Study of veterans reveals suicide-related behavior not direct result of anti-epileptic drugs

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Suicidal ideation peaks before, not after, drugs are prescribed

SAN ANTONIO (January 8, 2013) — A large new study of the suggested link between antiepileptic drugs and suicide-related behavior among veterans revealed that the risk for that behavior peaked in the month before the drugs were prescribed.

It doesn’t discount the link completely, said Mary Jo Pugh, Ph.D., an associate professor in the Department of Epidemiology in the School of Medicine at The University of Texas Health Science Center at San Antonio, but it raises important questions about the association that has been codified in an FDA warning.

“I think what it suggests is that we need to be careful about attributing everything to a drug,” said Dr. Pugh, who is also a Research Health Scientist for VA Health Services and Development Service, which funded the study.

Pugh and her fellow researchers analyzed the records of more than 90,000 older military veterans and published the findings in the Nov. 26, 2013, issue of Neurology, the medical journal of the American Academy of Neurology.

Many of the veterans who were prescribed the medicines, called AEDs, had mental health conditions such as depression or bipolar disorder, and not all had epilepsy.

“This is a cohort that may be more likely to have suicidal ideation or attempts even before receiving the drug,” Dr. Pugh said. “Probably people with depression or mental health-related diagnoses need to be screened more carefully and checked more frequently.”

The results from this group also lead to questions about how different drugs work in other age groups, she said.

“I think we need more information on specific kinds of drugs and younger patients,” Dr. Pugh said.

 

The University of Texas Health Science Center at San Antonio, one of the country’s leading health sciences universities, ranks in the top 3 percent of all institutions worldwide receiving National Institutes of Health funding. The university’s schools of medicine, nursing, dentistry, health professions and graduate biomedical sciences have produced more than 29,000 graduates. The $765 million operating budget supports eight campuses in San Antonio, Laredo, Harlingen and Edinburg. For more information on the many ways “We make lives better®,” visit www.uthscsa.edu.

Dual fellowship-trained orthopaedic oncologist joins UT Medicine

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SAN ANTONIO (Jan. 13, 2014) – With the arrival of Zachary Child, M.D., the Health Science Center is now one of only five locations in the United States with an orthopaedic surgeon who is trained in complex spinal and musculoskeletal oncology.

The other civilian locations with a similarly trained spine surgeon are the UT MD Anderson Cancer Center in Houston, the Mayo Clinic in Minnesota, Massachusetts General Hospital (the largest teaching hospital of Harvard Medical School) in Massachusetts, and the Carolinas Medical Center in North Carolina.

Robert Quinn, M.D., professor and chair of the Department of Orthopaedic Surgery at the UT Health Science Center San Antonio, said for the first time the university can offer an orthopaedic spine service.

“His expertise allows us to treat the most challenging conditions in the field of orthopaedics: tumors of the spine,” Dr. Quinn said. “Dr. Child is one of few surgeons in South Texas with the training to tackle everything from childhood cancer to artificial disk replacement. With his training, demeanor and superb bedside manner, he is the perfect individual to build a center of excellence in orthopaedic spine surgery here at the UT Health Science Center.”

The California native began his career as a firefighter before becoming a paramedic and paramedic instructor. His interest in medicine led him to earn his medical degree at the University of Nevada School of Medicine. He went on to complete his residency in orthopaedic surgery at the University of New Mexico School of Medicine.

In 2012, Dr. Child completed a clinical fellowship in orthopaedic oncology from the Harvard Medical School/Massachusetts General Hospital. In 2013, he completed a clinical fellowship in orthopaedic spine surgery from the University of Washington School of Medicine at Harborview Medical Center in Seattle.

Dr. Child said this is an exciting time for spine surgery. “We are doing surgeries now – especially those involving cancer that starts in the spine – that 20 years ago no one would have even attempted. New technology and new techniques now are allowing us to treat these tumors like you would ones anywhere else in the body. Our goal is to remove 100 percent of the tumor. By doing that, we give our patients their best chance at disease-free survival,” he said.

Dr. Child, an assistant professor of orthopaedic surgery at the university, calls working in orthopaedic oncology a real privilege.

“Taking care of cancer patients offers a completely different level of satisfaction. Even with cancer patients who cannot be cured, surgery can take away their pain and give them incredible quality of life for the rest of their time. You can make their lives better,” he said.

Dr. Child said orthopaedic oncology is truly a team-based collaboration.

“You cannot do these surgeries on your own. When we have a new patient to discuss, a team of eight will usually sit down to discuss the surgery and what each of us will do,” he said. “Together we will decide how to best treat the patient. I am very fortunate to be able to work with an incredibly talented team of orthopaedists and other specialists from throughout the university.”

