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UofL scientists enhance understanding of muscle repair process with second publication in 10 days

UofL scientists enhance understanding of muscle repair process with second publication in 10 days

Ashok Kumar, Ph.D. and Yuji Ogura, Ph.D.

In today’s issue of Nature Communications, University of Louisville scientists reveal research that increases the understanding of the mechanisms regulating adult stem cells required for skeletal muscle regeneration. Sajedah M. Hindi, Ph.D., of UofL’s Department of Anatomical Sciences and Neurobiology, and Yuji Ogura, Ph.D., now of Japan, and other researchers show that the protein kinase TAK1 (transforming growth factor-ß-activated kinase 1) is vital in regulating the survival and proliferation of satellite stem cells. These cells are responsible for regenerating adult skeletal muscles in response to damage from disease or injury.

Specialized stem cells known as satellite cells reside in the skeletal muscles of adults in an inactive or quiescent state. When muscle injury occurs, a chain of signals prompts the satellite cells to awaken and generate new muscle cells to repair the injury. As part of this process, the satellite cells self-renew in order to replenish the pool of satellite cells for future muscle repair.

In the article, the authors reveal that when the protein TAK1 is reduced, satellite stem cells do not vigorously self-renew and many eventually die. Alternately, when TAK1 is increased, the satellite cells prosper. These results lead the authors to conclude that TAK1 is required for satellite cell proliferation and survival for regeneration of adult skeletal muscle.

This publication complements research published just last week in the Journal of Clinical Investigation by Hindi and Ashok Kumar, Ph.D., a professor and distinguished university scholar in UofL’s Department of Anatomical Sciences and Neurobiology, that describes the role of another protein, TRAF6 (TNF receptor-associated factor 6), in ensuring the vitality of the satellite stem cells. TAK1 and TRAF6 support distinct functions that regulate satellite cell survival and functionality. In the JCI article, Hindi and Kumar show that TRAF6 is critical for the satellite cells to retain their stem properties and prevents them from undergoing premature differentiation.

Kumar, also the corresponding author on the Nature Communications publication, believes the research in both of these publications may lead to multifaceted therapies for muscular dystrophy, cancer cachexia and other muscle-wasting conditions, including aging.

“In one disease state the muscle stem cells are undergoing premature differentiation. In that situation, TRAF6 is very important in preventing premature differentiation so the satellite cells maintain their stemness,” Kumar said. “But in some disease conditions, the overall cell population is reduced. If the cells are dying, we need to look at the protein TAK1 and if we put this protein back, determine whether it improves satellite cell survival.”

Hindi, a post-doctoral fellow at UofL, and Ogura are the primary authors of the Nature Communications publication. Ogura was a post-doctoral fellow in UofL’s Department of Anatomical Sciences and Neurobiology from 2012-2014 and now is an assistant professor at St. Marianna University School of Medicine in Japan. Co-authors include Kumar, Guangyan Xiong, Ph.D., of UofL, Shuichi Sato, Ph.D., now an assistant professor at the University of Louisiana at Lafayette, and Shizuo Akira of Japan.

Research reported in this press release was supported by the National Institute of Health grants R01AR059810, R01AR068313, and R01AG029623 to Ashok Kumar.

 

December 9, 2015

Youth justice system should be viewed through public health lens

Annual UofL pediatrics lecture to examine ‘Juvenile Justice Reform’ on Dec. 11
Youth justice system should be viewed through public health lens

Matthew Aalsma, Ph.D.

More than 65 percent of youth in the juvenile justice system in the United States meet the criteria for a disability, a rate three times higher than that of the general population. Research also shows that the more serious and prolonged a youth's interaction with the justice system becomes, the more likely he or she is to die prematurely.

Juvenile justice reform, therefore, is not only a law enforcement concern, it is a public health concern, said Matthew C. Aalsma, Ph.D., associate professor of pediatrics and psychology and director of the Juvenile Forensic Psychology Clinic at Indiana University.

Aalsma will deliver the 15th Annual Doctor Elliott Podoll Adolescent Medicine Lecture, sponsored by the University of Louisville Department of Pediatrics. The lecture will be at 8 a.m., Friday, Dec. 11, at Wade Mountz Auditorium, second floor of Norton Hospital, 200 E. Chestnut St. Admission is free.

Youth involved in the justice system “are a vulnerable population due to their high rates of mental illness, physical health problems and early mortality,” Aalsma said. “Juvenile justice reform that decreases the reliance on incarceration and improves behavioral health and medical services are very important public health initiatives.”

Trained as a pediatric psychologist, Aalsma focuses on research with vulnerable populations, including youth in the mental health and juvenile justice systems. His current research agenda includes exploring system-wide and individual efforts to improve the utilization of mental and physical health care for children and adolescents.

As director of the Juvenile Forensic Psychology Clinic, Aalsma oversees the provision of comprehensive psychologic assessments for court-involved youth. “The clinic provides thorough and fair assessments for vulnerable populations and trains psychology Ph.D. students in conducting juvenile forensic assessments,” he said.

The Podoll lectureship was established by the family of the late Elliott Podoll, M.D., a longtime Louisville pediatrician and clinical faculty member at the University of Louisville and a local pioneer in the provision of appropriate health care services for adolescents. The yearly lectureship brings an expert in the field of adolescent medicine to UofL in the spirit of what Podoll cared about: an increased awareness and development of the skills necessary to improve the lives of young people in the region.

For additional information, contact the UofL Department of Pediatrics at 502-852-8600.

 

UofL scientists identify a critical pathway to improve muscle repair

TRAF6 ensures health of stem cells and may lead to improved stem cell therapies for DMD and other muscle wasting diseases
UofL scientists identify a critical pathway to improve muscle repair

Ashok Kumar, Ph.D. and Sajedah Hindi, Ph.D.

Researchers at the University of Louisville have discovered a mechanism involved in skeletal muscle repair that may enable clinicians to boost the effectiveness of adult stem cell therapies for diseases such as muscular dystrophy. The research, published today in the Journal of Clinical Investigation, describes the role of TNF receptor-associated factor 6 (TRAF6), an adaptor protein and E3 ubiquitin ligase, in ensuring the vitality of stem cells that regenerate muscle tissue.

Specialized stem cells known as satellite cells reside in skeletal muscle in an inactive state. When muscle injury occurs, a complex chain of signals prompts the satellite cells to awaken and generate new muscle cells to repair the injury. Previous research had shown that Pax7 (a paired-box transcription factor) is essential to this regeneration. When Pax7 is missing or reduced, the satellite cells undergo premature differentiation, or lose their stem properties and their ability to regenerate injured muscles.

