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October 2017 Archives

23
2017

Hepatologist Arun Sanyal Honored as 2017 Distinguished Scientific Achievement Award Winner Recipient

Housestaff alumnus Arun Sanyal, M.D., now on faculty with the medical school, received the 2017 Distinguished Scientific Achievement Award from the American Liver Foundation.

Housestaff alumnus Arun Sanyal, M.D., now on faculty with the medical school, received the 2017 Distinguished Scientific Achievement Award from the American Liver Foundation.

Arun J. Sanyal, M.D., has been honored by the American Liver Foundation with its 2017 Distinguished Scientific Achievement Award. The award was presented on Oct. 23 at an ALF reception in Washington, D.C.

Continuously funded by the National Institutes of Health for more than 25 years, his research has spanned the spectrum of translational science from basic discovery to first-in-humans and advanced phase clinical trials as well as regulatory aspects of drug development.

“Dr. Sanyal’s record of achievement is remarkable both for its longevity and also for its scope,” says Peter F. Buckley, M.D., dean of the VCU School of Medicine. “I am proud to see him receive this latest honor, which is an endorsement of the translational value that his work carries for patients with liver disease – both now and into the future.”

Sanyal’s work has focused on end stage liver disease and nonalcoholic steatohepatitis for over 20 years. More recently, he has led several efforts in the National Institute on Alcohol Abuse and Alcoholism-funded TREAT consortium that is investigating the pathophysiology and management of alcoholic hepatitis. He recently established the Liver Forum, which provides a neutral platform for the U.S. Food & Drug Administration, the European Medicines Agency and other stakeholders in fatty liver disorders to work collaboratively on the regulatory science required to accelerate drug development in liver disease.

Internationally recognized for his contributions to the understanding of the science and clinical implications of non-alcoholic liver disease, he has created a proprietary mouse strain to test potential therapeutics to treat the disease, which has become a leading cause of liver-related mortality.

Sanyal is a professor of internal medicine, physiology and pathology at VCU School of Medicine and completed his gastroenterology and hepatology fellowship training on VCU’s MCV Campus in 1990.

The American Liver Foundation was created in 1976 by the American Association for the Study of Liver Disease to facilitate, advocate and promote education, support and research for the prevention, treatment and cure of liver disease.

21
2017

Dean of Medicine Peter Buckley authors book on physical health problems associated with schizophrenia

Dean of Medicine Peter F. Buckley, M.D., authors book Physical Health and Schizophrenia on physical health problems associated with schizophrenia.

Dean of Medicine Peter F. Buckley, M.D., authors book Physical Health and Schizophrenia on physical health problems associated with schizophrenia.

“It’s well known that schizophrenia and serious mental illnesses carry a reduced life expectancy, but it’s often assumed that suicide is the main cause of this disparity,” says Peter F. Buckley, M.D., dean of the VCU School of Medicine. “Actually, suicide accounts for no more than a third of the early mortality associated with schizophrenia. The vast majority is due to cardiovascular factors.”

Buckley has joined with David J. Castle and Fiona P. Gaughran in authoring a new book on the physical health problems associated with schizophrenia that provides a clear overview of strategies and interventions for tackling these issues.

Physical Health and Schizophrenia is written as a resource for researchers and clinicians in the mental health field as well as those working in primary care. It also includes an appendix designed specifically for patients and those who care for them, with practical tips on how to be actively involved in monitoring and managing physical health problems.

Before joining the School of Medicine as its 24th dean in January 2017, Buckley served for almost seven years as dean of the Medical College of Georgia at Augusta University, with the last two years of additional responsibilities while also serving as interim CEO of the academic healthcare system. Alongside his administrative responsibilities, he has remained active in research on the neurobiology and treatment of schizophrenia and is recognized internationally for his research.

