UNC Cardiology News

Cell molecule identified as central player in the formation of new blood vessels

The molecule is the protein Shc (pronounced SHIK), and new blood vessel formation, or angiogenesis, is seriously impaired without it.
Cell molecule identified as central player in the formation of new blood vessels click to enlarge Control endothelial cells embedded in fibrin gel sprout and form new capillary-like tubes whereas Shc knockout endothelial cells fail to form new vessels.

Media contact: Les Lang, (919) 966-9366, llang@med.unc.edu

Monday Nov. 28, 2011

CHAPEL HILL, N.C. – Scientists at the University of North Carolina at Chapel Hill School of Medicine have identified a cellular protein that plays a central role in the formation of new blood vessels. The molecule is the protein Shc (pronounced SHIK), and new blood vessel formation, or angiogenesis, is seriously impaired without it.

The study, which appeared online Nov. 16, 2011 in the journal Blood, was led by associate professor of cell and molecular physiology at UNC, Ellie Tzima, PhD, who is also a member of the university’s Lineberger Comprehensive Cancer Center and the McAllister Heart Institute.

“Angiogenesis is the formation of new blood vessels from existing blood vessels and it’s a process that’s important during embryonic development and in the development of diseases such as cancer,” Tzima said. “So understanding the molecular mechanisms of how blood vessels form is important from the basic science perspective and for understanding and treating disease.”

Vascular networks form and expand by sprouting, similar to the way trees grow new branches. The process allows fresh oxygen and nutrients to be delivered to tissues, whether in a developing embryo or a cancerous tumor. Blood vessel formation is spurred by a variety of chemical signals that zoom along complex pathways. Some are cues that come from growth factors, others from the tissue matrix that the cells sit on. This extracellular matrix (ECM) serves the cell in a number of ways, such as supporting the cell’s structure, helping to regulate cell-to-cell communication.

The protein Shc, is known to regulate a number of important molecular signaling pathways, but its role in angiogenesis has remained unknown until now, Tzima says. She also points out that Shc is evolutionarily conserved, which indicates its essential importance across species.

“We hypothesized that Shc would be the central player that accepts signals from all of the stimuli that have been previously shown to be important for regulating blood vessel formation and would process them and regulate the cell’s response,” Tzima said. “And that is what we found – that Shc coordinates signals, those coming from growth factors as well as from the extracellular matrix.”

Tzima suggests that we imagine the cell as a complex highway network with electronic toll plazas through which cars with a transponder can whiz at highway speeds without slowing down. The system works because the transponder’s personalized signal is relayed to a computer system that calculates the toll and charges the car’s account in a flash. “Shc is the toll plaza, the checkpoint through which signals crucial to blood vessel formation must pass and get coordinated for proper angiogenesis to occur.”

In the study, Tzima and her team found that Shc is required for angiogenesis in zebrafish, mouse and human endothelial cell culture models of blood vessel formation.
“The animal studies gave us the broad perspective that Shc may be important to this process,” said graduate student and study first-author Daniel T. Sweet. “Zebrafish and mice have previously been used to explore blood vessel formation in vivo. We found that without Shc, blood vessel formation is impaired.”

“Then for a closer look we used a cell culture model to determine which endothelial cell processes require Shc for angiogenesis. We found it mediates signals from growth factor receptors and extracellular matrix receptors,” Sweet said.  “Shc is important for the crosstalk between these processes, meaning that they need to “talk” to each other in order to properly form a tube or to sprout and migrate. That’s the exciting thing about this paper.”

Tzima notes that elegant genetic models of mice have been used to understand important cellular processes, including angiogenesis. “But if you want to think about designing therapeutics it becomes much more important to understand the molecular mechanism. And this was the strength of the study.  We went all the way down to molecular interactions that allowed us to figure out this new angiogenesis pathway.”

UNC co-authors with Tzima and Sweet are Zhongming Chen, David M. Wiley, and Victoria L. Bautch. The research was supported by grants from the National Heart, Lung and Blood Institute, American Heart Association and Ellison Medical Foundation.

Scarring a necessary evil to prevent further damage after heart attack

Researchers have long sought ways to avoid scarring of the heart after a heart attack. But now new research from the University of North Carolina at Chapel Hill School of Medicine shows that interrupting this process can weaken heart function even further.
Scarring a necessary evil to prevent further damage after heart attack click to enlarge Epicardial cells (blue) form a single layer in the adult uninjured heart (panel A, arrowheads) but expand and give rise to cardiac fibroblasts in the injured heart (panel B, arrowheads). Image source: Arjun Deb, MD.

Media contact: Les Lang, (919) 966-9366, llang@med.unc.edu

Tuesday, Nov. 15, 2011

CHAPEL HILL, N.C. – After a heart attack, the portions of the heart damaged by a lack of oxygen become scar tissue. Researchers have long sought ways to avoid this scarring, which can harden the walls of the heart, lessen its ability to pump blood throughout the body and eventually lead to heart failure. But new research from the University of North Carolina at Chapel Hill School of Medicine shows that interrupting this process can weaken heart function even further.

In a study appearing online November 15, 2011, in the EMBO journal, the investigators observed that cells in the outer layer of the heart generated scar tissue. But when they blocked these cells from doing so, they essentially demonstrated that when fixing a broken heart, timing may be everything.

“We now know that scarring is a good thing, because it prevents a precipitous decline in heart function immediately after heart injury,” said Arjun Deb, MD, senior study author and assistant professor of medicine and cell and molecular physiology at the UNC School of Medicine. “The question is not whether, but when it makes the most sense to manipulate the cells of the heart to decrease scarring and enhance regeneration.” Deb is also a member of the UNC McAllister Heart Institute and the UNC Lineberger Comprehensive Cancer Center.

Regeneration happens naturally in lower organisms like zebrafish – the striped, thumb-sized inhabitants of household aquariums – but for some reason not in higher organisms like humans. Years ago researchers noticed that a thin outer layer of cells on the surface of the heart muscle – known as the epicardium – was playing an important role in regenerating the zebrafish heart after injury. But what role the epicardium might have in an injured mammalian heart was an open question.

By studying a mouse model of cardiac injury, Deb and his colleagues found that the epicardium of the mammalian heart was also activated after a heart attack. But unlike in zebrafish where the epicardium contributed to generation of heart muscle cells, in the mouse the epicardium generated fibroblasts, the fibrous cells that underlie scar tissue.

The researchers then found that a protein called Wnt1, which they had formerly shown to enhance function of human vascular stem cells, was driving stem cells within the epicardium to become fibroblasts. They wondered if interrupting this molecular pathway could ameliorate scarring and improve heart function. Surprisingly, when they interrupted Wnt1 signaling in genetically engineered mice, the mutants developed heart failure within 2 weeks after cardiac injury.

“There are clearly evolutionary parallels between the zebrafish and the mouse, but there must be some sort of a selection pressure in mammals to respond to heart injury by scarring, because if we interrupt this process then the heart quickly fails following injury,” said Deb. “In organisms where there is a high pressure of blood flow, these cells may need to turn into scar tissue to maintain the tensile strength of the heart wall and prevent catastrophic rupture,” speculates Deb.

Now Deb and his colleagues are genetically manipulating the stem cells residing in the epicardium at later time points to see if they can coax them to stop turning into fibroblasts and start forming heart-regenerating myocytes. If so, the approach could prove to be an invaluable way to help patients recover from a heart attack.

The research was funded by the National Institutes of Health and Ellison Medical Foundation. Study co-authors from UNC were Jinzhu Duan, PhD (first author), Costin M. Gherghe, MD, PhD, Dianxin Liu, PhD, Eric Hamlett, Luxman Srikantha, Laurel Rodgers, PhD, Jenna N. Regan, Mauricio Rojas, MD, MPH, and Monte Willis, MD, PhD.