In their research, authors Sajedah M. Hindi, Ph.D., and Ashok Kumar, Ph.D., discovered that removing TRAF6 depletes Pax7, resulting in reduced muscle regeneration in both normal and Duchenne muscular dystrophy (DMD) mouse models. Hindi, a post-doctoral fellow, and Kumar, professor and distinguished university scholar in UofL’s Department of Anatomical Sciences and Neurobiology, believe this is because TRAF6 is upstream from Pax7 in the signaling process involved in muscle repair and orchestrates multiple signals controlling the muscle regeneration process.

“We have discovered a pathway by which the Pax7 and myogenic potential of satellite cells is regulated. The protein TRAF6 is a very important adaptor protein that is involved in multiple signaling pathways and its functions are important to maintain the stemness of satellite cells in adults,” Kumar said.

“In normal conditions, skeletal muscle is a self-healing tissue and can recover promptly from most trauma because of the satellite cells. But in disease conditions like muscular dystrophies, satellite cells can’t keep up with repeated cycles of injury and are ultimately exhausted or functionally impaired,” Hindi said. “Our next step is to see if this functional impairment is partially due to lack of TRAF6 signaling in satellite cells. If so, we are thinking we can take a patient’s stem cells, restore the TRAF6 activity, put them back and boost their regenerative potential.”

Kumar and Hindi believe their research ultimately will lead to improved treatments for muscle wasting diseases such as muscular dystrophy, ALS, cancer cachexia, diabetes, heart disease and others.

“Right now the problem in donor stem cell therapy is that we inject the stem cells into the patient but most of the stem cells don’t proliferate very well, so they repair very little part of the muscle,” Kumar said. “But if you have stem cells that are over expressing this protein TRAF6, they may proliferate longer and they may repair the muscle much more effectively.”

Research reported in this press release was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institute on Aging of the National Institutes of Health under award numbers R01AR059810, R01AR068313, R01AG029623 and F31AG046950.

IMAGES: TRAF6 fl/fl (top) are control injured muscle whereas TRAF6scko (bottom) are from satellite cell-specific TRAF6- knockout mice which show drastic deficit in muscle regeneration due to lack of TRAF6.

 

 

 

 

 

 

November 30, 2015

Skydiving spiders and zombie ants at next Beer with a Scientist

Steve Yanoviak, Ph.D., to speak on rainforest research December 9
Skydiving spiders and zombie ants at next Beer with a Scientist

Steve Yanoviaqk, Ph.D.

For the December edition of Beer with a Scientist, Steve Yanoviak, Ph.D., associate professor and the Tom Wallace Endowed Chair of Conservation at the University of Louisville, will share stories of his adventures in the tropical rainforest.

Yanoviak has been conducting research in the tropical rainforest canopy for more than two decades. In his discussion, "How to Fall From Trees,” he will highlight some of the amazing discoveries he and his colleagues have made regarding the behavior and ecology of insects that live in the treetops. He will share videos of swimming ants and skydiving insects and spiders, and a story about zombie ants. His presentation will conclude with a brief look at the next phase of his research, which explores the effects of lightning on tropical trees.

The program begins at 8 p.m. on Wednesday, December 9 at Against the Grain Brewery, 401 E. Main St. A 30-minute presentation will be followed by an informal Q&A session.

The Beer with a Scientist program began in 2014 and is the brainchild of UofL cancer researcher Levi Beverly, Ph.D. Once a month, the public is invited to enjoy exactly what the title promises:  beer and science.

Admission is free. Purchase of beer, other beverages or menu items is not required but is encouraged.

Organizers add that they also encourage Beer with a Scientist patrons to drink responsibly.

For more information and to suggest future Beer with a Scientist topics, follow Louisville Underground Science on Facebook.

 

December 1, 2015

Conjoined twins separated by UofL pediatric surgical team

Conjoined twins separated by UofL pediatric surgical team

Conjoined twin girls were separated by UofL physicians on Nov. 11.

Specialists with University of Louisville Physicians have announced they performed a surgery to separate 7-week-old conjoined twin girls on Nov. 11 at Kosair Children’s Hospital. Since the surgery, the girls have been under close watch of experts in the hospital’s “Just for Kids” Critical Care Center. They are currently still on ventilators but have been getting stronger by the day. Their long-term prognosis is not yet known, but indicators are favorable for continued improvement.

“In any situation where you have so complex a surgery, there is always a long road to recovery,” said Erle H. Austin III, M.D., pediatric surgeon with UofL Physicians and the UofL School of Medicine's Department of Cardiovascular Surgery. “We are cautiously optimistic, as one or both may require additional surgeries in the future.” Austin also is chief of cardiovascular surgery at Kosair Children’s Hospital.

“God was definitely watching over the girls and the medical team on the day of the surgery,” said the babies’ mother. “We are so thankful to God and everyone at Kosair Children’s Hospital for getting them this far.

“We are also thankful to the hospital chaplain, who prayed with us before the delivery and the day of the surgery.”

The twins were born at Norton Hospital and had been under close watch of UofL Physicians’ neonatologists in the Kosair Children’s Hospital Level IV neonatal intensive care unit.

The twins were defined as thoraco-omphalopagus, which means their bodies were joined at the chest and abdominal cavity. Their livers were joined and they shared some of the same heart structures.

Conjoined twins occur in approximately one out of 200,000 live births. Forty to 60 percent are stillborn, and about 35 percent survive only one day. The overall survival rate of conjoined twins is between 5 percent and 25 percent.

The surgical team waited as long as possible prior to performing the separation surgery. The decision to operate was made after the twins began to need increased breathing support. They also were not growing as they should. One of the infants was more fragile than the other, and survival was in question. The separation procedure was risky for both.

While originally expected to last about 12 hours, the procedure went smoothly and was completed in approximately eight hours. To prepare, the surgical team had undergone multiple drills using dolls.

The UofL Physicians' medical team involved in the procedure included two cardiovascular surgeons, a transplant surgeon, a plastic surgeon, two pediatric surgeons, a pediatric surgery fellow and a cardiologist. Other specialists included two additional plastic surgeons, three anesthesiologists, a radiologist, extracorporeal membrane oxygenation specialists, advanced surgical nurses, surgical technologists, biomedical and engineering specialists, information systems technologists, respiratory therapists and blood bank team members. In all, more than 45 people were involved in the planning and surgery. More have been involved in the babies’ care throughout their stay.

