News

The black death still has lessons to share

UofL research into bacterium causing bubonic plague yields clues to fighting pneumonia, sepsis
The black death still has lessons to share

A live microscopy image of macrophages, white blood cells that mediate innate immunity, infected with Yersinia pestis, shown in red. UofL photo by Matthew Lawrenz and Tiva VanCleave, a former doctoral student in Lawrenz’s lab.

Bubonic plague may not seem like a significant problem in the world today. While it killed millions of people in Europe in the Middle Ages and was known as the “black death,” it mostly has faded from public concern.

Microbiologists at the University of Louisville study Yersinia pestis, the bacteria that causes bubonic plague, however, because it has the potential to be used as a bioweapon and it provides knowledge that may apply to efforts to defeat other bacteria. Through this work, they have made an important discovery about a molecule secreted by Y. pestis and other bacteria that helps defeat the host’s immune defenses, allowing the bacteria to infect its hosts.

Sarah Price, a doctoral student researcher, and her mentor, Matthew Lawrenz, associate professor of microbiology and immunology, have found that yersiniabactin, a small molecule secreted by Y. pestis, gathers zinc, a necessary element for bacterial replication. This discovery may have implications in other infections as well since bacteria causing pneumonia, sepsis and other illnesses also are known to release yersiniabactin.

“While yersiniabactin’s role in iron acquisition has been well known for over 30 years, we were surprised to see its significant impact on zinc acquisition during Y. pestis infection,” Price said “This is very exciting because it helps us understand how Y. pestis and other bacteria acquire nutrients that allow them to cause disease.”

Invading bacteria as well as the hosts they infect all require iron, zinc and other metals in order to grow. The host’s immune system employs a strategy called nutritional immunity to protect against these bacterial infections, sealing the metals away from the bacteria.

It has been known for many years that yersiniabactin defeats this defense by stealing away iron and delivering it into the bacterial cells. Price and Lawrenz have discovered that the molecule also is involved in securing zinc and perhaps even other metals to assist Y. pestis infection.

Yersiniabactin also is used by Escherichia coli, which causes a multitude of infections such as intestinal illness and kidney infections, and Klebsiella pneumoniae, which causes pneumonia and sepsis. These more common diseases can be life-threatening and multidrug-resistant infections. The new understanding may lead to additional strategies for controlling infection by all of these bacteria.

An article describing the research published Oct. 29 in PNAS provides details about how the researchers determined that yersiniabactin was responsible for the collection of not only iron, but zinc. Price is first author on the publication, “Yersiniabactin Contributes to Overcoming Zinc Restriction during Yersiniapestis Infection of Mammalian and Insect Hosts.” Lawrenz, associate professor of microbiology and immunology, is senior author, and researchers from the University of Kentucky, Washington State University and the University of Illinois also contributed to these studies.

“With this understanding of the broader role of yersiniabactin in plague infection, we can explore further to understand its role in enabling other bacteria to infect a human or other host,” Lawrenz said. “If this mechanism holds true across these bacteria, it may be possible to develop a drug or vaccine that could inhibit yersiniabactin’s effectiveness, thus preventing all of these infections.”

Bubonic plague most often is transmitted to humans through the bite of an infected flea, usually carried by a rodent. By not handling animal carcasses, preventing flea bites and avoiding contact with bodily fluids of those infected, the spread of bubonic plague is largely controlled. However, since human-to-human transmission is possible, mortality from an infection ranges from 30-90% and no vaccine is available to prevent the infection, it remains an important pathogen for research. In addition, Y. pestis, has the potential for weaponization and is considered a bioterrorism threat.

Lawrenz, Price and their colleagues conduct research within the UofL Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases, which focuses on the development of prevention and treatment strategies for infectious diseases and other harmful pathogens. Its researchers utilize the UofL Regional Biocontainment Laboratory, a member of the National Institute of Allergy and Infectious Diseases network of 12 regional and 2 national biocontainment laboratories for studying infectious agents. The lab includes Biosafety Level 3 facilities built to the most exacting federal safety and security standards to protect researchers and the public from exposure to the pathogens being investigated. 

The center’s researchers were called upon in early 2020 to develop tests and prevention and treatment strategies against SARS-CoV-2, the virus that causes COVID-19. This work continues.

Kosair Charities grants $6.4 million to UofL for children’s health programs

Funding continues work that helps families go ‘from feeling hopeless to hopeful’
Kosair Charities grants $6.4 million to UofL for children’s health programs

Luke Madson on a specially designed pediatric treadmill for therapy at the Kosair Charities Center for Pediatric Neurorecovery

The Kosair Charities Center for Pediatric NeuroRecovery at the University of Louisville brings about recovery for children with spinal cord injuries through therapies developed by the center’s director, Andrea Behrman, professor in the UofL Department of Neurological Surgery, and her team within the Kentucky Spinal Cord Injury Research Center.

Kosair Charities, which supported the program at its inception in 2014, has extended that support through 2026 with a new grant for $5.5 million over five years.

Children in the clinical and research programs of the Center for Pediatric NeuroRecovery are treated with innovative, science-based therapies such as activity-based locomotor training, neuromuscular electrical stimulation and transcutaneous spinal stimulation. These therapies have led to improved strength, abilities and overall health for the children in ways their families thought would not be possible.

“We went from feeling hopeless to hopeful after just one conversation with Dr. Behrman,” said Kylee Hoelscher who, with her husband and older daughter, moved from California to Louisville in 2016 so their then-six-year-old daughter Eden could continue therapy.

“This is the only program in the world that offers hope for children with a spinal cord injury,” Hoelscher said. “When she started, Eden could not even sit up on her own and attended school at home. Now she goes to school independently and has sleepovers with friends. She rock climbs. She plays tennis. What they’re doing for her is life-changing.”

“We are grateful to Kosair Charities for their continued support for the Center for Pediatric NeuroRecovery, a remarkable program that gives hope for recovery to children with spinal cord injuries – hope and care they can find almost nowhere else,” said UofL President Neeli Bendapdudi. “This support, along with that of other pediatric research and clinical care programs at UofL, will help us fulfill our commitment to advancing our health, not only for children in Louisville and Kentucky, but the world over.”

In addition to the multi-year $5.5 million in new funding for pediatric neurorecovery, Kosair Charities has designated $900,000 this year for other pediatric programs at UofL:

  • $475,000 for the Kosair Charities Division of Pediatric Forensic Medicine, led by Melissa Currie, professor of pediatrics, to support education, research and advocacy to help curb all forms of child maltreatment.
  • $225,000 to purchase cardiorespiratory monitors at the UofL Health – UofL Hospital Neonatal Intensive Care Unit, led by Tonya Robinson. These cardiorespiratory monitors provide real-time and trended vital signs, allowing for a comprehensive evaluation of an infant’s current status and of changes occurring before a devastating event. The monitors assist in determining the causes of medical events and help prevent them from happening again.
  • $200,000 for pediatric cancer immunotherapy research at UofL Health – Brown Cancer Center, directed by Jason Chesney, that will allow the center to build on the cancer immunotherapy drug discovery work begun in 2020 that already has revealed new small-molecule inhibitors.

“Everything we do is for children, whether it be with spinal cord injuries, cancer, those born prematurely, or vulnerable – every child who has specialized needs – they are the motivation behind everything we do,” said Keith Inman, president of Kosair Charities. “There’s no better investment than the children in our community, and we simply cannot do this work without partners like the University of Louisville. The partnership of UofL and Kosair Charities helps ensure so many children have the healthiest lives possible.”

At the Center for Pediatric NeuroRecovery, the funding from Kosair Charities will support further advances in therapy for children with spinal cord injury, as well as research and training for future researchers and providers. It also will enable the program to accept younger and medically complex children, develop a teen-focused recovery-based program and study neuromodulation, a way to stimulate the spinal cord and improve mobility and health.

“Children with spinal cord injury are at risk for multiple medical and health complications. This grant from Kosair will allow us to expand our focus to improve areas of their health beyond movement,” Behrman said. “This will not only get these children physically better but help them have a healthy life.”

The Madson family also relocated to Louisville for this program, moving from the Minneapolis area to ensure their son Luke could continue the therapy, based at UofL Health – Frazier Rehab Institute.

“The more Luke moves, the more alive he is,” Sarah Madson said of her now-two-year-old son, who was the youngest child to start the program at 15 months. “When we arrived, he was crawling on the ground, maybe doing little circles, with no forward movement. He is now walking in a walker everywhere and engaging with the world. This program has meant everything to us.”

The grant announced today brings Kosair Charities’ total support for the center to $13 million.

In April, UofL and Kosair Charities celebrated a milestone of topping $50 million in gifts from Kosair Charities to UofL since 1982. The grants announced today bring that total to $56.8 million.

