Researchers at the USF Health Morsani College of Medicine were awarded $5.6 million of expected funds for a 4-year study from the U.S. Department of Defense to examine why many people with Friedreich’s Ataxia (FA) go on to also develop heart disease, a major cause of death for those with FA.

Principal investigator for the USF study is Thomas McDonald, MD, professor in the Department of Internal Medicine (Division of Cardiology) and the Department of Molecular Pharmacology and Physiology in the USF Health Morsani College of Medicine. Dr. McDonald is also a researcher in the USF Health Heart Institute and director of the USF Health Cardiogenetics Clinic.

“We still don’t have a full understanding of the genetic mutation for Friedrich’s ataxia to determine why so many patients go on to get heart disease – we need to know,” Dr. McDonald said. “The physiology is not well characterized. This study will help us gain a better understanding of the basic mechanisms of the gene that carries FA, and help identify clinical predictors of the FA-associated heart disease.”

The new study dovetails with current work taking place in Dr. McDonald’s lab, including an R56 grant from the National Institutes of Health, which focuses on the fundamental mechanisms of LMNA-associated heart disease passed from one generation to the next — and what can be done to help prevent disease and its consequences.

This FA-heart disease study will follow FA patients and their parents over four years, and will involve careful clinical monitoring of heart health, examination of biomarkers, whole genome sequencing, stem cell modeling of heart tissue, and mitochondrial function studies.

From left, Dr. Kami Kim, Dr. Aarti Patel, Dr. Thomas McDonald, and Dr. Theresa Zesiewicz. Not pictured is Sami Noujaim, PhD.

Spearheading the work in the DoD study is a multidisciplinary team of USF Health experts representing cardiology, genetics, neurology, molecular pharmacology, cardiac electrophysiology and predictive modeling. The diverse expertise will help distinguish the clinical, genetic, and biological factors that contribute to cardiac disease in FA patients. Data from FA families and basic science models will be integrated with clinical data to identify unique factors in the heart that influence the cardiac phenotype and separate cardiac-specific traits from those influencing the neurological phenotype.

“Study results could lead to tools used in patient care settings to identify those FA families most at risk for cardiomyopathy and allow for potential intervention and treatment that could help delay onset of the heart disease,” Dr. McDonald said.

The USF Health interdisciplinary team for the study includes:

• Thomas McDonald, MD: clinical cardiology, molecular pharmacology and cardiogenetics (Division of Cardiology, Department of Internal Medicine, MCOM)
• Aarti Patel, MD: neurocardiogenetics and cardiac imaging (Division of Cardiology, Department of Internal Medicine, MCOM)
• Sami Noujaim, PhD: molecular pharmacology and cardiac electrophysiology (Department of Molecular Pharmacology and Physiology, MCOM)
• Kami Kim, MD: machine learning and clinical predictive modeling (Division of Infectious Diseases, Department of Internal Medicine, MCOM; Center for Global Health Infectious Diseases Research, COPH)
• Theresa Zesiewicz, MD, clinical neurology (Department of Neurology, MCOM)

Dr. Zesiewicz, professor in MCOM and director of the USF Health Ataxia Research Center, has specialized in clinical research and patient care for ataxias and other movement disorders’ for more than 20 years and is recognized as an international expert and leader in the field of hereditary ataxias. Her movement disorders clinic supports the evaluation of over 3,000 patients per year, likely the busiest in the world.

“Dr. Zesiewicz will play a vital role in recruiting research participant and in overseeing neurological assessments of patients as they are longitudinally followed in this study,” Dr. McDonald said.

The funding for the study came from the DoD through its Congressional Directed Medical Research Programs (CDMRP), a section of DoD that funds novel approaches to biomedical research. Link: https://cdmrp.health.mil/

The team will begin recruiting study participants next month.

Photo by Ryan Rossy, USF Health Communications

A unique scientific collaboration that could offer an innovative potential treatment for atrial fibrillation has blossomed within USF Health, thanks to a chance encounter in a hallway, a plain green chalkboard and a most surprising star: the European honeybee.

It represents a convergence of two distinctly different medical mindsets – pharmacology and immunology – and a blend of high-tech bio-engineering with an old-school writing surface. And then there’s the bee, which has pollinated the process in an exciting and novel way.

The result is a newly published paper in the Proceedings of the National Academy of Sciences that details efforts to develop a non-invasive treatment for atrial fibrillation (also referred to as AFIB or AF) by blocking a potassium channel that can go rogue within the heart, leading to a dangerous, irregular and fast rhythm in the atria, the heart’s upper chambers, increasing the risk of blood clots that can travel to the brain and cause a stroke.

The material to create this blocker  is a small peptide that has been successfully tested in mice and sheep.

