In the laboratory and the clinic, Dr. Thomas McDonald focuses on inherited heart diseases that can lead to potentially deadly heart rhythm disturbances

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Sudden cardiac death most often makes the news when athletes in peak physical condition collapse and die while exercising or competing.  This spring, Zeke Upshaw, 26, a basketball player for the Grand Rapids Drive, a G-league affiliate of the Detroit Pistons, collapsed face-down on home court during the final minute of a game and later died at the hospital. A medical examiner ruled that he had suffered sudden cardiac death.

“Sudden cardiac death is when someone, usually otherwise healthy and often young, tragically drops dead – without any warning,” said Thomas V. McDonald, MD, a professor in the USF Health Department of Cardiovascular Sciences.

Most of the 200,000 to 450,000 sudden cardiac deaths each year in United States are caused by heart rhythm disturbances  provoked by certain strenuous activities, prescription medications, recreational drugs, or other triggers. “Sometimes it just happens in your sleep.  The most severe and earliest form would be sudden infant death, or SIDS,” Dr. McDonald said.

Physician-scientist Thomas McDonald, MD, a professor in the USF Health Department of Cardiovascular Sciences and member of the USF Health Heart Institute, with his laboratory team.

Dr. McDonald was recruited to the USF Health Heart Institute in October 2017 from Albert Einstein College of Medicine in New York City, where he was a professor of both cardiology and molecular pharmacology. He also co-directed the thriving Montefiore-Einstein Clinic for CardioGenetics, the first such interdisciplinary clinic in metropolitan New York for families at risk of sudden cardiac death from arrhythmias.

At USF Health his laboratory continues to focus on the fundamental causes of heart conditions passed from one generation to the next — and what can be done to help prevent disease and its consequences.  The hereditary conditions he studies include those affecting the heart’s electrical system to cause arrhythmias, like long QT syndrome and Brugada syndrome, and those affecting heart muscle, such as hypertrophic cardiomyopathy and dilated cardiomyopathy.  While rare, these conditions can substantially increase an individual’s risk for sudden cardiac death and devastate families.

In long QT syndrome, the heart takes longer than normal to recharge between beats. This electrical disturbance, called a prolonged QT interval, can often be seen on an electrocardiogram (ECG) like the one pictured here.

Dr. McDonald has also started a USF Health Cardiogenetics Clinic, modeled after the Montefiore-Einstein center he co-founded, to evaluate and treat families in which members succumb to unexplained sudden cardiac death or SIDS, or where suspicion of an underlying, hereditary heart rhythm disturbance exists.

His work bridging the laboratory and clinic has implications for a much larger population than people with relatively rare inherited cardiac disorders.  Dr. McDonald points to growing evidence of the interplay between genetics and environmental factors like diet, exercise and stress.

“By studying these rare or uncommon cardiac diseases,” he said, “we may uncover more generalizable biochemical pathways that could be influenced to harm the heart given the wrong environment — even in genetically unaffected families.”

 Studying uncommon (inherited) heart diseases to gain better insight into more common ones.

Dr. McDonald lifts a container including pluripotent stem cells from storage in liquid oxygen. Alexander Bertalovitz, PhD, (right) an assistant professor of cardiovascular sciences who helps manage the cardiogenetics laboratory, followed Dr. McDonald to USF Health from Albert Einstein College of Medicine in New York City.

Pinpointing the meaning of genetic variants of “unknown significance”

Dr. McDonald analyzes genetic changes, or mutations, which may lead to malfunctioning of ion channels that create electrical signals in the heart.

His team has spent the last few years characterizing the function of 1,000 different mutations found in cardiac ion channel genes associated with hereditary rhythm conditions such as long QT syndrome and Brugada syndrome. The researchers recreate the genetic variations in a cellular model and use automated electrophysiology techniques to analyze how the mutations affect the ion channel’s ability to correctly generate each heartbeat. All these variations have been cited in published scientific literature; however, it is still largely unclear which ones truly increase the risk of abnormal rhythms leading to palpitations, seizures, fainting or sudden death – and which are benign.

The research project is supported by a five-year, $1.7 million R01 grant from the NIH’s National Health, Lung and Blood Institute.

“Our ultimate goal is to work with other investigators to create a NIH-curated public database that physicians and genetic counselors could access to find out whether a genetic variant is likely, or unlikely, to cause a potentially life-threatening heart rhythm disturbance in a patient or their family members,” Dr. McDonald said.

As genetic testing is becomes more common, a growing challenge is that lab reports of people referred for DNA sequence testing often come back listing many “variants of unknown significance,” Dr. McDonald said. “That drives physicians and patients crazy because they don’t know what that means… what do they do with that information?”

