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an online version of the magazine Fall 2009
Circling the Dome
Beatty
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> Now back home and riding his vintage 1951 Ford 8N tractor, Bill Beatty is hoping a recent infusion of stem cells will repair his damaged heart.
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Stemming the Damage

A new stem cell trial holds promise for repairing cardiac function after a heart attack.

 

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Stemming
Johnston and Brinker, two among the stem stars.
Photos by Keith Weller

By the time Bill Beatty made it to the Emergency Department in Howard County he was already several hours into a major heart attack. His physicians performed a series of emergency treatments that included an intra-aortic balloon pump, but the 57-year-old engineer’s blood pressure remained dangerously low. The cardiologist called for a helicopter to transfer him to Johns Hopkins.

It was fortuitous timing: Beatty was an ideal candidate for a clinical trial, and soon received an infusion of stem cells derived from his own heart tissue, making him the second patient in the world to undergo the procedure.

Of all the attempts to harness the promise of stem cell therapy, few have garnered more hope than the bid to repair damaged hearts. Previous trials with other stem cells have shown conflicting results. But this new trial, conducted jointly with cardiologist Eduardo Marbán at Cedars-Sinai Medical Center in Los Angeles, is the first time stem cells come from the patient’s own heart.

Cardiologist Jeffrey Brinker, a member of the Hopkins team, thinks the new protocol could be a game-changer. That’s based partly on recent animal studies in which scientists at both institutions isolated stem cells from the injured animals’ hearts and infused them back into the hearts of those same animals. The stem cells formed new heart muscle and blood vessel cells. In fact, says Brinker, the new cells have a pre-determined cardiac fate. “Even in the culture dish,“ he says, “they are a beating mass of cells.

“ What’s more, according to Hopkins lead investigator Gary Gerstenblith, the animals in these studies showed “a significant decrease in relative infarct size,“ shrinking by about 25 percent. Based on those and earlier findings, investigators were cleared by the FDA and Hopkins’ Institutional Review Board to move forward with a human trial.

In Bill Beatty’s case, Hopkins heart failure chief Stuart Russell extracted a small sample of heart tissue and shipped it to Cedars Sinai, where stem cells were isolated, cultured, and expanded to large numbers. Hopkins cardiologist Peter Johnston says cardiac tissue is robust in its ability to generate stem cells, typically yielding several million transplantable cells within two months.

When ready, the cells were returned to Baltimore and infused back into Beatty through a balloon catheter placed in his damaged artery, ensuring target-specific delivery. And the watching and waiting began. For the Hopkins team, Beatty’s infarct size will be tracked by imaging chief Joao Lima and his associates using MRI scans.

Now back home and still struggling with episodes of compromised stamina and shortness of breath, Beatty says his Hopkins cardiologists were “fairly cautious“ in their prognosis, but he’ll be happy for any improvement.

Nurse coordinator Elayne Breton says Beatty is scheduled for follow-up visits at six and 12 months, when they hope to find an improvement in his heart’s function. At least one member of the Hopkins team was willing to acknowledge a certain optimism. “The excitement here is huge,“ says cardiologist Brinker.

— Ramsey Flynn



Medical Students Without Borders

A partnership with Mexico’s Monterrey Tec pays off.

 

Loyo
Loyo, now a resident
Photo by Keith Weller

When medical student Myriam Loyo arrived at Hopkins from Mexico in 2007 to do a three-month clinical rotation, she wasn’t sure what to expect. “We didn’t know how involved we were going to be in patient care since we were coming from a different country and a different system,“ recalls Loyo. “But they took us in with open arms. On Day One, I was scrubbed in the OR for an operation where they took almost half of a patient’s face off—and reconstructed the defect in the same sitting!“

Loyo and Lourdes Quintanilla-Dieck were the first students from Monterrey Tec to complete medical rotations at Hopkins, as part of a strategic partnership crafted in 2005 between the school and Johns Hopkins Medicine International (JHI).

Charles Cummings, executive director of JHI and a key architect of the agreement, watched with satisfaction as Loyo and Quintanilla-Dieck—ranked No. 1 and No. 2 respectively in their med school class at Monterrey Tec—quickly took to life at Hopkins, wowing everyone they met.

