and five minutes before that … and five minutes before that. It really does require superhuman patience.
I think of the wonderful woman who took her husband on a long, special trip to an elite event because she could not bear for him to be disappointed, even though several physicians (including me) advised against it, thinking it would be too difficult. With careful planning and determination, she pulled it off beautifully.
A woman in clinic yesterday told me she has participated in the 5K for the Alzheimer’s Association for years. She admitted that in the back of her mind, she was thinking that she might get the disease someday and should support the organization. Tears welled up in her eyes as she said she never imagined it would be her husband who now has the disease.
And then there is the man who spends every day with his wife, reading to her, encouraging her and walking with her, although she doesn’t know who he is. But he tells me, “I know who she is.”
I also think of my patients who continue to find purpose despite coping with significant limitations. Cognitively impaired people compensate for their deficits better if they have a regular, calm routine. It takes courage to allow a degree of independence within that supervised structure, but a conscious effort to do so conveys respect and often improves confidence. Whether it is helping with the laundry, sweeping the porch or setting the table, each of these tasks gives the person a way to contribute and to be a more meaningful part of the family or community.
The most inspiring example I know regarding a patient with Alzheimer’s disease maintaining a strong sense of purpose was demonstrated by San Antonio philanthropist Glenn Biggs. Even as his disease advanced, he remained committed to raising funds to help patients with Alzheimer’s and to support related research. He was a remarkable man.
It is such an honor to be a small part of these lives, but it’s a very difficult journey that these patients and their families are on. They need to know that everything that can be done medically will be done and to have the assurance that we will continue to walk alongside them.
Caregiver support is critical. No one should have to face the care challenges without guidance. For example, it’s hard to know when driving is no longer safe and even harder sometimes to convince the person to stop when it’s not. What do you do when someone hits five cars in a parking lot, but insists he is safe to drive?
Dementia is, of course, a major disruption for relationships, but it can also bring people closer together. Constant adjustments for a new balance in the relationship are required. What worked for the first 50 years of marriage often no longer applies. It is helpful to acknowledge these difficult transitions to the caregiver and to encourage participation in support groups.
A multidisciplinary team is needed to address these and the many other daily challenges that arise. When the Biggs Institute for Alzheimer and Neurodegenerative Diseases opens, a team of health care professionals from many disciplines will partner with community resources to address the medical and social needs of these patients. In addition, clinical trials will be offered and ongoing basic research increased.
My hope is that I’ve given you a sense of the heroes I serve—the courage and perseverance of my patients and their caregivers—and conveyed the promise of the Biggs Institute to provide comprehensive, compassionate medical care and research. We can do no less, because this disease affects the people we love.
Diane Solomon, M.D., is a professor of neurology in the Long School of Medicine. She practices at UT Medicine’s Memory Disorders Clinic at the Medical Arts & Research Center. She is also the director of medical student education for the Department of Neurology.
White House notes hepatitis C efforts
The Center for Research to Advance Community Health (ReACH), a part of UT Health San Antonio, was recognized by the White House at its 2016 National Hepatitis Testing Day observance in Washington, D.C. The White House acknowledged the ReACH Center’s initiatives to screen, evaluate and cure chronic hepatitis C virus infection in diverse health care settings serving low-income populations across South Texas.
The Viral Hepatitis Testing Recognition Award, given by the Department of Health and Human Services, recognizes four ReACH projects that have been conducted since 2012 with funding from multiple federal and state agencies. These projects follow the new national guidelines to test everyone in the U.S. who was born from 1945 through 1965—the baby boomers—for hepatitis C.
“Without treatment, the disease may cause liver scarring and failure and, in some cases, liver cancer,” said Barbara J. Turner, M.D., MSED, MACP, director of the ReACH Center. “In fact, hepatitis C infection is the most common reason for liver transplantation for end-stage liver disease in the U.S., and it is also the main reason that people get liver cancer. Deaths from liver cancer are rapidly increasing in the U.S.”
Dollars for cancer cures
UT Health San Antonio received millions of dollars for cancer research in 2016 from the Cancer Prevention & Research Institute of Texas (CPRIT).
In November, the institute announced $5.8 million for research and training programs at the Cancer Therapy & Research Center, one of the state’s four National Cancer Institute-designated cancer centers.
The largest grant, $3.9 million, will fund five additional years of cancer research training for six postdoctoral fellows and six graduate students per year. In addition, the funding supports a summer program that brings a dozen undergraduate students from across the country annually to learn about cancer research.
