Spring 2014 Saint Louis University School of Medicine

GrandRounds

Schizophrenia’s assault on cognitive function New chair keeps drug discovery in house Match Day 2014

Stimulating The Brain:Neurosurgeon earns award for pioneering navigational tool.

For more information about the magazine or to submit story

suggestions, please contact 314 | 977-8335 or

grandrounds@slu.edu.

Grand Rounds is published biannually by

Saint Louis University Medical Center

Development and Alumni Relations.

Grand Rounds is mailed to alumni and friends of the Saint Louis University School of Medicine.

Philip O. Alderson, M.D. Dean|Saint Louis University

School of Medicine Vice President|Medical Affairs

Schwitalla Hall M268 1402 S. Grand Blvd.

St. Louis, MO 63104-1028

Grand rounds Editorial Board Philip O. Alderson, M.D.

Edward J. O’Brien Jr., M.D. ’67 Cheryl Byrd

maGazinE ContriButors Coordinator and Writer|Marie Dilg|SW ’94

Writer|Mike Plotnick Designer|Dana Hinterleitner

Laura Geiser|A&S ’90|Grad ’92 Nancy Solomon

Carrie Bebermeyer|Grad ’06 Riya V. Anandwala

Photo and illustration CrEdits Steve Dolan|Cover, 1, 10, 13, 20 and Back

J.B. Forbes|19 Kevin Lowder|6, 8-9 and 16

Michelle Marie Peltier|21 Jim Visser|14-15

sChool of mEdiCinE ExECutivE alumni Board

President|Edward J. O’Brien Jr., M.D. ’67|St. Louis

Emil DiFilippo, M.D. ’66|Saint Charles, Mo.

James A. Junker, M.D. ’79|St. Louis

Thomas Lieb, M.D. ’82|St. Louis

Marsha McBride, M.D. ’95|St. Louis

Gloria Merenda, M.D. ’82|St. Louis

Ellen Nicastro, M.D. ’04|Chesterfield, Mo.

Joseph Ojile, M.D. ’84|St. Louis

Leroy Ortmeyer, M.D. ’55|St. Louis

Christopher R. Spencer, M.D. ’10|St. Louis

© 2014, Saint Louis University All rights reserved

On the cover Computer graphic created by a StealthStation surgical navigational system depicting the trajectories of two subthalamic electrodes and their interactions with white matter pathways as detected with diffu-sion tensor imaging. |page 10

Vital Signs page 2

Alumni Pulse page 19

GrandRoundsVol. 12 No.1Saint Louis University School of Medicine SPRiNG 2014

Tearing Down the WallsNew chair of neurology and psychiatry focuses on cross fertilization of brain-related disciplines|page 6

A Fitting TributeNew museum honors the roots and achievements of Edward A. Doisy, Ph.D.|page 8

Guiding the WayRichard Bucholz, M.D., is named a Fellow of the National Academy of Inventors for the StealthStation navigational device he developed |page 10

Match Day 2014Students open white envelopes and the doors to their futures|page 14

Drug Discovery ExpertiseA distinguished researcher leads the department of pharmacological and physiological sciences|page 16

Philip o. alderson, m.d.

From the Dean When our new University president, Fred Pestello, Ph.D., joins Saint Louis University on July 1, the transition will mark the beginning of a new era. Many exciting plans will get underway, and there will be a lot of work to do. I’ve had the opportunity to speak with Dr. Pestello and am convinced that the School of Medicine will have his support in continuing its major role in the future of the University.

Dr. Pestello is not SLU’s only new arrival. In this issue of Grand Rounds, you’ll find a story about Tom Burris, Ph.D., the new William Beaumont Professor and chair of pharmacological and physiological science. He joined SLU last July from the Scripps Institute in Florida. This issue also features a story about Henry Nasrallah, M.D., new chair of the combined department of neurology and psychiatry, who joined SLU last October from University of Cincinnati. There also is an article in the Vital Signs section of this magazine about our most recent chair arrival, Wolf Stapelfeldt, M.D. Dr. Stapelfeldt joined SLU in January from the Cleveland Clinic, where he led the general anesthesiology program. These new leaders will bring their years of success at other strong institutions to bear on the Pestello era at SLU.

As they arrive, however, one longtime and highly successful SLU medical leader has announced his retirement. Raul Artal, M.D., has been chair of the department of obstetrics and gynecol-ogy and women’s health for the past 16 years. His excellent leadership has helped the department grow from a faculty of just six to more than 35 today. Dr. Artal will be missed, but his departure is simply another of the inevitable transitions that occur from time to time. Good people depart, and other good people arrive to take their place. Welcome to Dr. Pestello, those above and others who will join us in continuing and enhancing SLU’s tradition of excellence in patient care, medical education and research.

Dean | Saint Louis University School of Medicine Vice President | Medical Affairs

SLU President-Elect Fred Pestello, Ph.D. with Alderson

precedes a diagnosis of pancreatic cancer and the time between these two diagnoses.

Using the electronic health records of patients from the Veterans Health Administration between 1998 and 2007, researchers were able to determine the likelihood that a diagnosis of pancreatic cancer follows a diagnosis of acute pancreatitis, how often pancreatic cancer is preceded by acute pancreatitis, and the time between an initial episode of acute pancreatitis and diagnosis of pancreatic cancer. In addition, researchers identified patient characteristics most associated with a greater pancreatic cancer risk.

The study shows that in patients older than 40 with an episode of acute pancreatitis, 1.5 percent were eventually diagnosed with pancreatic cancer compared to 0.13 percent of patients without a prior episode of acute pancreatitis. In addition, 12.1 percent of patients with pancreatic cancer had an episode of acute pancreatitis prior to the diagnosis of their cancer. Age also was found to significantly impact the risk of pancreatic cancer, with patients older than 70 having almost four times the risk of being diagnosed with pancreatic cancer compared to patients between the ages of 41 and 50.

In addition, of all the cases of pancreatic cancer diagnosed after an episode of acute pancreatitis, 55 percent were diagnosed three to 24 months after the episode of pancreatitis. This result indicates that many cases of pancreatic cancer potentially could have been diagnosed earlier had patients with acute pancreatitis been evaluated for pancreatic cancer.

In light of the late stage when pancreatic cancer is typically diagnosed and the significant rate of people diagnosed with acute pancrea-titis that are subsequently diagnosed with pancreatic cancer, the study’s authors suggest that patients over the age of 40 with acute pancreatitis should be

evaluated for pancreatic cancer with esophageal ultrasound.

“As a point of reference, it’s useful to consider that the relative number of patients with acute pancreatitis who are subsequently diagnosed with pancreatic cancer is greater than that of cancer discovered during colonoscopy screening,” said Agarwal.

Scientists from SLU’s Center for World Health and Medicine reviewed medical literature that identified the mechanism of action used by ReoPro® as potentially promising in treating sickle cell crises because it attacks blockages in blood flow on two fronts. They then approached Ferguson about conducting the research, said Peter Ruminski, executive director of the center.

“ReoPro® hits both of the proteins that affect the stickiness of platelets and the flow of red blood cells through the walls of the blood vessels. Our research will help us discover whether medications that have similar properties can be effective against sickle cell disease,” Ruminski said. “Sickle cell disease is a neglected disease that dramatically affects members of the St. Louis community who are African American. It is devastating for those who have it in terms of diminished quality of life and shortened lifespan.”

SLU’s Center for World Health and Medicine brokered the research project, which is the first clinical trial to come out of its work.

3 Grand Rounds Saint Louis University School of Medicine

VitalSignsLong-Term Use of Opioids increases Risk of DepressionA team of investigators led by a SLU researcher has discovered a link between chronic use of pain-relieving medication and an increase in the risk of developing major depression.

Their findings, published in the Journal of General Internal Medicine, analyzed the medical record data of about 50,000 veterans who had no history of opioid use or depression, and were subsequently prescribed opioid pain killers.

According to the findings, patients who started and remained on opioids for 180 days or longer were at a 53 percent increased risk of

developing a new episode of depression, and those using opioids for 90-180 days were at a 25 percent increased risk compared to patients who never took opioids for longer than 1-89 days.

“These findings suggest that the longer one is exposed to opioid analgesics, the greater is their risk of

developing depression,” said Jeffrey Scherrer, Ph.D., associate professor of family and community medicine and principal investigator of the study. “Opioids have long been known to allay pain and suffering, but reports of adverse effects are abundant and continue to emerge.”

Scherrer said even though there is no clear evidence about the mechanisms by which opioids may contribute to the development of depression in a patient, there could be several factors that lead to it.

Some of these include opioid-induced resetting of the brain’s ‘reward pathway’ to a higher level, which means the chronic use of narcotic pain killers can elevate the threshold for a person’s ability to experience pleasure from natural rewards such as a food or sexual activity.

Other factors may include body aches months and years after the use of opioids has stopped, side effects such as adrenal, testosterone and vitamin D deficiencies, and glucose dysregulation.

The study also suggests that the higher the dose of opioid analgesics, the greater the risk of depression.

