Who said engineering and neuroscience aren’t good bedfellows?

Two University of South Florida professors are proof that disparate disciplines can work together for a common cause – gaining a better understanding of a common health emergency.

Ashwin Parthasarathy, Ph.D., assistant professor in the Department of Electrical Engineering, and Maxim Mokin, M.D., Ph.D., associate professor in the Department of Neurosurgery and Brain Repair, are collaborating on a device that could help prevent strokes in patients during surgery.

(L-r) Dr. Ashwin Parthasarathy, PhD, and Dr. Maxim Mokin, MD, PhD, at Tampa General Hospital as Dr. Parthasarathy tests probes for electrical activity.

“We’re looking to see how new technologies can help drive patient care,’’ Dr. Parthasarathy said of their multi-disciplinary work. “As an engineer, I’m interested in the technology aspect and as a neurologist, Maxim is interested in the medical aspect. But I can address what his needs are and come up with solutions.’’

The engineering department is on the USF campus in northeast Tampa, while much of the work in neurology takes place downtown, at the USF Health South Tampa Center and Tampa General Hospital, USF Health’s primary teaching partner. Traditionally, most teamwork among scientists is done in closer proximity.

“It’s quite rare to be doing this because physically, we don’t even run into each other on campus,’’ Dr. Mokin said. “Engineers live and breathe in their silos and we clinicians don’t get exposed to what they do.’’

The faculty members recently were awarded a two-year, $400,000 research grant from the National Institute of Neurological Disorders and Stroke, a part of the National Institutes of Health. The money will help them collect more quantitative data from their new device, with the goal of improving treatment for patients. They also will purchase tools to refine the technology and make it fully automated, capture more data points, and hire a research coordinator.

“We’re working to make it more robust and easy to use,’’ Dr. Parthasarathy said.

Called a DCS − for diffuse correlation spectroscopy − the optical monitoring tool uses fiber optics to emit light and capture a returning signal. The light monitors blood flow to the brain during surgery and gives real-time information. Any abnormalities in how the light travels alerts doctors to a potential problem, such as a stroke or brain bleed. An explanation of their initial research findings has been published in the Journal of NeuroInterventional Surgery.

For years, neurologists have used MRIs, CAT scans and transcranial dopplers to take images of the brain, but these don’t always give surgeons the information they need at a precise moment. The new, non-invasive device – which has been tested on more than a dozen patients at TGH − uses small plastic caps attached to the head that send real-time data to a monitor in the operating room.

An image of the before (left) and after treatment delivered at Tampa General Hospital.

“The others are good tools but they’re bulky and only give you a snapshot,’’ Dr. Mokin said. “This is a small portable device that studies brain functions in an acute setting, and it gives a continuous recording.’’

The faculty members believe their invention could be a breakthrough in a critical aspect of health care. Each year, nearly 800,000 people in the United States suffer a stroke – one every 40 seconds, according to the American Heart Association. The majority of these incidents are ischemic, meaning blood flow to the brain is reduced or blocked.

“This device is giving us more data to better understand brain signals that might indicate a stroke,’’ Dr. Mokin said. “We need to know more about what is noise, what is normal function, what are the thresholds, and what changes indicate that something bad is about to happen.’’

The more information gathered in the operating room the better, the doctors say, as it will lead to efficiencies on the engineering bench.

“It’s an exciting way to do science,’’ Dr. Parthasarathy said. “I’m able to get instantaneous feedback on how my device is working, so it’s not just me toiling alone in the lab.

“Our hope is to show how this technology has great clinical value, maybe by predicting if a patient is getting better or worse. That’s the end game − predictive value in our measurements.’’

– Story by Kurt Loft for USF Health News; photos by Allison Long, USF Health Communications 

Caring for a loved one with dementia can be overwhelming and isolating. Never was that more true than during the COVID-19 pandemic.

Eileen Poiley understands that challenge well, having dedicated more than 35 years to educating caregivers at the USF Health Byrd Alzheimer’s Center. When the world stopped, she knew this important work could not.

