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A higher healing power
AIDS vaccine headed for new clinical trial
Never too young

When AIDS gets up close and personal
New hope for bipolar moms-to-be

Nurses get the write stuff
Hey, you, get off of my cloud
Some strings attached
A little help from our (animal) friends

A higher healing power
By Dana Goldman

A nurse and a theologian walking into a classroom might seem like the setup for a good joke, but for Emory’s new Interdisciplinary Program in Faith and Health, it’s the beginning of a beautiful relationship.
     The certificate program, run collaboratively by the Nell Hodgson Woodruff School of Nursing and the Candler School of Theology, is available to master’s level students in both schools. Nursing students learn how to more fully support patients coming from different faith traditions. Theology students explore ways that faith communities can address the health needs of their congregations.
     “When nurses know how to work in a faith care team, they not only bring a rich fund of health care knowledge, but they can bring a deep understanding of spirituality and faith as it relates to patient health,” says Darla Ura, clinical associate professor in nursing and architect of the program, now concluding its pilot year.
     And with a rapidly aging U.S. population and rates of chronic diseases like diabetes skyrocketing, many religious leaders also are considering health outreach as a way to better care for the lives—spiritual and physical—of the faithful.
     But rather than the traditional church health fairs that focus on prevention, says Ura, “we’re actually working with the ministerial team to help the students develop more in-depth clinic situations.”
     These community collaborations may take drastically different forms, depending on the population served by the congregations. “If the congregation is more elderly, we need to do more things like addressing caregiver burden,” she says. “If it is a homeless congregation, where the members are on their feet all day, we may consider having a podiatrist come, or holding foot care clinics.”
     The dual focus attracts students like Daniel Calhoun, a registered nurse with more than a decade of experience who enrolled this year in Emory’s masters in nursing program to become an emergency nurse practitioner. As one of the 22 students participating in the Program in Faith and Health this year (six hail from the School of Nursing, while 14 come from the School of Theology), he plans to use what he learns to help his patients and to establish a parish nurse program for members of his church, Mount Holly Church of God in Bremen.
     In addition to completing coursework, Calhoun and his classmates, who come from a range of faith traditions, will each assess the health care needs of one congregation and design a program to address those needs.
     “This program gives students more awareness of the relationship between faith and health,” Calhoun explains. “I knew it would give me a good background and a good start.”


AIDS vaccine headed for new clinical trial

The experimental AIDS vaccine developed by researchers at the Yerkes National Primate Research Center has progressed to a new stage in human clinical trials.
     This April, the full experimental vaccine will be tested in 30 human volunteers to determine whether people can safely take it. A portion of the vaccine was tested in people in a preliminary trial in 2003 and showed encouraging results.
     The Emory-developed vaccine uses a two-step strategy: two doses of a DNA vaccine that primes the immune system to recognize HIV, then two doses of a recombinant pox virus vaccine booster. Neither component contains the actual virus but expresses three of the virus’s main proteins to stimulate the immune system. Since it does not use any of the actual virus, the vaccine poses no risk of infection.
     This first trial is expected to last one year and will involve giving low doses of the vaccine to healthy volunteers. If the results are successful, then higher doses of the vaccine will be tested. If those trials are successful, then a third testing phase will be needed to determine the appropriate dosing schedule to maintain immunity.
     That phase, expected to last three to four years, would need to be completed before the vaccine would be tested in people at high-risk for getting HIV infection.
     The vaccine was developed by Yerkes researcher Harriet Robinson. In 1999, she tested a precursor to the current vaccine in a group of rhesus macaques, finding a favorable immune response.
Even though a workable AIDS vaccine may still be years away, this new clinical trial will be particularly important to show whether humans will have a similar response to that of the nonhuman primates, Robinson says.