“Preliminary evidence suggests that if you can keep your daily dose low, you may be at lower risk for depression,” he said.

Scherrer notes that even though a minority of patients takes these pain killers chronically, they are at risk of developing depression that can affect their quality of life and ability to cope with chronic pain.

He said recent studies indicate that the use of prescription opioid analgesics has quintupled recently and that more than 200 million prescriptions were issued to patients in 2009 in the United States.

Possible Relief for Sickle Cell PainSLU researchers are studying whether ReoPro® (abciximab), a drug given to heart patients undergoing angioplasties to open blocked arteries, also could help children and young adults who have severe pain from sickle cell disease.

“Sickle cell crises, which are acute episodes that can land patients in the hospital, can be excruciatingly painful,” said William Ferguson, M.D., director of the division of pediatric hematology and oncology and a SLUCare pediatrician at SSM Cardinal Glennon Children’s Medical Center.

“The typical vaso-occlusive crisis puts patients in the hospital for three to five days on intravenous medications,” he said. “All we can do is give supportive care, such as pain killers, and wait for the crisis to run its course. Our research will tell us if using a medicine like ReoPro® could be a valuable strategy in treating a sickle cell crisis.”

Ferguson, who is the study chair, said the research examines whether ReoPro® could reduce the length of time sickle cell patients spend in the hospital.

Screening Patients with Acute Pancreatitis May Catch Cancer EarlierIn a study published in Clinical Gastroenterology and Hepatology, researchers have found a link between acute pancreatitis and pancreatic cancer, a finding that may eventually lead to some pancreatic cancers being detected earlier.

Principle investigator Banke Agarwal, M.D., associate professor of gastroenterology and hepatology, said the study builds on earlier research suggesting a connection between the two illnesses.

“Our study demonstrates that there is a much higher risk of pancreatic cancer in patients with acute pancreatitis than commonly believed,” Agarwal said.

Pancreatic cancer, the fourth most common cause of cancer death in the U.S., is usually diagnosed at an advanced stage because it has few early warning signs and no established screening method.

Only four percent of those who have pancreatic cancer survive five or more years after diagnosis. This low survival rate is in large part due to the advanced stage when most pancreatic cancer is diagnosed. Surgical removal is the only chance to cure pancreatic cancer, but surgery is not an option in cases where the cancer has spread. At diagnosis, fewer than 20 percent of cases of pancreatic cancer are still localized enough to be removed surgically.

Prior to this study there was some evidence of a higher incidence of pancreatic cancer in patients who are diagnosed with acute pancreatitis. What was unknown, however, was the rate that acute pancreatitis

scherrer

Daniela Salvemini, Ph.D., professor of pharmacological and physiological sciences, has been honored by the Academy of Science of St. Louis. The Fellows Award, which recognizes a distinguished individual for outstanding achievement in science, was given to Salvemini for her contributions to understanding pain.

In announcing the award, the academy released this statement: “Dr. Salvemini has contributed more to the

eventual control of pain and opioid-induced tolerance than anyone else currently working in the field.”

Salvemini’s career includes studying with a Nobel Laureate, discovering peroxynitrite, a key molecule in the development of pain and inflammation, and uncovering some of the reasons why certain chemotherapy drugs can cause patients extreme and lasting pain.

Her work is supported by a $600,000 grant from the Leukemia & Lymphoma Society and $1.5 million grant from the NIH, which Salvemini is using to capitalize on her recent breakthrough, identifying a molecular pathway by which pain occurs with certain anti-cancer drugs. Her findings were published recently in Pain.

Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating side effect of many anti-cancer drugs. In addition, CIPN is often a limiting factor when it comes to treatment.

Salvemini’s research opens the door to finding ways to block CIPN, which could save more lives by permitting the administration of larger, potentially more effective doses of chemo drugs to cancer patients.

ferguson

Pain Researcher Named Fellow of Academy of Science

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5 Grand Rounds Saint Louis University School of Medicine

a pioneering fetal in-utero microneurosurgery for fetuses with myelomeningocele (spina bifida).

Elbabaa received the 2013 Cardinal Glennon St. Luke’s Faithful Healer Award and the 2013 Research Support Award from the American Association of Neurological Surgeons/Congress of Neurological Surgeons Section on Pediatric Neurosurgery.

Curriculum Reform Architect Captures a National AwardStuart Slavin, M.D., M.Ed., associate dean for curriculum and a pioneer in reforming medical school education, received one of the Association of American Medical Colleges’ highest teaching awards for 2013.

Slavin is one of four educators to receive the Alpha Omega Alpha Robert J. Glaser Distinguished Teaching Award for significant contributions to medical education made by gifted teachers.

A professor of pediatrics, Slavin has demonstrated a passion for medical education and curricular design throughout his 26 years in academic medicine. He also is a national leader in curricular innovations that allow medical students to both decrease their stress levels and enhance their scholarly performance.

Disrupting the Fibrosis TriggerA team of scientists that includes Saint Louis University researchers has identified a new way to intervene in the molecular and cellular cascade that causes fibrosis — a condition where the body’s natural process of forming scars for wound healing goes into overdrive and causes diseases.

Elbabaa invested As Reinert Endowed Chair Samer K. Elbabaa, M.D., associate professor of neurological surgery, has been named the Reinert Endowed Chair in Pediatric Neurosurgery.

Elbabaa is the director of pediatric neurosurgery at SSM Cardinal Glennon Children’s Medical Center and an attending neurosurgeon at Saint Louis University Hospital. His clinical practice focuses on all aspects of general and sub-specialized pediatric neurosurgery, with particular interest in microsurgery for pediatric brain and spinal cord tumors, minimally invasive endoscopic treatment of hydrocephalus, pediatric craniofacial surgery, skull-base surgery, and fetal repair of myelomeningocele and cranio-cervical junction anomalies.

The Reinert Endowed Chair has been fully funded by an anonymous donor and SSM Cardinal Glennon Children’s Medical Center, enabling the hospital and Saint Louis University School

of Medicine to enhance the care of hundreds of Midwestern children each year by funding

the scholarly work of an outstanding neurosurgeon.

Elbabaa came to SLU in July 2011 to lead the pediatric neurosurgery program, which has continued to grow under his leadership. Since his arrival, he has collaborated with maternal-fetal medicine and pediatric surgery teams on advancing and promoting

VitalSigns

notably as chairman of transplant anesthesiology at its Jacksonville, Fla., location, which at the time was one of the largest liver transplant programs in the country.

He was vice chairman for education in the Mayo Clinic’s department of anesthesiology in Florida as well as an assistant professor of anesthesiology and physiology in Rochester, Minn.

Stapelfeldt held other previous appointments as professor and chairman of the department of anesthesiology at the University of Florida College of Medicine,

director of liver transplant anesthesiology and director of research for the anesthesia service at the VA Medical Center

in Pittsburgh, and assistant professor of anesthesiology at the University of Pittsburgh.

He is a founder and chief medical officer of Talis Clinical, LLC, an information management company that was spun off from the Cleveland Clinic last year. Talis Clinical’s software distills and analyzes the most important data sources in a real time to guide physicians in making decisions in the high stress operation room environment.

Stapelfeldt’s research interests are liver transplantation and developing electronic systems and predictive models to help physicians make decisions about patient care. He is the author of more than 85 academic research contributions and holds two patents related to clinical decision support.

fibrosis had begun, Griggs added. “It’s really a platform technology that could be applied to a number of fibrotic conditions,” he said.

New Chair of Anesthesiology Brings Experience From Major ClinicsWolf H. Stapelfeldt, M.D., took the helm as chairman of the department of anesthesiology on Jan. 1, 2014.

Prior to joining SLU, Stapelfeldt was chairman of general anesthesiology and vice chairman of surgical operations at the Cleveland Clinic. He also was vice chairman for information systems and technologies at its Anesthesiology Institute.

In addition, Stapelfeldt served in many roles at the Mayo Clinic during the course of his career, most

The findings, published in Nature Medicine, demonstrate a potential novel therapeutic approach to treat fibrotic diseases such as idiopathic pulmonary fibrosis and liver fibrosis.

The research targets a pathway that turns off the trigger for the major molecular mediator of fibrosis, a protein called Transforming Growth Factor (TGF) beta. This protein normally is present in the body in an inactive state and must be turned on to cause fibrosis. Once activated, TGF beta protein stimulates cells called myofibroblasts to produce excess collagen, which is a principle component of scars.

The researchers showed that removing a gene in the myofibroblasts that makes a specific subset of proteins called alpha v integrins blocks the ability of these cells to trigger activation of TGF beta. Furthermore, they were able to replicate the effect of the gene deletion by treatment with a small molecule compound, thus opening the door to a potential new therapy for patients.

“This is the first foray into targeting not just a single integrin, but rather several integrins that appear to be working in concert to promote fibrosis,” said David Griggs, Ph.D., director of biology at SLU’s Center for World Health and Medicine and an author of the paper.