A distinguished fellow of the American Psychiatric Association and fellow of the Royal College of Psychiatrists, Buckley is a past president of the American Association of Chairs of Departments of Psychiatry and has served as an executive committee member of the International Congress of Schizophrenia Research. With 500 original articles, book chapters and abstracts to his credit, Buckley is editor of the journal Clinical Schizophrenia & Related Psychoses. He is senior author of a postgraduate textbook of psychiatry and has also authored or edited 17 books on schizophrenia and related topics. He serves as associate editor or as a member of the editorial boards of nearly a dozen other psychiatric journals.

Co-author David J. Castle, M.D., is professor and chair of psychiatry at St Vincent’s Hospital at the University of Melbourne in Australia. Fiona P. Gaughran, M.D., is lead consultant in the National Psychosis Service and R&D director of the South London and Maudsley NHS Foundation Trust. She also is a reader in psychopharmacology and physical health at the Institute of Psychiatry, Psychology and Neuroscience in London, U.K.

Physical Health and Schizophrenia is published by Oxford University Press, a department of the University of Oxford in the U.K.

By Erin Lucero

16
2017

Through your eyes

Tom Eichler, M’87, H’92, auditioned for the play “Music Man” on a lark.

By the end of his first performance, there was no turning back.

“I remember delivering my lines and the audience roared,” he says. “I was thinking, ‘Hey, I’m funny!’ I was hooked.”

This story first appeared in the fall 2017 issue of the medical school’s alumni magazine, 12th & Marshall. You can flip through the whole issue online.

Tom Eichler, M’87, H’92, as the character of Andrew Carnes in a production of “Oklahoma!”

Tom Eichler, M’87, H’92, as the character of Andrew Carnes in a production of “Oklahoma!”

Since that first performance with St. Michael Theatre Group in 2007, Eichler has appeared in several other theatrical productions around the Richmond, Virginia, area. He’s taken on a wide variety of roles, including Kris Kringle in “Miracle On 34th Street” and Andrew Carnes in “Oklahoma!”

“People think you just go out there and say a few lines and make a few faces,” says Eichler, who has also appeared in five radio productions. “But it’s so much more than that. It requires a lot of discipline. You really have to think on your feet. It’s the same with medicine. Every patient is different and you have to respond to that.”

Eichler, a radiation oncologist with Virginia Radiation Oncology Associates, sees other parallels between acting and medicine. Both, for example, are pressure-packed.

“Every patient expects you to be on your game every day,” Eichler says. “On stage, the actors around you expect you to be at your best as well. Obviously, the stakes are higher with medicine. But in theater, no one wants to be the one who forgets a line. No one wants to lay an egg on stage.”

A graduate of the University of Notre Dame with a degree in American Studies, Eichler worked as an orderly before taking pre-med classes at Le Moyne College. After failing to gain admission to medical school, he accepted a friend’s offer to serve as the stage manager for First Street Theater in Dayton, Ohio. He later relocated to Northern Virginia with his future wife, Alison, and worked at the Folger Theatre as the box office manager.

One night, his parents and future in-laws joined him for dinner.

“I got up to use the restroom, and when I returned they had decided I was going to be a cardiologist,” Eichler says. “It got me thinking.”

He applied again to medical school and this time was accepted to Virginia Commonwealth University.

“I just love the whole process of medicine,” he says. “Being responsible for helping people, along with the rigor and discipline involved, really excites me.”

Despite working 12-hour days and serving on the board of directors for the American Society for Radiation Oncology, Eichler continues to carve out time for theater. Sometimes he works with his wife who serves as costume mistress and producer for several Richmond-area theater companies.

“Everyone has something they do that provides a release,” he says. “It might be riding a motorcycle or mountain climbing. For me, it’s theater.”

Eichler, who plans to retire from his practice later this year, hopes to continue acting for years to come.

“Usually I’m the oldest person at auditions,” the 65-year-old says. “And that’s OK. I have a lot of life experiences that I can pull from. You may be called upon to play a happy role or a sad one. I can get there by remembering the best day of my life or the worst day. I get such a rush from standing on stage and hearing the applause from the crowd. Everyone wants to be loved.”

By Janet Showalter

 

16
2017

Piece of the past

All work and no play can make medical students ripe for burnout. History tells us that activities away from the hospital can not only ease stress, but provide new opportunities for lasting friendships.