First-in-world heart implant: Woman receives novel type of artificial heart at UofL Health – Jewish Hospital by University of Louisville physicians

First-in-world heart implant: Woman receives novel type of artificial heart at UofL Health – Jewish Hospital by University of Louisville physicians

Cardiothoracic surgeons with UofL Health – Jewish Hospital and the University of Louisville performed the world’s first Aeson® bioprosthetic total artificial heart implantation in a female patient on Sept. 14, 2021. Photo by UofL Health.

A cardiothoracic surgical team with UofL Health – Jewish Hospital and the University of Louisville has performed the world’s first Aeson® bioprosthetic total artificial heart implantation in a female patient. The investigational device, currently intended as a bridge to heart transplant, is part of an Early Feasibility Study (EFS) sponsored by CARMAT, a French medical device company, in partnership with UofL, UofL Health – Jewish Hospital and the UofL Health – Trager Transplant Center.

Led by cardiothoracic surgeons Mark Slaughter, M.D., and Siddharth Pahwa, M.D., both of UofL Health - UofL Physicians and the UofL School of Medicine, the team performed the implant of the device on Sept. 14, 2021 at UofL Health – Jewish Hospital. The same team completed the nation’s second implantation in a male patient last month, also at Jewish Hospital.

“For the other half of the world’s population, completion of this procedure by the Jewish Hospital team brings new hope for extended life,” said Slaughter, UofL Health surgical director of heart transplant and professor and chair of the Department of Cardiovascular and Thoracic Surgery in the UofL School of Medicine. “Size limitations can make it harder to implant artificial hearts in women, but the Aeson artificial heart is compact enough to fit inside the smaller chest cavities more frequently found in women, which gives hope to a wider variety of men and women waiting for a heart transplant and increases the chances for success.”

More than 3,500 individuals are awaiting a heart transplant in the U.S. and 900 of them are women. There are few treatment options for patients with biventricular heart disease, meaning both the left and right sides of the heart are not pumping blood adequately. The Aeson device is designed to solve the limitations of current left-ventricular assist devices (LVAD), which pump blood in just one chamber, by pumping blood in both heart chambers. Aeson also contains pressure sensors that estimate the patient’s blood pressure and automatically adapts cardiac output according to the sensor information. It is fully implanted as a heart replacement and powered by a portable external power supply.

During this procedure, the Aeson total artificial heart was implanted into a 57-year-old Kentucky woman with severe biventricular heart failure during an eight-hour surgery. The recipient, whose identity is being withheld upon request, was referred to the Advanced Heart Failure Therapies Program at Jewish Hospital earlier this year with end-stage heart failure and had undergone cardiac surgery years before. The patient is recovering well in the cardiovascular intensive care unit (CVICU). Jewish Hospital is just one of four programs in the nation approved to perform this clinical trial procedure.

“The varying pumping ability of the Aeson device increases its viability among more patients,” said Pahwa, UofL Physicians cardiothoracic surgeon and assistant professor in the UofL Department of Cardiovascular and Thoracic Surgery. “While other devices are set at a fixed rate or create a continuous flow, CARMAT has developed the Aeson to automatically adjust the flow, creating an improved performance to meet the body’s changing blood flow needs.”

Currently, the Aeson artificial heart is tested as a bridge to transplant for patients with end-stage biventricular heart failure, allowing more time for the patient to receive a permanent heart organ transplant. The device already has been approved for such use in Europe, where approximately 20 devices have been implanted. It currently is being tested in the U.S. as part of a feasibility study approved by the Food and Drug Administration. The first Aeson artificial heart in North America was implanted in a male patient in July at Duke University Medical Center. The second implantation, also in a male patient, was performed at Jewish Hospital in August. This third North American implantation is the first to involve a female patient.

“Even as we have fought this deadly pandemic, our researchers and health care providers have also been on the front lines of improving care and quality of life for not only Kentuckians, but for people around the world,” said Kentucky Gov. Andy Beshear. “I am proud that UofL, Jewish Hospital and their doctors are leading the world in implanting this promising and innovative device that could offer hope and time to thousands of people, including our wives, mothers and other loved ones, in coming years.”

Stéphane Piat, chief executive officer of CARMAT, said, “This third implant in the U.S. was a landmark event not only because it allowed us to finalize the enrollment of the first cohort of patients of the EFS, but very importantly because it is the first time ever that our device has helped a woman suffering from heart failure. This achievement confirms that the size limitations for adults are minimal, which makes us very confident in Aeson’s potential to become a therapy of choice for a broad patient population.”

Preclinical research for CARMAT’s artificial heart began at UofL more than five years ago. Researchers at UofL’s Cardiovascular Innovation Institute (CII) tested Aeson’s autoregulation capability, which allows the device to adapt its flows according to the patient’s needs by detecting changes of pressure in the device. UofL researchers have conducted preclinical testing of artificial heart components and mechanical assist devices at CII for many years, testing some portion of nearly every mechanical assist device that is commercially available today.

Jewish Hospital and the University of Louisville share a storied history in advancing heart care. Highlights include:

  • Aug. 24, 1984: Kentucky’s first heart transplant performed at Jewish Hospital by UofL physicians
  • July 2, 2001: The world’s first AbioCor® artificial heart was implanted at Jewish Hospital by UofL physicians, led by cardiothoracic surgeon Laman Gray, M.D.
  • Dec. 21, 2011: Kentucky’s first transcatheter aortic-valve replacement (TAVR) performed at Jewish Hospital by UofL physicians
  • Jan. 18, 2015: Kentucky’s first HeartMate 3TM left ventricular assist device (LVAD) implanted at Jewish Hospital by UofL physicians
  • Feb. 21, 2018: UofL Health - Trager Transplant Center’s 500th heart transplant performed at Jewish Hospital
  • June 14, 2019: The first EvaHeart®2 LVAD implanted as bridge to transplant at UofL Health - Trager Transplant Center
  • April 22, 2021: UofL Health - Trager Transplant Center’s 1000th TAVR performed at Jewish Hospital

“This world-first artificial heart implant into a female patient is another demonstration of UofL Health’s commitment to provide both the world-class care of today and develop the world-class standards of tomorrow,” said John Walsh, chief administrative officer of Jewish Hospital. “We celebrate this first as a milestone and recognize the hard work of Drs. Slaughter and Pahwa and the entire team. The true impact of their work will be measured in the dozens, hundreds and thousands of lives improved in the years to come.”

The patient who received the nation’s second Aeson implant, on Aug. 20, 2021, continues to improve at Jewish Hospital. An update is expected in the coming weeks.

UofL Health – Frazier Rehab Institute to celebrate new location for unique Louisville accessible fitness gym

UofL Health and Louisville leaders are celebrating the new home of UofL Health – Frazier Rehab Institute's Community Fitness and Wellness gym, now located on the ground floor of Medical Plaza II, 250 E. Liberty Street. The UofL Health – Frazier Rehab Institute team provides rehabilitation services through a wide-variety of inpatient and outpatient programs for adults and children with disabling conditions including, but not limited to brain injury, spinal cord injury, stroke, and movement disorders.

“Quality care for those living with physical impairments is now even more accessible,” said Tom Miller, CEO of UofL Health. “Our mission is to build a stronger community by improving the health and quality of life for everyone we serve. This is yet another example of our commitment to do just that.” 

The CFW is a fully wheelchair-accessible community gym with state-of-the-art equipment and professional staff trained to provide specialized activity-based exercise interventions for people with disabilities. Individualized exercise plans are developed to meet each client’s personal fitness goals.

“Over the past seven decades, Frazier Rehab has become a recognized leader in rehab care both regionally and nationally,” said Cathy Spalding, Chief Administration Officer of Frazier Rehab Institute. “Frazier Rehab has helped thousands of people regain both mental and physical strength that they thought would be nearly impossible to get back after their illness or injury.”

In 2006, Elizabeth Fust suffered a spinal cord stroke that left her paralyzed. She has been a member of the CFW gym since it first opened back in 2007. Fust is also currently serving on the UofL Health - Frazier Rehabilitation Institute Board of Trustees and is the founder of the 501(c)(3) charity,  Gathering Strength, Inc., in Louisville.

“The CFW gym has been vital to maintaining and improving my health because it is the only place in Louisville that has wheelchair accessible exercise equipment and specially trained staff who are not afraid to work with people like me, who have disabling conditions,” Fust said. “It is unique also because it offers an opportunity for me to be around many people who have similar injuries and challenges, and we can support each other.”

This year the CFW moved to the ground floor of Medical Plaza II from Frazier Rehab’s 9th floor gym, located at 220 Abraham Flexner Way. The new location is not only more accessible, but also offers opportunities to grow and expand services. Thanks, in part, to a $190,000 dollar grant from the Craig H. Neilsen Foundation the CFW is upgrading equipment, further marketing the program, and growing its membership through a partnership with Gathering Strength, Inc.

