By Ben Boulden

To the sounds of bingo numbers being called out, speakers on a main stage and the general murmur of conversations, several hundred seniors circulated through the Statehouse Convention Center in downtown Little Rock to participate in the Senior Expo.

Sponsored by UAMS and presented by the Arkansas Democrat-Gazette, the event pulled visitors from throughout central Arkansas and beyond.

About 243 seniors received free health screenings for blood glucose, blood pressure and heart rate as well as medication and vaccination education.

The UAMS Donald W. Reynolds Institute on Aging provided geriatricians to give free consultations throughout the day at the “Ask the Doctor” booths. UAMS Harvey & Bernice Jones Eye Institute staff performed 60 vision screenings.

As part of a panel discussion and question-and-answer session, Jeanne Wei, M.D., Ph.D., executive director of the UAMS Donald W. Reynolds Institute on Aging, and Johnathan Goree, M.D., director of Interventional Pain Management Services at UAMS, gave a presentation on “New Treatments for Managing Pain.”

Both Goree and Wei agreed someone experiencing pain, particularly in the joints and limbs, should not stay still for too long.

“I work with a physical therapist who says ‘movement is lubrication for the joints,’” Goree said. “One of the best things you can do to keep out of our offices is to keep moving. Pain makes you want to keep from moving. Pain can cause inactivity and inactivity can cause pain”

Wei provided three tips for treating acute pain:

• Applying ice to an affected area is the best because it stops nerve traffic and reduces inflammation, making it easier to recover.
• Taking over-the-counter medications like acetaminophen or ibuprofen for the first 48 hours.
• Keeping an affected arm, leg or foot above the level of your heart, so fluids can drain and reduce swelling.

“All of us know there is an epidemic of opioids and other medications that don’t really work for ongoing pain,” Wei said. “We don’t want anybody to get hurt by continuing to take those medicines long term. Research has shown that you only need between three days to seven days of a prescription of opioid medication after a surgery or procedure or injury.”

For anyone, but especially for patients older than 60, use of opioids to treat chronic pain can lead to negative side effects like nausea, constipation, respiratory changes, falls, walking difficulty and bladder issues.

Beyond just a few days of opioid use, patients should try to use mindfulness, meditation and even hypnosis to cope with the mental and emotional stress of chronic pain.

Among the UAMS services and medical specialties represented at the Expo with booths were geriatrics, orthopaedics, caregiver training, ARresearch, stroke, vascular, cancer and nutrition services.

Other presentations made by UAMS physicians included: “Retinal Diseases— Seeing into Your Senior Years,” ophthalmologist Ahmed Sallam, M.D.; “Colon Cancer Screening: Why It’s More Important Than Ever,” colorectal surgeon W. Conan Mustain, M.D.; “Protecting Our Hands and Wrists,” orthopaedic surgeon Theresa Wyrick-Glover, M.D.

By Ben Boulden

One patient with sickle cell disease can experience severe pain and other symptoms while another with the same disease type only has moderate or even mild pain crises, said UAMS’ Issam Makhoul, M.D.

“What makes that disease so severe in one individual over another one?” he asked. “That’s what we need to learn more about. By participating in clinical trials, we will gain more knowledge about that.”

Adult Sickle Cell Clinical Program and director of the Division of Hematology/Oncology in the UAMS College of Medicine’s Department of Internal Medicine.

He was one of three presenters Sept. 17 at the Sickle Cell Symposium at UAMS. Sixty-one attended the gathering, sponsored by the UAMS Adult Sickle Cell Clinical Program.

Suzanne Saccente, M.D., is a pediatric hematologist and medical director of the Sickle Cell Program and Apheresis Program at Arkansas Children’s Hospital. She discussed the past of sickle cell disease research and treatment; Makhoul, the present; and Shelley Crary, M.D., the future. Crary is a pediatric hematologist at Arkansas Children’s and an associate professor in the UAMS College of Medicine’s Department of Pediatrics. Saccente also is an assistant professor in the same department.

