University of Louisville Hospital and community partners will be offering free hepatitis C screenings at 18 locations in Louisville and surrounding counties for World Hepatitis Day on Saturday, July 28.

Hepatitis C, a blood-borne illness, is prevalent in the Louisville area and throughout the state. Currently, providers are encouraged to test for hepatitis C only in patients with certain risk factors or are from the Baby Boom generation (born 1946-1964). 

“A growing body of evidence suggests age and risk-based screening is missing a significant number of people, including children, with hepatitis C infection. Universal hepatitis C screening will be a future standard of care,” said Barbra Cave, a family nurse practitioner specializing in gastroenterology and hepatology who leads the Hep C Center at UofL Hospital. Cave is helping to organize the event.

Kentucky has one of the highest hepatitis C infection rates in the country – seven times the national average. “Up to half of patients who have it may not know they are infected, and people may carry the disease for decades before they have symptoms,” Cave said.

While in the past certain groups were known to be at risk, Cave said a recent spike in hepatitis C cases among those who have no or unrecognized risk factors has prompted health officials to consider screening all adults. This spring, the state of Kentucky passed a law requiring all pregnant women to be tested for hepatitis C, as the disease can be passed from mother to baby. The law went into effect July 1. Kentucky is the first state in the nation to require universal hepatitis C screening in pregnant women.

“The goal of the World Hepatitis Day screening event is to expand testing and awareness, link more people to curative treatment, and normalize the conversation about hepatitis C,” said Cave. “There should be no stigma surrounding hepatitis C. Anyone could have it, including babies.”

Screenings will be offered from 10 a.m.-6 p.m. on Saturday, July 28. Screening is done with a simple finger prick, similar to checking a blood sugar, and results will be available on site in 20 minutes. Hepatitis C experts will be available at all sites to answer questions, and help link those affected by hepatitis C to appropriate care.

This is the second year UofL Hospital and community partners are offering the free screenings on World Hepatitis Day. Screening sites, staffed by more than 130 health care volunteers, will be set up in Louisville and Jefferson County, along with sites in Oldham, Shelby and Bullitt counties and Clark County, Indiana. Last year, 488 people were tested. Cave said she hopes to double that number this year.

There are some known risk factors for hepatitis C:

• Born between 1945 and 1965. The U.S. Centers for Disease Control and Prevention recommends  screening for all baby boomers.
• A blood transfusion or organ transplant prior to 1992
• Had blood filtered by a machine (hemodialysis) for a long period of time because kidneys were not working
• IV drug use at any point in life, even if just once
• Intranasal drug use at any point in life
• HIV or hepatitis B infection
• Healthcare workers exposed to blood through a needle stick or other contact with blood or bodily fluids
• Exposure to contaminated tattoo equipment, including ink
• Men who have sex with other men
• Prior military service. “Older veterans are particularly at risk due to the use of the old ‘jet gun’ vaccinators by the military, and from combat injuries requiring blood transfusion,” Cave said.

Contaminated dental equipment, such as that used before most items were single patient/single use, may have also spread hepatitis C, and Cave said the virus can live on a surface for six weeks if not sterilized properly.

But there are many cases of hepatitis C that are not tied to any risk factors, Cave said.

Left untreated, the disease can cause major complications. It can cause cirrhosis of the liver or liver cancer, and is a leading cause of liver transplant. Hepatitis C may also predispose those infected to diabetes and depression, and has an association with joint pain, certain skin disorders and lymphoma.

World Hepatitis Day is marked across the globe on July 28 every year. The purpose is to increase awareness of viral hepatitis, including hepatitis A, B and C. “We have a local goal to decrease the stigma about hepatitis C, and let people know it is easy to test for and treat,” said Cave.

“Some may still remember the old days of treating hep C when treatment was difficult,” Cave said. “It involved a triple therapy with interferon that lasted almost a year, with multiple side effects. Not everyone was a candidate for treatment, and some patients opted to not get treated at all.

“Today, hepatitis C is easily curable and relatively inexpensive to treat. Treatment is one pill, once a day, for 8-12 weeks – with minimal side effects. It is covered by almost all insurance plans, including Medicare and Medicaid. Cost and side effects are no longer an excuse to defer treatment.”

Partners with UofL Hospital in the screening event include the Louisville Metro Department of Health and Wellness, the Kentucky Department of Public Health, KentuckyOne Health, Volunteers of America, the Sullivan University College of Pharmacy, the nursing programs of Galen University and Bellarmine University, and University of Louisville Schools of Medicine, Nursing, Dentistry and Public Health.

Free hep C testing sites on July 28

• St. Matthews Mall (2 sites within the mall), 5000 Shelbyville Road, Louisville, 40207
• Walgreens, 3980 Dixie Highway, Louisville, 40216
• Walmart, 10445 Dixie Highway, Louisville, 40272
• Walmart, 500 Taylorsville Road, Shelbyville, 40065
• Walgreens, 152 N. Buckman St., Shepherdsville, 40165
• Walgreens, 4310 Outer Loop, Okolona, 40219
• Wayside Christian Mission, 432 East Jefferson St., Louisville, 40202
• CVS Pharmacy, 1002 Spring St., Jeffersonville, IN 47130
• CVS Pharmacy, 1950 State St., New Albany, IN 47150
• Kroger, 10645 Dixie Highway, Louisville, 40272
• Walmart, 7100 Raggard Road, Louisville, 40216
• Southwest Family YMCA, 2800 Fordhaven Road, Louisville, 40214
• Oldham County Family YMCA, 20 Quality Place, Buckner, 40010
• Kroger, 2710 W. Broadway, Louisville, 40211
• CVS Pharmacy, 3229 Poplar Level Road, Louisville, 40213
• Walmart, 11901 Standiford Plaza Drive, Louisville, 40229
• St. Stephen Church, 1018 S. 15th St., Louisville, 40210
• Churchill Downs, Backside

A beloved high school basketball coach suffers cardiac arrest at practice. Alone with his players, they are forced to step in to help save his life until an ambulance can arrive.

Dramatic, yes, but it’s a scene that could happen, and it’s the plot of a new CPR training film developed by a University of Louisville doctor. Lorrel Brown, M.D., physician director for resuscitation at UofL Hospital and an assistant professor at the UofL School of Medicine, is hoping the novel approach will improve high school CPR training by helping students remember what they have learned by applying it to a real-life situation they can relate to.

CPR instruction in high school is now required by law in a growing number of states. Thirty-nine states have passed laws requiring the training before graduation, including Kentucky, which passed its law in 2016. Similar laws are being considered in the remaining states.

“The goal is to create a real, emotional scenario,” said Brown. “There are so many lives that could be saved if more Americans knew CPR, and we have all of these students coming out of high school with CPR training.”

About 4 million students per year now graduate with CPR training. Brown has studied CPR training in high school, with her work recently published in the Journal of the American College of Cardiology. She found CPR skill retention in high school students was poor, with only 30 percent able to perform adequate CPR six months after training. She also found that there was no standard method of implementation.

“We wanted to know, is there a better way to do it?” she said.

That’s where the film comes in. Working with the local Start the Heart Foundation and using $10,000 in grant money she received from winning the prestigious Stamler award for young researchers at Northwestern University last October, she modeled the film after one done in the United Kingdom, where CPR training also is required.

The interactive film, designed for classroom use in high schools and shot at Ballard High School by a local film company, forces students to make choices along the way about how to respond. It will be rolled out in local high schools this fall, then Brown will determine whether it improves skill retention. If it does - and Brown said she believes it will - the plan is to expand it across Kentucky and the nation.

“This could be a game-changer in the way CPR is taught in the United States,” she said.

