baylor college of medicine quarterly review 2013

www.bcm.edu

A new approach to understanding osteoarthritis

Stronger and Healthier

BCM BITES

For the third year in a row, Baylor College of Medicine rose in the U.S. News & World Report rankings of top medical schools. The medical

school entered the ranks of the top 20 in the research category.

“These numbers show the growing strength of the Baylor College of Medicine community as a whole, making us the highest ranked medical school in Texas as well as in the southwest region,” said BCM President and CEO Dr. Paul Klotman. “We will continue to move forward as we focus on our missions of education, healthcare, research and community service.”

MEDICAL SCHOOL

in Texas

in Research

in Primary Care

in Pediatrics

GRADUATE SCHOOL*

in Biological Sciences

ALLIED HEALTH SCIENCES*

in Nurse Anesthesia

in Physician Assistant

M.D./M.B.A. Program with Rice University Business School,

ranked

.

M.D./J.D. Program with The University of Houston Law School,

ranked

for Health Law and

for Intellectual

Property Law.

M.D./M.P.H. Program with the University of Texas Health Science Center at The Houston School of Public Health, ranked

.

DUAL PROGRAMS

The relationships between Baylor College of Medicine and other Houston-based schools provides our students options to complete dual degrees with other programs that are also ranked among the best in the nation:

* Graduate School and Allied Health rankings are from previous years as U.S. News & World Report did not survey these areas this year.

1

Dr. Bradford Scott and Houston’s Tactical Medical Team practice emergency medical techniques during simulated encounters on the BCM campus.

PARTNERSHIP WITH SCHOOL DISTRICT BOOSTS SCIENCE EDUCATION

For years, Baylor College of Medicine has worked closely with the Michael E. DeBakey High School for Health Care Professions and nine other high schools to encourage students in health sciences fields. Now, the College is expanding its focus to include a middle school with that same intent.

The Houston Independent School District’s Board of Education has approved the creation of the Baylor College of Medicine Academy at Ryan, a new magnet middle school with a rigorous curriculum focused on the health sciences.

“Having been in Houston for 70 years, Baylor College of Medicine has always had a commit­ment to the community, especially when it comes to educating young people in the fields of science and math,” said Dr. Paul Klotman, president and CEO of BCM

The school will be aligned with DeBakey High School, which BCM and HISD have jointly operated since 1972. Now, with almost 6,000

SWAT TEAM TRAINING

For the second year in a row on Feb. 14, the surgical training group at Baylor College of Medicine welcomed Dr. David Persse, physician director of Emergency Medical Services for the City of Houston, and the city’s Tactical Medical Team for an exercise in simulating emergency response during stressful situations.

The Tactical Medical Team is called on to accompany the Houston Police SWAT team during high­risk encounters. Team members are specially trained and have knowledge of SWAT and police department operations.

Persse, who is also professor of medicine and surgery at BCM, and Dr. Bradford Scott, associate professor of surgery at BCM, simulated a series of scenarios on the BCM campus in which the responders practiced emergency medical techniques while encountering sounds of gunfire, people screaming, lights out and other similar challenges.

KEATHLEY OVERSEES CLINICAL EXPANSION

Wayne Keathley was named president of the Baylor College of Medicine Medical Center and Health Network.

The BCM Medical Center currently is being built out to serve as home to most of the College’s adult clinical practices, diagnostics and procedures. It is located on the McNair Campus of BCM, already home to the Lee and Joe Jamail Special Care Center.

Keathley is a health care industry veteran, most recently serving as president and chief operating officer of The Mount Sinai Hospital in New York City. Mount Sinai enjoyed remarkable growth under Keathley’s leadership, showing markedly improved operating and financial performance and credit strength. It first achieved national ranking as a “Best Hospital” by U.S. News and World Report during his tenure and earned Honor Roll status in 2012.

“BCM provides an exciting and unique platform to create a new paradigm for healthcare, with a commitment to creating a unique patient care experience and setting a new standard for clinical quality, patient safety and patient satisfaction,” Keathley said.

While academic medical centers often speak of a tripartite mission—education, healthcare, and research—we all, in fact, share one mission. Our raison d’êtra is to improve lives.

This issue of BCMQ highlights some of the very different ways in which Baylor College of Medicine is pursuing our goal. Researchers like Dr. Brendan Lee (page 4) are creating tools, making discoveries, and applying their findings in the clinic for the benefit of patients.

Our new partnership in San Antonio (page 8), our work with the Houston Emergency Medical Services (page 1), and the new Baylor College of Medicine Academy at Ryan (page 1) are recent examples of our working with other institutions to ensure access to opportunities and high­quality care for patients whether in Texas, Botswana, Honduras or elsewhere in the world.

