2013 award recipients include:
Richard H. Feins, M.D.’73, a professor of surgery in the division of cardiothoracic surgery at the University of North Carolina School of Medicine in Chapel Hill, is a thoracic surgeon celebrating his 40th reunion year at the UVM College of Medicine. Trained in general surgery and cardiothoracic surgery at the University of Rochester, where he served on the faculty until 2005, Feins moved to the University of North Carolina at Chapel Hill as a professor of surgery and head of general thoracic surgery. Throughout his career, he has demonstrated creative leadership and innovation in thoracic surgery education. Feins has served on the American Board of Thoracic Surgery as a director for eight years and then as chair from 2007 to 2009. In addition, he has served on the Board of Directors of the Society of Thoracic Surgeons, the Joint Council for Surgical Education, the Thoracic Surgery Foundation for Research and Education, and the General Thoracic Surgery Club. He is the co-director of the national Cardiothoracic Surgery Resident Boot Camp and the executive director of the Cardiothoracic Surgery “Senior Tour,” a nationwide organization of retired cardiothoracic surgeons who volunteer in the training of cardiothoracic surgery residents. Feins is recognized nationally as a “go-to guy” on matters pertaining to the education of future thoracic surgeons and for simulation-based training.

Edward P. Havranek, M.D.’83, a professor of medicine at the University of Colorado School of Medicine and a cardiologist and director of Health Services Research at Denver Health Medical Center, is celebrating his 30th reunion year. A Denver, Colo., cardiologist with a long-standing interest in measuring and improving the quality of care for cardiovascular disease, particularly heart failure, his current funded research focuses on causes and solutions to the problems of health disparities based on race and ethnicity. Havranek served as chair of the American Heart Association’s Quality of Care and Outcomes Research Annual Scientific Forum Program Committee, and was a member of the Database Steering Committee for the American Heart Association, as well as a member of the Technical Advisory Committee for Colorado’s Regional Health Information Organization. He was a clinical coordinator for the Centers for Medicare & Medicaid Services sponsored National Heart Care Projects from 1999 to 2005, chair of the Care Standards Committee of the Heart Failure Society of America from 2002 to 2006, and a member of the governor’s Health Information Technology Advisory Committee for Colorado in 2008 and 2009. Havranek serves on the editorial boards for several major cardiology journals. He will present on “Social Determinants of Cardiovascular Outcomes” at the UVM Department of Medicine Grand Rounds on Friday, May 31, 2013, at 8 a.m. in the Davis Auditorium.

Douglas W. Losordo, M.D.’83, an interventional cardiologist and professor of medicine at the Northwestern University Feinberg School of Medicine in Chicago, Ill., is celebrating his 30^th reunion year. Losordo is board-certified in internal medicine, cardiovascular disease, and interventional cardiology and is a fellow of the American College of Cardiology, the American Heart Association, the American Association for the Advancement of Science, the American College of Physicians, the American College of Chest Physicians, and the Society for Cardiac Angiography and Interventions. His major research interests encompass angiogenesis/vasculogenesis, progenitor/adult stem cells, tissue repair/regeneration, and vascular biology. Working with the late Jeff Isner at St. Elizabeth’s Medical in Boston, Mass., he developed a program in therapeutic angiogenesis and cell-based tissue repair and executed the full “translational medicine” paradigm: identifying novel therapeutics in the laboratory, developing these strategies in small and large animal models and designing and executing  first in human clinical trials. Losordo previously served as director of the Feinberg Cardiovascular Research Institute and the Eileen M. Foell Professor of Heart Research at Northwestern University’s School of Medicine and director of the Program in Cardiovascular Regenerative Medicine at Northwestern Memorial Hospital.

Learn more about Reunion 2013 at the UVM College of Medicine.

“While poor fitness is already known to predict future cardiovascular disease, this is the first study to explore fitness as a marker of future cancer risk prognosis,” says lead study author Susan Lakoski, M.D., assistant professor of medicine and director of the cardiovascular prevention program for cancer patients at the University of Vermont/Fletcher Allen Health Care. “This finding makes it clear that patients should be advised that they need to achieve a certain fitness level, and not just be told that they need to exercise. And unlike exercise behavior, which relies on patient self-reporting, fitness can be objectively and accurately measured in a clinical setting.”

Lakoski’s research was selected for ASCO’s official Press Program, which took place May 15 via teleconference.  Less than one percent of Annual Meeting abstracts are chosen for this distinction and the Press Program plays a vital role in garnering accurate media coverage of cancer research presented at the meeting.

The study included 17,049 men who had a single cardiovascular fitness assessment as part of a specialized preventive health check-up visit at a mean age of 50 years offered at the Cooper Institute. The fitness test, which is similar to a stress test for heart disease risk, entailed walking on treadmill under a regimen of changing speed and elevation. The men’s performance was recorded in established units of fitness called metabolic equivalents or METs. Study participants were divided into five groups (quintiles) according to their fitness performance.

Researchers subsequently analyzed Medicare claims data to identify the participants of this study who had developed lung, colorectal, or prostate cancer – the three most common types of cancer among U.S. men. Over a median follow-up period of 20-25 years, 2,332 men were diagnosed with prostate cancer, 276 were diagnosed with colorectal cancer, and 277 were diagnosed with lung cancer. There were 347 deaths due to cancer and 159 men died of cardiovascular disease.

Researchers found that the risk of being diagnosed with lung or colorectal cancer was reduced by 68 and 38 percent, respectively, in men who were the most fit, relative to those who were the least fit. Fitness did not significantly impact prostate cancer risk. In the analysis, data were adjusted for smoking and other factors, such as body mass index and age.

Among the men who developed cancer, those who were more fit at middle age had a lower risk of dying from all the three cancers studied, as well as cardiovascular disease. Even a small improvement in fitness (by 1MET) made a significant difference in survival ─ reducing the risks of dying from cancer and cardiovascular disease by 14 and 23 percent, respectively.