“This peptide was originally isolated in the past from the European honeybee’s venom,” said Sami Noujaim, Ph.D., associate professor in Molecular Pharmacy & Physiology and senior author of the eight-person study that includes lead investigator Bojjibabu Chidipi, Ph.D., a researcher in the USF Health Morsani College of Medicine. “We have demonstrated in tests on small animals that it can block this rogue potassium channel. And by blocking this channel, it was able to eliminate atrial fibrillation.”

That research might well have never progressed to this point had it not been for a pair of fortuitously situated offices. Co-author Michael Teng, Ph.D., an associate professor in the Division of Allergy and Immunology in the College of Medicine, works in an office adjacent to the one occupied by Dr. Noujaim – in spite of their divergent fields.

Micheal Teng, PhD, (left) and Sami Noujaim, PhD, have collaborated to study whether a bioengineered peptibody could help treat atrial fibrillation.

“I work in viruses, a completely different area than Sami’s,” said Dr. Teng. “But there’s this green chalkboard hanging on the wall outside our offices – I can see it right now from my desk, in fact. You’d think, ‘Let’s take it down, nobody uses chalkboards anymore.’ But Sami loves this chalkboard. So, we’re neighbors and we talk to each other. And one day, prior to the pandemic, he was trying to figure out a problem.”

Here’s how Dr. Noujaim remembers it unfolding: “I was at the board with Bojji and other members of the lab. We drew the potassium channel on the board. And I was telling them that the drugs currently available for AF are small molecules and have side effects. What if we’re able to actually design our own blocker? And instead of that blocker being a small molecule, what if it was a protein? Because we can design and generate proteins.”

At that moment, Dr. Teng was passing by the group in the hallway en route to his office.

“I go, ‘Hey Mike, I know that in immunology there are ways people have been engineering proteins – can we do this here?’ “ Dr. Noujaim recalled. “Mike said, ‘Absolutely,’ and that’s where things took off.”

Electrical activity is generated by the heart via ion channels of sodium and potassium. They work like resistors and can conduct current. Atrial fibrillation occurs, in part, when a specific type of potassium channel in the heart goes out of whack, and starts passing potassium when it should not.

Bojjibabu Chidipi, PhD, (left) talks with Sami Noujaim, PhD, about how a bioengineered peptibody could help treat atrial fibrillation.

“This is where the problem occurs,” Dr. Chidipi said. “Instead of contracting and emptying the blood vessels into the ventricles, and the ventricles contracting and ejecting blood into the circulation, these atria cannot contract because of the atrial fibrillation caused by the rogue potassium current. They just sit there and quiver.”

“When that happens, they cannot completely empty the blood,” Dr. Noujaim added. “And blood does not like to stay stagnant. So there’s a high probability of forming a clot in the atrial chamber. At some point that clot can launch into the circulation and reach the brain, causing a stroke.”

One common form of treatment is to put a person with AFIB on blood thinners.  Pharmaceuticals are also utilized to restore normal sinus rhythm of the heart. A more invasive step is called ablation, a procedure in which the trouble spots in the atria are located and corrected via catheters inserted through the groin and advanced to the atria.

“The problem is that there is a high chance the AF will return at some point,” Dr. Noujaim said. “Another alternative is medication. But the problems with the existing medications are two-fold: One, they are not very effective, and two, they may cause other types of arrhythmia. And that is where we came in. We asked ourselves, ‘What would be the best way to restore the normal sinus rhythm with a pharmaceutical, without having other side effects on the heart?’”

Several members of Dr. Sami Noujaim’s team collaborated on the peptibody research. Pictured (l-r) are Bojjibabu Chidipi, PhD, Dr. Noujaim, Obada Abou-Assali, MS, and Mengmeng Chang, MD, PhD.

Now back to the green chalkboard. The challenge was that the very small peptide, called tertiapin, comprised of 21 amino acids from honeybee venom, doesn’t last long enough to be effective as a blocking agent. It is very short-lived when exposed to air. That led previously to the creation of a synthetic oxidation-resistant version called tertiapinQ. This is what Dr. Noujaim and his team would rely upon in their testing.

But there was still a problem with these peptides breaking down too quickly in the body, whether injected or taken as a pill. So they wondered: Could this peptide be fused with an antibody fragment and give it longer-lasting life to combat AFIB?

“We talked it through and drew on the board for about 15-20 minutes,” Dr. Teng said. “And we came up with this idea of attaching that little peptide onto the stem of an antibody.”

The stem could be hooked onto the peptide, forming a “peptibody.” That concept has been utilized before, but not for treating atrial fibrillation. With this new peptibody AFIB application, a drug could remain in the bloodstream for longer periods of time without breaking down.

“That way you will have a sustained effect of the therapeutics,” Dr. Noujaim said. “Now we have a formulation that does not need to be administered daily– it could be every week or every month. We’re excited to have received a patent for this as well as a nice grant from the National Institutes of Health.”