Each year in the United States, there are approximately 2,000 primary bone cancers, which are those that start in the bone. Of all bone tumors, 6 percent affect the spine.

In addition to being able to treat orthopaedic oncology, this medical team also can provide care to individuals who are suffering from traumatic injuries, degenerative diseases and complex spinal deformities.

To make an appointment with UT Medicine – Orthopaedics, please call 210-450-9300. UT Medicine is the clinical practice of the School of Medicine at the UT Health Science Center. UT Medicine – Orthopaedics is located in the Medical Arts & Research Center (MARC) at 8300 Floyd Curl Drive in the Medical Center.

 

UT Medicine San Antonio is the clinical practice of the School of Medicine at the UT Health Science Center San Antonio. With more than 700 doctors – all School of Medicine faculty – UT Medicine is the largest medical practice in Central and South Texas. Expertise is in more than 100 medical specialties and subspecialties. Primary care doctors and specialists see patients in private practice at UT Medicine’s flagship clinical home, the Medical Arts & Research Center (MARC), located at 8300 Floyd Curl Drive, San Antonio 78229. Most major health plans are accepted, and UT Medicine physicians also practice at several local and regional hospitals. Call (210) 450-9000 to schedule an appointment, or visit www.UTMedicine.org for a list of clinics and phone numbers.

Discovery leads to patent for novel method of treating traumatic brain injury

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Compounds stimulate ‘caretaker cells’ to reduce swelling

James D. Lechleiter, Ph.D.
James D. Lechleiter, Ph.D.

SAN ANTONIO (Jan. 8, 2014) — A researcher in the School of Medicine at The University of Texas Health Science Center at San Antonio received a U.S. patent Dec. 31 for his discovery that a class of compounds is protective against traumatic brain injury (TBI). The patent, No. 8,618,074, covers novel methods of preventing or treating neuronal damage, and work is continuing on development of potential therapies for TBI based on this invention.

James D. Lechleiter, Ph.D., professor of cellular and structural biology at the Health Science Center, reported the findings in cell and animal models in peer-reviewed journals. Studies yet to be published extend the results to human brain tissue obtained from patients who underwent temporal lobectomies to curb treatment-resistant epilepsy. Dr. Lechleiter filed the patent application in 2007 and worked closely with the Health Science Center’s Office of Technology Transfer and Commercialization (OTTC). “OTTC was invaluable in shepherding my application through the patenting process,” Dr. Lechleiter said. “They really championed the patent at critical junctures.”

Untreated Human Brain Tissue
Untreated Human Brain Tissue, Left, Treated Human Brain Tissue, Right, Astrocytes (green), Neurons (red)

He found that two compounds stimulate the ability of the brain’s caretaker cells (called astrocytes) to do their job. The compounds, called 2-methylthio-ADP and MRS2365, are among a class of compounds called purinergic receptor ligands. “Normally people want to block things to stop injury,” Dr. Lechleiter said. “We’re saying let’s stimulate the natural caretakers of the brain, part of whose job is to help control edema.” Edema is swelling that compresses brain tissue and neurons while increasing pressure inside the skull.

Dr. Lechleiter and Murat Digicaylioglu, M.D., Ph.D., associate professor of neurosurgery in the School of Medicine, published a study showing that, after an injury to the mouse brain, treatment of the astrocyte cells with 2-methylthio-ADP and MRS2365 significantly reduced the edema. “With this treatment, astrocytes themselves, as well as neurons, live longer,” Dr. Lechleiter said. “It is hoped these preliminary studies will soon lead to a new class of safe and effective drugs that can be administered if a traumatic brain injury, even a mild one, is suspected to have occurred.”

External signs and symptoms of TBI are not always present or can go unnoticed in stressful situations such as war, car accidents or many sport-related injuries. Because the skull is a defined space, there is no place to expand. Edema pushes the brain aside, placing pressure on the neurons and tissues.

“Undiagnosed traumatic brain injuries are time bombs,” Dr. Lechleiter said. “This injury continues in the brain. Sometimes, people do not recognize or admit that they are having problems. Others may not understand why they are having problems and what their problems are, which can make them nervous and upset. In the case of soldiers wounded in war, the trauma happens in Afghanistan, but you carry it home.”

Support for this research program is from the National Institute on Aging. Dr. Lechleiter is now working with the Center for Innovation in Drug Discovery, a joint center of the Health Science Center and The University of Texas at San Antonio, to refine and further develop robust purinergic receptor-based medications for people with TBI.

Once the significant pre-clinical studies that need to be done are completed, promising drugs that stimulate this caretaker pathway will then be entered into Phase I clinical trials to begin the process of evaluating their therapeutic potential and safety in people. Most often, this phase of development is done in partnership with the pharmaceutical industry or is spun out into a start-up company, and OTTC is working with Dr. Lechleiter to identify the best next step.