Sickle cell disease is a group of inherited red blood cell disorders. Healthy red blood cells are round and travel through small blood vessels to carry oxygen throughout the body. With sickle cell disease, the red blood cells become hard and sticky, and result in a C-shape or “sickle.” When sickle cells travel to small blood vessels, they get trapped and block blood flow to the area. This results in pain and may lead to other problems such as infection, acute chest syndrome and stroke.

Both Makhoul and Crary discussed the challenges of using gene therapy and its future promise as well as other possible cures like bone marrow transplants.

Makhoul described the two approaches to gene therapy being developed. One uses a modified virus to insert a gene segment into a patient’s cells to correct the genetic disorder that causes sickle cell disease.

“What’s wrong with this scenario? It’s so hard to do,” Makhoul said. “Our body is designed to fight any kind of infection. The cell is going to try to destroy that virus. It also might try to silence that new gene segment because it’s coming from an outside source.”

Another technology makes the same genetic correction to a patient’s cells in the lab so they can be injected into patients to replace the cells that cause sickle cell disease.

The cost per patient is estimated to be $500,000 to $700,000.

Bone marrow transplants are one of the procedures used to restore stem cells and cure sickle cell disease. Recent advances in ‘half-matched’ bone marrow transplantation have allowed for a much broader range of donors.

Transplantation comes with risks of chronic complications and even death, although the risk is less than 10 percent with a matched sibling donor, Crary said.

“But, for some people, it’s worth the risk to cure their child’s sickle cell,” Crary said. “We present it to families and they have to choose what is right for them.”

Apart from treatments and potential cures, the presenters discussed drug therapies like hydroxurea and L-glutamine for treating symptoms and pain crises, as well as pain medications like opioids.

“We shouldn’t just treat pain crises with pain medications,” Makhoul said. “Oxygenation, hydration and transfusion also are important. All those measures can lessen the pain because it’s a symptom of an acute inflammatory process, sometimes infectious and sometimes not. You need to target all those factors. Low-oxygen levels are the trigger.”

By Susan Van Dusen

Internationally recognized medical oncologist Michael Birrer, M.D., Ph.D., has been named vice chancellor and director of the Winthrop P. Rockefeller Cancer Institute at the University of Arkansas for Medical Sciences (UAMS). Birrer specializes in gynecologic cancers and will join the university by the end of the year.

He formerly served as director of the O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham. Birrer succeeds Laura Hutchins, M.D., who served as interim director of the UAMS Cancer Institute since June 2018.

“It is an honor to welcome Dr. Birrer as the new director of the UAMS Winthrop P. Rockefeller Cancer Institute. As a highly regarded physician-scientist, Dr. Birrer is uniquely qualified to increase the Cancer Institute’s capacity for innovative research and advanced clinical care in the years ahead,” said UAMS Chancellor Cam Patterson, M.D., MBA.

As director of the UAMS Cancer Institute, Birrer will lead all cancer-related activities for UAMS, whose cancer clinics reported more than 150,000 patient visits during the last fiscal year. There are about 150 UAMS faculty members engaged in cancer-related research and clinical activities.

“I left a professorship at Harvard Medical School in an attempt to help a broader number of patients suffering from cancer. This position at UAMS will allow me to do that for cancer patients throughout Arkansas,” said Birrer, who also will hold the position of Cancer Service Line director.

“Dr. Birrer possesses the strong leadership experience needed to move the Winthrop P. Rockefeller Cancer Institute toward the goal of achieving designation by the National Cancer Institute,” said Christopher Westfall, M.D., executive vice chancellor and dean of the UAMS College of Medicine. “He will no doubt be an outstanding addition to the Cancer Institute and to UAMS as a whole.”

NCI Designation is awarded through a highly competitive assessment process during which cancer centers must demonstrate outstanding depth and breadth of high-quality cancer research. Receiving designation brings substantial benefits, including the ability to access federal research funding and offer clinical trials not available to non-designated centers. It also is expected to result in a $72 million economic impact on Arkansas and create about 1,500 new jobs over five years.

