A research team at UofL has discovered that an immune checkpoint molecule they developed for cancer immunotherapy also protects against future development of multiple types of cancer when administered by itself.

The recombinant protein molecule SA-4-1BBL has been used to enhance the therapeutic efficacy of cancer vaccines with success in pre-clinical animal models. It accomplishes this by boosting the effectiveness of CD8⁺ T cells, adaptive immune cells trained to target the tumor for destruction. Surprisingly, when the researchers treated normal healthy mice with SA-4-1BBL alone, the mice were protected when the researchers later exposed them to different types of tumor cells.

“The novelty we are reporting is the ability of this molecule to generate an immune response that patrols the body for the presence of rare tumor cells and to eliminate cancer before it takes hold in the body,” said Haval Shirwan, Ph.D., professor in the UofL Department of Microbiology and Immunology and the UofL Institute for Cellular Therapeutics. “Generally, the immune system will need to be exposed to the tumor, recognize the tumor as dangerous, and then generate an adaptive and tumor-specific response to eliminate the tumor that it recognizes. Thus, our new finding is very surprising because the immune system has not seen a tumor, so the response is not to the presence of a tumor.”

The researchers have determined that the molecule generates a tumor immune surveillance system through activation of what are known as CD4⁺ T cells and innate NK cells, thereby protecting the mice against various cancer types they have never had. This function is an indication of the molecule’s effectiveness in cancer immunoprevention.

In the research, published today in Cancer Research, mice that had never had cancer were treated with SA-4-1BBL alone, then challenged with cervical and lung cancer tumor cells at various time intervals. The mice showed significant protection against tumor development, with the greatest protection when challenged two weeks after treatment with SA-4-1BBL. The cancer immunoprevention effect generated by SA-4-1BBL lasted more than eight weeks.

“Just giving SA-4-1BBL alone prevents the formation of tumors in animal models,” Shirwan said. “To our knowledge, this is the first study to demonstrate that an immune checkpoint stimulator, known for its function for adaptive immunity, as a single agent can activate an immune system surveillance mechanism for protection against various tumor types.”

Additional testing showed that CD8⁺ T cells were not required for the protection, but when CD4⁺ T and NK cells were eliminated in the mice, protection failed, indicating these two cell types were necessary to achieve the effect. The lack of necessity for CD8⁺ T cells indicates the process is not one of conventional acquired immunity.

Although the research, which was conducted in collaboration with FasCure Therapeutics, LLC, tested the mice for cervical and lung cancers, the protective function of SA-4-1BBL works without context of specific tumor antigens, giving it the potential to be effective in preventing any number of tumor types.

“We are very excited about the cancer immunoprevention possibilities of this molecule. Its effectiveness is not tumor specific, and as a natural ligand, it does not cause toxicity, as is found with 4-1BB agonist antibodies. Plus, the fear of autoimmunity is highly minimized, as evident from our data, because it is activating the innate immune cells,” said Esma Yolcu, Ph.D., associate professor at UofL and co-author of the study.

Immune checkpoint stimulators and inhibitors are major regulators of the immune system and work in a similar fashion to the “brake” and “gas” pedals in a vehicle. Cancer evades the immune system by various means, including immune checkpoint inhibitors, which apply the brake on the immune response against a tumor. Stimulators, on the other hand, serve the accelerator function, improving immune responses against cancer.

Drugs to block the action of immune checkpoint inhibitors already have shown therapeutic efficacy for several cancer types in the clinic and are approved by the Food and Drug Administration (FDA). According to Shirwan, the focus now is on immune checkpoint stimulators.

“Several antibody molecules are in clinical testing for cancer immunotherapy as immune checkpoint stimulators. However, nothing so far is approved by the FDA that gives a positive signal to the T cells,” Shirwan said. “The immune checkpoint inhibitors take the foot off the brake, so to speak. This ligand, as an immune checkpoint stimulator, puts the gas on the immune system to destroy the tumor.

“Another big surprise is that an antibody to the same receptor targeted by SA-4-1BBL did not protect against tumors, demonstrating unique and desired features of SA-4-1BBL for caner immunoprevention.”

Shirwan and Yolcu plan to conduct further tests for SA-4-1BBL in cancer immunoprevention.

“Although the notion of cancer immunoprevention is an attractive one, the design of clinical trials presents a challenge with respect to the target population,” Shirwan said. “However, with advances in cancer screening technologies and genetic tools to identify high-risk individuals, we ultimately are hoping to have the opportunity to test the SA-4-1BBL molecule for immunoprevention in individuals who are predisposed to certain cancers, as well as in the presence of precancerous lesions.”

To encourage and accelerate research in cancer prevention, the National Institutes of Health have created a network for research into immunoprevention, outlining possible methods for testing promising preventive substances and provided opportunities for associated funding. The Immuno-Oncology Translational Network is designed to create a fertile environment for research and to facilitate cancer immunoprevention research projects focusing on people who are genetically predisposed to certain cancers, those who have been diagnosed with pre-malignant lesions or polyps, and individuals exposed to cancer-causing substances, such as smokers and asbestos workers.

Feb. 15, 2019

A professional with almost a decade in caring for patients who identify as lesbian, gay, bisexual, transgender, gender non-binary and those born with differences in sex development has been selected to lead the LGBT Center at the University of Louisville Health Sciences Center.

Bláz Bush of New York will join UofL Feb. 25. He brings a skill set particularly attuned to the needs of the LGBT community at the HSC, said Vice Provost for Diversity and International Affairs Mordean Taylor-Archer.

“Bláz combines a wealth of experience in LGBT health care with a collaborative, inclusive leadership style,” Taylor-Archer said. “These qualities make him perfectly positioned to take the HSC LGBT Center to the next level of success in serving our students, faculty, staff, community and ultimately patients.”

Bush comes to UofL after serving as the director of care coordination of the Callen-Lorde Community Health Center, one of the largest LGBT community health centers in the world, serving 18,000 patients annually.

At Callen-Lorde, Bush oversaw 40 case managers, patient navigators and prevention and outreach counselors. He also led the health center in a number of initiatives, including improving community HIV viral-suppression rates and developing interventions to address social determinants of health.