This story first appeared in the fall 2017 issue of the medical school’s alumni magazine, 12th & Marshall. You can flip through the whole issue online.

An MCV baseball uniform from the 1930s is a new addition to the medical artifact collection of Tompkins-McCaw Library’s Special Collection and Archives.

An MCV baseball uniform from the 1930s is a new addition to the medical artifact collection of Tompkins-McCaw Library’s Special Collection and Archives. Photography by: Kevin Schindler

At the turn of the 20th century, one of the most popular outlets for students was sports. The MCV Campus was fielding a baseball team, dubbed the Medicos, as early as 1907. The recreational team continued competing through 1956.

“Medical students put in so much work in the classroom, it’s easy to forget that they had and continue to have a life outside of that,” says Andrew Bain, who manages the medical artifact collection of Tompkins-McCaw Library’s Special Collection and Archives. “Sports were an important part of student life.”

For the first time, the school will be able to share that story. In May, a Medicos baseball uniform worn by left fielder Earle Carlton Gates, M’32, was donated to Tompkins-McCaw. While the library houses about 6,000 artifacts, including about 100 textiles, this is the first athletic uniform worn by an MCV student.

“We have lots of nurses’ uniforms, but to have something that represents a different aspect of student life is truly special,” Bain says. “This represents a whole new dimension.”

Gates, who was from Highland Springs, Virginia, graduated from the University of Richmond before entering medical school. He also received a master’s degree at Johns Hopkins University. A captain in the Army Reserves, he was serving as the chief of medical and surgical service at Central State Hospital in Petersburg when he passed away at the age of 60 in 1968.

His uniform includes a wool baseball cap, wool jersey and pants, and two pairs of socks. On the front of the uniform is the name of the team, along with an embroidered skull and bones patch on the sleeve. There is also a bulkier wool sweater, which Bain says was probably not part of the uniform but was worn by Gates.

You can check out this piece of the past for yourself. It will be on display in the Pastore Memorial Exhibit Hall on the first floor of the Tompkins-McCaw Library through Reunion Weekend in April.

“All pieces of the uniform are in excellent shape, which is unusual for textiles,” Bain says. “Typically they don’t stay stable because they are made of organic material and are subject to the ravages of bugs and hot and cold.” This find, then, is especially important, Bain says, because so few have survived.

“It’s not a big shock that this is the first of its kind in our collection,” he says. “After students graduated and left, they really didn’t have a need for their uniforms, so they just discarded them. To find one, that’s extraordinary. We can’t wait to showcase it.”

Don Richardson, M’76, discovered the uniform at an estate sale in his Norfolk neighborhood earlier this year. He immediately contacted the medical school.

“I was astounded when I saw it,” he says. “My jaw dropped.”

Richardson, an associate professor of medicine at Eastern Virginia Medical School, was especially thrilled with the find because of his family’s ties to the MCV Campus. His father, David Richardson, H’55, was on faculty for more than 30 years and served as chairman of the Division of Cardiology from 1972–86.

“I grew up here at MCV, so this has special meaning,” the younger Richardson says. “But everyone can enjoy this piece of history. We can all learn from it. I had no idea MCV even had a baseball team.”

The Medicos, also referred to as the “Sawbones,” were not a very good team during Gates’ era. College yearbooks feature photos of the team and point out, “Since this is a professional school, many capable men can spare no time for baseball. Even those who love the sport dearly enough to indulge occasionally are handicapped by the lack of time to practice.” In 1931, playing against such teams as Bridgewater, William and Mary, the University of Delaware and Randolph-Macon, they finished 1–5. “There obviously was no correlation between being a good medical student and being a good athlete,” Bain jokes.

Baseball was not the only popular sport during the early 1900s. MCV also fielded football, basketball, tennis and golf teams. The women’s basketball team was known as the “Sawbonettes.”

“We don’t have a lot of information on the teams, other than the little bit we see in the yearbooks,” Bain says. “That’s the curse of social history. People don’t always leave us much about their everyday lives. They don’t think it’s interesting, so it’s left up to us to fill in the blanks as best we can.”