“We have developed small molecular compounds that selectively inhibit these integrins, which suppress TGF beta protein, and these have been effective in animal models of lung and liver fibrosis.”

The small molecule was not only able to prevent fibrosis; it made fibrosis less severe even when the treatment was started after

BEyOND VitalSigns“ The inflammatory response and the resulting damage from the prolonged inflammation are caused by the body’s own immune response to harmless microbiota.” — Rajeev Aurora, Ph.D., professor of molecular microbiology and immunology, on findings published in JAMA Otolaryngology - Head & Neck Surgery, that innocuous members of microbiome spark an immune response in people with chronic rhinosinusitis.

“ I’m honored to be receiving an award in Corinne Walentik’s name. She was a dear colleague and an admirable person.” — William Keenan, M.D., professor of pediatrics, on receiving the Dr. Corinne Walentik Provider Champion Award.

“ Our research suggests these extracts made from herbs might have beneficial effects on altering the course of age-associated cognitive decline.”

— Susan Farr, Ph.D., research professor in geriatrics on a study that found spearmint and rosemary may stave off Alzheimer’s disease.

For details on these stories and more go to slu.edu/alumni

stapelfeldt

Elbabaa

Associate Dean to Lead National Effort to Advance Women in MedicineAngela Sharkey, M.D., associate dean for faculty affairs and de-velopment, has been elected to a position with the Association of American Medical Colleges (AAMC) that sets the direction for the coming year in advancing women in academic medicine.Sharkey is chairing the steering committee of the Group on Women in Medicine for the AAMC, which represents all accredited medical schools in North America.“In order for women faculty to achieve leadership positions, they, like their male colleagues, need to continue to demonstrate aca-demic success,” said Sharkey, who also is a professor of pediatrics at SLU.“During the upcoming year, our group will focus on scholarship — enhancing our tool kit on mentoring, sponsorship and academic writing. We also will continue to focus our efforts to advance women to leadership roles in academic medicine.”While women have comprised more than 40 percent of incom-ing medical school classes since 1991, they hold only 14 of 120 dean positions and 8 percent and 19 percent of clinical and basic science departmental chair positions, according to the 2011-2012 AAMC Women in Academic Medicine Benchmark-ing report. Sharkey said more progress is needed.She previously had served as one of 10 members of the Group on Women in Medicine and Science’s steering committee, which advances the participation of women faculty, post-doctoral fellows, residents and students within academic medicine.

In a separate honor, Heartworks St. Louis presented sharkey with the agency’s 2014 Hero with a Heart award. Heartworks raises funds to support awareness and medical education pro-grams for people with Marfan syndrome and related disorders. Sharkey was hon-ored for her “tremendous clinical care” of patients. She received the award from Alan Braverman, M.D., professor of internal medicine at Washington Uni-versity School of Medicine, who hosted the Heartworks gala. Braverman’s father died from Marfan syndrome. His brother and nephew also have the disease.

Pictured are ophthalmology residents Tonya Albarelli, M.D. and David Dodds, M.D. who, this year, have taken the reins of the eyeglass matching program, ReSpectacle, at SLU. They are pictured next to former SLU neuro-ophthalmology fellow Aaron Grant, M.D. and resident Anusha Vasamsetti, M.D. who, respectively, have been involved in creating and running the innovative program that helps those who cannot afford glasses.

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6 Grand Rounds

“I’ve spent half of my 30 years in academic medicine trying to convince my colleagues that psychiatry and neurol-ogy should be merged,” said Nasrallah, who was appointed the Sydney W. Souers Endowed Chair and professor and chair-man of the Department of Neurology and Psychiatry in October 2013. “Both specialties focus on the same divine organ – the human brain. The separation between the two is artificial.

“Neurologists tend to focus on the brain’s hardware, such as tissue damage, seizures, grey or white matter degenera-tion, or sensory/motor deficits following a stroke. Psychiatrists focus on disorders of the software of the brain — mani-festing in aberrations of mood, emo-tions, thought, impulses, cognition and behavior. A department that integrates neurology and psychiatry provides op-timal care for persons afflicted with any brain disorder because both the hardware and software always are involved. To ignore one or the other would be a dis-service to our patients. It’s like trying to put together a puzzle without looking at all the pieces.”

Covering Both HemispheresNasrallah said the specialties had been in the same department for 100 years but drifted apart in the mid 1950s when neurologists became uncomfortable with the intense psychoanalytic (Freudian) focus of psychiatry that was not evidence based.

Neurologists slowly pulled away and established their own departments, journals and societies. The only bridge that remained between the two specialties was the American Board of Psychiatry and Neurology, which provides board certification. The walls between the two specialties thickened over time, and they rarely interacted.

Since that separation, however, Nasrallah said the neuroscience revolution that began with the discovery of medica-tions to treat psychosis, depression and mania has exploded with new scientific knowledge that elucidated the neurologic basis of mental disorders and the psychi-atric consequences of neurologic lesions.

The neuroscience revolution has ac-celerated with the discovery of neuroim-aging technology, as well as astonishing progress in neurobiological and molecu-lar research, including genetics.

He said research, training and clinical practice of neurology and psychiatry are destined to move toward integration, despite the persistence of the departmen-tal silo model in most medical schools. In this regard, Saint Louis University is a national leader in integration. The School of Medicine became one of the first medical schools in the country to recog-nize the value in reintegration when it combined its departments of psychiatry and neurology in 2007. The two depart-ments originally were combined from 1892 to 1962 but were split for more than 40 years before the reunification.

“The unification of diseases of the brain and mind will lead to a higher qual-ity of care and will diminish the unjusti-fied stigma of mental illness,” Nasrallah said.

He also noted that the neurobiology of psychiatric disorders has become an intensely active and promising research area, evidenced by the fact that the funding for psychiatry and neurosci-ence research is among the highest at the National Institutes of Health (NIH) over the past decade.

Step Into My OfficeNasrallah’s interest in psychiatry began at an early age. The son of a conserva-tive minister, Nasrallah’s family did not have a TV because it was deemed too distracting. Instead, he spent most of his time reading. Fascinated by what makes

people tick, Nasrallah checked out nearly every psychology book he could find in the school library. He became so well versed in psychological theory in high school that his friends sought him out for counseling and advice.

“I thought I knew much more than I actually did,” he said. “But I also knew I wanted to learn more. Unlike many psychiatrists who didn’t realize they were interested in the field until rotations in medical school, I entered medical school so I could become a psychiatrist.”

Nasrallah received his bachelor’s and medical degrees at the American Univer-sity of Beirut. Following his psychiatric residency at the University of Rochester and post-residency neuroscience research fellowship at the NIH, he served as a faculty member at the University of California at San Diego and the Univer-sity of Iowa before assuming the chair of the Ohio State University department of psychiatry for 12 years.

In 2003, following a research sabbati-cal, he joined the University of Cincinnati College of Medicine as associate dean for faculty development and professor of psychiatry and neuroscience.

Nasrallah is editor in chief of two well-known peer-reviewed journals: Schizophrenia Research and Current Psychiatry. He has received numerous awards including The Ohio State University’s highest research honor. He also has received the Exemplary Psychiatrist Award from Ohio’s chapter of the National Alliance on Mental Illness, the Presidential Commendation from the American Psychiatric Associa-tion, President’s Award from the Ohio Psychiatric Physicians Association and the Golden Apple Teaching Excellence Award from residents at four different universities where he served as faculty.

Brain DrainThroughout his career, Nasrallah said he has felt a hunger to learn the most about the sickest patients, those with schizophrenia. His main research focus is the neurobiology and psychophar-macology of schizophrenia and related psychoses. He is the author of 12 books, including the five-volume reference text The Neurology of Schizophrenia (Handbook of Schizophrenia).

Nasrallah is interested specifically in abnormal neuroplasticity in the brains of patients with schizophrenia. In healthy adults, the brain is able to reorganize itself by forming new neural connec-tions throughout life, but in patients with schizophrenia, neurogenesis is compro-mised. Nasrallah said that with acute psy-chotic episodes, brain cells are destroyed, and the brain shows regional and global atrophy.

“If you’re looking at an MRI brain scan of a 24-year-old male with schizo-phrenia, it would be similar to the brain of a 70-year-old man,” he said.

This diminished brain capacity means that patients with schizophrenia cannot remember things, cannot plan ahead or formulate decisions. They become apa-thetic, neglect their own health, develop poor eating habits, smoke heavily and of-ten become noncompliant with medica-tion, thus experiencing further psychotic episodes.

“It breaks my heart when a young patient comes back to my office or hospital three months later sicker than he was before and no longer responds to the medication that previously helped him. Preventing these treatment relapses to improve functional outcomes in young adults with schizophrenia is one of my life’s missions.”

New chair focuses on cross fertilization of brain-related disciplines

Tearing Down the Walls

Henry A. Nasrallah, M.D., wasn’t look-

ing to leave his position at the University

of Cincinnati College of Medicine. The

professor of psychiatry and neuroscience,

and director of the Schizophrenia Research

Program, also wasn’t looking to chair

another department after having served 12

years in a leadership position. But when he

learned that Saint Louis University’s School

of Medicine was searching for someone to

chair its department of neurology and psy-

chiatry, Nasrallah seized the opportunity.