“So far, there are two peptibodies approved by the FDA and available in the market to treat low blood platelet counts, and for glucose control in type 2 diabetes” Dr. Chidipi added. “We are the first to demonstrate that bioengineered peptibodies could potentially treat cardiac arrhythmia.”

Meanwhile, new collaborators are on board at a cardiovascular center in Spain to work with USF Health in testing it further..

It took collaboration with a bee and a board at USF Health to make it all possible.

— Story by Dave Scheiber for USF Health News; photos by Allison Long, USF Health News.

It is a part of the heart that most people have never pondered, let alone heard of, in their lives. But the left atrial appendage – a physical trait that all humans share – is worth knowing about because it is involved in the vast majority of strokes. Now, a prestigious new grant obtained by a team from the USF Health Morsani College of Medicine and Tampa General Hospital could significantly enhance preventive treatments.

Thanks to the innovative work of Dr. Hiram Bezerra, professor at the USF Health Morsani College of Medicine and director of the TGH Interventional Cardiology Center of Excellence, the $460,000 grant could lead to key improvements of an existing procedure to block the opening to the left atrial appendage (LAA) in certain patients who are at high risk for stroke. And it ultimately could deliver safer, faster, and more effective results for patients.

This marks the first time a National Institutes of Health R01 grant – designed to support advanced, hypothesis-driven research projects with strong preliminary data – has been awarded to USF Health’s Division of Cardiology Sciences in the Morsani College of Medicine.

“I think this is reflective of the journey we are on to become a national presence in the forefront of cardiology,” said Dr. Guilherme Oliveira, chief of the division and Ed C. Wright Professor and Chair of Cardiovascular Research, as well as co-director of the USF Heart Institute for Research. Dr. Oliveira also is vice president and chief of the Tampa General Hospital Heart & Vascular Institute.

“This has never been done here before – the ability to get an R01 grant for our division that basically is developing a new technology – with potential clinical applications going all the way from basic pre-clinical engineering of an innovation and taking it all the way to the bedside,” said Dr. Oliveira. “And I think it’s very telling of where we are with the type of talent we’ve been able to attract to USF and Tampa General.”

In this case, the grant, three years in the works, will allow Dr. Bezerra and his team to produce a better, more streamlined approach for dealing with the left atrial appendage – an area in the heart’s left atrium akin to a little pocket. While the structure may help lower pressure in the atrium, it also is possible for blood to pool there in patients with atrial fibrillation, a type of irregular heartbeat, and raises the risk of a clot that could travel to the brain.

“The actual magical aspect of it, and what we are trying to achieve, is a therapy that is offered for stroke prevention,” said Dr. Bezerra. “More than 90 percent of strokes originate from the left atrial appendage chamber. And by occluding the left atrial appendage, you will prevent a stroke in a population prone to have one – the atrial fibrillation, or AFib, population.”

Those suffering from AFib experience an array of symptoms that include an irregular heartbeat, a racing heart, shortness of breath, fatigue and chest pain. People with the condition are some five times more likely to suffer a stroke than those without it – with some 12 million in the U.S. estimated to have AFib by 2030.

“The patients we are targeting have AFib and for some reasons are not a good candidate for the standard preventive therapy of blood thinners,” Dr. Bezerra added. “The next treatment in line is occluding the left atrial appendage. And we are talking about hundreds of thousands of patients in the United States.”

The primary device in the U.S. used to block the left atrial appendage is called the Watchman, manufactured by Boston Scientific, with some doctors employing the Amplatzer Amulet heart device from Abbott. In the current protocol, a patient typically receives a transesophageal echocardiogram two weeks ahead of the procedure to examine the structure and functioning of the heart and evaluate the size of the appendage.

This allows doctors to plan the procedure and select the device. Patients commonly receive general anesthesia for the procedure, which again involves a transesophageal echocardiogram as a real-time guide. In most cases, patients return home the next day.

“But we are pushing to implement a workflow that is less resource intense, and that we believe is actually safer to do,” Bezerra said.

The grant proposed that patients will not have to undergo general anesthesia for the procedure, and a single cardiac MRI would be employed, allowing a patient to just come in once and not have to undergo a separate pre-imaging appointment. The scanner on the day of the procedure would perform the sizing to determine the best device to use. And it would also allow for improved visibility in real-time guidance during the procedure – providing live, higher-resolution images than the current method affords.

“It will all be done with a single modality,” Dr. Bezerra explained. “In addition, the patient is awake. There is no additional cost of the intracardiac echo, or the inconvenience of general anesthesia. And it increases the chances of a patient to go home the same day.”

Dr. Bezerra wrote the grant to be tied specifically to the Watchman because it is more frequently used. But ultimately, replicating the procedure on a different device would not be difficult to achieve. The grant includes a pre-clinical stage at Cleveland’s Case Western University followed by a clinical phase at USF Health and Tampa General. He estimates that it could be available for use on USF Health patients at TGH in three years.