Dr. McDonald with Jiajia Yang, a PhD student in the Department of Molecular Pharmacology and Physiology.

An important step toward improving the guidance that doctors offer individuals with inherited heart disorders would be the ability to more precisely distinguish between disease-causing mutations and mutations with little or no harmful physiological effects through a resource like a scientifically validated database, he added.

Recommended treatment options for long QT are life-long and vary, including regular cardiac monitoring, taking medication such as beta blockers, restricting strenuous sports activities, or sometimes implanting pacemakers or defibrillators to help control abnormal heartbeats.  So, for example, if DNA testing of a child or young adult revealed a long QT genetic variation characterized as having little risk of leading to sudden cardiac death, prescribing beta blockers and routine cardiac monitoring might be the best preventive therapy – avoiding the long-term management and small, but real, lifetime risk of complications from an implantable device.

 Dr. McDonald comments on the focus of his laboratory’s research on genetic variations.

Opening Tampa Bay region’s first CardioGenetics Clinic

The twice-monthly Cardiogenetics Clinic, which opened in March, is held at USF Health Cardiology’s Armenia Avenue location. The new clinic is staffed by a team with the expertise to address the diverse medical, psychological, social and ethical issues arising when evaluating genetic heart conditions that predispose patients to sudden cardiac death.

Dr. McDonald — with certified genetic counselor Melissa Racobaldo (far left) and clinical geneticist Christopher Griffith, MD — leads a comprehensive discussion of family medical history with a patient and his mother referred to the USF Health Cardiogenetics Clinic.

“When I arrived there was no formal cardiogenetics program in the greater metropolitan area of Tampa Bay where 4 million people live — so the prospect of building one from scratch was very attractive,” said Dr. McDonald, who specializes in adult cardiology. He leads the clinic working with USF Health faculty members Christopher Griffith, MD, assistant professor of pediatrics and a clinical geneticist; and Melissa Racobaldo, a genetic counselor; as well as Gary Stapleton, MD, a pediatric interventional cardiologist from Johns Hopkins All Children’s Hospital. USF College of Public Health students specializing in genetic counseling are expected to join the clinic in coming months.

Many with congenital cardiac conditions have no signs or symptoms. Patients and their families referred to the clinic typically have experienced a history of arrhythmias or other cardiac events, or suffered the unexpected death of a loved one.

During the initial visit, families meet with team members for a cardiac history and examination, review of medical records and/or autopsy reports, and baseline tests that include an electrocardiogram and echocardiogram.  Based on the family’s medical history, a tree-like chart known as the DNA pedigree is created to identify familial genetic patterns and sudden unexpected deaths linked to cardiac disorders.  “The most important genetic test is still a complete family history,” Dr. McDonald said.

Certified genetic counselor Melissa Racobaldo consults with Dr. McDonald about a patient.

DNA testing is usually only recommended when the team discerns that the pattern of cardiac-related events is highly likely to be genetic rather than environmental.  For instance, a family history indicating that a few relatives died from heart disease in their 80s might be considered environmental.

If a mutation is found in one of the genes known to be associated with a dangerous cardiac arrhythmia, then the first (affected) patient who got tested receives immediate counseling by a cardiologist, and genetic testing and counseling will be offered to all at-risk relatives. Different heart rhythm genetic mutations have different effects on ion channels, so individualized remedies are required.

“Genetics is still quite complex to most people, so we try to make our explanations understandable and not so scary,” said Dr. McDonald, who has co-authored several articles on how patients are affected by cardiogenetic testing, including in the journals Qualitative Health Research and Personalized Medicine.

“Our dominant message is ‘we’re here to provide information, which gives you knowledge, and knowledge gives you power to manage your life and to help the next generation.”

A pedigree, which depicts the relationship between individuals and relevant facts about their medical histories, can be used to help understand the transmission of genes within the family. Dr. McDonald points to a square indicating the presence of a particular genetic trait in a male.

The Cardiogenetics Clinic will offer patients access to the latest clinical trials for new drugs or devices. Dr. McDonald was recently named USF site lead investigator for a world-wide Phase 3 study testing the effect on walking endurance of an investigational medication for patients with dilated cardiomyopathy caused by a rare genetic mutation. This form of heart disease, in which inadequate pumping of blood causes the heart to become weaker, can lead to heart failure.

“Heart in a dish” as a drug screening tool

Interested in drug discovery for inherited heart diseases lacking effective medications, Dr. McDonald’s lab has begun collecting blood cells from USF Health cardiomyopathy patients who provide informed consent.