SLU is one of only three medical schools in

the country with a combined department

of neurology and psychiatry.

The Big PictureAs chair of the department at SLU, Nasrallah said his

goal is to see that all patients get a full 360-degree

evaluation of their brains and minds. He also wants

psychiatry and neurology residents to do more cross

training.

“My dream is to make our model work so

well that other medical schools will adopt it and

reintegrate those two brain specialties,” he said.

“Actually, I hope one day members of the AAMC

(American Association of Medical Colleges) get

together and decide to dissolve the departmental

model and reconfigure all specialties into

‘disciplines’ to enhance scientific discovery,

training of physicians and ultimately, the medical

care of patients.”

8 Grand Rounds

The Edward A. Doisy Research Center stands as a 10-story shimmering monument to the generosity of the Doisy family

and the Nobel Laureate’s legacy of excellence in research. A more personal tribute to the scientist who spent five decades teaching at Saint Louis University can be found on the second floor of the School of Medicine.

Just down the hall from the dean’s gallery is the new Edward A. Doisy Museum.

The museum is filled with artifacts from Doisy’s lab and personal items donated by family members.

The idea for the museum came to Enrico Di Cera, M.D., the Alice A. Doisy Professor and chairman of the Edward A. Doisy department of biochemistry and molecular biology, as a result of his contacts with the Doisy family.

“Dr. Doisy is a scientific icon and a great benefactor,” said Di Cera, whose research with thrombin builds on Doisy’s discoveries. “He deserves our utmost and continued attention. To have these personal artifacts in one place for all to see means a great deal to me, the University and to Dr. Doisy’s family.”

A Fitting Tribute

The new E d wa r d a . d o i s y M u s E u M in Schwitalla Hall celebrates the professor’s life and achievements.

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7 Some of the items on display include:

1 Mission style chair from Doisy’s home office

2 Doisy’s honorary degree academic hoods from Yale University, Washington University in St. Louis, the University of Chicago, the

University of Illinois, Saint Louis University, Gustavus Aldolphus College and Paris Universities

3 Doisy’s fume hood relocated from the research lab on the first floor of Schwitalla Hall where Doisy discovered the chemical

nature of vitamin K

4 Gold-topped cane presented to Doisy’s great grandfather, Adelbert Jacques Doisy. Born in Paris, France, he fought under Napoleon, taught at the Royal Belfast Academy and moved his

wife and seven children to the United States in 1846. He spoke four languages, became the vice-consul for Italy and was awarded

the Chevalier of the Crown of Italy

5 Doisy’s roll-top desk from his home office

6 Persian rug from Doisy’s home

7 Doisy’s World War I service medal

8 Doisy family silver tea service

9 Portrait of Doisy and his wife, Alice, taken at the White House in 1962 at a dinner hosted by President John F. and Jacqueline

Kennedy honoring 49 Nobel Laureates

10 Doisy’s balance

11 Telegram Doisy received upon being awarded the Nobel Prize in Medicine. Scrapbooks in the museum are filled with

congratulatory telegrams from throughout the world

12 Civil War commemorative sword that belonged to Doisy’s grandfather, Edward Adelbert Doisy.

Doisy’s grandfather was born in Belfast in 1837 and came to the United States with his father

in 1846. He was an officer with the Ohio Volunteers during the Civil War

13 Advertisement card from the Patrick Henry, the three-masted sailing ship that brought Doisy’s

great grandfather, Adelbert Jacques Doisy (also pictured) to

the United States from Ireland in 1846

In the 20 years since Richard Bucholz, M.D., FACS, FAANS, pioneered a navigational device to guide the hands of neurosurgeons in real time and three dimensions, the StealthStation has become a global standard of care. Often described as a GPS system for the brain, the platform has decreased the invasiveness of intracranial surgery while improving operational efficacy.

And the StealthStation continues to expand into new areas of care, with a majority of hospital operating rooms relying on the device to treat brain tumors, hydrocephalus, Parkinson’s disease through deep brain stimulation, as well as for spinal and pelvic trauma and for ENT surgery.

In recognition of the positive impact of StealthStation on medicine and society, Bucholz recently earned recognition as a Fellow of the National Academy of Inventors. The honor acknowledges his role in helping to usher in new and improved treatments for a growing range of diseases and conditions.

“It’s an enabling technology that others build upon to develop new ap-plications,” said Bucholz, professor and vice chairman in the Department of Neurosurgery and K.R. Smith Endowed Chair in Neurosurgery. “It’s not isolated to a specific disease entity or area. It is an infrastructure, like the telephone, that al-lows others to hone their techniques and go to the next level.”

Emerging applications for StealthSta-tion include the new frontier of medicine that involves addressing the debilitation that occurs as human beings age.

“As we get older, our memories fade, our muscles fade, our joints fail, and there’s tremendous interest in how we can address — and even reverse — this deterioration,” Bucholz said.

Treatment of these issues through neuromodulation involves delivering elec-trical or pharmaceutical agents directly to a target area to restore or enhance function.

“If you’re going to alter the function of the brain, you have to navigate an electrode through an extremely delicate structure to a small target deep in the brain that subserves that function,” Bucholz said. “This has been shown to be transformative for many Parkinson’s disease patients who suffer great disability because of the tremors and rigidity as-

sociated with the disease. You can actu-ally eliminate some of the symptoms in many patients.”

The StealthStation also stands at the threshold of more effective psychosurgi-cal treatments for a range of psychiatric disorders, such as obsessive-compulsive disorder, schizophrenia and depression.

Mapping the ConnectionsKey to the discovery of more effective treatments is a more complete under-standing of the complex neural and vascular connections within the brain.

“The brain is undoubtedly the most complex structure in the universe that we know of,” Bucholz said. “What we don’t know about the brain dwarfs what we do know about it.”

To help facilitate greater knowledge of the brain’s connections, SLU is participat-ing in the Human Connectome Project, a five-year, $37 million research consor-tium funded by the National Institutes of Health.

The project is a comprehensive effort to map the billions of neural links that make the mind work. It will yield funda-mental information about how individual brain circuitry is related to behavioral, environmental and genetic factors. This data will pave the way for future studies that reveal how brain circuitry changes during development and aging and how it differs in neurological and psychiatric disorders.

“The frontier of this technology is just beginning to open up,” Bucholz said. “If we have better maps of connectivity, then we can use them right in the operat-ing room with our navigational systems and intervene based on abnormalities detected on these maps.”

Guiding the Way

Bucholz said the broader goal is to integrate the nervous system with a person’s surroundings to provide optimal responsiveness and mobility within that environment — particularly when faced with an advancing disease or age.

“The premise with all of this is that we, as neurosurgeons, can navigate to any part of the brain with great preci-sion and place a stimulating electrode, recording electrode, virus, drug or any other effector accurately and safely at a specific location. This ability is the basis for potentially integrating the brain with the external environment, bypassing neural structures that may have become dysfunctional because of age or disease.”

Another new horizon for image-guided neurosurgery involves geographic expansion of the technology into India, China and Africa, where large segments of the population are moving into the middle class and demanding more so-phisticated medical treatments.

“This navigational technology is a hallmark of an improved medical sys-tem,” Bucholz said.

Given the progress of computa-tion technology, procedures can now be performed using a navigational system

Three right angle views of human brain atlas superimposed upon a pa-tient’s images during the planning process for a deep brain stimulator placement. The fourth, lower right hand image is a “probe’s eye” view showing the structures entered during lead placement.

10 Grand Rounds

Richard Bucholz, M.D., is named a Fellow of the National Academy of Inventors for the StealthStation navigational device he developed.

Bucholz placing a deep brain stimulator electrode using the StealthStation (upper right) within a portable CT scanner, with image transfer and fusion performed by Lee McDurmont (mid right side of image, behind Stealth LCD panel).

running on a tablet computer, bringing the benefits of the invention to more cost-sensitive markets. Less sophisti-cated hospitals, however, may lack the neurosurgical experience or expertise to use these systems to perform detailed procedures.

By connecting these systems to worldwide networks, remote consul-tants can share their expertise virtually. Using a high-speed Internet connection, teleconferencing and videoconferencing, an experienced neurosurgeon can review the imaging and guide the hands of the inexperienced surgeon in the field, all while tracking the progress of surgery in real time.

“Connecting an inexperienced neu-rosurgeon to a remote consultant closes the loop and brings experience where it is needed,” Bucholz said.

Discovering NeurosurgeryA self-proclaimed computer geek, Bucholz followed a nontraditional path to neurosurgery. Although his dad was a physician, Bucholz found himself more drawn to basic science.

As a kid, he learned how to build an analog computer using wire, screws and paper clips.

In high school, he had access to a shared computer terminal at nearby Dart-mouth College, a rare opportunity for a student in the late 1960s.

“I used it all the time to perform the mathematics required for the analyses of my science experiments,” he said.