In support of the Cancer Institute’s efforts of achieve NCI Designation, the Arkansas House and Senate unanimously passed in March 2019 Senate Bill 151, which established an account into which funds supporting NCI Designation could be deposited.

Then, with the support of Gov. Asa Hutchinson, an annual amount of at least $10 million was designated for efforts related to the institute’s quest for designation. The funds will be used to recruit top grant-funded scientists to bring their research dollars to UAMS to meet the requirements set by the NCI.

“Given the state support, UAMS and philanthropic support, we estimate a $70 million investment over the next five years in the Cancer Institute, which will strengthen our chance at NCI designation,” said Birrer.

“We look forward to working hand in hand with Dr. Birrer to ensure the Cancer Institute is actively serving the cancer care needs of all Arkansans, while also pursuing dynamic and forward-thinking research,” said Steppe Mette, M.D., interim vice chancellor for clinical programs and chief executive officer of the UAMS Medical Center. Mette served as chair of the director search committee.

“As I step down as Cancer Institute interim director, I am confident Dr. Birrer has the skills and desire to advance our mission and move the institute forward in many vital areas,” Hutchins said.

Birrer completed his medical degree and doctorate of philosophy in 1982 in the Medical Scientist Training Program at the Albert Einstein College of Medicine in New York. Following a medical internship and residency at Massachusetts General Hospital, Birrer entered the Medical Oncology Fellowship program at the National Cancer Institute in Bethesda, Maryland. After his fellowship, Birrer was appointed senior investigator (with tenure) and established the molecular mechanism section in the Division of Cancer Prevention and Control.

In 2008, Birrer was appointed professor of medicine at the Harvard School of Medicine and assumed the position of director for both Gynecologic Medical Oncology at Massachusetts General Hospital and the Gynecologic Oncology Research Program at the Dana Farber/Harvard Cancer Center.

In 2017, he accepted the position of director of the O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, where he served as professor of medicine, pathology and OB-GYN.

Recognized nationally and internationally as an expert in gynecologic oncology, Birrer’s primary research interest is in characterizing the genomics of gynecologic cancers to improve the clinical management of these diseases. His clinical interests include ovarian cancer, endometrial cancer and cervical cancer.

Birrer has approximately 400 publications, including peer-reviewed manuscripts, book chapters and review articles. He served as chair and chair emeritus of the Department of Defense Ovarian Cancer Research Program, chair of the Committee for Experimental Medicine of the Gynecologic Oncology Group, chair of the Translational Science Working Group of the Gynecologic Cancer Intergroup, and a member of the Gynecologic Cancer Steering Committee.

By Amy Widner

Imagine there’s an outbreak of an infectious disease. Could health officials on the ground harness the power of new handheld DNA and RNA sequencers to monitor outbreaks in real-time and quickly contain them?

This question lies at the heart of research published in the journal Infection, Genetics and Evolution by UAMS graduate student Duah Alkam. She and her advisers from the College of Medicine Department of Biomedical Informatics and the Department of Microbiology and Immunology collaborated with the Arkansas Department of Health to look at specimens collected during a 2016 mumps outbreak in Northwest Arkansas.

It took the Human Genome Project 13 years to complete the first sequence of a human genome in 2003. As sequencers became available for purchase, they were large, expensive and slow.

That has changed. Alkam used a device called the Oxford Nanopore Technologies MinION to sequence each sample in a matter of hours. To offload the data, she simply connected the MinION through a USB port to a laptop.

“You see results on your computer in real time,” Alkam said. “It’s fast, affordable and simple. The idea is that something like this might be useful during an outbreak, especially in a rural setting. If you can quickly identify a strain, you’re that much closer to understanding the origin of the outbreak, which may help contain it and protect the at-risk population.”

The new challenge for scientists is how to interpret the massive amount of data produced by these powerful sequencers. That is where the relatively new field of biomedical informatics comes in.

“Biomedical informatics allows us to look at genomes within a matter of hours and compare them, pinpointing connections and what might be important about these datasets,” Alkam said. “In this way, biomedical informatics is sort of the bridge between raw data and relevant information.”