UNC cardiologist named 2012 Judah Folkman Award recipient

Cam Patterson, MD, MBA, division chief of cardiology at the University of North Carolina at Chapel Hill School of Medicine, has been named the recipient of the 2012 North America Vascular Biology Association Judah Folkman Award in Vascular Biology.
UNC cardiologist named 2012 Judah Folkman Award recipient click to enlarge Cam Patterson, MD, MBA

Media contact: Les Lang, (919) 966-9366, llang@med.unc.edu

Thursday, Oct. 6, 2011

CHAPEL HILL, N.C. - Cam Patterson, MD, MBA, division chief of cardiology at the University of North Carolina at Chapel Hill School of Medicine, has been named the recipient of the 2012 North America Vascular Biology Association Judah Folkman Award in Vascular Biology.

The award recognizes outstanding contributions from vascular biologists who are at mid-career (within fifteen years of their first faculty appointment). Patterson is the Ernest and Hazel Craige Distinguished Professor of Cardiovascular Medicine and professor in the departments of pharmacology and cell and developmental biology. He is also associate dean for health care entrepreneurship and physician-in-chief for the UNC Center for Heart and Vascular Care.

In its announcement, the association states the Folkman Award “recognizes Patterson’s significant contributions to our understanding of the molecular mechanisms that control angiogenesis,” blood vessel development. Among other areas, this includes “groundbreaking work” in vascular endothelial growth factor (VEGF) cell receptor signaling.  

Moreover, group notes that the basic research findings emerging from Patterson’s laboratory are already making their way toward clinical trials involving new therapies aimed at cardiovascular blood vessel growth.

Patterson will present the Judah Folkman Award Lecture during the NAVBO Workshops in Vascular Biology 2012 to be held in Pacific Grove, California at the Asilomar Conference Grounds on Thursday, Oct. 18, 2012. At a ceremony following the lecture, Patterson will receive a plaque to commemorate the event and a monetary award.

Moses Judah Folkman, MD was a Harvard Medical School professor best known for his research on tumor angiogenesis, the process by which a tumor attracts blood vessels to nourish and sustain its existence. Folkman founded the field of angiogenesis research, which has led to the discovery of a number of therapies based on inhibiting or stimulating new blood vessel development.

UNC shares $6 million Leducq award to study heart failure

A collaborative network of European and North American scientists, including from the University of North Carolina at Chapel Hill School of Medicine, have been awarded a total of $6 million over five years to explore the biology of heart failure and to find new therapies for it.
UNC shares $6 million Leducq award to study heart failure click to enlarge Cam Patterson, MD, MBA

Media contact: Les Lang, (919) 966-9366, llang@med.unc.edu

Monday, Oct. 3, 2011

CHAPEL HILL, N.C. – A collaborative network of European and North American scientists, including from the University of North Carolina at Chapel Hill School of Medicine, have been awarded a total of $6 million over five years to explore the biology of heart failure and to find new therapies for it.

The grant was awarded by Fondation Leducq Transatlantic Networks of Excellence Program, headquartered in Paris, France. Fondation Leducq is a French non-profit health research foundation, which is designed to promote collaborative research involving centers in North America and Europe in the areas of cardiovascular and neurovascular disease.

“Proteotoxicity: an unappreciated mechanism of heart disease and its potential for novel therapeutics” is the title of this network’s award-winning project.  “Proteotoxicity” refers to potential health consequences due to the failure of cells to degrade and clear intracellular aggregated proteins. This may include misshapen or misfolded proteins that could, for instance, disrupt intracellular messages and impede chemical reactions.

“Recent discoveries suggest that the failure to clear aggregated proteins is a major factor in hereditary and acquired cardiac and skeletal muscle diseases,” said Network of Excellence Core member, Cam Patterson, MD, MBA, Ernest and Hazel Craige Distinguished Professor of Medicine and cardiology division chief at UNC. “This network is the first to harness the synergy between skeletal and cardiac muscle research in the emerging area of cardiac protein turnover and proteotoxicity by including experts in both fields.”

The project’s 3 main research aims are to (1) define the role of proteotoxicity in clinically relevant models of heart failure, (2) determine the networks of genes and gene products operating in cardiac muscle cell protein degradation and aggregation, (3) explore novel interventions to reduce and/or block proteotoxicity in animal models of cardiomyopathy and heart failure.

Sharing the new award with Patterson at UNC are network members Jeff Robbins, PhD at Cincinnati Children’s Hospital in Ohio; Mathias Gautel, MD, PhD at King’s College in London, England; Lucie Carrier, PhD, at the University Medical Center Hamburg-Eppendorf, in Hamburg, Germany; Marco Sandri, MD, PhD at the Venetian Institute of Molecular Medicine and University of Padova, Padova, Italy; and Joseph A. Hill, MD, PhD at the University of Texas Southwestern Medical Center, Dallas, Texas.

Since 2004 when grants were first awarded under the Transatlantic Networks of Excellence in Cardiovascular Research Program, 31 collaborative networks have been selected for Leducq support, representing more than 300 investigators at 115 institutions in 17 countries, with research interests spanning from heart failure to cerebral hemorrhage.

Paula F. Miller, MD

Paula F. Miller, MD is an associate professor, the Director of Cardiac Rehabilitation, and the Director of Women's Heart Program in the Department of Medicine. She is an expert in general cardiology with interest in prevention, stress and general echocardiography, cardiovascular fitness counseling, and womens' heart health.
Paula F. Miller, MD click to enlarge Paula F. Miller, MD

To set up an interview with Dr. Miller, contact:

Tom Hughes
Media Relations/Social Media Strategist
UNC Health Care Communications, Marketing and External Affairs
984-974-1151 Office
919-923-6964 Mobile


Crystal Wiley Cené, MD, MPH

Crystal Wiley Cené, MD, MPH, is an assistant professor in the Department of Medicine and an expert in cardiovascular disease, health disparities, social context of disease, and community-based participatory research.
Crystal Wiley Cené, MD, MPH click to enlarge Crystal Wiley Cené, MD, MPH

To set up an interview with Dr. Cené, contact:

Tom Hughes
Media Relations/Social Media Strategist
UNC Health Care News Office
(984) 974-1151 Office
(919) 923-6964 Mobile
Tom.Hughes@unchealth.unc.edu


A second chance for Jakeina

UNC heart surgeon Dr. Andy Kiser reflects on the remarkable story of one of his patients, Jakeina Sutton of Rose Hill, N.C., a 16-year-old who recently received a heart and kidney transplant. For Jakeina, this was her second heart transplant.
A second chance for Jakeina click to enlarge Members of UNC Women's Volleyball Team visit Jakeina Sutton in her room at UNC Hospitals. Photo by Tom Hughes.

Thursday, July 14, 2011

CHAPEL HILL, N.C. - How could this young lady need a heart transplant?  This was my first thought when I walked into the Emergency Room to see Jakeina for the first time.  Had it not been for the IV pump she carried I would have thought I was in the wrong room.

Jakeina and her family had been called to Chapel Hill from their home in Rose Hill for a potential heart and kidney transplant. Unfortunately, the transplant did not proceed and Jakeina had to return home. Jakeina had been born with an inherited heart disorder that causes it to fail. At four months of age, Jakeina underwent her first heart transplant by Dr. Michael Mill, the Director of Pediatric Cardiac Surgery at UNC. She recovered quickly and, for sixteen years, lived a normal life.  She joined a dance club, played volleyball, tennis, and soccer, and enjoyed her childhood in a near normal way.  