“This invention is part of our ongoing basic and translational research,” Dr. Lechleiter said. “Our most recent results indicate that purinergic ligand treatment of TBI also eliminates the long-term neurological deficits typically associated with repetitive head injuries. We’re very excited about the clinical impact of these findings and hope this success leads to new drug therapies for people with multiple brain injuries.”

 

The University of Texas Health Science Center at San Antonio, one of the country’s leading health sciences universities, ranks in the top 3 percent of all institutions worldwide receiving National Institutes of Health funding. The university’s schools of medicine, nursing, dentistry, health professions and graduate biomedical sciences have produced more than 29,000 graduates. The $765 million operating budget supports eight campuses in San Antonio, Laredo, Harlingen and Edinburg. For more information on the many ways “We make lives better®,” visit www.uthscsa.edu.

Nurse leader appointed to serve on federal health care commission

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SAN ANTONIO (Jan. 9, 2014) – Norma Martinez Rogers, Ph.D., RN, FAAN, professor of nursing at the UT Health Science Center San Antonio, has been appointed to a second three-year term as a commissioner for the Medicaid and CHIP Payment and Access Commission (MACPAC).

Dr. Martinez Rogers was an inaugural member of MACPAC, which is a non-partisan, federal agency charged with providing policy and data analysis to Congress on Medicaid and CHIP, an acronym for the Children’s Health Insurance Program. The commissioners make recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide range of issues affecting these programs.

The Commission conducts independent analysis and research on topics including eligibility, enrollment and benefits; payment; access to care; quality of care; interactions of Medicaid and CHIP with Medicare and the health care system generally; and data development to support policy analysis and program accountability.

Appointed by the U.S. Comptroller General, the 17 Commissioners have diverse backgrounds, offer broad perspectives on Medicaid and CHIP, and represent different regions across the United States.

Diane Rowland, chair of the MACPAC, said, “We are pleased that Dr. Martinez Rogers will continue to serve on the Commission at this critical time for Medicaid and health care reform. Her considerable expertise and experience working with underserved populations is invaluable in the Commission’s deliberations.”

Dr. Martinez Rogers has served on the faculty of the UT Health Science Center since 1996. She specializes in cultural diversity, mentoring, recruitment and retention of nursing students through her research and teaching.

She has initiated a number of programs, including a support group for women transitioning from prison back into society and the Martinez Street Women’s Center, a non-profit organization designed to provide support and educational services to women and teenage girls.

She is a fellow of the American Academy of Nursing and is the former president of the National Association of Hispanic Nurses. She received a master of science in psychiatric nursing from the UT Health Science Center at San Antonio and her doctorate in cultural foundations from The University of Texas at Austin.

 

The University of Texas Health Science Center at San Antonio, one of the country’s leading health sciences universities, ranks in the top 3 percent of all institutions worldwide receiving National Institutes of Health funding. The university’s schools of medicine, nursing, dentistry, health professions and graduate biomedical sciences have produced more than 29,000 graduates. The $765 million operating budget supports eight campuses in San Antonio, Laredo, Harlingen and Edinburg. For more information on the many ways “We make lives better®,” visit www.uthscsa.edu.

Amino acid’s increase is suspected in diabetes

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Research examines effects of lower and higher tyrosine levels

SAN ANTONIO (Jan. 6, 2013) — Elevated levels of an amino acid, tyrosine, alter development and longevity in animals and may contribute to the development of diabetes in people, new research from the UT Health Science Center at San Antonio indicates. This line of study could potentially lead to a novel way to prevent or treat the disease. The research was reported Dec. 19 in PLOS Genetics, a journal of the Public Library of Science.

Tyrosine is increased in the blood of people who are obese or diabetic, said study senior author Alfred Fisher, M.D., Ph.D., of the Barshop Institute for Longevity and Aging Studies at the UT Health Science Center. Among people who are obese, those at the highest risk of developing diabetes tend to have higher tyrosine levels. “It was unknown whether this was simply a marker of diabetes risk or could be playing a direct role in the disease,” Dr. Fisher said. “Our work suggests that tyrosine has a direct effect.”

Dr. Fisher is a physician scientist with the Barshop Institute’s Center for Healthy Aging and the Geriatric Research, Education and Clinical Center of the South Texas Veterans Health Care System. He has studied tyrosine’s effect on insulin signaling in an animal model called C. elegans (roundworms) since 2005. The observation that tyrosine was elevated in human diabetics further spurred the research. Now he is ready to take research insights back into people.

“This will be tested in small human clinical trials,” Dr. Fisher said. “Our team will augment tyrosine levels in study participants for a short period and observe whether this changes the ability of the body to respond to insulin, which is a key hormone involved in controlling blood sugar levels. This will not be detrimental to participants, as the increase will be transient and well below the level of what is clinically relevant.”