Bucholz entered Yale College in 1970 as a physics major, but soon opted to pursue a degree in molecular biophysics and biochemistry instead.

He discovered the field of neurophys-iology after consulting the Yale course catalog in search of the most interesting option for a biology curriculum require-ment.

“I thought, ‘nerves have electrical impulses, and in a way, they function as computers, and I’m interested in comput-ers,’” he said. “So a course in neurophysi-ology seemed to be the optimal way of completing a degree requirement.”

During the class laboratory, Bucholz used a microscope to conduct delicate, time-consuming experiments such as re-cording the hind ganglion of a cockroach or performing a frontal lobotomy on a snail.

“I found this area of applied science to be quite compelling, and I also discov-ered that I had the manual dexterity to easily perform the required preparations,” Bucholz said. “For the first time in my life, I started thinking about neurosurgery as a career.”

But first he decided to share his new-found enthusiasm with a young woman who caught his eye during a trip with the university glee club.

“For four hours, we sat next to each other on a bus, and I decided to take that opportunity to describe to her in great detail how to do a frontal lobotomy on a snail,” he said. “She could have either de-cided that I was clearly deranged or that I was, at the very least, passionate about my quest to find a role for my life.”

Richard and Kathleen Bucholz have been married for more than 40 years.

“So one undergraduate course brought me both my life’s companion and my vocation,” he said.

The Journey To Better Navigation While completing both medical school and his residency at Yale, Bucholz first became acquainted with computed to-mography (CT), which delivered a virtual three-dimensional image of the brain.

“It became very apparent to me that these three-dimensional pictures could serve as surrogates for the patient them-selves,” he said. “We could plan the path before we even got into the operating room to minimize the trauma and maxi-mize the efficacy of a procedure.”

At the time, stereotactic frames were the most advanced technology available to guide surgeons, but they were outdated and cumbersome to use.

“Stereotactic frames looked like something out of the 19th century,” Bucholz said. “Only about 2 to 3 percent of neurosurgeons used them because you had to be somewhat of a computer geek to understand all of the calculations and formulas to make them work.”

And although the devices could ef-fectively restrict a surgeon’s path within the brain, they did not provide real-time guidance throughout the procedure.

When Bucholz joined the SLU faculty in 1983, he was committed to finding a simpler and better way to track a sur-geon’s instruments — in real time and in three dimensions.

With the enthu-siastic support of Kenneth R. Smith Jr., M.D., then director of the division of neurosurgery at the School of Medi-cine, Bucholz began tinkering in his home workshop.

He worked closely with Lee McDur-mont, currently IT manager for the SLU department of surgery, who has been actively involved in the clinical research, engineering, technical develop-ment, refinement and commercialization of StealthStation since 1990.

They collaborated with Smith’s nephew, Kurt Smith, D.Sc., an electrical engineer at Southern Illinois University Edwardsville, and his graduate students to develop an improved navigational system.

But the path to suc-cess wasn’t an easy one. The team encountered a healthy dose of skepticism from both the medical and business communities.

“Many key opinion leaders in neurosurgery would say, ‘I don’t need your instrument to tell me where I am,’” Bucholz said. “There was tremendous skepticism.”

Potential investors also questioned the viability of the innovation as a success-ful commercial product.

“It’s one thing to think of an idea; it’s another thing to get others to think that the idea is worthwhile and, particularly, for others to fi-nance the idea,” Bucholz said. “Getting businesspeople to invest within the medical mar-ketplace is incredibly complex and difficult.”

But he soldiered on. “I never got to the point of wanting to

throw in the towel because I always had such faith that the concept had applicability,” he

said.Fabricating the first prototype of a naviga-

tional system in the late ’80s, Bucholz and his team successfully completed the first six proce-

dures using the system in 1991 to demonstrate proof of concept.

The next hurdle — securing FDA certification — came in 1996, after placing 16 units in hospitals

worldwide. An entire wall of Bucholz’s office is devoted to the

28 gold plaques that represent the patents StealthSta-tion has earned over the years from the U.S. Patent and

Trademark Office.The device even entered the world of pop culture in

2001 when the television drama ER depicted the technol-ogy during the brain surgery of Dr. Mark Greene, played

by actor Anthony Edwards. Bucholz served as an adviser to the show’s producers to ensure an accurate portrayal.

The StealthStation is currently manufactured and distrib-uted by Medtronic Navigation, earning $120 million in annual

revenue.“One of the most gratifying things is when I go to a neuro-

surgical meeting where people present their surgical experience, and all of them say they use navigation in their procedures,” Bucholz said. “The same key opinion leaders who were very skeptical 20 years ago now feel that it is the foundation of neu-rosurgical procedures, just like an operative microscope or sterile technique. It has become the standard.”

He attributes its success, in large part, to being in the right place at the right time.

“I think SLU has been an ideal place to bring this concept to fruition because it doesn’t have the barriers of other institutions, yet it has the resources that smaller colleges don’t have,” he said. “I was fortunate to be placed into a situation that would nurture my ideas, provide financial and engineering support, and offer the networks that allowed us to build the initial systems and get them out into the world.”

Bucholz’s interest in computers continues to be evident both at work and in his personal life, where he and his family live in a house that integrates an advanced technology and telecommuni-cations infrastructure.

“I’m extremely lucky that I was able to combine my hobby with my vocation,” he said. “That is perhaps the best thing that anyone can do, to take the forces in your life and combine them seamlessly in such a way that makes

every day an exercise in discovery.”

“ I never got to the point of wanting to throw in the towel because I always had such faith that the concept had applicability.”

Bucholz

lEft Computer produced image of the paths of two deep brain simulator electrodes travelling through the brain as shown during surgical planning for a procedure. lEft Bottom Three right angle views of a single electrode’s target

deep within the brain during the planning process, with the fourth image consisting of a 3D view with the brain “cut away” to show the structures surrounding the target.

12 Grand Rounds

DAY

Grand Rounds 15

OtOlaryngOlOgyCollin Chen Barnes-Jewish HospitalKatherine lees Mayo School of Graduate Medical Education (Minn.)annika Meyer Icahn School of Medicine at Mount Sinai (N.Y.)

PediatriCsgregory adamson University of California San Franciscosarah Becht St. Louis Children’s Hospital Brianna Brei Rush University Medical Center (Ill.)Michael Carl St. Louis Children’s Hospital Chelsea davis University of Washington Affiliated Hospitalsandrew ellis Indiana University School of Medicinerachel Han Saint Louis University School of MedicineJessie Hu Rush University Medical Center (Ill.)Jennifer Johnson University of Arkansas-Little Rockrussell Kesman Baylor College of Medicine-Houstonaamer Khan Case Western/University Hospitals Case Medical Center (Ohio)Charlene lai Jefferson Medical College/DuPont Hospital for Children (Pa.)amy lindley Saint Louis University School of MedicineMichelle louie Children’s Hospital-Oakland (Calif.)Vijay Manne Baystate Medical Center (Mass.)shreya nannepaga University of California Irvine Medical CenterPatrick Ogurick Children’s National Medical Center (D.C.)ruchi Punatar Children’s Hospital-Oakland (Calif.)Margaret rozier Saint Louis University School of Medicinerusha shah St. Louis Children’s Hospitalelyse shaw Indiana University School of MedicineMolly Weisert Children’s Hospital-Los Angeles

PediatriCs/PM&rtaron davis University of Colorado School of Medicine-Denver

PediatriCs/PsyCHiatry/CHild PsyCHiatryXiaoxi Ouyang Indiana University School of Medicine

PHysiCal MediCine and reHaBilitatiOnCharles gonzales Barnes-Jewish HospitalJane Hwang Loyola University Medical Center (Ill.)sonal Oza Northwestern McGaw/RIC (Ill.)

PsyCHiatrystephanie Chang University of Washington Affiliated Hospitalssarah ghebrendrias University of San Francisco-FresnoJessica Whitfield Brown University Psychiatric Residency (R.I.)

radiatiOn OnCOlOgyMichael Cardenas Duke University Medical Center (N.C.)Jeevin shahi McMaster University (Ontario, Canada)

radiOlOgy-diagnOstiCMichael Beal Barnes-Jewish Hospitallauren davies Northwestern McGaw/Northwestern Memorial Hospital/VA (Ill.)Vivek Pandey Advocate Illinois Masonic Medical CenterJohn Vu Barnes-Jewish Hospitallisansha Zahirsha Loyola University Medical Center (Ill.)

surgery-generalKarun amar Western Michigan University School of Medicineryan Chen University of Louisville School of Medicine (Ky.)austen Hufton Charleston Area Medical Center/West Virginia Universityamy Hurt University of Vermont/Fletcher Allen Health Careandrew Jung University of Cincinnati Medical CenterBianca Kenyon Loyola University Medical Center (Ill.)Melissa Millar Rush University Medical Center (Ill.)Caroline neff University of Kentucky Medical CenterBrian nguyen University of Southern Californiascott schwiesow Keesler Medical Center-Keesler Air Force Base (Miss.)Michael totten University of Kentucky Medical Center

urOlOgyryan dornbier Loyola University Medical Center (Ill.)