Poiley launched the Alzheimer’s Caregivers Podcast in May 2021 to offer practical guidance to caregivers where and when they need it. As the show posts its 100^th episode this month, this resource has helped more than 7,000 unique listeners around the world with downloads from six continents.

Eileen Poiley.

“Some caregivers are at the end of their ropes, and they don’t know what to do,” Poiley said. “We help caregivers deal with the challenges from a non-medication perspective, as there are a lot of behaviors that medication can’t change.”

The podcast features 30-minute episodes on a wide range of topics affecting families dealing with Alzheimer’s disease and dementia, including understanding short-term memory loss, managing the challenges of daily life, reducing safety risks, frequently asked questions and more.

Podcast producer Scott Huetteman, whose mother has Alzheimer’s disease, encouraged Eileen to create the podcast after hearing one of her presentations in person.

“There are a lot of ways to get information out, and the challenge with caregivers is that there is so much they need to know,” Huetteman said. “The podcast is a great way caregivers can listen to episodes any time of the day or night at their convenience.”

Poiley agrees that caregivers need a large volume of information, but that comprehensive books that cover a wide range of topics aren’t typically useful for caregivers. The podcast format allows them to pick the topic they need at the right moment.

Eileen Poiley.

One caregiver who has listened to all 100 episodes—several many times—said he was in a dire situation looking for help as he cared for his family member. She was diagnosed with Alzheimer’s five years before he reached out for support beyond medical care.

“I wish that I could reconstruct the morning I discovered the Institute,” said the caregiver, who asked to remain anonymous. “I had been looking through articles I had collected in a file over the previous five years, as her needs were getting well past what I could provide. Things were getting really emotionally intense for both of us.”

The Pinellas County caregiver became hopeful upon discovering the nearby virtual Alzheimer’s support programs at USF, along with the podcast series, through a Google search.

“It was like Eileen was here in the home, how she described what we were going through at the time,” said the caregiver. “She was spot on, and I could implement what I was learning and see almost immediate results.”

“My loved one and I are now both much calmer, in a better place, all because I listened to the podcasts. Eileen identified behaviors to watch for, explained them, and gave me strategies for how to respond and how to cope.”

Alzheimer’s disease is the 7^th leading cause of death in the United States, and one in three seniors dies with dementia.

To support Alzheimer’s caregiver education at USF Health, give online at usf.to/caregivers or contact Dan Minor at danielminor@usf.edu.

Story by Davina Gould, USF Foundation.

This year’s USF Health Research Day set new records as more participants than ever filled the USF Tampa campus Marshall Student Center on March 3 to showcase the best of their scientific work.

The 33^rd USF Health Research Day included 457 research poster presentations by students, postdocs, residents, faculty, and staff across all health disciplines. Research Day is the largest research-oriented event of its kind at USF and remains the largest celebration of health sciences research collaboration across all four USF Health colleges (medicine, nursing, public health and pharmacy) as well as with colleagues in other USF colleges, including social work and engineering.

From left, Dr. Charles Lockwood, Dr. Kim Orth, Rhea Law, and Dr. Steve Liggett.

Research Day kicked off with the Annual Roy H. Behnke, MD, Distinguished Lectureship featuring speaker Kim Orth, PhD, professor of Molecular Biology and Biochemistry at University of Texas Southwestern Medical Center and an investigator at the Howard Hughes Medical Institute, at UT Southwestern Medical Center.

Dr. Orth’s presentation was titled “Black Spot, Black Death, Black Pearl: Tales of Bacterial Effectors” – click here for more about Dr. Orth and her work.

Dr. Kim Orth.

* * *

Tampa General Hospital, the primary teaching hospital for USF Health Morsani College of Medicine, was the presenting sponsor for USF Health Research Day 2023.

Following Dr. Orth’s presentation was the judging of work. Judges reviewed the posters that lined the Marshall Center Ballroom, asking the students for more detail and clarifications about their research projects. Presentations ranged from pilot, preliminary, empirical and case studies to system reviews and reviews of literature or charts.