Identical adult twins undergo first-of-its-kind procedure performed by UofL physician

A woman who survived a rare childhood cancer successfully underwent a first-of-its-kind procedure with University of Louisville Physicians to help restore her appearance.

Jarrod Little, M.D., a plastic and reconstructive surgeon with UofL Physicians, used fat grafted from Janna Coleman’s identical twin, Jessie, to reshape Janna’s face from the damaging effects of radiation and chemotherapy. While fat grafting has been done for years, there are no instances in medical literature of it taking place from one person to another, and never before on identical twins. While tissue from twins has been used for organ transplants, soft tissue procedures between twins are rare, Little said.

The surgery took place at University of Louisville Hospital, part of KentuckyOne Health, over about three hours on Thursday, Nov. 19, and was a success.

“It will make a huge difference for her,” Little said. “She looks like a new person. I’m very happy with the results.”

Janna, 28, was diagnosed with an aggressive rhabdomyosarcoma at the age of 7. Childhood rhabdomyosarcoma is a disease in which malignant cells form in muscle tissue, and Janna’s formed behind her jaw. She was successfully treated, but the surgery, radiation and chemotherapy to her head and neck left lasting effects, damaging her pituitary gland, which disrupted her growth, most noticeably around her face. He jawbone never grew to an adult size.

While Janna is an identical twin, her sister, Jessie, did not have the same condition. Though they once looked so much alike even their father had trouble telling them apart, after her treatment Janna no longer looked as much like her sister.

“The cancer was the easy part; the aftermath is what’s been hard,” Janna said.

Janna went through more than 10 reconstructive surgeries over the years to help, but without much success. After moving to Louisville and working as an oncology nurse, she heard of Little and went to him to see if there was anything else that could be done.

With the jawbone in Janna's face damaged and stunted from radiation, Little determined reconstruction of her jaw was not an option. Fat grafting to help re-shape her face was, but Janna did not have enough fat, and was unable to gain weight because of her development issues.

But when Little learned Janna was an identical twin, he came up with the idea to take fat from Jessie and transplant it into Janna’s face. The procedure also was unique in that many people with Janna’s condition and location of her tumor do not survive to adulthood.

By increasing volume to the face and repairing some of the damaged tissues, the goal of the procedure was to give Janna’s face a more natural volume and contour so the size of the jaw bone will not be as noticeable, Little said.

Fat also was a good option for Janna because it has a high concentration of stem cells, which are beneficial because they can form into new types of cells. When they are introduced to a new area, they can regenerate surrounding soft tissue. And with the twins having a nearly 100 percent genetic match, the probability of success was high.

“I just want to look like my sister and more like a twin,” Janna said. "It is hard being her twin. She's gorgeous.”

To donate fat, Jessie had to make an effort to gain weight. For months, the normally health-conscious Jessie ate high-calorie foods – including ice cream, pizza and fast food – to develop enough fat that could be removed by liposuction for Janna.

“She’s my sister, my twin,” Jessie said before the surgery. “Of course I’m going to do anything I can to help.”

“I want her to be more confident in herself and be proud to say we're twins and not be shy about it because we're exactly alike.”

It will take several months to assess the full effects of the procedure. One or two more sessions may be needed before the reconstruction is complete.

While Janna’s portion of the procedure was covered by insurance, Jessie’s was not, so UofL Hospital donated her costs.

What salamanders can teach us about baseball

UofL researcher shows how amphibians use prediction to compensate for sensorimotor delays to connect with moving prey
What salamanders can teach us about baseball

Salamander catching a fly

If a baseball player waits until he sees the ball arrive in front of him to swing his bat, he will miss miserably. By the time the batter sees the ball’s position, plans his swing and moves the bat, the ball will be firmly in the catcher’s mitt.

This time lag is known as sensorimotor delay. University of Louisville researcher Bart Borghuis, Ph.D., has increased our understanding of how people and animals deal with this delay in day-to-day interactions by analyzing the hunting skills of salamanders. His article, The Role of Motion Extrapolation in Amphibian Prey Capture,” is published in today’s issue of The Journal of Neuroscience.

A skilled baseball player compensates for sensorimotor delay by predicting when the ball will cross the plate and starting his swing in time to meet it. Borghuis’ research reveals the salamander also predicts the future location of its prey as it catches moving fruit flies by projecting its long, sticky tongue.

The sensorimotor delay is caused by the time it takes for the visual image to be processed by the retina, time to plan the motor action and time to activate the motion. When a salamander hopes to catch a moving fly, in the time it takes to make the strike – about 230 milliseconds – the fly will have moved from the location it was in when the salamander launched its attack. If the salamander sends its tongue to the location where it sees the fly, by the time the tongue gets there, the fly will be gone. Despite this delay, salamanders are efficient hunters, catching their prey more than 90 percent of the time in Borghuis’ experiments.

Why are salamanders so effective in their attacks?

Borghuis, assistant professor in the Department of Anatomical Sciences and Neurobiology at UofL, and Anthony Leonardo, Ph.D., of the Howard Hughes Medical Institute, used high speed videography to capture 270 instances of salamanders striking at flies. Through analysis of the videos, Borghuis developed an algorithm that predicted where the salamander’s tongue would strike based on the fly’s path.

The algorithm mimics the salamanders’ process using extrapolation to anticipate the prey’s position in the future based on its bearing and velocity. The salamanders’ tongue strikes were consistent with the algorithm, and were consistently successful – unless the fly changed course between the time the salamander initiated the attack and the time of the actual strike.

In successful strikes, the salamander caught the fly by sending its tongue tip to the position where the fly was when the tongue arrived. When the salamanders missed, the salamander’s tongue struck the location where the fly would have been had it continued on the same path it had been following. However, in these cases, the fly had changed direction after the salamander launched its attack.

“The misses confirmed the model,” Borghuis said. “This is the first demonstration that the salamanders were making a prediction.”

The tongue struck where the fly never had been, yet would have been had the fly continued its previous course of motion. Thus the salamander was predicting where the fly would be at the time the tongue reached it based on the fly’s direction and speed.

“This information adds to a small set of clear examples of how vertebrates – including humans – use prediction for dealing with delays in motor processing,” Borghuis said. “Now that we know how the salamander does this, we can further investigate the neuromechanisms that make this happen.”

