Illustration of enteroviruses | Credit: Kateryn Kon

A 2019 Nature Medicine paper by Kendra Vehik, PhD, MPH, and colleagues at the USF Health Informatics Institute has been recognized as one of 24 key advances in diabetes research since insulin was discovered 100 years ago.

Highlighted this month as part of a Nature Milestones in Diabetes special issue, the 2019 research by Vehik et. al. provided intriguing evidence showing that, in young children with increased genetic risk for type 1 diabetes (T1D), prolonged enterovirus infection plays a role in the autoimmune destruction of insulin-producing beta cells. Beta cell autoimmunity ultimately leads to the onset of T1D, a serious chronic disease that requires life-long insulin injections to treat.

The USF Health-led work represented a major advance in understanding the links between the virome (all the viruses in the body) and T1D. Dr. Vehik (lead author) and USF Health coauthors Kristian Lynch, PhD, and Health Informatics Institute Director Jeffrey Krischer, PhD, were members of the research team that used sophisticated genomic sequencing technologies to delve deeper into a possible infectious cause for T1D.

Kendra Vehik, PhD, is a professor of epidemiology at the USF Health Informatics Institute.

The pivotal study was one of many that continue to be generated from The Environmental Determinants of Diabetes in the Young (TEDDY) consortium, the largest multicenter prospective study of young children with a genetic susceptibility to T1D. Dr. Krischer is the principal investigator overseeing the National Institutes of Health-supported TEDDY project, which aims to identify environmental factors, including diet, infections and psychological stress, that may trigger or protect against autoimmunity and T1D onset.

“Our next step includes pinpointing biological responses — changes in inflammatory markers, metabolites and proteins — that may explain how viral infections can influence or contribute to beta cell autoimmunity and the progression of T1D,” Dr. Vehik said. “We are honored to be counted among the researchers whose many years of cumulative work has greatly improved our understanding of the complexity of diabetes.”

To read more about the scientific achievement (Milestone in Diabetes No. 23), go to: https://www.nature.com/articles/d42859-021-00026-x

Dr. Stanley Krolczyk, director of the USF Multiple Sclerosis Center, performs a neurological exam on patient Caroline Holloway during a routine appointment.

The same day that the University of South Florida celebrated the 20^th anniversary of its USF Multiple Sclerosis Center, the U.S. Food and Drug Administration approved a new oral therapy (Aubagio) for multiple sclerosis, a neurodegenerative autoimmune disease.

The news reinforces what Center Director Dr. Stanley Krolczyk says about how recent advances in “disease-modifying” drugs are helping to reduce the frequency and severity of MS relapses and slow the rate of disease progression.

Until recently patients diagnosed with MS typically had to turn to injectable drugs like beta interferons for chronic treatment, while infusions of high-dose steroids are mainly used to treat exacerbations of the disease. While these treatments can help alleviate symptoms, they do little or nothing to alter the course of the disease or delay disability.

Aubagio is the second oral MS medication to enter the market (following the first FDA-approved MS pill Gilenya in 2010), with more disease-modifying prospects expected in the near future.

“Before 1993 there were no treatments for MS,” said Dr. Krolczyk, associate professor and director of the Multiple Sclerosis Division in the USF Health Department of Neurology.  “It’s great that we can now offer our patients more treatment choices than ever before to help improve the quality of their lives.”

Between patient appointments, Dr. Krolczyk stops for a quick hallway conversation with the center’s nurse practitioner Lise Casady. Casady helped establish the multiple sclerosis clinic.

MS is the most common disabling neurological disease among young adults, affecting about 400,000 Americans, according to the National Institute of Neurological Disorders and Stroke. Caused by damage to the myelin sheath – the protective coating of nerves in the brain and spinal cord – MS  can trigger a broad spectrum of symptoms, including fatigue, pain, numbness, muscle spasms, vision loss, problems with balance and other difficulties. The disease – afflicting twice as many women as men — is usually diagnosed between the ages of 20 and 50, and often gradually worsens over time.

MS is still incurable, but the rapid pace at which investigational treatments have moved from clinical trials to market over the last decade encourages patients like Jzon Livingston, Sr., of Clearwater.

Livingston, 33, has relapsing-remitting MS, the most common form of the disease, which is characterized by attacks lasting from days to weeks followed by remission, or periods of little or no symptoms. Diagnosed in 2008, he participates in an ongoing clinical trial for a promising once-a-year infusion therapy for MS (alemtuzumab), a monoclonal antibody designed to target certain cells in the immune system believed to trigger damage in people with MS.