Another interesting finding was that men who had low fitness had an increased risk of cancer and cardiovascular disease even if they were not obese. This suggests that patients should focus on improving their fitness, regardless of their body weight. Adequate fitness level depends on gender and age. In this study, men who fell in the lowest quintile for fitness achieved less than 13.5 minutes during the treadmill exercise test if they were 40-49 years old, less than 11 minutes if they were 50-59, and less than 7.5 minutes if they were 60 or older.

“This important study establishes cardiorespiratory fitness as an independent and strong predictor of cancer risk and prognosis in men,” says ASCO President Sandra M. Swain, M.D., F.A.C.P. “While more research is needed to determine if similar trends are valid in relation to other cancers and among women, these results indicate that people can reduce their risk of cancer with relatively small lifestyle changes.”

This research was supported by the National Cancer Institute.

(This news release was produced by Kelly Baldwin of the Science Communications office at the American Society for Cancer Oncology press office.)

Accreditation with Commendation is only awarded to those institutions that have demonstrated compliance to all of ACCME’s criteria. Fewer than 20 percent of institutions accredited by the ACCME achieve this level.

The CME Office, which launched in 1965, is led by Associate Dean Cheung Wong, M.D., associate professor of obstetrics, gynecology and reproductive sciences, and Director Terry Caron. Wong credits the support of senior leadership, technology services, the faculty of the College and the CME staff for making the Accreditation with Commendation possible.

CME offers 20 conferences annually and supports a weekly Grand Rounds schedule for 16 specialties at UVM/Fletcher Allen. Learn more.

Among participants with optimum health, the risk of blood clots was 44 percent lower than those with inadequate health. Those with average health had a 38 percent lower risk.

Maintaining ideal levels of physical activity and body mass index were the most significant lifestyle changes related to lower risk of blood clots.

(This article is based on a news tip created by Darcy Spitz of the American Heart Association.)

The current lab must be replaced because it has outgrown its space and the structure is outdated. Planning for the new facility has been in process for more than 10 years.

The building will be co-located and connected to the University of Vermont’s Colchester Research Facility and was designed, in part, to facilitate collaboration between university researchers and public health scientists. A number of scientists from the UVM College of Medicine Departments of Biochemistry, Medicine, Pathology, and Pediatrics are conducting work in the basic sciences and population science in laboratories at the Colchester Research Facility.

The state health lab routinely performs a wide range of analyses to detect biological, toxicological, chemical and radiological threats to the health of the population – from testing for blood lead levels, rabies, pertussis and salmonella to drinking water contaminants, toxic contaminants, and to support disease outbreak investigations.

The lab also has capabilities to respond rapidly to public health emergencies such as novel strains of flu, suspicious substances containing anthrax or ricin, and unusual events like the tritium leak at Vermont Yankee or widespread flooding after Tropical Storm Irene. More than 50,000 tests are performed at the facility every year.

“This is a great new facility that will serve the state well,” said Governor Peter Shumlin. “And the collaboration between the Health Department and UVM scientists will advance public health, medical research, health care and policy in the healthiest state.”

“This is a great day for public health,” said Health Commissioner Harry Chen, M.D. “The lab is a cornerstone of our ability to protect and promote the health of Vermonters. The new facility will give our professionals the modern scientific environment and space for the new technologies that are essential to support the daily work of disease investigation and environmental testing and monitoring.”

“I’m proud of the part UVM is playing in helping create a state-of-the-art public health facility for Vermont,” said Tom Sullivan, J.D., UVM president. “This critically important facility is an example of what can happen when the university and the state partner to achieve common goals.”

State health lab one of oldest in country

The state health lab dates back to 1898, when the Vermont State Laboratory of Hygiene was established by the Legislature, just the third of its kind to be organized in the U.S. The Health Department’s current lab facility is now one of the oldest in the country. Built in 1952, it originally housed administrative offices as well as the lab. The building was renovated in 1985 to serve exclusively as a lab, but the renovations did not replace the antiquated heating, ventilating, and air conditioning systems. There is also no additional space for new instrumentation.

Because of these limitations, it has become increasingly difficult to adapt the current facility to accommodate changing scientific technology that requires special facility design, such as safe specimen receipt/processing areas, “clean room” areas for preparing specimens for testing by molecular biology or low level contaminant chemistry procedures, and temperature/humidity and controls.

Co-located labs will bring tangible benefits

The new building was designed collaboratively by the Health Department and UVM to maximize the advantages of having the two buildings in close proximity. The new building will be physically connected to the Colchester Research Facility and the two buildings will share a front door.

“The goal is to create a state scientific campus,” said Chen. “This collaboration is very much in line with the national trend in health sciences research to build facilities that bridge the distance from the research bench to the community to health policy. This positions us to meet the future challenges of emerging diseases and health threats.”

“The co-location allows us to bring professionals at the Health Department who are actively engaged in public health issues together with UVM faculty who work nationally and internationally to investigate patterns of disease and look for new diagnostics and treatments,” said John Evans, Ph.D., UVM senior advisor for business engagement.

Health and UVM officials cited a number of mutual benefits, such as the ability to partner on specialized medical research, the potential for increasing research funding and enhanced recruitment, and cost economies for both resulting from sharing facilities.

From the Health Department’s point of view, being connected to a major medical research facility keeps public health on the leading edge of the health sciences, expands the training ground for future laboratorians, and provides surge capacity with specialized labs, instruments and personnel in the event of a public health emergency that requires 24/7 response.

For UVM, there are many benefits from sharing specialized space for biomedical research with health department scientists, including expanded opportunities for cooperative projects and increased external funding. In addition, the state-of-the-art facilities provide training and internships in research and public health for undergraduate, graduate and medical students.

Among the vendors involved in the Department of Health Lab project are:

Design Team                                     

Architects and engineers from HDR Architects Engineers Planners, Princeton, N.J.; civil engineers from Krebs and Lansing Consulting Engineers, Colchester, Vt., exterior envelope experts from Scott and Partners Architects, Essex Junction, Vt.; soils engineers from Civil Engineering Associates, South Burlington, Vt.; geo-technical engineers from GeoDesign, Inc., South Burlington, Vt.