However, over the last three months, Jakeina had found herself more short of breath.  Her cardiologist at UNC, Dr. Elman Frantz,, discovered that her transplanted heart had begun to fail due to chronic rejection.  Additionally, the medication she had been taking for so long had caused her kidneys to begin to fail.  Jakeina needed another heart transplant and this time a kidney transplant.  On June 15, Jakeina was called back to Chapel Hill. She underwent successful retransplantation of her heart and twelve hours later had a new kidney transplanted.

As was expected, she recovered quickly and before long was roaming the halls with her younger brother and mother.  Before returning home, she was visited by the UNC volleyball team and their head coach. They were each one inspired by Jakeina’s attitude and enthusiasm about returning home and playing volleyball again.  In fact, she has a special invitation to participate in the UNC volleyball camp this summer.  God has blessed Jakeina with not one, but two, heart transplants. 

She is an example of courage and determination to her friends, her family, and to UNC.

Andy C. Kiser, MD, is Chief of the Division of Cardiothoracic Surgery.

Kiser named chief of Cardiothoracic Surgery

Andy C. Kiser, M.D., has been named chief of the UNC Division of Cardiothoracic Surgery, effective July 1, 2011. Dr. Kiser is a cardiothoracic surgeon who joined UNC as professor of surgery on Nov. 1, 2010. He is recognized as an international leader in arrhythmia surgery, having pioneered the paracardioscopic procedures to treat atrial fibrillation.
Kiser named chief of Cardiothoracic Surgery click to enlarge Andy C. Kiser, M.D.

He is a Fellow of the American College of Surgeons, American College of Cardiology, and the American College of Chest Physicians.

Dr. Kiser, a native of Moore County, N.C., earned his M.D. degree at UNC-Chapel Hill and completed his training in both General and Cardiothoracic Surgery at UNC, finishing in 2000. He practiced cardiac and thoracic surgery in Pinehurst until he joined the UNC faculty in November 2010. Since his return to UNC, Dr. Kiser has increased his clinical activity in minimally invasive cardiac and thoracic surgery, heart failure, and transplantation.

He replaces Michael R. Mill, M.D., who led the division as interim chief from 1998 to 1999 and as chief from 2000 to 2011.

Dr. Mill came to UNC in 1988 to be director of the UNC Heart and Heart-Lung Transplant programs. He performed both the first heart-lung transplant and the first pediatric heart-lung transplant in North Carolina. He has served as Director of the UNC Comprehensive Transplant Center since 1994 and has performed 150 heart transplants, including 50 pediatric heart transplants, here. He also started the mechanical cardiac assist device program at UNC. He specializes in pediatric cardiac surgery and will continue to serve as a faculty member and attending physician at UNC.

“The Department of Surgery especially appreciates the 13 years that Dr. Mill has provided strong leadership for the division, and his continued direction of the congenital heart surgery program,” said Anthony Meyer, chairman of the UNC Department of Surgery.

Dr. Mill has been active on regional and national levels with Carolina Donor Services, the United Network for Organ Sharing, the Society of Thoracic Surgeons, the Thoracic Surgery Directors Association, the American Association for Thoracic Surgery, the Congenital Heart Surgeons Society, and the Southern Thoracic Surgical Association. He helped the American Board of Thoracic Surgery develop the requirements for the first specialty certification in congenital cardiac surgery and in 2009 became one of the first physicians to earn that certification.

Dr. Mill was director of the UNC cardiothoracic surgery residency program during his time as chief. He served on the Residency Review Committee for Thoracic Surgery of the Accreditation Council for Graduate Medical Education, and participated in writing the requirements for the six-year integrated residency in cardiothoracic surgery, which enables medical-school graduates to enter a cardiothoracic residency straight from medical school and streamline their surgical training. (Previously, the path to becoming a cardiothoracic surgeon included about eight years of training after medical school.)

While Dr. Mill was chief, UNC added a six-year integrated residency in cardiothoracic surgery, which is now in its second year.

Dr. Mill earned an M.D. at the University of Colorado and did his residency in General Surgery there. He completed a residency in Thoracic Surgery and a fellowship in Heart and Heart-Lung Transplantation at Stanford University, where he trained with pioneering heart surgeon Norman Shumway.

Dr. Meyer said he would work with Dr. Kiser “to continue to further the goals of the Division of Cardiothoracic Surgery.” There are seven surgeons and six physician extenders in the division, which offers advanced treatments for a wide range of diseases and problems.

The division “is committed to caring for patients with complex cardiovascular problems such as aortic dissection, advanced heart failure, chronic atrial fibrillation, and lung or esophageal cancer,” Dr. Kiser said. “Collaboration is important, both within UNC Hospitals and statewide. Our vision is to develop more clinical partnerships with our colleagues.”

The division is part of the UNC Center for Heart and Vascular Care, which now has a one-call referral service (866-862-4327) to enable physicians to arrange consultations as well as admissions and transfers of patients to UNC Hospitals for care.

UNC Hospitals qualifies for American Heart Association’s Mission: Lifeline Recognition for heart attack care

The award recognizes UNC Hospitals’ commitment and success in implementing a higher standard of care for heart attack patients that effectively improves the survival and care of STEMI (ST Elevation Myocardial Infarction) patients.
UNC Hospitals qualifies for American Heart Association’s Mission: Lifeline Recognition for heart attack care click to enlarge For more information, see www.heart.org/quality.

Media contact:  Tom Hughes, (919) 966-6047, tahughes@unch.unc.edu

Monday, June 27, 2011

CHAPEL HILL, N.C. – UNC Hospitals recently qualified for the American Heart Association’s Mission: Lifeline Silver Performance Achievement Award. The award recognizes UNC Hospitals’ commitment and success in implementing a higher standard of care for heart attack patients that effectively improves the survival and care of STEMI (ST Elevation Myocardial Infarction) patients.
     
Every year, almost 250,000 people experience the STEMI type of heart attack. Unfortunately, a significant number don't receive prompt reperfusion therapy, which is critical in restoring blood flow.  Mission: Lifeline seeks to save lives by closing the gaps that separate STEMI patients from timely access to appropriate treatments. Mission: Lifeline is focusing on improving the system of care for these patients and at the same time improving care for all heart attack patients.
   
Hospitals involved in Mission: Lifeline strive to improve care in both acute treatment measures and discharge measures. Systems of care are developed that close the gap of timely access to appropriate, life-saving treatments. Before they are discharged, appropriate patients are started on aggressive risk reduction therapies such as cholesterol-lowering drugs, aspirin, ACE inhibitors and beta-blockers in the hospital and receive smoking cessation counseling.
   
Hospitals that receive the Mission: Lifeline Silver Performance Achievement Award have demonstrated for 12 consecutive months that at least 85 percent of eligible STEMI patients (without contraindications) are treated within specific time frames upon entering the hospital and discharged following the American Heart Association’s recommended treatment guidelines. 
   
“UNC Hospitals is dedicated to making our cardiac unit among the best in the country, and the American Heart Association’s Mission: Lifeline program is helping us accomplish that by making it easier for our professionals to improve the outcomes of our cardiac patients,” said Cam Patterson, MD, MBA, Chief of Cardiology at UNC Hospitals and Physician-in-Chief of the UNC Center for Heart & Vascular Care. “We are pleased to be recognized for our dedication and achievements in cardiac care.”