VasCular surgeryMelanie sabbagh Louisiana State University School of Medicine-New Orleans

Cybill esguerra Rutgers-R.W. Johnson Medical School (N.J.)sarah Jarrett Barnes-Jewish HospitalKimberly lincenberg Wright State University Boonshoft School of Medicine (Ohio)Jacqueline lou Santa Clara Valley Medical Center (Calif.)Mary reagan Barnes-Jewish HospitalMichelle turley Baylor College of Medicine-Houstonanne Wheeler Loma Linda University (Calif.)Jacob Wright-Piekarski Lankenau Hospital (Pa.)

OPHtHalMOlOgyandrew Melson University of Oklahoma -Oklahoma CityMichael Merkley SAUSHEC-Fort Sam Houston (Texas)devin West University of Tennessee-Memphis

OrtHOPaediC surgeryelyse Brinkmann Loyola University Medical Center (Ill.)anthony egger Cleveland Clinic Foundation (Ohio)amanda goldin University of California San Diego Medical Center Mary grady University of Washington Affiliated Hospitalssyed Hussaini Wake Forest Baptist Medical Center (N.C.)Brock Johnson Marshall University School of Medicine (W.Va.)Michael Mahan Henry Ford Health Sciences Center (Mich.)Jay Patel Saint Louis University School of Medicinenicholas Wilson Mount Carmel Health System (Ohio)ting Zhang University of Wisconsin Hospital and Clinics

Putting Out the Welcome Match Beginning a residency program in a new city at an unfamiliar institution generates both excitement and anxiety. You can help our recent graduates make the transition through the SLU Medical Alumni Mentor program. The alumni office will match recent graduates with alumni in the community where they will be undertaking their residency programs. Whenever possible, students will be matched with alumni in the same health care institution or in the same field of interest. To become a SLU Medical Alumni Mentor, email the alumni office at mdalumni@slu.edu.

One hundred and sixty students successfully matched with a broad spectrum of high quality programs through the country during Match Day 2014. The celebration was held at the Redbird Club in downtown St. Louis.

Day2 0 1 4syed rahman Medical College of Wisconsin Affiliated HospitalsJennifer ray Loyola University Medical Center (Ill.)Jalpan ringwala Boston University Medical Center nathan robertson Saint Louis University School of MedicineBonnie ronish UCLA Medical Center (Calif.)Peter rothstein University of Colorado School of Medicine-Denvertimothy schmidt University of Illinois College of Medicine-Chicagoaradhna seth Baylor College of Medicine-Houston Justin starke Mercy Hospital St. LouisJessica sturgess Rush University Medical Center (Ill.)Charles Viet tran Mercy Hospital St. Louisdaniel Wu Harbor-UCLA Medical Center (Calif.)

internal MediCine/PediatriCsHieu duc do Loma Linda University (Calif.)Jeremy snyder Johns Hopkins Hospital (Md.)Keith Wickenhauser University of Louisville School of Medicine (Ky.)

internal MediCine/PsyCHiatryOlivia Knowles University of Iowa Hospitals and Clinics

neurOlOgiCal surgerysujit Bhimireddy University of Illinois-St. Francis Medical Centerrohit Kesarwani University of Alberta Edmonton, Alberta, Canada

neurOlOgydeborah Kerrigan Cleveland Clinic Foundation (Ohio)

OBstetriCs and gyneCOlOgyHayley Barnes University of Wisconsin Hospital and Clinics

anestHesiOlOgydavid Bissing Loyola University Medical Center (Ill.)Victor Kang Saint Louis University School of MedicineJohn le UCLA Medical Center (Calif.)david lee University of Southern Californiaronald nguyen University of Southern Californiaellen Phamduong University of Southern CaliforniaJoseph rutledge Saint Louis University School of MedicineManasa tripuraneni University of Utah Affiliated HospitalsMark Willingham Barnes-Jewish Hospitalamber Zdanovec Medical College of Wisconsin Affiliated Hospitals

derMatOlOgyJennifer albus Saint Louis University School of Medicinetheresa Mattingly Southern Illinois University School of Medicine & Affiliated Hospitalselizabeth soucy Indiana University School of Medicine

eMergenCy MediCineJenny Bao Resurrection Medical Center (Ill.)Brandon Barth Texas A&M-Scott & White HealthcareCharles Caffrey Northwestern McGaw/Northwestern Memorial Hospital/VA (Ill.)James Carr Texas A&M-Scott & White Healthcaredwayne Corcoran Harbor-UCLA Medical Center (Calif.)Katie doering Stanford University Programs (Calif.)Jonathan Kneib Stony Brook Teaching Hospitals (N.Y.)Kathryn Majors-Foley Denver Health Medical Center (Colo.)richard Paul St. John Hospital (Mich.)Jacob sanning Saint Louis University School of Medicine

Kristina sycamore University of New Mexico School of Medicineeric Wevers Hershey Medical Center/Penn State (Pa.)

FaMily MediCine nathan Billington St. Francis Hospital Center (Ind.)Wesley Carr Scott Medical Center -Scott Air Force Case (Ohio)Queena dai University of California Davis Medical Centerandrew Hellenga Saint Louis University School of MedicineZachary Kaufman St. Mary’s Hospital (Colo.)Jason Keister Halifax Medical Center (Fla.)Michael Magill-Collins Exempla St. Joseph Hospital (Colo.)Joshua Martak Methodist Health System Dallas alexander Mazzaferro Mercy Hospital St. Louistiffany Mitchell Montana Family Medicinestefanie rademacher University of Kansas School of Medicine-WichitaMallorie rhymer Mercy Hospital St. LouisMeghan tierney Group Health Cooperative (Wash.)Kanika turner Saint Louis University School of Medicinesida yan University of Texas Health Science Center-San Antonio

internal MediCinetarek adam Dartmouth-Hitchcock Medical Center (N.H.)adiba azad Icahn School of Medicine at Mount Sinai (N.Y.)Megan Chan Case Western/University Hospitals Case Medical Center (Ohio)Kristal Choi Mayo School of Graduate Medical Education (Ariz.)

shelley Choi University of California Davis Medical CenterJared Cohen SAUSHEC-Fort Sam Houston (Texas)lauren Counts Saint Louis University School of MedicineFrancis dailey Cedars-Sinai Medical Center (Calif.)Bali gill Loyola University Medical Center (Ill.)david gill University of Utah Affiliated Hospitalsdivya gumber Cleveland Clinic Foundation (Ohio)robert Hilton Rutgers-R.W. Johnson Medical School (N.J.)Kamran Hussaini Saint Louis University School of MedicineJoana Kang Mayo School of Graduate Medical Education (Minn.)Minsung Kim St. Mary Medical Center-Long Beach (Calif.)austin Knott University of Arkansas-Little Rockanthony Kruse Saint Louis University School of MedicinePriyadarsini lakireddy Boston University Medical Center Jason law New York Presbyterian Hospital-Weill Cornell Medical CenterCerena leung Saint Louis University School of Medicineandrea Ma University of Colorado School of Medicine-DenverMichael Millard University of Virginiaryan Miller Washington Hospital Center (D.C.)Christina Molumby University of Oklahoma College of Medicine-TulsaOwais nadeem Henry Ford Health Sciences Center (Mich.)tyler O’Flahrity University of California Davis Medical Centerdana Pan Cedars-Sinai Medical Center (Calif.)

Video of Match Day can be found at slu.edu/x92273.xml

aB

ovE m

icheal Beal celebrates his m

atch in radiology-diagnostic at Barnes-Jew

ish Hospital with his parents, Eugene Beal Jr., M

.D. (Res. ’86), and his mother,

Catherine Beal, M.D. (’82).

Grand Rounds 17

Thomas P. Burris, Ph.D., joined the

School of Medicine in July as the William

Beaumont Professor and Chairman of

the Department of Pharmacological and

Physiological Sciences. He said he was

drawn to Saint Louis University by the

opportunity to take on a larger role in

the leadership of a department and to

develop a vision.

Burris moved to St. Louis from

Jupiter, Fla., where he was a professor in

the Department of Molecular Therapeutics

and the Department of Metabolism and

Aging at the Scripps Research Institute.

He also directed the Scripps Center

for Diabetes and Metabolic Diseases.

He shares his vision in this article.

Scripps is what you’d describe as a soft-money institution. Everything is sup-ported through grants, including your salary and operating budget. I’ve been fairly successful in securing grants — I currently have three NIH grants that total more than a million dollars annually — but with NIH funds decreasing year after year, it’s not enough to be good anymore. You have to be good and lucky. A decade ago, an ROI was being funded at the 25th percentile. Now it’s below the 10th per-centile. A lot of great science is not get-ting funded, so I was looking for a place where I could continue to pursue grants at the level I normally would pursue but where there would be an institutional commitment to maintaining a department and supporting great science. I feel that commitment at SLU.