Construction Team                          

General Contractor: PC Construction, Inc., So. Burlington, Vt.; concrete: S.D. Ireland Concrete Construction, Williston, Vt.; curtain wall & storefront: St. Albans Glass Company, Inc., St. Albans, Vt.; drywall/metal framing/acoustical ceilings: Denis White Interior Contractors, Williston, Vt.; electrical: Omega Electric Construction, South Burlington, Vt.; fireproofing: Thermal & Water Barriers of VT, Fairfax, Vt.; H-Piles & Steel Erection: CCS Constructors, Inc., Morrisville, Vt.; masonry: Ziter Masonry, Inc., Barre, Vt.; mechanical/plumbing/controls: Vermont Heating & Ventilating Co., Winooski, Vt.; metal stairs & misc metals: Charles Leonard Steel Services LLC, Concord, N.H.; painting: Russ/Wood Decorating, Inc., Richmond, Vt.; Roofing & Metal Panels: Monahan Brothers, Inc., Plattsburgh, N.Y.; site work: S.D. Ireland Brothers Corp., South Burlington, Vt.; spray foam insulation: East Shore Drywall, Colchester, Vt.; structural steel fabrication: Canatal Industries Inc., Thetford Mines, QC; waterproofing: Nicom Coatings Corporation, Barre, Vt.

(This article was produced from a press release written by the Vermont Department of Health.)

When HIV (human immunodeficiency virus) was first identified in the U.S. in the 1970s, and for 20 years thereafter, it was considered a death sentence, because it led to the fatal AIDS (acquired immunodeficiency syndrome). However, successful treatment of the condition has contributed substantially to the longevity of this population, which, according to The Centers for Disease Control and Prevention, totals an estimated one million people in the U.S.

“Many have suspected that while progression to AIDS has been lessened – or in some groups of people, essentially eliminated – a new risk for non-AIDS related chronic diseases has emerged,” says Tracy. The JAMA Internal Medicine study, he adds, utilized data from the largest cohort yet examined in what is known as the “VA Virtual Cohort.”

In order to determine any relationship between HIV and an increased risk of heart attack, Tracy, along with lead study investigator Matthew Freiberg, M.D., M.Sc., of the University of Pittsburgh School of Medicine, senior author Amy Justice, M.D., M.Sc., Ph.D., of the Yale School of Medicine/VA Connecticut Healthcare System, and colleagues analyzed data from 82,459 veterans – both those infected with HIV and those uninfected. The researchers found that there were 871 acute myocardial infarction (AMI or heart attack) events during a follow-up of about 5.9 years, which represented many more on a percentage basis in the HIV-infected group than in the non-infected group, even after adjusting for all standard Framingham risk factors. “This confirms a substantial increased risk due to HIV infection on top of the risk due to traditional risk factors such as blood pressure and cholesterol,” says Tracy, who adds that “the source of the increased risk isn’t known with certainty.”

However, Tracy and other experts in this field do have an idea about the underlying cause. In a different, but related study, titled “Inflammatory and Coagulation Biomarkers and Mortality in Patients with HIV Infection” and published in PLoS Medicine in 2008, he and colleagues demonstrated that chronic, well-controlled HIV infection is associated with a level of inflammation consistent with increased cardiovascular disease risk.

“Despite our best medications, and since inflammation is known to be an important participant in atherosclerosis and heart attacks, this chronic pro-inflammatory state is the leading candidate,” Tracy says.

(This article includes information adapted from a JAMA Internal Medicine press release.)

The award is named in honor of the work of the late Roger R. Williams, M.D., who founded the division of cardiovascular genetics at the University of Utah School of Medicine and was a pioneer in the field of the genetics of inherited lipid disorders and the prevention of atherosclerosis.

To be eligible for this award, a candidate must be a member of the AHA, the first and presenting author of the abstract, and their work may not have been previously presented or published in any form. The winning abstract is the one achieving the highest average score of all applicants who submit abstracts to the category of genetic epidemiology. The Roger R. Williams Award recipient receives a cash prize of $1,500 and a plaque.

Olson’s winning abstract, titled “Common Single Nucleotide Polymorphisms in the Coagulation Factor XII Gene (F12) are Associated With Endogenous Thrombin Potential via In Situ Activation of the Intrinsic System of Coagulation: the Cardiovascular Health Study,” is coauthored by several UVM colleagues, including Tracy; Saulius Butenas, Ph.D., associate professor of biochemistry; Nancy Swords Jenny, Ph.D., associate professor of pathology; and Mary Cushman, M.D., M.Sc., professor of medicine. Olson and his colleagues’ work received support from a National Heart, Lung and Blood Institute (NHLBI) grant titled “Thrombosis Genetics, MI and Stroke in Older Adults,” led by Alex Reiner, M.D., M.Sc., at the University of Washington, of which Tracy is a co-investigator.

Olson and colleagues’ work utilized a recently developed laboratory test, called the endogenous thrombin potential (ETP) assay in samples from approximately 5,400 people participating in the Cardiovascular Health Study (CHS), an NIH-funded observational study of risk factors for cardiovascular disease in older adults. The ETP test measures the generation of thrombin, an enzyme critically important in blood coagulation. Increased generation of thrombin can result in blood clots, which are the hallmark of such diseases as venous thrombosis (clots in the deep veins of the leg or in the arteries of the lungs), heart attack, and stroke.

The researchers sought to understand the contributions of genetic factors to an individual’s capacity to generate thrombin. For their study, the group analyzed genetic variation, called single nucleotide polymorphisms (SNPs), with the goal of identifying variation in genes associated with variation in thrombin generation. Results from their work identified variation in one gene, the gene for Coagulation Factor XII (FXII), as being significantly associated with higher or lower thrombin generation, depending on which allele, or copy, of the gene participants carried.

“This was a particularly exciting finding because FXII is the initiating component of what is referred to as the contact, or intrinsic, pathway of blood coagulation,” says Olson. “This pathway has long been considered unimportant in blood clotting experiments in humans. Our results suggest a previously unsuspected importance of intrinsic pathway-dependent coagulation in vivo, and may have important implications in diseases such as arterial and venous thrombosis.”