As a postdoctoral fellow at the University of California, San Francisco, Dr. Fisher found that increasing the levels of tyrosine in roundworms promoted their longevity. Worms with mutations of certain genes lived 10 percent to 20 percent longer. One combination of genetic mutations produced an almost 60 percent increase in life span.

“In both humans and worms, the effect is due to an inhibition of insulin signaling,” Dr. Fisher said. “Interfering with this pathway produces longevity in worms, whereas in people it leads to insulin resistance and an elevated risk of developing diabetes.”

Tyrosine has been studied for decades, but few if any research groups have made the connection between tyrosine and diabetes.

“The key concept that comes out of our latest paper is, rather than amino acids being only building blocks in our bodies, they are detected and produce changes in physiology, including potentially undesirable ones such as diabetes in humans,” Dr. Fisher said.

Dr. Fisher, associate professor of medicine in the School of Medicine, joined the Health Science Center in 2013 from the University of Pittsburgh School of Medicine. He earned Ph.D. and M.D. degrees at the Weill Cornell Medical College in New York, and completed residency and a geriatrics fellowship at the University of California, San Francisco.

“It was attractive to me to move my lab here,” he said. “The number and diversity of people studying the basic biology of aging here is very impressive.”

Funding for the project is from the National Institute on Aging, the National Institute of Environmental Health Sciences, and the Geriatric Research, Education and Clinical Center of the South Texas Veterans Health Care System.

 

The University of Texas Health Science Center at San Antonio, one of the country’s leading health sciences universities, ranks in the top 3 percent of all institutions worldwide receiving National Institutes of Health funding. The university’s schools of medicine, nursing, dentistry, health professions and graduate biomedical sciences have produced more than 29,000 graduates. The $765 million operating budget supports eight campuses in San Antonio, Laredo, Harlingen and Edinburg. For more information on the many ways “We make lives better®,” visit www.uthscsa.edu.

Childhood cancer survivor grant allows HSC researchers to launch survivorship program

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SAN ANTONIO, Texas (December 16, 2013) – While survival rates for adolescents and young adults with cancer have improved over the past two decades, those patients often develop health problems that are frequently not addressed because of a lack of both resources and awareness of their unique medical needs. This leads to inconsistent medical follow-up, low clinical trial enrollment, and delayed detection of sometimes dangerous health conditions.

UT Health Science Center researchers are changing that by developing a new survivorship program, and the St. Baldrick’s Foundation has awarded a one-year infrastructure grant of $50,000 to the Health Science Center to help kick-start it.

The UT Health Science Center’s AYA (Adolescent/Young Adult) Survivorship Program will help these patients and further the understanding of the health problems in this population.

By supporting a clinical coordinator for the clinic, this infrastructure grant will ensure accrual to open clinical trials and provide appropriate survivorship planning and research for these young people.

“This grant gives us some great resources to get headed in the right direction, and we’re very excited about it,” said Helen Parsons, Ph.D., M.P.H, an assistant professor in the Department of Epidemiology and Biostatistics in the School of Medicine at the UT Health Science Center. “We’ve been building the project for some time, so the funding for a coordinator gives us the opportunity to really move it forward.”

To locate or organize an event or Do What You Want fundraiser in your community, sign-up to shave, donate or volunteer, visit www.StBaldricks.org. Also become a fan on Facebook, follow us on Twitter, and visit the Foundation’s YouTube and Vimeo channels.

 

The University of Texas Health Science Center at San Antonio, one of the country’s leading health sciences universities, ranks in the top 3 percent of all institutions worldwide receiving National Institutes of Health funding. The university’s schools of medicine, nursing, dentistry, health professions and graduate biomedical sciences have produced more than 29,000 graduates. The $765 million operating budget supports eight campuses in San Antonio, Laredo, Harlingen and Edinburg. For more information on the many ways “We make lives better®,” visit www.uthscsa.edu.
The St. Baldrick’s Foundation is a volunteer-driven charity committed to funding the most promising research to find cures for childhood cancers and give survivors long and healthy lives. St. Baldrick’s coordinates its signature head-shaving events worldwide where participants collect pledges to shave their heads in solidarity with kids with cancer, raising money to fund research. Since 2005, St. Baldrick’s has awarded more than $127 million to support lifesaving research, making the Foundation the largest private funder of childhood cancer research grants. St. Baldrick’s funds are granted to some of the most brilliant childhood cancer research experts in the world and to younger professionals who will be the experts of tomorrow. Funds awarded also enable hundreds of local institutions to participate in national pediatric cancer clinical trials, and the new International Scholar grants train researchers to work in developing countries. For more information about the St. Baldrick’s Foundation please call 1.888.899.BALD or visit www.StBaldricks.org.