“The plan is for me now to make a few trips to Cleveland, when it’s time for the animal experiments and to help facilitate that,” Dr. Bezerra said. “The next step will be testing for MRI compatibility and starting basic engineering work. A lot of bench and pre-clinical work still needs to take place before we can offer it to patients.”

Dr. Oliveira put it in perspective: “This is the holy grail of grants – where you go, as I said, from a bench concept and have a grant that will support the development of that product all the way to the bedside. It is not easy to do outside of the industry.”

The research also will be a natural fit for work that other physicians, such as Dr. Bibhu Mohanty, already are doing at USF and TGH to advance stroke care, Dr. Bezerra said. Dr. Mohanty, an associate professor in Internal Medicine at the College of Medicine, is an interventional cardiology specialist.

“This grant will complement our very active multidisciplinary neurocardiac program led by Dr. Mohanty in close collaboration with Neurology and Electrophysiology,” Dr. Bezerra said. “With the addition of this translation grant, USF/TGH will continue to be on the very cutting edge of stroke prevention.”

Story by Dave Scheiber for USF Health News.

USF Health doctors are among the best and listed as such in the Top Doctor® list by Castle Connolly.

The list, released earlier this year, includes over 400 local physicians among 55 medical specialties – 82 of them are with USF Health.

USF Health Neurologist Dr. Theresa Zesiewicz.

For more than 25 years, Castle Connolly has conducted the survey that provides the Top Doctors list.

The annual survey involves nominations from peer physicians, who are asked “Where would you go if you needed care?” The process is anonymous and confidential, and doctors cannot nominate themselves. The resulting list, based on merit and inclusion cannot be bought, provides a collection of trusted resources for quality health care.

On this year’s list, 82 physicians on the list are with USF Health. The following list is of USF Health faculty physicians currently practicing medicine within nearly three dozen clinical sites, specialty care centers and affiliated hospitals throughout the region.

Allergy & Immunulogy
Mark C Glaum, MD, PhD
Richard F Lockey, MD
Mandel R Sher, MD
Jolan E Walter, MD/PhD

Cardiac Electrophysiology
Bengt Herweg, MD

Child Neurology
Sagarika Nallu, MD

Colon & Rectal Surgery
Jorge E Marcet, MD
Jaime E Sanchez, MD

Dermatology
Basil S Cherpelis, MD
Nishit S Patel, MD

Endocrinology, Diabetes & Metabolism
Madeline Candelario-Cosme, MD
Yevgeniya Kushchayeva, MD

Family Medicine
Eric E Coris, MD
Eduardo C Gonzalez, MD
Kira K Zwygart, MD

Gasterenterology
Patrick G Brady, MD
John W Jacobs Jr, MD
Jay J Mamel, MD
Joel E Richter, MD
Pushpak Taunk, MD

Gynecology Oncology
Diana Peta-Gay English, MD
Thomas J Rutherford, MD, PhD

Infectious Disease
Sally Fathi Alrabaa, MD
Beata C Casanas, DO
Ambika Eranki, MD
Charurut Somboonwit, MD

Internal Medicine
Nathan A Brinn, MD
Denise K Edwards, MD
Lucy Guerra, MD
John D McCormick, MD
Hugo J Narvarte, MD
Kevin E O’Brien, MD

Interventional Cardiology
Fadi Matar, MD

Maternal & Fetal Medicine
Jan M Lanouette, MD
Charles J Lockwood, MD
Judette M Louis, MD
Stephanie Teresa Ros, MD

Neurological Surgery
Thomas B Freeman, MD
Donald A Smith, MD
Harry R Van Loveren, MD

Neurology
William Scott Burgin, MD
Rossitza I Chichkova, MD
Clifton Gooch, MD
Robert A Hauser, MD
Juan R Sanchez-Ramos, MD
Tuan H Vu, MD
Theresa A Zesiewicz, MD

Obstetrics & Gynecology
Shelly W Holmstrom, MD
Catherine M Lynch, MD
Dawn Palaszewski, MD
Odalis Sijin, MD

Ophthalmology
Ramesh S Ayyala, MD
Mitchell Drucker, MD
Lewis Groden, MD

Orthopaedic Surgery
Roy W Sanders, MD

Otolaryngology
Mark H Tabor, MD

Pediatric Endocrinology
Ellen Verena Jorgensen, MD
Henry Rodriguez, MD
Dorothy Shulman, MD

Pediatric Infectious Disease
Carina A Rodriguez, MD

Pediatric Nephrology
Valerie M Panzarino MD

Pediatrics
Sharon Dabrow, MD
Carol M Lilly, MD
Jennifer C Takagishi, MD

Physical Medicine & Rehabilitation
Naomi A Abel, MD

Plastic Surgery
C. Wayne Cruse, MD
Michael Harrington, MD
Nicholas J Panetta, MD
David J Smith Jr, MD
Paul D Smith, MD