According to Olson, the laboratory group is currently investigating the ETP assay for prediction of future cardiovascular disease events in the Cardiovascular Health Study, and examining the mechanism for how genetic variation in FXII affects thrombin generation, as well as other components of the coagulation system.

Olson received his Ph.D. from UVM in 2011 and was mentored by Albert van der Vliet, Ph.D., professor of pathology. He is currently supported by the NHLBI-funded Hemostasis and Thrombosis Training Grant directed by Kenneth Mann, Ph.D., professor emeritus of biochemistry.

Spring 2013 lecture dates, topics and speakers include:

• April 16, “Top of Mind: The Brain’s Frontal Lobes and their Role in Memory” by Deborah Black, M.D., Clinical Assistant Professor of Neurological Sciences

• April 25 (Thurs.), SPECIAL PRESENTATION: “The Coming Changes in Vermont’s Health Care Delivery System,” by Governor Howard Dean, M.D.

• April 30, “Hot Off the Press: The Latest News in Menopause” by Zaher Merhi, M.D., Assistant Professor of Obstetrics, Gynecology and Reproductive Sciences

•  May 7, “My Regeneration: Using Stem Cells to Repair the Heart,” by William Hopkins, M.D., Associate Professor of Medicine, and Jeffrey Spees, Ph.D., Associate Professor of Medicine and Director, Stem Cell Core

• May 14, “Cancer and Exercise: Improving Physical Function and Cardiopulmonary Health During and After Treatment” by Kim Dittus, M.D., Assistant Professor of Medicine, and Susan Lakoski, M.D., Assistant Professor of Medicine

To register, or for more information, visit the Community Medical School website or call 802-847-2886.

The CME (Continuing Medical Education) Educator of the Year award recipient receives $1,500 cash and a $6,000 education grant. This year’s winner is Mark Hamlin, M.D., UVM associate professor of anesthesiology and director of anesthesia critical care and medical director of respiratory care services at Fletcher Allen. He has twice received Fletcher Allen’s Anesthesiology Teacher of the Year Award and is the course co-director for Northern New England Critical Care conferences.

John Lawrence, M.D., UVM associate professor of surgery and pediatric surgeon at Fletcher Allen, is the recipient of the GME (Graduate Medical Education) Teacher of the Year Award, which provides the recipient with $1,500 cash and a $6,000 education grant. Lawrence has received numerous teaching awards in his career and is known for challenging residents and students to think thoroughly about each patient encounter, and for holding them to high standards.

The UVM Medical Group consists of approximately 450 physicians from all fields of medicine devoted to advancing patient care through clinical and laboratory research, and educating the next generation of providers.

Named for a long-time Dismas volunteer, the Ann Atherton Award is presented annually to dedicated volunteers who through their efforts, make a difference in the Dismas community.

“I have been a Dismas volunteer now for about five years now,” says Pantel. “Both my wife and I cook dinner at the house once a month. I have met many people from many different backgrounds over the course of my time at Dismas.”

Dismas Vermont, which has residences in Burlington, Winooski, Rutland and Hartford, seeks to serve former prisoners in their difficult transition from prison to the community, assuring harmony in their lives and greater public safety. The Burlington Dismas House was founded in 1986.

“It has been a great way to give back to my local community and also stay in touch with many diverse people from all over,” says Pantel. “The experience has truly kept me grounded during my time in medical school.”

Pantel will receive his medical degree from the UVM College of Medicine on Sunday, May19, 2013, following which he will be serving a residency in general surgery at the Lahey Clinic in Burlington, Mass.

Learn more about Dismas of Vermont.

The study appears in the March 15, 2013 issue of the Journal of Infectious Diseases.

Transmitted to humans by Aedes mosquitoes and prevalent in many tropical and subtropical regions of the world, dengue infection is caused by any of four related viruses: Dengue viruses (DENV) 1 through 4. Classically described dengue fever includes fever, headache, severe joint and muscle pain, and rash. Severe dengue infections, dengue hemorrhagic fever, and dengue shock syndrome include a higher risk of complications and death and are more commonly seen after a second infection with dengue viruses. The World Health Organization estimates that 500,000 patients, many of them children, are hospitalized every year with severe dengue-related disease.

Launched in July 2010 and led by principle investigators Beth Kirkpatrick, M.D., UVM associate professor of medicine, and Anna Durbin, M.D., of Johns Hopkins Bloomberg School of Public Health in Baltimore, Md., the Phase I clinical trial tested a single dose of each of four versions of the investigational dengue vaccine TetraVax-DV. The vaccine was developed by scientists in the National Institute of Allergy and Infectious Diseases’ Laboratory of Infectious Diseases. It is a live-attenuated vaccine, which means that the viruses it contains are weakened enough such that they do not cause illness, but still can induce an immune response. Each of the four vaccines tested included different mixtures of components designed to protect against all four dengue viruses.

The Phase I study was conducted in Baltimore, Md., Burlington, Vt., and Washington, D.C. The final study analysis included 112 healthy men and women ages 18 to 50 years who had not previously been exposed to dengue or related viruses such as West Nile virus and yellow fever virus.

Participants were randomized into four groups. In each group, 20 volunteers received a single 0.5-milliliter subcutaneous (under the skin) injection of one of the tetravalent candidate vaccine combinations, and eight others received placebo. All were monitored for immediate adverse reactions for at least 30 minutes after vaccination, and subsequently took their body temperatures three times daily for 16 days to check for possible adverse reactions. Participants also received a physical exam every other day up to Study Day 16, and then again on study days 21, 28, 42 and 180, when blood tests were also performed.

The researchers found that all four candidate vaccine combinations induced antibody responses against each of the dengue viruses. However, one vaccine combination, TV003, appeared to induce the most balanced antibody response against the dengue viruses. A single dose of TV003 resulted in an antibody response to all four dengue viruses in 45 percent of participants and against three of the four viruses in an additional 45 percent. Overall, an immune response to at least three viruses was seen in 90 percent of vaccinees given TV003.