“Through our Creating Opportunity & Independence (CO&I) portfolio, the Craig H. Neilsen Foundation is proud to support UofL Health – Frazier Rehab Institute’s Community Fitness and Wellness gym and the vital opportunities it provides to enhance the health and wellbeing of people living with spinal cord injury,” said Darrell Musick, CO&I Program Officer.

To learn more about UofL Health – Frazier Rehab Institute's Community Fitness and Wellness gym, visit UofLHealth.org or call them at 502-582-7411.

Neal Dunlap tapped to lead Department of Radiation Oncology

Neal Dunlap tapped to lead Department of Radiation Oncology

Neal Dunlap, M.D.

Neal Dunlap, M.D., on October 1 will become the new Chair of the University of Louisville Department of Radiation Oncology.

Dr. Dunlap served as Vice Chair and Professor of the Department of Radiation Oncology before accepting his new role. In addition, he serves as the Residency Program Director for the department since 2017 and Associate Director of the Head & Neck Multidisciplinary Clinic. Previously, he held an academic endowed chair appointment through Humana Professorship in Clinical Trials Research at the UofL Brown Cancer Center.

"The Department of Radiation Oncology consists of a group of dynamic faculty and staff who are committed to the advancement of cancer care in Louisville and the Commonwealth.  I am excited by the prospect of deepening our relationship with this community to expand access to advanced cancer care and clinical trials, train the next generation of physicians, and promote patient health and dignity," Dunlap said of accepting his new role.

Dr. Dunlap earned his medical degree from the University of Cincinnati College of Medicine. He completed his internship at University of Cincinnati’s University Hospital, and his residency at the University of Virginia Medical Center in Charlottesville. His clinical focus is primarily on multidisciplinary approaches to the treatment of lung cancer, esophageal cancer, head & neck cancers, and liver cancers. His research interests include the application of new treatment technologies in treatment of lung, liver, and head & neck malignancies to improve outcomes and reduce side effects. He currently has investigator-initiated trials open for the re-treatment of lung cancers after previous radiation and the evaluation of early radiation-induced lung injury with 4-dimensional CT. He is currently the institutional principal investigator for multiple national cooperative group studies through NRG/RTOG in the treatment of lung and head & neck cancers. He is member of the American Society for Radiation Oncology.

“I am confident that Dr. Dunlap has the leadership skills, experience and expertise to build on current strengths of the department and to also move it forward in innovative ways,” said Toni Ganzel, M.D., M.B.A., dean of the School of Medicine.

Long-time UofL staff and faculty member joins School of Medicine as Chief of Staff

Long-time UofL staff and faculty member joins School of Medicine as Chief of Staff

Glenn Gittings, Ph.D.

The University of Louisville School of Medicine has named Glenn Gittings, PhD., as its new Chief of Staff.

In this position, Gittings will provide support with planning, monitoring and implementing the strategic agenda for the school, serving in the capacity of advisor to Dean Toni Ganzel in interactions with colleagues across the schools and institution to ensure institutional alignment with strategic initiatives. He will collaborate with senior leaders and executives, external affiliate leadership, and other external partners on projects that support the missions and strategic priorities, including enterprise alignment, strategic planning, security and other compliance initiatives. Gittings will also lead the School of Medicine Advancement, Retention and Training (SMART) Staff Development Program designed to engage staff in professional and personal development efforts through a number of new initiatives such as mentoring, professional development, community outreach and engagement, recognition and reward, wellness, and a staff retreat.

“I am thrilled to welcome Dr. Gittings to our administrative team. He brings a great deal of experience in the areas of strategic planning, staff development and stakeholder relations, which will provide tremendous support to the School of Medicine priorities of supporting our faculty, residents, staff and students,” said Toni Ganzel, M.D., M.B.A., dean of the School of Medicine.

A long-time staffer and faculty member, Gittings has spent the last 19 years in progressive higher education and the nonprofit sector with experiences at multiple institutions and organizations. He previously served as the Director of the Student Activities Center & Special Programs on the Belknap campus at the University of Louisville where he fulfilled the role of student union management, First Year Initiative programming, Parent & Family Relations, and External Relations for the division of Student Affairs. Gittings has previous higher education experience in Advancement/Development, Alumni Relations, Assessment, Diversity & Inclusion, Educational Nonprofits, Enrollment Management, External Relations, Event Planning, HR, International Service Learning Program Faculty (Philippines, Trinidad & Tobago), Parent & Family Relations, SACS Accreditation, Sponsorships, Staff Senate, Strategic Planning, Student Union Mgmt., VPSA Special Projects, and Welcome Week/First Year Experience. He also served as a UofL Staff Senator including a role on the Staff Senate Executive Committee.

Gittings is very active in regional and national professional organizations through research opportunities, publications, committee membership, conference presentation, and conference attendance. He served nationally as chair of the NASPA Student Affairs Fundraising and External Relations Knowledge Committee, publishing books, articles, online short courses, and conference presentations on the topic of higher education fundraising. For more than 10 years, he has been a long-standing graduate Adjunct Faculty member for UofL’s College of Education in both the Higher Education Administration program and the College Student Personnel program.   

Gittings earned both his bachelor’s degree and Ph.D. from University of Louisville and master’s degree from Western Kentucky University and his dissertation research highlighted key student and institutional factors affecting doctoral student persistence.  He and his spouse, Jennifer, have two daughters ages 10 and 7.

Gittings began his new role August 2.

UofL researchers find more health benefits of living in a greener environment

UofL Green Heart Project needs new participants from South Louisville neighborhoods for study on how greenness affects health
UofL researchers find more health benefits of living in a greener environment

Trees are planted in South Louisville for the UofL Green Heart Project, an ongoing assessment of the effects of neighborhood greenness on individual health.

Evidence is growing that living in areas of high greenness, surrounded by trees, shrubs and other vegetation, has beneficial effects on human health. Researchers at the University of Louisville’s Christina Lee Brown Envirome Institute and other colleagues recently published two studies showing positive effects of greenness: one on cancer survival and the other on depressive symptoms.

In the first study, UofL researchers Aruni Bhatnagar, professor of medicine and director of the Envirome Institute, Ray Yeager and Daniel Riggs, with Carver Coleman and Arden Pope of Brigham Young University and others, analyzed retrospective data from more than 5.5 million cancer patients and survivors from 2003 to 2016. They found that cancer patients in greener counties lived longer than those in counties with less greenness. The protective effects of greenness against cancer mortality were seen with both males and females and individuals of all ages, but were more pronounced at urban locations. Individuals with cancers that were highly survivable – such as breast, prostate and skin cancer – benefitted more from greenness than those with cancers with low survival rates such as brain, esophageal, liver, lung and pancreatic cancer.   

The study, “Greenness, air pollution, and mortality risk: A U.S. cohort study of cancer patients and survivors,” published in the journal Environment International, evaluated associations between greenness and fine particulate matter in the air on causes of death in a large group of cancer patients and survivors in the United States.

“This is the largest study of the relationship between greenness and cancer mortality, and it provides clear evidence that living in green areas is beneficial to cancer patients,” said Bhatnagar “However, we do not yet understand why greenness protects against cancer mortality. Much more remains to be done to see whether greenness benefits cancer patients by lowering mental stress and anxiety or by reducing the levels of air pollutants or whether some other mechanisms are at play.”

The study also found that cardiopulmonary disease, but not cancer, was associated with higher levels of fine particulate air pollution. Mortality from cardiopulmonary causes – stroke, heart attack or COPD – was not affected by county greenness, except in rural locations.  

Greenness and depression

A second study, led by Kandi Walker and Joy Hart, professors in the UofL Department of Communication, Bhatnagar and other researchers in the Envirome Institute, found that people’s satisfaction with levels of greenness in their neighborhood was associated with lower levels of self-reported depressive symptoms.  

The researchers surveyed participants about their perceptions of greenness in their neighborhoods and their mental health symptoms and found that those who were more satisfied with the greenness surrounding their homes also reported lower depression symptoms on a health survey, the Patient Health Questionnaire-9.

The 44.5% of survey participants who reported they were satisfied with the level of greenness in their neighborhood collectively scored better on the health questionnaire for depression.

“Given the pervasiveness of depression in the U.S. population, any changes that can reduce depression are essential, particularly those that can affect a large number of people,” Hart said. “The findings of this study suggest that greening interventions that focus on greenness satisfaction may be a strategy to reduce depression in urban populations.”

The study, “The importance of urban planning: Views of greenness and open space is reversely associated with self-reported views and depressive symptoms,” was published in July in the journal Population Medicine.

South Louisville study participants needed

Participants in the greening satisfaction study were part of the Health, Environment and Action in Louisville (HEAL) study of the Great Heart Project, which is an ongoing assessment of the effects of neighborhood greenness on individual health. Additional participants are needed for the HEAL Study by the end of September. More information is available on the HEAL Study website.