One of my visions is to bring chemical biology expertise to the department. The department has a lot of expertise in pharmacology, but one component of pharmacology that often is ignored in aca-demic medicine is drug discovery. Usually drugs are discovered outside academia, but there has been a recent trend toward innovative drug design in academia. I’d like to design these drugs in house and explore drug targets that people haven’t been successful with in the past or have been generally ignored as “too diffi-cult.” That requires having both biology pharmacologists and chemists working together. While this hasn’t been done in our department before, SLU brought to-gether this expertise and put an academic drug-discovery machine in place when it created the Center for World Health and Medicine. One of the major reasons I took this position was because the University agrees that drug discovery is an important focus for an academic institution. A lot of institutions haven’t made this step yet.

The advantage of keeping drug discovery in house is that a lot of our trainees will go into the drug-discovery industry. To be able to offer drug discovery here dur-ing their training is highly valuable. The other advantage is financial. Over the last decade, pharmaceutical companies have changed the way they do business. They used to invest a lot of money in conduct-ing basic research to discover where the next classes of drugs would be. Due to changes in the economy, however, they’re

focused more on developing compounds at a later stage. They’re looking to biotech firms, small pharmaceutical companies and academic institutions to make those innovations and then they buy them. If we’re making the discoveries and big pharma buys in, this could generate revenue through the intellectual property rights that SLU would own and allow the University to expand research programs and infrastructure.

The department is in a growth stage. I’ve already recruited a few chemists and will recruit more faculty members next year when some current faculty members reach retirement. I’m looking for people who can collaborate, have an entrepre-neurial spirit and have the ability to teach. I’m also looking to develop themes as I recruit. Certainly this department has strengths in the neurosciences, and I want to maintain that. In addition, I want to develop our expertise in metabolism; metabolic diseases, such as diabetes and obesity; and potentially research in the area of cancer metabolism.

I’ve spent many years in industry. Teach-ing wasn’t the primary focus in my labs, but I always looked for opportunities to teach wherever I went. I became an adjunct professor at nearby medical schools (Indiana University, Louisiana State University, Rutgers State University of New Jersey, Florida State University), and I’ve had several students complete their graduate degrees in my labs. I enjoy teaching.

A distinguished researcher with a focus on drug discovery joins SLU to

lead the Department of Pharmacological and Physiological Sciences.

drug discovery expertise

18

Another reason I wanted to join SLU was the opportunity to interact with clinicians. While we may develop the drugs, researchers don’t have the clinical expertise to identify criti-cal unmet needs. We can read about it, but when you’re in a clinical setting you can see where the gaps are. This is important in the early stages of drug development, and it’s almost essential to have clinicians involved when you’re applying for grants. We’ve had the NIH come back and say, “It’s very nice you’re developing this new anxiolytic agent, but you don’t have a psychia-trist involved in the project.” When I was at Scripps we had to recruit a psychiatrist from the University of Miami two hours away to col-laborate with us, which isn’t ideal. Here at SLU, the opportunities to interact with clinicians are much greater.

My research focuses on nuclear receptors. The most common receptors are steroid, estrogen, progesterone and androgen, but these represent only a small sub-family of this class of recep-tors. There are 48 receptors in humans, and we don’t know the signaling molecules for about half of those. Because they’re in the same family and have the same domain structure as other receptors in their class, however, we suspect they have small molecules that will bind to them. From a scientific standpoint, we’d like to identify those, but from the drug-discovery side we don’t necessary need to know about the natural molecules because we may be able to design something synthetically that will bind to a receptor and modulate its activities.

We’ve had some success with REV-ERB (a nuclear receptor known to partially control circadian rhythms and metabolism in animal models). We’ve found that heme, a natural hormone, can bind to and modulate REV-ERB, which gives us a possible drug target for diseases associated with aberrant circadian rhythms. For example, we started testing the REV-ERB drug in disease models of obesity and diabetes and found that it can

decrease obesity by increasing muscle metabo-lism. Our findings were published in the journal Nature and featured in the New York Times. We also noticed some unique effects we weren’t expecting, which happens when you test a drug that’s never been tried before. We found that the animals were easier to catch, so we started put-ting the drug into animal models of anxiety and depression and discovered that it relieved anxi-ety and improved wakefulness. This is significant because if you think about the widely used anti-anxiety medications — Valium and Xanax — they’re benzodiazepines that cause sleepiness. Here’s a drug candidate that reduces anxiety and increases wakefulness. The potential is huge.

When I was younger I wanted to be a pilot. I thought about joining the military. Then in high school I took a chemistry class and every-thing started to click. I took a lot of biology in college, and the interaction between chemistry and biology fascinated me. I considered medical school but liked the research component better. During my post-doctoral fellowship, I chose to work for one of the leaders in nuclear recep-tors because I saw these receptors as great drug targets.

I’m not a micromanager. As a leader, I want to facilitate success. I want to remove barriers so faculty can be successful. I’ve always run my lab this way, and my lab has been loyal. With the exception of one person, my entire lab moved with me from southern Florida to St. Louis. With the terrible winter weather we had, I’m

surprised they’re not throwing things at me.

I wanted to go somewhere that I could be comfortable living for a long period of time. I grew up here, my wife is from here, most of my family is here, so they were happy to see me come back after 25 years.

liVing tHe MissiOnShaped by Service

a 90-minute plane ride away. We were totally struck and overwhelmed by the contrast between what we have in the United States and what we had just left.”

During the week-long service project, Place had worked 18-hour days to treat a range of medical issues: spinal deformities, clubfoot, fractures and infections.

To say that the experience inspired Place and his eldest son would be an understate-ment.

“It had a profound impact on both of us,” he said. “I had never done anything like that, and to share the experience with Howie was great.”

Eager to repeat the experi-ence, Place returned to Milot

the following year, this time accompanied by his 16-year-old daughter. He made several annual pilgrimages to Haiti be-fore broadening his outreach to other countries in Central America and Africa.

Four of his five children have shared a service experi-ence with him, as has his wife. He’s completed a dozen trips so far.

“It rejuvenates me every time,” he said. “It’s kind of like a mini retreat. We work long and hard hours, but there’s a shot of energy that comes with the experience.”

In 2010, Place traveled to Port-au-Prince to help deliver emergency medical care in the wake of the earthquake that devastated southern Haiti.

One of his patients was a little boy named Woodler who was afflicted with a crooked spine brought on by active tuberculosis. Unable to cor-rect his spine before treating the TB, Place started the boy on medication and wrote a lengthy note detailing his treat-ment recommendations.

Two weeks later, Place received a call from a fellow SLU colleague, Gary Albers, M.D., who recognized Place’s name when treating the same boy during a medical mission assignment Albers was com-pleting in northern Haiti.

Albers connected Woodler with the Healing the Children organization, which helped secure a sponsor so he could travel to the United States and receive surgical treatment and follow-up care from Place.

The boy, age 8, now calls Columbia, Mo., home.

“Woodler has been ad-opted by the family who cared for him, and he’s doing great,” Place said.

While it’s rare for Place to witness the fruits of his service work so directly, he has observed its impact within the SLU medical community.

“This year we sent our first resident to Malawi, Africa, for a month, and that is going to become a more consistent part of our residency,” he said.

In recognition of his con-tributions, Place received the SLU School of Medicine 2013 Alumni Association Commu-nity Service Award.

AlumniPulse lEft Place examines a young boy who fell out of a mango tree and suffered a paralyzing spine fracture. BElow Place assesses the gait of a young girl.

EduCation

B.A. Chemistry, magna cum laude,

Southern Illinois University 1989

Ph.D. Molecular Biophysics,

Florida State University 1993

Postdoctoral Fellowship Baylor College of Medicine

1993-1994

Postdoctoral Fellowship UCLA School of Medicine

1994-1995

ExPEriEnCE

The Scripps Research Institute 2008-2013

Pennington Biomedical Research Center at Louisiana State University

2006-2008

Lilly Research Laboratories 1999-2006

R.W. Johnson Pharmaceutical Research Institute,

Johnson & Johnson Research and Development

1996-1999

Author of more than 120 manuscripts, holder of four patents

and a fellow of the American Association for the

Advancement of Science

A snapshot of the ligand binding pocket of the nuclear receptor REV-ERB generated by X-ray crystallography. The left panel illustrates binding to cobalt protoporphyrin, the middle panel illustrates binding to heme, and the right panel illustrates an empty binding pocket.

Returning home from his first medical mission trip to Milot, Haiti, in 2001, Howard Place, M.D. (’83), and his 16-year-old son experi-enced the thin line between poverty and prosperity.

As they ran to catch a connecting flight at Miami International Airport, both came face to face with a group of college students arriving in southern Florida to celebrate their spring break.

“There were all these kids being picked up by BMWs and Mercedes,” said Place, professor and vice chair of the department of orthopaedic surgery at Saint Louis Uni-versity School of Medicine. “We had just been in a dif-ferent world, and it was only

Saint Louis University School of Medicine Grand Rounds 19

“ We work long and hard hours,

but there’s a shot of energy that

comes with the experience.”