Psychiatry
Jean Fils, MD
Amanda G Smith, MD

Pulmonary Disease
Kapilkumar N Patel, MD
Ricardo Restrepo-Jaramillo, MD

Rheumatology
John D Carter, MD

Surgery
Michael H Albrink, MD
Christopher G DuCoin, MD
Paul C Kuo, MD

Urology
David J Hernandez, MD

Vascular Surgery
Murray L Shames, MD

Colon & Rectal Surgery
Robert D Bennett, MD

Urology
Kevin Heinsimer, MD

USF Health microbiome expert Hariom Yadav, PhD, has received a grant from the National Institute on Aging to help determine if a common medication can restore microbiome diversity in older patients who have a form of heart failure and, thus, prevent the subsequent problems that tend keep these patients inactive and cause their conditions to worsen.

Hariom Yadav, PhD, was recently recruited to lead the USF Microbiome Research Center and his research focuses on the gut-brain connection (gut-brain axis) in relation to cognitive function.

Dr. Yadav, associate professor in the Division of Digestive Diseases and Nutrition for the Department of Neurosurgery and Brain Repair and Internal Medicine in the USF Health Morsani College of Medicine and director of the USF Center for Microbiome Research in the Microbiomes Institute, is a co-principal investigator and is working with co-principal investigator and project lead Dalane Kitzman, MD, at Wake Forest University in Winston-Salem, North Carolina.

The 3-year NIH consortium project research, which will include patients diagnosed with heart failure with preserved ejection fraction (HFpEF), is titled “Repurposing of Metformin for Older Patients with HFpEF.”

Preclinical studies show that gut barriers, including mucin production, are reduced in older gut and cause ‘leaky gut’, which allows certain antigens to diffuse into blood circulation, thus causing systemic inflammation. Preliminary data also suggest that older HFpEF patients have markedly reduced microbiome diversity, including reduced production of beneficial metabolites such as butyrate, which maintain health and gut wall integrity, and may help reduce leaky gut.

Metformin prescription bottle. Metformin is a generic medication name and label was created by photographer.

Metformin is a generic FDA-approved medication used for diabetes. Earlier studies, including research in Dr. Yadav’s lab, shows that metformin decreases leaky gut by improving microbial diversity and increasing intestinal wall mucin production thereby reducing systemic inflammation and improving physical function in lab model studies.

This new study seeks to translate these findings to determine if metformin improves microbiome diversity, reduces leaky gut, and reduces the inflammation associated with HFpEF in patients, a common condition in older people, particular older women.

“Earlier research suggests that metformin can inhibit a root cause of systemic inflammation – leaky gut – and its adverse consequences which are highly relevant to HFpEF, including exercise intolerance, a known barrier for HFpEF patients for staying active,” Dr. Yadav said. “We propose to test repurposing of metformin, a promising medication for improving heart failure outcomes by improving gut leakiness and microbial diversity, and that metformin will restore gut microbiome diversity and increase gut wall mucin, which in turn will reduce leaky gut and systemic inflammation and improve physical function for HFpEF patients.”

This new study is a randomized, blinded, placebo-controlled trial over 20 weeks in 80 non-diabetic HFpEF patients age 60 and older. The Wake Forest and Atrium Health team will coordinate the patients, measuring physical function, provide a quality of life questionnaire, and collect stool and blood samples. The team in Dr. Yadav’s lab will examine the samples and measure microbiome diversity and the key markers of leaky gut and of inflammation.

This study is supported by the National Institute on Aging of the National Institutes of Health under Award Number U01AG076928.

Dr. Yadav is conducting similar research associated with leaky gut and inflammation, including their connections to Alzheimer’s disease and other related dementias.

The USF Health Morsani College of Medicine is the fastest-rising medical school in the country, climbing over the last decade from #80 to #46 in U.S. News & World Report rankings for medical schools for research.

Based on data from U.S. News & World Report Academic Insights, the Morsani College of Medicine has climbed 34 spots in rankings for 2014 to 2023. No other medical school in the data – public or private – has risen as far in rankings as fast as the Morsani College of Medicine.

In the last decade, the USF Health Morsani College of Medicine has made great strides, pushing metrics upward in the college’s three mission areas — education, research and patient care – in an effort to place the college among the best medical schools in the country.

With improved metrics, the college’s placement in the national rankings soared from No. 80 in the 2014 U.S. News list to No. 46 in the recently published 2023 list – a seismic 34 spots.

No other medical school in the country has experienced that same improvement in rankings, making the USF Health Morsani College of Medicine the fastest-rising medical schools in the country.