The adult blood cells can be genetically reprogrammed into induced pluripotent stem cells (iPSCs) with the potential to develop into any cell type in the body, including heart cells.  The goal is to model the early stages of inherited heart disease with patient-specific cells grown in a petri dish, working out at a molecular level how the disease does its damage to heart muscle.

 On the horizon: Modeling inherited heart diseases using pluripotent stem cells

Dr. McDonald and Maliheh Najari Beidokhti, PhD, a postdoctoral associate in the Department of Cardiovascular Sciences.

“Once you do that,” Dr. McDonald said, “you can use the ‘heart disease in a cell culture dish’ to screen any number of drugs or chemical compounds for their potential therapeutic benefit.”

Dr. McDonald is also collaborating with colleagues in the USF Health Department of Neurology to look at rare genetic mutations for nervous system diseases, such as certain types of muscular dystrophy and ataxias, which can lead to severe heart damage,

Dr. McDonald received his bachelor’s degree in zoology from USF in 1977 and MD degree from the University of Florida.  He completed a residency in medicine and research fellowship in cardiology at Columbia-Presbyterian Medical Center in New York City. At Stanford University School of Medicine, he conducted fellowships in clinical cardiology and interventional cardiology, as well as a postdoctoral research fellowship. He spent 22 years as a faculty member at Albert Einstein College of Medicine before joining the USF Health Morsani College of Medicine last fall.

Continuously funded throughout his career by the NIH or the American Heart Association (AHA), Dr. McDonald has authored more than 70 peer-reviewed publications.   Among his many high-impact papers was a 2013 article published in FASEB.  The NIH-supported study was among the first to report that synonymous (silent) changes in DNA traditionally considered neutral may adversely affect the processing speed and efficiency of ion channels associated with the heart arrhythmia syndrome Long QT and alter disease severity.

Dr. McDonald has served on multiple study sections of the NIH and AHA. He was elected in 2011 as an AHA Fellow-Basic Cardiovascular Sciences Council.

Dr. McDonald says his clinical practice helps inform and complement the translational science he conducts in the laboratory.

Some things you may not know about Dr. McDonald

• During high school, he worked one year as a head cook for a restaurant in Winter Park, Fla., before entering college. “It made me realize that hard work is important, but also motivated me to study so I could make a living by using my head more than my hands.”
• Wife Kami Kim, MD, also a USF Health physician-scientist, is a professor with joint appointments in the Department of Internal Medicine and in the Department of Global Health. They met in the cardiac intensive care unit at Columbia Presbyterian Medical Center when Dr. McDonald was a resident and Dr. Kim was rounding as a medical student.  Their two sons, both studying theoretical math, are Clayton, 24, a PhD student at Boston College, and Vaughan, 20, starting his junior year at Harvard University.
• McDonald enjoys bicycling, Japanese cooking, and nearly exclusively reads fiction – “it’s another window on the human condition.” His two favorite books are One Hundred Years of Solitude, an acclaimed novel by Nobel Prize-winning Latin-American author Gabriel García Márquez, and Infinite Jest, a literary bestseller and unconventional comedy by David Foster Wallace.

-Video and photos by Torie M. Doll, USF Health Communications and Marketing

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Leaning forward, Julio Robaina intently watched as USF Health cardiologist Bibhu Mohanty, MD, sketched a series of shapes on a piece of notebook paper. As Dr. Mohanty pulled his hand away, the sketches were revealed. It was a heart, Robaina’s heart.

Minutes earlier, Dr. Mohanty smiled and asked what had prompted Robaina to come to see him for a second opinion. In tears and obviously frightened about his health, the 57-year-old explained that days earlier he had suffered his second heart attack in seven years. Again, a stent had been placed in one of his coronary arteries, further testing had been performed, and for reasons he did not understand, his cardiologist had recommended surgery.

Dr. Mohanty then pointed to his sketch and shook his head no.

“You could tell right away he knew what he was talking about,” Robaina said.

Julio Robaina, went to USF Health cardiologist Bibhu Mohanty, MD, for a second opinion after suffering his second heart attack in seven years.

Robaina’s eyes were laser focused as his doctor pointed to the heart on the piece of paper and explained what was going on inside his chest. “‘Dr. Mohanty told me, ‘This is your heart, these are your arteries and here is where the cardiologist placed the stents after your first heart attack’,” Robaina recalled.

Then came the great news: with some necessary dietary modifications, a guided exercise program, adherence to medication and regular follow up about any changes, Dr. Mohanty told Robaina he could beat this problem without additional procedures. Robaina was relieved — a huge load was lifted off his already taxed shoulders, and he wholeheartedly agreed to making the changes.