The film used six local high school and college actors, and paramedics from Louisville Metro Emergency Medical Services, who brought an ambulance for one scene. In the film, the coach (Brown’s real-life husband, who auditioned for the part) stuffers cardiac arrest during basketball practice, and staggers out into the lobby, where he becomes unconscious and falls onto the floor. He is found by a player, who, along with the other students at practice, must call an ambulance and perform CPR on the coach together until the paramedics arrive. The coach regains consciousness, and the students are congratulated by paramedics for saving his life.

In the United States, 350,000 people suffer cardiac arrest outside a hospital each year. Only 30 percent get bystander CPR, which affects whether they survive, Brown said. Only 11 percent of the 350,000 receive CPR. Brown has said that if CPR survival improved by just 1 percent, 3,500 more people would live.

Expanding and improving CPR training has been a personal mission for Brown, who has worked for several years on unique approaches.  These days, effective CPR is hands-only, removing a barrier for some from the old mouth-to-mouth method. She also founded and directs a program called “Alive in 5” (www.alivein5.org), a five-minute method of teaching CPR she developed.

The American Heart Association wants to double the percentage of cardiac arrest victims who receive bystander CPR by 2020, and CPR training in high schools has been endorsed by a variety of organizations.

“It’s important that people be willing to act, and that they remember the skills that they’ve learned,” she said. “As most cardiac arrests that don’t occur in a hospital happen in homes, it is likely they will save the life of someone important to them.”

See the filming

To watch a video on the making of the film, click here.

More on CPR training

Watch a video on how to perform hands-only CPR, and find printable posters and fact sheets, on the American Heart Association’s web site here.

About the Start the Heart Foundation

The Start the Heart Foundation is a group dedicated to teaching hands-only CPR classes to improve survival from cardiac arrest in the community.  Classes are free and taught by CPR-certified college students. The foundation educates people about cardiac arrest and empowers them to act during a cardiac emergency. For classes and other information, visit the website at www.starttheheartfoundation.org.

Laura Jones, an oncology social worker at the University of Louisville Brown Cancer Center, received a Marc A. Lehmann Spirit of Service Award for her compassion in her work with cancer patients.

On Tuesday, an unsuspecting Jones was led by co-workers into the M. Krista Loyd Resource Center at the cancer center, where she was presented with her award by Marc Lehmann’s father, George.

Marc Lehmann, a UofL student, passed away in 2012 after an eight-year battle with cancer. He had been diagnosed with acute myeloid leukemia just a few months after high school graduation.

The Spirit of Service Awards in his name are given to oncology support staff who show compassionate patient support.

At the Brown Cancer Center, Jones provides psychosocial support and clinical case management for patients in the neuro, bone marrow transplant and gynecological oncology clinics. She works closely with bone marrow transplant patients with complicated issues that require lengthy care.

In her award nomination, nurse manager Dianne Thomas wrote that Jones “possesses a warm and friendly mannerism that is evident on your first encounter.” She noted Jones’ dedication and compassion to low-income patients, and her ability to build a strong rapport. Thomas noted that Jones has carved out new avenues for funding for patients, and “has become a valuable asset to her peers, as well as patients.”

She said Jones “deserves to be recognized for her dedication and loyalty.”

The Marc A. Lehmann Spirit of Service Award Foundation’s mission is to conduct and promote initiatives that encourage medical care with empathy and compassion, and to recognize physicians, caregivers and support staff with long-standing service to patients and their families in the areas of hematology and oncology.

Each October, the foundation holds an awards banquet at Vincenzo’s Italian restaurant, where five deserving oncology support staff from the community are recognized, along with one physician.

This year’s banquet will be held on Oct. 26. The featured speaker will be Jason Chesney, M.D., director of the Brown Cancer Center, and the featured physician will be Kelly McMasters, M.D., chair of the Hiram C. Polk Jr. M.D., Department of Surgery at UofL and director of the Multidisciplinary Melanoma Clinic.

Paul Resch, director and advisory committee member of the foundation, is a leukemia survivor himself. He told Jones that in addition to doctors, he knew from experience how important the support staff was to cancer patients.

“It’s the feet on the ground that touch us every day that make a difference - whether it’s a touch, or a conversation. You’re blessed that you have those skills, and you’re sharing them with others. And it does make a difference.”

A new study published this week in the New England Journal of Medicine found that for hospitalized patients with type 2 diabetes who were receiving noncritical care, the use of an automated, closed-loop insulin delivery system (an artificial pancreas) to deliver basal insulin resulted in better glycemic control than standard insulin therapy injected under the skin.

With increasing evidence that an artificial pancreas can improve glucose control in patients with type 1 diabetes, investigators had sought to see if it could also help patients with type 2 diabetes.

The study also found the improved glucose control in patients with type 2 diabetes was achieved without increasing the risk of hypoglycemia. One of the major limiting factors in achieving improved glucose control is the increase in hypoglycemic events.

Conducted by researchers at the University of Cambridge and Manchester University in the United Kingdom, along with the University of Bern in Switzerland, the study was published to coincide with a presentation at the American Diabetes Association’s 78th Scientific Sessions in Orlando, Fla., this week.

It was notable as most studies of automated closed-loop insulin delivery systems include patients with type 1 diabetes, said Sri Prakash Mokshagundam, M.D., an endocrinologist and diabetes specialist with University of Louisville Physicians. It also focused on hospitalized patients, where most studies have focused on outpatients who were already on insulin, he said. About 25 percent of hospitalized individuals have diabetes.

In the study, patients who were not already on a pump or sensor to control their diabetes prior to admission were placed on the system upon admission to the hospital. Mokshagundam said that using the technology in an inpatient setting has certain advantages, such as less burden on nursing staff as they try to manually adjust insulin doses. Meal-time insulin delivery still has to be planned by the health care team.

He said that while the technology helps in the acute setting, procedures need to be developed to transition it from acute to chronic care after patients leave the hospital.

He noted there also are some hurdles at this time to implementing the technology in the United States, as the technology used in the study has not yet been approved by the U.S. Food and Drug Administration for inpatient use here. A slightly different type of system has been approved for outpatient use, which uses a different algorithm to calculate the dose.

“The study that shows that this can be done, but we are still a ways off, before this becomes routine practice,” Mokshagundam said. “There is some refinement needed.”

A University of Louisville cardiologist and data scientist stressed the need for more accurate heart disease risk-prediction models in an editorial published in the Annals of Internal Medicine this week.

The editorial by Andrew DeFilippis, M.D., director of Cardiovascular Disease Prevention at the UofL School of Medicine and a cardiologist with UofL Physicians, and Patrick Trainor, a data scientist on DeFilippis’ research team, accompanied a study of a new risk prediction model that could improve the guideline-recommended scoring systems for who is at risk.

That study, by a group of researchers from Stanford University, the University of Michigan, the University of Washington, the University of Mississippi and Harvard Medical School, showed a widely used scoring system that helps physicians identify who is at risk for heart disease may inaccurately estimate risk, especially for certain patients, such as African-Americans. The scoring system, last updated in 2013, is recommended by the American College of Cardiology and the American Heart Association.

DeFilippis said that accurate risk predication is needed to effectively balance the risks and benefits of medicines used to prevent heart disease, and is important to help doctors decide who needs a statin, blood pressure medications or aspirin.

“Doctors must balance the risk of medication side effects with the risk of disease,” DeFilippis said. “Medications are expensive, and unnecessary treatment also costs the healthcare system, which is not an endless resource.”

DeFilippis has led efforts to evaluate cardiovascular disease risk prediction scoring systems, analyzing how they perform using data from clinical studies. He said the while this new study is helpful, risk scoring must continue to evolve based on demographic and societal trends and the availability of new biomarkers for assessing cardiovascular disease.

“Risk prediction is of tremendous benefit,” DeFilippis said. “The guideline-recommended scoring models were created from data collected from groups of patients decades ago. This new study used more modern patient groups and new methods for making the risk calculations.”

He noted that as heart disease is the leading killer of Americans, assessing risk is a critical issue. And while the calculator isn’t perfect, “there is no question these calculators are better than the eyeball test and certainly outperform a physician just saying ‘I think this person is high or low risk’ after looking at them.”

