March 5, 2021, NIH Record, Vol. LXXIII, No. 5

March 5, 2021 Vol. LXXIII, No. 5

‘WE FOLLOW THE SCIENCE’ President Biden Pays NIH a Call BY CARLA GARNETT

Curbing the coronavirus pandemic is President Joe Biden’s top priority. To stress the urgency, he stopped by NIH, source of a powerful weapon against Covid-19—biomedical research. On Feb. 11—after just more than 3 weeks in office—Biden toured the lab where the Moderna vaccine was co-developed by scientists at the Vaccine Research Center. While there, the President also was briefed on investigations into Covid therapeutics and diagnostics and other topics by NIH At NIH on Feb. 11 are (from l) VRC deputy director Dr. Barney Graham, President Joe Biden, NIAID director Dr. Anthony Fauci, White House Covid Response Coordinator Jeff Zients, NIAID research fellow director Dr. Francis Collins, NIAID director Dr. Kizzmekia Corbett and NIH director Dr. Francis Collins.

Dr. Anthony Fauci, who also is Biden’s chief PHOTO: CHIA-CHI CHARLIE CHANG SEE PRESIDENT, PAGE 6

RETHINKING THE HIERARCHY Housing Segregation a Law Professor Proposes New Central Cause of Racial Health Health Care Architecture Inequities BY DANA TALESNIK BY ERIC BOCK

It’s tough to Structural racism innovate on a in the housing large scale. There system is a fun- comes a time, damental cause though, when of racial health advances within a inequity in the NIAID division directors brief White House science chief at VRC. See story, p. 2. sector compel us United States, said to reevaluate the Dr. David Williams ALSO THIS ISSUE bigger picture. during a recent Dr. Barak NIMHD/NINR Science Offers More Evidence for Everyone to Dr. Barak Richman Mask Up...... 3 Richman, a pro- Dr. David Williams Joint Directors’ fessor of law and Seminar on the New NIAMS Director Takes Oath...... 5 business at Duke University, proposes a new Science of Structural Racism. First Lady Biden Visits NCI Virtually . . . . . 7 framework for the U.S. health sector, one “We will not make the progress we would he believes would be more affordable and like to make in reducing health inequities if Han Named Senior Scientist...... 9 sustainable. He shared his ideas at a recent we don’t address it,” said Williams, professor Digest...... 10 virtual NIMH Director’s innovation lecture. of African and African-American studies at Milestones...... 11 Within our current health care system, Harvard University and the Florence and Seen...... 12 SEE RICHMAN, PAGE 8 SEE WILLIAMS, PAGE 4 BRIEFS

NIMHD Seminar To Host Mokdad, Mar. 11 Dr. Ali Mokdad will deliver the next lecture in the virtual NIMHD Director’s Seminar Series on Thursday, Mar. 11 at 2:30 p.m. He will present “Disparities in Life Expectancy.” Mokdad is a professor of health metrics sciences at the Institute for Health Metrics and Evaluation and chief strategy officer for Population Health at the University of Washington. At a coronavirus research response briefing in the VRC on Feb. 10 are (clockwise) Dr. Eric Lander As a public health (front, c), Kei Koizumi, Dr. John Mascola, Dr. Cliff Lane. Dr. Emily Erbelding, Dr. Alan Embry and Dr. researcher, Mokdad Anthony Fauci. Several other NIH’ers participated via video conference. has published PHOTOS: CHIA-CHI CHARLIE CHANG groundbreaking work on local-level White House Science Chief Lander Dr. Anthony Fauci, who also serves as Biden’s chief disease trends and Visits NIH medical advisor. some of the leading risk factors for poor Dr. Eric Lander, President Biden’s nominee to lead Fauci gave an overview of NIAID with a focus health. His work on the White House Office of Science and Technology on vaccine development; VRC director Dr. John obesity is among the Policy (OSTP), visited NIH on Feb. 10. Accompanied Mascola provided a VRC overview with an emphasis most highly cited in by OSTP Chief of Staff Kei Koizumi, Lander met at on Covid-19 vaccine research. the field. the Vaccine Research Center with NIAID director “Both emphasized the importance of prior Dr. Ali Mokdad is For reasonable basic research in speeding the development of NIMHD’s next virtual accommodation, call a vaccine,” noted Dr. Cliff Lane, NIAID deputy Director’s Seminar director for clinical research and special projects, (301) 402-1366 or Series speaker. the Federal Relay, who also attended the meeting at the VRC, along 1-800-877-8339. The with Dr. Emily Erbelding, director of the Division talk will be videocast at https://videocast.nih.gov. of Microbiology and Infectious Diseases (DMID), and Dr. Alan Embry, chief of DMID’s Respiratory To learn about the NIMHD Director’s Seminar Diseases Branch. Series, visit https://nimhd.nih.gov/news-events/ conferences-events/directors-seminar-series/. Joining the gathering by video were VRC deputy director Dr. Barney Graham; Dr. Daniel Rotrosen, director of the Division of Allergy, Immunology and Transplantation; NIAID principal deputy director Dr. Hugh Auchincloss; and Dr. Carl Dieffenbach, director of the Division of AIDS. Lane and other division directors briefly discussed OSTP Chief of Staff Koizumi (l) and Lander (c) chat with Fauci. what their divisions are doing as part of the NIH Covid-19 response.