For Robaina, the prospect of another procedure added a lot more anxiety to an already stressful situation.  Robaina had lived in Florida for 14 years after residing most of his life with his extended family in northern New Jersey.

“His fear, anxiety, lack of understanding, lifestyle and issues with medications all would have rendered any additional procedure futile, no matter how technically correct,” said Dr. Mohanty, an assistant professor in the USF Health Morsani College of Medicine Department of Cardiovascular Sciences. “This is why we devised a plan to address him — the patient. First, maximize his health status, and see where that landed us. If he needed surgery in the future, he’d be a vastly different, and better-suited candidate.”

It wasn’t easy to change his lifestyle, but with the support of wife Magaly (pictured here) and Dr. Mohanty, Robaina continues working to optimize his health to reduce the risk of future heart attacks. Dr. Mohanty developed the patient-centered care plan in consultation with Robaina.

Dr. Mohanty detailed the nutritional elements that needed to be a part of the changes. Some choices were easy: cut out sodas. Some weren’t as easy: cut out the high-fat meals, like fast food, which he grabbed on the run while working his busy customer service job.

Changing his lifestyle wasn’t easy, but with the support of Dr. Mohanty and his wife, Magaly, Robaina stuck with it. “The hardest part was getting accustomed to the different foods and getting rid of the salt shaker.  Trying to get the stress out of my life is an ongoing battle,” Robaina said.

Along with eating better, Robaina took Dr. Mohanty’s advice and began to take more time for himself.  “I’m in the customer service business so it’s not always easy. These days people want everything yesterday. The hours I work are getting longer,” Robaina said. “But we like to garden. We are doing a lot more of that.  It’s the way I relieve stress on my time off work.”

Better nutrition and guided exercise, along with medication adjustments as needed, have helped Robaina improve his blood pressure numbers.

Dr. Mohanty also recommended Robaina begin doing cardiovascular rehabilitation. It is offered to any patient with prior heart attack, stenting or bypass surgery. In the past, it was very expensive, but 36 sessions are now covered by most insurance companies. It’s tailored to the patient’s metabolic needs and ability. Blood pressure and heart rate are monitored as patients are taken through a series of exercises that pushes them but does notovertax their abilities.

Because of past knee issues, Robaina’s twice-weekly cardio sessions included a lot of time on the recumbent bike. “Exercising has become very important for me and I enjoy it,” Robaina said. “It’s helped my blood pressure and I feel a lot better. I want to live to see my four grandkids get married and go to college — that’s the whole idea.”

“Many patients going through this, that I have met, even a young “fit” 45-year-old who had a heart attack out of the blue, love it because they find that while they are moved along slowly, they reach further in their fitness goals than they otherwise would have,” Dr. Mohanty added. “In clinical studies, few of the drugs we use have as much mortality and future heart attack risk reduction than cardiac rehab. And this brings us back to Mr. Robaina – and why lifestyle change was so important.”

Dr. Mohanty, an assistant professor in the USF Health Department of Cardiovascular Sciences, specializes in structural interventional cardiology.

Robaina had suffered with high blood pressure issues for years. Following Dr. Mohanty’s advice, Robaina has seen his blood pressure numbers improve. He also made sure to report changes in blood pressure or side effects quickly to Dr. Mohanty, and they made adjustments together that have continued to yield good results.

In addition to receiving excellent medical care, Robaina also enjoys Dr. Mohanty’s sense of humor. He recalled a recent incident at the hospital cafeteria. “I had a healthy plate of food and was drinking water.  My wife Magaly had a soda,” Robaina said. “Dr. Mohanty walked in and saw the orange drink, and said ‘What? There’s a soda in the room!’”

“‘That’s my wife’s!’ I told him,” Robaina said. “Dr. Mohanty laughed and started busting her chops instead.”

“That’s the kind of guy he is. Dr. Mohanty makes you feel real comfortable — like you are one of the family. I love him,” Robaina said. “He’s going to go far in life. I want him to be around for as long as I’m around. I definitely want to keep him as my physician.”

Robaina enjoys gardening at his home, and is doing more it to help relieve the stress that accompanies his high-intensity customer service job.

-Video and photos by Torie M. Doll, USF Health Communications and Marketing

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After suffering his first heart attack 22 years ago, David Gilberg has endured more heart procedures than anyone could count on both hands. Fourteen in fact.  But today, the 72-year-old Minnesota native has a new lease on life, thanks to a procedure performed by cardiologist Bibhu Mohanty, MD, of the USF Health Department of Cardiovascular Sciences.

While the procedure to open a narrowed coronary artery in Gilberg’s heart was fairly routine as far as percutaneous coronary intervention (PCI) goes, the real magic occurred when he felt someone listened to his concerns at long last.