In previous studies, DeFilippis and other researchers at the University of Louisville, Johns Hopkins University and the University of Washington looked at the 2013 scoring system, along with three others, in a study of different ethnic groups. They collected information on patients who began participating in 2000-2002 and followed them for 10 years, evaluating the accuracy of the 2013 scoring model and publishing the results in 2015 in the Annals of Internal Medicine. That study found that the guideline-recommended calculator overestimated a person’s risk.

A 2017 study in the journal The BMJ (formerly the British Medical Journal) noted more than one in five Americans between the ages of 40 and 75 takes a statin. It has been hotly debated who should take statins, and several studies have questioned the accuracy of the risk calculator.

DeFilippis said the new study published this week rebuilds the risk score using a different statistical approach. It re-analyzed data from participants in multiple large studies. The new risk prediction model was shown to make more accurate predictions of risk for many patients, especially for some ethnicities, though further validation is needed.

Because of the need to continually update data, the team in the study that was published this week made the statistical model and computer code public so other scientists could evaluate them.

DeFilippis said that ultimately, “the decision on who should take statins or other medications to reduce risk should be a conversation between doctor and patient.”

While the guidelines still generally recommend them for some groups with a particular score, he said treatment should be individualized.

By instructing key immune system cells to accept transplanted insulin-producing islets, a team of researchers including those from the University of Louisville have opened a potentially new pathway for treating type 1 diabetes. If the approach is  successful in humans, it could allow people with type 1 diabetes to be treated without the long-term complications of immune system suppression.

The technique, reported this week in the journal Nature Materials, uses synthetic hydrogel particles (microgels) to present a protein known as the Fas ligand (FasL) to immune system T-effector cells along with the pancreatic islets being transplanted. The FasL protein “educates” the effector cells – which serve as immune system watchdogs – causing them to accept the graft without rejection for at least 200 days in an animal model.

The FasL-presenting particles are simply mixed with the living islets before being transplanted into the mice, which suffer from chemically-induced diabetes. The researchers believe the FasL-presenting hydrogels would not need to be personalized, potentially allowing an “off-the-shelf” therapy for the transplanted islets.

Researchers from the University of Louisville, Georgia Institute of Technology and the University of Michigan collaborated on the work, which was supported by the Juvenile Diabetes Research Foundation and the National Institutes of Health.

“We have been able to demonstrate that we can create a biomaterial that interrupts the body’s desire to reject the transplant, while not requiring the recipient to remain on continuous standard immunosuppression,” said Haval Shirwan, Ph.D., the Dr. Michael and Joan Hamilton Endowed Chair in Autoimmune Disease at the University of Louisville School of Medicine and director of the Molecular Immunomodulation Program at the Institute for Cellular Therapeutics at UofL.

“We anticipate that further study will demonstrate potential use for many transplant types, including bone marrow and solid organs,” he said.

In the United States, some 1.25 million persons have type 1 diabetes, which is different from the more common type 2 diabetes. Type 1 diabetes is caused by immune system destruction of the pancreatic islet cells that produce insulin in response to glucose levels. Current treatment involves frequent injection of insulin to replace what the islets no longer produce. There is no long-term cure for the disease, though persons with type 1 diabetes have been treated experimentally with islet cell transplants – which almost always fail after a few years even with strong suppression of the immune system.

“Drugs that allow the transplantation of the islet cells are toxic to them,” said Andrés García, the Rae S. and Frank H. Neely Chair and Regents' Professor in Georgia Tech’s George W. Woodruff School of Mechanical Engineering. “Clinical trials with transplantation of islets showed effectiveness, but after a few years, the grafts were rejected. There is a lot of hope for this treatment, but we just can’t get consistent improvement.”

Among the problems, García said, is toxicity to the islet cells from the immune system suppression, which also makes patients more susceptible to other adverse effects such as infections and tumors. Other researchers are exploring techniques to protect the islets from attack, but have so far not been successful.

The research reported in Nature Materials takes a totally different approach. By presenting the FasL protein – which is a central regulator of immune system cells – the researchers can prevent the immune system from attacking the cells. Once they are educated at the time of transplantation, the cells appear to retain their acceptance of the transplanted islet cells long after the FasL has disappeared.

“At the time of transplantation, we take the islets that are harvested from cadavers and simply mix them with our particles in the operating room and deliver them to the animal,” García explained. “We do not have to modify the islets or suppress the immune system. After treatment, the animals can function normally and are cured from the diabetes while retaining their full immune system operation.”

The hydrogels can be prepared up to two weeks ahead of the transplant, and can be used with any islet cells. “The key technical advance is the ability to make this material that induces immune acceptance that can simply be mixed with the islets and delivered. We can make the biomaterial in our lab and ship them to where the transplantation will be done, potentially making it an off-the-shelf therapeutic.”

In the experimental mice, the islets were implanted into the kidneys and into an abdominal fat pad. If the treatment is ultimately used in humans, the islets and biomaterial would likely be placed laparoscopically into the omentum, a tissue with significant vasculature that is similar to the fat pad in mice. Garcia’s lab has previously shown that it can stimulate blood vessel growth into islet cells transplanted into this tissue in mice.

In future work, the researchers want to see if the graft acceptance can be retained in more complex immune systems, and for longer periods of time. By reducing damage to the cadaver islets, the new technique may be able to expand the number of patients that can treated with available donor cells.

García’s lab uses polymer hydrogel particles that are about 150 microns in diameter, about the same size as the islet cells. They engineer the particles to capture the FasL – a novel recombinant protein developed by Shirwan and Esma S. Yolcu, associate professor of microbiology and immunology at the University of Louisville – on the particle surface, where it can be seen by the effector cells.

Thousands of women diagnosed with the most common type of breast cancer can now skip chemotherapy and still have the same outcome, according to a new study presented this week.

The long-awaited study, presented at the American Society of Clinical Oncology meeting over the weekend in Chicago, confirmed what many breast cancer specialists, including those at the James Graham Brown Cancer Center at the University of Louisville, had already believed.

For women with this common type of cancer - early stage estrogen-receptor positive - anti-estrogen treatment alone provide the same benefit as chemotherapy, without the harsh and sometimes devastating side effects. Chemotherapy can cause hair loss, a weakened immune system and heart problems, among other issues. Breast cancer is the most common cancer in women worldwide.

“The name of the study is TAILORx, which is perfect, because what this means is that for a large group, treatment can be truly tailored to a woman’s circumstances,” said Elizabeth Riley, M.D., FACP, a breast cancer expert at UofL’s Brown Cancer Center and deputy director of the center. “We now have solid data that chemotherapy is not needed for many in this group and helps validate what many specialists already knew.

“For years, physicians made treatment decisions solely based on a woman’s stage of breast cancer. TAILORx now confirms the biology of the tumor may be more important. This study should reassure a woman with very early stage, estrogen-driven breast cancer that chemotherapy can be avoided without increasing her risk of breast cancer,” Riley said.

The study, published Sunday in the New England Journal of Medicine, analyzed how well a widely used genetic test called the Oncotype DX Breast Recurrence Score assessed the risk of breast cancer returning. The Oncotype DX test looks at 21 genes linked with a likelihood of recurrence. The test has a range between 0 and 100, and determines whether these genes are turned off or on, or are over expressed.

The study’s lead author, Joseph Sparano M.D., associate director for clinical research at the Albert Einstein Cancer Center and Montefiore Health System in New York City, said the data confirms women can be spared “unnecessary treatment if the test indicates chemotherapy is not likely to provide benefit.”

Riley noted there are multiple types of breast cancer, with multiple genes involved in the growth of tumors. She said those patients who will benefit from the study’s findings are estrogen sensitive, test negative for HER2 (human epidermal growth factor receptor 2), a gene that can play a role in the development of breast cancer, and have early-stage tumors below 5 centimeters that have not spread to lymph nodes.