Following the 13^th Annual Joseph Krzanowski Invited Oral Presenters by select students representing medicine, nursing, public health, and pharmacy, Research Day culminated with an Awards Ceremony in the Oval Theatre announcing the winners in 29 competitive categories – including 18 monetary awards totaling $8,600.

* * *

For the list of Research Day 2023 award winners, click here.

For the list of Research Day judges and sponsors, click here.

More photos

Photos by Freddie Coleman, video by Allison Long, USF Health Communications

Until recently, scientists knew little about how important cells called fibroblasts might help protect the brain when a life-threatening bleeding stroke occurs.

But these cells may function like a plumber making an emergency house call, said Yao Yao, PhD, associate professor in Molecular Pharmacology and Physiology in the USF Health Morsani College of Medicine.

The analogy may help explain the healing power of fibroblasts, a type of cell that contributes to the formation of connective tissue.

Little has been known about fibroblasts in the brain until recently. But studying how they function there – and their healing power on the protective sheath called the blood-brain barrier (BBB) – could hold an important key to mitigating damage done by hemorrhagic strokes, for which there is currently no treatment, making them the deadliest kind of strokes.

“In the small vessels or capillaries of your brain, you normally don’t have any fibroblasts there because the vessels are tight – not leaky,” Dr. Yao said. “It’s like a home where all the plumbing system works perfectly. But when there’s a neurological disorder like a stroke, these small vessels become leaky and toxic blood components enter the brain. And we have found that fibroblasts travel from the large vessels to the small vessels, and repair a BBB injury.”

That, he explained, is the equivalent to fibroblasts serving as a plumber coming to fix broken pipes, with water suddenly pouring into the house.

“What we know so far is that the fibroblasts are functioning like the plumber,” Dr. Yao said. “They come. They repair damage. And then they leave.”

(Sadly, the plumber alluded to in the headline above, who achieved cartoon fame in the children’s TV show The Electric Company by telling a parrot, “It’s the plumber – I’ve come to fix the sink,” does not manage this kind of dignified departure.)

Dr. Yao and his team recently published their findings about fibroblasts (sans parrots) in the journal Cell Reports.

Some aspects of fibroblasts have been thoroughly studied, such as how these cells contribute to connective tissue in the skin. But for many years, scientists didn’t know that fibroblasts could be found within the brain or central nervous system. They were thought to exist only on the surface of the brain, in layers of the protective membrane called the meninges.

“But in 2018, there was a breakthrough with a report that said fibroblasts did exist in the brain, not just on the surface,” Dr. Yao said. “So the big question for us then was, ‘What do they do? What is their function?’ From skin studies, we knew that fibroblasts are known to repair injuries if, for instance, we cut ourselves. So in the brain, does the fibroblast do the same thing?”

This prompted Yao and his colleagues to conduct a thorough search of the existing literature about fibroblasts, which was limited to “four or five papers over the past 100 years,” he said.

Complicating the matter was that most existing studies utilized non-specific markers to identify the fibroblasts.

“Most fibroblast markers also label other cell populations,” Dr. Yao said. “When these markers are used, it is difficult to determine if fibroblasts or other cells are involved.”

That led Dr. Yao’s group to study the 2018 paper, in which a marker unique to fibroblasts – known as collagen one-alpha-one (Col 1α1) was identified. That was the key step in starting their own work, leading in time to a significant discovery.

“We found out that fibroblasts do repair a very important structure called the blood-brain barrier – the area that separates blood from the central nervous system, the brain and spinal cord,” he said. “This is so important, because blood-brain barrier disruption is found in almost all neurological disorders – anything you can think of.”

Furthermore, they knew that after a brain injury or neurological disorder, it is critical to repair the disruption as quickly as possible. Tests were soon conducted on laboratory mice. Those mice deprived of fibroblasts experienced significant blood brain-barrier leakage and died within a week; those with fibroblasts recovered.

“So we had evidence,” he said. “The collagen one-alpha-one fibroblasts – in this population of mice – functioned to repair the BBB after hemorrhagic stroke.”

What comes next?