By Janet Showalter

16
2017

Alumni spotlight: Cynthia Morton

Cynthia Morton, PhD’82 (HGEN), has been interested in genetics since eighth grade when she needed a topic for a term paper. One of Morton’s former teachers suggested focusing on twins. Morton delved deep, and she has been hooked ever since.

This story first appeared in the fall 2017 issue of the medical school’s alumni magazine, 12th & Marshall. You can flip through the whole issue online.

Cynthia Morton with her mentor Walter Nance, M.D., Ph.D., at her American Society of Human Genetics presidential address in 2014.

Cynthia Morton with her mentor Walter Nance, M.D., Ph.D., at her American Society of Human Genetics presidential address in 2014.

Today Morton is a professor of OB-GYN and reproductive biology and of pathology at Harvard Medical School and director of cytogenetics at Brigham and Women’s Hospital. A past president of the American Society of Human Genetics, her research aims to uncover the genetic causes of hearing loss and uterine tumors. She also is drawing on her training in cytogenetics, a field that looks at chromosomal rearrangements, to hunt for genes associated with human development.

Morton earned her Ph.D. in human genetics on the MCV Campus in 1982. There she became the protégé of Walter Nance, M.D., Ph.D., longtime chair of the Department of Genetics and a past president of the American Society for Human Genetics. “She was one of my best students,” he says. Even after Morton graduated, Nance continued her education by teaching her about applied probability in the annual poker game he organized.

In her 35-year career, Morton has received many accolades. She served as editor of the American Journal of Human Genetics, chair of the Board of Regents of the National Library of Medicine and in 2015 was elected a fellow of the American Association for the Advancement of Science.

Morton and her colleagues are on the cusp of launching a project called SEQaBOO (it rhymes with ‘peekaboo’ and is shorthand for SEQuencing a Baby for Optimal Outcome), which aims to sequence the whole genomes of approximately 400 newborns who do not pass newborn hearing screening. “We want to be able to identify new genes involved in hearing loss and also potentially mutations that have been difficult to detect by alternative methodologies.” she says, such as chromosomal structural rearrangements.

The hope is that once more therapies become available, physicians will be able to tailor interventions for different kinds of deafness. Eventually they might even be able to correct hearing loss by gene editing or gene therapy.

But this information can be valuable today, too, Morton says. For example, researchers know that children who have a mutation in one particular gene, called GJB2, tend to respond well to cochlear implants. And children with a mutation in another gene may not do well with hearing aids. In fact, these devices may even make the problem worse.

Some 150 genes have been implicated in deafness, but Morton expects that number will more than double. “This is the tip of the iceberg,” she says.

16
2017

Medicine gets personal

Nearly two decades ago, researchers decoded the human genome. Ever since, they’ve been trying to use that code to transform the practice of medicine.

Long flights make her feet swell. Cynthia Morton, PhD’82 (HGEN), has known this for years and wears compression stockings when she flies. But it wasn’t until Morton had her genotyping done that she realized her genetic makeup puts her at an increased risk of developing clots in her veins. The condition can be deadly. She recently used the knowledge as a bargaining chip. Last year, she was invited to give a talk in Europe. She told the organizers about her test results, and asked for a business class seat with more space to stretch her legs. And she got it. Now in a course she teaches she includes a few slides titled, “How I used my genome to get a business class ticket.”

This story first appeared in the fall 2017 issue of the medical school’s alumni magazine, 12th & Marshall. You can flip through the whole issue online.

Nearly two decades ago, researchers decoded the human genome. Ever since, they’ve been trying to use that code to transform the practice of medicine.

But the value of genetic sequencing goes far beyond getting more legroom. The hope is that one day medical decisions will be based not just on lab tests and family history, but on the unique suite of variations found within our DNA. This idea, once called personalized medicine and now commonly referred to as precision medicine, has been around for more than a decade. But only in recent years has precision medicine become part of clinical practice.