They also have what is considered an intermediate score on the OncotypeDX test, one between 11 and 25.

Riley said that past research has shown women with scores between 0 and 10 could safely forego chemotherapy, while those with scores over 25 were best treated with a combination of chemotherapy and anti-estrogen hormonal treatment, as the cancer recurrence risk in this group was high.

“There have been clear guidelines on treatment for woman with a high or low score OncotypeDX score. It was the group in the intermediate range, from 11 to 25, that the degree of benefit of chemotherapy was not well established,” Riley said.

The study followed over 10,000 women diagnosed with breast cancer between 2006 and 2010. Of those, 6,711 had intermedia scores between 11 and 25. That group was split into two: one receiving hormone therapy and chemotherapy, and the other only hormone therapy.

The women were followed for an average of nine years, and researchers found the outcome in recurrence and survival was virtually the same.

“If you are seen by a doctor tomorrow and have a low to intermediate score on the test, you should expect not to be offered chemotherapy, unless you are under the age of 50,” Riley said.

That is the caveat, she said. Breast cancer in younger women is biologically different, and typically comes with a poorer prognosis. In premenopausal women and those younger than 50, the TAILORx results suggested that hormonal therapy alone may not be enough and chemotherapy may still be needed, she said.

While these patients should discuss their options with their doctor, they would be likely candidates for the more aggressive combination therapy, she said.

“In that case, the treatment decisions are going to depend on more than just the test, such as a thorough analysis of a patient’s particular tumor type. We can’t say that everyone under 50 needs chemotherapy, but future studies may be necessary to interpret the test in this age group,” Riley said.

Breast cancer in younger women is a focus of Riley’s. At the Brown Cancer Center, she also leads the HER Breast Cancer Program, which addresses the challenges this group faces with regional experts in the management of breast cancer in young women. The program also addresses the impact of treatment on fertility, the patient’s young children, and her career. HER stands for Hope, Empower and Restore.

The University of Louisville and the Jewish Hospital Trager Transplant Center marked an important milestone on Wednesday – the 500^th heart transplant performed at the hospital since the heart transplant program began there nearly 35 years ago.

“As we end American Heart Month, it’s the perfect time to share this wonderful news,” said Mark Slaughter, M.D., surgical director of heart transplant for University of Louisville Physicians and Jewish Hospital, and professor and chair, Department of Cardiovascular and Thoracic Surgery, UofL School of Medicine.

Dr. Slaughter performed the 500^th transplant on Wednesday, Feb. 21, on a 59-year-old man who had a left ventricular assist device implanted to support his heart until the donor heart was available for transplant. An LVAD is a surgically implanted mechanical pump attached to the heart.

The first heart transplant at the hospital, which was also the first heart transplant in Kentucky, took place on Aug. 24, 1984, performed by the University of Louisville’s Laman Gray Jr., M.D. The state and region waited in suspense as 40-year-old Alice Brandenburg received a new heart. The surgery, which took seven hours, was groundbreaking at the time. The UofL and Jewish Hospital transplant team is one of the leading providers of organ transplantation in the country.

“Jewish Hospital is a place where miracles happen every day and patients’ lives are changed forever,” said Ronald Waldridge II, M.D., president of Jewish Hospital. “Five-hundred hearts is much more than a milestone. It represents the life-changing impact on our patients, their families and the entire region. Together, with UofL, Jewish Hospital’s Trager Transplant Center is investing in research, technology and advance procedures to increase access to transplant services.”

On Wednesday, doctors and heart transplant recipients gathered at the Jewish Hospital Rudd Heart and Lung Center to celebrate the 500^th milestone and the many lives that have been saved over the years thanks to heart transplantation. 

“The 500^th heart transplant is a reminder of the commitment by Jewish Hospital and the University of Louisville to provide advanced therapies for patients with advanced heart failure,” said Dr. Slaughter. “We’ve come a long way since Dr. Gray broke ground with that first heart transplant more than 30 years ago. Every day, we continue to advance the science of heart transplantation here at UofL and Jewish Hospital. I’m excited about the future of this program, and I’m confident that we’ll mark a lot more milestones over the next 30 years.”

For Dr. Gray, Wednesday’s celebration marked decades of dedication to the heart transplant program.

“After performing the first heart transplant, it means a lot to me to see the 500^th and where we are today,” said Dr. Gray.

Gray continues to research new ways to help patients with heart disease at UofL’s Cardiovascular Innovation Institute, a center focused on bio-adaptive heart innovations, including the integration of heart-assist device, biodfeedback sensors and related technologies. In 2001, Gray and the Trager-UofL surgical team implanted the first fully implantable replacement heart, the AbioCor™.

Today, patients like Jeffrey McMahan continue to benefit from the heart transplant program. McMahan was the center’s 479^th heart transplant, and he attended the celebration on Wednesday along with other recipients.

Before his heart transplant, McMahan, 61, was no stranger to the procedure – it had helped save many of his family members. The Memphis, Indiana, resident had four family members receive heart transplants - two by University of Louisville surgeons at Jewish Hospital. In 2015, McMahan learned he, too, needed one.

“I was serving in the military at Fort Knox when I developed a cough,” said McMahan. “It finally got bad enough that doctors flew me to Jewish Hospital, where I was diagnosed with a cardiomyopathy, a condition where the heart muscle is weakened. I learned that I would need a transplant in the next 10 years, but that timeframe quickly changed to 10 months after my condition worsened.”

On Aug. 15, 2015, McMahan was added to the organ donor transplant list. A month later, he received the transplant that forever changed his life.

“I wouldn’t have lived without the transplant,” McMahan said. “It means a lot to be here to celebrate the 500^th. I’m forever thankful to the transplant team that helped save my life and gave me more time with family.”

It has been an exciting year for the Jewish Hospital Trager Transplant Center and University of Louisville team. In December 2017, the center – a joint program with the UofL School of Medicine and KentuckyOne Health – broke its all-time record for number of organs transplanted in the center’s 53-year history, with 175 organs transplanted in a year. The center also achieved several other milestones in 2017, including its 5,000^th transplanted organ, its 3,000^th kidney transplant and its 900^th liver transplant. In addition to Kentucky’s first heart transplant, the program is known for performing Kentucky’s first adult pancreas, heart-lung and liver transplants.

But the 500^th heart transplant and other milestones wouldn’t have been reached without organ donors, noted David Lewis, director of Transplant Services at the Jewish Hospital Trager Transplant Center.

“We often encourage people to sign up as organ donors to help save lives. The need for organ donors is unfortunately greater than the number of people who donate, so each day, an average of 20 people pass away while waiting for a transplant in the United States,” Lewis said. “Knowing that we have helped save 500 people in need of a new heart is a wonderful feeling, and it would not be possible without the donors and their families.”

For information on the Jewish Hospital Trager Transplant Center, visit www.kentuckyonehealth.org/transplant-care.

For video of the first heart transplant at Jewish Hospital, visit https://youtu.be/b8AFYN-TsDY.

Smoking harms nearly every organ in the body. It causes about 1 in every 5 deaths in the United States each year, and is the main preventable cause of death and illness. We know the harmful effects of tobacco, so why is it so hard for people to quit?

“The benefits of not smoking, in particular to the heart, are huge. And with February being American Heart Month, it’s a good time to think about quitting,” said the University of Louisville’s Rachel Keith, Ph.D., APRN, a specialist in cardiovascular medicine and tobacco treatment. “But it’s a lot more than just halting a bad habit. That’s why we can say our relationship with tobacco is, ‘complicated.’”

Keith, who runs the new UofL Physicians Tobacco Treatment Clinic, said there are “strange dynamics” with tobacco.

“Smoking cessation is hard in general,” she said. “Helping patients to quit smoking often involves a lot of talking and figuring things out.