“Our sustained rise in national rankings reflects the rapidly increasing strength of our educational, research and clinical missions at the USF Health Morsani College of Medicine. We are now competing with the nation’s most storied and respected programs,” said Dr. Charles Lockwood, senior vice president for USF Health and dean of the USF Health Morsani College of Medicine. “These outstanding metrics also position us to attract the highest caliber students and faculty, further advancing our program into the national spotlight for its outstanding education, exceptional research and world class clinical care.”

Tampa General Hospital is once again the #1 hospital in the Tampa Bay area and is now tied for third among Florida hospitals, as listed by U.S. News & World Report 2022-23 rankings released today.

In the listing, U.S. News recognized 12 USF Health and Tampa General specialties for their strong national reputation and performance, including seven in the top 50 – USF Health doctors lead or co-lead most of these top-ranked specialties.

The news shines a light on the many USF Health faculty who care for patients within these specialties, seeing patients at Tampa General and within USF Health clinical facilities, said Dr. Charles J. Lockwood, senior vice president at USF Health and dean of the USF Health Morsani College of Medicine.

“This national recognition is a wonderful achievement, built upon the dedication, compassion and commitment to world-class care that our physicians and providers deliver every day,” Dr. Lockwood said. “I would like to thank each of them, as well as all of our Tampa General caregivers and colleagues, for their continuing pursuit of excellence and belief in making life better for residents of Tampa Bay and beyond.”

The seven specialties ranked among the top 50 in the nation are:

• Diabetes & Endocrinology – #27
• Ear, Nose & Throat – #16
• Gastroenterology and GI Surgery – #34
• Obstetrics & Gynecology – #40
• Orthopedics – #33
• Pulmonology – #49
• Rehabilitation – #40

Five more specialties were recognized as “high performing,” and are among the top 10% in the nation:

• Cancer
• Cardiology & Heart Surgery
• Geriatrics
• Neurology & Neurosurgery
• Urology

Although stroke is a leading killer, experts say it demands more attention and funding.

On a Thursday night in mid-January, Dr. Rahul N. Mehra, a prominent Tampa psychiatrist, wasn’t feeling well and laid down on a couch in his south Tampa home. His wife Cathy was resting in the bedroom when she heard a loud thump and came out to investigate. She found her husband on the floor, disoriented.

“She looked at me and clearly realized that something wasn’t right,’’ Dr. Mehra said. “She asked me ‘who am I?’ and I wasn’t able to respond, so she immediately called the paramedics.’’

Dr. Rahul Mehra

Dr. Mehra is the CEO and Chief Physician Executive for the National Center for Performance Health (NCPH), a Tampa based health care company. NCPH creates and provides original and innovative resources intended to empower professional and amateur athletes of all ages. NCPH clients include large and small businesses, schools, colleges, universities and non-profit agencies. Dr. Mehra created a tool kit called Emotional Vaccines to address the effect of stress for individuals and families.

“Tampa General Hospital was just seven minutes away, so the paramedics got me there quick, and that saved my life.’’

But something else kept him motivated to live: “My spiritual belief pulled me through,’’ said the 60-year-old MD. “And my wife. If it wasn’t for her quick thinking, I might not be here today.’’

Dr. Rahul and Cathy Mehra

When the paramedics placed their patient into the ambulance, one of Dr. Mehra’s neighbors walked over to see what the commotion was about. She looked at him and held her hands together in prayer. In response, he gave her a thumbs up to say “I’m going to be ok.’’

And there was also COVID to consider: Both Dr. Mehra and Cathy had recently been vaccinated for COVID, but he still tested positive.

From there, it was up to a quickly assembled medical team at TGH to get Dr. Mehra back on his feet. Two days later, while in his hospital bed, Dr. Mehra suffered a second stroke.

Being a Saturday, some of the neurosurgery crew had to be called into work, led by Dr. W. Scott Burgin, Professor and Cerebrovascular Division Chief at the USF Health Morsani College of Medicine’s Department of Neurology and director of the Comprehensive Stroke Center at Tampa General Hospital.

“The nurse on shift found me unresponsive and alerted Dr. Burgin,’’ Dr. Mehra said.

The TGH team conducted a CAT scan and quickly identified the problem. “We converged on him within a matter of minutes, opened his artery back up and removed the clot in short order. Everyone worked as a finely tuned team,’’ Dr. Burgin said.

When news about Dr. Mehra’s failing health spread, three childhood friends flew to Tampa in a show of support. Each packed black clothing, “because they thought they were coming to a wake.’’

Rumors of Dr. Mehra’s passing were exaggerated and of course there was no funeral. In fact, he viewed what happened as a celebration of a renewed life.