Gilberg spent his entire life farming dairy cattle in northern Minnesota.  A humble and spiritual man, Gilberg worked an area of the country that he termed as having “real, real cold weather.” After visiting Florida for years to escape the frigidity, he moved permanently to Sun City in 2013.  Solidifying the lifestyle change, Gilberg sold his farm last year.  “I had a hard time letting it go. When you’ve been a farmer all of your life, that soil is in your hands. It’s just something that is a part of you.”

Patient David Gilberg of Sun City Center with USF Health cardiologist Bibhu Mohanty, MD.

For more than a year, Gilberg dealt with a severe dysfunction, including shortness of breath.  At times Gilberg could hardly get from bed to bathroom. A quick trip to the grocery store was dreaded.

“I had to know exactly what I wanted and where it was,” he said.  I hurried through the aisles, sometimes having to sit down. After just a few minutes, I returned to the car out of breath and exhausted.”

Gilberg’s ongoing heart issues stemmed from heart disease on both sides of his family. Before seeing Dr. Mohanty, Gilberg took as many as 15 nitroglycerine pills daily. The pain in his arms and chest grew stronger every day.  When he complained to his cardiologist of five years, the doctor said he was fine.

In December, he’d finally had enough.  On a recommendation, he made an appointment with Dr. Mohanty for a second opinion.

When Gilberg met Dr. Mohanty in Sun City, he was concerned that the doctor would diagnose his problem and it would be the last time he saw him.

At the initial visit, the USF cardiologist wondered if one of the stents was possibly clogging up.

“From the beginning, Dr. Mohanty assured me he would be with me throughout my hospital stay.  He said he’d be right there and he was,” Gilberg said with a big smile.  “He came to my hospital room, checked in several times, and always had a very positive attitude.  His bedside manner is second to none. He is the nicest, most concerning fella.”

Not only is Dr. Mohanty’s bedside manner on point, “He saved my life!” said Gilberg, after Dr. Mohanty placed a 10th stent in his heart in January.  Just one month later, Gilberg is walking up to a mile and a half each day.

Dr. Mohanty speaks with Gilberg during an office follow-up visit.

“Being strictly adherent to an optimal medication regimen for coronary artery disease is critical,” Dr. Mohanty said. “When we met, his regimen was not optimal for his history, and we made some significant adjustments.”

With a new vigor, Gilberg is now making plans to visit Minnesota, and might even travel to Sweden to visit relatives in his homeland.  With a daughter, Jenny, in Sarasota and another, Molly, still in Minnesota, he has a lot of love and support.  Molly’s family will welcome their eighth child in July.  Gilberg now plans to visit them twice a year to celebrate his grandchildren’s birthdays.

Gilberg smiles big when he talks about visiting family in Minnesota, an adventure he never dreamed possible a couple of months ago.  “No matter where you go in this world, there is a place that’s home.  ‘Home’ sometimes is the things you have – what you bring with you that kind of makes it feel like home.  But home is always where you were born and raised. And home for me is Minnesota.”

Gilberg’s grandkids are a bright spot as well.   Prior to Hurricane Irma, they wanted to Facetime every day, and nervously asked him about impending Hurricane Irma.   “You know Papa,” 10-year old grandson George said at the time, “I want to see you a few more times — not just in heaven, so you have to take care of yourself and go to a shelter if the storm comes, ok?”

Thanks to Dr. Mohanty, Gilberg will be much more than a just a face on a phone screen. His grandkids will now be able to play with “Papa” in person for a long time.

***

Dr. Mohanty attended Duke University Medical School and also did his residency at Duke.  He completed three fellowships: Cardiovascular Disease at Mouth Sinai School of Medicine, Interventional Cardiology at Johns Hopkins Medical Center, and Structural Intervention at Dartmouth Medical School.

To learn more about life-changing cardiovascular research and patient care at USF, visit the USF Health Heart Institute website.

-Story and photos by Michelle Young, USF Health Communications and Marketing

Seeking to understand how the heart short circuits, Sami Noujaim looks for new drugs to fix atrial fibrillation

Within the last three years, USF biomedical scientist Sami Noujaim, PhD, lost his older brother to sudden cardiac death and his 80-year-old father was diagnosed with atrial fibrillation.

The experiences gave Dr. Noujaim a new appreciation for his research on understanding how normal and abnormal electrical impulses are generated in the heart. The Cardiac Electrophysiology Research Laboratory he directs focuses on finding more effective drugs to treat atrial fibrillation, the most common irregular heart rhythm and a condition for which prevalence rises markedly after age 65.