Never too young

For most 13-year-olds, helping find a cure for deadly illness is the last thing on their minds.
     But not Ben Rechler. The 13-year-old New York teenager recently sent a portion of his bar mitzvah money to help the Emory Vaccine Center find a cure for AIDS.
     During the bar mitzvah service, which honors reaching the age of responsibility and accountability in society, Rechler spoke about his decision: “The Emory Vaccine Center is a research facility working
hard to find a cure for AIDS. I chose this because a very close friend of me and my family is suffering from this disease. Everyone who knows this person loves him because he is the nicest person you will ever meet. I think that it is time for me to help him.”
     This gift is not Rechler’s first to the center. In 2004, both he and his sister, Willi, sent a portion of their Chanukah money as a donation, a gift doubled by an additional donation from their parents, Mitchell and Debbie Rechler. Ben’s uncle, Roger Rechler, also matched Ben’s bar mitzvah donation with one of his own.
     The family friend Rechler mentioned in his speech is Andrew Lipschitz, a physician who contracted HIV after being exposed to an infected patient’s blood. No longer in private practice, Lipschitz now serves as scientific adviser for Concerned Parents for AIDS research. He recommended Emory as a worthy place to receive Ben Rechler’s donation.
     The Rechlers say they want to instill a “culture of giving” in their household and in their children’s lives, encouraging them to learn about different issues and to support organizations that they value.
It’s a lesson their kids appear to have taken to heart.



The National Cancer Institute (NCI) has awarded one of the largest lung cancer research grants in the United States
—approximately $7.5 million—to the Winship Cancer Institute for a collaborative project to explore early diagnostic strategies for non-small cell lung cancer and potential new therapies. Winship’s grant is built around four scientific projects, supported by three core laboratory facilities. The grant team is composed of 40 researchers, clinicians, fellows and technicians from 10 departments throughout the Woodruff Health Sciences Center. The Georgia Cancer Coalition, Georgia’s innovative public/private cancer research partnership, will provide additional financial support for lung cancer research and treatment.

The Crawford Long Medical Office Tower, which sits on top of Emory Crawford Long Hospital, won the Building Owner and Managers Association’s (BOMA) 2005–2006 award for Office Building of the Year in the medical office building category. The award recognizes quality in office buildings and office building management.

Scientists at Emory will use a $10 million grant from the National Institutes of Health to develop new strategies for vaccination that can better protect organ transplant recipients and other immune-suppressed patients from infectious disease threats. The five-year grant from the National Institute of Allergy and Infectious Diseases was awarded to scientists in the Emory Transplant Center, the Emory Vaccine Center, and the Yerkes National Primate Research Center.

Emory has been named the top-ranked university and the No. 4 institution overall in the “Best Places to Work for Postdocs” 2006 survey conducted by The Scientist magazine. Emory ranked No. 1 among academic institutions in the list, which included the top 35 private, government, and academic institutions in North America for post-doctoral students. The ranking was based on the approximately 470 post-doctoral students employed through Emory University School of Medicine.