Bush also served on the Health and Human Services HIV Planning Council of New York’s Integration of Care subcommittee, working with city leaders to develop HIV/AIDS programs focused on transgender and non-binary gender health disparities, housing, opioid-use reduction, food and nutrition and care coordination programs.

Prior to Callen-Lorde, Bush was with the New York Blood Center’s Infectious Diseases Research Program. He earned a master’s degree with a focus in community counseling from the University of Oklahoma.

UofL is a leader in the field of educating medical students in the needs of LGBT patients, serving as the pilot program for the Association of American Medical Colleges recommendations to embed training in the care of these patients throughout the medical school curriculum. UofL’s project, eQuality, won the 2016-2017 Innovation in Medical Education Award from the Southern Group on Educational Affairs.

“The work being done at the University of Louisville to educate future generations of health care providers in lesbian, gay, bisexual and transgender and gender non-binary health care needs is essential, lifesaving and radical,” Bush said. “Having worked at an LGBT health center, I understand the vital importance of adequate training and the desperate need for sensitive, quality health care to be widespread and accessible for all communities, especially for communities of color.

“The University of Louisville is already the leader in creating an LGBT-inclusive campus and is an innovator in creating LGBT educational programs. I am humbled and excited for this opportunity to help lead the Health Sciences Center forward and continue its progressive leadership in educating the caregivers of tomorrow.”

Individuals living with Parkinson’s disease, along with their families and caregivers, will have the opportunity to hear from a popular author and expert on the treatment of Parkinson’s, J. Eric Ahlskog, M.D., Ph.D., at the annual Bill Collins Symposium for Parkinson’s Disease. The annual symposium also will include care insights for patients, families and caregivers by the providers of UofL Physicians – Parkinson’s Disease and Movement Disorders clinic.

The half-day event is Saturday, March 2, from 8:30 a.m. to 12:15 p.m. in the conference center of the Rudd Heart and Lung Building, 201 Abraham Flexner Way, next to Jewish Hospital. There is no charge to attend.

Ahlskog, professor of neurology at Mayo Clinic Alix School of Medicine, is the author of “The New Parkinson’s Disease Treatment Book,” a popular guide for people with Parkinson’s disease and their families. He will give the keynote talk for the symposium, “Debunking Ten Myths that May Sabotage Treatment of Parkinson’s Disease.”

In addition, Karen Robinson, Ph.D., F.A.A.N., of the UofL School of Nursing, will discuss the importance of support for caregivers, and Robert Friedland, M.D., professor and researcher in the Department of Neurology at UofL, will explain the impact of the microbiome in Parkinson’s disease and dementia. Finally, a panel discussion will include providers from the UofL Physicians – Parkinson’s Disease and Movement Disorders clinic.

“We have organized this opportunity to allow patients and their families to meet one another and to learn about the best ways to manage the journey of Parkinson’s disease,” said Kathrin LaFaver, M.D., director of the UofL Physicians – Parkinson’s Disease and Movement Disorders clinic and the Raymond Lee Lebby Chair in Parkinson’s Disease Research at the University of Louisville School of Medicine. “This year, they will have a unique chance to hear from Dr. Ahlskog, a renowned expert in Parkinson’s care. We also will introduce a caregivers’ support group, which will begin in March.”

Parkinson’s disease caregiver support group

Caring for a partner or family member with Parkinson's disease has many rewards, but also has been associated with physical, mental, social and financial stressors. Beginning in March, the UofL Physicians – Parkinson's Disease and Movement Disorders clinic will offer a monthly caregiver support group led by Kelly Bickett, a registered nurse in the movement clinic with special expertise in the care of Parkinson's disease. To facilitate attendance at support group meetings, respite care will be made available on an as-needed basis through a professional health-care agency for up to four hours. 

The group will begin Friday, March 29, and meet the fourth Friday of each month from 2:30 - 4:00 p.m. Register for the support group by calling 502-582-7654.

Bill Collins Symposium for Parkinson’s Disease agenda

• Keynote: “Debunking Ten Myths that May Sabotage Treatment,” by J. Eric Ahlskog, M.D., Ph.D.
• Active Break:  Dance for Health – David X. Thurmond, professional dancer, choreographer and teacher.
• Microbiome in Parkinson’s disease and dementia - Robert P. Friedland, M.D., UofL Department of Neurology and the Mason C. and Mary D. Rudd Endowed Chair in Neurology.
• Supporting caregivers of those with Parkinson’s disease – Karen Robinson, Ph.D., F.A.A.N., UofL School of Nursing.
• Panel discussion with Ahlskog and Kathrin LaFaver, M.D., along with Victoria Holiday, M.D., UofL Department of Neurology and Laura Dixon, D.N.P. A.P.R.N., UofL Physicians – Parkinson’s Disease and Movement Disorders.

There is no charge to attend the symposium, but please register by Feb. 25 by calling 502-582-7654 or via email to UofLPhysiciansMovement@ulp.org. Please include your name, the number of guests attending and a telephone number.

February 7, 2019

A number of potentially life-threatening toxins found in many households can seriously harm your furry best friend. Even things humans safely ingest every day can be fatal to pets.

At the next Beer with a Scientist, Kate Baker, D.V.M., M.S., a veterinary clinical pathologist with Blue Pearl Specialty and Emergency Veterinary Hospital, will explain why some seemingly harmless substances actually are very dangerous for our animals. She also will address what veterinarians do to save pets when they ingest a toxin.

"Many of us share our homes with pets, and sometimes, they eat things they shouldn’t. While some of these things may be harmless, others can seriously harm pets, even things people consume every day with no issues, from common medications such as Tylenol or ibuprofen, to foods we eat every day like onions and grapes,” Baker said.

Baker’s talk will begin at 7 p.m. on Wednesday, Feb. 13, at Holsopple Brewing, 8023 Catherine Lane, Louisville, 40222. A 30-minute presentation will be followed by an informal Q&A session.

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

Organizers encourage Beer with a Scientist patrons to drink responsibly.

UofL cancer researcher Levi Beverly, Ph.D., created the Beer with a Scientist program in 2014 as a way to bring science to the public in an informal setting. At these events, the public is invited to enjoy exactly what the title promises:  beer and science.

Upcoming Beer with a Scientist dates:  March 13, April 17, May 15.