The exceptional work of the BCM Resource Stewardship and Sustainability Program (page 2) exemplifies our commitment to ensure that every aspect of our organization carries out its work in a manner that contributes to the betterment of our world.

These stories and the others in this issue represent just a few of the ways in which we are fulfilling our mission. I look forward to sharing more with you in future issues.

Best regards.Paul Klotman, MD President and CEO, Baylor College of Medicine

Welcome toBCM Quarterly.

TABLE OF CONTENTS

BCM Update ...................................................... 1

Accolades ............................................................3

Stronger and Healthier ....................................4

Texas Institutions Team Up for San Antonio’s Children ...................................8

Research Briefs ...............................................10

BCM BITES

For the third year in a row, Baylor College of Medicine rose in the U.S. News & World Report rankings of top medical schools. The medical

school entered the ranks of the top 20 in the research category.

“These numbers show the growing strength of the Baylor College of Medicine community as a whole, making us the highest ranked medical school in Texas as well as in the southwest region,” said BCM President and CEO Dr. Paul Klotman. “We will continue to move forward as we focus on our missions of education, healthcare, research and community service.”

MEDICAL SCHOOL

in Texas

in Research

in Primary Care

in Pediatrics

GRADUATE SCHOOL*

in Biological Sciences

ALLIED HEALTH SCIENCES*

in Nurse Anesthesia

in Physician Assistant

M.D./M.B.A. Program with Rice University Business School,

ranked

.

M.D./J.D. Program with The University of Houston Law School,

ranked

for Health Law and

for Intellectual

Property Law.

M.D./M.P.H. Program with the University of Texas Health Science Center at The Houston School of Public Health, ranked

.

DUAL PROGRAMS

The relationships between Baylor College of Medicine and other Houston-based schools provides our students options to complete dual degrees with other programs that are also ranked among the best in the nation:

* Graduate School and Allied Health rankings are from previous years as U.S. News & World Report did not survey these areas this year.

Baylor College of Medicine is the academic center around which the Texas Medical Center, the world’s largest health center, evolved.Within the four schools of BCM our faculty creates, imple­ments and shares new knowledge, new systems and new technologies that improve the lives of our patients, our community, our nation and our world.

Baylor College of Medicine – Consistently ranked as one of the leading research­intensive medical schools in U.S. News & World Report and ranked sixth in the nation by StudentDoc.com, BCM is the least expensive private medical school in the U.S.

BCM Graduate School of Biomedical Sciences – BCM’s extensive research portfolio combined with faculty who are world­leaders in their fields support 12 programs, which are ranked among the top 10 percent of graduate programs in biological sciences

BCM School of Allied Health Sciences – Drawing highly regarded applicants from throughout the region and the nation, the programs of BCM School of Allied Health Sciences consistently rank among the best in the country.

BCM National School of Tropical Medicine – This is the only school in the nation dedicated exclusively to patient care, research and education related to neglected tropical diseases, the most common infections of the world’s poorest people.

At BCM, leading research and technology translate to exceptional patient care. Our doctors and staff provide a patient -centered, multi disciplinary team approach to healthcare with a focus on quality and safety. More than 2,000 BCM doctors care for patients in over 40 locations across the Houston area, including:

Baylor ClinicLee and Joe Jamail Specialty Care CenterAffiliated Hospitals Children’s Hospital of San Antonio Harris Health System Ben Taub Hospital and health centers Michael E. DeBakey Veterans Affairs Medical Center St. Luke’s Episcopal Hospital Texas Children’s Hospital TIRR Memorial Hermann The Menninger Clinic The Methodist Hospital The University of Texas MD Anderson Cancer Center

1

Dr. Bradford Scott and Houston’s Tactical Medical Team practice emergency medical techniques during simulated encounters on the BCM campus.

PARTNERSHIP WITH SCHOOL DISTRICT BOOSTS SCIENCE EDUCATION

For years, Baylor College of Medicine has worked closely with the Michael E. DeBakey High School for Health Care Professions and nine other high schools to encourage students in health sciences fields. Now, the College is expanding its focus to include a middle school with that same intent.

The Houston Independent School District’s Board of Education has approved the creation of the Baylor College of Medicine Academy at Ryan, a new magnet middle school with a rigorous curriculum focused on the health sciences.

“Having been in Houston for 70 years, Baylor College of Medicine has always had a commit­ment to the community, especially when it comes to educating young people in the fields of science and math,” said Dr. Paul Klotman, president and CEO of BCM

The school will be aligned with DeBakey High School, which BCM and HISD have jointly operated since 1972. Now, with almost 6,000

SWAT TEAM TRAINING

For the second year in a row on Feb. 14, the surgical training group at Baylor College of Medicine welcomed Dr. David Persse, physician director of Emergency Medical Services for the City of Houston, and the city’s Tactical Medical Team for an exercise in simulating emergency response during stressful situations.