Sami Noujaim, PhD, directs the Cardiac Electrophysiology Research Laboratory in the USF Health Department of Molecular Pharmacology and Physiology.

“When life throws something like that at you, the work you do takes on a more personal tone, a sense of mission.  I realized that neither myself nor my loved ones are immune from the cardiovascular diseases I’m studying,” said Dr. Noujaim, an assistant professor in the Morsani College of Medicine’s Department of Molecular Pharmacology and Physiology. “We are all at risk.”

 Dr. Sami Noujaim describes the focus of his laboratory’s research.

Searching for noninvasive solutions to atrial fibrillation

Atrial fibrillation is a problem with the cardiac electrical circuitry that controls the rate and rhythm of the heartbeat. The condition affects about 9 percent of the U.S. population age 65 or older, according to the Centers for Disease Control and Prevention, and can lead to potentially deadly complications such as stroke and heart failure. While signs of atrial fibrillation may include heart palpitations, fatigue, lightheadedness, dizziness and shortness of breath, some people experience no noticeable symptoms.

Treatment and management options include lifestyle changes, medications to help control heart rate and rhythm and reduce the risk of blood clots, controlled electrical shock (cardioversion to reset heart rhythm), invasive procedures (catheter ablation) and surgical implantation of pacemakers.  However, a major challenge is that atrial fibrillation frequently recurs after normal heart rhythm (sinus rhythm) is restored.

“The existing treatments can be good, but there is a lot of room for improvement, so we are focusing on contributing to noninvasive treatment options,” Dr. Noujaim said. “If we could help physicians get patients with atrial fibrillation to long-term normal sinus rhythm, and perhaps increase the ability to take them off blood thinners, it would be a significant improvement.”

Dr. Noujaim’s laboratory uses specialized equipment to measure the electrical activity of heart muscle cells and image what he describes as “atrial fibrillation in a dish.”

Closing in on a pathway linking aging and Afib

Dr. Noujaim currently works with colleagues at USF and other institutions, including Tufts University, the University of Michigan, and Northeastern University, to investigate how age-related changes in specific potassium ion channels known as GIRK may trigger a cascade of molecular events leading to atrial fibrillation. His research, supported by a five-year $2.14 million RO1 grant from the National Heart, Lung and Blood Institute employs techniques including structural biology, molecular simulations, and cellular and whole organ electrophysiology.

The researchers hypothesize that in aging-associated atrial fibrillation, the condition may arise when a biochemical pathway controlling the GIRK postassium channels begins behaving abnormally, in part because of structural and metabolic cardiovascular changes that occur with aging.  High blood pressure, diabetes, and coronary artery disease– among the most common risk factors for atrial fibrillation – become more common as people grow older.

At USF, Dr. Noujaim collaborates with Javier Cuevas, PhD, in Molecular Pharmacology and Physiology, Michael Teng, PhD, in Molecular Medicine and in Allergy and Immunology, and Juan Del Valle, PhD, in Chemistry to investigate ways to target and block the GIRK potassium channels using pharmacological approaches that rely on immunology and chemistry.

Mohammed Alhadidy (left), a biomedical graduate student, and Bojjibabu Chidipi, PhD, a postdoctoral scholar in Molecular Pharmacology and Physiology, record the electrical signals from several cells using a multichannel automated patch clamp.

 The significance of investigating the relationship between aging and atrial fibrillation.

Designing a “perfect plug” using an antimalarial drug model

“Right now, we are trying to design a perfect plug using the antimalarial drug chloroquine as a model,” Dr. Noujaim said, “We have evidence that if we block that specific type of potassium channels we will be able to stop atrial fibrillation or at least reduce its occurrence.”

Earlier work by Dr. Noujaim and others, including a study reported in the journal FASEB, demonstrated that the antimalarial drug chloroquine was effective in blocking the GIRK potassium channels and suggested a new path for discovering antiarrhythmic drugs.

Dr. Noujaim continues using cellular and animal models to pinpoint how and where the chloroquine molecule interacts with the potassium channel – with the aim of discovering a “plug” that works even better than the antimalarial drug. At the same time, he has reached out to USF Health Department of Cardiovascular Sciences to begin applying the laboratory findings to the clinic.

Working with cardiologists Bengt Herweg, MD, and Dany Sayad, MD, Dr. Noujaim recently gained approval for a pilot study to enroll 40 adults without heart damage whose atrial fibrillation has persisted more than one week and less one year. The team will test the effectiveness of chloroquine in restoring and maintaining normal heart rhythm in patients with atrial fibrillation.