LISTENING TO THE GENOME
The human genome contains more than three billion base pairs. It would take a competent typist working around the clock more than half a century to type out the entire code. When Morton was on the MCV Campus as a graduate student in the late 1970s, she and her colleagues could only manage to sequence chunks about 200 letters long. “At that point, sequencing the entire human genome was a pretty far-fetched idea,” says Morton, now a professor of OB-GYN and reproductive biology and of pathology at Harvard Medical School. (Read more about Morton’s career here.)

Today technological advances have made this far-fetched idea reality. But the promise of precision medicine has yet to be realized in many fields. “The technology often exceeds our understanding of the information we’re getting back,” says Gerald Feldman, PhD’82 (HGEN), M’84. He is the immediate past president of the American College of Medical Genetics and Genomics, and professor of molecular medicine and genetics, pediatrics and pathology at Wayne State University School of Medicine. Although scientists can now access the entire sequence of any individual, the health information locked within that sequence has been difficult to parse. Biologist Eric Lander, who helped lead the Human Genome Project, offered this famous quip: “Genome: Bought the book; hard to read.”

Still, researchers are making steady headway. Morton is working to decipher the pages related to deafness. More than half of all congenital deafness is genetic, but most children never know the particular alterations responsible for their hearing loss. Morton, however, believes that information is crucial, and will become even more so in the coming decades. “It’s really important to know the etiology and to know it early,” she says.

In 2006, she and her mentor, VCU’s founding Department of Human Genetics Chair Walter Nance, M.D., Ph.D., co-authored a paper that argued for more genetic evaluation of infants with hearing loss. At the time, their vision seemed like an “audacious dream,” Morton says. But the advent of next generation sequencing has made that dream feasible.

PRECISION MEDICINE IN THE CLINIC

Nearly two decades ago, researchers decoded the human genome. Ever since, they’ve been trying to use that code to transform the practice of medicine.

In oncology, precision medicine has already become part of clinical practice. Doctors typically order genetic testing for patients with melanoma and some leukemias as well as breast, lung, colon and rectal cancers. The goal is to identify mutations within the tumor that might be driving the cancer. The results help oncologists select therapies that target those pathways. “It’s a really exciting time to be in cancer medicine,” says Charles Clevenger, M.D., Ph.D., chair of VCU’s Pathology Department and holder of the Carolyn Wingate Hyde Endowed Chair of Cancer Research.

Clevenger is impressed at the strides that have been made in treating metastatic melanoma, once considered one of the most difficult cancers to treat. Since 2011, five new targeted therapies have been approved for melanoma patients who have a handful of mutations in the BRAF gene, and more are on the way. “There are some real cures occurring now that five years ago would have been a death sentence,” Clevenger says.

One major advantage of targeted medicines is that they tend to be less toxic. In the 1980s and ’90s oncologists would “take the biggest and baddest drugs and give them to the patient almost irrespective of the particular type of cancer they had,” says Raymond Lewandowski, M.D., a professor in the Department of Human and Molecular Genetics at VCU. Now oncologists can tailor treatment and potentially use drugs with fewer side effects.

Lewandowski is particularly excited about the promise of a new, even more personalized therapy for cancer called CAR-T. The procedure begins with extraction of a patient’s T-cells from the blood. These cells are then engineered in the lab to recognize specific markers on the patient’s cancer cells and expanded to form a cancer-fighting army. Researchers then re-infuse the cells back into the patient. There, “they go hunting,” seeking out and destroying all cancer cells, Lewandowski says.

“The trials have been very exciting and, to a large extent, very successful,” he adds. So successful, in fact, that the Food and Drug Administration approved CAR-T in August. “These cells have the really unique ability to hunt out all of those little, bitty metastatic cells and find them wherever they’re hiding and wipe them out,” he says. “That type of treatment is going to revolutionize cancer treatment for many, many patients.”

Targeted treatments are helping people with heritable genetic disorders as well, Feldman says. In 2012, the FDA approved the first targeted therapy for cystic fibrosis. A second targeted drug became available in 2015. Rather than just addressing the symptoms of cystic fibrosis, these medicines help correct the function of defective proteins in people with specific mutations in the cystic fibrosis gene.