The Tactical Medical Team is called on to accompany the Houston Police SWAT team during high­risk encounters. Team members are specially trained and have knowledge of SWAT and police department operations.

Persse, who is also professor of medicine and surgery at BCM, and Dr. Bradford Scott, associate professor of surgery at BCM, simulated a series of scenarios on the BCM campus in which the responders practiced emergency medical techniques while encountering sounds of gunfire, people screaming, lights out and other similar challenges.

KEATHLEY OVERSEES CLINICAL EXPANSION

Wayne Keathley was named president of the Baylor College of Medicine Medical Center and Health Network.

The BCM Medical Center currently is being built out to serve as home to most of the College’s adult clinical practices, diagnostics and procedures. It is located on the McNair Campus of BCM, already home to the Lee and Joe Jamail Special Care Center.

Keathley is a health care industry veteran, most recently serving as president and chief operating officer of The Mount Sinai Hospital in New York City. Mount Sinai enjoyed remarkable growth under Keathley’s leadership, showing markedly improved operating and financial performance and credit strength. It first achieved national ranking as a “Best Hospital” by U.S. News and World Report during his tenure and earned Honor Roll status in 2012.

“BCM provides an exciting and unique platform to create a new paradigm for healthcare, with a commitment to creating a unique patient care experience and setting a new standard for clinical quality, patient safety and patient satisfaction,” Keathley said.

2

graduates, the high school is recognized as one of the finest in the country, with U.S. News & World Report ranking it at No. 4 in Texas and No. 36 nationally.

“Middle school is a critical transition point for many students. We hope that the new program will stimulate their interest in and enthusiasm for health and science careers,” said Dr. Nancy Moreno, professor and senior associate director of BCM’s Center for Educational Outreach. “The new program will enable middle school students to explore real­world topics in science and health as well as career opportunities in a variety of fields.”

MATCH MADNESS

Match Day, the day graduating medical students across the country discover where they will be going for residency training, is always filled with both anxiety and excitement. Upon opening her envelope this year, Elyse Portillo discovered pure joy. She matched to her first choice program, pediatrics at Children’s Hospital of Boston.

While at BCM, Portillo enrolled in a dual degree program with The University of Texas School of Public Health to earn a master’s in public health along with her medical degree. Her passion is for healthcare for the underserved, and she was able to pursue that passion through BCM’s Care of the Underserved Track, for which she served as student coordinator, and through outreach projects of the Latino Medical Student Association.

One day she plans to couple pediatric clinical practice in an underserved urban setting with leadership in community­based interventions to improve access to care for underserved families, especially those in the Latino immigrant population.

Porillo’s 188 classmates participating in the Match also had cause for celebration. Students matched all over the country with 42 staying at BCM and 90 entering primary care residency programs.

RECYCLING EFFORTS EARN TOP STATE HONORS

Baylor College of Medicine is the top medical school in Texas, according to U.S. News & World Report. But that’s not all. It’s also the top school in the state—and fourth in the nation—in recycling.

The ranking was the end result of an eight­week competition in which colleges and uni­ver sities were ranked according to how much recycling, trash and food waste they collected. RecycleMania included more than 523 institu­tions in the period from February 3 to March 30.

During that time, BCM recycled more than 69 tons of paper, plastic and aluminum. That translates to preventing the release the equivalent of 193 metric tons of carbon dioxide into the atmosphere.

“BCM’s recycling program is almost entirely volunteer­driven, highlighting the importance the BCM community places on recycling and the environment,” said Gabi De la Rosa, coordinator of BCM’s recycling program, called the BCM Resource Stewardship and Sustainability Program.

Recycling is a yearlong program at the College.Some stats from 2012:

n Recycled more than 709,000 pounds of paper/cardboard—enough to save 7,234 trees

n Recycled 73 tons of metal—enough to make 73 full­sized cars

n Recycled 6 tons of plastic—or enough to save 23 barrels of crude oil

n Conserved more than 33 million gallons of water—enough to fill 53 Olympic­sized swimming pools

One of BCM’s newest doctors, Dr. Caitlin Rexses, takes time celebrate with her family during Match Day festivities.

3

Dr. Matthew Rasband, professor of neuroscience at Baylor College of Medicine, was awarded the Javits Neuroscience Investigator Award.

Dr. Cameron Decker, emergency medicine resident at Baylor College of Medicine, is president of the Emergency Medicine Residents’ Association.

Dr. Greg Butler, assistant professor of emergency medicine at Baylor College of Medicine, was named a fellow of the American College of Emergency Physicians.

Dr. Ervin Adam, pro­fes sor of molecular virology and microbiology at Baylor College of Medicine, received the Ceska Hlvana Award, the highest scientific award given in the Czech Republic.