Kristen Pierce, M.D., assistant professor of medicine and investigator at UVM, says that she and her collaborators found that a single dose of the NIH vaccine induced an immune response comparable to three doses of the leading candidate vaccine, which was developed by Sanofi Pasteur. Pierce adds that the trial had another plus – low production cost, and thereby, greater potential for better accessibility.

“The safety of the vaccine has now been clearly demonstrated after many vaccine trials at both UVM and Johns Hopkins,” says Pierce. “Over the last year, the focus has really been to determine which of the formulations, or combinations, of the four vaccines will provide vaccine recipients with the best antibody response to all four serotypes of dengue.”

Infection with one dengue virus results in immunity to that specific virus, but not to the other three. Research shows that the likelihood of severe disease increases when a person is subsequently infected with a different dengue virus. This observation suggests that the ideal dengue vaccine would be tetravalent – that is, protective against all four dengue viruses.

“What is promising about TV003 is that it elicited solid antibody responses after just one dose,” explained Stephen Whitehead, Ph.D., of NIAID’s Laboratory of Infectious Diseases, who led the development of the vaccine candidates. “Other vaccines in development require two or three injections at higher doses to achieve similar results.”

All four candidate tetravalent vaccines were found to be safe, and no participants experienced fever or dengue-like illness after vaccination.

“The results of this Phase I dengue vaccine study look very promising, and the NIAID is pursuing further development of TV003,” says Kirkpatrick., director of UVM’s Vaccine Testing Center. The NIAID, in conjunction with the site investigators, are conducting studies to further evaluate the vaccine's safety and ability to stimulate an immune response in healthy volunteers  and in people who have been infected previously by dengue or related viruses.

TV003's inexpensive production cost – less than $1 per dose – is critical to its potential use in developing countries, Kirkpatrick says. Manufacturers in Brazil, India and Vietnam – countries where dengue is prevalent – have licensed the vaccine technology for production and further evaluation. Phase II trials to evaluate the safety of TV003 and its capacity to create an immune response will begin soon in Brazil and Thailand.

To date, UVM Vaccine Testing Center researchers have tested the experimental vaccine on approximately 200 healthy volunteers.

“The next phase is to ensure that this antibody response will be adequate to provide protection against natural dengue infection, and whether a booster of the vaccine would provide better protection,” explains Pierce.

UVM’s Vaccine Testing Center has made significant contributions to the development and testing of a variety of vaccines of global importance since 2002. For the NIH dengue vaccine, UVM’s role in the future will focus on defining a precise dose and timing, as well as benefit of a second dose. In addition, says Pierce, the UVM researchers may also engage in vaccine trials on West Nile infection.

Learn more about NIAID’s dengue research and the UVM Vaccine Testing Center.

(This article was adapted from a news release produced by the National Institutes of Health.)

The Ceremony took place in Davis Auditorium on Level 2 of Fletcher Allen Health Care’s Ambulatory Care Center. A reception followed.

Following opening remarks from William Jeffries, Ph.D., senior associate dean for medical education, students heard from UVM College of Medicine Dean Frederick C. Morin III, M.D., and Fletcher Allen Health Care President and CEO John Brumsted, M.D. Associate Dean for Students Christa Zehle, M.D., the 2012 recipient of the Leonard Tow Humanism in Medicine Award, was the keynote speaker.

To mark the beginning of clerkships at the College’s four clinical training sites – Fletcher Allen Health Care, Danbury Hospital in Connecticut, St. Mary’s Medical Center in West Palm Beach, Florida, and Eastern Maine Medical Center in Bangor – members of the Class of 2015 were presented with a gift.

Through reciting the Oath they first uttered upon receiving their white coats, the Class of 2015 reaffirmed a commitment to professionalism and respect for patients, fellow students, and teachers as they begin the clinical care and decision-making component of the Vermont Integrated Curriculum. During the next 12 months, they will receive training in surgery, internal medicine, neurology, psychiatry, family medicine, pediatrics, and obstetrics & gynecology. In addition, they will participate in four “Bridge” courses, which cover topics such as patient safety; evidence-based medicine; simulation; palliative care; global health; professionalism; health care finance and other topics.

Tania Bertsch, M.D., associate dean for clinical education, and David Adams, M.D., associate dean of graduate medical education, presented the Arnold P. Gold Foundation Humanism and Excellence in Teaching Awards to the residents, voted on by the Class of 2014. Residents from Fletcher Allen and affiliate sites were nominated.

The 2013 award winners are:

Sean Ackerman, M.D., psychiatry, Fletcher Allen, has co-authored several articles related to the genetics of autism and treatment for autism. He received his medical degree from the University of Washington School of Medicine in 2010, and a bachelor of fine arts degree from the Tisch School of the Arts at New York University in 2001. Prior to receiving his medical degree he worked as a film director, writer, and producer, and has directed two feature films.

John Cole, M.D., M.Sci., pediatrics, Fletcher Allen, earned a medical degree in 2010, and a master of science degree in anatomy and cell biology in 2009, both from Rush University. He received his undergraduate degree from Colby College in 2005. He was inducted into the Gold Humanism Society in 2008, and is the recipient of a National Institutes of Health Training Grant titled "Training in Orthopedic Skeletal Biology."

Anne Dougherty, M.D.’09, obstetrics, gynecology and reproductive sciences, Fletcher Allen, graduated from Goddard College with a master of arts degree in health arts and sciences with a concentration in medical anthropology and oral history. She holds an undergraduate degree from Wesleyan University. Dougherty authored a book about American herbalism, and has developed an online learning module about the ethics of complementary and alternative medicine in a conventional medical setting.

Sanchit Maruti, M.D.’10, psychiatry, Fletcher Allen, received undergraduate degrees in psychology and microbiology from the University of Texas at El Paso in 1994, and a master of science degree in epidemiology from the University of Texas School of Public Health in 1996. Maruti is co-principal investigator on a project aimed at creating an expert system for suicide risk assessment. This is the second time medical students have honored Maruti with the Arnold P. Gold Foundation Humanism and Excellence in Teaching Award. 