“My recovery has been without any physical, sensory, or speech deficits,’’ he said. “The unparalleled recovery is the focus of the world-class care I received. Recall that three days after being found unconscious, paralyzed, blind and unable to speak in my hospital bed, I walked out of Tampa General’s Neuro ICU for discharge – not in a wheelchair but walking on my own strength.’’

Because a stroke cuts off blood and oxygen to the brain, it must be treated as an emergency. However, treatment is no easy task, Dr. Burgin said: A micro-catheter is inserted into the lower body and run upward to find the blockage in what may be a narrow blood vessel. “It’s like pushing a piece of string through the leg and up into the head.’’

More than 800,000 people a year in the United States suffer a stroke: enough to fill Tampa’s Raymond James Stadium 12 times over. Many of these people don’t know what hit them, and like Mehra, are in good health. This makes strokes difficult to predict and prevent. If not addressed quickly, a stroke can lead to brain hypoxia, permanent disability or death.

Stroke is among the top 10 leading causes of death in the United States:

• Heart disease
• Cancer
• Unintentional injuries
• Chronic lower respiratory disease
• Stroke and cerebrovascular diseases
• Alzheimer’s disease
• Diabetes
• Influenza and pneumonia

More on strokes: https://www.nhlbi.nih.gov/health/stroke

“Stroke is an incredibly under-resourced segment in medicine, even though it’s the No. 1 cause of disability and the No. 5 cause of death in the United States,’’ Dr. Burgin added. “We have heart centers everywhere, but not stroke centers.’’

For more about strokes and vascular neurology at USF, visit: https://health.usf.edu/care/neurology/services-specialties/stroke-vascularneurology

Story by Kurt Loft

Scientific research is often a low-key exercise, with fastidious people peering into microscopes and working under the radar. Seldom are they described as rising stars, but Jiajia Yang may have broken the mold.

This month, Dr. Yang became the first person to earn a PhD from USF through a new degree program within the newly opened USF Health Heart Institute.

The 30-year-old earned her degree in medical sciences from the USF Health Morsani College of Medicine, with a focus on heart disease, specifically genetic arrhythmia and cardiomyopathy gene mutations within a family.

The Heart Institute is housed within the new Morsani College of Medicine + Heart Institute building in the Water Street Tampa district of downtown Tampa. The facility, which also includes the MD degree program, opened in January 2020.

“You can’t imagine how excited I am,’’ Dr. Yang said of her degree and new career. “The most exciting part for me is that our research is really translational for patients. This isn’t just bedside to bench, but bench to bedside.’’

Originally from a small village in rural China, Dr. Yang attended medical school in Shanghai, then won a scholarship in 2015 at Descartes University in Paris. While there, she earned her Masters and learned to speak French ─ adding to her verbal portfolio of Chinese and English.

Dr. Thomas McDonald with Dr. Jiajia Yang.

After a year, she accepted a position as a research assistant at the USF Health Morsani College of Medicine and quickly showed promise as a fast and inquisitive learner, said Thomas McDonald, MD, professor in the Department of Molecular Pharmacology & Physiology. He would later work with Dr. Yang on a variety of heart-related research projects, including the role of patient-specific induced pluripotent stem cells.

“This is all technically difficult and she overcame so many obstacles,’’ Dr. McDonald said. “She really laid the ground work to help this take off.’’

During her time at USF, Dr. Yang published five research papers in peer-reviewed journals, including new findings on using patient-specific stem cells to study disease in human tissue.

“That had not been on the map at USF until now,’’ Dr. McDonald said. “Jiajia’s papers were the first.’’

Dr. Yang wasn’t shy about sharing her love for discovery.

“I don’t think I’ve ever run across anyone as enthusiastic about her work,’’ Dr. McDonald added. “She was literally jumping up and down in the hallways screaming (about the stem cells) ‘They’re beating! They’re beating!’ Her enthusiasm was contagious.’’

Armed with her degree, Dr. Yang accepted a job as resident physician in internal medicine at the University of New Mexico School of Medicine in Albuquerque. She expects to be there at least three years, but could stay longer if needed: Heart disease is the leading cause of death in New Mexico, according to the state’s Department of Health. When not working, Dr. Yang will devote time to her other passions: cooking, hiking and biking, tennis, and working out at the gym.

Dr. McDonald expects big things from his former colleague, and has no reservations about asking her to return to Tampa: “I’d like to see her career blossom and recruit her to come back to USF.’’

For more on the USF Heart Institute, visit: https://health.usf.edu/medicine/heart-institute

Written by Kurt Loft

Dr. Ganesh Halade’s investigation in how “good’’ fats repair the heart could enhance treatment of cardiovascular disease.

TAMPA, FL (April 11, 2022) – New breakthrough research by a University of South Florida lab team describing how certain fats can harm or repair the heart after injury has been accepted by a journal of the American Physiological Society.