About UNC Hospitals
UNC Hospitals is an 803-bed public, academic medical center operated by and for the people of North Carolina. The Hospitals' mission is to provide high quality patient care, to educate health care professionals, to advance research and to provide community service. UNC Hospitals includes North Carolina Cancer Hospital, North Carolina Children's Hospital, North Carolina Memorial Hospital, North Carolina Neurosciences Hospital, and North Carolina Women's Hospital. Each year UNC Hospitals cares for patients from all 100 counties in North Carolina and several surrounding states.

About Mission: Lifeline
The American Heart Association’s Mission: Lifeline program helps hospitals and emergency medical services develop systems of care that follow proven standards and procedures for STEMI patients. The program works by mobilizing teams across the continuum of care to implement American Heart Association/American College of Cardiology clinical treatment guidelines. For more information, visit heart.org/missionlifeline and heart.org/quality.

Mackman appointed Director of the UNC McAllister Heart Institute

The School of Medicine is pleased to announce the appointment of Nigel Mackman, PhD, FAHA, as the new Director of the UNC McAllister Heart Institute (MHI).

Dr. Mackman, the John C. Parker Distinguished Professor of Hematology in the Department of Medicine, has served as Associate Director of the UNC MHI  since 2009.  Dr. Mackman came to UNC in 2007 from The Scripps Research Institute in La Jolla , CA where he worked for 20 years.

Dr. Mackman’s research focuses on hemostasis, thrombosis and crosstalk between coagulation and inflammation. In particular, he studies tissue factor, which is the primary cellular initiator of blood coagulation. His research has been recognized by the American Heart Association (AHA) and the International Society of Thrombosis and Hemostasis. He won the AHA Louis N. Katz Basic Science prize in 1991, presented the prodigious AHA Sol Sherry Distinguished Lecture in Thrombosis in 2009 and received the AHA Jeffery M. Hoeg Arteriosclerosis, Thrombosis and Vascular Biology Basic Science Award in 2011. Currently, he is Chair of the ATVB Council of the American Heart Association.

The school is confident that Dr. Mackman will provide the vision and leadership that will establish the UNC MHI as a leading cardiovascular center with excellence in research.  The UNC MHI will continue to strengthen and develop its cross-disciplinary collaborations and interactions with other departments and centers on campus.

Stavas inducted into SIR as a Fellow

Joseph Stavas, MD, professor of Radiology, has been inducted into Society of Interventional Radiology (SIR) as a Fellow. The induction took place on March 30, during SIR's 36th Annual Scientific Meeting in Chicago.
Stavas inducted into SIR as a Fellow click to enlarge Joseph Stavas, MD

"Being named a Society of Interventional Radiology Fellow is the highest recognition by one's peers and acknowledges sustained outstanding performance," said SIR President Timothy P. Murphy, M.D., FSIR, who represents the society's nearly 4,700 doctors, scientists and allied health professionals dedicated to improving health care through minimally invasive treatments.

Stavas earned his medical degree from the Creighton University and did specialty training at the University of Minnesota and University of California, San Diego.

SIR is a national organization of physicians, scientists and allied health professionals dedicated to improving public health through disease management and minimally invasive, image-guided therapeutic interventions. More information about the Society of Interventional Radiology, interventional radiologists and how to find an interventional radiologist in your area can be found online at www.SIRweb.org.

Project TICKER underway; first newsletter published

Project TICKER (Teamwork to Improve Cardiac Kids' End Results), which began in September of last year, aims to implement a patient- and family-centered safe practice infrastructure for pediatric congenital heart disease patients at N.C. Children’s Hospital.

The Project TICKER plans to do this by (1) implementing a robust communication and teamwork foundation for the general care of the inpatient pediatric congenital heart disease service line using a tailored training program, TeamSTEPPS and (2) designing and implementing integrated clinical pathways (ICPs) for two of the most common congenital heart disease diagnoses using the specific teamwork tools of TeamSTEPPS and evidence‐based standardized care.

The project is funded by a $580,000, two-year grant from the Agency for Healthcare Research and Quality (AHRQ). Tina Schade Willis, MD, assistant professor of anesthesiology is principal investigator for the project. Co-investigator Michael Mill, MD, professor of surgery and chief of the UNC cardiothoracic surgery division, is the lead surgical content expert for the project and Scott Buck, MD, associate professor of cardiology and another co-investigator on the project, is the lead cardiology content expert, providing cardiology expertise for clinical pathways design and teamwork units across the service line.

Since September, the team has focused specifically on the first goal of the project - to train all personnel involved in the Pediatric Cardiac Service Line in TeamSTEPPS. So far, all areas - the Pediatric Cardiac OR, Pediatric ICU, Children’s Intermediate Cardiac Care (CICC), and the Newborn Critical Care Center – have participated in training and expect to have all staff trained by the end of June.

Additionally, since Project TICKER aims to take a family-centered approach to medical care, five patient families are acting as advisors to the project. Dr. Willis led the first family advisor meeting in March.

With TeamSTEPPS training near completion, the group is beginning to work toward their second goal – to design and implement ICPs, which are essentially patient care plans. The ICPs are designed to improve quality by decreasing unnecessary variations in care and standardizing best practices. Frontline staff, patients, and the families advisors will all play an important role the development of these clinical pathways.

To read more about the TeamSTEPPS training and the family advisors for the project, please take a look at the first issue of the Project TICKER newsletter, which was published in April.

Be on the lookout for more news about the project over the next few months.

Family House Diaries: A New Heart + A New Kidney = A New Life

A new heart and a new kidney give a 28-year-old Wilson woman, unwell since age 7, a second chance at life. Crystal Sharpe becomes the 11th recipient of a heart and kidney transplant at UNC Hospitals.
Family House Diaries: A New Heart + A New Kidney = A New Life click to enlarge Crystal Sharpe, at left, and her mother, Patricia Sanders.

Media contact: Tom Hughes, (919) 966-6047, tahughes@unch.unc.edu

Wednesday, May 18, 2011

Written by Elizabeth Swaringen for UNC Health Care

CHAPEL HILL, N.C. – Crystal Sharpe’s smile radiates energy, even over the telephone.  A new heart and a new kidney will do that.

Sharpe, 28, of Wilson, N.C., received a new heart and a new kidney on March 27, becoming the 11th heart-kidney transplant patient at UNC Hospitals. Unwell since age 7, Crystal is ready to get on with living.

“I don’t think this was a hard journey,” said Crystal, matter-of-factly. “I know God had my back.  I know the surgeries had to be done. I really feel like I have more energy. I’m ready to get on with life.”

Crystal, a dynamo at 4’ 6” and 64 pounds, became a patient at UNC Hospitals in 2008 because her only kidney was growing weaker. She had lost her right kidney in 1989 to Wilm’s tumor, a rare kidney cancer in children.

Crystal started dialysis in January 2009 and in August contracted Stevens-Johnson Syndrome (SJS), a rare disorder in which skin and mucous membranes react severely to medications or infection. Already on the kidney transplant list, Crystal joined the heart transplant list with congestive heart failure in October 2010. 

Crystal had completed two years at N.C. A&T State University in Greensboro and was working as a Wal-Mart manager when she got sicker. She moved back home to Wilson, to her primary caregiver, her mother, Patricia Sanders.

“Whenever she’s sick, I’m right there, always have been,” said Patricia, 49, who would spend weekdays in Greensboro and weekends in Wilson caring for her brother who had cancer. “I love my family, and I do whatever it takes to care for them.”

Crystal’s condition worsened and on Jan. 4 she was admitted to UNC Hospitals. Patricia came with her and when not at Crystal’s side, stayed at SECU Family House, a 40-bedroom hospital hospitality house minutes from UNC Hospitals.  Family House provides comfortable, convenient and affordable housing for seriously ill adult patients and their family member caregivers.