Deanna Nelson, M.D.’08, surgery, Fletcher Allen, received her undergraduate degree in biological science from UVM in 2002. While a medical student at UVM, she was elected to the Gold Humanism Society and received honors for clerkships in surgery, obstetrics/gynecology and neurology, and acting internship honors in surgical critical care, vascular surgery, and general surgery. From 2002 to 2004, she was a clinical research coordinator in the division of vascular surgery.

Steve Runyan D.O., psychiatry, Fletcher Allen, graduated from the University of New England College of Osteopathic Medicine in 2009, and received his undergraduate degree from Juniata College. He is currently doing research on psychosomatic medicine service in collaboration with Terry Rabinowitz, M.D., professor of psychiatry and family medicine at the College of Medicine.

Nominees for the 2013 Arnold P. Gold Foundation Humanism and Excellence in Teaching Award

Family Medicine
Emily Bryant, D.O., Eastern Maine Medical Center
Sarah Chamberlain, D.O., Eastern Maine Medical Center
John Chisholm, M.D., Fletcher Allen Health Care
Jesse Coenen, M.D., Fletcher Allen Health Care
Brady Didion, M.D., Fletcher Allen Health Care
Aaron Glenney, M.D., Fletcher Allen Health Care
Lincoln Heath, M.D. ‘12, Fletcher Allen Health Care
Joyce Pilar Johnson, M.D., Eastern Maine Medical Center
Megan Malgeri, M.D. ‘11, Fletcher Allen Health Care
Lisa Stout, D.O., Eastern Maine Medical Center

Internal Medicine
Zubin Agarwal, M.D., Fletcher Allen Health Care
Michele Burke,  M.D. ‘10, Fletcher Allen Health Care
Markus Degirmenci, M.D., Fletcher Allen Health Care
Robert Disantis, M.D., Fletcher Allen Health Care
Adedayo Fashoyin, M.D., Fletcher Allen Health Care
Cesar Artiles Feliz, M.D., Danbury Hospital
Elizabeth Hill, M.D. ‘10, Fletcher Allen Health Care
Patrick Hohl, D.O., Fletcher Allen Health Care
Marcos Lamas, M.D., Danbury Hospital
Timothy Leclair, M.D. ‘11, Fletcher Allen Health Care
Samuel Merrill, M.D., Fletcher Allen Health Care
Thomas Pace, M.D. ‘12, Fletcher Allen Health Care
Benjamin Parkhurst, M.D., Fletcher Allen Health Care
William Prabhu, M.D., Fletcher Allen Health Care
David Rand, M.D., Fletcher Allen Health Care
Samreen Raza, M.D., Fletcher Allen Health Care
Makeda Semma, M.D. ‘12, Fletcher Allen Health Care
Deva Sharma, M.D., Fletcher Allen Health Care
Krystine Spiess, D.O., Fletcher Allen Health Care
Justin Stinnett-Donnelly, M.D. ‘10, Fletcher Allen Health Care

Neurology
Mohamed-Ali Babi, M.D., Fletcher Allen Health Care
Erica Sweet, M.D., Fletcher Allen Health Care

Obstetrics/Gynecology
Anne Dougherty, M.D. ‘09, Fletcher Allen Health Care
Karina Haber, M.D., Danbury Hospital
Holli Jakalow, M.D., Fletcher Allen Health Care
Robert Kelley, D.O., Danbury Hospital
Lauren MacAfee, M.D., Fletcher Allen Health Care
Julie Nicole, M.D. ‘09, Fletcher Allen Health Care
Adrian Salinas, M.D., Danbury Hospital
Brooke Schlappe, M.D., Fletcher Allen Health Care
Michelle Yang, M.D., Fletcher Allen Health Care

Pediatrics
Rachel Cohen, M.D., Fletcher Allen Health Care
John Cole, M.D., Fletcher Allen Health Care
Kristen Connolly, M.D. ‘10, Fletcher Allen Health Care
Lauren Faricy, M.D., Fletcher Allen Health Care
Amelia Fisher, M.D., Fletcher Allen Health Care
Ryan Good, M.D., Fletcher Allen Health Care
Lauren McLaughlin, M.D., Fletcher Allen Health Care
Colleen Moran, M.D. ‘10, Fletcher Allen Health Care
Adrienne Pahl, M.D. ‘11, Fletcher Allen Health Care
Elizabeth Prabhu, M.D., Fletcher Allen Health Care

Psychiatry
Sean Ackerman, M.D., Fletcher Allen Health Care
Winston Chung, M.D., Fletcher Allen Health Care
David DeVellis, M.D., Fletcher Allen Health Care
Patricia Fintak, M.D.,, Fletcher Allen Health Care
Matt Frankel, M.D., Fletcher Allen Health Care
Sarah Guth, M.D. ‘11, Fletcher Allen Health Care
Amber Kostial, M.D., Fletcher Allen Health Care
Sanchit Maruti, M.D. ‘10, Fletcher Allen Health Care
Sara Pawlowski, M.D., Fletcher Allen Health Care
Steve Runyan, D.O., Fletcher Allen Health Care
Efrat Shavit, M.D., Fletcher Allen Health Care

Surgery
Alfred Croteau, M.D., Fletcher Allen Health Care
Fuyuki Hirashima, M.D., Fletcher Allen Health Care
Sarah Lomas, M.D. ‘09, Fletcher Allen Health Care
Patrick Mannal, M.D., Fletcher Allen Health Care
Maria Michael, M.D. ‘12, Fletcher Allen Health Care
Deanna Nelson, M.D. ‘08, Fletcher Allen Health Care
Conor O'Neill, M.D., Fletcher Allen Health Care
Charles Parsons, M.D. ‘09, Fletcher Allen Health Care
Reshma Patel , M.D., Fletcher Allen Health Care
Sarah Pesek, M.D., Fletcher Allen Health Care
Adrian Seah, M.D., Fletcher Allen Health Care
Scott Wasilko, M.D. ‘12, Fletcher Allen Health Care

The study was published online January 31, 2013 in The FASEB Journal.

Estrogens are female sex hormones that are involved in a variety of physiological processes, including growth and development of the uterus and mammary gland. According to Wall, a postdoctoral associate in immunobiology, the response of reproductive tissues to the estrogen known as 17β-estradiol (E₂) is genetically regulated, but the mechanisms underlying the genetic control, and the pathways involved, are unknown.

