Philip Ades, M.D., has lengthened the lives of hundreds of heart patients, and Marilyn Cipolla, Ph.D., is working on ways to improve treatment of stroke and save women from suffering seizures during pregnancy.

Both professors in the University of Vermont College of Medicine have led extensive and internationally pioneering research in their fields – Ades in cardiac rehabilitation and Cipolla in blood vessel injury in the brain. They were honored as two of four University Scholars for 2015-16 by the UVM Graduate College, which for 35 years has overseen the program to recognize “sustained excellence in research, creative and scholarly activities.”

An induction ceremony for the University Scholars was held April 29, 2015, in Memorial Lounge in UVM’s Waterman building.

A cardiologist and professor of medicine, Ades directs the Cardiac Rehabilitation Program at the UVM Medical Center’s cardiac exercise facility on Tilley Drive in South Burlington. With ongoing support from the National Institutes of Health, he began a series of studies in the late 1980s examining the benefits of exercise for patients who had had a heart attack or coronary bypass surgery. The focus of the research has been those at highest risk – older patients, women over 65, overweight patients and most recently, the low-income population.

 “I view it as the upside of cardiology and the upside of medicine,” Ades says. “People are getting better here and it is uplifting.”

The latest phase of his work targets Medicaid patients with an aim to improve patient participation in a cardiac rehabilitation prescribed exercise and prevention regimen.

“These folks are commonly overweight – they smoke at higher rates, they often don’t eat right or take their pills as prescribed,” he says. And, he adds, they frequently have excessive stress in their lives. “They not only don’t do cardiac rehab, but they’re the people who could stand to benefit the most as they are more likely to be re-hospitalized.”

Ades’ current study, co-led by Diann Gaalema, Ph.D., UVM assistant professor of psychiatry, under combined mentorship with Stephen Higgins, Ph.D., professor of psychiatry and director of the Vermont Center on Behavior and Health, is testing whether offering financial incentives renders Medicaid patients more likely to attend and complete their cardiac rehab program. Patients receive financial incentives depending on how many sessions they attend, with a possible payout of $1,500 for the typically prescribed 36 sessions; a fraction of what re-hospitalization would cost.

About 50 patients have entered the study, now almost half-way complete. “The numbers are stark,” Ades says. “The people who you give incentives to come are more than two times as likely to attend and complete cardiac rehabilitation.”

His impact on the field is clear, especially in the eyes of his peers, who nominated him for the University Scholar honor. A faculty panel selects the University Scholars from the nominations submitted by UVM colleagues.

“His research has changed how cardiac rehabilitation is performed and so has saved countless lives throughout the world,” reads one letter nominating Ades. “The research of Dr. Ades has been instrumental in demonstrating that higher intensity exercise is not only safe but markedly more effective in reducing cardiovascular risk factors.”

Cipolla, UVM professor of neurological sciences, received similar high praise from colleagues regarding her pursuit to determine the causes of eclampsia – a life-threatening complication of pregnancy marked by seizures, coma and sometimes death.  

“Her enthusiasm for research and mentoring is palpable,” reads one. “Marilyn brings incredible energy to work every day, and it is clear that she loves her job. Her incredible intellect and curiosity serves her well as both a scientist and mentor. Her love of science combined with her ‘can-do’ attitude makes her a wonderful role model for junior faculty and students.”

Working with Anthony Morielli, Ph.D., UVM associate professor of pharmacology, and doctoral student Abbie Chapman Johnson, Ph.D., Cipolla has looked at neurotransmitter receptors that become more “excitatory” in the brains of pregnant rats. The normal adaptation of those receptors, which keep the nervous system in balance, is thrown off in some women, leading to eclampsia. Cipolla hypothesizes that a genetic mutation may be the root cause.

Separate research, conducted by Cipolla and Richard Kraig, M.D., Ph.D., professor of neurosciences at the University of Chicago, found that a serum released in the blood of pregnant rats is normally prevented from reaching the brain, where it would further aggravate those neurons and cause seizure. Transporters through the blood-brain barrier may fail to block the serum from entering the brain in cases of eclampsia, Cipolla found. Multiple factors could be combining to cause seizures during pregnancy, she says.

“That’s the whole idea, really – to prevent women from going to seizure,” she says of her work. “Some women just aren’t adapting properly during pregnancy.”

These blood vessel malfunctions in the brain also inform her study of ischemic strokes – those caused by a blocked artery – which account for 87 percent of all strokes, Cipolla says. The faster doctors can clear the blood clot and restore normal blood flow – known as reperfusion – the better the outcome for the patient.

Once the new flow of blood begins, however, some of the vessels constrict, which can severely retrict blood flow where it is needed, Cipolla found. “It makes perfect sense that they’re protecting the downstream capillaries from being blown out.”

She now is trying to determine the best way to apply reperfusion treatment for acute brain injury. Over the past 18 years, her research in both areas has been funded by the NIH, and she has also received funding from the Preeclampsia Foundation and American Heart Association.

Besides Ades and Cipolla, the other two University Scholars for 2015-16 are: UVM Professor of Spanish Tina Escaja, Ph.D., and Ray Vega, UVM senior lecturer in jazz combos, trumpet and jazz history. Learn more about the 2015-16 University Scholars.