“We have to really get at WHY they smoke. Perhaps their grandmother died at age 100 even though she smoked, so they don’t believe there’s a connection. Or, she got them smoking and that’s their connection to her now that she’s gone.”

She said many people who come to the clinic have smoked for 30 or 40 years, and they are hesitant to quit. “That’s because it’s almost a part of them. In their view, you are taking away something they don’t know how to replace.”

She said she encourages patients to try different things and look for healthier alternatives when they have the urge for a cigarette.

“But when I ask them, ‘What are some other things you like to do for 10-15 minutes?,’ a whole lot of people can’t name those things. Many don’t have anything else. We try to help them find them, whether it’s a hobby or something like taking a walk,” she said.

But again, it’s complicated.

“A lot of patients feel sick, so they think they can’t get out and walk, even though they know it will be easier when they quit. There’s just a lot that goes into smoking, culturally and hormonally.”

People “can’t see the immediate effects of quitting, but they can quickly gain the rewards of smoking, because it’s almost instant. The body actually gets hard-wired to anticipate the effects from tobacco.”

That’s why the new clinic approaches all the factors that make it hard for people to stop, making it Louisville’s only comprehensive tobacco treatment program.

Keith meets with patients and develops a personal, individualized approach that best suits each patient’s needs. During sessions, Keith and patients discuss the benefits of stopping smoking, medication options, and different skills, such as mindfulness and relaxation, to help overcome anxiety.

Medications to treat withdrawal symptoms are paired with the cognitive-behavioral therapy to help patients sustain attempts to quit. Any medical issues also are addressed. One treatment Keith is studying is how to increase people’s motivation with virtual reality therapy, where an immersive session allows patients to imagine what life will be like once they’ve quit.

“The good news is, this type of program has been proven over and over as the most effective method for long-term cessation,” Keith said. “But until we opened, it was hard to find one in this area to get into.”

She said those who try to quit on their own have about a 6 percent chance of succeeding. If they work with a health provider, their chances improve to 10 percent to 15 percent. But with the comprehensive program, patients see a success rate of 30 percent and above.

“Those who have come through the program have done really well,” she said. “Almost everyone who comes through has quit.”

It generally takes about six sessions, usually once a week or every other week, to complete. Afterward, patients return on a more limited basis, and Keith follows up by phone.

Anyone who wants to quit smoking can come to the clinic, and many insurance plans will cover the program at little or no cost to the patient. It is located in Suite 310 of the UofL Physicians Health Care Outpatient Center, 401 E. Chestnut St.

To make an appointment, call 502-588-4600.

According to The Beatles, love is all you need. While it may not be all you need, there’s evidence it makes the heart healthier.

On Valentine’s Day, people may find themselves celebrating their relationships, or contemplating their lack of one. However, it’s not just love in the traditional sense that affects the heart, but also social bonds with friends and family.

University of Louisville cardiologist Lorrel Brown, M.D., studies the heart and says there is definitely a correlation between heart attacks, heart failure and other cardiac problems and loneliness, depression and anxiety.

While doctors know about the effects of diet, blood pressure and cholesterol on the heart, “now the medical community is interested in other components of heart health, that whole body connection,” Brown said. “Emotions are definitely part of this new way of understanding the body. Ideal cardiovascular health is now going beyond things you’ve already heard.”

In fact, some experts – including former U.S. Surgeon General Vivek Murthy, M.D. - are calling loneliness and social isolation a sort of epidemic, noting the increased risk for cardiovascular disease, among other health problems. Last month, the United Kingdom even appointed a “Minister for Loneliness” to address the finding that 9 million British people often or always feel lonely.

In an article in the Harvard Business Review in September, Murthy wrote, “Loneliness and weak social connections are associated with a reduction in lifespan similar to that caused by smoking 15 cigarettes a day and even greater than that associated with obesity.

“But we haven’t focused nearly as much effort on strengthening connections between people as we have on curbing tobacco use or obesity.”

Brown said Eastern medicine has long correlated the connection between emotions, love and health, and Western medicine is now starting to apply science to those observations.

“There’s ongoing research now into the question, ‘Is there some way to intervene?’” Brown said.

She said “Broken Heart Syndrome” (clinically named stress-induced cardiomyopathy or takotsubo cardiomyopathy) is the most clear and dramatic example of the effect of the emotions on heart health.

The phenomenon, where people actually suffer from a broken heart, is common in medical literature, and named after a Japanese takotsubo, a ceramic pot used to trap octopus, as the stressed heart takes on the pot’s shape. The condition was first identified in Japan.

It starts abruptly, with chest pain and often shortness of breath, usually triggered by an emotionally stressful event, Brown said, and it is not uncommon to see after spouses argue or one passes away. People experiencing Broken Heart Syndrome often end up in the emergency room because they think they are having a heart attack, which is caused by a blocked coronary artery.

Tests will show an unusual shape of the heart’s left ventricle (the pumping chamber), with a narrow neck and ballooned lower portion, giving the condition the “takotsubo” name. While cause is still unknown, it may be due to an increase in stress hormones such as epinephrine and norepinephrine, and is treated with medication to block those hormones.

While all of our social bonds are important, “it does seem that married people live longer than those who aren’t,” Brown said.

There are a few small studies that show the benefits of traditional love on the heart, and “we do know that people react most positively to stress when they are in love,” she said. The hormone released in love is the powerful oxytocin, which also acts as a neurotransmitter in the brain. When oxytocin levels go up, blood pressure goes down, and the heart rate slows. Inflammatory markers also tend to go down.

“However, love can apply to other types of relationships as well,” Brown said. “Happiness and companionship are an important part of heart health. People with strong bonds, whether it’s a spouse, many friends, or a close family, tend to have healthier hearts. While we don’t understand yet the nuances, there’s certainly a significant connection.”

A University of Louisville study has found a connection between Medicaid expansion and improved quality of breast cancer care, including an increase in the early-stage diagnosis of the disease and greater utilization of breast-conserving surgery instead of more invasive treatments, such as mastectomy. 

The study, “Evaluating the Early Impact of Medicaid Expansion on the Quality of Breast Cancer Care in Kentucky,” appears today on the website of the Journal of the American College of Surgeons in advance of print publication.

“We found several good things happened by the expansion of Medicaid,” said the study’s senior author, Hiram C. Polk, Jr., M.D., of the division of surgical oncology in the Department of Surgery at the UofL School of Medicine. “It really did work. The care was better because people were getting what they need.”

Since passage of the Affordable Care Act in 2010, 32 states and the District of Columbia have expanded Medicaid coverage, with the federal government covering the increased costs. Kentucky is one of the Medicaid expansion states, and the study looked at the effects of the expansion here.

“What we learned is that the expansion of some form of third-party coverage for health care leads to people doing more things that are intrinsically good for their health,” said Polk, who also has served as Kentucky’s public health commissioner.

UofL researchers who were co-authors on the study were Nicolas Ajkay, M.D., as first author; Neal Bhutiani, M.D.; Jeffrey Howard, M.D.; Charles Scoggins, M.D.; and Kelly McMasters, M.D., Ph.D. Also involved were researchers from the University of Kentucky.

The researchers looked at breast cancer as a marker of the impact of Medicaid expansion as it is “a very common cancer,” Polk said. “Our goal was to get an early measure of what really happened with Medicaid expansion.”

The study evaluated measures related to breast cancer from 2011 to 2016, using 2014 - the year Kentucky’s Medicaid expansion went into effect- as the cutoff between pre- and post-expansion.

“We knowingly took on the possibility of making too early of an observation on Medicaid expansion, but the degree of change that occurred so promptly in two years surprised me,” Polk said. “It’s amazing these changes happened in just two years.”

Researchers examined the Kentucky Cancer Registry for all women ages 20 to 64 who were diagnosed with breast cancer between 2011 and 2016.