A manuscript by Ganesh Halade, PhD, an associate professor of cardiovascular sciences at the USF Health Morsani College of Medicine and a researcher in the USF Health Heart Institute, appears  in the American Journal of Physiology-Heart and Circulatory Physiology, published March 25.

Dr. Ganesh Halade.

Dr. Halade’s research article is titled “Metabolic Transformation of Fat in Obesity Determines the Inflammation Resolving Capacity of Splenocardiac and Cardiorenal Networks in Heart Failure.’’

A key message of the manuscript is how a certain type of healthy fat known as docosahexaenoic acid (DHA) – which is present in Omega-3 fish oil, as found in salmon and tuna – works in tandem with enzymes from the spleen to clear the inflammation in a damaged heart. The spleen plays an important role because it sends immune cells with bags of healthy fat that operates cardiac repair after major injury such as a heart attack.

“So the fat intake needs to be of optimal quality and used by the right enzyme of immune cells,’’ Dr. Halade said. “This is all about cardiac repair and the inflammation clearing molecules (resolution mediators) involved in that repair. It’s essential to the resolution process.’’

Another key message is more about prevention and the genesis of cardiovascular disease: How a chronic and surplus dietary intake of safflower oil (SO, omega-6) can lead to residual inflammation of spleen, kidney, heart, and biosynthesis of pro-inflammatory mediators after an ischemic event. SO is a type of fat commonly used in processed and fast foods that drives chronic inflammation.

“The big question for most people is whether a fat is good or bad, or is omega-3 helpful for heart health?’’ Dr. Halade said. “Everyone is dealing with this question. We’re thinking beyond that by looking at how fat is used in the body after a heart attack and in what forms.’’

“All fats are not created equal,’’ he added, “and despite the extensive literature, the effect of fat intake is the most debated question in obesity, cardiovascular, and cardiorenal research.’’

In his research, Dr. Halade and his team put 100 mice on a 12-week diet of processed (SO) foods to develop residual inflammation and then 50 mice randomized on a primarily DHA-enriched diet for next eight weeks before subjecting to ischemic surgery in mice.

The team made sure both diets had same quantity of calorie per gram of diet. The surplus and chronic intake of SO increased inflammation along with a dysfunctional cardiorenal network. In contrast, DHA increased survival following such heart damage (heart attack).

A result of the study was that the alignment of immune cell enzymes from the spleen and DHA fats are essential to cardiac repair. These so-called “resolution mediators (a family of specialized pro-resolving mediators) is the body’s natural defense process without a negative impact on the body’s physiological response,’’ Dr. Halade said.

Among the key findings in the study:

• DHA supplement improved survival after experimental heart attack to mice
• DHA boost safe clearance of inflammation (resolution) from an injured heart without change in the acute phase of the inflammatory response (day 1), with increased expression of Arg-1, MRC-1, and YM-1 in spleen and infarcted area. These agents are resolution and reparative markers of immune response.
• DHA, along with the body’s natural enzymes, enhanced the ability for the spleen and heart to work together in repairing damage.
• SO primed the spleen and kidney to induce pro-inflammatory pathways and renal inflammation.

“Our next step is to determine the enzymatic machinery or immune responsive enzymes that biosynthesize resolution mediators after ischemic (decreased blood flow commonly called a heart attack) event,’’ Dr. Halade said.

Part of Dr. Halade’s research focuses on how unresolved chronic inflammation and immune responsive metabolic dysregulation contributes to ischemic and non-ischemic heart failure. He is involved in studies of heart failure etiology with an integrative approach focusing on splenic leukocytes and heart, as well as the measurement of inflammatory mediators that impair cardiac repair and resolving lipid mediators that facilitate cardiac repair after a heart attack.

Related story on Dr. Halade’s heart research at USF: /blog/2021/05/10/blocking-lipoxygenase-leads-to-impaired-cardiac-repair-in-acute-heart-failure/

Dr. Halade hopes his latest work can shed new light on controlling chronic inflammation and treating heart failure — a progressively debilitating condition in which weakened or stiff heart muscle cannot pump enough blood to meet the body’s demand for nutrients and oxygen.

It has become a growing public health problem, fueled in part by an aging population, poor diet and obesity epidemic. About 6.2 million adults in the U.S. suffer heart failure, and nearly have died within five years of diagnosis, according to the Federal Centers for Disease Control and Prevention.

The American Physiological Society (APS), which publishes the journal, is a nonprofit devoted to fostering education, scientific research, and dissemination of information in the physiological sciences.

“The editors commend you on your outstanding contribution to the journal,’’ the accepting team wrote to Dr. Halade. “We would like to thank you for contributing this novel and important article.’’

The USF Health study was supported by grants from the National Center for Complementary and Integrative Health (NCCIH, formerly known as National Center for Complementary and Alternative Medicine; (NCCAM), and the National Heart, Lung and Blood Institute.

Written by Kurt Loft