NHGRI’s Dr. Daniel Kastner recently was awarded Sweden’s Crafoord Prize.

Kastner Earns Sweden’s Crafoord Prize The Royal Swedish Academy of Sciences recently VRC director Mascola (l) provides a VRC overview with an emphasis on Covid-19 vaccine development, awarded this year’s Crafoord Prize in Polyarthritis as Lane (c), Erbelding and other division directors discuss their work. to Dr. Daniel Kastner, NHGRI scientific director. The prize, worth 6 million Swedish kronor (approx- imately $700,000) this year, is one of the major diseases that are unusual in most of the world, but responsible for selecting the laureates. Its subject international science honors, with subject areas may have a higher incidence in some areas. One areas rotate every year, between mathematics that complement the Nobel Prizes and rotate from or two of every thousand people in the eastern and astronomy, the geosciences, biosciences and year to year. Mediterranean have familial Mediterranean fever, polyarthritis (such as rheumatoid arthritis). The The prize’s website cited Kastner “for establishing while TRAPS was initially discovered among polyarthritis prize—instituted because the donor, the concept of autoinflammatory diseases. He families in Ireland and Scotland.” Holger Crafoord, suffered from severe rheumatoid arthritis toward the end of his life—is only awarded has identified the mechanisms responsible for The Crafoord Prize is awarded by the Royal familial Mediterranean fever, TRAPS and other when there has been scientific progress that Swedish Academy of Sciences and the Crafoord motivates a prize. diagnoses within this group. They are genetic Foundation in Lund, with the academy being