February 7, 2019

A new initiative between the University of Louisville and several community partners will help residents of Louisville’s Smoketown neighborhood learn their heart health, and connect them with the right care.

The free clinics will be held in Smoketown starting Feb. 9 and last into the spring and early summer. Participants will learn how healthy their heart is and their risk of heart attack and stroke, and those who need treatment will be given a referral for care. Health insurance is not required.

Inspired by Smoketown’s Muhammad Ali, who trained for boxing in the neighborhood, “Heart of a Champion” is a partnership between the UofL schools of Medicine, Nursing, and Public Health and Information Sciences; the Have a Heart Clinic; UofL Physicians; the UofL Envirome Institute; Surgery on Sunday; the American Heart Association; UofL’s Get Healthy Now; IDEAS xLab; Dare to Care; YouthBuild; Smoketown Family Wellness Center; and several Smoketown-area churches.

“With February being American Heart Month, it’s the perfect time to kick off these screenings,” said Erica Sutton, M.D., a general surgeon with UofL Physicians and associate professor at the UofL School of Medicine who will lead the UofL doctors staffing the clinics.

“This is a model for community-engaged care, where we work with partners in the community who are taking care of a population we want to reach. It’s important for us not just to open our office doors to people, but really provide a presence for health and access to care by going out into the community.

“In Smoketown, there’s an abundance of heart disease, and we have the ability to make an impact on risk factors, such as diabetes, obesity and smoking. And screenings are a well-known tool to identify heart disease before the heart is irreversibly damaged. The saying ‘an ounce of prevention is worth a pound of cure’ really rings true here. Not only is prevention or identifying the potential for heart disease easier and more cost effective, but it’s healthier than trying to cure it.”

American Heart Month is a program of the U.S. Department of Health & Human Services’ National Heart, Lung and Blood Institute. The month aims to encourage and motivate everyone to adopt heart healthy behaviors, including screening for risk factors.

Referrals will go to the Have a Heart Clinic and University of Louisville Physicians, and Surgery on Sunday also will be providing services. Dr. Sutton also volunteers with Surgery on Sunday.

The clinics will be held at churches and community centers in the Smoketown neighborhood. UofL doctors will staff the clinics, assisted by students and residents from school.

Other UofL faculty involved include cardiologist Andrew DeFilippis, M.D., an expert in cardiovascular diseases whose research focuses on cardiovascular risk prediction, and cardiothoracic surgeon Kristen Sell-Dottin, M.D.

Clinic dates

No advance registration is required. Dates and locations for the clinics are:

Bates Memorial Church (620 Lampton St.)
Feb. 9 (Saturday) from 10:30 a.m.-1:30 p.m.
Feb. 10 (Sunday) from 9:30 a.m. to 2 p.m.

Smoketown Family Wellness Center (760 S. Hancock St., Suite B100)
Feb. 23 (Saturday) from 12 to 2 p.m.

Coke Memorial United Methodist Church (428 E. Breckinridge St.)
June 2 (Sunday) from 1:30 to 3:30 p.m.

Grace Hope Presbyterian Church (702 E. Breckinridge St.)
(TBD)

Little Flock Missionary Baptist Church (1030 S. Hancock St.)
(TBD)

YouthBuild (800 S. Preston St.)
(TBD)

Clinic services

Participants will get screenings for factors that affect heart health, such as blood pressure and cholesterol, body mass, diet, exercise, use of tobacco products and sleep. Arterial ultrasounds also will be available.

A heart health profile will be provided, as well as information on actions to take to reduce the risk of heart attack or stroke.

Those who attend will also be able to participate in short informational sessions on diet (including how to cook healthy foods), exercise (including low-intensity options), better sleep and smoking cessation.

Heart disease prevention

In addition to screenings to learn risk, the likelihood of heart attack and stroke can be reduced by:

• Lowering cholesterol (consider what you eat)
• Burning calories every day (exercise or walk) and strength training (you can use your body to strength train)
• Decreasing stress (meditate or relax)
• Eating a healthy diet, including heart-healthy foods
• Stopping smoking
• Finding a physician

For more information

To sign up for updates on the clinics, go to www.smoketownvoice.com/heart-of-a-champion. For questions about the Heart of a Champion program, contact Lora Cornell, senior program coordinator at the UofL School of Medicine, at 502-852-2120. 

With spring just around the corner, Louisville area residents will expect not only April showers and May flowers, but spring tornadoes. These destructive storms are fairly common in the greater Louisville area, which may lead weather buffs to wonder:  What causes tornadoes and what makes them more or less destructive?

At the next Beer with a Scientist, Jason Naylor, Ph.D., an assistant professor at the University of Louisville, will discuss the formation of tornadoes and share data that indicate there may be pockets in and around Louisville that are more prone to severe weather. Naylor studies severe weather events with the goal of identifying factors that affect their intensity, duration and frequency.

“The number of tornadoes in the United States in 2018 was far below normal. This may have been an anomaly or it may be related to climate change,” Naylor said. “There are factors related to climate change that may impact the frequency and spatial distribution of U.S. tornadoes and other severe weather events.”

He also will discuss how humans may be affecting severe weather on a smaller, more local scale. His current research is investigating how severe weather patterns may be altered by the presence of large cities.

Naylor’s talk will begin at 7 p.m. on Wednesday, Jan. 23, at Holsopple Brewing, 8023 Catherine Lane, Louisville, 40222. A 30-minute presentation will be followed by an informal Q&A session.

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

Organizers encourage Beer with a Scientist patrons to drink responsibly.

UofL cancer researcher Levi Beverly, Ph.D., created the Beer with a Scientist program in 2014 as a way to bring science to the public in an informal setting. At these events, the public is invited to enjoy exactly what the title promises:  beer and science.

Upcoming Beer with a Scientist dates:  Feb. 13, March 13, April 17, May 15.

Jan. 17, 2019

Scientists at UofL have shown that a microbial metabolite, Urolithin A, derived from a compound found in berries and pomegranates, can reduce and protect against inflammatory bowel disease (IBD). Millions of people worldwide suffer from IBD in the form of either ulcerative colitis or Crohn’s disease, and few effective long-term treatments are available.