In previous rodent model studies, Teuscher, a professor of medicine who has been studying the genetic control of uterine responsiveness to E₂ for 20 years, has identified several key genetic pathways underlying differential responsiveness to E₂. For this study, he, Wall and colleagues used two strains of inbred mice – one with high and one with low responses to E₂ – in order to examine E₂-regulated genetically controlled pathways. Their aim was to identify the genes and pathways associated with the differences in the uterine response to E₂ in each strain and, when comparing the strains at baseline, determine which of the genes and pathways that were expressed differently might regulate the uterotropic response. They also measured E₂-induced cellular changes that could be linked to the strain differences in tissue architecture after treatment with E₂.

Their findings revealed that the uterine response to E₂ is associated with at least 80 genes that are differentially expressed between the strains at baseline and are also located within the boundaries of previously identified regions of the genome influencing the uterotropic response to E₂.

“One of these genes, Runx1, has been recognized as being able to intensify E₂-signaling and might underlie the heightened uterine response to E₂ in the more sensitive mice,” says Wall. The research also showed that there are marked differences in E₂-induced uterine epithelial (surface) cell death, which Wall says could explain genetically-controlled differences in uterine weight.

Because the key factors involved in the regulation of uterine and mammary function are consistent across species, the team’s findings, though performed in mice, have direct application to other animals, including humans.

Elizabeth Bonney, M.D., UVM professor and director of research in obstetrics, gynecology and reproductive sciences, says “This is important work that provides a better understanding of the normal reproductive biology of women, and has implications for the treatment of infertility and evaluation of risk for endometrial cancer.”

“These results provide a potential explanation for differential responses to exposure to environmental estrogens noted in both mammalian and human studies and should enhance our understanding of potential vulnerable populations and help inform environmental health policy,” says Frances Carr, Ph.D., professor of pharmacology, whose research includes the study of the impact of environmental estrogens on thyroid cancer and development.

According to Teuscher, the current finding underscores comments by Jeffrey W. Pollard, Ph.D., director of the Center for Study of Reproductive Biology and Women’s Health at Albert Einstein College of Medicine, featured in an editorial review of his team’s article in Endocrinology (40:556-61, 1999): “A Holy Grail of the pharmaceutical industry is to find estrogens that are effective in one tissue but not others so that preventative treatments can be employed for bone loss, or in the prevention of cardiovascular disease, without increasing the risk of endometrial or breast cancer.”

The current findings delineating the gene pathways that affect estrogen responsiveness pave the way for the development of alternative therapeutic approaches.

According to Tamara Williams, Ph.D., first author on the study, a lecturer in nursing and postdoctoral fellow in pharmacology at UVM, cancerous tumors quickly outgrow their local blood supply. When they do, the cancer cells send out signals, TARS is secreted, and the angiogenesis process is initiated.

“In our study, we showed that TARS, once thought to only function in the housekeeping role of protein synthesis within cells, ‘moonlights’ as a secreted signaling agent in the endothelial cells that line vessels, in response to factors commonly produced by cancer cells,” says Williams.

The study’s in vivo model of angiogenesis was performed using a chick chorioallantoic membrane assay. This experiment utilizes the vascular membrane that surrounds a ten-day-old chicken embryo, which is removed from its shell. Williams and her research teammates placed small pieces of surgical sponges on the surface of the membrane and added compounds, including TARS, to the sponges. The researchers took images of the sponges and surrounding tissues every 24 hours for three days and then analyzed the images to assess the impact of the compounds on local blood vessel development around the sponge. Their test determined whether the compound was angiogenic (creates new blood vessels), had no effect, or was angiostatic (inhibits blood vessel development). Using this assay, the group was able to demonstrate that TARS prompts angiogenesis by increasing the directional movement, or migration, of vessel cells towards the cancer cell signals. The group’s research also showed that a potent inhibitor of TARS activity – called inhibitor BC194 – blocked its induction of angiogenesis.

“The implications of these novel and surprising findings are substantial for the cancer research community and include potential opportunities to develop new, early, and sensitive diagnostics,” Williams says.

“Commercially, compounds that reduce TARS could be used to stop angiogenesis in cancer, compounds that increase TARS could promote angiogenesis, and a laboratory blood test for TARS could serve as a diagnostic for progression in certain cancers,” says Kerry Swift, M.S., technology licensing officer in the UVM Office of Technology Commercialization.

Williams adds that the anti-angiogenic activity of the potent inhibitor of TARS paves the way for new therapeutics to block tumor growth and metastasis by stopping TARS-induced angiogenesis.

“These types of therapeutics could be used in combination with other treatments that target and kill cancer cells as part of a personalized cancer medicine approach to treat patients with greater success,” she says.

On April 22, 2013, Francklyn will present a poster session on this research, titled “Mode of Action of Bioactive Natural Products,” at the annual American Society for Biochemistry and Molecular Biology meeting in Boston, Mass. Lounsbury will present the project at the American Association for Cancer Research meeting, which takes place April 6 to 10, 2013 in Washington, D.C.

Nora Enright, a sophomore from Otter Valley Union High School in Brandon, Vt., clinched first place, which includes funding to travel to and compete in the National Brain Bee in Baltimore, Md., March 2 to 4, 2013. Champlain Valley Union High School senior Gabriel Peck Frame qualified for second place, and John Mlcuch, a senior from Mount Abraham Union High School in Bristol, came in third place. All of the Brain Bee participants received a certificate at the conclusion of the event.

In addition to Otter Valley, CVU and Mount Abraham, this year’s Brain Bee also included participants from Rice Memorial High School in Burlington; Vergennes Union High School; Stowe High School; Middlebury Union High School; and Burlington Technical Center. Many of these schools have Brain Science or Neuroscience clubs that helped students prepare for the Bee all year-long.