When AIDS gets up close and personal

After her first year as a student at the Rollins School of Public Health (RSPH), Kate Bowler felt comfortable with her understanding of the magnitude of the global AIDS epidemic. She could cite statistical chapter and verse about the numbers of new cases reported each year, the risk factors, and recommendations for prevention strategies. With her peers in the Department of Global Health, she participated in efforts to advocate for improved access to medicine and health care for people living with HIV.
     That was before an O.C. Hubert Fellowship in International Health sent her to Africa. There, she worked in a clinic for HIV-positive mothers.
     “I saw people living every day with this disease,” Bowler says. “I was confronted with the realities of their lives and the choices they had to make. It was no longer about numbers and plans. It completely changed my perspective.”
     Bowler’s experience helped her better understand the complexities of working in public health in an international context, she says. Being “on the ground” gave her a first-person understanding of local resources and how health messages are perceived and used in a given community.
     “Because of this experience, I truly feel better prepared to go out and make a difference,” she says.
     Bowler and another student, Erin Jones, shared stories of their field research at the March 30 dedication of the school’s newly named Hubert Department of Global Health. The name honors the Hubert Foundation, a family charity with a longstanding commitment to global health at Emory.
     In addition to funding global field research fellowships each year, the foundation has endowed the Ruth and O.C. Hubert Chair in Religion and Health and the William H. Foege Chair in Global Health. Foege, presidential distinguished professor of global health, was instrumental in introducing the Huberts to the work at the RSPH. Keith Klugman, the world’s leading expert on antibiotic resistance in pneumonia, is the first Foege chair.
     Now, with additional support bringing its commitment to $10 million, the Hubert family is allowing the school to expand its already impressive global health reach. The gift establishes the Richard N. Hubert Fund for Global Health Excellence, which will help develop more international programs and recruit additional faculty and staff.
     The Hubert Foundation needs Emory and the RSPH as much as they need it, says Richard Hubert, a trustee of the family’s foundation, which honors his father, a self-made businessman who at his death in 1986 was the largest private individual owner of property in Cobb County, Georgia, and his mother, 95, who attended the dedication.
     “You are the ones who are helping us fulfill the lofty goals of this foundation’s mission, which is to alleviate suffering around the world,” he says. “We have the money, but we don’t have the people to go out and do the work. You are the ones with the knowledge and the willingness to go solve problems. If we can provide the means that will allow you to do this, then we will do it.”
Photographs by Erin Jones.

New hope for bipolar moms-to-be

Women with bipolar disorder who want to have children are often faced with a wrenching decision: Should they risk stopping their medication when they become pregnant? Or do they keep taking it and risk the exposure of the developing child?
     A new study by Emory researchers indicates that expectant mothers may safely continue to use one of the most common medications within certain guidelines.
     “Women with untreated bipolar disorder do not do well during pregnancy and are particularly vulnerable during the postpartum period,” says Jeffrey Newport, associate director of the Emory Women’s Mental Health Program and leader of a research team
examining this issue. In fact, bipolar pregnant women who discontinue treatment have a greater than 80% likelihood of relapse during pregnancy. And a woman with bipolar disorder is 100 times more likely than the average woman to suffer postpartum psychosis.
     Newport’s team studied whether halting lithium just prior to delivery would reduce the level of the drug in a newborn’s blood and lower the rate of complications. They found that neonatal adverse events were related to higher lithium concentrations in the blood of newborns, but that withholding lithium for 24 to 48 hours prior to delivery significantly reduced the concentration.
     Lithium use during pregnancy is controversial because the drug does cross the placenta. Babies born to mothers who take lithium have levels of the drug in the bloodstream after birth, and lithium can cause side effects such as lower Apgar scores, longer hospital stays, and higher rates of cardiac, neuromuscular, and central nervous system defects. But few researchers have ever examined ways to limit fetal exposure to lithium short of asking pregnant women taking the drug to stop.
     Given the recent study’s results, which were published in the November 2005 issue of the American Journal of Psychiatry, Newport has proposed guidelines for continuing lithium use during pregnancy for women who are at high-risk of experiencing complications without it.

Nurses get the write stuff
By Pam Auchmutey

Filling prescriptions became easier for patients and health care providers with a new state law. Signed by Gov. Sonny Perdue and effective July 1, the law expands the authority of advanced practice registered nurses (APRNs) to prescribe medications under certain conditions.
     Nurses’ “right to write” has been more than a decade in coming. That’s how long APRNs and their supporters have lobbied state legislators to change the law, a move previously opposed by the Medical Association of Georgia. Until now, Georgia was the only state that did not grant APRNs—nurse practitioners, nurse-midwives, nurse anesthetists, and psychiatric/mental health nurses—prescriptive authority. Now they can write prescriptions to treat common illnesses—cold, flu, and ear infections—and chronic illnesses such as diabetes or asthma, all within strict guidelines in consultation with a supervising physician.
     Many at the Woodruff Health Sciences Center were among those working behind the scenes to move the legislation forward. Marla Salmon, dean of the Nell Hodgson Woodruff School of Nursing, and Lucy Marion, dean of nursing at the Medical College of Georgia, met with key legislators to urge passage of the law, as did Linda Womack, director of state affairs for the University. Maureen Kelley, chair of the Department of Family and Community Nursing, testified before a House subcommittee in support of the bill. Wright Caughman, director of The Emory Clinic, also visited the legislature to express support for the bill on behalf of the clinic and Emory physician leaders. Last but not least, Health Sciences Center CEO Michael Johns, School of Medicine Dean Thomas Lawley, and Salmon sent a joint letter of support to every member of the Georgia House and Senate.
     “The power of this nurse-physician partnership proved that prescriptive authority is a winning proposition for better access and quality of care for Georgians, especially those in rural or underserved areas,” says Salmon.
     Proponents of the new law believe it will save time and frustration for patients, nurses, and physicians by streamlining the prescription process. And it will be a definite plus for patients in areas with few doctors and where nurses often serve as the touchstone to primary care.