The researchers at UofL have determined that Urolithin A (UroA) and its synthetic counterpart, UAS03, mitigate IBD by increasing proteins that tighten epithelial cell junctions in the gut and reducing gut inflammation in animal models. Tight junctions in the gut barrier prevent inappropriate microorganisms and toxins from leaking out, causing inflammation characteristic of IBD. Preclinical research published today in Nature Communications shows the mechanism by which UroA and UAS03 not only reduce inflammation and restore gut barrier integrity, but also protect against colitis.

“The general belief thus far in the field is that urolithins exert beneficial effects through their anti-inflammatory, anti-oxidative properties. We have for the first time discovered that their mode of function also includes repairing the gut barrier dysfunction and maintaining barrier integrity,” said Rajbir Singh, Ph.D., a postdoctoral fellow at UofL and the paper’s first author.

Venkatakrishna Rao Jala, Ph.D., assistant professor of microbiology and immunology at UofL, led the research, conducted by Singh and other collaborators at UofL, the Institute for Stem Cell Biology and Regenerative Medicine (inStem) in Bangalore, India, the University of Toledo College of Medicine and Life Sciences, and Dalhousie University in Nova Scotia. Jala, Singh and other researchers at UofL have been investigating how metabolites produced by the human microbiota – bacteria, viruses and fungi that inhabit the human body – affect many areas of health. By understanding the effects of specific metabolites, they hope to use them directly as therapeutic agents in treating disease.

It has been reported that the microbe Bifidobacterium pseudocatenulatum INIA P815 strain in the gut has the ability to generate UroA from ellagic acid (EA), a compound found in berries and pomegranates. Variations in UroA levels, despite consumption of foods containing EA, may be the result of varied populations of bacteria responsible for the production of UroAfrom one individual to another, and some individuals may not have the bacteria at all. While encouraging natural levels of UroA in the gut by consuming the appropriate foods and protecting populations of beneficial bacteria should have positive health effects, the researchers believe the use of the more stable synthetic UAS03 may prove to be therapeutically effective in cases of acute colitis. Further experiments and clinical testing are needed to test these beliefs.

“Microbes in our gut have evolved to generate beneficial microbial metabolites in the vicinity of the gut barrier,” Jala said. “However, this requires that we protect and harbor the appropriate gut microbiota and consume a healthy diet. This study shows that direct consumption of UroA or its analog can compensate for a lack of the specific bacteria responsible for production of UroA and continuous consumption of pomegranates and berries.”

Haribabu Bodduluri, Ph.D., professor of microbiology and immunology at UofL and an author of the article, said another key finding of the research is that UroA and UAS03 show both therapeutic and protective effects. Administration of UroA/UAS03 after the development of colitis reverses the condition and administration prior to development of colitis prevents it from occurring.

This research was facilitated by funding from the National Cancer Institute to Jala and the Center of Biomedical Research Excellence (CoBRE), established at UofL in 2018 with funding from the National Institute of General Medical Sciences.

The article, “Enhancement of the gut barrier integrity by a microbial metabolite through the Nrf2 pathway,” is available on the web site, Nature Communications (DOI: 10.1038/s41467-018-07859-7). This research was supported by the National Institutes of Health, U of L, Rounsavall Foundation, The Jewish Heritage Fund for Excellence Research Enhancement Grant and the James Graham Brown Cancer Center. The Department of Biotechnology and the Institute for Stem Cell Biology and Regenerative Medicine (inStem), India, also supported the work.

Several authors hold a patent application related to this technology.

Jan. 9, 2019

Medical residents and fellows at the University of Louisville have donated 870 new toys to local children for Christmas.

For the fourth consecutive year, the UofL School of Medicine House Staff Council, the representative body for resident and fellow physicians, led a weeklong collection for the U.S. Marine Corps Reserve Toys for Tots Program. Donations were received from individual residents and fellows and School of Medicine faculty, staff and students.

The Toys for Tots Program collects new, unwrapped toys and distributes them as Christmas presents to economically disadvantaged children in the community in which a campaign is conducted.

“This is our community,” said Jared Winston, M.D., a UofL internal medicine resident from St. Louis. “Louisville is hosting a lot of residents who aren’t from this area. It’s a way to say ‘thank you’ to our community.”

There was some healthy competition among School of Medicine departments over donating the most toys. Stock Yards Bank & Trust is providing a luncheon and plaque to the three residency programs that donated the most toys.

The winning program for the fourth straight year, the Department of Psychiatry and Behavioral Sciences, collected 370 toys. The Department of Radiology donated the second-most number of toys with 139, and the Department of Obstetrics, Gynecology and Women’s Health finished third by contributing 102 gifts.

“The residents love helping out with the toy drive,” said Jamie Morris, M.D., a UofL radiology resident. “The House Staff Council is very big into community outreach and this is such a fun way to do it. We have multiple people in our department who love going shopping for Toys for Tots.”

People who live in leafy, green neighborhoods may have a lower risk of developing heart disease and strokes, according to new research published online today (Dec. 5, 2018) in the Journal of the American Heart Association, the open access journal of the American Heart Association/American Stroke Association.

In this study, the first of its kind, researchers from the University of Louisville investigated the impact of neighborhood greenspaces on individual-level markers of stress and cardiovascular disease risk.

Over five years, blood and urine samples were collected from 408 people of varying ages, ethnicities and socioeconomic levels, then assessed for biomarkers of blood vessel injury and the risk of having cardiovascular disease. The participants were recruited from the UofL Physicians-Cardiovascular Medicine outpatient cardiology clinic and were largely at elevated risk for developing cardiovascular diseases.

The density of the greenspaces near the participants’ residences were measured using the Normalized Difference Vegetation Index (NDVI), a tool that indicates levels of vegetation density created from satellite imagery collected by NASA and USGS. Air pollution levels also were assessed using particulate matter from the EPA and roadway exposure measurements.

Researchers found living in areas with more green vegetation was associated with:

• lower urinary levels of epinephrine, indicating lower levels of stress;
• lower urinary levels of F2-isoprostane, indicating better health (less oxidative stress);
• higher capacity to repair blood vessels.

They also found that associations with epinephrine were stronger among women, study participants not taking beta-blockers – which reduce the heart’s workload and lower blood pressure – and people who had not previously had a heart attack.