In this case, Alkam was able to determine the unique characteristics of the specific variation of the mumps virus that was behind the 2016 outbreak. They used a computational technique called immunoinformatics to plot a “family tree” of sorts for the virus.

“We found that it was very similar to a strain that started an outbreak in Massachusetts around the same time in 2016, and it was also related to another strain that spread in Washington state, which may suggest that all three outbreaks originated from the same strain.”

While Alkam’s experiment was not conducted during an active outbreak, she and her advisers believe the results demonstrate great promise for the technique to be applied in the real world. Earlier in 2019, other scientists in the Department of Bioinformatics collaborated with researchers around the world for the first demonstration that the MinION could be used for the rapid genetic sequencing of multiple human viruses.

“The possibility of infectious disease outbreaks in health care settings and communities is something that unites us across the globe. We’re all vulnerable,” said Se-Ran Jun, Ph.D., Alkam’s adviser for the project and an assistant professor in biomedical informatics. “So at UAMS, it’s exciting each time we demonstrate how we can harness the power of new sequencing technology, big data science and analytics, and high performance computing in biomedical informatics to offer solutions.”

The project was funded with a grant to Jun from the UAMS for Translational Research Institute.

Alkam is a student in the UAMS Graduate School’s Graduate Program in Interdisciplinary Biomedical Sciences (GPIBS). Her other advisers are David Ussery, Ph.D., a professor in the Department of Biomedical Informatics; and Mark Smeltzer, Ph.D., a professor in the Department of Microbiology and Immunology.

By Benjamin Waldrum

Two UAMS medical students have each been awarded a $20,000 Arkansas Blue Cross and Blue Shield Primary Care Scholarship, which encourages aspiring physicians to pursue primary care practices in rural Arkansas.

This year’s recipients are Drake Cullum of Bono, a senior, and Olivia Brasher of North Little Rock, a junior. The scholarship has been presented to UAMS College of Medicine juniors or seniors annually since 2012.

Arkansas Blue Cross, the state’s largest insurer, established the endowed scholarship in 2010 with a $1 million gift to the UAMS Foundation Fund.

The scholarship is part of a broad effort to produce more family medicine, general internal medicine and general pediatrics doctors for Arkansas, especially in rural areas where access to primary care is limited. More than two-thirds of Arkansas’ 75 counties include federally designated Primary Care Health Professional Shortage Areas. Primary care physician shortages are expected to increase substantially as the state’s population continues to age and require more medical care, and as more Arkansans seek primary care services.

The College of Medicine has worked with private partners such as Arkansas Blue Cross to increase scholarships. The high cost of medical school and the burden of educational debt that most medical students face when entering their postgraduate residency training can be a factor in choosing higher-paying specialties instead of primary care and practicing in rural areas. The average medical school debt of recent UAMS graduates who have educational debt is about $195,000.

”Scholarships reduce debt concerns for outstanding students like Drake and Olivia who want to make a difference in rural communities in Arkansas, and allow them to focus on their education and becoming excellent physicians,” said Christopher T. Westfall, M.D., FACS, executive vice chancellor of UAMS and dean of the College of Medicine. “We are very thankful for Arkansas Blue Cross and Blue Shield’s investment in our students and our state.”

”We see the challenges rural Arkansans face with getting needed medical services, and Arkansas Blue Cross is committed to improving access to quality health care throughout our state,” said Curtis Barnett, president and chief executive officer of Arkansas Blue Cross. “This scholarship addresses a small part of that need. We congratulate Drake and Olivia on this year’s award and commend them for their desire to serve rural Arkansans.”

Cullum graduated from Westside High School in Jonesboro and received his undergraduate degree from Arkansas State University in Jonesboro. His family history on both sides dates back several generations in northeast Arkansas. He plans to practice family medicine in one of the counties in either northeast or south Arkansas depending on greatest need.

Since his freshman year, Cullum has been keenly interested in rural primary care, and has consulted with multiple family practice doctors and hospital administrators to better understand recruiting and retention in rural Arkansas as well as the needs of patients there.