2 • NIH RECORD • MARCH 5, 2021 mask, a 2-ply cotton-polyester mask and Humidity from a heavy cotton mask. To measure the level Masks May Lessen of humidity, researchers had a volunteer breathe into a sealed steel box. When the Severity of person wore no mask, the water vapor of the Covid-19 exhaled breath filled the box, leading to a rapid increase in humidity inside the box. Research has shown masks When the person wore a mask, the help protect the wearers buildup of humidity inside the box greatly and those around them decreased, due to most of the water vapor from Covid-19. Now, NIH in the mask becoming condensed and being investigators have uncov- re-inhaled. To ensure no leakage, the masks ered another potential were tightly fitted against the volunteer’s benefit: the humidity NIDDK’s Dr. Joseph Courtney breathes into a sealed box while face. Measurements were taken at three wearing a mask. created inside the mask different air temperatures, ranging from 46 PHOTO: NIDDK may offer another layer of to 98 degrees Fahrenheit. protection. mechanism that removes mucus—and All four mask types increased the level The study, led by NIDDK and published potentially harmful particles within the of humidity of inhaled air, but the humid- in the Biophysical Journal, found that face mucus—from the lungs. High levels of ifying effects were greatest at lower air masks substantially increase the humidity humidity can also bolster the immune system temperatures. The thick cotton mask led to in the air that the mask-wearer breathes in. by producing special proteins, called inter- the most increased level of humidity at all temperatures. This higher level of humidity in inhaled air • • • may explain why wearing masks has been linked to lower disease severity in people “This research supports the infected with SARS-CoV-2. importance of mask-wearing “We found that face masks strongly increase the humidity in inhaled air and as a simple, yet effective way propose that the resulting hydration of the to protect the people around respiratory tract could be responsible for us and to protect ourselves the documented finding that links lower Covid-19 disease severity to wearing a from respiratory infection.” mask,” said the study’s lead author, NIH ~NIDDK DIRECTOR DR. GRIFFIN RODGERS distinguished investigator Dr. Adriaan Bax. • • • “High levels of humidity have been shown ON THE COVER: Illustration of neuron with to mitigate severity of the flu, and it may be ferons, that fight against viruses. Low levels dendrites and nucleus applicable to severity of Covid-19 through a of humidity have been shown to impair both IMAGE: NIMH similar mechanism.” MCC and the interferon response, which High levels of humidity can limit the may be one reason why people are likelier to The NIH Record spread of a virus to the lungs by promoting get respiratory infections in cold weather. Since 1949, the NIH Record has been published biweekly by the Editorial Operations Branch, mucociliary clearance (MCC), a defense “This research supports the importance Office of Communications and Public Liaison, of mask-wearing as a National Institutes of Health, Department of Health simple, yet effective and Human Services. For editorial policies, email [email protected]. way to protect the Associate Editor: Carla Garnett people around us and to [email protected] protect ourselves from Staff Writers: respiratory infection, Eric Bock • [email protected] especially during these Dana Talesnik • [email protected] winter months when Subscribe via email: Follow: susceptibility to these Facebook “f” Logo [email protected] / .eps Facebook “f” Logo CMYK / .eps http://nihrecord.nih.gov/ viruses increases,” said The NIH Record is recyclable as NIDDK director Dr. mixed paper. Griffin Rodgers. The study tested 4 common types of NIH distinguished investigator Dr. Adriaan Bax masks: an N95, a 3-ply disposable surgical

NIH RECORD • MARCH 5, 2021 • 3 Williams water, transportation and health care, all system, workplace policies and home CONTINUED FROM PAGE 1 disappear. mortgage discrimination. In the 100 largest metropolitan areas Acts of interpersonal racism also Laura Norman professor of public health in the U.S., studies show two-thirds of all adversely affect health, he noted. Everyday and chair of the department of social and African-American children, 58 percent discrimination, such as being treated with behavioral sciences at Harvard’s T.H. Chan of Latino children and 53 percent of less courtesy and respect or receiving poorer School of Public Health. service, predicts adverse health Structural racism—also outcomes that have enormous known as institutional or health consequences, such as systemic racism—is a societal higher levels of type 2 diabetes, system that “categorizes and heart disease, breast cancer, ranks populations and groups, poorer sleep and obesity. devalues and disempowers People who experience these some groups,” he explained. little indignities are biologically It “leads to the development older than their chronological of negative attitudes and age, Williams said. Some beliefs, prejudice and stereo- research studies found African types, differential treatment Americans are biologically and discrimination by both 7.5-10 years older than non-His- individuals and societal panic whites who are the same institutions.” chronological age based on their Residential segregation, Residential segregation is one of the most prominent examples of structural physiology. racism, said Williams. or “the physical separation of “One of the consequences the races by forcing residents of this is the earlier onset of into different areas,” is one of the most indigenous American children live in diseases and greater severity of diseases,” prominent examples of structural racism. low-opportunity neighborhoods. Almost he said. The system was developed in the South and two-thirds of non-Hispanic whites and Going forward, Williams said public expanded to the North. He said it has been Asian kids live in high- or very high-oppor- health researchers must better understand “locked in place” since 1940. tunity neighborhoods. how poor neighborhoods and substandard Historically, the segregation of African “There are striking differences in access housing lead to stress. They also need Americans has been unique. While other to opportunity at the neighborhood level,” to identify exposure to non-traditional groups are segregated depending on Williams said. stressors, such as the viewing of traumatic income levels, segregation is higher for Residential segregation is just one videos of persons being beaten, arrested African Americans at all income levels. But aspect of systemic racism. Other examples or detained or being shot by police, that not by choice. include immigration and border policy, adversely affect health. “Studies show African Americans show political participation, the criminal justice “Addressing segregation will not be easy,” the highest prefer- Williams said. “There ence for residing are deep fears of segre- in integrated areas gation and its impact on [compared to] any the United States.” other group,” he said. Williams indi- Williams cated that although compared segregation there are not many to toxic emissions success stories, there produced by an is the Purpose Built industrial plant in a Communities model neighborhood. Both that shows it is possible are often impercepti- to create mixed-income ble and cause illness housing that addresses and death. When all of the challenges they appear, valuable faced by poor commu- resources such as nities simultaneously, quality schools, and markedly improve safe playgrounds public safety, educa- NINR director Dr. Shannon Zenk and NIMHD director Dr. Eliseo Pérez-Stable share a lighthearted and housing, good moment with Williams during the Q&A. tion, employment and jobs, clean air and child care.