The laboratory uses techniques including structural biology, molecular simulations, and cellular and whole organ electrophysiology to conduct its NIH-funded research.

Collaborating with clinicians on new treatment options

Dr. Sayad, initially surprised at Dr. Noujaim’s proposal to try chloroquine, said the strength of the preclinical data convinced him of the antimalarial drug’s potential as another antiarrhythmic option. “Treating atrial fibrillation can be especially challenging in older patients, who experience a higher recurrence of atrial fibrillation (following cardioversion) and more failure on drugs used to regulate heart rhythm,” he said.

Clinicians help biomedical scientists like Dr. Noujaim frame and focus their studies to make the research more relevant to challenges faced in treating patients, such as maintaining sinus rhythm once a normal heartbeat has been restored.

“It does not mean that the fundamental, basic science questions are not important,” Dr. Noujaim said. “To the contrary, those questions are at the heart of every single experiment we do; however, we must always think about the big picture and why we are asking those questions. And that always goes back to the clinic.”

In previous electrophysiology experiments, Dr. Noujaim and colleagues helped better define the contribution of the nervous system within the heart, otherwise known as the intrinsic cardiac ganglia, to normal and abnormal heart rhythm. Using both mouse models and patients with atrial fibrillation, the study shed light on how nerves emerging from these cardiac ganglia regulate activity of the sinus node, the heart’s natural pacemaker.  The study appeared in Cardiovascular Research in 2013.

Dr. Noujaim with members of his research team, from left, Bojjibabu Chidipi, Mohammed Alhadidy and laboratory manager Michelle Reiser.

 Dr. Noujaim comments on the importance of a clinical perspective to frame biomedical research.

Impressed by USF’s biomedical research opportunities

Dr. Noujaim came to USF in 2015 from the Molecular Cardiology Research Institute at Tufts University School of Medicine. He received his PhD in pharmacology, with distinction, from SUNY Upstate Medical University in Syracuse, NY, followed by a year of postdoctoral training there.  He then completed a three-year postdoctoral fellowship, supported by the American Heart Association, and the National Institutes of Health, at the Center for Arrhythmia Research, University of Michigan, in Ann Arbor, MI.

Dr. Noujaim said he was attracted to USF by the opportunity to be part of an emerging preeminent university committed to establishing a cardiovascular institute bridging top biomedical research and clinical care.

“The opportunities that the University of South Florida is providing for scientists are equal or greater than those at any other major academic medical center,” he said.  “It was also striking to me that, in a place the size of USF, the USF Health leadership is so actively engaged in research, with their own laboratories and grants. That’s not what you would see in a lot of places, and as a biomedical scientist it makes me feel that the leadership here really values research.”

Dr. Noujaim is passionate about the cardiovascular research his laboratory conducts, which he says has taken on a greater sense of mission since his own family’s experience with sudden cardiac death and atrial fibrillation. 

 His take on the benefit of brainstorming with scientists in other disciplines.

Some things you may not know about Dr. Noujaim:

• Born in Lebanon, he moved to the United States after graduating from high school.
• He routinely swims laps in an indoor pool.
• He enjoys experimenting with cooking, specializing in inventing new dishes by combining ingredients he finds in his refrigerator. “I’ve discovered by trial and error that no matter how bad what I cook really is, adding a tablespoon of soy sauce makes it alright,” he said.
• His first scientific experiment as a college student volunteering in Boston’s Beth Israel Deaconess Medical Center laboratory was unforgettable. He fainted while his blood was being drawn so he could use it to help study blood platelet activation and aggregation. Click on video below to find out more.

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-Photos and video by Eric Younghans, and audioclips by Sandra C. Roa, USF Communications and Marketing

Tampa, FL (Nov. 10, 2015) – Dr. Arthur J. Labovitz, the Edward C. Wright endowed professor and chair of USF Health Department of Cardiovascular Sciences, has been appointed president of the American Heart Association (AHA) Tampa Bay Metro Board.  He will serve a two-year term.

Dr. Labovitz serves as acting co-director of the USF Health Heart Institute, which is committed to integrating the latest research and leading cardiovascular care. He is also director of the Cardiovascular Fellowship Program at USF and medical director for both non-invasive cardiology services and atrial fibrillation services at Tampa General Hospital.

Arthur Labovitz, MD

The AHA Tampa Bay Metro Board is responsible for advancing the health and revenue priorities of the organization. These include promoting cardiopulmonary resuscitation (CPR) training initiatives, engaging some of the largest and most influential local corporations with heart health activities, serving as leaders for advocacy and mission goals, and raising funds to advance the mission of the American Heart Association.