“Everything about Family House is good,” Patricia said. “I met a lot of different people there, and we were able to comfort each other.  And the variety of people and organizations voluntarily cooking is a special treat.”

On March 26, Patricia was in Wilson when the call came that donor organs were available.

“That very day we had held a fundraiser for Crystal with family and friends,” Patricia remembers. “We raised about $1,800. Crystal’s sister, Syreeta, carried a plate of food to UNC. Crystal ate it and about an hour and 15 minutes later she got the call there was a donor.”

Three carloads of family and friends with Patricia leading the way came to UNC Hospitals to see Crystal before the heart transplant surgery, which would be followed by the kidney transplant once Crystal stabilized. After visiting until the wee hours of March 27, all left but Patricia, who was with Crystal when word came that both the heart and the kidney – which had to come from the same donor – were for Crystal.

“When you need both a heart and a kidney it can be an ordeal to make sure everything matches up,” said Andy C. Kiser, MD, professor of surgery in the Division of Cardiothoracic Surgery at the UNC Center for Heart and Vascular Care, who implanted the new heart. “It took us a few hours to make sure everything was going to work.”

By the time Dr. Kiser came to share the good news, both Crystal and Patricia had fallen asleep. Patricia figures she had been up about 36 hours since she was up at day break the day before cooking for the fundraiser.

“I’ll never forget their reaction,” Dr. Kiser said. “Her Mom woke up first, then Crystal. They are a very Christian family with a lot of faith in the Lord. They were extremely grateful and gratified and not the least bit apprehensive, although it was major surgery. When you have dealt with a chronic disease most of your life, you deal with life and death on a different level from most people. You see the surgery, however major, as another chance at life.”

And that’s what Crystal has done. She returned home on April 14 and looks forward to returning to her college studies in child development.

“She should begin to start living a normal life,” Dr. Kiser said. “She doesn’t have to do dialysis anymore, but we do have to continue monitoring her heart and kidney to make sure they are working as they should. She has such a wonderful attitude and a strong support network in her family. She is very dear to a lot of the staff because she was in the hospital so long. We are very optimistic she will do fine.”

And the smile? 

“As sick as she was, she never gave up, and she has always had a smile on her face,” said Patricia. “Now, it might just be a little bigger or a little deeper, if that’s possible.”

New implantable cardiac pacemaker approved for use in MRI

The FDA has approved for use in MRI a new implantable cardiac pacemaker, Medtronic’s RevoMRI SureScan Pacing System.

Dear faculty and staff,


The FDA has approved for use in MRI a new implantable cardiac pacemaker, Medtronic’s RevoMRI SureScan Pacing System. The Centers for Medicare and Medicaid Services have also approved billing for MR services for patients with this device.  Please note that at the present time, this is the only approved pacemaker for use in MRI, so prior to anticipated MR scanning, it is essential that we are certain the patient has this device.

Richard Semelka
Director MR Services

UNC, Feins win grant to study surgery simulation training

The Agency for Healthcare Research and Quality (AHRQ) has awarded a three-year, $1.05 million grant to the University of North Carolina at Chapel Hill to study use of simulators for cardiac surgery training.
UNC, Feins win grant to study surgery simulation training click to enlarge Richard H. Feins, M.D.

The multi-institution project will study whether resident physicians who are learning cardiothoracic surgery can become safer surgeons by using surgery simulators to acquire skills before they operate on people. Richard H. Feins, M.D., a thoracic surgeon in the Division of Cardiothoracic Surgery at UNC, is principal investigator of the project, which will involve cardiothoracic surgery residents at UNC and physicians and residents at seven other institutions:

Massachusetts General Hospital (Jennifer Walker, M.D.); Mayo Clinic (Harold Burkhart, M.D.), Johns Hopkins University (John Conte, M.D.), University of Rochester (George Hicks, M.D.), Stanford University (James Fann, M.D.), Vanderbilt University (Jonathan Nesbitt, M.D.), University of Washington (Nahush Mokadam, M.D.).

In most surgical training, technical skills are taught by apprenticeship: residents learn surgery in the operating room, doing parts or all of real operations on real patients. Dr. Feins' study intends to show that training in cardiac surgical techniques can be improved by using surgery simulation technology combined with a rigorous, simulation-based curriculum.

The project will determine the effectiveness of using simulator-based training of resident surgeons in component tasks and overall procedures based on six modules: three types of cardiac surgical operations and three significant adverse events that can occur during cardiac surgery. The procedures will be taught using a computer-controlled, tissue-based cardiac surgery simulator which has been shown to realistically duplicate the actual patient undergoing cardiac surgery. The simulators are mannequins with computer-controlled pig hearts placed inside the chest area.

Assessment data from each site will be entered into a study database which will be developed and managed at the University of North Carolina. While the study will test the hypothesis that cardiac surgery residents can be trained to be safer surgeons by using appropriate simulator-based training, the results should apply equally well across a broad spectrum of surgical practice.

AHRQ is part of the U.S. Department of Health and Human Services. The grant period is May 1, 2011, to April 30, 2014.

A 2011 article in Endeavors, UNC's research magazine, describes the simulation training. Read the article here.

FDA approves pacemaker for use in MRI

The FDA has approved for use in MRI a new implantable cardiac pacemaker, Medtronic’s RevoMRI SureScan Pacing System.

The Centers for Medicare and Medicaid Services have also approved billing for MR services for patients with this device.  Please note that at the present time, this is the only approved pacemaker for use in MRI, so prior to anticipated MR scanning, it is essential that we are certain the patient has this device.

Mackman to give the Jeffrey M. Hoeg Lecture at ATVB Spring Meeting

Nigel Mackman, PhD, FAHA, is the John Parker Distinguished Professor of Medicine in the Division of Hematology/Oncology. He is also Associate Director of the UNC McAllister Heart Institute. He will give the honorary lecture at the 2011 Spring Arteriosclerosis, Thrombosis and Vascular Biology meeting in April.
Mackman to give the Jeffrey M. Hoeg Lecture at ATVB Spring Meeting click to enlarge Dr. Nigel Mackman

The Jeffrey M. Hoeg Arteriosclerosis Award for Basic Science and Clinical Research was established in 1999. The award recognizes an established investigator in the prime of his/her career who has made an outstanding contribution to further understanding of the pathophysiology of atherosclerosis and/or for the development of treatment strategies for its prevention through basic and clinical research efforts.

The award honors the memory of Jeffery M. Hoeg, chief of the Section of Cell Biology within the Molecular Branch of the National Heart, Lung and Blood Institute. He was an extraordinary research scientist and physician who, in the prime of his career, was working on the field of lipoprotein metabolism and atherosclerosis. Dr. Hoeg died in July 1998 after a courageous battle with cancer.


Scientists identify molecule that can increase blood flow in vascular disease

UNC researchers have discovered that a molecule called Wnt1 can improve the function of endothelial progenitor cells, increasing the blood flow to organs that previously had been cut off from the circulation.
Scientists identify molecule that can increase blood flow in vascular disease click to enlarge Human endothelial progenitor cells grown in the lab (left) and forming capillary tube like structures (right).

Media contact:  Les Lang, (919) 966-9366, llang@med.unc.edu

Thursday, March 10, 2011

CHAPEL HILL, N.C. – Circulating through the bloodstream of every human being is a rare and powerful type of cell, one that can actually create new blood vessels to bypass blockages that cause heart attacks and peripheral artery disease. Though everyone has these cells – called endothelial progenitor cells – they are often dysfunctional in people prone to vascular disease.