4 • NIH RECORD • MARCH 5, 2021 NIAMS Director Sworn In Dr. Lindsey Criswell has officially joined the NIH community as director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Her virtual swearing-in ceremony was held on Feb. 16. NIH director Dr. Francis Collins administered the oath of office. As NIAMS director, Criswell will oversee the institute’s annual budget of nearly $625 million, which supports research into the causes, treatment and prevention of arthritis and musculoskeletal and skin diseases. Acting director Dr. Robert Carter has NIH director Dr. Francis Collins administers the oath of office virtually on Feb. 16 to NIAMS director Dr. returned to his position as deputy director Lindsey Criswell. of NIAMS.

VIRTUAL ‘COFFEE’ EVENT, MAR. 9

MI Program Opens Rotations are available in these career tracks: I still work for an incredible team devoted to conquering disease and providing quality of life Recruitment Season • Administrative Management for those who suffer, but in a slightly different • Financial Management The NIH Management Intern (MI) Program way…Had I not been part of • Grants Management the MI program and had the recruitment season is underway, coordinated • Human Resources by the Training Center in the Office of Human experiences I had, I might Management not be in the position I love Resources. The program offers highly motivated • Communications NIH employees an opportunity to transition now. Today I still enjoy the • Contracts Management vast network of mentors and from their current field into an administrative • Information Technology management career. leaders I cultivated during my Management time as an intern. I continue “When I graduated from nursing school, my • Management or Program to push my career to new dream job was to help seriously ill children Analysis horizons..I am grateful for the and their families navigate the difficult road to MI program jump-starting this recovery,” recalled former MI Kathleen Tepas, Program features include exciting new career path and legislative coordinator in NIAAA’s Office of access to a senior-level mentor, can’t wait to see where the Science Policy and Communications. “I immedi- an individual training budget, next 20 years will take me at ately gravitated to the one hospital devoted to an opportunity to participate NIH.” enhancing life and reducing the burden of disease in challenging projects and and disability. Twenty years ago, I stepped ner- committees, and face-to-face For program details, eligibility vously into the Clinical Center atrium on my very interactions with NIH leaders. requirements and information first day with a head full of ambition and a heart on the application process, “I was able to meet the visit https://hr.nih.gov/train- ready to support patients embarking bravely on executive officers of each of the biomedical research studies. ing-center/programs/intern/ institutes and centers, sit in on mi/management-intern-pro- “It was thrilling to be an active part of an incred- advisory council meetings and Former MI Kathleen Tepas, in gram-mi. front of the U.S. Capitol early in ible team devoted to conquering disease and shadow our Health and Human her career bringing quality of life back to those who suffered Services colleagues downtown,” A “Coffee with an MI,” run in what can best be described as the heartbeat of Tepas noted. “Through my solely by current management the ‘National Institutes of Hope.’ Over the years I various rotations I learned about the different interns, will be held on Mar. 9 from 1 to 2:30 p.m., found myself more and more curious about how grants available to researchers and the important via WebEx. Registrants can drop in to ask ques- NIH operated as a federal agency…I was fortunate steps needed to continue their efforts, from tions and hear more about MI experiences. To to discover NIH supports a program designed the first time a grant is reviewed to its renewal register, send an email to [email protected]. to expose scientific or medical personnel such application seeking to expand on preliminary For reasonable accommodation to participate, as myself to [administrative] processes and was results. I was able to hear how NIH leaders and email at least 4 days before the session. thrilled to be selected for the class of 2013.” scientists share their findings at congressional briefings, highlighting the importance of The MI job vacancy announcement opens Mar. 22 Management interns gain valuable experience continued research to develop new therapies and and closes Mar. 26 in USAJobs.gov (https://www. and insight through rotations in a variety of evidence-based prevention methods…Twenty usajobs.gov/). Current GS-7 through GS-12 NIH administrative management areas for 2 years. years after that first step into the Clinical Center, employees are invited to apply.