Dr. Mauro Costa-Mattioli, assistant professor of neuroscience at Baylor College of Medicine, was awarded the Inter-national Society for Neurochemistry’s Young Scientist Lectureship Award.

“I am pleased to be able to congratulate some of my BCM colleagues who have recently been honored for the outstanding work they do.”

Dr. Paul Klotman, president and CEO

ACCOLADES

Dr. Dennis Bier, director of the USDA/ARS Chil­dren’s Nutrition Research Center at Baylor College of Medicine, was awarded the Rhoads Lecture and Award by the American Society for Parenteral and Enteral Nutrition.

Dr. Bert O’Malley, chair of molecular and cellular biology at Baylor College of Medicine, received a Breast Cancer Research Program Innovator Award from the U.S. Department of Defense.

Dr. J. Clay Goodman, professor of pathology & immunology and of neurology and assistant dean for medical educa­tion at Baylor College of Medicine, was appointed a neurology director of the American Board of Psychiatry and Neurology.

Dr. John Oldham, pro­fessor in the Mennin ger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, is one of the editors of the new open­access journal, Borderline Personality Disorder and Emotion Dysregulation.

Dr. Douglas Koch, pro­fessor of ophthalmology at Baylor College of Medicine, was named recipient of the Leslie Dana Gold Medal by the St. Louis Society for the Blind and Visually Impaired.

Dr. James Lupski, vice chair and professor of molecular and human genetics, and Dr. Ken McClain, professor of pediatrics­ hematology/oncology, at Baylor College of Medicine, have been named to the Rare Disease Research Hall of Fame.

Dr. Samir Desai, assistant professor of medicine at Baylor College of Medicine, gave the keynote address at the University of Nebraska Residency Symposium.

Dr. Christie Ballantyne, professor of medicine and chief of the section of cardiology and cardiovascular research at Baylor College of Medicine, was awarded the 2013 Distinguished Scientist Award by the American College of Cardiology.

Dr. Susan Rosenberg, professor of molecular and human genetics, and Dr. Richard Lloyd, professor of molecular virology and microbiology at Baylor College of Medicine, were elected fellows in the American Academy of Microbiology.

Dr. Martin Matzuk, professor of pathology & immunology and director of the Center for Drug Discovery at Baylor College of Medicine, was awarded the International Fundacion IVI Award for the Best Basic Research Record in Reproductive Medicine over the last five years.

Dr. Shigenori Hirose, postdoctoral associate in the laboratory of mentor Dr. Adam Kuspa, professor and senior vice president for research at Baylor College of Medicine, and Dr. Liya Hu, postdoctoral associate in the laboratory of mentor Dr. B.V.V. Prasad, professor of bio­chemistry and molec ular biology and molecular virology and microbiology at Baylor College of Medicine, received the Ruth McLean Bowman Bowers Excellence in Research Awards.

Lex Frieden, adjunct, professor of physical medicine and rehabili­tation at Baylor College of Medicine, received a 2013 Henry Viscardi Achievement Award in recognition of his work as a founder and leader of the independent­living movement by people with disabilities and for his involvement in drafting the Americans with Disabilities Act.

Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, gave the 2013 David Packard Lecture at the Uniformed Services University of the Health Sciences.

Dr. Rajani Katta, professor of dermatology at Baylor College of Medicine, was elected to the board of directors of the American Contact Dermatitis Society.

Molly Gee, registered dietician at Baylor College of Medicine, was elected registered dietician on the Commission on Dietetic Registration, the credential agency for the Academy of Nutrition and Dietetics.

4

(Top left) Sagittal section (showing half the body) of a mouse embryo at 13.5 days of gestation. Color was applied according to density of the tissue after the scan. (Top right) Sagittal section of a one-day-old mouse knee joint. Color was applied according to density of the tissue after the scan, which shows femur, tibia and muscles. (Middle right) Three-dimensional reconstruction of the urinary system of a 15.5-day old mouse embryo. Image shows kidneys, testicles and bladder. (Bottom) Sagittal section of a healthy adult mouse knee joint. Bone is labeled in white, femoral cartilage in red, tibial cartilage in green and menisci in blue.

5

For years, Dr. Brendan Lee has concen­trated on genetic diseases that affect the bones and cartilage—usually beginning in childhood. In a recent article in the journal Science Translational Medicine, he and members of his laboratory took on a problem with a delayed onset and a growing patient population—osteoarthritis.

Osteoarthritis occurs when cartilage in the joint breaks down. Bones rub against one another, causing pain, stiffness and loss of movement. For 27 million Americans, it is a daily burden, lessening mobility and resulting in frequent pain.