“Together, these studies add weight to the importance of trees, shrubs and other vegetation in urban areas in benefitting and nurturing human health. Accumulation of such evidence strengthens the case that increasing greenness in urban locations can decrease the high rates of non-communicable diseases in cities,” Bhatnagar said. “And since greenness improves health in general, it may also be effective against infectious disease.”

University of Louisville cardiac surgery team second in U.S. to implant new artificial heart

Device is a new-generation bridge to transplant for patients with disease on both sides of the heart
University of Louisville cardiac surgery team second in U.S. to implant new artificial heart

Mark Slaughter, M.D.

A University of Louisville cardiac surgery team at UofL Health - Jewish Hospital is the second in the United States to implant a new experimental advanced total artificial heart within the framework of an early feasibility study.

The team, led by Mark Slaughter, M.D., professor and chair of the Department of Cardiovascular and Thoracic Surgery in the UofL School of Medicine and lead cardiothoracic surgeon at UofL Health – Jewish Hospital, performed the implant of the investigational device on Aug. 20.

The artificial heart, Aeson®, developed by French medical device company CARMAT, serves as a bridge to transplant for patients with end-stage biventricular heart failure – heart disease affecting both left and right sides of the heart – allowing more time for the patient to receive a permanent heart organ transplant. More than 3,400 individuals in the U.S. currently are awaiting a heart transplant and there are few other treatment options for patients with biventricular heart disease.

“We are excited to bring this new technology to patients in Kentucky and the surrounding region and be one of the first U.S. centers to implant this new total artificial heart,” Slaughter said. “This device has the potential to save the lives of critically ill patients suffering from biventricular heart failure who currently have very limited treatment options.”

The new total artificial heart was implanted into a middle-aged man from Southern Indiana with severe biventricular heart failure during a seven-and-a-half-hour surgery. The recipient, whose identity is being withheld upon request, was referred to the advanced heart failure program at Jewish Hospital. The patient currently is doing well in the cardiac surgery ICU.

The new device is designed to solve limitations of left-ventricular assist devices (LVAD), which pump blood in just one chamber, by pumping blood in both heart chambers. Aeson also contains biosensors that detect the patient’s blood pressure and position and automatically adapts cardiac output according to the sensor information. It is fully implanted as a heart replacement and powered by a portable external power supply.

“We are honored that our device is implanted at UofL Health - Jewish Hospital, which is recognized throughout the United States for its quality of care and cardiovascular research” said Stéphane Piat, chief executive officer of CARMAT. “I would like to congratulate the teams at the Jewish Hospital, the University of Louisville, as well as our technical and medical staff, on this exceptional milestone for both patients and our company.”

The device is medically approved in Europe, where approximately 20 have been implanted. The first Aeson artificial heart in North America was implanted in July at Duke University.

This is not the first time University of Louisville physicians and Jewish Hospital have made artificial heart history. Just over 20 years ago, on July 2, 2001, UofL cardiothoracic surgeon Laman Gray led the surgical team that implanted the first self-contained artificial heart in the United States at Jewish Hospital. The AbioCor artificial heart was implanted into Robert Tools, who lived five months on the device. The UofL surgical team also performed the first heart transplant in Kentucky at Jewish Hospital in 1984.

Renowned cardiac imaging and atherosclerosis prevention researcher joins UofL School of Medicine as chief of cardiology

Renowned cardiac imaging and atherosclerosis prevention researcher joins UofL School of Medicine as chief of cardiology

Dinesh Kalra, M.D., chief, University of Louisville Division of Cardiovascular Medicine

Dinesh Kalra, M.D., will join the faculty of the University of Louisville Department of Medicine as chief of the Division of Cardiovascular Medicine on Sept. 1. He also will serve as professor of medicine and Endowed Chair of Cardiovascular Innovations.

Kalra comes to UofL from Rush University Medical Center in Chicago, where he was director of advanced cardiac imaging, director of the infiltrative cardiac disease program and director of the lipid clinic. He is internationally renowned for his work in advancing the understanding of cardiac computerized tomography (CT) and magnetic resonance imaging (MRI), and lipidology, especially as it relates to finding new ways to prevent atherosclerosis.

“I am proud to be part of an exceptional institution like UofL with a rich history and tradition of excellence, innovation and research,” Kalra said of his new role at UofL. “The program has a very strong reputation for clinical training and outstanding patient care. The resident and fellow teaching and the service to the community are outstanding. The opportunity to lead such an outstanding division was appealing, and I have no doubt it will achieve national excellence in multiple areas over the next few years.”

Kalra will use his clinical operations, leadership and education experience to support the UofL cardiology faculty and staff as well as grow and lead the cardiovascular medicine service line across the UofL Health System. 

“With Dr. Kalra at the helm of the UofL cardiology team, I am confident that we will deliver on building upon our successful history of cardiovascular care and scale new heights of innovative and accessible care for our patients,” said Kristine Krueger, professor and interim chair of the UofL Department of Medicine. “He is an experienced physician with a demonstrated history of building successful programs in academic cardiology, skilled in patient-care delivery, change leadership and lean management processes. His arrival at UofL will catalyze our progress forward in transitioning cardiology to meet our future needs.”

Jason Smith, chief medical officer of UofL Health, said Kalra will infuse new energy and talent into the cardiology units and related disciplines at UofL health.

“He is uniquely well suited to lead UofL cardiology academic group during this unprecedented time,” Smith said. “His clinical and leadership experience will be invaluable in optimizing interdisciplinary care along the continuum, as consumers and clinicians navigate new paradigms in health care stemming from the recent COVID-19 pandemic and new models of cardiovascular care delivery. The new chief will shape the growth of cardiovascular services and, in collaboration with community cardiology leaders, will be intimately involved in developing and executing a strategic plan for integrated cardiovascular care across the UofL Health system.”

Kalra is a graduate of All India Institute of Medical Sciences where he completed his MD with honors. He then completed his residency in internal medicine in the MERIT pathway at Baylor College of Medicine in Houston. He stayed on for his fellowship in cardiology at Baylor, graduating with advanced training in cardiac imaging (echocardiography and nuclear cardiology). Prior to his arrival UofL and term at Rush, Kalra served at Baylor College of Medicine and Lahey Clinic. He is board-certified in cardiology, cardiovascular CT and MRI, echocardiography, nuclear cardiology and lipidology.

UofL School of Medicine residency program fuels physician supply for smaller communities, while offering career options to new doctors

UofL School of Medicine residency program fuels physician supply for smaller communities, while offering career options to new doctors

Glasgow Family Medicine Residency program 2021 graduates, left to right, Dillon Pender, Lauren Hansen, Laura Inabnitt and Emily Marsh.

While Elizabethtown, Kentucky, native Dillon Pender was a medical student at the University of Louisville, he realized that life and medical practice in an urban setting were not a good fit for him.

So, he chose a family medicine residency program that was close to his hometown and offered the environment of a community-based hospital.

“The Glasgow Family Medicine Residency is the best of both worlds,” Pender said. “As part of UofL, it offers the privileges and resources of a major institution, and as a community hospital, it provides the autonomy you can only have outside a large health care system.”

And now that Pender has completed his residency, he plans to stay in Glasgow, serving as a hospitalist at T. J. Samson Community Hospital and caring for the community’s population. That is a win both for the community of Glasgow and the Commonwealth of Kentucky.

A shortage of physicians has threatened the health of residents in rural communities in Kentucky for more than three decades. Approximately 40% of Kentuckians live in rural areas, yet only 17% of primary care physicians practice there, and Kentucky ranks 43rd nationally in its supply of primary care physicians relative to its population.

Primary care physicians – those in family medicine, internal medicine, pediatrics or other general health disciplines – ensure access to cost-effective management of illness and disability. Since more than half of physicians practice within 100 miles of where they do their residency training, it is important for physicians to train in the smaller communities where they are needed.

The UofL School of Medicine leads two family medicine residency programs in smaller communities in the state so that small and rural communities in Kentucky and beyond have access to primary care physicians.

The Glasgow Family Medicine Residency Program trains resident physicians in the south-central Kentucky community of approximately 14,000, preparing them to practice in a similar small or rural community. Glasgow’s T.J. Samson Community Hospital is the primary clinical training site for the residency program and was named one of  the Top 100 Rural & Community Hospitals for 2021 by the Chartis Center for Rural Health.

R. Brent Wright, associate dean for rural health innovation at UofL, was director of the Glasgow Family Medicine Residency Program from 2002 to 2013.

“In terms of a residency program, if you have a community that embraces graduate medical education, like Glasgow has done, they are taking a long-term approach for serving their stakeholders, ” Wright said.  “They are making a commitment to those they treat for decades to come. They know that by training physicians in a close-knit and caring community, they will most likely stay within that community, close by or in a similar setting.”

The program’s 24-year track record bears out its mission. Approximately 70% of the more than 80 physicians who have completed training in the program still practice within a 90-minute drive of Glasgow, including Wright, Pender, a 2021 graduate, and Kara Gilkey, who now leads the hospital’s emergency department.