NIH RECORD • MARCH 5, 2021 • 5 Flanked by Collins (l) and Fauci (r) on stage in Kirschstein Auditorium, the nation’s Commander-in-Chief addresses the NIH workforce.

PHOTOS: CHIA-CHI CHARLIE CHANG

President ‘We Give Back’ CONTINUED FROM PAGE 1 all kinds of viruses and, partnering with academia and industry, prepare for the next Taking the stage at the Natcher Bldg., medical advisor, and VRC director Dr. John one—because there will be others. HIV, Biden praised Collins and Fauci for agreeing Mascola. SARS, West Nile, Zika, Ebola and, today, to stay in their positions as the new adminis- VRC deputy director Dr. Barney Graham, Covid-19. To all of you, your work made tration assumed office. chief architect of the prototype pathogen possible the remarkably rapid development “Our nation is fortunate to have both of preparedness strategy combined with the of the Covid-19 vaccines we have today… you in these critical roles and that goes for mRNA vaccinology approach of biotech People were initially talking years, if not all the world-class doctors, scientists and partner Moderna, and research fellow Dr. decades before we’d have a vaccine. On researchers working at NIH,” said the 46th Kizzmekia Corbett, coronavirus team lead in behalf of a grateful nation—and I don’t say Commander-in-Chief, who acknowledged NIAID’s Viral Pathogenesis Laboratory, also that lightly—I want to thank you and your Covid’s toll. “I know it hasn’t been easy. The talked with Biden. families for your work and your sacrifice. For devastation of this pandemic, the loss of life “It’s incredible,” POTUS declared. “It’s there’s no doubt your families sacrificed a and livelihoods, hasn’t spared the scientific a place where our top minds spend years great deal for the endless hours you put in to community. Labs closed. Research delayed. researching vaccines and treatments for save the rest of us.” Careers disrupted—especially for those in

‘HE LISTENED…HE CARED’ our families’ experience of going through this pandemic response over the last year,” Graham noted. In Lab Tour, Biden Connects “He listened and he cared. At the end of the lab with Scientists tour I mentioned that my wife (Dr. Cynthia Turner- Graham) and grandson (D.J.) both asked me to say When President Biden visited the Dale and Betty hello from them. [The President] pulled out his cell Bumpers Vaccine Research Center at NIH on Feb. phone and asked for my wife’s number, then called 11, VRC deputy director Dr. Barney Graham and her and proceeded to have a 5- to 10-minute call research fellow Dr. Kizzmekia Corbett described with her while everyone else waited.” various aspects of vaccine development science. This is the second meeting with a U.S. President in “I showed a 3C At left, Dr. Barney Graham and President Biden less than a year for Graham and Corbett. They met model of the whole bump elbows. Above, Dr. Kizzmekia Corbett with President Trump on Mar. 3, 2020. Graham’s virus to show how talks vaccine science with POTUS. work has placed him in this position several times the spike molecule over the last couple of decades. was on the virus Corbett talked about how her group decided surface,” Graham on the protein sequence for making the spike “I had the opportunity to meet with President recounted. “I protein in different forms for assay development, Obama in December 2014, when he came to thank then showed a 10 cryoelectron microscopy, probes for antibody us for our work on Ebola during the West African million X-enlarged discovery and vaccine. outbreak,” Graham recalled. He also met with 3D model of the President Bush who visited in 2003 to learn about spike protein. I had “[We] designed the vaccine insert sequence [over VRC work post-9/11. a weekend],” Corbett recalled. other models of What stood out for Corbett was “POTUS ad hoc the prefusion and In response to the science blitz and research calling Dr. Graham’s wife for casual conversation postfusion forms of briefing, Biden inquired about how the investiga- and gifting us with the POTUS challenge coin.” RSV F and some of our new nanoparticle designs tors themselves were coping. for influenza, but didn’t have time for those.” “I never imagined meeting an active president as a “He was interested in our personal experience and research fellow,” she said.