“Our goal is to fully understand the molecular mechanisms of fibroblast-mediated BBB repair, so that we can find a way to target fibroblasts to minimize neurological damage,” Yao said. “With this knowledge, we can signal fibroblasts to either come more quickly to repair BBB injury – mostly in the early phase of disease – or leave small vessels after the BBB is repaired to avoid fibrosis, which occurs mostly in the late phase of disease.”

Fibrosis can result when fibroblasts linger too long, causing a thickening or scarring of connective tissue. That led Dr. Yao back to his analogy.

“You wouldn’t want a plumber just to stay in your house when the job is done, either, just as you don’t want fibroblasts staying around when they complete their repair,” Dr. Yao said. He extends the comparison further. He and his team have learned that the fibroblasts accomplish their BBB repair by secreting a protein called TIMP2.

“Think of that as the plumber’s main tool for the job,” he said.

In addition to hoping to learn how to signal fibroblasts, Dr. Yao said he and his team will be looking into the future possibility of injecting TIMP2 directly to the injured brain, and circumventing the need for fibroblasts to deliver it.

Yao gives special credit to Lingling Xu, PhD, who played a leading role in the research and Cell Reports paper, and is now a post-doctoral researcher at Emory University. They worked together at the University of Georgia before Dr. Yao came to USF in 2021. “Our whole team will continue studying fibroblasts,” Dr. Xu said. “There’s still a long way to go to fully understand this cell.”

Meanwhile, they all know how high the stakes are in their research.

“When a hemorrhagic stroke happens, there’s not even one treatment for it, unlike ischemic strokes,” Dr. Yao said. “It is a leading cause of death. And hopefully our research will lead to saving many lives.”

— by Dave Scheiber for USF Health Communications

USF Health patients now have access to a specialized device meant to reduce back pain, thanks to the donation by Excite Medical.

Excite Medical donated two devices – the DRX9000 and the DRX9000C – as treatment options that may prove helpful to patients not benefiting from other standard non-surgical options for easing back pain, said Nathan Schilaty, DC, PhD, assistant professor and the Lincoln Endowed Chair in Chiropractic and Biomechanics Research in the Department of Neurosurgery in the USF Health Morsani College of Medicine.

USF Health’s Dr. Nathan Schilaty and Saleem Musallam, president of Excite Medical.

“Thanks to our industry partner Excite Medical, we can now offer patients a highly advanced non-surgical option for spinal decompression,” said Dr. Schilaty, who also directs the Center for Neuromusculoskeletal Research.

“In addition to providing patients with this treatment as another tool in our non-surgical arsenal, we are collecting data on the use of DRX9000 through evidence-based, peer-reviewed studies, which will better inform the medical community on its true efficacy. Earlier studies on DRX9000 are promising, and this additional data could not only validate its effectiveness but also provide the empirical data needed to expand availability and help more patients suffering with back pain.”

The DRX9000 and the DRX9000C were provided to USF Health as a gift-in-kind through a grant from the Florida High-Tech Corridor to provide clinical care and research. They are non-surgical spinal decompression devices cleared by the FDA to treat patients suffering from incapacitating lower back pain, sciatica, and neck pain caused by herniated discs, degenerative discs, and posterior facet syndrome. Decompression is currently available for spinal levels C1-T1 (cervical spine) and L1-S1 (lumbar spine).

“It is an excellent first choice for those with disc lesions as it is non-invasive and requires no medications,” said Saleem Musallam, president of Excite Medical. “Many patients can experience relief and excellent outcomes without undergoing surgery, avoiding the complications of surgery, and at a fraction of the cost of a spinal surgery.”

Patients of all ages could benefit from the DRX9000 & DRX9000C, although the treating physician may determine if there are exclusionary criteria from medical history. Even those who have had prior spinal surgery may be eligible for treatment at different levels of that previously operated.