Jzon Livingstong,Sr., says his life changed for the better after he started on a new drug for MS, available through a clinical trial at the USF Multiple Sclerosis Center.

None of the standard MS treatments worked for Livingston, and he battled relapses every two to three months. When the attacks flared, he had a hard time dragging himself off the couch to do anything, he said. “It was a fairly miserable existence.”

Since beginning alemtuzumab as a patient at the USF Multiple Sclerosis Center, Livingston said, his life has changed significantly.  He experiences few relapses and works as a self-employed IT network administrator, travels, and enjoys spending time with his wife and three sons.While not without side effect risks – alemtuzumab is a cancer drug used by doctors to treat leukemia for decades — the investigational MS regimen “has been effective beyond anything I thought possible,” Livingston said. “At USF, I was able to find a path to treatment unavailable anywhere else I had tried. It’s given me, my family and my entire extended network hope for the future.”

Livingston shared his perspective as an MS patient with those who gathered Thursday evening, Sept. 13^th to mark the 20-year anniversary of the USF Multiple Sclerosis Center.

Dr. Peter Dunne, founding director of the center, shared stories about its 20-year history at the anniversary celebration.

Among the speakers was the center’s founding director Dr. Peter Dunne, who provided an entertaining overview of the MS clinic’s history.  The center was opened by Dr. Dunne and nurse practitioner Lisé Casady at Tampa General Hospital in 1993 and moved to the USF Medical Clinic in 2000 before relocating to expanded space in the Morsani Center for Advanced Healthcare in 2008.

While he talked about changes in technology and discoveries that have led to more treatment options, Dr. Dunne emphasized the importance of patients, staff and volunteers in helping build the MS Center.

“Let’s not forget the role people play in this story,” he said. “I think they are all heroes.”

Before retiring, Dr. Dunne tapped Dr. Krolczyk, a new neurology faculty member at USF Health, to serve as the center’s next director. Dr. Clifton Gooch, USF Health chair of neurology, said that Dr. Dunne was instrumental in laying the foundation needed to make the university’s MS center a force in “the therapeutic revolution in neurology,” and Dr. Krolczyk continues to propel the center “to the next level.”

The Center’s Founding Director Dr. Peter Dunne (center)was presented a plaque recognizing his contributions to MS care and research at USF by Clifton Gooch(left), chair of the USF Health Department of Neurology, and Dr. Stanley Krolczyk, the center’s current director.

Under Dr. Krolczyk’s tenure, the MS Center has grown to one of the largest comprehensive MS clinics in the Southeast, serving more than 1,500 patients across Central Florida and overseeing 15 active clinical trials, with six studies currently recruiting patients.

The center focuses on early diagnosis and chronic treatment of MS, while offering eligible patients an opportunity to join clinical studies of potential new treatments years before they may become commercially available.

Because MS is a disease that can impair movement, sensation and thinking, its management requires multidisciplinary expertise. The center’s team includes physicians, a physician’s assistant, nurse practitioner, research coordinator, and neuropsychologist, and patients have ready access to urological care, physical therapy and neuropsychiatric evaluation.

Through USF’s partnership with the mid-Florida Chapter of the National Multiple Sclerosis Society, center patients benefit from educational resources and consultations with the local chapter’s staff.The center actively pursues new avenues for MS therapies, Dr. Krolczyk said, including the identification of biomarkers that may lead to earlier diagnosis and more effective treatments based on an individual’s genetic profile.

Carroll Franklin, president of the Mid-Florida Chapter of the National Multiple Sclerosis Society, recognized the vital partnership between USF’s multidisciplinary MS center and the society.

In addition to news about new treatments on the horizon, MS has attracted more national exposure lately with mentions by high-profile people like Ann Romney, wife of presidential candidate Mitt Romney, and First Lady Michelle Obama. Romney has spoken publicly about her diagnosis with MS in 1998, including last month at the Republican National Convention in Tampa. Obama shared her father’s 30-year struggle with the disease a week later at the Democratic National Convention in Charlotte, NC.

“There’s a positive impact when patients see someone at the podium like Ann Romney who lives with MS, but has successfully managed a full schedule,” Dr. Krolczyk said. “It puts a different face on the disease.”

Dr. Krolczyk remains optimistic about the future of MS research given the remarkable advances in MS treatment over the last 20 years.

“Today MS does not have to take control of patients,” he said. “They have options to take control of MS.”

For more information about the USF Multiple Sclerosis, visit http://health.usf.edu/medicine/neurology/clinicalprograms/multiple_sclerosis.htm

Photos by Eric Younghans, USF Health Communications