From 2011 to 2013, 635,547 screening mammograms were performed in the state. That number increased to 680,418 from 2014 to 2016.

In 2011, 208,600 screening mammograms were performed, compared with 234,315 in 2016.

The number of screening mammograms covered by Medicaid increased from 5.6 percent before expansion to 14.7 percent after, and the number of women who had screening mammograms and were uninsured declined almost tenfold, from 0.53 percent before to 0.05 percent after expansion.

Breast cancer incidence and treatment rates did not vary significantly from year to year. But the changes in the rates of early-stage vs late-stage disease treated in the pre- and post-Medicaid expansion periods were statistically significant. 

Early stage (stage I-II) breast cancers accounted for 64.5 percent of the diagnoses in 2011-2013, compared with 66.7 percent in 2014-2016. Late-stage (III-IV) cancers accounted for 15 percent, compared with 12.9 percent.

Rates for breast-conserving surgery increased significantly after Medicaid expansion, from 44 percent pre-expansion to 48.8 percent, while rates of other resections, including mastectomy, declined, falling from 50.5 percent to 44.5 percent.

While the time from diagnosis to surgical treatment for the disease was shorter before expansion, an average of 28.6 days compared with 36, two other key treatment variables were either unchanged or improved after expansion:  time from the operation to chemotherapy (47.5 days before, and 46.6 days after); and time from the operation to radiation (96.4 days before, and 91.5 after).

“Chemotherapy and radiation didn’t happen as quickly as we’d like,” Polk said.

The study noted the findings were mirrored by experiences in other states, but Polk said a thorough analysis of the Medicaid expansion in Kentucky requires longer-term study. 

“Two years is a very short run,” Polk said. “But on the other hand, it’s a very pure study.”

University of Louisville cardiologist and researcher Roberto Bolli, M.D., has been awarded the 2018 Honorable Maestro Award by the Kentucky Chapter of the American College of Cardiology, the chapter’s highest honor.

Bolli is director of UofL’s Institute of Molecular Cardiology and serves as scientific director of the Cardiovascular Innovation Institute at UofL. He is also a professor and chief of the Division of Cardiovascular Medicine at the School of Medicine.

The Maestro Award recognizes achievements in the field of cardiology and medicine, leadership in the regional and national cardiology community, charity work, mentorship and vigilant care of the sick.

In the past year, Bolli received one the largest grants ever for medical research at the University of Louisville, saw the impact factor jump on a major medical journal he edits, and led the Stem Cell Summit at the annual meeting of the American Heart Association in Anaheim, Calif.

The $13.8 million grant Bolli and his UofL team received from the National Institutes of Health is to study a promising new type of adult cardiac stem cell that has the potential to treat heart failure.

Bolli’s research focus has been on how to repair the heart and cure heart failure using a patient’s own stem cells. It is an approach that could revolutionize the treatment of heart disease.

He also serves as editor of the journal Circulation Research, which achieved its highest-ever “impact factor,” a measure of its importance in the medical field, last year. Circulation Research is an official journal of the American Heart Association and is considered the world’s leading journal on basic and translational research in cardiovascular medicine.

Bolli will be recognized and presented with the Maestro Award on stage at the Kentucky chapter’s annual meeting at the Lexington Center in Lexington, Ky., on Oct. 13, 2018.

A national talk the following year will be named in his honor.

While CPR instruction in high school is required by law in a growing number of states, there is no standard method of implementation, according to a study by a University of Louisville doctor published in the Journal of the American College of Cardiology.

The study by Lorrel Brown, M.D., an assistant professor at the UofL School of Medicine and physician director for resuscitation at UofL Hospital, is titled “CPR instruction in U.S. high schools: What is the state in the nation?”

In the U.S., 350,000 people suffer cardiac arrest outside a hospital each year. Only 30 percent get bystander CPR, which affects survival, Brown said. Only 11 percent of those 350,000 survive.

“If we improve survival by just 1 percent, that’s 3,500 more people who will live,” Brown said.

The American Heart Association wants to double the percentage of cardiac arrest victims who receive bystander CPR by 2020, and CPR training in high schools has been endorsed by a variety of organizations. Thirty-nine states have passed laws requiring the training before graduation, including Kentucky, which passed a law last year. Similar laws in the remaining 11 states are being considered.

For the study, Brown examined the state laws and characterized them based on stringency of training. 

“We know high school students can learn CPR. However, we have found CPR skill retention in high schoolers is poor, with only 30 percent performing adequate CPR six months after training,” she said. “We wanted to know, is there a better way to do it? How can we make the best use of this opportunity?”

The study had two parts: 1) what the law in each state requires and 2) how the laws are being implemented in schools.

To find out, Brown sent a survey to schools in the 39 states. She asked how CPR was being taught, who was doing the teaching and at what grade level.

“We found a wide degree of variability from state to state, and even school to school,” she said. “While the laws all have some similar features, such as teaching the hands-only method, they still leave a lot to the individual schools to decide.”

Most laws don’t recommend a specific program. Some require the training take place in a specific grade, while others don’t.  Most training was being taught as part of a physical education class, but it varied widely who taught it, from a firefighter, a nurse, to the American Red Cross. Most laws don’t require the instructor to be certified to teach, an important distinction, Brown said, since not everyone who is certified in CPR will necessarily be a good instructor.

She said a major barrier for schools is the cost of CPR training.  Certified instructors are not always readily available, and most states don’t provide funding for CPR training, leaving it to individual schools and districts.  And high-quality mannequins, which are important for a more realistic experience and muscle memory, are expensive, Brown said. Thirty-six percent of schools surveyed were using a low-quality, inexpensive inflatable one.

She said the study “hopefully will help standardize the process to provide high-quality training.” Brown was assisted in the study by two UofL medical students, third-year Carlos Lynes, and fourth-year Travis Carroll, with Henry Halperin, M.D., of Johns Hopkins University School of Medicine, advising on the study.

She said it’s too early to tell whether the training in U.S. high schools has been effective in saving lives, but in some places such as Denmark, similar laws lead to increased rates of bystander CPR and survival.

“We’re still about 10 years out in the U.S.,” she said. With about 4 million students per year now graduating with CPR training, “by then we’ll have an army of people trained in CPR.”

Expanding CPR training has been especially important to Brown, who has worked for several years on unique approaches such as halftime demonstrations at UofL men’s basketball games.  She founded and directs a program called “Alive in 5” (alivein5.org), a five-minute method of teaching CPR she developed that could become a standard for training. She studied the method at the Kentucky State Fair and found adults could learn high-quality CPR in just 5 minutes.

“We are still investigating the best method that is effective and efficient,” she said.  

When she was eight years old, Meliha Hrustanovic-Kadic and her family fled war-torn Bosnia as refugees. They settled in Bowling Green, Ky., adapting as quickly as they could to the new language and culture.

Soon afterward, her grandfather arrived in the United States as well, but his health quickly deteriorated.

“I was the oldest of my siblings and the oldest of the grandchildren. I found myself riding in an ambulance with my grandfather on a frequent basis. I became his interpreter for every emergency room visit and hospital stay. As his condition unfortunately worsened, my curiosity and passion for medicine grew.”

Early in her college career, she made it official.

“I declared pre-medicine as my major during my sophomore year at Western Kentucky University. I can’t imagine myself doing anything else.”

Hrustanovic-Kadic considered other medical schools, but knew she wanted to be at UofL.

“I felt a welcoming atmosphere from the start and loved how diverse it was. I wanted to attend a medical school that excelled in patient care, research, teaching and was involved in the community. UofL has surpassed all of my expectations.”

Hrustanovic-Kadic appreciates the school’s commitment to students’ well-being, with wellness initiatives, mental health counseling, an active LGBT program and diversity events. As a medical student at UofL, she has served as a representative on the diversity committee and volunteers for Kentucky Refugee Ministries.

“So many individuals, from instructors and attendings to fellow medical students to the medical student affairs staff, have become like family over the years.”