Patients typically receive 20-24 treatments over six to eight weeks with each treatment lasting less than 30 minutes. As low back pain can accompany difficulty laying down or getting up, the table is power adjustable, which enables a patient to get on the table in a standing posture and then be gently lowered to a supine position for treatment. After treatment, it will assist them back to an upright posture. While the patient is undergoing treatment, they lay supine and are gently decompressed 18 cycles during the treatment session.

“It is gentle and relaxing,” Dr. Schilaty said, “and many patients will even often fall asleep, as they experience low-back pain relief.” Both the DRX9000 and the DRX9000C are in the USF Health Morsani Center for Advanced Healthcare on the USF campus in Tampa.  

While the devices are cleared by the FDA, treatment may not yet be covered by some insurance carriers.

Call 813-821-8634 to learn more or make an appointment.

USF Health researchers are studying how a little-known protein known as BIN1 may contribute to the formation of tangles in the brain that are a hallmark of Alzheimer’s disease, a degenerative brain condition that affects more than 6 million Americans today.

Their findings have been published in the peer-reviewed Brain: A Journal of Neurology. Leading the study was Gopal Thinakaran, PhD, CEO of the USF Health Byrd Alzheimer’s Center and Research Institute and professor of molecular medicine in the USF Health Morsani College of Medicine. Contributing to the report were Moorthi Ponnusamy, PhD, and other members of the Thinakaran Lab at the Byrd Institute.

The paper focuses on a protein called Bridging Integrator 1 – or BIN1 – a protein that is found in cells in the brain and other organs. Understanding BIN1 has been a challenge because it appears in different forms in brain cells, but breakthroughs could lead to improved therapies for people who develop Alzheimer’s as they age.

“Aging is the leading risk factor for Alzheimer’s disease,’’ Dr. Thinakaran said. “A comparison of small changes in the DNA of people worldwide with and without Alzheimer’s disease found up to 40% carry small changes in the BIN1 gene, and many of those are at a higher risk for developing the disease.’’

Until recently, other proteins, such as beta amyloid and tau, which contribute to the formation of plaques and tangles in the brain, have received more attention from researchers. But now scientists are turning to risk factors such as BIN1, believing understanding their function might offer targets for potential treatments.

BIN1 is the second-most prevalent genetic risk factor identified for late-onset Alzheimer’s disease. It encodes an adaptor protein that regulates certain functions in the brain, and evidence suggests BIN1 can alter the dynamics of cell membranes within the brain.

Thinakaran’s team looked at whether the presence of BIN1 inside the brain’s neurons favors the accumulation of tau, a toxic protein, in structures called tangles. Greater numbers of these tangles in the brain have been associated with memory loss and the death of brain cells.

The team found that laboratory mice without BIN1 in their neurons developed only milder degeneration in the regions of the brain essential for memory. Also, brain inflammation was reduced by the loss of BIN1, suggesting that BIN1 in neurons also influences nerve, or glial, cell activation during the development of Alzheimer’s disease.

“These findings mean that BIN1 in neurons promotes Alzheimer’s disease tau pathology, stimulates brain inflammation, and contributes to memory loss, thus identifying BIN1 as a possible drug target,’’ Dr. Thinakaran said.

The timing of the team’s work is critical: The number of Americans affected is expected to rise to 13 million by 2050 and cost the United States more than $1 trillion, according to the Alzheimer’s Association, a global voluntary health organization dedicated to care, support and research.

Alzheimer’s is a specific brain disease that progressively and irreversibly destroys memory and thinking skills. Eventually, Alzheimer’s disease takes away the ability to carry out even the simplest tasks.

The vast majority of people who develop Alzheimer’s dementia are age 65 or older. Experts believe this late-onset Alzheimer’s, like other common chronic diseases, develops as a result of multiple factors rather than a single cause. Although a handful of laboratories worldwide are studying how BIN1 is involved in the disease process, Thinakaran’s team is leading the research efforts to define how BIN1 acts as a risk for Alzheimer’s disease in the elderly.

Their work is funded by three major research grants totaling $7 million from the National Institute on Aging, which is part of the National Institutes of Health, along with grants from the Cure Alzheimer’s Fund and the Alzheimer’s Association.