“All of us will get it if we live long enough,” said Lee, professor of molecular and human genetics at Baylor College of Medicine and director of the Rolanette and Berdon Lawrence Bone Disease Program of Texas. “Yet, in spite of a lot of investment, particularly on the part of industry, there is no disease­modifying treatment that truly impacts the course of osteoarthritis. There is physical therapy. You can inject hyaluronic acid into the joint to ease pain and stiffness. Those may have some benefit, but they do not affect the course of the disease.”

Joint replacement is another possibility, but it has its own risks and benefits.

Lee has spent his career looking for answers to genetic diseases. As a student in the 1980s, he cloned genes for two connective tissues disorders—Marfan syndrome and skeletal dysplasias, findings that set his course in life. He went on to earn an M.D. and Ph.D. degrees because he was interested in translational medicine— taking laboratory findings into the clinic and back again. He has used those skills to have an impact on a host of genetic diseases.

“We believe in using mouse and human genetics to try to determine the best molec­ular targets to go after. Then we try to develop tools to achieve those therapeutic goals,” Lee said.

“You might ask why it has been so hard to make an impact in osteoarthritis.”

There are many answers to that question. One basic answer is that the optimal tools to study this problem genetically did not exist.

Stronger and HealthierA new approach to understanding osteoarthritis

6

Building tools is something Lee’s laboratory does best.

Dr. Merry Ruan, now a postdoctoral fellow in Lee’s laboratory, was the “super talented” graduate student who took the lead on the project to develop the imaging tool that allowed the use of mice as a model of osteoarthritis.

Quantifying the changes in cartilage in the joints of mice is a painstaking task. “The usual way of evaluating cartilage to determine if it is deteriorating is time consuming and the evaluation can be subjective,” she said. “Healthy joints do not always look like the textbook.”

Instead, she and Lee decided that a three­dimensional system might result in better findings. At a retreat attended by bone researchers, she saw a three­dimensional image of a mouse embryo that was incredibly detailed. The researcher told her he used a machine developed for the oil and gas industry. That solved the hardware problem, said Ruan.

Software developed by a professor in Tokyo allowed her to select and quantify portions of the three­dimensional image. Yet that still did not provide the best image of the soft tissues. Most stains do not work well, but she found one used in electron microscopy involving the use of heavy metals. The soft tissue absorbs the stain, which then is more visible to the X­rays.

With this in place, she could look at the volume of cartilage in a joint, the amount of surface area it covers and whether the coverage was of equal thickness or had a sandpaper­like effect cause by pieces of bone. The quantification steps were necessary to find out if the cartilage has degraded. The pieces of bone have implications for pain. “It’s like having little pebbles in your shoes, only it is in your joint,” she said.

“We call the technique phased contrast ultra­high resolution micro­CT,” said Lee. “It’s similar to doing MRI (magnetic resonance imaging, which produces pictures of soft tissue) but at the resolution of CT (that normally does not allow you to see soft tissues).”

Now that they had the tool necessary to determine the effect of their genetic manipulations on the cartilage, they had to look for a molecular target.

“We asked, ‘Is there a human genetic disease where parents or children get early onset osteoarthritis?” Lee said. It turns out there is, a disorder known as Camptodactyly­Arthropathy­Coxa Vara­Pericarditis Syndrome. Those who have it lack a protein called lubricin, which is made by cartilage and the tissue around the joint called the synovium. The common thought was that lubricin lubricated the joint—hence the name.

The gene associated with the disorder is proteoglycan 4. When the gene is knocked out in mice, they develop osteoarthritis.

It might seem that the answer would be to simply pump more lubricin into the joint. Cartilage, however, is a tough tissue. As it provides a barrier between bones, it also is a barrier to drugs. The answer, they thought, might lie with the gene itself—proteoglycan 4.

“We did a simple genetic experiment—overexpressing lubricin in the cartilage of mouse knee joints,” said Lee. “If loss of this

“It’s similar to doing MRI (magnetic resonance imaging, which produces pictures of soft tissue) but at the resolution of CT (that normally does not allow you to see soft tissues).”

– Dr. Brendan Lee

7

protein actually affects the metabolism of the cartilage, fighting against the negative effects of osteoarthritis.

“We have something that we can inject into the joint that will protect against osteoarthritis,” said Lee.

This is just the beginning. Lee does not think lubricin will become a magic pill on its own. Osteoarthritis is complicated. The ideal therapy would be to add something to fight inflammation and maybe even regenerate cartilage.

Yet he and colleagues are now beginning to test the potential of their therapy in large animals. The future in humans would probably start with those athletic injuries that lead to post­traumatic osteoarthritis.

Many questions remain. When would you intervene with this treatment in osteoarthritis? And how do you assess the disease in humans? What are the markers and what imaging would give the best answer as to the stage of the disease?

“Could you give this to someone to prevent age­related changes?” said Lee. That question is one of many that remain to be answered. •

Drs. Brendan Lee and Merry Ruan

protein causes early onset osteoarthritis, will making more be protective or does too much cause a problem?”