6 • NIH RECORD • MARCH 5, 2021 training. Yet for every and large-scale vaccination It’s a patriotic responsibility…Mask up, moment of despair in this centers set up by the federal America. Mask up.” past year, you and all the government.” Biden noted that NIH and the broader heroes and heroines on Retired doctors and “scientific community repurposed labs to the frontlines and at the nurses, including some from work on Covid-19, developed therapeutics, frontiers of this pandemic FEMA, the Department new diagnostic technologies and vaccines remind us who we are. We of Defense and the U.S. in record time. You’re highlighting lessons are Americans. We never Commissioned Corps, are learned on the importance of pandemic give up. We never give in. being recruited back to work preparedness, public-private partnerships, We give back. We follow Biden thanks NIH’ers for their as vaccinators. real-time data-sharing and most of all, the science and find the example during the pandemic. “Our end goal is beating speed and efficiency without compromising answers.” Covid-19,” Biden declared. science and good conscience.” In addition to thanking the scientific ”That brings us to the challenge that remains: Science has modeled the example for enterprise, the President also came to NIH to We remain in the teeth of this pandemic. everyone else, Biden concluded. cite progress in his national strategy to fight January 2021 was the deadliest month we’ve “You’re a good group of people—I’ve been Covid-19 and to discuss the American Rescue had—we lost over 100,000 of our fellow out here many times, trying to help my son Plan, which bolsters economic recovery. citizens.” who passed away with cancer…We have to do Besides getting 100 million people vac- Mask Up, It’s Patriotic what you all do here at NIH and across the cinated in his first 100 days in office—a goal scientific community. We have to keep the also announced at NIH 2 weeks previously Ending his visit, Biden said all citizens faith—with purpose, with vision and with by Vice President Kamala Harris—Biden’s can help get the nation through this crisis. every dose of hope we have…You’re the best strategy addresses nationwide shortages of “Masking remains the easiest thing to America has to offer, NIH. Thank you from vaccine and vaccinators. do to save lives,” he said. “Everyone needs the bottom of my heart.” Already the administration has to mask up. I know it’s a pain in the neck. “increased the weekly supply of vaccine shipped to the states by almost 30 percent,” First Lady Biden Biden reported. Just that afternoon, his team Virtually Visits NCI had negotiated with two major pharmaceu- First Lady Dr. Jill Biden recently tical manufacturers, Moderna and Pfizer, to virtually visited the National supply 100 million more doses each of their Cancer Institute to learn about vaccines. They were also able to accelerate advances in cancer research. the delivery timeline by a month. By July, he “There is one challenge that intends to have enough vaccine to immunize unites us all, one thread of pain 300 million Americans. that runs through every community, North and South, rich NCI director Dr. Ned Sharpless welcomed the First Lady to NCI. “Within 3 weeks [through] round-the- and poor, in the best of times, clock work with so many people, we’ve the depth of this pandemic and now purchased enough vaccine supply to that’s cancer,” said Biden on Feb. NIH director Dr. Francis Collins and NCI director vaccinate all Americans,” said the President. 3, the day before World Cancer Day. Dr. Ned Sharpless welcomed the First Lady. “Now we’re working to get those vaccines During her visit, three scientists from NCI told Biden into the arms of millions of people.” about recent advances in ‘Administering a Dose of Hope’ cancer research. She thanked NCI staff for their contribu- One thousand more federal staff have tions to cancer research. been deployed to vaccination sites around “Cancer touches us all and the country, he noted. because of that your work On Super Bowl Sunday, the National touches us all,” she said. Football League invited the Biden administra- The theme for this year’s tion to use all 30 stadiums as mass vaccination World Cancer Day is “I Am stations. Biden accepted the offer, and the and I Will” with a subtheme federally run centers will target areas that of “Together, all of our have been hardest hit by the illness. actions matter.” Recalling the words of a nurse involved Dr. Jill Biden spoke with several experts in cancer research View the recording at in giving the vaccine shot, POTUS said including (from l) Sharpless, Dr. Worta McCaskill-Stevens of NCI https://www.youtube.com/ the vaccinator described the experience Community Oncology Research Program; Dr. Stephanie Goff of the watch?v=VUSUi2wBtUE&- as “’administering a dose of hope’…We’re Center for Cancer Research’s Surgery Branch and Dr. Ligia Pinto of feature=youtu.be. NCI’s Vaccine, Immunity and Cancer Program. going to get those doses of hope out at new