“The residents on otolaryngology–head and neck surgery commented how spectacular the students were and that they were at least as good, if not better, than the [Hopkins] students who had come through on elective rotations,“ says Cummings. “The faculty was also similarly impressed with the qualifications and core knowledge of these students.“

The student rotations (available in oncology and otolaryngology–head and neck surgery) are aimed at broadening educational opportunities for Monterrey Tec’s top medical school students. “In the future, there is great potential to expand the relationship and the areas of consultation“ between Monterrey Tec and JHI, Cummings says.

Loyo enjoyed her rotation so much that she chose to take a year off to do research in the lab of Hopkins’ David Sidransky, then applied to do her residency in otolaryngology–head and neck surgery, facing fierce competition. Of the 275 who matched, only five had been trained outside the United States—and Loyo was one of them. She matched with her first choice, Johns Hopkins, and began work this summer.

Loyo says that her most eye-opening experience has been watching the faculty at Hopkins straddle the two worlds of research and clinical practice. “At my home institution in Mexico, people tend to go in one route,“ she says. “They are either a full-time scientist or a full-time clinician. There is a communication gap between these two fields. In order to bridge that gap, you really need people who are doing both. I think Hopkins has excelled in doing that.“

Loyo expects to spend at least five more years at Hopkins completing her residency, using the experience and knowledge she gains to make an impact in Mexico when she collaborates in the future with academic clinicians in her home country.

— Rajendrani Mukhopadhyay ’04

 

 


Minor’s Major Appointment

Otolaryngology head tapped as provost.

 

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Minor
Minor at Homewood
Photo by Keith Weller

Three days after the announcement that Lloyd Minor would become the provost and senior vice president of academic affairs—the second-in-command for Johns Hopkins University—the trailblazing otolaryngologist was back in the operating room performing the surgical procedure he devised for a dizziness-inducing inner ear defect that he discovered. Minor, 52, says that the operation will “probably be my last one for a while,“ as he assumes oversight of the university’s academic divisions scattered over 11 campuses and locations in Maryland, the District of Columbia, and abroad. In his new post, Minor sees himself “building programs that will have a whole far greater than the sum of the parts. That’s the real challenge of the provost’s job,“ says Minor, who joined the School of Medicine as an assistant professor in 1993 and has headed the Department of Otolaryngology—Head and Neck Surgery for six years. During his tenure, the department expanded annual research funding by more than half, increased clinical activity by more than 30 percent, and strengthened teaching and student training.

Minor’s “passion is surpassed only by his ability to build consensus and implement ambitious, strategic priorities,“ said Hopkins president Ronald Daniels, in making the appointment.

Minor, long renowned for treating Meniere’s disease—a complex syndrome involving dizziness, hearing loss, and ringing or pressure in the ear—will oversee all university-wide issues, including accreditation, compliance with federal regulations, and research collaborations between schools. The academic deans will report to him.

“Hopkins has been my home for 16 years,“ he says, “and having the opportunity to participate in the process of taking us all, collectively, to new levels of excellence is really exciting.“

Previously, Minor headed the Laboratory of Vestibular Neurophysiology, where he advanced understanding of how the body perceives head motion and maintains balance. One of his greatest achievements came with his research into a little-known disorder of the inner ear that torments its sufferers with a range of disturbing symptoms, including various forms of vertigo. Some patients also experienced “autophony,“ in which they report hearing their own bodily noises—their heartbeat, for instance—conveyed through their bones into their hearing center.

Minor tracked the disorder to previously unnoticed little holes that had developed in the area of bone between the inner ear canals and the larger cavity that housed the brain. He named the disorder superior canal dehiscence syndrome, or SCD, and soon devised a way to surgically patch the holes, bringing relief to a previously untreated patient population.

A native of Little Rock, Arkansas, Minor received his bachelor’s and medical degrees from Brown University. His wife, Lisa Keamy, is a family practice physician in Baltimore. They have two children, Emily, 18, and Samuel, 15.

— Neil A. Grauer

 


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What She's Thinking

Rapid rise brings Miller to influential post as VP for medical affairs.

 

Miller
Miller makes her move.
Photo by Keith Weller

Redonda Miller ’92, Hopkins Hospital’s new vice president for medical affairs, has spent nearly half her life—and all of her career—at Hopkins. “Isn’t that crazy?” she says with a typically engaging laugh. “What am I thinking?”