Wartime displacement prevented her parents from completing higher education, which, combined with learning a new language, put the best jobs out of reach. Ultimately, they reached for the American Dream, opening their own transportation company.

“I was 15 at the time and have helped them manage it ever since,” Hrustanovic-Kadic said. She has continued to support the family business even during medical school.

“We function as a team and everyone tries to pitch in to help when they can. Don’t ask me how I’ve balanced everything because I don’t even know – perhaps a mix of good time management and organization, along with a ‘when there’s a will, there’s a way’ attitude!”

Her family has supported her during her medical education as well, with frequent visits to Louisville and even preparing her favorite Bosnian foods – krofne, pita, hurmasice and others – during exam weeks.

“You name a way and I can assure you they’ve done it – emotionally, spiritually, physically, financially,” Hrustanovic-Kadic said. “I cannot even begin to describe just how important a supportive family is, especially through medical school.”

She will receive her diploma at the UofL School of Medicine Convocation on Saturday, but her days at UofL are not over. Hrustanovic-Kadic will remain at UofL to pursue residency in internal medicine.

“I enjoy taking care of patients in both inpatient and outpatient settings and there are so many interesting routes one can take with a career in internal medicine. I am looking forward to the experiences I will gain during residency.”

The University of Louisville has expanded its oncology research strength through the addition of approximately 33,000 human tissue samples and specimens. The samples were transferred by Catholic Health Initiatives (CHI) to further the shared commitment and collaboration in advancing research and action in the fight against cancer.

Researchers from the University of Louisville and James Graham Brown Cancer Center are partners with CHI through national oncological research between the two organizations, as well as locally as part of KentuckyOne Health. This close collaboration has delivered significant impact in the understanding of a variety of cancers and is supporting physicians and patients in Kentucky and across the country.

“These specimens provide our researchers with opportunities to build on existing research initiatives and open the door for new areas of study in fighting cancer,” said Dr. James Ramsey, president of the University of Louisville. “We now will be able to extend our efforts to build upon our advances and we continue to work to reduce the human costs of cancer.”

Research teams in Louisville now have access to triple the number of medical specimens to guide cancer research. The more than 47,000 samples in the University of Louisville biorepository cover 111 unique primary tumor sites and include cancer types that are particularly prevalent in Kentucky, including breast, lung, colon and kidney cancers.

“Cancer is one of the most prevalent health issues facing the people of the Commonwealth,” said Ruth Brinkley, CEO of KentuckyOne Health. “The gifting of these specimens reinforces our shared commitment to bring wellness, health and hope to patients in Kentucky and across the country. The innovative treatments, diagnostic tests and other insights our local researchers are developing are critical to helping us reduce the rate and impact of cancer.”

The specimens will arrive at the University of Louisville on May 24, 2016, enabling immediate access for research teams.

About KentuckyOne Health

KentuckyOne Health, the largest and most comprehensive health system in the Commonwealth, has more than 200 locations including, hospitals, physician groups, clinics, primary care centers, specialty institutes and home health agencies in Kentucky and southern Indiana. KentuckyOne Health is dedicated to bringing wellness, healing and hope to all, including the underserved. The system is made up of the former Jewish Hospital & St. Mary’s HealthCare and Saint Joseph Health System, along with the University of Louisville Hospital and James Graham Brown Cancer Center. KentuckyOne Health is proud of and strengthened by its Catholic, Jewish and academic heritages.

About University of Louisville/James Graham Brown Cancer Center

The James Graham Brown Cancer Center is a key component of the University of Louisville Health Sciences Center. As part of the region's leading academic, research and teaching health center, the cancer center provides the latest medical advances to patients, often long before they become available in non-teaching settings. The JGBCC is a part of KentuckyOne Health and is affiliated with the Kentucky Cancer Program. It is the only cancer center in the region to use a unified approach to cancer care, with multidisciplinary teams of physicians working together to guide patients through diagnosis, treatment and recovery.

Individuals in the early stages of Huntington’s Disease (HD) or who are at risk of developing it may be able to play a part in efforts to conquer the disease. Patients are invited to apply for participation in SIGNAL, a Phase 2 research trial that will assess the safety, tolerability and effectiveness of VX15, a novel monoclonal antibody that may delay onset or slow the progression of HD.

Kathrin LaFaver, M.D., Raymond Lee Lebby Chair for Parkinson’s Disease Research in the Department of Neurology at the University of Louisville, will lead the study in Louisville, one of 23 sites around the United States participating in SIGNAL. LaFaver also is the director of the Parkinson’s and Movement Disorders Clinic at UofL Physicians.

Animal models have shown that monoclonal antibodies bind to and block a molecule that may cause inflammation in the brain of individuals who develop HD. In addition, VX15 may protect against the inflammation that has been shown to affect the thinking, movement and behaviors that affect HD patients.

Huntington’s Disease is a genetic disorder that causes the progressive breakdown of nerve cells in the brain. It is characterized by personality changes, mood swings, depression, forgetfulness and impaired judgment. Patients experience unsteady gait and involuntary movements (chorea), slurred speech, difficulty in thinking and mood disturbances. HD affects approximately 30,000 Americans and more than 200,000 have the gene that causes the disease. HD is autosomal dominant, meaning that a parent with Huntington’s Disease has a 50/50 chance of passing the gene trait that causes the disease on to his or her children.

The SIGNAL trial is the first time a monoclonal antibody will be investigated for potential treatment of HD. Participants in the trial will receive monthly intravenous infusion of the drug and be monitored with advanced brain scan techniques and analyses utilizing MRI and PET.

“This is a great opportunity for patients in early stages of Huntington’s to be involved in a study that may slow the progression of the disease,” LaFaver said. “The drug was already tested for safety in patients with multiple sclerosis and was well tolerated.”

Trial participants should be individuals who:

• Are at risk for developing HD
• Have undergone genetic testing
• Are thought to be in the early stage of HD
• Are able to undergo brain scans (MRI and PET)
• Are at least 21 years of age

SIGNAL will enroll study participants through the second part of 2016. Participants in the study will receive monthly infusions for 12 months and follow up for an additional three months. Participants will receive study related medical care, tests and drugs used in the study, along with reimbursement for time spent during in-person visits and reasonable travel and lodging costs.

For information on participating in SIGNAL, contact Annette Robinson, RN, BSN, CCRC at 502-540-3585, annette.robinson@louisville.edu.

Individuals also may contact the Huntington Study Group at 1-800-487-7671, email info@hsglimited.org or http://www.huntington-study-group.org.

_{September 21, 2015}

Michael Lovelace, a third-year student at the University of Louisville School of Medicine, has been selected as a member of the inaugural class of the Family Medicine Leads (FML) Emerging Leader Institute, sponsored by the American Academy of Family Physicians (AAFP) Foundation. The FML Emerging Leader Institute was created to identify family medicine residents and medical students who display leadership potential and to provide those individuals with training to help equip them for leadership roles in medicine. From 115 applicants, 15 medical students and 15 family medicine residents (30 total participants) were selected for participation in the year-long leadership development program.

“Michael's achievement in being named to the inaugural class of the Family Medicine Leads Emerging Leader Institute is an outstanding tribute to Michael and to the University of Louisville's commitment to primary care at the national level,” said Diane Harper, M.D., M.P.H., chair of the UofL Family and Geriatric Medicine department.

After obtaining his degree in finance and MBA, Lovelace spent 10 years in business, serving as a project manager and operations manager. Since enrolling in medical school at UofL, Lovelace led the student-run Family Medicine Interest Group and is a student member of the Admissions Committee.

“The FML Emerging Leader Institute intrigued me because it of the opportunity to gain leadership experience in a health-care setting that will complement my business background,” Lovelace said.