NIH RECORD • MARCH 5, 2021 • 7 Richman that reworks power centers and priorities. CONTINUED FROM PAGE 1 Interrelationships are critical in providing high-quality care, along with the location there’s been great modular innovation over and organization of care, which affect cost, the years, from new medicines to surgical quality, patient behaviors, convenience and techniques, among other groundbreaking optimized use of new technology. interventions, he noted. “But if the last 40 years of innovation Empowering the Patient have taught us anything,” said Richman, The new model would sever the local “it’s that we also need to pursue organiza- hospital from the main architecture of health tional innovation. We need to develop a despite the digital advances of the past 25 care delivery. Instead, doctors and insurers new architecture that can really harness years—from the internet to smartphones— would collaborate with patients, who could new capabilities, reduce costs and improve health care productivity remains ossified. shop around for hospitals and other primary quality and productivity.” “The way we have delivered health care and chronic care needs. Such a transformation involves rethink- has not really responded to dramatically Richman’s work on antitrust issues led ing our approach to health care delivery, he significant technologies said, so we’re no longer constrained by the that have really trans- w w w existing architecture. Rather than centering formed and reorganized care around available resources—hospitals, most other sectors in “The way we have delivered health care physicians, payors—the new structure would the economy,” argued has not really responded to dramatically be built around patients, who could then Richman. better access the kinds of medical services Digital technologies significant technologies that have they need. have unleashed myriad transformed and reorganized most other “We really want to resist thinking only opportunities for health sectors in the economy.” about how we deploy our resources,” care, linking patients Richman said. “Instead, we might want to to health information -DR. BARAK RICHMAN think about how we can deploy or create or sources and telemedicine provide high-value services.” consultations, digitizing w w w The current hierarchical architecture health records and puts hospitals at the center of health care enabling data analytics to automate diag- him to consider a new health care model. delivery. But in this top-down system, nostics and guidance. These technologies, he Removing hospitals from the epicenter of doctors have increasingly become tethered asserted, enable and necessitate a reorgani- the current architecture offers new possibili- to hospitals and insurers, which continues to zation of U.S. health care delivery. ties to contract with other hospitals, which in inflate health care costs, he said. Meanwhile, Richman suggested a business model turn resolves antitrust problems by stimu- lating competition. Providers would still be the main organizers and visionaries of health care, but they wouldn’t have to play a role in day-to-day delivery. “With digital medicine and different kinds of arrangements and relationships, we can think more of a bottom-up approach,” he said, which delivers care to patients in a cost-effective way. Need for a New Framework One case that exemplifies how an inno- vative idea was hampered by our existing health care architecture is the effort to develop an electronic health records system. After 8 years and a massive federal subsidy, an integrated, interoperable system remains elusive. Why? “Hospitals built the electronic health records to duplicate and reinforce the kind of architecture we currently have,” Richman advocates for a decentralized model of health care delivery that removes the local hospital Richman explained. from the epicenter, instead empowering the patient. Another model, one undertaken by IMAGES: FLATICON.COM/FREEPIKCOMPANY France, instead organizes health care