“Our study shows that living in a neighborhood dense with trees, bushes and other green vegetation may be good for the health of your heart and blood vessels,” said Aruni Bhatnagar, Ph.D., lead study author and professor of medicine and director of the UofL Christina Lee Brown Envirome Institute and the Smith and Lucille Gibson Chair in Medicine. “Indeed, increasing the amount of vegetation in a neighborhood may be an unrecognized environmental influence on cardiovascular health and a potentially significant public health intervention.”

The findings were independent of age, sex, ethnicity, smoking status, neighborhood deprivation, use of statin medications and roadway exposure.

Previous studies also have suggested that neighborhood greenspaces are associated with positive effects on overall physical and psychosocial health and well-being, as well as reduced rates of death from cardiovascular and respiratory diseases and improved rates of stroke survival, according to Bhatnagar. However, these reports are largely limited by their reliance on self-reported questionnaires and area-level records and evaluations, Bhatnagar said.

Co-authors of this study are Ray Yeager, Ph.D.; Daniel W. Riggs, M.S.; Natasha DeJarnett, Ph.D.; David J. Tollerud, Ph.D.; Jeffrey Wilson, Ph.D.; Daniel J. Conklin, Ph.D.; Timothy E. O’Toole, Ph.D.; James McCracken, Ph.D.; Pawel Lorkiewicz, Ph.D.; Xie Zhengzhi, Ph.D.; Nagma Zafar, M.D., Ph.D.; Sathya S. Krishnasamy, M.D.; Sanjay Srivastava, Ph.D.; Jordan Finch, M.S.; Rachel J. Keith, Ph.D.; Andrew DeFilippis, M.D.;  Shesh N. Rai, Ph.D. and Gilbert Liu, M.D. Author disclosures are on the manuscript.

The WellPoint Foundation and the National Institute of Environmental Health Sciences of the National Institutes of Health supported the study.

###

Additional Resources:

• View the manuscript online.
• Chronic exposure to excess noise may increase risk for heart disease, stroke
• Follow AHA/ASA news on Twitter @HeartNews

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available at http://www.heart.org/corporatefunding.

About the American Heart Association

The American Heart Association is a leading force for a world of longer, healthier lives. With nearly a century of lifesaving work, the Dallas-based association is dedicated to ensuring equitable health for all. We are a trustworthy source empowering people to improve their heart health, brain health and well-being. We collaborate with numerous organizations and millions of volunteers to fund innovative research, advocate for stronger public health policies, and share lifesaving resources and information. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

The Centers for Disease Control and Prevention (CDC) has granted the University of Louisville Physicians Diabetes and Obesity Center full recognition as a certified Diabetes Prevention Program. The three-year designation recognizes programs that effectively deliver a quality, evidence-based program that meets all of the standards for CDC recognition. The UofL program is one of just two in Louisville to earn full recognition.

More than 84 million Americans – one in three adults -- now have prediabetes. Of those 84 million, nine out of 10 of them don’t know they have it. Without intervention, many people with prediabetes could develop type 2 diabetes within five years.

In Kentucky, diabetes and prediabetes are at epidemic levels, according to the American Diabetes Association. More than 531,000 people in Kentucky, or 14.5 percent of the adult population, have diabetes. Of these, an estimated 108,000 have diabetes but don’t know it, greatly increasing their health risk. In addition, 1.168 million people in Kentucky – 35.5 percent of the adult population – have prediabetes with blood glucose levels higher than normal but not yet high enough to be diagnosed as diabetes. Every year an estimated 27,000 people in Kentucky are diagnosed with diabetes.

The center is located in the UofL Physicians Outpatient Center, 401 E. Chestnut St., and serves as the clinical arm of the UofL Diabetes and Obesity Center headed by Aruni Bhatnagar, Ph.D., which focuses on research into prevention of diabetes. “It is immensely gratifying to see the science of diabetes prevention being implemented to improve the public’s health,” Bhatnagar said. “It is through programs such as this that we will turn the tide in the fight against the epidemic of type 2 diabetes.”

In addition to the CDC recognition, the UofL Physicians - Diabetes and Obesity Center, in a partnership with ULP Department of Medicine, is recognized by the American Diabetes Association for Quality Diabetes Self-Management Education and Support.

The Uof Physicians - Diabetes and Obesity Center was created in part from support by KentuckyOne Health to provide preventive care and education and to promote research in diabetes and obesity. The Center is directed by Sri Prakash Mokshagundam, M.D. “Once you have diabetes, you can’t get rid of it, but if you have prediabetes, which is higher than normal blood sugar levels, or if you are at risk for developing diabetes, you can prevent it with lifestyle changes,” Mokshagundam said. “Diabetes also can be effectively managed with physician-directed care.

“We want people to know they have the power to change their outcome.”

The program is directed by Registered Dietitian and Certified Diabetes Educator Beth Ackerman, who cited UofL’s own employee wellness program, Get Healthy Now, in earning the recognition. “This recognition was made possible through collaboration with UofL Get Healthy Now and its director, Patricia Benson, assistant vice president for health, wellness and disease management,” Ackerman said. “We currently offer the program to UofL employees who are covered by the university’s health plan, and will begin offering it to other patients in January.”

The UofL Physicians Diabetes and Obesity Center works to:

• Elevate the health status of our community by raising awareness of the risks for diabetes and heart disease;
• Facilitate prevention and management programs;
• Be a resource to our patients and community health care providers; and 
• Support researchers in their efforts to fight the growing epidemic of diabetes and obesity.

The Diabetes and Obesity Center at UofL Physicians offers diabetes self-management education and support if a patient is newly diagnosed or has had diabetes for many years. The center’s diabetes educators assess each patient’s needs and help them individually or to enroll in an education class to meet those needs. Classes cover:

• Diabetes Prevention
• Diabetes Self-Management 
• Pregnancy Planning
• Diabetes Medications
• Diabetes and Technology
• Medical Nutrition Therapy
• Weight Management
• Monitored Activity Options

Registered Nurse and Certified Diabetes Educator Paula Thieme is the quality coordinator of the diabetes self- management and support program. For information or to make an appointment, call 502-588-4600.