VIDEO

The videos above show the researchers’ trajectory duplicating the salamander’s prediction of the location of the fly at the point of impact with the tongue. In the first video, the salamander successfully predicts the path and catches the fly. In the second video, the fly alters its direction after the salamander launches its strike, so the tongue misses the fly, hitting instead the location where the fly would have been had it not changed its course. The final video is a 4000 fps video showing a salamander striking a fruit fly. In real time, this motion would take about 1/5 of a second or 180 milliseconds.

November 18, 2015

UofL post-doctoral fellow earns award from veterans’ group for top funding application

UofL post-doctoral fellow earns award from veterans’ group for top funding application

Lynnette Montgomery, Ph.D. receives Fritz Krauth Award from PVA

University of Louisville researcher Lynnette Montgomery, Ph.D., has received the 2015 Fritz Krauth Memorial Fellowship Award from the Paralyzed Veterans of America (PVA), for submitting the top scholarship application to the organization for the year. Earlier this year, Montgomery was awarded a two-year, $100,000 scholarship from the PVA for research she is conducting in the lab of Charles Hubscher, Ph.D., in the Department of Anatomical Sciences and Neurobiology.

Montgomery, one of eight researchers who received grants from the PVA Research Foundation in 2015, is studying how activity-based rehabilitation can improve bladder function after spinal cord injury (SCI). Often, following SCI, the bladder produces excessive urine, a condition known as polyuria. This can lead to a high number of catheterizations, each of which increases the possibility of urinary complications.

Preliminary work in Hubscher’s lab has shown that the hormone vasopressin decreases following spinal cord injury, causing an increase in the production of urine. Montgomery is working with rodent models to understand the mechanisms behind vasopressin reduction and hopes to determine whether exercise and medication aimed at increasing vasopressin levels will alleviate polyuria following SCI.

“It’s an exciting area of research and it is very under studied,” Montgomery said. “Bladder control is one of the top quality-of-life issues for spinal cord injury patients. If a patient has to use a catheter four times a day instead of six, or is able to sleep through the night instead of waking for catheterization, it makes a big difference in quality of life.”

The Krauth Fellowship is named for Fritz Krauth, a Navy veteran who incurred a spinal cord injury as a naval aviator. Prior to his death in 2002, Krauth provided a gift to PVA to support research initiatives through the PVA Research Foundation. The foundation provides grants that will lead to improved understanding and treatment of spinal cord injury and disease. The researcher submitting the top fellowship application to the PVA each year is honored with the Fritz Krauth Memorial Fellowship Award.

“Paralyzed Veterans of America is dedicated to advancing research for spinal cord injury and dysfunction and supporting leading medical experts such as Dr. Montgomery. Her breakthrough findings will improve the life of veterans and every person living with SCI. It will also ensure they have the means to pursue a life undefined by disability,” said Sherman Gillums, Jr., deputy executive director of PVA.

A native of Australia, Montgomery came to the University of Louisville in 2013 to join Hubscher’s lab. Hubscher was recently awarded continued funding from the Department of Defense.

“The translational research studies being conducted in our laboratory address the areas of highest priority and utmost importance for the spinal cord injured population, bladder and sexual function,” Hubscher said. “The award from the Paralyzed Veterans of America and continued funding from the Department of Defense will allow us to address multiple questions regarding potential underlying mechanisms for the benefits of activity-based rehabilitation on urogenital function after spinal cord injury.”

 

About Paralyzed Veterans of America

Paralyzed Veterans of America is a congressionally chartered veterans service organization dedicated solely for the benefit and representation of veterans with spinal cord injury or disease. For nearly 70 years, PVA has ensured that veterans have received the benefits earned through their service to our nation, monitored their care in VA spinal cord injury units and funded research and education in the search for a cure and improved care for individuals with paralysis. In addition, PVA develops career services, works to ensure accessibility in public buildings, provides health and rehabilitation opportunities through sports and recreation, and advocates for veterans and all people with disabilities.

 

November 16, 2015

UofL medical education innovations showcased at national conference

Programs addressing interprofessional education, human trafficking and emergency resuscitation team performance are highlighted at AAMC conference
UofL medical education innovations showcased at national conference

Monica Ann Shaw, M.D.

Educators from the University of Louisville School of Medicine are sharing two successful programs with medical educators from around the nation today at the 2015 Association of American Medical Colleges (AAMC) Medical Education Meeting. Two teams are delivering presentations at the Baltimore event, and an educational grant will be announced for an interdisciplinary training program for internal medicine residents.

“The recent curriculum revision at the UofL School of Medicine has been a catalyst for multiple innovative approaches to medical education. We are committed to developing best practices in medical education and translating those practices to meet the needs of our immediate community by improving patient care,” said Monica Ann Shaw, M.D., M.A., vice dean for undergraduate medical education for the UofL School of Medicine. “I am very proud of the momentum we are gaining in educational scholarship and am proud of my colleagues and the University of Louisville’s presence at this national conference."

Members of UofL’s Interdisciplinary Curriculum for Oncology Palliative Care Education (iCOPE) Council will detail the program for training medical, nursing, social work and chaplaincy students in interprofessional palliative care education. Presenters Shaw, Leslee Martin, M.A., director of medical education, and Susan Sawning, M.S.S.W., director of medical education research, will share the details of iCOPE, developed with a grant from the National Cancer Institute. Surveys of 758 students reveal the program significantly improves the students’ palliative care knowledge, skills and self-efficacy related to working in teams.

In another session, Olivia Mittel, M.D., and Carrie Bohnert, M.P.A., are presenting a program that helps medical students learn to identify and assist victims of human trafficking. Mittel, assistant dean of student affairs, and Bohnert, director of the standardized patient program, developed a training unit for medical students that utilized a standardized patient encounter and an online learning module to teach the students to identify victims of human sex trafficking, communicate with suspected victims and refer victims to safety. This program addresses the fact that although 400,000 Americans are at risk for exploitation each year, only 10 percent of doctors will recognize trafficking victims.

Finally, Lorrel Brown, M.D., associate director of UofL’s Cardiovascular Medicine Fellowship Program, has been awarded a grant from the Southern Group on Educational Affairs for her curriculum that improves resuscitation effectiveness through team simulations. The program, called “Code Blue,” brings together internal medicine residents, nurses, respiratory therapists and pharmacy residents to learn as a team to respond more effectively in actual “code blue” events. The grant will be announced during the conference.

