Patient care: Making people healthy

As an academic medical center, Emory has both special opportunity and responsibility to make health care better, not just pioneering innovations but also creating new models of providing care to make it more accessible, affordable, and effective. 

To understand this opportunity and responsibility, one needs only to look at Emory’s footprint in Atlanta, where last year Emory medical faculty provided almost 4 million patient services, a substantial proportion of all care in the city. These services ranged from neonatal medicine to geriatrics, from primary to tertiary care unavailable elsewhere in the city, state, or, in some cases, region. Emory doctors make Emory Healthcare the largest, most comprehensive health system in Georgia. They also provide the majority of care at Atlanta’s public hospital, at the Atlanta VA Medical Center, and at the nationally ranked children’s hospital, with which Emory operates the largest pediatric multispecialty group practice in the state.

 

In this section

Clinical trials

Cancer

Brain and nervous system

Heart disease

Transplantation

Clinical trials

Improving research through partnership—Established in 2007 as part of a national NIH clinical research consortium, the Atlanta Clinical & Translational Science Institute (ACTSI) has been a powerful force in accelerating translation of lab discoveries into innovations for patients. Led by Emory, ACTSI partners include Morehouse School of Medicine and Georgia Tech. A major ACTSI focus is engaging the community in the biomedical discovery process. Through community interaction, ACTSI researchers seek to discover what new health care tools, tests, and therapies a community needs and then find ways to meet those needs. ACTSI’s clinical interaction network currently supports more than 260 research protocols, with clinical sites throughout Atlanta. This year ACTSI received an additional $1.6 million in NIH funding to support translational imaging studies and expand health promotion to address health disparities.

Making room for more—Last fall, Emory’s Winship Cancer Institute opened a new 2,000-sq-ft unit dedicated to phase 1 (first-in-human) clinical trials designed to test safety of new treatments. Community oncologists had expressed strong interest in such a unit, which increases the odds of finding new treatments.

Cancer

Turning the table on BRCA genes—Emory’s Winship Cancer Institute is leading a national study for patients with mutations in BRCA1 or 2 genes who have breast, pancreas, colon, ovarian, or any other type of cancer. The drug under study is ABT-888 (Valiparib), which inhibits an enzyme that helps cancer cells repair DNA damage and which may make tumors more vulnerable to existing chemo compounds.

Herceptin-resistant breast cancer—For the majority of women with HER2-positive breast cancer, Herceptin can be a silver bullet, targeting HER2 cells while sparing healthy ones. About 10% of HER2-positive breast cancers are resistant to Herceptin at diagnosis, and almost all metastatic HER2-positive cancers eventually become so. A recent phase 1 trial found that adding taxol and RAD001 (Afinitor) to Herceptin caused the cancer to either stop growing or shrink in almost 80% of Herceptin-resistant cases. Disease control rate in cancers resistant to both Herceptin and taxanes—a group of drugs that includes taxol—was even higher, about 85%, suggesting that Afinitor is responsible for reversing Herceptin resistance. Data from a phase 2 trial will be available this year, and a phase 3 trial is under way.

Finding a reset button after treatment—Winship Cancer Institute offers a variety of programs to counteract the debilitating emotional and physical problems that cancer patients suffer both during and after treatment. Surgery, chemotherapy, radiation, and stress all activate the immune system, leading to release of cytokines that cause inflammation and result in depression, fatigue, and impaired memory and concentration. Doctors in Winship’s mind-body program are working with former cancer patients whose depression has failed to respond to other treatments, using brain imaging to pinpoint cytokine damage and exploring whether they can block cytokines to reduce depression and fatigue.

Brain and nervous system

Gene therapy for Alzheimer’s—Emory is one of 12 institutions involved in a phase 2 trial to see if gene therapy can slow progression of mild to moderate Alzheimer’s. An experimental medication, CERE-110, is injected directly into the part of the brain where neuron death occurs. CERE-110 packages a gene for nerve growth factor, a naturally occurring protein that helps nerve cells survive and produce acetylcholine, which plays a vital role in memory and cognitive function. An earlier study found that the treatment was safe and well tolerated and also that it increased brain metabolism.

Treatment-resistant depression—Early findings from a clinical trial at Emory hold out hope that deep brain stimulation (DBS) can restore function in patients with severe, treatment-resistant depression. Although DBS has been used for Parkinson’s and essential tremor, its use for depression is new. Electrodes implanted in the brain are connected to a small battery unit implanted in the chest. The battery lasts up to five years. When it dies, patients regress to their depressed state within weeks and then improve rapidly when a new one is implanted.

Heart disease

Fat around the heart—Emory cardiologists have determined that imaging epicardial fat tissue provides valuable diagnostic intelligence. Patients with a large volume of fat around the heart tend to have the noncalcified atherosclerotic plaques that cardiologists deem most dangerous. In addition, in patients with chest pain but no known cardiovascular disease, the presence of ischemia correlates more closely with volume of epicardial fat tissue than with the heart’s overall coronary calcium burden, itself a good predictor of heart disease. The doctors say that imaging fat around the heart could be used as a “gatekeeper,” helping cardiologists decide if a patient should go on to have a nuclear stress test.

Telehealth—Emory’s Heart & Vascular Center now offers access to specialized heart care throughout Georgia using telehealth technology. Video cameras and computer monitors allow the doctor, often hundreds of miles away, to examine a patient’s legs and feet for swelling. An on-site nurse reviews vital signs and uses an amplified stethoscope so the doctor can listen to the patient’s heart and lungs. The result? Patients in rural areas without access to cardiac specialists get the help they need and are able to participate in clinical trials that otherwise would be unavailable to them. Emory is linked to nearly 40 telehealth sites throughout the state through the Georgia Partnership for Telehealth.

Transplantation

Less toxic drugs—Emory Transplant Center helped develop a new immunosuppressant called belatacept. A recent trial showed that kidney transplant patients taking belatacept had graft survivals similar to those taking cyclosporine, while maintaining higher kidney function and lower blood pressure and cholesterol. In addition, belatacept can be given once every few weeks compared with twice daily dosing regimens necessary for standard immunosuppressive drugs.

         
  those on borrowed time  

Help for those on borrowed time

In Emory’s ALS center, neurologists, nurses, a speech language pathologist, a social worker, dieticians, and occupational, physical, and respiratory therapists address all aspects and stages of the disease, focusing on independence and quality of life. “The patient and family come to us, and we bring the providers to them,” says center director Jonathan Glass. Glass, a neurologist, is working with Emory geneticists to find protein biomarkers that can predict the severity and progression of ALS. He also is participating in a landmark phase 1 trial to treat ALS with injection of neural stem cells into the spinal cord. To hear Glass talk about the study, visit http://tinyurl.com/ALS-study.

 
         

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Emory School of Medicine Annual Report 2010