“I can’t say I have pinpointed a specific area, but I am willing to go wherever there is a need,” Cullum said. “I love Arkansas, and with my long family ties and wonderful experiences growing up here, I wouldn’t look anywhere else to practice.”

Brasher graduated from North Little Rock High School and received her undergraduate degree from Hendrix College in Conway. Although she has lived in central Arkansas her entire life, she gained experience in family medicine in Helena-West Helena, and is interested in practicing pediatrics in a rural community in Northwest Arkansas.

“In getting to know Helena-West Helena and its people, I witnessed the struggles that community faces, and how much medical care can vary in different areas,” she said. “I learned the tremendous measures that some take to receive proper medical care, and how others that aren’t able to take those measures often suffer for it. After that experience, I became more open to serving in a rural area.”

Brasher’s own experiences as a patient with her family pediatrician inspired her to become a doctor. “I want to create that same familial environment, the one I have yet to find outside of primary care, while providing quality holistic care for my patients,” she said.

By Amy Widner

Professor William C. Culp, M.D., and colleagues at the University of Arkansas for Medical Sciences (UAMS) have published promising results from the first human trial of a new drug to treat strokes.

If the results of this Phase I clinical trial are repeated in the next phases, the UAMS professors could be responsible for developing a completely new method for treating strokes and significantly improving their life-altering consequences.

Their results were published in the Journal of Vascular and Interventional Radiology.

During a stroke, the blood supply to the brain is cut off and its cells begin to die. Clots clogging a blood vessel are a common cause. Current treatments focus on breaking up or removing the clot and restoring blood supply to the brain, but doctors must move quickly to prevent death or major debilitation. That is not always possible, especially in a rural state like Arkansas.

Culp has spent 10 years testing a different method using dodecafluoropentane emulsion (DDFPe). The drug is more efficient at carrying oxygen than a human red blood cell, and it is also smaller, on a nano-size scale. The DDFPe method allows the drug to travel past the clot, taking oxygen along with it to keep the brain alive and functioning during the stroke.

“What this drug gives us is time,” Culp said. “It stops the clock so the patient can get to the right hospital with the right expertise to restore blood flow, and that kind of time is something that more than 90% of stroke patients just don’t get.”

Culp is a professor of radiology, surgery and neurology in the UAMS College of Medicine. His UAMS co-authors are Sanjeeva Onteddu, M.D., (neurology), Aliza Brown, Ph.D., (radiology/neurology), Krishna Nalleballe, M.D., (neurology), Rohan Sharma, M.D., (neurology), Robert Skinner, Ph.D., (neurobiology/developmental sciences), Taylor Witt, M.D., (radiology), Paula Roberson, Ph.D., (biostatistics), and James Marsh, M.D., (internal medicine).

As is typical with Phase I trials, the main objective was to demonstrate the drug’s safety. However, among the 24 stroke patients tested at UAMS, not only did the researchers find that the method was safe, it was also effective. The more of the drug the patients got, the more improvement they showed.

The next step, a Phase II clinical trial, will involve many more patients, likely at different medical centers across the United States. It will confirm the drug’s effectiveness on a larger scale and help identify any possible side effects. Phase III and Phase IV trials would include even more patients.

For many scientists, seeing an area of research reach the clinical trial phase can be a once-in-a-career experience.

“It’s truly exciting,” Culp said. “We have conducted hundreds of experiments at UAMS to prepare for our first clinical trial, and they have shown, in various models, that this method could save about 80% of an area of stroke.”

There are about 800,000 stroke cases in the United States annually. Culp said that of those, 12% of those patients die and 12% suffer a major loss in ability to function and 10-15% are only able to live with constant help. Additionally, other studies have estimated that only about 10 percent of people who have a stroke actually get treatment, so the number of stroke cases could be much larger.

Culp’s research is part of a larger mission at UAMS to improve stroke treatment for Arkansans.