 


November 12, 2015

UofL event prepares future health professionals to improve health equity

The 10th annual Cultural Competency Day set for Nov. 10

Among the most important issues facing health care are social barriers to care. To ensure future health professionals are equipped with the understanding to reduce health inequities, the University of Louisville Health Sciences Center Office of Diversity and Inclusion will hold its 10th annual Patricia Allen Cultural Competency Day on Tuesday, November 10. Nearly 700 students will participate in “Health Equity through Interprofessional Practice,”a day-long workshop that includes discussions on Poverty and Accessing Health Care, LGBT Health, Immigrant and Refugee Populations and Cultural Barriers in Health Care.

Students from UofL Schools of Medicine, Nursing, Dentistry, Public Health and Kent School of Social Work, as well as the Sullivan University School of Pharmacy and nurses with Passport Health Plan will take part in the program, to be held at the Kentucky Center for African American Heritage (KCAAH).

Vivian Lasley-Bibbs, the acting director for the Office of Health Equity in the Kentucky Department for Public Health, will open the event with a keynote address on the increasing racial, ethnic, cultural and linguistic diversity in the American population and the need for health-care practitioners to understand the socio-cultural background of their patients in order to deliver high quality health care.

“This is the 10th year for this conference reflecting the Health Sciences Center’s commitment to health equity for all. In addition to this important milestone, the program has expanded to include almost 700 students from multiple health disciplines,” said V. Faye Jones, M.D., Ph.D., assistant vice president for health affairs – diversity initiatives. “We all have a role in achieving health equity, and this year’s program allows students to learn with and from each other in the community setting of the Kentucky Center for African American Heritage.”

Attendees will be assigned to interprofessional teams that rotate together among 75-minute breakout sessions covering each topic. This format, which differs from previous years, will ensure that all attendees are exposed to each topic and will accommodate the large number of participants. The interprofessional teams, which mix students and residents from dentistry, speech pathology, pharmacy, social work, public health and medicine, allow the students to experience the topics from the unique perspectives of each field.

UofL’s Cultural Competency Day was first held in 2006, the result of efforts by Jones and Patricia Allen, administrative associate for the Area Health Education Center (AHEC) program office at UofL, to improve cultural understanding of UofL Health Sciences Center students. Approximately 150 students attended the event its first year. The event is named for Allen, who helped lay the groundwork and planning for the event.

November 9, 2015

UofL psychiatry resident wins national fellowship

Award provides for 10-month advocacy role with Congress
UofL psychiatry resident wins national fellowship

Daniel Jackson, M.D.

A third-year resident in the University of Louisville Department of Psychiatry and Behavioral Sciences has been awarded the Jeanne Spurlock, M.D. Congressional Fellowship of the American Psychiatric Association and the association’s related organization, the American Psychiatric Foundation.

Daniel T. Jackson, M.D., is serving in the Capitol Hill office of U.S. Rep. James McDermott, M.D. (D-Wash.) for the 10 months of the fellowship beginning in September. The award is offered to only one individual each year and provides the opportunity to represent the profession of psychiatry in Congress, working with federal policy makers to shape public policy.

“My work with Rep. McDermott – who is a psychiatrist himself – focuses on mental health issues including the Mental Health Reform Act of 2015 in the Senate and the Helping Families in Mental Health Crisis Act of 2015 in the House,” Jackson said. “We hope to see action on one or both bills in the coming months.”

Both bills propose to reform current mental health law to make available needed psychiatric, psychological and supportive services to individuals with mental illness and families in mental health crisis. The bills focus on providing more programs and resources to help those suffering from mental disorders.

 

Jackson is a two-time graduate of UofL, earning his medical degree in 2013 and a bachelor of arts degree cum laude in psychology with concentration in the natural sciences in 2007. He entered the residency program in July 2013.

As a resident, he lectures on substance abuse topics to third- and fourth-year medical students and sits on the UofL Psychiatry Residency Admission Committee. He also is a member of the American Psychiatric Association, Kentucky Psychiatric Medical Association, Kentucky Medical Association and Greater Louisville Medical Society.

He also has undertaken public policy advocacy work as a resident, attending the Advocacy Leadership Conference in Washington last year. There, he joined with others in the health care profession to recommend for increased federal investment through the National Institutes of Health, Substance Abuse and Mental Health Services Administration and Indian Health Service. He has lobbied for passage of the Ensuring Veteran’s Resiliency Act and helped efforts that were successful in reforming Medicare’s physician payment formula.

 

UofL’s Trover Campus a national model in drawing physicians to rural practice

UofL’s Trover Campus a national model in drawing physicians to rural practice

William J. Crump, M.D.

Although many rural residents who were previously uninsured now have health insurance thanks to the Affordable Care Act, a shortage of physicians in many rural communities means it still can be difficult for rural residents to obtain health care.

The University of Louisville School of Medicine has been working to increase the number of physicians in rural communities by training doctors at Trover Campus at Baptist Health Madisonville for 17 years. William J. Crump, M.D., associate dean for the Trover Campus, and his colleagues at UofL have assembled data to demonstrate that their efforts are paying off. The physicians who spent the last two years of medical school at the rural location are much more likely to ultimately practice in a rural setting.

In a study published online last week in The Journal of Rural Health, Crump reveals that 45 percent of the physicians who completed medical school at the rural campus now practice in rural areas, compared with only 7 percent of graduates who remained on the urban campus. The authors examined data for 1,120 physicians who graduated from the UofL School of Medicine between 2001 and 2008, including those who completed training at the traditional urban campus as well as Trover Campus. They used statistical methods to control for the percentage of graduates who had rural upbringing and chose family medicine, factors that previously were shown to predispose a physician to rural practice, and were able to demonstrate the rural campus itself added to the likelihood a physician would choose a rural practice.

“We were able to show that the investment of resources in our campus over the past 17 years has made a real difference for our Commonwealth,” Crump said. “There are almost 20 other such small campuses that have been established recently around the country. It will be another 10 to 15 years before they are able to prove the outcomes that we have, but we are confident that they will find the same thing. Not only will physicians be placed into small towns, but the small towns that host these rural regional campuses will benefit greatly from the financial investment by the parent campus as well as potentially recruiting their graduates to make their own medical care better."