Now researchers at the University of North Carolina at Chapel Hill have discovered that a molecule – called Wnt1 – can improve the function of endothelial progenitor cells, increasing the blood flow to organs that previously had been cut off from the circulation. The finding could enhance clinical trials already testing these powerful cells in patients hospitalized with cardiac arrest.

“The premise of these trials is that these cells will supply the ischemic organ with new blood vessels and allow the damaged organ to function better,” said senior study author Arjun Deb, MD, assistant professor of medicine in the UNC School of Medicine. “But because you are isolating these cells from the patients themselves, you know that the cells are dysfunctional -- so the approach is almost flawed from the very beginning. We want to see how we can improve the function of these cells so they can do their job better.”

The study, published online Feb. 14, 2011, in the FASEB (Federation of American Societies for Experimental Biology) Journal, is the first to show that the Wnt1 protein, one of a family of 19 such molecules, can stimulate blood vessel formation.

A number of studies in the past few years have suggested that genes that play an important role during early development and get “turned off” during adulthood may also get “turned on” or expressed again in response to injury, such as heart attack.

Deb, who studies the Wnt family of developmental genes, looked to see if any of its members follow this same pattern. He found that one gene in particular, Wnt1, was expressed during development of blood vessels, shut off during adulthood and then re-expressed in angiosarcoma, a cancer of endothelial cells.

Deb wanted to see what would happen if he put the Wnt1 protein on human endothelial progenitor cells. He found that treating these special cells with Wnt1 not only greatly increased their function but also their number. Next, Deb and his colleagues investigated what effect the protein would have on a mouse model of peripheral artery disease, an illness in humans caused by decreased blood flow to the extremities. They found that treating these animals with a single injection of the Wnt1 protein resulted in almost three fold increase in blood flow in the affected areas.

“We found that Wnt1 is a novel proangiogenic molecule, something that has never been shown before,” said Deb. “It gives us hope that injecting the Wnt1 protein -- or molecules that stimulate the Wnt1 signaling pathway -- into ischemic tissues in humans could improve blood flow and assert a therapeutic effect.”
 
Approximately 1 in 4 deaths in adults in the US are secondary to heart disease and as many as 15 percent of Americans age 65 and older have peripheral artery disease. In the future, Deb plans to use his findings to identify such small molecules or drug candidates that could reverse the endothelial progenitor cell dysfunction observed in so many patients with vascular disease.

The research was funded by the National Institutes of Health and Ellison Medical Foundation. Study co-authors were Costin M. Gherghe, MD, PhD, postdoctoral fellow in Deb’s lab; Jinzhu Duan, PhD, postdoctoral fellow in Deb’s lab; Jucheng Gong, lab manager in Deb’s lab; Mauricio Rojas, MD, MPH, director of mouse cardiovascular models core lab; Nancy Klauber-Demore, MD, associate professor of surgery; and Mark Majesky, PhD, Professor of Pediatrics, University of Washington, Seattle.

Smith leads World Heart Federation

Dr. Sidney Smith, Professor of Medicine/Cardiology, began serving a two-year term as President of the World Heart Federation (WHF) in January 2011.
Smith leads World Heart Federation click to enlarge Sidney Smith, MD

The WHF, based in Geneva, is a non-governmental organization focused on coordinating the programs of its 204 member cardiovascular societies and foundations worldwide in the global fight against heart disease and stroke, with an emphasis on low and middle income countries. The American Heart Association and the American College of Cardiology are member organizations representing the United States.

Dr. Smith’s tenure as president will include presiding at the 2012 WHF World Congress of Cardiology in Dubai, United Arab Emirates, in 2012. The WHF held its last Congress in 2010 in Beijing, China. One of Dr. Smith’s major goals for the WHF is to bring cardiovascular disease to the forefront of the global health agenda through a partnership with the Non-Communicable Disease Alliance. He will also attend a United Nations summit in September 2011 to discuss the global problem of cardiovascular disease. In addition major programs in international guidelines have been initiated.

While serving as president Dr. Smith will continue to be clinically active, working at UNC as an attending physician and seeing his regular patients.


Just in time for Valentine’s Day: UNC researchers identify a gene critical for heart function

It's a gene called DOT1L, and if you don’t have enough of the DOT1L enzyme, you could be at risk for some types of heart disease. These findings by UNC researchers appear in the journal Genes and Development.
Just in time for Valentine’s Day: UNC researchers identify a gene critical for heart function click to enlarge Hearts from a wild type control mouse (left) and from a DOT1L-deleted mouse displaying dilated cardiomyopathy (right) . In the absence of DOT1L hearts become severely enlarged, compromising heart function.

Media contact: Les Lang, (919) 966-9366, llang@med.unc.edu

Friday, Feb. 4, 2011

CHAPEL HILL, N.C. – Everyone knows chocolate is critical to a happy Valentine’s Day. Now scientists are one step closer to knowing what makes a heart happy the rest of the year.

It’s a gene called DOT1L, and if you don’t have enough of the DOT1L enzyme, you could be at risk for some types of heart disease. These findings from a study led by researchers at the University of North Carolina at Chapel Hill School of Medicine appear in the Feb. 1, 2011 issue of the journal Genes and Development.

The team created a special line of mice that were genetically predisposed to dilated cardiomyopathy, a condition in which the heart expands like a balloon, causing its walls to thin and its pumping ability to weaken. About one in three cases of congestive heart failure is due to dilated cardiomyopathy, a condition that also occurs in children.

These mice lack DOT1L. The big discovery came when the researchers were able to prevent the mice from developing the disease by re-expressing a single downstream target gene, Dystrophin.

“We saw this phenotype in the heart and it could be attributed to anywhere between 1 and 1,000 genes. But when we just added back this one gene, the heart function was completely rescued,” said the study’s lead author, Anh Nguyen, a graduate student in the lab of biochemist Yi Zhang, PhD, at UNC’s Lineberger Comprehensive Cancer Center. “It was very surprising to us,” Nguyen added. “Normally you’d think you’d have to add in a number of genes to really see that effect.”

The researchers discovered that the gene depends on the enzyme DOT1L to activate it. If DOT1L levels fall too low, Dystrophin ceases to perform its function, eventually leading to heart disease.

“We’ve identified a new function of DOT1L, which has been linked to leukemia before, but never linked to heart defects,” said Zhang, Kenan Distinguished Professor of biochemistry and biophysics and an Investigator of the Howard Hughes Medical Institute.

Learning how the DOT1L affects Dystrophin could eventually help to improve diagnosis and treatment of patients with dilated cardiomyopathy and other conditions. “The more we know about the protein, the better we can use it,” Zhang said.

The protein could be a target for gene therapy, for example. “If you could manipulate the function of DOT1L, then you could essentially regulate everything else downstream, including Dystrophin or other genes,” explained Nguyen.

In addition to their experiments using mice, the team examined samples of human heart tissue. Patients with dilated cardiomyopathy had lower levels of DOT1L than patients with no underlying heart condition, suggesting that the protein’s role in humans is similar to its role in mice.

The findings also have potential relevance for Duchenne muscular dystrophy, which is caused by defects in Dystrophin function. About 90 percent of people with muscular dystrophy develop dilated cardiomyopathy; this study suggests perhaps low levels of DOT1L could be a common factor in both conditions.

The study’s collaborators include Xiao Xiao, PhD, Fred Eshelman Distinguished Professor of Gene Therapy in the division of molecular pharmaceutics in the UNC School of Pharmacy, Da-Zhi Wang, PhD, of Harvard Medical School, and Taiping Chen, PhD, of Norvartis Institutes for Biomedical Research.