PlAce

May 1 John H. Gladney, M.D., Diversity Award Reception

May 16 School of Medicine Precommencement

Aug. 3 White Coat Ceremony

Oct. 23-25 Reunion Weekend

May 2-3 Techniques in Foot and Ankle Reconstructive Surgery

July 25-27 Cosmetic Blepharoplasty and Fundamentals of Face Lift

Aug. 9 Resident Update in Rhinology

Aug. 12-14 ER Skills

Aug. 21-23 The 21st Advanced Techniques in Cervical Spine Decompression and Stabilization

Sept. 4-6 2nd Annual SLU Department of Neurosurgery Combined Ventricular and Skull Base Endoscopy Course for Neurosurgeons

Sept. 24-27 Microsurgery of Aneurysms: Recent Advances

Oct. 2-4 innovative and Advanced Surgery of the Degenerative and Deformed Lumbar Spine

Oct. 10-11 Contemporary Techniques in Facial Rejuvenation: Fillers, Fat Transfers and Neck Lifting

Oct. 23-26 Hair Transplant

Oct. 30-Nov. 1 impact of Fiber Dissection for intrinsic Brain Tumor Surgery

Nov. 20-23 Endoscopic Ear Surgery and Advanced Otology Workshop

efforts with establishment of the annual Rodney M. Coe Physician with Distinction in Community Service Award.

Dr. Coe authored, co-authored or edited 22 books including Sociology of Medicine and Community Medicine: Some New Perspectives. Much of his writing focused on medical care for older people, includ-ing Endocrine Function and Aging; and Cardiovascular Disease in Older People.

Friedrich G. Schuening, M.D. 1942-2014Friedrich G. Schuening, M.D., professor of internal medicine and international expert in bone marrow transplantation, died in March. Dr. Schuening, who dedicated his life to treat-ing those with blood cancers, was himself diagnosed with acute myeloid leukemia in 2012.

Prior to his diagnosis, Dr. Schuening served as director of the division of hematology and oncology at SLU, as well as director of the outpatient

bone mar-row transplant program at Saint Louis University Hospital.

During his more than 30-year career, Dr.

Schuening conducted exten-sive research on bone marrow transplant, gene therapy and regenerative medicine. He served as principal investigator of several large preclinical and clinical studies and authored numerous scholarly articles.

Dr. Schuening was a member of the American Society of Clinical Oncol-ogy, the American Society of Hematology and the American Society for Blood and Marrow Transplantation.

DeceaseD alumnicharles cain, m.D. (’30)clyde Von Der ahe, m.D. (’43)William mitro, m.D. (’44)John Kellett, m.D. (’47)William schierman, m.D. (’49) William Bruck, m.D. (’50)John mcnamara, m.D. (’51)Robert O’neill, m.D. (’52)Robert Glein, m.D. (’53)Otto carabba, m.D. (’55)Donald st. John, m.D. (’55)courtney clower, m.D. (’57)Richard merriman, m.D. (‘59)nicholas criares, m.D. (’60)manfred soiderer, m.D. (’60)larry alves, m.D. (’69)Robert meyer, m.D. (’76)David Hoelzer, m.D. (’79)Dennistoun Brown, m.D. (‘83)Kevin Took, m.D. (’85)Jeffrey ager, m.D. (’87)Joseph liddle, m.D. (’97)

in MemoriamRodney M. Coe, Ph.D.1933-2014Rodney M. Coe, Ph.D., retired chairman of the department of family and community medicine, died in March at the age of 80 following a pro-longed illness.

Dr. Coe was a member of the School of Medicine faculty for nearly 30 years. In 1989, he became chair of the depart-ment of family and commu-

nity medicine, where he was instrumental in developing residencies in family medicine, occupational medicine and

public health. Dr. Coe was committed to help students understand the communities in which they would serve. The school honored his

FOR ALUMNi iNFORMATiON:

314-977-8335 medschool.slu.edu/alumni/

MARK yOUR CALENDARSchool of Medicine AluMni eventS

FOR CME iNFORMATiON:

314-977-7401 medschool.slu.edu/cme/

continuing MedicAl educAtion ProgrAMS

Med reuniOn 2014 October 23 - 25 Celebrating the classes of 2009, 2004, 1999, 1994, 1989, 1984, 1979, 1974, 1969, 1964, 1959, 1954 and earlier.

Each month, the School of Medicine sends an e-mail to alumni with updates about reunion weekend. If you are not currently receiving email updates about reunion weekend from the School of Medicine, please email: mdalumni@slu.edu and share your name, class year and email address.

Learn more about reunion weekend at medschool.slu.edu/alumni.

Scenes from reuniOn 2013

Robert Stanley, M.D. (’63) Receives 2013 Alumni Merit AwardStanley got his start in academic radiology at the Mallinckrodt Institute of Radiology (MIR) at Washington University in St. Louis in 1970. Within a year, Stanley was named chief of MIR’s abdominal radiology section. In 1975, he was given the opportunity, along with one of his colleagues, to lead the newly created body CT facility. He then spent the next seven years at the MIR, focused on abdominal CT.

Just prior to leaving the MIR, Stanley and two colleagues completed the first edition of a CT textbook, the fourth edition of which is now in print. In addition, he is the author of more than 180 scientific publications and has lectured worldwide.

Stanley was appointed chair of radiology at the University of Alabama at Birmingham in 1982, where he served for 20 years. He stepped down as chair in 2002 for a sabbatical to learn about the world of electronic publishing. He was named the editor-in-chief of the American Journal of Roentgenology, one of the most widely read and respected radiology journals in North America in March 2003.

Stanley has served in a leadership role in numerous radiology organiza-tions, including as president of the Society of Uroradiology and the Society of Computed Body Tomography and MR.

He has been a member of the board of chancellors of the American College of Radiology and committee chairman and officer of the American Roentgen Ray Society. He is a past president of the Alabama chapter of the American College of Radiology and recently received the Silver Medal of this organization for 20 years of service to the state chapter.

toP lEft From left: tom dalsaso sr., m.d. (’63); tom dalsaso Jr., m.d. (’93); William Kauffman, SLU’s interim president; and Bill

Coman, M.D.

aBovE Members of the class of 1993

riGht Members and friends of the class of 1953 celebrating their 60-year reunion

20 Grand Rounds Saint Louis University School of Medicine

Coe

schuening

o’Brien

From your Alumni Association President edWard J. O’Brien Jr., M.d. (’67)

them get a sense of place and stay connected. Turn to page 14 for details.

Your alumni association aspires to foster the crucial link between students of today and yesterday. With this in mind, the Executive Advisory Board reached out to members of the Class of 2014 with a first-time presentation by a board member who is recent gradu-ate. The presentation included tips on navigating the difficult transition from medical school to post-graduate education; organizing academic, clinical and personal responsibilities; and keeping connected to our medical school.

This is an exciting time of year for our medical school. Fourth-year students have been matched with their future training locations, and their graduation is right around the corner. Your Medical Alumni Association welcomes our newest members. Their success is paramount in promoting our school and our profession.

You can contribute to their success by volunteering to mentor graduates who may be matched with your institution. What a tremendous way to help

Our graduates build on the School of Medicine’s tradition of success and excellence. The school pays homage to this tradition with the new Edward A. Doisy Museum (page 8). This unique collection of Doisy’s personal possessions serves as a permanent reminder of his extraordinary accom-plishments as a scientist and educator whose legacy contin-ues to inspire to the present day. You are invited to visit the museum on the second floor in Schwitalla Hall.

We continue to be encour-aged by the increasing number of medical alumni who read the monthly email updates

and respond to the quarterly editions of “Dialogue with the Dean.” Please let us know if there is anything we can do to communicate with alumni more effectively.

And remember, members of classes ending in 4 and 9 celebrate their reunions in October. Watch for invitations and schedules. Keep current with your classmates and the medical school by becoming a class volunteer or social chair-person. For all alumni, reunion year or otherwise, please keep us updated with your contact information and whereabouts. See you in October.

1 N. Grand Blvd., Salus 609

St. Louis, MO 63103

Address Service Requested

Non-Profit Org.U.S. Postage

PaidSt. Louis, MOPermit No. 134

“Robust partnerships between the School of Medicine and its

alumni and supporters encourage both the engagement and financial support that bolster our tradition

of academic excellence. The White Coat Society celebrates these

partnerships and creates unique opportunities for friends and alumni

to contribute to the advancement of quality medical education. I invite

you to explore the avenues that most engage you.”

PhiliP O. AldersOn, M.d.Dean, School of Medicine

Vice President for Medical Affairs

“The White Coat Society represents

an investment in the future success

of the School of Medicine, in the

students who will pass through these

halls as we once did, and in the future

physicians they will become, carrying

on the legacy of our University.”

dr. Jerry dwyer ’85Cardiologist

We invite you to join the

Please visit giving.slu.edu/whiteCoat for more information about the newly reintroduced annual giving society developed specifically for our medical school supporters.