“We assessed the mouse making more lubricin in their cartilage and we found, to our delight, that there was nothing wrong with it.”

Then they tried overexpressing lubricin in mice who had a traumatic form of osteoarthritis—similar to athletic injuries. Using both their three­dimensional imaging technique and histology, they confirmed that these mice were protected against osteoarthritis.

“Then we said, ‘What about age­related changes?” said Lee. Again, the cartilage of old mice that overexpressed lubricin looked like that of a young mouse. The protein protects against age­related cartilage changes.

Now that they had a target, Lee and his team had to turn knowledge into therapy.

“We took advantage of 20 years of work we and others have done in gene therapy,” he said. “We asked what would happen if we put this gene into a helper­dependent adenoviral vector, discovered at Baylor by Dr. C. Thomas Caskey in the 1990s?”

They found that one injection of the adeno­viral vector into the joint resulted in sustained expression—expression that lasted as long as the mouse lived. When they added the proteoglycan 4 gene to the vector and injected into the joint, again they got sustained expression. The lubricin was expressed and the mouse protected against osteoarthritis­ both after injury or with aging.

“How can you explain such a dramatic effect?” said Lee. “Is it really just lubri­cation?” When they did a very high resolu­tion microarray analysis looking at all the RNA molecules and what happened in cartilage, they found that the lubricin

8

Just east on I­10, in fact.

In an all­Texas announcement, hospital officials reported they would move forward on their plans for the only freestanding children’s hospital in San Antonio, located in the heart of downtown, with Baylor College of Medicine and Texas Children’s Hospital as affiliates.

The news was sweet for a crowd packed in the lobby of the hospital on Feb. 28. Bringing in Baylor to recruit, employ and oversee physicians, and Texas Children’s to provide consulting and clinical expertise gave the San Antonio hospital a significant boost.

In April 2012, CHRISTUS Health System, which owns the hospital, announced that it would renovate its downtown hospital to become a separate children’s hospital.

In September of the same year, The Uni­versity of Texas Health Science Center at San Antonio, the hospital’s long­time academic partner, made the decision to end its relationship with CHRISTUS. Thus started the search for a new academic affiliate.

“We’re here for the long haul,” BCM President and CEO Dr. Paul Klotman said to

Texas Institutions Team Up for San Antonio’s ChildrenWith the goal of providing world class pediatric care, leaders of Children’s Hospital of San Antonio sought affiliates with the experience and expertise necessary to realize this goal. They didn’t have to go very far.

Architectual rendering of the planned Children’s Hospital of San Antonio

9

the crowd. “Baylor and Texas Children’s are able to provide a level of expertise in a short period of time that otherwise would take decades to build. This is not some vestigial opportunity for us. It is key to our mission. It’s who we are and what we want to do.”

Dr. Mark Kline, chair of pediatrics at BCM and physician­in­chief at Texas Children’s, and Dr. Charles Fraser, surgeon­in­chief at Texas Children’s and head of congenital heart surgery at BCM, also were on hand for the announcement.

BCM is actively recruiting physicians for its faculty in San Antonio. They will be 100 percent based in the city. Dr. Mark Gilger, who pre viously served as section head and service chief of pediatric gastroenterology at Baylor and Texas Children’s, assumed the position of pediatrician­in­chief for Children’s Hospital of San Antonio and BCM vice chair of pediatrics for San Antonio on March 1.

A beaming Pat Carrier, president and CEO of CHRISTUS Santa Rosa, introduced the new team.

“Our children have always been first,” Carrier said. “The physicians and staff at Baylor College of Medicine and Texas Children’s Hospital share the same mindset. As three Texas home­grown, not­for­profit organizations, we know the needs of Texas children best. ”

Klotman was quick to acknowledge the Sisters of Charity of the Incarnate Word, who opened the first hospital in San Antonio in 1869.

“I met the sisters,” he said, looking over at several members of the order attending the announcement. “And I already have a homework assignment. Two­volume history. Next time I’m here I’m going to be tested thoroughly. We’re an academic organization. I’ve got to live up to their expectations.” •

Baylor College of Medicine registered nurse Alma Flores with Vannie Cook patient Leidy Martinez.

VANNIE E. COOK CHILDREN’S CANCER CENTER AND HEMATOLOGY CLINIC

For parents, it is devastating and scary when their child is diagnosed with cancer. For many years, families in the Rio Grande Valley also had to endure the hardship of traveling to Houston or San Antonio for treatment.

But since the opening of the Vannie E. Cook Jr. Children’s Cancer and Hematology Clinic in McAllen, Texas, in 2001, Rio Grande families have access to state­of­the art treatment in their own backyard.