Arjun Deb awarded Louis N. and Arnold M. Katz Basic Science Research Prize for Young Investigators

The Louis N. and Arnold M. Katz Prize is one of the oldest and prestigious awards offered by the American Heart Association and encourages new investigators to continue research careers in basic cardiovascular science.
Arjun Deb awarded Louis N. and Arnold M. Katz Basic Science Research Prize for Young Investigators click to enlarge Arjun Deb, MD

Media contact: Les Lang, 919-966-9366, llang@med.unc.edu

Tuesday, Nov. 30, 2010

CHAPEL HILL, N.C. -- On Nov. 16, 2010, at the annual American Heart Association meeting in Chicago, Arjun Deb, MD, was awarded the Louis N. and Arnold M. Katz Basic Science Research Prize for Young Investigators. Deb is an assistant professor of medicine and of cell and molecular physiology, and a member of the McAllister Heart Institute and the Lineberger Comprehensive Cancer Center.

The Louis N. and Arnold M. Katz Prize is one of the oldest and prestigious awards offered by the American Heart Association and encourages new investigators to continue research careers in basic cardiovascular science. This award recognizes research involving biochemical, cellular, molecular and genetic studies in basic cardiovascular science. This is the first time in the history of the award that a researcher from the University of North Carolina has won the first prize. Winner of the prize receives a plaque and $1,500.

Deb’s laboratory is broadly interested in understanding the biology of adult stem cells and specifically how they can be targeted to enhance organ regeneration and repair. He was awarded the Katz prize for his work: "Wnt1 mediated dynamic injury response activates the epicardium and is critical for mammalian cardiac repair."

In July, 2008, Deb received a New Scholar Award in Aging from the Ellison Medical Foundation for his investigation into the role of cardiac stem cells in the biology of aging of the adult heart.



CICU wins Beacon Award

The Cardiac Intensive Care Unit (CICU) has received the Beacon Award for Critical Care Excellence from the American Association of Critical Care Nurses! Only 315 of the estimated 6,000 intensive care units in the United States have earned this award. Congrats to our team in the CICU!

The award is specifically designated to recognize the nation’s top pediatric, progressive, and adult critical care units across a multitude of hospitals. The recognition itself is priceless, as it represents extraordinary commitment to high-quality critical care standards, and dedication to the exceptional care of patients and their families.

The Beacon Award requires success in the following areas, as measured again evidence-based national criteria:

  • Recruitment and retention
  • Education, training and mentoring
  • Research and evidence-based practice
  • Patient outcomes
  • Leadership and organizational ethics
  • Healing environment

The CICU joins the Cardiothoracic Intensive Care Unit at UNC Hospitals, which also received the Beacon Award (its second) earlier this year. Congratulations again to both units for their great work!

 


UNC Hospitals receives performance achievement award from American College of Cardiology Foundation

UNC Hospitals is one of only 26 hospitals nationwide to receive this award, which recognizes our commitment and success in implementing a higher standard of care for heart attack patients.

Media contact: Tom Hughes, 919-966-6047, tahughes@unch.unc.edu
 
Wednesday, August 25, 2010

CHAPEL HILL — UNC Hospitals has received the American College of Cardiology Foundation’s NCDR ACTION Registry–GWTG Silver Performance Achievement Award for 2010 – one of only 26 hospitals nationwide to do so.

The award recognizes UNC Hospitals’ commitment and success in implementing a higher standard of care for heart attack patients, and signifies that UNC Hospitals has reached an aggressive goal of treating coronary artery disease patients with 85 percent compliance to core standard levels of care outlined by the American College of Cardiology/American Heart Association clinical guidelines and recommendations.

To receive the ACTION Registry–GWTG Silver Performance Achievement Award, UNC Hospitals consistently followed the treatment guidelines in ACTION Registry–GWTG for 12 consecutive months. These include aggressive use of medications like cholesterol-lowering drugs, beta-blockers, ACE inhibitors, aspirin, and anticoagulants in the hospital.

“The American College of Cardiology Foundation and the American Heart Association commend UNC Hospitals for its success in implementing standards of care and protocols. The full implementation of acute and secondary prevention guideline-recommended therapy is a critical step in saving the lives and improving outcomes of heart attack patients,” Gregg C. Fonarow, MD, ACTION Registry-GWTG Steering Committee Chairperson and Director of Ahmanson-UCLA Cardiomyopathy Center.

“The time is right for UNC Hospitals to be focused on improving the quality of cardiovascular care by implementing ACTION Registry–GWTG. The number of acute myocardial infarction patients eligible for treatment is expected to grow over the next decade due to increasing incidence of heart disease and a large aging population,” said Cam Patterson, MD, MBA, UNC’s chief of cardiology and director of the UNC McAllister Heart Institute.

Created by the merger of the American College of Cardiology Foundation’s NCDR ACTION Registry® and the American Heart Association’s Get With The Guidelines-CAD program, ACTION Registry–GWTG combines the best of both programs into a single, unified national registry. The new registry joins the robust data collection and quality reporting features of the ACTION Registry with the collaborative models, unique tools, and quality improvement techniques of the GWTG-CAD program. With the collective strengths of these two programs, ACTION Registry–GWTG empowers health care provider teams to consistently treat heart attack patient according to the most current, science-based guidelines; and establishes a national standard for understanding and improving the quality, safety, and outcomes of care provided for patients with coronary artery disease, specifically high-risk STEMI and NSTEMI patients.

Genetics underlie the formation of the body’s back-up bypass vessels

The new knowledge could help inform the current development of what are called collaterogenic therapies – drugs or procedures that can cause new collaterals to form and enlarge before or after a person suffers tissue damage from a blocked artery in the heart, brain, or peripheral tissues.
Genetics underlie the formation of the body’s back-up bypass vessels click to enlarge Cerebral arterial circulation showing the left brain hemisphere of a C57BL/6 mouse and the right hemisphere of BALB/c mouse. Note the difference typical for these strains in number of collaterals (red stars). Image source: Faber lab.

Media contacts: Les Lang, (919) 966-9366, llang@med.unc.edu or Tom Hughes, (919) 966-6047,  tahughes@unch.unc.edu

Thursday, August 19, 2010

CHAPEL HILL – Researchers at the University of North Carolina at Chapel Hill School of Medicine have uncovered the genetic architecture controlling the growth of the collateral circulation – the “back-up” blood vessels that can provide oxygen to starved tissues in the event of a heart attack or stroke.

The new knowledge could help inform the current development of what are called collaterogenic therapies – drugs or procedures that can cause new collaterals to form and enlarge before or after a person suffers tissue damage from a blocked artery in the heart, brain, or peripheral tissues.

“This has really been the holy grail in our field, how to get new collaterals to form in a tissue with few in the first place” said senior study author James E. Faber, PhD, professor of cell and molecular physiology at UNC. “Our thesis has been that if we can figure out how these endogenous bypasses are formed in the first place in healthy tissues, what mechanisms and genetic pathways drive this, and collaterals abundance varies so widely in healthy individuals, then we may have our answer.”

The results of the research, published in the August 20, 2010, issue of the journal Circulation Research, is the first to pinpoint a portion of the genome associated with variation in the density and diameter of collateral vessels.

“This may well be the seminal paper in one of the most important mysteries in vascular biology: the mechanisms controlling collateral formation in the arterial tree,” wrote Stephen Schwartz, a professor of physiology at the University of Washington, in a review of the study for Faculty 1000.

The UNC research, conducted in animal models, combined classical genetic mouse crosses with a new genomic technology called association mapping to identify the section of DNA involved, starting with the whole genome, narrowing it down to several hundreds of genes and finally landing on nine candidates on mouse chromosome 7.