Brain Bee participants completed a half-hour written test in the College’s Medical Education Center, a half-hour practical test that included several “wet” specimens and took place in the Pathology Lab, as well as preliminary and final Oral Bee Rounds. For the first time in the event’s four-year history, all of the participants – versus two-thirds to three-quarters as in years past – qualified for the Oral Bee Rounds.

During the lunch break, Brain Bee attendees listened to a keynote presentation by Alexandra Potter, Ph.D., UVM assistant professor of psychiatry and psychology, titled “Adolescents, Impulsivity and Brain Function.” Following the Oral Bee Rounds, students heard a panel of UVM neuroscience undergraduate and graduate students discuss their educational and research experiences, as well as future plans.

Rae Nishi, Ph.D., UVM professor of neurological sciences, director of the Neuroscience Graduate Program, and director of the Neuroscience, Behavior and Health (NBH) Initiative, and Mark Stefani, Ph.D., assistant professor of psychology at Middlebury College, developed the exam questions for the Brain Bee. Nishi and Eugene Delay, Ph.D., UVM associate professor of biology, served as judges of the Oral Bee Rounds. Additional Vermont Regional Brain Bee committee members include Lisa Bernardin, M.S., a traumatic brain injury survivor from Middlebury and Vermont Brain Bee coordinator; John Green, Ph.D., UVM associate professor of psychology; George Wellman, Ph.D., UVM associate professor of pharmacology and president, Vermont Chapter of the Society for Neuroscience; Sharon Leach, Ph.D., clinical neuropsychologist and licensed psychologist at the Stern Center for Language and Learning; and Hallie Davis-Penders, NBH Initiative assistant.

The 2013 Vermont Brain Bee was co-presented by the Vermont Chapter of the Society for Neuroscience and the Neuroscience, Behavior and Health Initiative at UVM. Learn more about the Vermont Brain Bee.

A native of Hughsonville, N.Y., Evangelista has suffered from a heart rhythm condition known as premature ventricular contractions (PVCs) her entire life. While PVCs are often benign, they can cause debilitating symptoms for some patients, including fatigue, shortness of breath, and dizziness. In some cases, very frequent PVCs can lead to deterioration in the normal function of the heart. Despite the extra, abnormal heartbeats typical in PVC, she managed to be active – ranking nationally in track & field – succeed in school, graduate from Middlebury College, and complete an 18-month post-baccalaureate pre-medical program at Columbia University. While applying to medical school, she worked as a pediatric hematology research assistant at Weill Cornell Medical College in New York City and volunteered for 12-hour overnight shifts cuddling NICU babies at New York-Presbyterian’s Morgan Stanley Children’s Hospital. It was there that she started to experience a literally unsettling change in her condition.

Her PVCs, which had begun as a few irregular beats, became an every-other-beat situation. “If I could keep moving, my PVCs rarely bothered me,” says Evangelista. “But it isn’t easy to keep moving when you are holding a sleeping, two-pound baby connected to a CPAP machine, feeding pump, and a central line in the middle of the night.” Her fingers and toes would go numb, and she had a gut-wrenching, burning sensation in her chest. “I was almost to the point where I couldn’t hold babies anymore,” shares Evangelista.

Still raw from the experience, with no new treatment options except for medications saddled with multiple side effects, Evangelista started medical school at the University of Vermont College of Medicine in August 2011. A recommendation from the Office of Medical Student Education led to a consultation with Robert Lobel, M.D., assistant professor of medicine at UVM and a cardiac electrophysiologist – specializing in treating abnormal heart rhythms – at Fletcher Allen.

Lobel appreciated the quality of life and activities Evangelista aspired to enjoy, and determined a treatment course for getting her back on track, a catheter ablation. This procedure is performed using special tools called catheters, placed inside the heart via the large veins in the legs, while the patient is awake. During the ablation, the specialist maps the electrical activity of the heart, identifies areas that are responsible for causing irregular heart rhythms (in this case, the PVC focus), then destroys those areas by delivering energy through the catheter to the desired location.

“Dr. Lobel didn’t just give me back my heart, he gave me back the joy and passion I have for cuddling and helping babies,” says Evangelista, who underwent this procedure just over a year ago and is eager to share her story to promote awareness of heart conditions like hers, as well as her positive experience with Lobel.

“It’s been over a year since Jesse had her ablation, and she is doing great,” Lobel says. “One of the greatest rewards of our profession comes from helping improve the quality of life for our patients. Jesse has an incredibly bright future and will be an outstanding neonatologist.”

In honor of the American Heart Association’s Heart Month in February and Wear Red Day on February 1, Evangelista, who hopes to become a neonatologist after graduating from medical school, will be adorning medical student lockers with red decorations and attending the Vermont Go Red For Women Luncheon on February 14.

“Every time that I am cuddling a sleeping baby in the NICU, I remember what it felt like when I almost lost this most important satisfaction in my life,” says Evangelista. “Dr. Lobel is the kind of physician that I can only dream of becoming,” she says, adding, “I will strive every day to treat all of my patients with the compassion, respect, and understanding with which Dr. Lobel treated me.”

“I suspect that we will also be able to distinguish between bacterial, viral and fungal infections of the lung,” says Hill, who is among the junior faculty receiving support from the College of Medicine’s Center for Immunology and Infectious Diseases IDeA grant.

The World Health Organization estimates that one-third of the world’s population carries tuberculosis and that this lung disease causes more than a million deaths each year.

“TB takes about six weeks to diagnose,” says Hill, allowing an infected person to spread it unwittingly. “Faster diagnosis of the disease would allow for faster treatment decisions and would also decrease disease transmission.”

She anticipates a time when patients could visit a physician, breathe into an instrument and know within minutes, “what you’re infected with,” she says, and, perhaps, “whether your antibiotic regime is effective, whether you need different antibiotics, and whether you have more then one bug causing your problem.”

The new research has drawn the attention of international media including the BBC and Scientific American.

This research was supported by the UVM College of Medicine’s Institutional Development Award (IDeA) from the National Institute of General Medical Sciences (grant 8 P20 GM103496-07) within the National Institutes of Health; the Cystic Fibrosis Foundation; and NASA EPSCoR.

(Portions of this story were written by Michael Bishop, Institute of Physics.)