Building on the success of the Glasgow program, Wright assisted with the creation of the University of Louisville Owensboro Family Medicine Residency Program, launched in 2020. As the academic sponsor for the program, UofL provides not only experience, but residency director Jon Sivoravong and other faculty. The three-year program currently has 13 residents and is approved for up to 18, graduating an average of six family medicine physicians per year.

UofL medical students also can become familiar with rural medicine during their medical school years. Through the School of Medicine’s Trover Rural Track, UofL medical students can complete their final two years of medical school in Madisonville, a community of about 20,000 in southwestern Kentucky. Currently, 51% of Trover students who have completed their training initially chose a rural practice, and 48% of students from rural Kentucky are now in a rural Kentucky practice.

“To get physicians to practice in a small town, you have to admit students who are from a small town and train them in a small town,” said William Crump, associate dean of Trover Campus for the UofL School of Medicine.

Crump and his colleagues at UofL and Baptist Health Madisonville also prepare students from rural Kentucky communities for careers in health care through the High School Rural Scholars and College Rural Scholars programs. Of the 290 students who have participated in High School Rural Scholars, 75% have completed some type of health career training program. Of 97 students who have completed the College Rural Scholars program, 50 are either enrolled or have graduated from medical school.

For Pender, living and practicing in Glasgow is the right choice. He said many physicians who practice in urban areas are missing out on great opportunities in smaller communities, citing less traffic, a lower cost of living and friendlier people, as well as a wider scope of practice for primary care physicians since access to sub-specialty care is not as readily available. 

“For most of the physicians in an urban environment, the countryside is not on their radar. They think there is nothing here,” Pender said. “But there is a lot of opportunity here and you can make a good life.”

UofL researchers lead call to increase genetic diversity in immunogenomics

UofL researchers lead call to increase genetic diversity in immunogenomics

Corey Watson, Ph.D., Melissa Smith, Ph.D., and Oscar Rodriguez, Ph.D.

Historically, most large-scale immunogenomic studies – those exploring the association between genes and disease – were conducted with a bias toward individuals of European ancestry. Corey T. Watson, Ph.D., assistant professor in the University of Louisville Department of Biochemistry and Molecular Genetics, is leading a call to actively diversify the genetic resources he and fellow immunogenomics researchers use in their work to advance genomic medicine more equitably.

Watson, along with UofL post-doctoral fellow Oscar Rodriguez, Ph.D., and visiting fellow Yana Safonova, Ph.D., are part of an international group of researchers who say the narrow studies limit their ability to identify variation in human adaptive immune responses across populations.

“We need to better understand how genetics influences immune system function by studying population cohorts that better represent the diversity observed across the globe if we are to fully understand disease susceptibility, as well as design more tailored treatments and preventative measures,” Watson said.

In an article published in Nature Methods, Diversity in immunogenomics: the value and the challenge, the group advocates for resources used in immunogenomics research to actively include and specifically identify additional populations and minority groups. They say such diversity will make their research more relevant and help in understanding population and ancestry-specific gene-associated disease, leading to improvements in patient care.

"As scientists, we have a say in which populations are investigated. Therefore, it is critical for us to be actively inclusive of individuals representative of the world we live in. This is especially critical for genes that are as diverse and clinically relevant as those that encode antibodies and T cell receptors," Rodriguez said.

Watson’s research focuses on immune function and molecular genetics. His team is studying a specific area of the genetic code that controls antibody function to better understand how differences in an individual’s genes determine their susceptibility to certain diseases or immune responses to vaccines.

In collaboration with Melissa Smith, Ph.D., assistant professor in the Department of Biochemistry and Molecular Genetics, the team is conducting the largest sequencing efforts of the antibody gene regions in humans and in animal models, Watson said.

“Specifically in humans, we are working to build catalogs of genetic variation in samples from multiple ethnic backgrounds and are engaged in projects that seek to understand how this genetic variation influences the immune response in infection, vaccination and other disease contexts,” he said.

Watson is involved in efforts to improve the resources and data standards for antibody and T cell receptor genes for immunogenomics researchers around the world.

The article in Nature Methods was co-authored by researchers from the United States, Canada, Norway, France, Sweden, the United Kingdom, Russia, Saudi Arabia, Israel, South Africa, Nigeria, Chile, Peru, China, Japan, Taiwan and French Polynesia with expertise in biomedical and translational research, population and public health genetics, health disparities and computational biology as well as immunogenomics.

UofL, UK and Kentucky Department for Public Health receive CDC grant to improve stroke care, outcomes in Kentucky

UofL, UK and Kentucky Department for Public Health receive CDC grant to improve stroke care, outcomes in Kentucky

Kerri Remmel, MD, PhD

The University of Louisville, UK HealthCare, the Kentucky Department for Public Health’s Heart Disease and Stroke Prevention Program (KHDSP) and other state partners have been awarded the prestigious Paul Coverdell National Acute Stroke Program Grant by the Centers for Disease Control and Prevention. This $1.8 million grant aims to optimize both stroke prevention among those at high risk as well as improve the care and outcomes for stroke patients throughout Kentucky.

The three-year grant will allow the coordination and expansion of existing efforts to improve stroke-related health outcomes. Kentucky health care systems and community providers will work together to implement comprehensive stroke systems for those at high risk for stroke and those who have had a stroke. 

“This program will allow expansion of our statewide efforts to serve rural and underserved citizens of the Commonwealth, to reduce disparities and monitor our progress,” said Kerri S. Remmel, chair of the UofL Department of Neurology, director of the UofL Hospital Stroke Center and co-chair of the KHDSP Task Force. “The program will facilitate continuous quality improvement in the full continuum of care from the moment a patient has a stroke through their emergency services, hospitalization and rehabilitation to their outpatient preventive care. We are extremely enthusiastic about collaborating with our partners in the Coverdell Program to improve stroke systems of care in Kentucky.”

“This award validates the voluntary efforts of stroke center personnel, EMS representatives, community partners, KHDSP staff and colleagues in public health, as well as all other stakeholders who have worked tirelessly across geopolitical boundaries in a collaborative effort to advance stroke systems of care in our state,” said Kari Moore, chair of the Stroke Encounter Quality Improvement Project (SEQIP) and project co-investigator. “We are excited to continue to build upon these efforts supported by the Coverdell award.”

KHDSP and SEQIP have made significant strides over the last 10 years improving stroke systems of care in the Commonwealth and growing access to stroke care by increasing the number of certified stroke centers in the state, increasing delivery of acute stroke treatments that can reverse or minimize stroke deficits and sharing best practices to help facilitate care delivery during hospitalization and after discharge.

This grant will coordinate and expand existing efforts in Kentucky to improve stroke-related health outcomes by working with Kentucky health care systems and community providers to implement comprehensive stroke systems for those at high risk for stroke and those who have had a stroke. 

The Coverdell award also will allow the group to target areas of the Commonwealth that are disproportionately affected by stroke, such as the Appalachian counties. The mortality rate due to stroke in that region is 14% higher than the national average and 8% higher than the rest of the state.

“This award could not come at a better time, because Kentucky has among the highest rates of stroke-related deaths in the country,” said Larry B. Goldstein, chairman of the University of Kentucky Department of Neurology and principal investigator on the project. “Over 2,000 Kentuckians die from stroke or stroke-related complications each year. Health behaviors and conditions that contribute to stroke are present at high rates in Kentucky with contributions from smoking, obesity, diabetes, hypertension, excessive alcohol use and physical inactivity. Although there are several existing stroke programs in Kentucky, we are excited that this project will coordinate and expand upon these efforts to improve stroke outcomes for Kentuckians.”

As part of the Coverdell initiative, the Kentucky Stroke Improvement Cooperative (KSIC) will be created to provide leadership for improving the quality of stroke care in the Commonwealth. Building from the KHDSP Taskforce and SEQIP, the UK and UofL Stroke Programs and the SCN, this group will lead the collaborative effort to transform Kentucky’s stroke care and outcomes by improving health approaches and practices.

Since its inception in 2005, The Coverdell Program has funded programs to ensure that all Americans receive the highest quality stroke care, a leading cause of death and long-term disability, by supporting coordinated stroke systems of care.

Joining nine other states currently funded by the Paul Coverdell National Acute Stroke Program, Kentucky’s program will:

  • Increase access and participation in the statewide Kentucky Heart Disease and Stroke Prevention Task Force from the current 38 hospitals to help close the gap in stroke care for high burden populations. In addition to focusing on hospitals, the project will expand participation to encompass the community, primary care clinics, EMS, rehabilitation centers and long-term care facilities.
  • Expand coordination between existing programs including the Kentucky SEQIP, the statewide UK/Norton Healthcare Stroke Care Network, and the 36 certified stroke centers in Kentucky.
  • Increase access, understanding, utilization, and compliance with evidence-based performance measures of the American Heart Association’s Get With the Guidelines Stroke Program.
  • Expand existing systems of care to coordinate and extend access to rural and underserved populations.
  • Increase the dissemination of evidence-based guidelines for improvement of hypertension, obesity and diabetes control, which are the leading risk factors for stroke disproportionately affecting high-burden populations.
  • Reduce stroke disparities and deaths over the long term and improve outcomes throughout Kentucky with a focus on Appalachia and underserved communities at highest risk.