In June, the USF Health group published a related study in the journal Molecular Neurodegeneraton, which described BIN1’s impact on glial cells, which are responsible for brain inflammation.

— Story by Kurt Loft for USF Health News 

USF Health doctors are among the best and listed as such in the Top Doctor® list by Castle Connolly.

The list, released earlier this year, includes over 400 local physicians among 55 medical specialties – 82 of them are with USF Health.

USF Health Neurologist Dr. Theresa Zesiewicz.

For more than 25 years, Castle Connolly has conducted the survey that provides the Top Doctors list.

The annual survey involves nominations from peer physicians, who are asked “Where would you go if you needed care?” The process is anonymous and confidential, and doctors cannot nominate themselves. The resulting list, based on merit and inclusion cannot be bought, provides a collection of trusted resources for quality health care.

On this year’s list, 82 physicians on the list are with USF Health. The following list is of USF Health faculty physicians currently practicing medicine within nearly three dozen clinical sites, specialty care centers and affiliated hospitals throughout the region.

Allergy & Immunulogy
Mark C Glaum, MD, PhD
Richard F Lockey, MD
Mandel R Sher, MD
Jolan E Walter, MD/PhD

Cardiac Electrophysiology
Bengt Herweg, MD

Child Neurology
Sagarika Nallu, MD

Colon & Rectal Surgery
Jorge E Marcet, MD
Jaime E Sanchez, MD

Dermatology
Basil S Cherpelis, MD
Nishit S Patel, MD

Endocrinology, Diabetes & Metabolism
Madeline Candelario-Cosme, MD
Yevgeniya Kushchayeva, MD

Family Medicine
Eric E Coris, MD
Eduardo C Gonzalez, MD
Kira K Zwygart, MD

Gasterenterology
Patrick G Brady, MD
John W Jacobs Jr, MD
Jay J Mamel, MD
Joel E Richter, MD
Pushpak Taunk, MD

Gynecology Oncology
Diana Peta-Gay English, MD
Thomas J Rutherford, MD, PhD

Infectious Disease
Sally Fathi Alrabaa, MD
Beata C Casanas, DO
Ambika Eranki, MD
Charurut Somboonwit, MD

Internal Medicine
Nathan A Brinn, MD
Denise K Edwards, MD
Lucy Guerra, MD
John D McCormick, MD
Hugo J Narvarte, MD
Kevin E O’Brien, MD

Interventional Cardiology
Fadi Matar, MD

Maternal & Fetal Medicine
Jan M Lanouette, MD
Charles J Lockwood, MD
Judette M Louis, MD
Stephanie Teresa Ros, MD

Neurological Surgery
Thomas B Freeman, MD
Donald A Smith, MD
Harry R Van Loveren, MD

Neurology
William Scott Burgin, MD
Rossitza I Chichkova, MD
Clifton Gooch, MD
Robert A Hauser, MD
Juan R Sanchez-Ramos, MD
Tuan H Vu, MD
Theresa A Zesiewicz, MD

Obstetrics & Gynecology
Shelly W Holmstrom, MD
Catherine M Lynch, MD
Dawn Palaszewski, MD
Odalis Sijin, MD

Ophthalmology
Ramesh S Ayyala, MD
Mitchell Drucker, MD
Lewis Groden, MD

Orthopaedic Surgery
Roy W Sanders, MD

Otolaryngology
Mark H Tabor, MD

Pediatric Endocrinology
Ellen Verena Jorgensen, MD
Henry Rodriguez, MD
Dorothy Shulman, MD

Pediatric Infectious Disease
Carina A Rodriguez, MD

Pediatric Nephrology
Valerie M Panzarino MD

Pediatrics
Sharon Dabrow, MD
Carol M Lilly, MD
Jennifer C Takagishi, MD

Physical Medicine & Rehabilitation
Naomi A Abel, MD

Plastic Surgery
C. Wayne Cruse, MD
Michael Harrington, MD
Nicholas J Panetta, MD
David J Smith Jr, MD
Paul D Smith, MD