Feldman expects to see many more such drugs approved in the coming years for a whole host of heritable diseases. Although these diseases tend to affect relatively small numbers of people, “if you can extrapolate that to more common diseases that have
some underlying genetic influences, like heart disease or hypertension, there may be opportunities for that type of treatment as well,” he says (read more about Feldman’s career here).

DIY DNA
Some people, like Morton, are taking genetic testing into their own hands. A handful of companies in the U.S. offer direct-to-consumer genetic tests. With just a single sample of saliva, these companies provide information about health and disease risk. Perhaps the most well-known company, 23andMe, offers consumers information about their risk of a handful of diseases and whether they carry harmful mutations that could be passed on to their children. The company also provides information about wellness — for example, whether your genes predispose you to being overweight.

Morton enjoyed getting her test results. And she found the data useful. For example, the test showed she was a fast metabolizer of caffeine, so she stopped drinking decaf.

But other geneticists worry that these direct-to-consumer tests can be confusing and misleading for non-experts. Lewandowski says that companies often don’t provide enough support to consumers. “They send the patient a 15- or 20-page report, and tell them, ‘go to your doctor to have them explain what these mean,’” he says. But primary care physicians might not know how to interpret this information either.

Lewandowski also worries that such tests could give people a false sense of security. People who test negative for genetic variants associated with a given disorder assume that they have no risk, but in some cases the testing companies only look at a few risk variants. The Centers for Disease Control warns that direct-to-consumer genomic testing has little clinical utility and offers little to no health benefits. The agency advises consumers to “think before they spit.”

Feldman echoes that advice. “There are lots of things I think a consumer needs to think about before even having the testing done,” he says, including what kind of tests are being performed, how those tests will be interpreted and what will happen to the DNA sample after testing is complete. “Has the patient signed a consent form that allows that sample to be used for other purposes, or is that DNA to be destroyed after the test?” he asks. “One needs to be careful.”

The deeper geneticists peer into the genome, the more ethical conundrums arise. Parents often bring their sick children to geneticists like Lewandowski in the hope that he can discover the cause of their children’s illnesses. By sequencing all the genes in the genomes of both the child and the parents, he can often pinpoint the rare mutation that is to blame. But such extensive sequencing efforts may turn up other potential genetic risks too — some of them serious. “The parents or patients have to decide whether they want that information or not,” Lewandowski says. The choice isn’t easy, but most people choose to be informed. Knowledge, of course, is power. But it can also be a burden.

By Cassandra Willyard

6 TIPS FOR DIRECT-TO-CONSUMER TESTING

ONE Know what you’re getting. The companies that offer genetic testing aren’t sequencing your genome, or even your genes. They’re only looking at specific spots where variation typically occurs. Genetic variants can provide clues to your ancestry and insight into your risk of developing certain diseases, but the information they provide is limited.

TWO
Make sure you understand what will happen to your data. Will it be used for research? Will it be shared with pharmaceutical companies? What strategy will the testing company use to protect your privacy?

THREE
The test might tell you that you have variants associated with a certain disease, but not everyone with those variants will go on to develop that disease. Conversely, people without those risk variants can still develop that disease, too. The test doesn’t cover all variants.

FOUR
Your test results alone are not enough to guide medical decisions. And in some cases the results might not be all that meaningful. For example, the report might tell you that the average risk for a given disorder is 1 in 1,000, and your risk is 1 in 500. There isn’t much you can do with that information.

FIVE
Other results, however, might help guide your medical care. If you know that you have an increased risk for developing a certain disease, your doctor might be able to recommend lifestyle changes or prescribe medications.

SIX
The test might reveal information you weren’t expecting. Perhaps you’re a carrier for a variant associated with cystic fibrosis. If there’s something on the report that worries you, your best bet is to talk to a board-certified clinical geneticist or a board-certified genetic counselor.

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Updated: 04/29/2016