“I came here in 1988 as a medical student, so I’ve been here 21 years. Why would you leave when you’re already at the best place?”

Miller, 43, is an associate professor of medicine. She previously served as vice chair for clinical operations in the Department of Medicine and as assistant dean for student affairs. She succeeds Beryl Rosenstein, who had been medical affairs veep for 15 years and leaves what Miller calls “big shoes to fill.” (Rosenstein remains on the faculty.)

Miller says that keeping Hopkins “the best place”—and making it even better—will be a formidable but obtainable goal in an era of increasingly strict oversight; payer and consumer demand for quality; and yet-to-be-determined health care reforms.

In her new role, Miller oversees medical staff affairs; Hospital epidemiology and infection control; medical records and the pharmacy, among a host of other institutional activities. She notes that physician credentialing procedures will become “significantly more burdensome,” with the Joint Commission instituting twice yearly, rather than once-every-two-year reviews of physicians’ qualifications.

Her experiences in the Department of Medicine as head of several multidisciplinary teams that dramatically improved a number of core measures, including ones that combat pneumonia and post-hospitalization congestive heart failure among patients, should help her in tackling the challenges of her new job. “We’ve made great strides, not only helping patients but also improving our performance, which is publicly reported [online],” she says.

With “third-party payers, including our government, demanding proof of quality care for their money,” Miller says, Hopkins and other hospitals are being judged by new criteria. Known as PPCs (Potentially Preventable Complications) in most of the country and MHACs (Maryland Hospital Acquired Conditions) in Maryland, these are outcomes physicians and hospitals strive to avoid, such as post-operative blood clots and catheter-related urinary tract infections.

Medicare and other payers “are no longer going to pay for those complications. This is a big deal for hospitals,” Miller says. Hopkins already does much to prevent such setbacks. Miller is confident the Hospital can become even better.

 — Neil A. Grauer

 


He Did da Vinci

A Leonardo acolyte’s inventive stint on TV.

 

da Vinci Pevsner (far left), with the Doing da Vinci team.
Photo credit: Courtesy of the Discovery Channel.

Jonathan Pevsner was 17 when he first encountered a painting by Leonardo da Vinci in a museum. Mesmerized, he stood gazing for six hours straight at the master’s charcoal sketch for Virgin and Child with Saint Anne and Saint John the Baptist.

In the three decades since, the associate professor of neuroscience has collected more than 700 volumes about (and some by) Leonardo; delved deeply into his scientific notebooks and experiments; and endlessly pondered the workings of the man’s extraordinary mind.

Pevsner’s own remarkable scientific credentials and capacious knowledge of everything Leonardo made him the perfect scholar to participate in the Discovery Channel’s six-week reality series last spring, Doing da Vinci. In the series, which aired on Monday nights at 10 p.m., Pevsner was paired with a team of California-based designers, engineers, architects, and carpenters. Their goal: to work from Leonardo’s sketches to build six different weapons—a multi-cannon machine gun; a chariot armed with blades on its wheels; a self-propelled cart; a giant catapult; an armored tank; and a three-story siege ladder—to see if they actually work.

“Most of the inventions worked extremely well,” Pevsner says admiringly. The most difficult device to build was the catapult “because the main lever arm broke and it was hard to figure out how tightly to wind the ropes to aim a projectile in the right direction,” Pevsner says. “Given more time, the team would have overcome their mistakes.” There was also the not insignificant challenge of moving a medieval cannonball through the Los Angeles Airport.

Pevsner, 47, who is also an associate professor of neurology at the Kennedy Krieger Institute, says that the Discovery series made him “feel closer to Leonardo.”

“Even when tests didn’t work as expected, that made me feel even more connected to the process in which Leonardo confronted these machines.”

Author of Bioinformatics and Functional Genomics, Pevsner studies and teaches about pediatric brain disorders. He believes that Leonardo’s brain would have looked like anyone else’s—but he’d love to find out for sure.

“Each genius is a product of his or her time and place, and if Leonardo had been born 500 years earlier or later he surely would have had an entirely different life story because of the environment,” Pevsner says. “But in any case, I’d sure like to get ahold of some of his DNA to find out what we could learn from its sequence.”  

— Neil A. Grauer

 

 
 
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