Psychiatry
Jean Fils, MD
Amanda G Smith, MD

Pulmonary Disease
Kapilkumar N Patel, MD
Ricardo Restrepo-Jaramillo, MD

Rheumatology
John D Carter, MD

Surgery
Michael H Albrink, MD
Christopher G DuCoin, MD
Paul C Kuo, MD

Urology
David J Hernandez, MD

Vascular Surgery
Murray L Shames, MD

Colon & Rectal Surgery
Robert D Bennett, MD

Urology
Kevin Heinsimer, MD

USF Health microbiome expert Hariom Yadav, PhD, has received a grant from the National Institute on Aging to help determine if a common medication can restore microbiome diversity in older patients who have a form of heart failure and, thus, prevent the subsequent problems that tend keep these patients inactive and cause their conditions to worsen.

Hariom Yadav, PhD, was recently recruited to lead the USF Microbiome Research Center and his research focuses on the gut-brain connection (gut-brain axis) in relation to cognitive function.

Dr. Yadav, associate professor in the Division of Digestive Diseases and Nutrition for the Department of Neurosurgery and Brain Repair and Internal Medicine in the USF Health Morsani College of Medicine and director of the USF Center for Microbiome Research in the Microbiomes Institute, is a co-principal investigator and is working with co-principal investigator and project lead Dalane Kitzman, MD, at Wake Forest University in Winston-Salem, North Carolina.

The 3-year NIH consortium project research, which will include patients diagnosed with heart failure with preserved ejection fraction (HFpEF), is titled “Repurposing of Metformin for Older Patients with HFpEF.”

Preclinical studies show that gut barriers, including mucin production, are reduced in older gut and cause ‘leaky gut’, which allows certain antigens to diffuse into blood circulation, thus causing systemic inflammation. Preliminary data also suggest that older HFpEF patients have markedly reduced microbiome diversity, including reduced production of beneficial metabolites such as butyrate, which maintain health and gut wall integrity, and may help reduce leaky gut.

Metformin prescription bottle. Metformin is a generic medication name and label was created by photographer.

Metformin is a generic FDA-approved medication used for diabetes. Earlier studies, including research in Dr. Yadav’s lab, shows that metformin decreases leaky gut by improving microbial diversity and increasing intestinal wall mucin production thereby reducing systemic inflammation and improving physical function in lab model studies.

This new study seeks to translate these findings to determine if metformin improves microbiome diversity, reduces leaky gut, and reduces the inflammation associated with HFpEF in patients, a common condition in older people, particular older women.

“Earlier research suggests that metformin can inhibit a root cause of systemic inflammation – leaky gut – and its adverse consequences which are highly relevant to HFpEF, including exercise intolerance, a known barrier for HFpEF patients for staying active,” Dr. Yadav said. “We propose to test repurposing of metformin, a promising medication for improving heart failure outcomes by improving gut leakiness and microbial diversity, and that metformin will restore gut microbiome diversity and increase gut wall mucin, which in turn will reduce leaky gut and systemic inflammation and improve physical function for HFpEF patients.”

This new study is a randomized, blinded, placebo-controlled trial over 20 weeks in 80 non-diabetic HFpEF patients age 60 and older. The Wake Forest and Atrium Health team will coordinate the patients, measuring physical function, provide a quality of life questionnaire, and collect stool and blood samples. The team in Dr. Yadav’s lab will examine the samples and measure microbiome diversity and the key markers of leaky gut and of inflammation.

This study is supported by the National Institute on Aging of the National Institutes of Health under Award Number U01AG076928.

Dr. Yadav is conducting similar research associated with leaky gut and inflammation, including their connections to Alzheimer’s disease and other related dementias.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease affecting the nerve cells in the brain and spinal cord. The disease causes motor neurons to slowly degenerate, which causes the control of muscle movement and the brain’s ability to initiate that movement to be lost. This causes ALS patients to eventually lose the ability to speak, swallow, move, and even breathe.

The average life expectancy of individuals suffering from ALS is two to five years. However, consistent treatment and support from at an ALS clinic – with a multidisciplinary team that can provide the newest treatments, therapies and access to clinical trials – are proven to help slow the disease’s progression.