As recently as 2015, Arkansas ranked first in the nation in per capita stroke deaths based on data from the federal Centers for Disease Control and Prevention. In 2019, Arkansas ranked seventh in the nation, and the improvement is attributed in part to the UAMS digital health stroke program, part of the UAMS Institute for Digital Health & Innovation. It provides 54 Arkansas hospitals with round-the-clock access to stroke neurologists who can quickly assess whether a stroke patient can be helped by a clot-busting drug — alteplase — that often restores complete function to the patient.

Another new treatment is mechanical thrombectomy, during which an interventional radiologist threads a device into an artery at the groin and up to the clot, inserts a stent, then removes the clot to restore blood flow. UAMS is the only hospital in Arkansas able to provide this service 24 hours a day.

The ability to offer such services is why UAMS is the only health care provider in the Arkansas certified as a Comprehensive Stroke Center by The Joint Commission. The certification is the most demanding accreditation and is designed to designate hospitals that can treat the most complex stroke cases. It also means certified hospitals can provide endovascular procedures and post-procedural care and has an Emergency Department with a dedicated stroke-focused program.

Culp envisions a future where the DDFPe method could be added to these digital health, clot-busting and mechanical thrombectomy approaches to provide the vital time necessary for more patients to receive treatment.

“Strokes are terrible, life-altering things,” Culp said. “We have improved the outcomes through our digital health programs, but there are still so many people dying, so many people not getting the treatment they need right now. There’s so much more to be done to improve the delivery of care to the people of Arkansas, and to that end, we’re excited by these results and eager to continue the clinical trial process.”

By Amy Widner

Latunja Sockwell, a researcher at the University of Arkansas for Medical Sciences (UAMS), has received a $2.5 million federal grant to expand HIV and hepatitis C prevention education among African American men and women with a history of criminal justice involvement and substance abuse, especially opioid abuse.

The five-year grant comes from the Substance Abuse and Mental Health Services Administration, which is part of the U.S. Department of Health & Human Services.

Sockwell is partnering with Better Community Development Inc., a licensed and nationally accredited faith-based substance abuse treatment center based in Little Rock’s 12th Street neighborhood. Through Project HEAL, she will educate its clients about how HIV and hepatitis C are spread, with the aim of increasing the participants’ use of preventive measures, increasing screening, decreasing stigma and ultimately, reducing rates of infection.

Sockwell is a researcher in the Research and Evaluation Division of the Department of Family & Preventive Medicine, which is part of the UAMS College of Medicine.

“The fastest growing population for rates of new HIV infection are among African Americans, and much of that growth is happening in the South,” Sockwell said.

There are about 5,516 people living with HIV in Arkansas, according to AIDSvu.org, which helps visualize federal data on HIV in the form of maps, charts and graphs. In Arkansas, 77.1% of people living with HIV are male. The number of black males living with HIV in the state is 4.4 times that of white males. The highest concentrations of people living with HIV in Arkansas are in Lee, Pulaski and Crittenden counties.

“We know how to prevent HIV transmission, so I look at those numbers and ask myself, what are we doing to get this information out to people?” Sockwell said. “You can provide screenings, but if you don’t educate people on how to stay safe in the first place, those numbers are going to continue to go up. So yes, we test, and we promote that it’s important to know your status, but we also put the power in people’s hands by giving them the education to protect themselves.”

Project HEAL is an expansion of the AR Passion Project, a similar program in which Sockwell worked with Better Community Development’s female clients.

Although the aim of this grant is to work with African Americans with a history of substance abuse and criminal justice involvement, Sockwell will work with any demographic group that comes through the treatment center during the project. She estimates she will work with over 1,200 people over the project’s five years.

Her HIV services will be just one part of the center’s multifaceted evidence-based treatment, including medication-assisted treatment for drug abuse, recovery support services like substance abuse peer counseling and support groups, housing for homeless and low-income individuals and families, violence prevention, and prevention of incarceration and community re-entry services.

Cindy Crone, M.N.Sc., APRN, with the UAMS Fay W. Boozman College of Public Health, is assisting with Project HEAL.