Almost two-thirds of Kentucky’s counties are considered health professional shortage areas, meaning they have far too few primary care physicians. The University of Louisville focused on correcting this shortage by establishing the Trover Campus in Madisonville, Ky., a town of 20,000 that is 150 miles southwest of Louisville in the west Kentucky coal fields. It was believed that training students from small towns in a small town would more likely produce physicians for the small towns, and now this concept has been proven. Trover Campus was only the second in the United States to be placed in such a small town.


November 6, 2015

New option may help age-related hearing loss

UofL seeking trial participants for drug that may improve hearing in noisy environments
New option may help age-related hearing loss

New drug may help with age-related hearing loss

Over the past 10 years, Tom Schlindwein noticed it gradually became more difficult to follow conversations in public places.

“I have most difficulty in a restaurant or a venue where there is a lot of background noise,” Schlindwein said.

The 69-year-old Schlindwein is not alone. Many people find that as they get older, they have difficulty understanding conversations in crowded rooms or when there is significant background noise. Although hearing aids can help, age-related hearing loss can result from not only reduced loudness of speech, but also changes in central auditory processing in the brain. Thus, even with a hearing aid, people may find that understanding speech in noise is a problem.

“I have talked to people with hearing aids who say they do not work well in these situations,” Schlindwein said. “If there is an alternative, I am eager to pursue it.”

Schlindwein is participating in a clinical trial being conducted by researchers at the University of Louisville Program in Audiology for an investigational medication, AUT00063. The drug was developed for adults with age-related hearing loss and difficulty understanding speech in noisy environments.

Jill Preminger, Ph.D., chief of the Division of Communicative Disorders in the Department of Otolaryngology at UofL, is leading the trial of AUT00063, developed by Autifony Therapeutics. She said this medication, which focuses on improving brain-related aspects of age-related hearing loss, may be the first to help individuals with this condition.

“There have been very few drug studies for age-related hearing loss, yet approximately 45 percent of people over the age of 45 have some degree of hearing loss,” Preminger said.

Understanding speech involves distinguishing between similar sounds (such as p and b). These distinctions rely on not only reception by hair cells in the cochlea, which are lost with age, but on optimal function of auditory processing mechanisms in the brain.

“This drug is not targeting an improvement in hearing thresholds (i.e. making things louder), rather it is targeting how sound is processed in the auditory areas of the brain. This may result in improved hearing in noise,” Preminger said.

Coordinators are seeking additional individuals, age 50 to 89, with age-related hearing loss to participate in the trial.  Qualified individuals are those who experience difficulty understanding speech against high background noise but do not use hearing aids. Subjects accepted for the study will receive evaluations by an audiologist and physician and have a 50/50 chance of receiving the study medicine or placebo. Participation may last up to 10 weeks and include compensation.

People who are interested in participating in this clinical trial may call 502-852-5251 or email michelle.bottorff@louisville.edu to see if they qualify. For more information on the study, go to Age Related Hearing Loss Clinical Trial.

 

November 2, 2015

Optimal aging lecture provides practical legal information for seniors, Nov. 11

October 28, 2015

The Institute for Sustainable Health & Optimal Aging at the University of Louisville concludes its fall Optimal Aging Lecture Series with “Practical Legal Information for Seniors and Those Who Love Them,” Wednesday, Nov. 11. The lecture will be held from 11:30 a.m. to 1 p.m. at the University Club, 200 E. Brandeis Ave.

Misty Clark Vantrease and Kelly Gannott, partners at Kentucky ElderLaw PLLC, will engage the audience on how to navigate the financial maze and challenges that aging poses for individuals and their families.

The financial decisions of advancing age can be challenging for both individuals and their loved ones. Families who are faced with long-term care and increasing medical expenses can feel overwhelmed in managing the financial demands of this life-phase. This lecture will provide essential “financial caregiving” tips to help individuals and their families stay financially stable.

The Institute’s Optimal Aging Lecture Series will resume in February for the spring season.

Admission is $17 per person and includes lunch. Reservations are required online. For information, call 502-852-8953 or email ann.burke@louisville.edu.

Bolli to receive Schottenstein Prize for cardiovascular research from Ohio State University

Bolli to receive Schottenstein Prize for cardiovascular research from Ohio State University

Roberto Bolli, M.D.

Roberto Bolli, M.D., chief of the University of Louisville’s Division of Cardiovascular Medicine, will receive the 2015 Jay and Jeannie Schottenstein Prize in Cardiovascular Sciences from the Ohio State University Wexner Medical Center’s Heart and Vascular Center. The Schottenstein Prize is among the largest monetary prizes in the United States dedicated to cardiovascular research.

“We congratulate Roberto for achieving this award. He is such a scientist,” said Thomas Ryan, M.D., director of the Ohio State Heart and Vascular Center. “His work on heart muscle protection and regeneration has greatly increased our understanding of the cellular changes that occur during a heart attack and how to minimize and repair the damage that results.”

The Schottenstein Prize was established in 2008 with a $2 million gift from Jay and Jeanie Schottenstein for an endowed fund for a biennial award. The prize goes to a physician or researcher who is an international leader in cardiovascular medicine, cardiothoracic surgery or molecular or cellular cardiology. Bolli will receive his award during a ceremony on Nov. 4 in Columbus, Ohio. The prize includes an honorarium of $100,000.

“I am deeply honored to be the recipient of this prestigious award. I would like to thank the leadership of the University of Louisville for their steadfast support of my research efforts over the past 20 years and all of the members of our research team for their outstanding work and dedication, which have made this recognition possible. The Schottenstein Prize recognizes all of them,” Bolli said. “This award will further strengthen our resolve to advance the research agenda of the University of Louisville, focusing on pioneering studies of new therapies such as the use of adult stem cells to regenerate heart muscle in patients with heart failure and to improve blood flow in patients with peripheral arterial disease.”

Bolli is the Jewish Hospital Heart & Lung Institute Distinguished Chair in Cardiology and serves as director of UofL’s Institute of Molecular Cardiology, scientific director of the Cardiovascular Innovation Institute and executive vice chair in the Department of Medicine. He has conducted research on preventing damage caused during heart attacks by studying ischemic preconditioning, the phenomenon in which heart muscle exposed to brief periods of stress becomes resistant to the tissue death that might be caused by a heart attack.

Previous biennial Schottenstein Prize winners include Garret FitzGerald, M.D., the McNeil Professor in Translational Medicine and Therapeutics at the University of Pennsylvania in Philadelphia, Christine Seidman, M.D., professor in the Departments of Medicine and Genetics at Harvard Medical School and Brigham and Women’s Hospital, and Pascal Goldschmidt, M.D., the senior vice president for medical affairs and dean at the University of Miami Miller School of Medicine.