Emory’s Winship Cancer Institute is pioneering new treatments through more than 115 clinical trials.
     For example, Winship is the only cancer facility in Georgia offering a phase 2 trial for transitional cell carcinoma, a common form of bladder cancer. Researchers are testing the effectiveness of the experimental drug Vinflunine. Previous studies have shown that the drug exhibits anti-tumor activity by inhibiting cell division. The purpose of this trial is to see whether the drug will shrink tumors or slow their growth in patients with advanced bladder cancer that is worsening despite chemotherapy.
     Winship is one of only two cancer research facilities in the country to conduct a procedure to determine how much chemotherapy actually reaches certain kinds of brain tumors. In the procedure, a tiny tube called a microdialysis catheter is inserted
directly into the patient’s brain tumor. The patient then receives an intravenous infusion of methotrexate, a chemotherapy drug. Researchers use the catheter to remove fluid directly from the tumor. They hope to determine exactly how much of the drug reaches the tumor by removing fluid for 24 hours after the chemotherapy is delivered.
     Patients in the study have recurrent, malignant, high-grade gliomas, one of the most difficult types of brain tumors to treat.The American Cancer Society estimates that malignant tumors of the brain or spinal cord account for 2.2% of all deaths.
     Winship researchers also are participating in a phase 3 multi-center, international study that found that bortezomib, one of a new class of drugs known as proteosome inhibitors, showed promise against multiple myeloma, as reported in the New England Journal of Medicine last June.
      Multiple myeloma, a plasma cell malignancy, is diagnosed in approximately 15,000 people in the United States annually and accounts for some 11,000 deaths each year. Although high-dose chemotherapy and bone marrow transplant have shown some success in treatment, median survival remains three to five years and virtually all patients evenutally die of the disease.
     Winship’s study sets the stage for the next major revolution in myeloma therapy with bortezomib. Unlike traditional chemotherapy drugs, this drug works at the molecular level to interrupt the mechanism that myeloma cells use to reproduce themselves. “If you reduce the number of cancer cells, you reduce the malignancy,” says Winship hematologist Sagar Lonial, one of the authors of the report.
     What makes this drug exciting to investigators is that it targets only the malignant cells and has less impact on normal cells.
     Finally, Winship was the first cancer facility in the country to open a trial of a new combination of chemopreventive drugs for the oral cavity and larynx in former smokers. Researchers are studying premalignant lesions of the oral cavity and larynx in former smokers, using a combination of erlotinib and celecoxib to block epidermal growth factor receptor (EGFR) mediated signaling and to inhibit cyclooxygenase-2 mediated pathways.
     Erlotinib blocks EGFR tyrosine kinase protein messaging, which tells cancer cells to grow and divide, and celecoxib is an anti-inflammatory that reduces cell formation, blood vessel formation, and metastases. Individually, the drugs have been found to be effective chemopreventive agents. This study will evaluate the safety and effectiveness of the two drugs in combination.