Lovelace will work with a mentor to complete an individual project over the next year designed to build his leadership skills. Projects are assigned in one of three tracks:  policy and public health leadership, personal and practice leadership, and philanthropy and mission-driven leadership. Lovelace plans to complete a project in personal and practice leadership based on an idea he proposed to assist medical students, residents and young physicians with personal financial planning.

“Michael is the rare visionary who is at home working on the front lines. He presents and supports family medicine with facts, dedication, humor and a knowledgeable realization of its rightful place in the health-care system,” said Stephen F. Wheeler, M.D., senior faculty member in the UofL Department of Family and Geriatric Medicine.

Selection to the FML Emerging Leader Institute comes with a $1,000 scholarship for attendance at the 2015 AAFP National Conference of Family Medicine Residents and Medical Students in August and the Family Medicine Leads Emerging Leader Institute at the AAFP headquarters in Leawood, Kan. Each of the 30 projects completed by the FML Emerging Leader Institute Scholars will be evaluated by a special AAFP Foundation committee. Creators of the top two student and top two resident projects in each of the three tracks will earn additional $1,000 scholarships and will present their projects at the 2016 AAFP National Conference. The top project in each track will earn a $3,000 scholarship to participate in a designated major event related to their track.

About the American Academy of Family Physicians Foundation

The AAFP Foundation serves as the philanthropic arm of the American Academy of Family Physicians. Its mission is to advance the values of family medicine by promoting humanitarian, educational and scientific initiatives that improve the health of all people.

The University of Louisville School of Medicine recently was ranked third in the nation for career support for its students. The poll, produced by graduateprograms.com, defines career support as the quality of career planning, resources and support received during and after graduate studies.

“This is a very meaningful ranking for us because it says that our students believe we are preparing them for their futures,” said Toni Ganzel, M.D., M.B.A., dean of the UofL School of Medicine. “This is a reflection of the quality work of our Student Affairs leadership and staff and all our faculty as we prepare the next generation of physicians.”

UofL is ranked ahead of schools such as Vanderbilt, Duke, Stanford and the University of Pennsylvania. Ohio State topped the rankings, followed by the University of Southern California.

Graduateprograms.com assigns 15 ranking categories to each graduate program at each graduate school. Rankings cover a variety of student topics, such as academic competitiveness, career support, financial aid, and quality of network. For a given graduate program, rankings are determined by calculating the average score for each program based on the 15 ranking categories. These scores are then compared across all ranked schools for that program and are translated into a final ranking for that graduate program, i.e., business and management. A given graduate program is not ranked until a minimum threshold of graduate student surveys is completed for that graduate program.

UofL also ranked in the top 25 of the graduateprograms.com rankings for Financial Aid.

Faul and Shiels will serve terms on the council expiring in May 2019. The council’s 15 representatives help the Kentucky Department for Aging and Independent Living identify ways to help Kentuckians with memory loss and their families. Council members include representatives from state government, local health departments and Alzheimer’s associations, as well as consumers, health-care providers and medical researchers.

Faul is the executive director of the Institute for Sustainable Health and Optimal Aging (ISHOA) at the University of Louisville and the associate dean for academic affairs at UofL’s Kent School of Social Work. She also is a Hartford Faculty Scholar of the Gerontological Social Work Initiative, a national effort of the John A. Hartford Foundation to address gaps in social work education and research around the health and well-being of older adults.

“Only one-third of people with Alzheimer’s are properly diagnosed and that has a lot to do with awareness,” Faul said. “There needs to be a better way of delivering the diagnosis in a supportive environment. Once we have the diagnosis, the key is to create Alzheimer’s-friendly communities where these individuals and their families are supported and included.”

Shiels is the director of the Kentucky Person-Centered Care Program for Long-Term Care and the director of the Kentucky Emergency Preparedness for Aging and Long-Term Care Program, both administered through UofL’s Kent School of Social Work. She is the institutional director of the UofL Geriatric Education Center and manages the interprofessional training program in Alzheimer’s in collaboration with the UofL Department for Family and Geriatric Medicine, UofL School of Nursing, UofL’s Kent School of Social Work and Spalding University.

“My work focuses on improving quality of care and quality of life for those living in Kentucky's nursing homes, of which 60 to 70 percent have Alzheimer's or related dementia,” Shiels said. “It is impossible to separate nursing home care and Alzheimer's disease.”

As members of the Governor’s Alzheimer’s Disease and Related Disorders Advisory Council, Faul said she and Shiels can work synergistically to promote the understanding, management and prevention of the disease.

May 28, 2015

LOUISVILLE, Ky. – It’s a new weapon in the arsenal of cancer fighting treatments: utilizing genetically modified viruses to invade cancer cells and destroy them from the inside.

University of Louisville researcher Jason Chesney, M.D., Ph.D., deputy director of the James Graham Brown Cancer Center (JGBCC), and a team of international scientists found that stage IIIb to IV melanoma patients treated with a modified cold sore (herpes) virus had improved survival. The results of the findings were published recently in the Journal of Clinical Oncology.

UofL was one of the major sites for the phase III clinical trial involving 436 patients who received the viral immunotherapy, Talimogene laherparepvec (T-VEC). Scientists genetically engineered the herpes simplex I virus to be non-pathogenic, cancer-killing and immune-stimulating. The modified herpes virus does not harm healthy cells, but replicates when injected into lesions or tumors, and then stimulates the body’s immune system to fight the cancer.

“The results from this study are amazing,” Chesney said. “Patients given T-VEC at an early stage survived about 20 months longer than patients given a different type of treatment. For some, the therapy has lengthened their survival by years. ”

Shari Wells from Ashland, Kentucky is one of those patients. She entered the trial in 2010 with stage IV, or metastatic, melanoma. Before entering the T-VEC trial, she had been through numerous procedures and major surgeries. According to Wells, nothing worked and she was facing a death sentence.

“When you hear that you may only have three to six months to live, it is very scary,” Wells said. “I would not be alive today if I had not been accepted into the T-VEC trial. Dr. Chesney and the James Graham Brown Cancer Center saved my life.”

Wells drove to Louisville every two weeks for about two and a half years to receive injections in each of the more than 60 lesions on her leg. The lesions eventually began to fade and finally disappeared. She has been in remission for almost eight years.

“I want everyone to know they should never give up hope. With research there will always be something new tomorrow that wasn’t here today,” she said.

The U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) are considering findings from the trial to make the treatments available to more patients with advanced melanoma.

More Research

The Journal of Clinical Oncology report comes on the heels of Chesney’s findings from another study published this month in the New England Journal of Medicine. The article describes an immunotherapy for melanoma utilizing the checkpoint inhibitors, ipilimumab and nivolumab. In cell biology, their role is to reduce the effectiveness of two immune checkpoint proteins responsible for telling the immune system to turn off and not kill the cancer cells.

The study found that injection of the two inhibitors shrunk tumors in the majority of patients with advanced melanoma. The JGBCC was one of the top centers worldwide to enroll patients and find that ipilimumab combined with nivolumab resulted in the highest anti-cancer efficacy ever observed after treatment with a cancer immunotherapy.

Chesney and his team, working with the pharmaceutical company Amgen, are taking the success of their trials a step further – combining T-VEC with the immune checkpoint inhibitor ipilimumab into a treatment regimen. The clinical trial is underway at the JGBCC and other sites in hopes of accelerating cancer immunity and curing patients.

“We finally understand how to activate the human immune system to clear cancer cells, having developed new classes of immunotherapies that dramatically improve the survival of cancer patients,” Chesney said. “I believe T-VEC combined with immune checkpoint inhibitors will not only reduce cancer-related mortality in melanoma but in all cancer types, and we are moving quickly to develop these methods.”

Learn more about all melanoma and sarcoma related clinical trials at : http://browncancercenter.louisville.edu/pcare-and-clintrials/mel-sarc/melanoma-and-sarcoma or by contacting the Clinical Trials Office, CTOInfo@louisville.edu, 502-562-3429.