 

October 29, 2015

UofL physician to participate in UN Day panel Saturday

Mittel will discuss health consequences of human trafficking
UofL physician to participate in UN Day panel Saturday

Olivia Mittel, M.D.

October 28, 2015

Olivia Mittel, M.D., assistant dean for student affairs at the University of Louisville School of Medicine and assistant professor, Department of Pediatrics, will be among an expert panel discussing human trafficking Saturday, Oct. 31. The event is part of the 70th United Nations Day Commemoration Conference, hosted by the Kentucky Division of the United Nations Association of the United States of America (UNA-USA).

The event will kick off at 11 a.m. at the University Club Ballroom, 200 E. Brandeis Ave.

At UofL, Mittel is among the team that educates and trains medical students and residents to recognize the signs of human trafficking in patients and to intervene on their behalf.

In advance of the UN Day panel, Mittel shares the following statement:

“It is well known that human trafficking victims suffer severe mental and physical health consequences as a result of their exploitation. Because they often require immediate attention for violence-related injuries, serious psychological illness, pregnancy and substance abuse, health care workers are likely to be the only professionals to interact with these victims while they are being trafficked.

“For this reason, the University of Louisville School of Medicine, together with KentuckyOne Health, are committed to developing training protocols to teach our students, nurses and physicians how to identify these patients and refer them to safety.

“By increasing our efforts to understand the nature and scope of the problem in our community, we can better intervene on behalf of these patients and ultimately play a vital role in the fight to eliminate modern-day slavery.”

Mittel will be joined on the panel with Dianna Anderson, chair, Louisville Metro Human Trafficking Task Force; Amy Leenerts, founder and director, Free2Hope Inc.; and Jeanette Westbrook, UN Convention on the Elimination of All Forms of Discrimination Against Women.

Other speakers during the UN Day program include Rep. John Yarmuth, District 10 Louisville Metro Councilman Steve Magre and lecturer Ambassador Shabazz. Speakers in the afternoon include Mike Beard, executive director of UN Foundation Advocacy and global health director of the Better World Campaign; and Karen Mulhauser, national chair, UNA-USA.

For information, contact Teena Halbig, 502-267-6883 or teenahal@aol.com.

 

New immunotherapy treatment may clear cancer-causing HPV infections faster

Women with HPV 16, 18 infections needed for trial of therapeutic vaccine

Cervical cancer is the fourth most frequently occurring cancer in women. Human papillomavirus (HPV) is present in 99 percent of cervical cancers and is considered to be their cause. While most HPV infections will clear naturally within a few years, there has been no treatment available to hasten or improve the chance of natural eradication.

A new therapeutic vaccine, GTL001, developed by Genticel to clear HPV strains 16 and 18 – the types most likely to cause cancer – is being evaluated for safety in a Phase I clinical trial at the University of Louisville. Unlike prophylactic vaccines, which prevent diseases, therapeutic vaccines fight diseases after an individual is infected in a process known as immunotherapy. Physicians at UofL are seeking women with these infections to participate.Although HPV infections are detected in a Pap smear, there has been no standard treatment to eradicate an infection other than hoping it will clear naturally and monitoring for the development of precancerous lesions. Thus, finding a treatment for HPV will be an important step in preventing cancer. Prophylactic vaccines can prevent some HPV infections, but they are not effective against existing infections.

“While prophylactic vaccines such as Gardasil® are available for those who choose to use them, many women are not choosing to be vaccinated. In addition, most of the women in our population are older than the vaccine movement, so they may not have had the vaccine and may have acquired HPV infections,” said Diane Harper, M.D., M.P.H., M.S., chair of the Department of Family and Geriatric Medicine at UofL and a professor of obstetrics and gynecology.

Women age 25-65 who have been diagnosed with HPV 16 or HPV 18are needed to participate in a small Phase I tolerability clinical trial of GTL001 with only a three-month follow-up period. Participants must not have high-grade lesions (HSIL) as determined by Pap smear. In addition, participants must not have received an HPV vaccine and must not be pregnant or breastfeeding.

Participants in the study will receive two injections at six-week intervals, as well as various tests and assessments. All study-related visits, tests and medications will be provided at no cost. In addition, participants may be reimbursed for travel expenses.

Participants will be enrolled through early 2016. Current trial locations include Louisville, Philadelphia and Columbus, Ohio.

Women who would like to participate in the trial may contact Angela Siegwald at angela.siegwald@louisville.edu or 502-852-2043.

 

October 28, 2015

Bertolone receives Marc Lehmann Spirit of Service Award for patient care in pediatric oncology & hematology

Bertolone receives Marc Lehmann Spirit of Service Award for patient care in pediatric oncology & hematology

Salvatore J. Bertolone, Jr., M.D.

Salvatore J. Bertolone, Jr., M.D., professor and previous chief of pediatric oncology and hematology at the University of Louisville, will receive the third annual Marc A. Lehmann Spirit of Service Award for physicians on Oct. 30. The award recognizes Louisville-area physicians in hematology & oncology and is presented in memory of Marc A. Lehmann, a Louisville native and UofL student who succumbed to acute myeloid leukemia in 2012.

The Marc A. Lehmann Spirit of Service Award Foundation endeavors to seek out and identify physicians and support staff in the field of blood cancers and hematology to honor long-standing service to patients and their families that encompasses exceptional proficiency, empathy and understanding. Each year the foundation presents an award to one physician and to three support staff members from the Greater Louisville area.

“I am humbled  by this award – humbled because all I have tried to do is simply what every physician has pledged to do in the Hippocratic Oath:  Remember that there is art to medicine as well as science and that warmth, sympathy and understanding may outweigh the surgeon’s knife or the chemist’s drugs,” Bertolone said.

Marc Lehmann was stricken with acute myeloid leukemia at age 18, while a student at UofL’s J.B. Speed School of Engineering. Marc endured an eight-year battle with AML, graft vs. host disease and numerous immunosuppressed blood‐borne infections. Following his death in 2012, his family and friends created the Marc A. Lehmann Spirit of Service Award Foundation to honor his memory and the many compassionate health-care workers Marc encountered during his journey.

George J. Lehmann, III, Marc’s father and president and director of the foundation, said previous award recipients nominated Bertolone for the 2015 award. Committee members and directors then conferred with associates, fellow physicians and affected patients concerning Bertolone’s history of patient care.