Today, the Vannie Cook Children’s Cancer Clinic has treated more than 6,200 patients from the region. It offers comprehensive treatment and services, including the Rio Grande Valley’s first flow cytometry lab, which allows for faster diagnosis and initiation of treatment. Clinic services and programs also include a Long­Term Survivor Clinic, Cancer Genetics Clinic and the Childhood Cancer Epidemiology and Prevention Program.

The Vannie Cook Cancer’s Clinic is a joint program of Baylor College of Medicine, Texas Children’s Cancer Center and the Vannie E. Cook Jr. Cancer Foundation.

10

PUBLIC DATABASES, GENEALOGY SITES CAN BE PRIVACY THREAT

The explosion of genomic information on the worldwide web—both publicly funded genetic research and private

genetic genealogy—can be exploited by people with computer know­how and access to the Internet to identify individuals—even those for whom the computer experts do not have a DNA sample, said a consortium of researchers that includes those from Baylor College of Medicine in a report in the journal Science.

While other scientific articles have looked at the vulnerabilities of such databases, “This is the first one that shows you can identify people even without a reference sample,” said Dr. Amy McGuire, director of the Center for Medical Ethics and Health Policy at BCM and an expert in the ethics of genomic studies.

She emphasized that work is ongoing to enhance privacy protections and at the same time inform would­be research participants of the risks involved.

Funding for this work came from the National Defense Science and Engineering Graduate Fellowship and the Edmond J. Safra Center for Bioinformatics at Tel-Aviv University.

NEW CLUE FOR PROSTATE CANCER PROGNOSIS

The answer to which prostate cancers can be watched and which should be treated quickly may lie with a receptor called

COUP­TFII.

In a report in the journal Nature, Drs. Ming­Jer and Sophia Tsai, both professors of molecular and cellular biology at BCM, and their colleagues showed that overexpression of the receptor can overcome a natural barrier to progression of prostate cancer, allowing tumor cells to metastasize. Add the receptor to known markers for prostate cancer and the ability to predict progression of the cancer is enhanced, they said.

Mice studies show that loss of COUP­TFII inhibits the development of prostate tumors. On the other hand, in mice that produce insufficient levels of the protein PTEN, high levels of COUP­TFII enhances prostate tumor pro gres sion and spread.

Dr. Sophia Tsai holds the Gordon Cain Professorship and Dr. Ming­Jer Tsai holds the Charles C. Bell, Jr. and Distinguished Service Professorship in Cell Biology.

Funding for this study came from the National Institutes of Health (NIH DK62434, DK59820, DK45641 and HL76448).

LESS TAU REDUCES SEIZURES AND SUDDEN DEATH IN SEVERE EPILEPSY

Deleting or reducing expression of agene for tau, a protein associated with

Alzheimer’s disease, can prevent seizures in a severe type of epilepsy linked to sudden death, said researchers at Baylor College of Medicine and the Mayo Clinic in Jacksonville, FL, in the Journal of Neuroscience.

A growing understanding of the link between epilepsy and some forms of inherited Alzheimer’s disease led to the finding that could point the way toward new drugs for seizure disorders said Dr. Jeffrey Noebels, professor of neurology at BCM, and director of the Blue Bird Circle Developmental Neurogenetics Laboratory.

When Jerrah Holth, a graduate student in molecular and human genetics at BCM, deleted the gene for tau in mice with a severe form of epilepsy, the mice had no seizures or sudden death.

The work was funded by the National Insti tutes of Health, the Epilepsy Foundation and the Blue Bird Circle Foundation.

STRESS, MUTATION, ADAPTATION RESPONSES ILLUMINATED BY GENE NETWORK

For much of her professional life,  Dr. Susan Rosenberg has studied the puzzling response of bacteria to stress and the mutations that result. In the journal Science, she puts together the pieces of that puzzle, describing most of the members of an elaborate gene network that functions in causing mutations during repair of double­stranded breaks in the DNA of stressed cells.

Rosenberg, professor of molecular and human genetics at Baylor College of Medicine, has shown that the rate of mutation can be increased in response to stress such as starvation or environmental challenges such as antibiotics. In this work, she and her colleagues sought to define the cellular pathways that result in this stress response.

“We screened for every gene in Escherichia coli that is needed to make this happen,” said Rosenberg. They found that the mutagenic part of the process is not required to repair the broken DNA strands. When they “knock out” or remove the special “error­prone” DNA copying enzyme or polymerase, “the DNA is repaired beautifully and there are no mutations.” So, this mechanism appears to regulate production of mutations, making more during stress, when cells are poorly adapted to their environments, and most likely to benefit from mutations.

The work is also a demonstration that it is possible to detangle large protein networks into specific biological functions, which may be applicable to other networks.

Funding for this work came from grants from the National Institutes of Health and National Science Foundation.