The researchers are now looking at these genes to see if any one of them is responsible for variation in collateral formation.  Faber says they also cannot discount the possibility that it is not genes that are the deciding factor, but rather regulatory DNA or RNA elements that also reside in that same section of the genome.  Either way, Faber hopes they can discover a sequence that could one day be used to predict who is most likely to develop a severe heart attack, stroke, or peripheral limb disease so those individuals can either modify their lifestyle or receive collaterogenic drugs to acquire new and potentially life-saving collateral vessels.

The UNC research was funded by the National Institutes of Health. Study co-authors from UNC include Shiliang Wang, Hua Zhang, Xuming Dai and Robert Sealock.


UNC Hospitals qualifies for American Heart Association’s Mission: Lifeline Recognition for heart attack care

The award recognizes UNC Hospitals’ commitment and success in implementing a higher standard of care for heart attack patients that effectively improves the survival and care of STEMI (ST Elevation Myocardial Infarction) patients.

Media contact: Tom Hughes, 919-966-6047, tahughes@unch.unc.edu

Thursday, August 5, 2010

CHAPEL HILL — UNC Hospitals recently qualified for the American Heart Association’s Mission: Lifeline Bronze Performance Achievement Award. The award recognizes UNC Hospitals’ commitment and success in implementing a higher standard of care for heart attack patients that effectively improves the survival and care of STEMI (ST Elevation Myocardial Infarction) patients.

“UNC Hospitals is dedicated to making our cardiac unit among the best in the country, and the American Heart Association’s Mission: Lifeline program is helping us accomplish that by making it easier for our professionals to improve the outcomes of our cardiac patients,” said Cam Patterson, MD, MBA, UNC’s chief of cardiology and director of the UNC McAllister Heart Institute. “We are pleased to be recognized for our dedication and achievements in cardiac care.”

Every year, almost 400,000 people experience the STEMI type of heart attack. Unfortunately, a significant number don't receive prompt reperfusion therapy, which is critical in restoring blood flow. Mission: Lifeline seeks to save lives by closing the gaps that separate STEMI patients from timely access to appropriate treatments. Mission: Lifeline is focusing on improving the system of care for these patients and at the same time improving care for all heart attack patients.

Hospitals involved in Mission: Lifeline strive to improve care in both acute treatment measures and discharge measures. Systems of care are developed that close the gap of timely access to appropriate, life-saving treatments. Before they are discharged, appropriate patients are started on aggressive risk reduction therapies such as cholesterol-lowering drugs, aspirin, ACE inhibitors and beta-blockers in the hospital and receive smoking cessation counseling.

Hospitals that receive the Mission: Lifeline Bronze Performance Achievement Award have demonstrated for 90 consecutive days that at least 85 percent of eligible STEMI patients (without contraindications) are treated within specific time frames upon entering the hospital and discharged following the American Heart Association’s recommended treatment guidelines.

VIDEO: Cardiothoracic ICU receives the Beacon Award for Critical Care Excellence

The Cardiothoracic ICU (CTICU) has received the Beacon Award for Critical Care Excellence from the American Association of Critical Care Nurses for the second time!

This award requires success in the following areas, as measured again evidence-based national criteria:

  • Recruitment and retention
  • Education, training and mentoring
  • Research and evidence-based practice
  • Patient outcomes
  • Leadership and organizational ethics
  • Healing environment


"It is the day-to-day actions and teamwork in the CTICU that have contributed to making the Beacon award a reality again," said Deirdre Maisano, RN, BSN, CTICU nurse manager. "It is only thanks to everyone on the CTICU team that this is possible."

Out of an estimated 6,000 Intensive Care units in the United States, there have been only 315 units recognized for excellence with the Beacon Award, and of those, only 52 units have achieved the award more than once.

Congrats and thanks to everyone in the CTICU for your excellent work and care!


 

UNC receives $3.1 million to study alternative strategies to reduce heart disease and stroke

UNC's Center for Health Promotion and Disease Prevention has received a two-year, $3.1 million grant from the Centers for Disease Control and Prevention to research alternative ways to reduce the risk for cardiovascular disease.
UNC receives $3.1 million to study alternative strategies to reduce heart disease and stroke click to enlarge Tom Keyserling, M.D.
UNC receives $3.1 million to study alternative strategies to reduce heart disease and stroke click to enlarge Tom Keyserling, M.D.

The project will compare the effectiveness of a web-based program to that of a counselor-based program; both will focus on improving diet, physical activity and appropriate use of medication. The study will be based in five family practices in the North Carolina Family Medicine Research Network.

“Cardiovascular disease, including heart attacks and stroke, continues to be the leading cause of death in the U.S.,” said Tom Keyserling, M.D., associate professor at the UNC School of Medicine and the principal investigator of the study. “Lifestyle and appropriate use of medication can greatly reduce the risk of cardiovascular disease, yet both are underused.”

The project is one of four initiatives at CDC Prevention Research Centers awarded almost $10 million in 2009 Recovery Act funding. The comparative effectiveness research studies examine alternative public health strategies to improve health and/or reduce the risk for chronic disease.

Keyserling said as well as assessing the interventions’ impact on participants’ health, the study will measure outcomes such as cost effectiveness, acceptability and feasibility.

Stacey Sheridan, M.D., assistant professor at the medical school and adjunct assistant professor at the UNC Gillings School of Global Public Health, will co-lead the project.

For more information on the study, go to http://bit.ly/cRkgTs.


 


UNC Hospitals' 5 Anderson unit joining Center for Heart & Vascular Care

Starting July 1, 5 Anderson will officially join the Center for Heart and Vascular Care. The 15-bed unit primarily houses vascular patients and this transfer will further our collaborative care model.

We are looking forward to this change to help us further our goal of providing the best care and the best service to patients with cardiovascular diseases. On behalf of the inpatient nursing team I would like to formally welcome 5 Anderson to the Center for Heart and Vascular Care.

– Meghan McCann RN, MSN, director, Heart & Vascular and Inpatient Oncology Services



Conference: Heart Failure Management

This conference, which will take place in Amelia Island, FL, July 15 - 18 is designed for cardiologists, family medicine physicians, general internists, nurses and nurse practitioners, physician assistants, pharmacists, hospitalists and cardiology technicians.

The contemporary management of heart failure is characterized by a combination of evolving strategies and newer approaches that are based on recent research advances. The material presented will have an interdisciplinary focus and will be of interest to physicians and other health professionals who care for patients with heart failure.

Visit http://www.med.unc.edu/cme/events/heart-failure-2010/view for more information.



Benson R. Wilcox, M.D., 1932-2010

Benson Reid Wilcox, M.D., a distinguished heart surgeon who served 29 years as chief of the UNC Division of Cardiothoracic Surgery, died May 11, 2010, at his home after a courageous battle with brain cancer. He was 77.
Benson R. Wilcox, M.D., 1932-2010 click to enlarge Benson Reid Wilcox, M.D.

Dr. Wilcox, a native of Charlotte who earned his A.B. and M.D. degrees at UNC, served as chief of cardiothoracic surgery at UNC from 1969 to 1998. During that period, which was a time of dramatic advances in heart and lung surgery, UNC Hospitals began offering coronary artery surgery, heart and lung transplantation, successful surgery for congenital heart defects in newborn infants, and a comprehensive program for the treatment of lung and esophageal cancer.


He held important leadership posts in national medical organizations and was especially interested in the training of future surgeons. He was co-author of three books and an author of numerous medical journal articles and book chapters.
A memorial service is planned for Friday, May 14, at 2 p.m. in Gerrard Hall on the UNC campus. Gerrard Hall is on Cameron Avenue, across from the Old Well, between Memorial Hall and the South Building.

Read Dr. Wilcox's obituary here