“The cancer research training program at the health science center is a continuum from the undergraduate to the postdoctoral levels,” said the program’s director, Babatunde “Kay” Oyajobi, M.D., Ph.D., M.B.A., associate professor of cell systems and anatomy. “We are fortunate to have this support because it allows us to support more of our really promising trainees than is ordinarily possible. In this way, outstanding young scientists advance in their careers in cancer research, and more cutting-edge research is done in Texas on cancer.”
A second and third grant, each $900,000 over three years, will fund studies of mammary gland development with the goal of preventing breast cancer that is associated with the BRCA1 gene mutation, led by Yanfen Hu, Ph.D., associate professor of molecular medicine, and studies of a type of cancer called diffuse large B cell lymphoma, with Ricardo C.T. Aguiar, M.D., Ph.D., professor of medicine, leading that project.
This latest funding announcement follows the largest grant ever made by the organization to the university, $10.9 million, received in May. That funding included $5 million to develop animal models that can be used to test new therapies in children whose cancer has relapsed or who are from minority groups that typically have not responded well to current treatments. It was awarded to Peter Houghton, Ph.D., professor of molecular biology and director of the Greehey Children’s Cancer Research Institute.
Another $3.6 million was awarded to Yidong Chen, Ph.D., professor of epidemiology and biostatistics, to update and expand existing infrastructure to establish a Cancer Genome Sequencing and Computational Core. CPRIT also awarded $2 million for the recruitment of Myron Ignatius, Ph.D., from Massachusetts General Hospital/Harvard Medical School. Finally, $200,000 was awarded to Yuzuru Shiio, M.D., Ph.D., associate professor of biochemistry, to develop a strategy to target EWS-FLl-1, a fusion oncoprotein that causes Ewing sarcoma, a bone and soft tissue cancer in children.
And in August, CPRIT awarded nearly $4.6 million to the Center for Innovative Drug Discovery, a joint program of UT Health San Antonio and The University of Texas at San Antonio, to design more-effective cancer drugs through small-molecule drug discovery.
The state agency also awarded $1.3 million for a prevention grant to UT Health San Antonio’s Daisy Morales-Campos, Ph.D., to promote HPV vaccination among Hispanic adolescents. Dr. Morales-Campos works at the Institute for Health Promotion Research.
High marks
UT Health San Antonio is ranked among the top universities around the world, listed as No. 388, according to the 2016 edition of U.S. News & World Report’s international universities ranking.
Several university programs have also been singled out for excellence by U.S. News.
The University of Texas at Austin College of Pharmacy, including its Pharmacotherapy Division located at the health science center, was ranked the No. 3 pharmacy school in the nation. The school has been a top-5 school for decades. The Pharmacotherapy Division is one of five divisions in the college, and is the only division located outside of Austin.
The San Antonio pharmacy program has 12 full-time faculty and more than 120 part-time or preceptor faculty, who train nearly 80 Pharm.D., M.S., and Ph.D. students, and 20 pharmacy residents in affiliated programs, annually.
The School of Health Professions at the health science center also achieved a national ranking of three of its graduate health programs in U.S. News & World Report’s Best Grad Schools for 2016.
The graduate program in physician assistant studies is among the top 25 percent of all ranked schools (33/141). The occupational therapy program improved its position to 44th from last year’s ranking of 54th out of 163 programs that received rankings, placing it in the top one-third nationally. And the physical therapy program continues to place in the top half of PT programs in the nation ranked by U.S. News & World Report (79/193).
Trials and advances
The Cancer Therapy & Research Center has been named among the top 10 of the 990 institutions that are members of SWOG, an international network of researchers that design and conduct cancer clinical trials. The ranking is based on the number of patients currently involved in SWOG clinical trials.
Formerly called the Southwest Oncology Group, SWOG is one of the largest organizations that conducts cancer clinical trials sponsored by the National Cancer Institute and National Institutes of Health. With more than 6,000 physician-researchers, the network conducts clinical trials to improve the prevention, diagnosis and treatment of cancer, as well as to better the quality of life for cancer patients and survivors.
Grant to boost Alzheimer’s institute
The John L. Santikos Charitable Foundation, managed by the San Antonio Area Foundation, has given a $2.3 million grant to UT Health San Antonio for high-powered radiological equipment to diagnose Alzheimer’s disease and other age-related conditions.