UofL resident physician selected for prestigious national fellowship

UofL resident physician selected for prestigious national fellowship

Meena Vessell, M.D.

University of Louisville neurosurgery resident Meena Vessell, M.D. has been selected by the Council of State Neurosurgical Societies (CSNS) as 1 of 12 neurosurgery residents to serve as socioeconomic fellow for 2021-2022. The council selects three residents from each geographic quadrant of the U.S. annually. Vessell is the third UofL resident to serve as a CSNS socioeconomic fellow after Ian Mutchnick in 2008-09 and Paul Larson in 2001-02.

The fellowship is intended to broaden a neurosurgery resident’s working understanding of the socioeconomic issues affecting neurological surgery by working on various committees and dedicated mentorship from council members. The CSNS is made up of members of state neurosurgical societies and functions as a joint committee of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons (CNS). It began in the 1960s as a committee of the CNS, where it was charged with evaluating neurosurgery fees in the context of Medicare and a proliferation of other health insurance carriers. Today the CSNS is a collaborative organization of neurosurgeons and residents that serves as a resource and advocate on socioeconomic issues for the benefit of patients and the profession.

As a CSNS socioeconomic fellow, Vessell will participate actively in plenary sessions and on committees and will be expected to author or co-author a resolution or white paper on a relevant topic. During her fellowship year, Vessell will be trained in topics including the effects of socioeconomic issues on neurosurgical outcomes, the significance of billing/coding and reimbursements and practices that deliver cost-effective neurosurgical care.

Vessell is originally from Cincinnati, Ohio and earned her medical degree from Northeast Ohio Medical University. She will serve as a CSNS socioeconomic fellow during her seventh residency year. She has previously served as council representative to the American Medical Association (AMA) Council on Legislation, vice chair of the AMA Medical Student Section Council on Legislation and advocacy and government relations fellow for the Ohio State Medical Association. Vessell previously received the United States Public Health Service Excellence in Public Health Award on behalf of the Physicians Professional Advisory Committee of the Department of Health and Human Services and the United States Public Health Service, as well as the AMA Excellence in Medicine Award. 

UofL Health – Peace Hospital opens geriatric psychiatry inpatient unit

UofL Health – Peace Hospital opens geriatric psychiatry inpatient unit

UofL Health - Peace Hospital

UofL Health – Peace Hospital is expanding its care by opening a geriatric psychiatry inpatient unit providing short-term psychiatric treatment for adults aged 55 and older.

The secure 20-bed unit is specifically designed for the unique needs of the older adult and provides treatment for a range of mental health and substance use disorders.

“At our geriatric inpatient program, we will provide care for depression, schizophrenia, post-traumatic stress disorder, bipolar and agitation associated with dementia and more,” said Martha Mather, CAO of UofL Health – Peace Hospital. “This is another example of the commitment UofL Health has made to providing high-quality mental health care for people at all stages of life.”

The treatment team will focus on crisis stabilization and supporting the patient’s return to their home community or to a less restrictive level of care. The interdisciplinary team includes board-certified psychiatrists, gerontologists, nurse practitioners, registered nurses, Master’s level therapists, mental health technicians, activity therapists, occupational, speech and physical therapists, and chaplains.

“There’s not a one-size fits all solution when it comes to mental health treatments, so we use a team approach to make sure every patient gets exactly what he or she needs to thrive,” said Stephen Taylor, M.D., chief medical officer at UofL Health – Peace Hospital. “We’re excited to offer this geriatric program because we know there is a growing need for this care in our community.”

The Peace Hospital Geriatric Inpatient Program will be housed in downtown Louisville at UofL Health – Frazier Rehabilitation Institute to ensure a holistic approach by meeting both the behavioral health and physical health needs of the patient.

This expansion in services created approximately 40 new jobs in Louisville, including a program director, outreach coordinator, nurses, mental health technicians and more. UofL Health invested more than $1 million into this project.

With the addition of this new unit, Peace Hospital now operates 262 inpatient beds to children and adults in need of mental health treatment. Telehealth and 24/7 mobile assessments are also available.

UofL receives $11.3 million from NIH for liver research center

UofL receives $11.3 million from NIH for liver research center

Craig McClain, M.D., right, with Matthew Cave, M.D., liver researcher and H&T COBRE core director, center, and Jamie Young, Ph.D., using equipment known as the NanoDrop instrument to analyze RNA and DNA samples.

The University of Louisville Hepatobiology and Toxicology Center of Biomedical Research Excellence (COBRE) has received $11.3 million in funding from the National Institutes of Health to support its research into liver-related illness for an additional five years.

The UofL Hepatobiology and Toxicology Center was created in 2016 with an $11.5 million grant from the NIH to support unique research focused on liver injury and disease and toxicology. The center supports leading-edge research conducted by junior investigators with mentorship from senior researchers, as well as pilot projects and core laboratory facilities that support research across the university. The researchers’ goal is reducing the impact of many types of liver illness through prevention and the development of therapies.

Kentucky leads the nation in increases in cirrhosis-related deaths and in liver cancer-related deaths. According to research published in BMJ, mortality due to cirrhosis has been increasing in the U.S. since 2009, with the greatest increase in deaths from cirrhosis in Kentucky. Non-alcoholic fatty liver diseases affect approximately 25% of adults and 10% of children in the U.S.

“This vital research at the University of Louisville advances the health of Kentuckians and people throughout the world,” said UofL President Neeli Bendapudi. “Through this center, UofL researchers will continue to expand their work to find ways to prevent and treat liver illnesses, many of which today have no FDA-approved treatment.”

Researchers at the UofL H&T Center focus on liver injury, nutrition and gut-liver interactions as well as interactions between the liver and environment, toxicants and drugs. Their ultimate goal is to contribute to the prevention and treatment of non-alcoholic fatty liver disease, non-alcoholic steatohepatitis (a major cause of cirrhosis of the liver), alcoholic liver disease and liver cancer.

“This incredible cohort of researchers is discovering new ways to address the liver illnesses that afflict so many Kentuckians. I am thrilled that young researchers will continue to be supported with COBRE funding at UofL,” said Toni Ganzel, dean of the UofL School of Medicine.

In its first five years, four of the funded junior investigators in the UofL H&T Center received independent NIH research funding, making way for a new cohort of project researchers. The renewal of COBRE funding encourages a continuous supply of researchers in specialized areas of medicine and the search for new disease treatments.

“This unique thematic center is focused on liver injury, disease and toxicology. We evaluate critical barriers in our understanding of the development and progression of liver disease and we define potential therapeutic targets that could transform current practice,” said Craig McClain, associate vice president for health affairs and translational research and principal investigator for the UofL H&T Center. “This new phase will build on that success and extend and strengthen the scope of the program.”

“To push past the limitations of existing therapeutics, you need COBRE infrastructure grants to establish cutting-edge biomedical research centers and capabilities,” said Joshua L. Hood, a project investigator in the UofL H&T Center. “The more of these capabilities we have, the more we can explore multidisciplinary frontiers in biomedical science to facilitate the development of new treatments for liver-related cancer and other diseases.”

Current projects supported by the center include:

  • Yan Li, associate professor in the Department of Surgery, is investigating preventive strategies and possible mechanisms behind non-alcoholic steatohepatitis, a potential precursor of liver cancer.
  • Joshua L. Hood, assistant professor in the Department of Pharmacology & Toxicology, is examining how very small membrane-bound compartments known as nanovesicles that are released by cancer cells influence immune function in liver cancer.
  • Ming Song, assistant professor in the Department of Medicine, is studying the role of fructose consumption on the disruption of intestinal barrier function in non-alcoholic fatty liver disease.
  • Smita Ghare, instructor in the Department of Medicine, is investigating how alcohol-induced changes in the liver contribute to liver inflammation and injury.

UofL has a legacy of liver research dating to the 1970s when faculty members began investigating a cluster of cases of hepatic angiosarcoma, a rare liver cancer caused by exposure to vinyl chloride in a polymer manufacturing facility in an area of West Louisville known as Rubbertown. UofL researchers worked with the community and industry to document and reduce the effects of toxicants on worker health. UofL still maintains a biorepository of blood and liver tissue specimens begun during that research that serves as a resource for investigators studying the effects of environmental exposures on the liver.