The James Graham Brown Cancer Center has been granted a three-year/full reaccreditation designation by the National Accreditation Program for Breast Centers (NAPBC), a program administered by the American College of Surgeons. 

Accreditation by the NAPBC is granted only to those centers that have voluntarily committed to provide the highest level of quality breast care and that undergo a rigorous evaluation process and review of their performance. The Brown Cancer Center first received NAPBC accreditation in 2009.

To earn accreditation, the center must demonstrate compliance with standards established by the NAPBC for treating women who are diagnosed with the full spectrum of breast disease. The standards include proficiency in the areas of center leadership, clinical management, research, community outreach, professional education and quality improvement. 

“A breast center that achieves NAPBC accreditation has demonstrated a firm commitment to offer its patients every significant advantage in their battle against breast disease,” said Nicolas Ajkay, M.D., assistant professor of surgery, UofL Division of Surgical Oncology, who directs the breast cancer program as a surgical oncology specialist with UofL Physicians.

“I am extremely proud of this accomplishment. The breast program at the Brown Cancer Center was the first in Kentucky and remains the longest running NAPBC accredited breast program in our region,” said Beth Riley, M.D., deputy director of the James Graham Brown Cancer Center and a breast cancer specialist. “This continued commitment to excellence and quality care is evident among our dedicated team of specialists.  Several areas of the program were also nominated for ‘Best Practice’ highlights on a national level which speaks to the high level of care we are able to provide.”

The NAPBC is a consortium of professional organizations dedicated to the improvement of the quality of care and monitoring of outcomes of patients with diseases of the breast. This mission is pursued through standard-setting, scientific validation and patient and professional education.  Its board membership includes professionals from 20 national organizations that reflect the full spectrum of breast care. 

The American Cancer Society estimates that more than 232,000 patients are diagnosed with invasive breast cancer in the United States annually. In addition, hundreds of thousands of women who deal with benign breast disease require medical evaluation for treatment options.

Receiving care at a NAPBC-accredited center ensures that a patient has access to:

• Comprehensive care, including a full range of the latest treatment services
• A multidisciplinary team approach to coordinate the best treatment options
• Information about ongoing clinical trials and new treatment options
• And, most importantly, quality breast care close to home.

For more information about the National Accreditation Program for Breast Centers, visit the organization’s web site at www.accreditedbreastcenters.org.

More than 300 Special Olympics athletes and students from Jefferson and Bullitt Counties received free athletic physicals and health screening exams at University of Louisville’s Cardinal Stadium on Oct. 17. University of Louisville physical medicine and rehabilitation (PM&R) resident and faculty physicians provided the service as part of MedFest, an event organized by Special Olympics of Kentucky (SOKY) in partnership with Jefferson County Public Schools.

MedFest, part of the Special Olympics Healthy Athletes Initiative, is an annual event providing free pre-participation physicals for SOKY athletes and individuals with intellectual and developmental disabilities in the community age 8 through adult. The physicals are required for the athletes to compete in Special Olympics activities or unified track or bowling through the Kentucky High School Athletic Association.  Optional dental, vision and hearing screenings also are offered to the students and athletes.

<<CLICK TO WATCH A VIDEO OF THE EVENT

“It’s so important for our athletes to receive the medical screenings that they need. We know that through MedFest screenings, underlying conditions a lot of times are determined,” said Kim Satterwhite, senior director of field and athlete services for SOKY.

Priya Chandan, M.D., M.P.H., assistant professor in the UofL Division of Physical Medicine and Rehabilitation who serves as clinical director for the event, said participation in MedFest is not only a service to the community, but also a learning opportunity for the providers.

“Individuals with intellectual and developmental disabilities (IDD) experience health disparities, partly because many physicians in the community are not trained to provide care for them,” Chandan said. “It’s important for our trainees – medical residents and students, nurse practitioner and nursing students, and other providers – to have this opportunity to interact with this population.”

Maria Janakos, M.D., a resident physician in physical medicine and rehabilitation, was one of 10 UofL physicians who volunteered to provide pre-participation physical exams at this year’s event.

“The athletes are amazing individuals who have tremendous motivation and determination to succeed,” Janakos said. “It is rewarding to have the opportunity to interact with them. One of the individuals I met loves to play basketball. He told me his favorite athlete was LeBron James.”

MedFest has been held every year since 2005. The location alternates between Louisville and Lexington, however UofL PM&R physicians and trainees provide the screenings every year.

Dallas Derringer, one of the athletes at the event to obtain a physical for bowling, basketball and softball, expressed gratitude for the service:  “This physical is going to help me be ready!”

Nov. 20, 2018

Research led by scientists at the University of Louisville and the University of Kentucky has produced a more complete picture of the domestic horse reference genome, a map researchers will use to determine the role inherited genes and other regions of DNA play in many horse diseases and traits important in equine science and management.

By re-analyzing DNA from a thoroughbred named Twilight, the basis for the original horse reference genome, scientists generated a more than ten-fold increase in data and types of data to correct thousands of errors in the original sequence that was released in 2009. Since then, there have been dramatic improvements in nucleotide sequencing technology and the computational hardware and algorithms used to analyze data. It is now easier and less expensive to build a reference genome.

The new equine reference genome, known as EquCab3.0, was published today in Communications Biology, representing the work of 21 co-authors from 14 universities and academic centers around the world. The horse reference genome is publicly availablethrough the National Center for Biotechnology Information, a division of the National Institutes of Health.

Genome sequencing allows researchers to read and decipher genetic information found in DNA and is especially important in mapping disease genes – discovering diseases a horse might be genetically predisposed to developing.

Data gathered from future genetic and genomic studies of horses will use the new reference as a basis, which also has implications for tackling serious diseases in humans, said principal investigator Ted Kalbfleisch, Ph.D., of the Department of Biochemistry and Molecular Genetics at the UofL School of Medicine.

“Because we can sequence a horse and map it to the reference genome, we can know what genes might be affected by a mutation and come up with a hypothesis for what went wrong,” Kalbfleisch said. “Looking beyond the horse, we all want to cure cancer and other diseases that affect humans. Being able to accurately generate reference genomes gives us the tool that we need to map an individual’s genomic content. Having a high-quality reference genome makes it possible for us to know where an individual has a mutation and personalize therapies that will be right for an individual and the specific disease they have.”