Hey, you, get of of my cloud

Contrary to the Rolling Stones’ classic, sometimes you can get some satisfaction. Psychiatrist Gregory Berns has developed a theory about how people do so in Satisfaction: The Science of Finding True Fulfillment. He bases the theory on MRI studies done in his Emory lab on how the brain functions during tasks that have a level of uncertainty, novelty, and decision-making. His conclusion: satisfaction seems to come from doing something novel, whether it’s running a marathon or finishing a crossword puzzle. Tasks such as these tap directly into motivation centers in the brain.
     “Everything I have encountered inside the research lab and out in the world suggests that satisfaction is not the same as either pleasure or happiness,” Berns says. “Searching for happiness will not necessarily lead to satisfaction.”


Some strings attached

When cardiologist Joel Felner was a boy, his father presented him with a special violin. The violin was made by Giovanni Grancino in 1687 in Milan, Italy. But the gift came with strings attached, literally.
     Felner was required to practice for an hour every day while his father listened. His dad, a physician, had an office in the family home, and on more than one occasion Felner remembers his father interrupting a patient visit to come to where Felner was practicing and correct a wrong note.
     Music and doctoring run in the Felner family. Felner’s father had studied at Edinburgh College, where he could pursue an education in medicine and at the same time play in the symphony to earn some money. The violin next passed to Felner’s cousin, Peter Bornstein, who played in the London Philharmonic. Felner got his turn on the violin at age 12, when the instrument was appraised at $32,000. He completed his medical studies at Columbia and violin studies with the combined Columbia-Julliard orchestra. Both his sons have earned MDs from Emory, but that’s where the violin lessons stop. Neither Kevin nor Eric Felner took to the instrument.
     After a neck injury and a weakened left hand interfered with Felner’s own playing some 15 years ago, the instrument has been silent. Recently, Felner gave the Grancino to the Emory Symphony Orchestra. “Donating it was a way of having it around but getting some use out of it,” he says.
     The Grancino is valued at $270,000 in today’s currency. In recognition of the gift, the symphony has created the Joel M. Felner MD Chair, which will be occupied each year by the concertmaster. This auditioned chair who heads the violin section will play the Grancino during concerts, and this fall will mark the debut concert for the Grancino. This violin was one of two instruments donated to the University Symphony this year, the second made by Giuseppe Scarampella of Florence with a value of approximately $45,000.
     “The best feeling I ever had was when I gave this violin to Emory,” says Felner, who has served on Emory’s medical faculty for 35 years.

A little help from our (animal) friends

Surgeons have successfully reversed type 1 diabetes in humans by transplanting islet cells, but their success is limited by the availability of these islet cells. More than 1 million Americans have the disease, but each year, only 3,000 to 4,000 donor pancreases are available. And each can produce enough cells for, at most, only one transplant.
     Enter a promising near-term solution: islet cell xenotransplantation. Researchers from the Emory Transplant Center and Yerkes National Primate Research Center have transplanted insulin-producing neonatal porcine islet cells harvested by University of Alberta (Canada) researchers into diabetic rhesus macaque monkeys. The transplant restored the monkeys’ glucose control and allowed them to be free from sustained insulin injections.
     This research, published in the February 26 advanced online edition of Nature Medicine, also examines the effectiveness of a costimulation blockade-based regimen developed at Emory that has been proven to have fewer toxic side effects than currently used immunosuppressive regimens.
     Belatacept is a key ingredient in the costimulation blockade regimen that selectively blocks the second of two cellular signals the body needs to trigger an immune response. This regimen is less complex than the immunosuppressant compounds used in previous research, and its simplicity will make it more applicable in clinical use, says Larsen.
     In addition, the researchers addressed concerns of the possibility of cross-species disease transmission as a result of xenotransplantation. After extensive testing, they found no evidence of transmission of porcine endogenous retroviruses from the porcine cells to the transplant animals. The use of nonhuman primates was critical for testing cross-species viral transmission because of their close genetic link to humans, according to Larsen.
     The next step is to prove porcine islet cells can be a source for human transplantation and to verify the safety of the transplant procedures, a process researchers hope to begin in the next three to five years.


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