The new John L. Santikos CT and Nuclear Medicine Suite is a major component in the Biggs Institute for Alzheimer and Neurodegenerative Diseases, the first comprehensive center of its kind in San Antonio and South Texas.
The Biggs Institute, named for the late San Antonio community supporter Glenn Biggs, will feature expert diagnostics; physician specialists in Alzheimer’s, Parkinson’s and other diseases; support programs for caregivers; and access to clinical trials of new therapies. The Santikos Suite will include high-powered magnetic resonance imaging (MRI) and state-of-the-art nuclear medicine systems called SPECT-CT and PET-CT.
“We are deeply grateful for the $2.3 million gift provided by the John L. Santikos Charitable Foundation for specialized, high-powered radiological equipment,” said William L. Henrich, M.D., MACP, university president. “This equipment will substantially enhance our ability to accurately diagnose and care for seniors in our community who suffer from age-related neurodegenerative diseases such as Alzheimer’s and dementia.”
More than 55,000 patients and their families in South Texas are living with these irreversible conditions.
“The gift … will have a profound impact and will bring new hope for patients by supporting leading-edge clinical care, innovative medical research and access to cutting-edge clinical trials that will lead to the cures of tomorrow,” Dr. Henrich said.
The John L. Santikos Charitable Foundation has given more than $305 million in grants and scholarships since 1964. This year’s gifts to eight area organizations totaled $9.2 million, with the majority going to health care entities. UT Health San Antonio received the second-largest allotment, behind Christus Santa Rosa Children’s Hospital Foundation.
Landmark gift for cancer center
The San Antonio Cancer Foundation, formerly the CTRC Foundation, has pledged $17 million to support the UT Health San Antonio MD Anderson Cancer Center, a new affiliation between UT Health San Antonio and The University of Texas MD Anderson Cancer Center from Houston.
The $17 million gift will be used for physician and faculty recruitment.
“With this gift, the San Antonio Cancer Foundation wants to provide some of the resources needed to help support this affiliation,” said Gary V. Woods, chairman of the board of the San Antonio Cancer Foundation. “We are proud to be a part of the new UT Health San Antonio MD Anderson Cancer Center.”
UT Health San Antonio President William L. Henrich, M.D., FACP, said the foundation has been an important partner throughout the history of the university’s cancer center.
“The foundation’s commitment to our success in this new affiliation as the UT Health San Antonio MD Anderson Cancer Center will continue the tradition of leadership support for our lifesaving mission for cancer patients,” he said. “We are indebted to Gary Woods and to the entire board of the San Antonio Cancer Foundation for once again stepping forward to lead the way with this remarkable gift. Every patient will benefit because of their generosity.”
Beginning later this year, the UT Health San Antonio MD Anderson Cancer Center will provide adult cancer patients in South Texas greater access to the most advanced oncology care available.
Over the past nine years, the San Antonio Cancer Foundation has contributed approximately $48 million to support the Cancer Therapy & Research Center (CTRC), with grants made for faculty recruitment, research programs, equipment purchases, patient support, National Cancer Institute support and general CTRC operations.
Milestone moments
The Baptist Health Foundation of San Antonio’s commitment to supporting students at UT Health San Antonio achieved two milestones in 2016. The foundation announced an annual scholarship gift of $250,000 for academic year 2016-2017, and has now given more than $2 million to the university’s students since 2005.
“This is the largest scholarship gift to the university in the history of the Baptist Health Foundation of San Antonio, and I am profoundly grateful,” said William L. Henrich, M.D., MACP, president of UT Health San Antonio.
The scholarships will benefit students in the Long School of Medicine, School of Dentistry, School of Nursing and School of Health Professions, and students in the affiliated UT Austin College of Pharmacy clinical pharmacy program who study at UT Health San Antonio.
“Students in each of our schools will be touched by this generosity, and this is a very significant impact to our mission to educate the next generation of leaders in health care,” Dr. Henrich said.
In addition to scholarships, the Baptist Health Foundation has supported UT Health San Antonio programs, including a gift of more than $1 million for The Biggs Institute for Alzheimer and Neurodegenerative Diseases. The foundation has now given more than $4.5 million to university scholarships and programs.
“[UT Health San Antonio] remains a significant partner as the foundation furthers its God-ordained mission, and is a wonderful steward of our Lord’s money,” said Cody S. Knowlton, president and CEO of the Baptist Health Foundation of San Antonio.