In addition to research, the center provides support for community health. During the epidemic of Hepatitis A and C in the last decade, center investigators helped create the Kentucky Hepatitis Academic Mentorship Program. This program helped to train more than 140 primary care providers in the diagnosis and treatment of Hepatitis C. Those diseases now are declining.

COVID-19 vaccine clinical trial now open for children ages 6 months to 11 years

Norton Children’s Research Institute, affiliated with the UofL School of Medicine, to participate in COVID-19 investigational vaccine clinical trial for children ages 6 months to 11 years.
COVID-19 vaccine clinical trial now open for children ages 6 months to 11 years

The Norton Children’s Research Institute, affiliated with the UofL School of Medicine, will participate in a phase 2/3 clinical trial of the Pfizer-BioNTech COVID-19 investigational vaccine for healthy children ages 6 months to 11 years. The study will evaluate safety, tolerability and immune response in this age group. It is the only site in Louisville offering the trial and among 100 participating sites around the world.

“As of now, we do not have a vaccine that is authorized for use in children under age 12,” said Gary S. Marshall, M.D., chief of pediatric infectious diseases at Norton Children’s and the UofL School of Medicine, and principal investigator for the Louisville trial. “Having a safe and effective vaccine for children will not only keep them healthy but also would facilitate a return to normal in terms of school and other activities.”

In the randomized clinical trial, two children will be assigned to receive the vaccine for every one child who receives a placebo. The study is blinded, meaning that no one initially will know which injection they receive. Parents and caregivers will be asked to track changes to the child’s health in an electronic diary, and children will have at least six in-person visits over a two-year period, some to include blood draws.

Children who are randomly assigned to receive the placebo will be given the chance to receive the active vaccine after six months; therefore, all children in the study ultimately will have the opportunity to receive the active vaccine. 

The vaccine being studied is the same one that has been authorized for people ages 12 and older. In adults, this vaccine demonstrated 95% efficacy against COVID-19, and as of May 11, 2021, nearly 140 million people in the U.S. had received at least one dose. Preliminary data show the vaccine to be safe in children as well as able to generate a strong immune response.

The research team plans to enroll about 100 local volunteers for the trial; the overall enrollment will be about 4,500. Children ages 6 months to 11 years who are generally healthy are eligible to be included.

"The Pfizer-BioNTech vaccine has been shown to be very safe and effective in adults and adolescents," said Kimberly A. Boland, M.D., chief of staff, Norton Children's Hospital, and chair, UofL School of Medicine Department of Pediatriacs. "We have every reason to believe this study whill show the vaccine to be safe and effective in childrent and an important step forward for children's health and for protecting our communities."

Dr. Marshall is known for his work in vaccine development, advocacy and education. In fact, he has worked on many of the vaccines that children routinely receive today. The clinical trial team has responded to the pandemic, treating children with COVID-19 and its consequences.

“This is the most exciting vaccine trial I have ever been involved with, and I’ve been doing this for over 30 years,” Dr. Marshall said.

Parents and caregivers can sign children up to be considered for the trial by going to NortonChildrens.com/COVIDTrial.

UofL wastewater testing identifies new COVID-19 strain before traditional testing

University of Louisville research that uses wastewater to monitor the rates of COVID-19 infection was first to identify a variant in Louisville, alerting officials ahead of other testing methods and giving them valuable time to work to contain it.

UofL detected the variant, a Brazilian strain known as P.1, early in April in a wastewater sample from western Jefferson County. Once researchers received the results, they alerted the Louisville Metro Department of Health and Wellness as well as the state, which confirmed a positive case in the same zip codes with different testing methods a week later.

“The ability to detect viruses early, such as in this case, gives officials more time to take precautions and contain their spread,” said Aruni Bhatnagar, professor of medicine and director of UofL’s Christina Lee Brown Envirome Institute, which leads the wastewater research. “With pandemics, every second counts. In as little as one week, the virus can spread significantly, and then it becomes much harder to contain. This work gives us more time and an opportunity for targeted testing.”

UofL researchers began testing wastewater last year as part of the Co-Immunity Project, a groundbreaking partnership to track COVID-19 in Louisville Metro.

The Louisville/Jefferson County Metropolitan Sewer District has sent weekly samples from 12 sites representing multiple neighborhoods and five wastewater treatment facilities that aggregate the entire county.

Those samples are taken to the UofL Center for Predictive Medicine, where pharmacology and toxicology assistant professor Josh Fuqua and his team process the samples and isolate viral RNA, and to the UofL Genomics and Bioinformatics Core facilities, where computer science and engineering professor Eric Rouchka analyzes the virus sequences to detect variants.

UofL recently announced the expansion of this work, backed by an $8.6 million grant. That expansion goes one step further than previous work — from identifying whether disease exists in a neighborhood to estimating how prevalent it is there.

Bhatnagar said understanding that connection could “revolutionize the way we track and contain pandemics, and not just COVID-19.”

Rather than rely solely on direct testing, such as with nasal swabs, wastewater testing can give health departments another tool to gauge the severity of community infection and to identify areas where the infection is prevalent. The tool also is faster, more efficient and less invasive.

“This is cutting-edge work – and the fact that it’s being done right here in Louisville – right here at UofL – places us at the forefront of public health innovation,” said Louisville Mayor Greg Fischer. “It shows we’re doing the work to keep our city and cities around the world safe.”

Since the beginning of the pandemic, the Co-Immunity Project has conducted ongoing testing and surveys to better understand the spread of the coronavirus and COVID-19. In the past year, UofL researchers have tested more than 12,000 people for COVID-19 infection and antibodies, beginning with frontline health care workers. They also have worked to gauge how local citizens feel about COVID-19 vaccines, with 91% of Jefferson County residents in a recent poll saying they would like to be vaccinated.

“This is one more example of how UofL has led the charge in finding new and innovative ways to detect, contain and fight COVID-19,” said Kevin Gardner, UofL’s executive vice president for research and innovation. “Developing these new, more efficient tools for tracking pandemics, such as wastewater monitoring, is a big step in advancing health for our community and beyond.” 

The Co-Immunity Project needs 2,000 residents to undergo random testing for COVID-19 infection and antibodies the week of May 17-23 as part of this ongoing research. To learn more, visit http://bit.ly/uoflcovid, call 833-313-0502 or email covidsupport@louisville.edu.

UofL Post COVID-19 Research Clinic documents long-term effects of infection

Study adds to knowledge of how COVID-19 affects people over time
UofL Post COVID-19 Research Clinic documents long-term effects of infection

Louisville resident and podcaster A. Dale Josey is a participant in the UofL Post-COVID-19 Research Clinic

When Sophie Fritschner came down with COVID-19 on New Year’s Eve, she had a low-grade fever, cough and body aches. It took her a few weeks to get over the cough and congestion, but the 69-year-old resident of Louisville’s Highlands neighborhood has had no symptoms since.

For Catherine Gamas, it was a different story. Her symptoms were more severe and have lingered. She lost her senses of taste and smell and experienced extreme fatigue and confusion. Months after her diagnosis, the 56-year-old Clarksville, Ind., resident still has intermittent loss of taste and smell, dizziness, daily headaches and hair loss and said she bruises easily.

“I would do one thing and have to sit down. I could go down the stairs but not back up,” she said. “The hair loss is most distressing. It used to take two hours for my hair to dry normally. Now it’s 15 minutes at best.”

A. Dale Josey, a Louisville resident and podcaster, also reported symptoms that disrupted daily routines. He developed lethargy and weakness, had painful joints and was extremely cold. He also experienced blinding headaches, nausea and loss of taste.

“It was too intense to eat,” he said.

To help researchers better understand these and other short- and long-term effects of COVID-19, Fritschner, Gamas and Josey are participants with the Post COVID-19 Research Clinic at the University of Louisville. They are committed to furthering knowledge of post-COVID-19 conditions by sharing their COVID-19 experiences to help UofL researchers learn more about how the disease affects people differently and hopefully improve treatment for others during and after the illness.

For Josey, participation in the research clinic is essential “to add to the body of scientific research.” For the same reason he regularly donates blood (7 gallons of lifetime donations), Josey is participating to improve the health of the Louisville community.

The UofL Division of Infectious Diseases created the multidisciplinary research clinic to study the wide variety of symptoms and effects of COVID-19. Volunteer participants from Louisville and surrounding areas who previously were diagnosed with COVID-19 can participate in the research study to document and monitor their symptoms and health changes over time.

“We will conduct comprehensive mental and physical assessments to determine the many possible effects of COVID-19,” said T’shura Ali, Ph.D., M.P.H., a UofL postdoctoral associate who manages the research clinic. “We want to expand the knowledge of how the disease progresses, to help improve treatments and interventions – both when patients are initially sick and after – to define, measure and prevent the long-term effects of COVID-19.”