“ALS has different variants; some patients will have longer survival rates than others,” said Tuan Vu, MD, professor in the Department of Neurology in the USF Health Morsani College of Medicine and director of the USF Health ALS Clinic. “However, through supportive care, patients do live longer and there are studies showing that ALS clinics do prolong a patient’s life.”

The team at the USF Health ALS Clinic includes social workers, dietitians, and physical, speech, and respiratory therapists, as well as neurologists, nurse practitioners and primary care physicians. By bringing such a range of disciplines and experts together, the clinic can provide treatment all in one location at individual appointments, so patients do not have to make multiple appointments to see each provider. After each appointment, the team meets to discuss the patient’s current situation and coordinates next steps in care.

“Our meetings result in a much more seamless level of care that we would not be able to achieve otherwise,” Dr. Vu said. “As a team, the goal is to improve the quality of life of the patient and lessen the burden of the disease.”

Tina Orr is a patient at the USF Health ALS Clinic who has lived with ALS for three years.

Tina Orr visits the USF Health ALS Clinic.

“Here, they do not look at you as a number; they look at you as who you really are,” she said. “They will help you in any way possible. To have my voice, to be able to eat what I want, and be able to spend time with my family…They have made that possible for me.”

And Gina Rathbun was diagnosed with ALS in 2009 and has lived with the disease for more than 14 years.

David Rathbun and Gina Rathbun.

“All of these wonderful providers have helped us so much in adapting our life to live with this disease,” said David Rathbun, Gina’s husband. “Every time we go, we learn about what works and what doesn’t work. It’s been a really wonderful experience and incredibly helpful. Gina has been an inspiration to me and everyone around her.”

Currently, there is no cure for ALS. However, there are multiple efforts to produce effective treatment plans for patients. Recently, the U.S. Food and Drug Administration (FDA) approved Rilutek®, the first drug that has reliably extended the life expectancy of people with ALS. Despite this, the drug will not strengthen or restore patients’ strength. It is one of many new medications on the horizon that may help ease the burden for those facing ALS.

”Our hope is that when patients think they may have the condition, they reach out directly to our clinic,” Dr. Vu said. “We do make a concerted effort to reach back out to these patients as quickly as we can. The sooner we can implement treatment and involve patients in clinical trials that help slow down the disease the better they will be.”

For more information about the USF Health ALS Clinic and scheduling an appointment, call the Neurology scheduling line at 813-396-9478.

For more information on making a donation to the USF ALS Center please contact Jennifer Kuenning at 813-396-2523

Story and video by Ryan Rossy, USF Health Communications and Marketing

The USF Health Morsani College of Medicine is the fastest-rising medical school in the country, climbing over the last decade from #80 to #46 in U.S. News & World Report rankings for medical schools for research.

Based on data from U.S. News & World Report Academic Insights, the Morsani College of Medicine has climbed 34 spots in rankings for 2014 to 2023. No other medical school in the data – public or private – has risen as far in rankings as fast as the Morsani College of Medicine.

In the last decade, the USF Health Morsani College of Medicine has made great strides, pushing metrics upward in the college’s three mission areas — education, research and patient care – in an effort to place the college among the best medical schools in the country.

With improved metrics, the college’s placement in the national rankings soared from No. 80 in the 2014 U.S. News list to No. 46 in the recently published 2023 list – a seismic 34 spots.

No other medical school in the country has experienced that same improvement in rankings, making the USF Health Morsani College of Medicine the fastest-rising medical schools in the country.

“Our sustained rise in national rankings reflects the rapidly increasing strength of our educational, research and clinical missions at the USF Health Morsani College of Medicine. We are now competing with the nation’s most storied and respected programs,” said Dr. Charles Lockwood, senior vice president for USF Health and dean of the USF Health Morsani College of Medicine. “These outstanding metrics also position us to attract the highest caliber students and faculty, further advancing our program into the national spotlight for its outstanding education, exceptional research and world class clinical care.”