Senior author James MacLeod, V.M.D., Ph.D., of the University of Kentucky’s Gluck Equine Research Center added, “Increased accuracy of the horse reference genome achieved through this work will greatly facilitate additional research in many aspects of equine science.  Medical advances for horses as a patient population, both in terms of sensitive diagnostic tests and emergent areas of precision medicine, are addressing critical issues for the health and wellbeing of these wonderful animals.”  

Financial support for the research was provided by the Morris Animal Foundation, the United States Department of Agriculture and several additional grants to the laboratories of individual co-authors. 

Every snowflake has a unique crystal shape. Every human possesses unique fingerprints.

At the next Beer with a Scientist, Stuart J. Williams, Ph.D., will explain that every brand of bourbon has a unique signature as well. Like fingerprints, these patterns, called whiskey webs, can be used to verify a bourbon’s authenticity.

“We have discovered that if you evaporate a small, diluted drop of bourbon on a surface, it leaves behind a pattern unique to bourbon,” Williams said. “Moreover, each pattern is unique to a specific brand of bourbon. We are using these findings to detect counterfeit bourbons, as well as to investigate fundamental mechanisms of self-assembly and to introduce colloid science to bourbon enthusiasts.”

Williams, an associate professor in the Department of Mechanical Engineering at the University of Louisville, researches fluid dynamics with an emphasis on flow visualization, microfluidics and colloid science. Colloids are a combination of tiny particles of one substance that are suspended in a liquid, solid or gas, but do not join with that substance.

Bourbon enthusiasts – and anyone else – can learn more about colloid science and see images of the unique and beautiful whiskey webs at 7 p.m. on Wednesday, Dec. 5, at Holsopple Brewing, 8023 Catherine Ln., Louisville. A 30-minute presentation will be followed by an informal Q&A session.

Admission is free. Purchase of beer or other items is not required but is encouraged. (Bourbon is not available.)

Organizers encourage Beer with a Scientist patrons to drink responsibly.

UofL cancer researcher Levi Beverly, Ph.D., created the Beer with a Scientist program in 2014 as a way to bring science to the public in an informal setting. At these events, the public is invited to enjoy exactly what the title promises:  beer and science.

November 27, 2018

Levi Beverly, Ph.D., believes he can use his cancer research to help in the quest to understand a cause and find a cure for Alzheimer’s disease, and the National Institute on Aging is providing funding to allow him to investigate further.

To generate new ideas in Alzheimer’s disease research, the National Institute on Aging, one of the National Institutes of Health, has offered researchers in other fields already funded by the NIH additional money to explore links between their current field of research and Alzheimer’s disease. Beverly, a UofL cancer researcher, has received one of the first round of these $385,000 awards.

“They are hoping to spark some new directions, uncovering potential new areas for research,” said Beverly, Ph.D., associate professor of medicine at the University of Louisville. “This will get more people involved in the work and develop some preliminary seed data.”

Alzheimer’s and other neurodegenerative diseases affect more than 5 million people in the United States. As the population ages, this number is increasing.

Beverly’s primary research grant from the National Cancer Institute is to study ubiquilin proteins in cancer. Ubiquilin proteins are critical adapters that appear to be central to signaling pathways driving Alzheimer’s disease as well as cancer.

“The protein ubiquilin is lost in both cancer and Alzheimer’s and other neurodegenerative diseases,” Beverly said. “What we hope to discover is how this protein, which is associated with aberrant cell growth in cancer, also is associated with aberrant cell death in neurodegenerative diseases.”

Beverly plans to use the new funding to determine whether and how ubiquilin regulates contradictory signaling pathways in neuronal cells and epithelial cells, and how the loss of ubiquilin affects multiple types of tissues.

Robert Friedland, M.D., professor of neurology at UofL who has conducted research in Alzheimer’s disease for more than three decades, is collaborating with Beverly on the project.  

“We have known for many years that protein folding patterns are critical to neuronal damage in Alzheimer's,” Friedland said. “The work Dr. Beverly has done with ubiquilin has uncovered pathways that may be involved in key mechanisms of both Alzheimer’s disease and cancer. We anticipate that the interaction of researchers in cancer and neurodegeneration will help advance both fields.”

With combined annual national expenditures of approximately $300 billion for cancer and Alzheimer’s diseases in the United States, these conditions represent two of the largest burdens on the health-care system. Beverly believes the laboratory research conducted in this project will facilitate the development of therapeutic interventions for these diseases.

“Only by understanding the basic molecular, biochemical and genetic causes of these diseases will we be able to make significant progress in treating these patients,” Beverly said.

November 15, 2018

The University of Louisville James Graham Brown Cancer Center and School of Medicine will present a free seminar open to the public on immunotherapy in the treatment of cancer at 11:30 a.m., Thursday, Nov. 15, 2018. The event will be held in rooms 101-102 of the Kosair Charities Clinical and Translational Research Building, 505 S. Hancock St.

Charles Graeber, New York Times bestselling author of “The Good Nurse,” and Thomas Gajewski, M.D., Ph.D., a cancer researcher at the University of Chicago, will discuss Graeber’s new book, “The Breakthrough: Immunotherapy and the Race to Cure Cancer.” The book examines the ways in which cancer proliferates by avoiding the immune system, and the important new cancer immunotherapies that are beginning to unleash the immune system to fight – and beat –  the disease. 

Following the discussion, a question-and-answer session will be held.

Lunch will be provided at the seminar at no cost but seating is limited. For details, contact Diane Konzen at the Brown Cancer Center, diane.konzen@louisville.edu.

At 6 p.m. on the same date, the Kentucky Author Forum will present Graeber and Gajewski at the Kentucky Center for the Performing Arts, 501 S. Main St. Several admission packages are available. Details can be found on the Kentucky Author Forum website found here.

The University of Louisville Research Integrity Program will host two free presentations of the Oprah Winfrey movie, “The Immortal Life of Henrietta Lacks,” followed by question-and-answer sessions to discuss the issues raised by the movie.