Post-COVID symptoms can be any change in quality of life, health status or symptoms that emerge after the infection. COVID-19 patients have reported a wide variety of symptoms weeks and months following their initial infections, but some of the most common include:

  • Decreased cardiac function (fast-beating or pounding heart, heart palpitations, chest pains)
  • Decreased lung capacity (difficulty breathing or shortness of breath)
  • Joint or muscle pain
  • Blood clotting issues
  • Decline in mental health
  • Intense migraines or headaches
  • Fatigue
  • Brain fog (difficulty thinking or concentrating)
  • Continued loss of smell or taste

Participants for the study from Louisville and surrounding areas age 18 and over who have had COVID-19, confirmed by a diagnostic test, are eligible to participate in the study whether they have experienced long-term symptoms following infection or had no additional symptoms. Vaccination status does not affect eligibility.

Researchers will record study participants’ health history and all their COVID-19 symptoms and health changes over time. They will record vital signs, conduct physical examinations and administer validated health assessments, vision tests, lung function tests and electrocardiograms (EKG). Study participants also will be asked to provide blood and urine samples at each visit. The data will be analyzed by a group of experts led by Julio Ramirez, M.D., professor and chief of the Division of Infectious Diseases, including physicians and researchers in cardiovascular medicine, perioperative medicine, pulmonary care and critical care as well as clinical and translational researchers.

To further study decreased heart and lung function, some of the most common and severe symptoms associated with COVID-19, Jiapeng Huang, M.D., Ph.D., professor in the Department of Anesthesiology and Perioperative Medicine, is conducting a sub-study of the research clinic’s participants, supported by Gilead Sciences.

“For this project, we will study the heart, lungs and blood vessels of individuals who have been ill with COVID-19 using ultrasounds done at the clinic. This research will establish the foundation for future preventive and therapeutic strategies,” Huang said.

“These participants are helping to contribute to clinical care, research and science in understanding the burden of disease to help guide progress toward better treatment and care, which ultimately will improve the Louisville community’s overall health,” Ali said.

All appointments and tests are free for the participants. Information will be used for research purposes only and will remain confidential. The research clinic does not provide treatment or referrals, but abnormal findings will be reported to the participants. Study visits are conducted every three to six months and participants are followed for approximately one year.

To learn more, visit the division website, email COVClinic@louisville.edu or call 502-852-8680.

Republic Bank Foundation Optimal Aging Clinic recognized as an age-friendly health system

Republic Bank Foundation Optimal Aging Clinic recognized as an age-friendly health system

The UofL Trager Institute and the Republic Bank Foundation Optimal Aging Clinic

The Republic Bank Foundation Optimal Aging Clinic at the University of Louisville Trager Institute has been recognized as an Age-Friendly Health System by the Institute for Healthcare Improvement. The recognition acknowledges the clinic’s commitment to improve health care for older adults and comes just over one year after it opened.

“It is so exciting that the Republic Bank Foundation Optimal Aging Clinic received the Age-Friendly recognition so shortly after celebrating our one-year anniversary,” said Anna Faul, Ph.D., executive director of the UofL Trager Institute and the Optimal Aging Clinic. “This recognition serves as a testament to the impact we’ve made during our first year. We strive to be on the forefront of patient care for older adults and we look forward to continuing to provide every older adult with the best care possible as part of the Age-Friendly Health Systems initiative.”

As part of the Age-Friendly Health Systems initiative, The John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States, are helping hospitals, clinics and other care settings implement evidence-based interventions specifically designed to improve care for older adults. 

The interventions are tested and adapted through participation in Age-Friendly Health Systems Action Communities. These collaborative entities are comprised of health care teams from across the country that are committed to sharing data and learning together. The teams work to implement best practices across emergency departments, intensive care units, medical-surgical units, general wards and primary and specialty care settings.

The Optimal Aging Clinic now joins more than 450 health systems working to make care for older adults even more tailored to patients’ goals and preferences and consistently of high-quality as part of the initiative, which is based on a series of practices focused on addressing four essential elements of care for older patients known as the 4Ms:

What Matters: Know and align care with each older adult's specific health outcome goals and care preferences including, but not limited to, end-of-life care, and across settings of care.

Medication: If medication is necessary, use age-friendly medications that do not interfere with What Matters to the older adult, Mobility, or Mentation across settings of care.

Mentation: Prevent, identify, treat and manage dementia, depression and delirium across settings of care.

Mobility: Ensure that older adults move safely every day in order to maintain function and do What Matters.

Joe D’Ambrosio, J.D., Ph.D., director of behavioral health at the UofL Trager Institute and Republic Bank Foundation Optimal Aging Clinic, says the Age-Friendly initiative also is infused in the organization’s Behavioral Health Services Organization.

“We are so happy to include this initiative in the work we do with our therapy patients,” D’Ambrosio said. “The 4Ms of the initiative align perfectly with the behavioral health interventions we share with patients in their efforts to age optimally and we are excited to build upon the progress we have made in our first year to continue to help older adults thrive as they age.”

Learn more about the Republic Bank Optimal Aging Clinic in a video created to celebrate the clinic’s first anniversary.

For more information or a tour of the Trager Institute and the Republic Bank Foundation Optimal Aging Clinic, please contact Lisa Warner, UofL Executive Director of Development at 502-852-7448.

UofL receives $8.6 million for COVID-19 wastewater research

Findings could lead to public health breakthrough for monitoring pandemics

The University of Louisville has received $8.6 million from the U.S. Centers for Disease Control and Prevention (CDC) to back research that could help health departments use wastewater to monitor the rate of COVID-19 infection.

UofL researchers already are testing wastewater to determine whether coronavirus infection exists in different neighborhoods around Jefferson County. This new work goes one step further, with the goal of estimating how many people within those neighborhoods are infected. If virus levels are high in the wastewater, it may be a signal of widespread infection in the community. 

“This could revolutionize the way we track and contain pandemics, and not just COVID-19,” said Aruni Bhatnagar, professor of medicine. “It gives us an invaluable tool that could offer a clearer view of where and how the virus spreads.”

Researchers at UofL’s Christina Lee Brown Envirome Institute, where Bhatnagar is director, began testing wastewater last year as part of the Co-Immunity Project, a groundbreaking partnership with the Louisville Healthcare CEO Council to track COVID-19 in Metro Louisville. 

As part of that effort, the Louisville/Jefferson County Metropolitan Sewer District has sent weekly samples from 12 sites representing multiple neighborhoods and five water quality treatment centers that aggregate the entire county to the UofL Center for Predictive Medicine for virus analysis.

In this new work, MSD and other community partners will continue collecting wastewater samples over the next six months. After analysis, UofL will also send the results to the CDC’s National Wastewater Surveillance System, which will help inform efforts across the U.S. 

As with previous rounds of COVID-19 testing conducted through the Co-Immunity Project, researchers will recruit participants by sending letters to selected households across Jefferson County. They hope to continue to enroll a few thousand people every month and will compare their COVID-19 infection and antibody results with wastewater samples from the same area, with the goal of finding how they correlate.

“The aim of the project is to figure out whether we can estimate how many people in a given area are infected by simply testing the community wastewater,” said Ted Smith, associate professor of medicine and a lead on the wastewater epidemiology project. “Additionally, this is a passive and comparatively low-cost way to monitor community infection and has the additional benefit of being inclusive of all communities in our city and is a promising step to ensuring public health equity.”

Since the beginning of the pandemic, the Co-Immunity Project has conducted ongoing testing and surveys to better understand the spread of the coronavirus and COVID-19. In the past year, UofL researchers have tested more than 12,000 people for COVID-19 infection and antibodies, beginning with frontline health care workers. They also have worked to gauge how local citizens feel about COVID-19 vaccines, with 91 percent of Jefferson County residents in a recent poll saying they would like to be vaccinated.

“This is critically important work in our fight against COVID-19,” said Kevin Gardner, UofL’s executive vice president for research and innovation. “Our hope is that by working with the CDC, we can develop these new, more efficient tools for tracking pandemics and take a big step in advancing health for all of our community.” 

Last year, U.S. Senator Mitch McConnell (R-KY), then the Senate majority leader, negotiated and championed five historic and completely bipartisan COVID-19 rescue packages. In addition to supporting workers and propping up the economy, these relief bills also allocated $33.4 billion for COVID-19 testing. McConnell personally called then-U.S. Secretary of Health and Human Services Alex Azar to request that the CDC direct a portion of that funding to UofL’s Co-Immunity Project.

Our country has responded to this terrible pandemic with innovation and discovery and Kentucky continues to play a major role in beating this virus. I’d like to congratulate Dr. Bhatnagar and UofL’s entire Co-Immunity Project on their groundbreaking study,” McConnell said. After hearing about their work, I took this project to the highest levels of the federal government to help accelerate their research with additional federal funding. As UPS and other Louisville employers are sending safe and effective vaccinations around the country, I’m proud top researchers right here at UofL are pushing the boundaries of knowledge in detection and prevention.”