Brady urologist Trinity Bivalacqua, M.D., Ph.D., the R. Christian B. Evensen Professor, has received this year’s Gold Cystoscope Award, one of the highest honors awarded by the American Urological Association. The award recognizes the young urologist who has made the most contributions during the first 10 years after completing residency.
Bivalacqua is in very good company: recipients of this award have a distinguished history of going on to become leaders in the field. And, over the years, many Gold Cystoscope awardees have been Brady faculty and former residents, including: Patrick Walsh, William Catalona, Mani Menon, Herbert Lepor, Louis Kavoussi, Alan Partin, Jeffrey Cadeddu, and William Roberts.
“Trinity Bivalacqua defines a translational surgeon-scientist,” says Partin, Director of the Brady, “and he has made numerous contributions in two fields – sexual dysfunction and urologic oncology.”
After earning a bachelor’s degree in Cell and Molecular Biology from Tulane University, he entered the M.D./Ph.D. program at Tulane’s School of Medicine. “My Ph.D. thesis described the influence of systemic disease states on dysfunctional genes responsible for aberrant vascular control of the heart, pulmonary and penile circulation,” he recalls. Bivalacqua was the first to show that both gene and stem cell-based therapies improved penile vascular function in preclinical models of erectile dysfunction.
“I knew I wanted a career that would allow me to combine basic science research with clinical responsibilities,” Bivalacqua says. Urology was a perfect fit, and he “purposefully sought out a residency at Johns Hopkins, due to the Brady’s rich tradition of training surgeon-scientists in urologic oncology.” He applied for a postdoctoral fellowship during his research year in residency, and obtained an M.D./Ph.D. Fellowship from the AUA Foundation – the first resident to do so. In part because of Bivalacqua’s groundbreaking success, the AUA Care Foundation now encourages residents to apply for postdoctoral fellowships.
After his fellowship, Bivalacqua joined the Brady faculty. With a K08 Career Development Award from the NIH/ NIDDK, he studied next-generation therapies for nerve regeneration following radical prostatectomy – research that led to discoveries in the field of peripheral nerve biology and highlighted the detrimental effects of neuroinflammation in autonomic nerve degeneration. For this work, he was awarded the esteemed AUA Rising Star Award.
Over time, his clinical and research practice shifted to focus on bladder cancer.As the Brady’s Director of Urologic Oncology, Bivalacqua has built a program around multi-disciplinary care of urologic oncology patients. He heads a translational research program in genitourinary cancers and tissue engineering, using preclinical animal models of disease – in particular, transgenic mouse models of bladder cancer and of erectile dysfunction. “My research uses cell culture models of urothelial carcinoma and genetically engineered rodent models of bladder cancer to study the inflammatory and immune responses that mediate development and ultimate progression of urothelial carcinoma.”
The carcinogen model developed in Bivalacqua’s lab has led to the first preclinical model to study non-muscle invasive bladder cancer. Using this model, which has been characterized at the genetic and molecular level, Bivalacqua’s team has developed novel intravesical therapies. Recently, they developed a genetically engineered, recombinant BCG that over-expresses a STING (stimulator of interferon genes) agonist, “resulting in enhanced interferon signaling and greater therapeutic response than BCG alone.” His work has resulted in a patent and licensing of rBCG-STING, “which is soon to be tested in a phase 1 clinical trial in patients who have been unresponsive to BCG.”
Bivalacqua believes his greatest accomplishment – so far – has been the successful development and completion of a tissue-engineered conduit that may one day lead to development of a new artificial bladder. The trial, “Phase I Open Label Single Center Exploratory Study of Autologous Neo-Urinary Conduits in Subjects Requiring Incontinent Urinary Diversion following Cystectomy,” uses autologous cell-based, engineered genitourinary tissue – instead of a surgically removed section of intestine – to replace the lower urinary tract, to reduce complications following surgery. “This trial was conceived and designed from research performed in the lab, and was brought to the first in-human clinical trial in this field,” Bivalacqua says.
In addition to his clinical and scientific work, Bivalacqua has served on numerous national committees for the AUA, the Society of Urologic Oncology and Sexual Medicine Committee of North America.