The first showing will be at 10 a.m., Thursday, Nov. 8, in the basement auditorium of the Donald E. Baxter Biomedical Research Building (Baxter I) at 580 S. Preston St. on the UofL Health Sciences Center campus. The second showing will be at 2 p.m., Thursday, at the Floyd Theater located on the third floor of the UofL Student Activities Center, 2100 S. Floyd St. on the UofL Belknap Campus. Admission is free for both showings.

In 1951, cancerous cells from Baltimore resident Henrietta Lacks helped lead to breakthroughs that changed medicine. Her case sparked legal and ethical debates concerning the rights of individuals in determining how their tissue and genetic material are used – rights that are still being debated to this day.

The movie originally aired in April 2017 on HBO and stars Oprah Winfrey as Lacks’ daughter Deborah, who headed her family’s effort to find out exactly how their mother’s cells were used and what rights they had to reap the same financial rewards from the use of the cells as the researchers. Winfrey also was an executive producer of the film, taken from the best-selling book of the same name by Rebecca Skloot.

Following the HSC showing, Debra Schaller-Demers, director of research outreach and compliance at Memorial Sloan Kettering Cancer Center, New York, and Paula Radmacher, UofL export control administrator, will lead a discussion with audience members on the issues raised by the movie. Following the Belknap campus showing, Schaller-Demers and Radmacher will be joined by UofL faculty members Avery Harman and Faye Jones for the discussion.

For information, contact Carla Jones, training and outreach coordinator with the Research Integrity Program at UofL, 502-852-2403.

Selected for its excellence in creating innovative methods to reduce health care costs and improve quality of life for older adults, the Institute for Sustainable Health & Optimal Aging at the University of Louisville recently received the MediStar’s Bluegrass Care Navigators Aging Care Award.  

During a ceremony held October 30 at the Muhammad Ali Center, the institute was lauded for its Flourish Program, an innovative, evidence-based approach to health care grounded in the concepts of social determinants of health and integrated care coordination 

The program is based on the institute’s Flourish Care Coordination Model, which links clinical and behavioral health care plans with a community care plan. Patients in the program receive detailed assessments, weekly and monthly monitoring, interdisciplinary health care consultation and care planning, coordination of care, community resource planning and support, as well as behavioral and mental health support. 

In addition to improving health outcomes, the Flourish model hopes to reduce health care costs by leveraging new rules through Medicare Advantage that will pay for non-skilled in-home service providers beginning in 2019.

The institute was one of seven award winners. UofL School of Public Health and Information Sciences faculty member, Sarah Moyer, M.D., also was honored for her work as a co-chair of the Louisville Health Advisory Board. She is director of the Louisville Metro Department of Public Health and Wellness.

Ophthalmology residents are learning to perform advanced eye surgeries earlier in their training at the University of Louisville thanks to a unique partnership with Suburban Excimer Laser Center and training on laser equipment from J&J Vision, a division of Johnson & Johnson.

“This is a novel public-private venture that provides a unique opportunity to combine the resources of a Fortune 500 company, the UofL ophthalmology program and a private laser center staffed with highly experienced clinicians,” said Richard Eiferman, M.D., clinical professor of ophthalmology with the University of Louisville School of Medicine, who oversees the training.  

The UofL Department of Ophthalmology & Visual Sciences is one of only three programs in the United States in which the residents are trained for LASIK and PRK procedures during residency. The physicians in the laser center train the residents in performing the procedures, while representatives of Johnson & Johnson instruct them in the use of J&J Vision Surgical equipment for these procedures.

The program’s success promptly led to expanding it to include ophthalmology residents from the University of Kentucky Department of Ophthalmology and Visual Sciences as well. Eight residents from UofL and six residents from UK are participating in the elective program.

The final stage of the training takes place at Suburban Excimer Laser Center, in which the residents perform surgeries under the direction of Eiferman, a clinical professor in the UofL School of Medicine, Frank Burns, M.D., and Mark Cassol, M.D., a lecturer in the UofL School of Medicine.

Earlier this year, two senior residents from UofL were the first medical residents in the United States to complete all of the required training and become FDA certified to perform the laser surgery prior to completing their three-year residency program. The certification typically is achieved by physicians engaged in specialized cornea fellowships following ophthalmology residency.

Only two other eye programs in the United States, Wills Eye Hospital in Philadelphia and the University of Miami’s Bascom Palmer Eye Institute, have similar programs.

Sidharth Puri, M.D., chief ophthalmology resident at UofL, said access to this training gives UofL residency graduates a significant advantage.

“This is a big strength for our program. It gives residents top notch exposure to the newest surgical techniques available,” Puri said.

To assist these residents in their training, the program is offering more affordable eye surgery to UofL faculty, staff, students and alumni. Resident procedures, staffed by Richard Eiferman, M.D., Frank Burns, M.D., and Mark Cassol, M.D., range from $495-$795 per eye for custom LASIK. For an appointment, call 502-588-0550.

November 1, 2018

Last year, Jaclyn Maria and her husband were leaving University of Louisville Hospital with a brand new bundle of life, Luca. Taking home their baby boy the day before Halloween was a special time for the family, after a challenging journey awaiting his arrival.

Jaclyn had been on bed rest at the hospital for 10 weeks after going into labor at 22 weeks. She delivered Luca on Oct. 1, 2017, at 32 weeks, and he stayed in the NICU for a month.

Jaclyn says she had a unique experience at the Center for Women and Infants at UofL Hospital. She worked with a music therapist to write songs for her baby and visited with a therapy dog to ease her anxiety.

“I had a daily a routine, and the weeks passed quickly,” she said.

“The staff did so much to spoil us and make the season of Halloween with our son special despite being in the NICU,” Jacyln said. “Thanks to the staff, we have fond memories of what could have been a very difficult time for our family.”

She received a Halloween card with Luca’s footprint, and a group of volunteers who knit costumes for the NICU babies made him a sock monkey outfit with his name and birthdate.

“It was a gift you don’t expect that means so much, and we treasure that,” she said.

As a way to pay it forward, Jaclyn launched a fund-raiser this year to fill enough Halloween baskets for every family in the NICU. Filled with candy and care items like tissues and lotion, she delivered the baskets in time to make it a special Halloween for those in a similar circumstance.

“We can’t believe it has been a year – they did so much for us while we were here and we are glad to bring cheer to others,” Jaclyn said.