11

APPETITE LINKED TO BONE MARROW CELLS

The trigger for appetite starts with bone marrow cells that produce a protein called brain­derived neurotrophic

factor (BDNF), said BCM researchers in the journal Nature Communications.

Dr. Lawrence Chan, professor of molecular and cellular biology and director of the Diabetes Research Center at BCM, and colleagues found that the bone marrow cells travel to part of the hypothalamus in the brain where they fine tune appetite.

The studies represent a new mechanism by which these bone­marrow derived cells control feeding through BDNF and could provide a new avenue to attack obesity, Chan said.

Chan holds the Betty Rutherford Chair for Diabetes Research.

Funding for this work came from the Ministry of Education, Culture, Sports, Science and Technology, Japan; the President’s Discretionary Fund from Shiga University of Medical Science and the U.S. National Institutes of Health and the Diabetes Research Center.

NOVEL MECHANISM FOR MEMORY STORAGE

A single introduction goes in one ear and out the other, but if you chat with a person two or three times, your brain stores

the name, taking a short­term memory—the introduction—and converting it into a long­term one. The molecular key to this activity is mTORC2 (mammalian target of rapamycin complex 2), said researchers at Baylor College of Medicine in Nature Neuroscience.

“Understanding the precise mechanism by which memories are stored in the brain will lead to the development of new treatments for conditions associated with memory loss,” said author Dr. Mauro Costa­Mattioli, assistant professor of neuroscience at BCM. A small molecule he has identified activates mTORC2 to modulate the actin fibers, enhancing not only the synaptic strength between nerve cells but also long­term memory formation. A second drug that directly promotes actin polymerization promotes long­term memory more easily.

Funding for this work came from the National Institute of Mental Health, the National Institute of Neurological Disorders and Stroke, The Searle Award, a Whitehall Award, The George and Cynthia Mitchell Foundation, the National Institutes of Health and a Texas Norman Hackerman Advanced Research Program Award.

12

UNDOCUMENTED HISPANIC PATIENTS ADHERE

TO HIV TREATMENT

While undocumented Hispanic patients seek treatment at a more advanced stage of HIV than other patients, the

outcomes of their therapy are the same or better than those of other patients, said researchers from Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center in a report in PLoS One.

The finding has significant public health implications,” said Dr. Thomas Giordano, associate professor of medicine – infectious diseases at BCM and a member of the Health Services Research and Development Services Center of Excellence at the MEDVAMC. A review of more than five years of patient data showed that once undocumented HIV patients got into care, they got their HIV under control as well or better than patients from other ethnic groups. The study included more than 1,500 patients at Thomas Street Health Center, part of publicly funded Harris Health System, which cares for all patients with HIV.

GENE THERAPY REBUILDS BLOOD VESSELS

A 10­year review of patients with severe coronary artery disease who underwent gene therapy with a factor that

encourages the growth of blood vessels is encouraging, said Dr. Todd Rosengart, professor and chair of the Michael E. DeBakey Department of Surgery at Baylor College of Medicine, who oversaw the review of the patients treated at Weill Cornell Medical College in New York. The study, which was printed in the journal Human Gene Therapy, followed 31 patients who were diagnosed with severe coronary artery disease and given a direct injection into their heart muscle of a gene therapy that used a vector called an adenovirus to take the angiogenic growth factor (AdVEGF121) into the tissue. At five and 10 years, patients were as likely or more likely to be alive than those with similar heart issues treated with traditional medical therapy.

Rosengart, co­senior author, participated in the study while in his former position at Stony Brook University Medical Center.

This study was funded in part by a grant from the Lisa and James Cohen Foundation and supported, in part, by the Qatar Foundation and Weill Cornell Medical College in Qatar.

MUTATION LOCATION KEY IN

RETT SYNDROME PROGNOSIS

The location of mutations in the gene MECP2 affects the severity

of the symptoms experienced in Rett syndrome, said BCM researchers in the journal Cell. Dr. Huda Zoghbi, professor of molecular and human genetics at BCM and director of the Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, found the MECP2 gene in 1999, and confirmed that deficiency in the protein causes Rett syndrome, a post natal genetic disease that mainly affects girls. In this work, Zoghbi and colleagues, using data from rare male patients with disruptions in MECP2, found that place­ment of the mutations determines severity of the disease. The boys either suffered severe brain disease and death before age 4 or lived for decades with symptoms similar to Rett or other disorders. The differences depended on where in the gene the mutation occurred. Mouse studies showed that animals with mutations at amino acid 273 lived longer and developed symptoms later than mice who had mutations at amino acid 270 or those who lacked the MECP2 protein all together.

Funding for this work came from the Howard Hughes Medical Institute, the National Institute of Neurological Disease and Stroke, and the Baylor College of Medicine Intellectual and Developmental Disability Research Center.

Funds for this publication were provided by the BCM President’s Circle.

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