“Dr. Bertolone was found, by both the nominating committee and by the Foundation directors, to be a more than suitable nominee,” Lehmann said. “The more telling quality that this process reveals lies in the nearly countless stories and accolades provided by affected members of our community, both lay and physician, who enthusiastically endorse Dr. Bertolone's qualifications.”

Along with one physician, awards are presented each year to one support staff member from each Baptist Health System, KentuckyOne Health and Norton Healthcare. The 2015 support staff recipients are Katherine Mitchell, A.P.R.N., A.O.C.N.P. (Baptist), Melissa Pritchett, B.S.N./O.C.N. (KentuckyOne) and Rebecca Champion, Pharm.D., B.C.O.P. (Norton). The 2015 awards will be presented at a dinner on Friday, Oct. 30 at Vincenzo’s Italian Restaurant.

 

October 29, 2015

Associate dean for research releases book on risks of arsenic exposure

Associate dean for research releases book on risks of arsenic exposure

J. Christopher States, Ph.D.

University of Louisville School of Medicine’s associate dean for research has edited a new reference book covering the most current information on the health and environmental risks of arsenic exposure. J. Christopher States, Ph.D., vice chair for graduate education in the Department of Pharmacology and Toxicology at UofL, is the editor of “Arsenic:  Exposure Sources, Health Risks, and Mechanisms of Toxicity,” scheduled for release November 2.

Arsenic exposure has been linked to increased risks of cardiovascular disease and diabetes, as well as several types of cancer, abnormal fetal development and even death from other chronic diseases in humans. Arsenic occurs naturally but also is used in the production of pesticides, herbicides and insecticides, leading to exposure through arsenic-containing drinking water and in some foods, particularly seafood and rice.

Recent research, covered in the book, has produced more details about how arsenic affects the body and what levels of exposure are harmful. Scientists also are studying how an individual’s genetic makeup and exposure to other toxins or diseases can increase damage from arsenic exposure.

“The issue of how to capitalize on these ideas and how to integrate research findings into models of human pathology is a very exciting topic that requires an updated book on arsenic as a toxicant,” States said.

The book uses novel modeling techniques, population studies, experimental data and future perspectives to help readers understand the potential health risks and how research can improve and contribute to characterization and risk assessment of arsenic exposure. It was written to serve as a resource for toxicologists, risk assessors, epidemiologists, environmental chemists, medical scientists and other professionals and researchers in government, academia and industry.

Arsenic:  Exposure Sources, Health Risks, and Mechanisms of Toxicity” is published by Wiley and will be released on November 2, 2015. It is currently available for preorder.

 

October 27, 2015

'Noah and Dr. B'

UofL business professor, wife with son facing serious illness start fund to help other families
'Noah and Dr. B'

Salvatore Bertolone Jr., M.D., talks with 16-year-old Noah as parents Geneva and Mike Barone look on.

A University of Louisville College of Business professor and his wife have created a new fund to help families with children who are patients of the UofL Physicians-Pediatric Cancer and Blood Diseases clinic.

Donations are being accepted by the fund which has been set up to help families pay for expenses not covered by insurance and to help improve the clinic’s ability to treat patients. Approximately $16,000 of the $50,000 goal the family has set has been raised thus far.

The Dr.Salvatore Bertolone Pediatric Hematology/Oncology Fund has been created by Michael Barone, Ph.D., professor of marketing, and his wife Geneva to assist families with children who are patients of Salvatore J. Bertolone Jr., M.D., and other physicians at the clinic. Bertolone is a specialist in pediatric cancer and blood diseases with UofL Physicians and chief clinical operations officer for subspecialties with the Department of Pediatrics at UofL.

Nicknamed the “Noah and Dr. B” fund on Facebook and GoFundMe, the fund is named for Bertolone and the Barone’s 16-year-old son, who has been battling a rare brain disorder, inflammatory pseudotumor (IPT), since 2006. Bertolone has treated Noah since the family moved to Louisville from Iowa shortly after his diagnosis.

IPTs are non-cancerous lesions that can affect organ systems but originate in the central nervous system. In Noah, the IPTs have attacked his brain stem, affecting his ability to move, speak, see and maintain balance.

A variety of treatments were prescribed for Noah before Bertolone hit upon a chemotherapy-type drug known as Revlimid® (lenalidomide) and another chemotherapeutic agent, VP-16.

“We kept looking, and then decided to try an anti-inflammatory,” Bertolone said. “Now, Noah is in school every day. He’s walking, and we hope he can keep his disease at bay.”

“After these treatments, Noah saw improvement in just a week’s time,” said Geneva Barone. “His speech is better, his whole body is more mobile, and he has more energy.”

“During the summer, he worked hard in physical therapy, and his balance, strength, endurance and ability to get around greatly improved,” Michael Barone said.

Noah, who is a junior at North Oldham High School, said, “I believe that this disease has been a blessing in disguise because it has allowed me to have relationship with great people such as Dr. B and the others at the clinic.  The care I have received there has made me want to help other kids at the clinic and their families deal with their diseases.”

Noah’s success as a patient of Bertolone’s inspired the family to give back. In December 2014, Michael and Geneva made an initial gift of $10,000 to start the Noah and Dr. B fund, which assists the families of Bertolone’s patients with expenses not associated with their treatment but are just as necessary.

“We know not every family has the means for all the expenses associated with a serious illness of their child,” Michael Barone said. “The fund we have set up is designed to help with those ‘extras’ – gas money, transportation, meals – as well as medical-related expenses that aren’t covered by their health plan.” To date, the fund has been used by the clinic to purchase new infusion pumps used in treatment and to help some families with first-time prescription co-payments.

“We’re looking forward to raising more funds and seeing those monies being used to help the clinic and families in more ways. We have just recently been selected a Kentucky Derby Marathon Charity and are looking for other ways to raise money for the fund. Bottom line, we just want the fund to help families have less to worry about,” he said. “They already have so much to worry about as it is.”

“The fund that Noah’s family has set up is just so typical of that family,” Bertolone said. “They have seen the needs of the patients and the parents in the clinic, and they are just such loving, wonderful people.

“In spite of this overwhelming disease that their son has, they look out and say, ‘What can we do for others who come here (to the clinic) and help make life a little better for them?’”

For more information about this fund, visit the Noah and Dr. B page on Facebook at https://www.facebook.com/NoahAndDrB, and to donate, go to www.gofundme.com/sqb554.