Throughout his career, Dr. Labovitz has maintained a strong relationship with the American Heart Association and mirrors his care of patients to be consistent with AHA guidelines. His first research study on heart failure was funded by the AHA. In addition, he held the position of president on the St. Louis Metro Board, and received the AHA’s 2007 Hugh McCulloch Award for distinguished contributions in the treatment of cardiovascular disease.

About USF Health
USF Health’s mission is to envision and implement the future of health. It is the partnership of the USF Health Morsani College of Medicine, the College of Nursing, the College of Public Health, the College of Pharmacy, the School of Physical Therapy and Rehabilitation Sciences; and the USF Physicians Group. USF Health is an integral part of the University of South Florida, a high-impact, global research university dedicated to student success. For more information, visit www.health.usf.edu

About the American Heart Association 
The American Heart Association is devoted to saving people from heart disease and stroke – America’s No. 1 and No. 5killers. We team with millions of volunteers to fund innovative research, fight for stronger public health policies, and provide lifesaving tools and information to prevent and treat these diseases. The Dallas-based association is the nation’s oldest and largest voluntary organization dedicated to fighting heart disease and stroke. To learn more or join us, call 1-800-AHA-USA1 or any of our offices around the country, or visit heart.org.
For more information about The American Heart Association Tampa Bay: www.Facebook.com/AHATampaBay, @HeartTampaBay.

WASHINGTON (Feb. 8, 2012) — The USF Health Morsani College of Medicine is partnering with the American College of Cardiology’s CardioSmart initiative, a program that encourages patients to play an active role in their own heart health, to offer free cardiovascular health screenings 11 a.m. to 2 p.m. on Thursday, Feb. 14, as part of a National Heart Health Awareness Day taking place at major health care institutions across the country.

 Members of the community will have access to body mass index measurements, glucose (non-fasting) testing, cholesterol tests, blood pressure tests and waist circumference measurements. Cardiologists and cardiology nurses will be on hand to answer questions, and patients will have access to CardioSmart educational materials that offer tips for living a heart healthy lifestyle.

The free screenings will be offered at the following two USF Health locations.  (A minimal parking fee may be required):

–          USF Health Morsani Center for Advanced Health Care, 13330 USF Laurel Drive, Tampa FL 33612

–          USF Health South Tampa Center for Advance Health Care, 2 Tampa General Circle,  Tampa, FL 33606

“Health screenings are important in helping identify people with cardiovascular disease who may not notice any symptoms yet.  Many people are not even aware of the risk factors, which include diabetes, high blood pressure, and elevated cholesterol,” said Arthur Labovitz, MD, FACC, chair of the Department of Cardiovascular Sciences at the USF Health Morsani College of Medicine. “USF Health is committed to reaching out to the community to offer a full spectrum of services, including prevention and early detection.”

Major healthcare institutions and academic medical centers nationwide will offer similar screenings in mid-February as part of CardioSmart’s American Heart Month initiative to raise awareness of preventative measures that can be taken to reduce the risk of heart disease — the leading cause of death for both men and women in the United States.

“To reduce their risk of heart disease, people need to learn what the risk factors are, know their individual numbers associated with those risks and know how to improve those numbers if needed,” said CardioSmart Chief Medical Expert JoAnne M. Foody, MD, FACC. “Lifestyle changes that are implemented today, like eating healthy and being active, can make a measurable difference in a person’s risk for heart disease in the future.”

For more information on the cardiovascular screenings at USF Health, contact Bonnie Kirby at bkirby@health.usf.edu or (813) 259-8543.

USF Health’s mission is to envision and implement the future of health. It is the partnership of the USF Health Morsani College of Medicine, the College of Nursing, the College of Public Health, the College of Pharmacy, the School of Biomedical Sciences and the School of Physical Therapy and Rehabilitation Sciences; and the USF Physician’s Group. The University of South Florida is a global research university ranked 50^th in the nation by the National Science Foundation for both federal and total research expenditures among all U.S. universities. For more information, visit www.health.usf.edu

 The mission of the American College of Cardiology is to transform cardiovascular care and improve heart health. The College is a 40,000-member medical society comprised of physicians, surgeons, nurses, physician assistants, pharmacists and practice managers. The College is a leader in the formulation of health policy, standards and guidelines. The ACC provides professional education, operates national registries to measure and improve quality of care, disseminates cardiovascular research, and bestows credentials upon cardiovascular specialists who meet stringent qualifications. For more information, visit www.cardiosource.org/ACC.

Media Contacts:
Nicole Napoli, American College of Cardiology, nnapoli@acc.org, (202) 375-6523
Anne DeLotto Baier, USF Health Communications, abaier@health.usf.edu, (813) 974-3303

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