8 • NIH RECORD • MARCH 5, 2021 receive care without having to leave the comfort of home. Caring for an aging parent Han Named NCI Senior also could be done digitally, suggested Scientist Richman. The technology already exists to Dr. Paul Han has been named senior scientist monitor potential emergency triggers in the in the Behavioral Research Program (BRP), caregiver’s absence. A new architecture, he Division of said, could offer safer, more cost-effective Cancer Control independent living. and Population Sciences at the Another prospective improvement is National Cancer surgery, such as hip replacement. Local hos- Institute. pitals often charge high prices yet may not In France, individual health records are stored BRP initiates, electronically on insurance cards. even specialize in that area, said Richman. supports and IMAGE: GIE SESAM-VITALE Imagine implementing destination evaluates a medicine—the potential to shop elsewhere comprehensive delivery around the patient. There, individ- for care—reducing costs by expanding both program ranging competition and patient choice. from basic ual health records are stored electronically behavioral on insurance cards, allowing patients to A new architecture could integrate research to the Dr. Paul Han bring their personalized information to any specialists into primary care, while development, provider. telemedicine further expands patient testing and In the U.S., some tech companies are choice and the radius of care, since doctors dissemination of interventions in areas such as wouldn’t necessarily have to be local. tobacco use, screening, dietary behavior and investing in new patient-centered health sun protection. services. But can this be done, asked Rather than a hierarchical relationship Richman, without constructing a new with doctors, patients could have a more In addition to his senior scientist role, Han will direct relationship, perhaps through a new serve as an adjunct investigator in NCI’s Clinical architecture? Genetics Branch in the Division of Cancer information ecosystem. Lessons of a Pandemic Epidemiology and Genetics. Even though patients might not regularly Our relationships with each other, our see doctors physically, Richman said, “We’d Han’s background bridges the disciplines of health providers and digital technology behavioral and health services research. His have them much more integrated into our research interests include risk communication, have evolved over the past year due to the daily lives—whether through telemedicine, shared decision-making, predictive modeling Covid-19 pandemic. some kind of digital and examining clinical problems in cancer In March, telemed- interface or other care, genomic medicine and palliative and icine surged 50 information system— end-of-life care. percent; by August, having them much “With Paul’s expertise in shared decision-mak- these video-calls more actively engaged ing, health communication and most recently with doctors rose by in providing us with lung screening, I believe he offers an excep- 3,500 percent. But the tionally useful clinical perspective to our work information and at NCI,” said Dr. William Klein, BRP associate pandemic also illumi- direction.” director. nated a problematic During the Q&A, side of technology— Prior to joining NCI, Han served as the Richman was asked director of the Center for Outcomes Research the proliferation of how a new framework and Evaluation at the Maine Medical Center Caring for an aging parent could be done misinformation and Research Institute, and associate professor of digitally, suggests Richman. might affect vulnera- conflicting sources of ble and marginalized medicine at Tufts University School of Medicine. IMAGES: FLATICON.COM/FREEPIKCOMPANY health information. populations. Caring He led statewide initiatives to promote lung “We need to shift cancer prevention and screening and to study for low-income and the implementation of cancer genomic testing the source of information…to trusted provid- other vulnerable populations, who likely in clinical practice. Han has authored more than ers,” said Richman. “The entire information suffer from comorbidities, requires an 150 papers and book chapters in peer-reviewed ecosystem really needs to change, and there’s integrated strategy, he said, which individual medical literature and has been active in no reason that our providers—who know providers can’t accomplish. initiatives to promote shared decision-making us and our communities and who we have and teach risk communication skills to medical “That only accentuates the need to have students and physicians. relationships with—cannot be much more a comprehensive approach to delivering active in disseminating information to us.” care in a different kind of architecture that’s Han earned his medical degree from New York University School of Medicine. He received Looking to the Future patient-centered,” Richman said. “All of the a master of arts in bioethics and a master of intersections between the social determi- Richman envisioned several scenarios public health from the University of Pittsburgh. nants of health and health care delivery are He completed internal medicine residency train- within a restructured health sector. With going to have to be a part of developing this ing at the University of California, Los Angeles, telehealth, a parent with a sick baby could new architecture.” and an NCI Cancer Prevention Fellowship.

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Combination Treatment for regimen, which combines D-2-HG and immune disease’s ties to Parkinson’s but also suggested checkpoint inhibition, radiation and temozolomide that people with LBD may share similar genetic Glioma Shows Promise for patients with astrocytomas. profiles to those who have Alzheimer’s disease. Gliomas are common brain tumors that comprise Four Potential Therapeutics for Lewy body dementia usually affects people over about one-third of all cancers of the nervous 65 years old. Early signs include hallucinations, system. In an NIH-funded study, researchers Covid Enter Phase 2/3 Testing mood swings and problems with thinking, tested a novel combination treatment on mice Enrollment has begun to test additional inves- movements and sleep. As the disease worsens, with tumors with characteristics similar to patients become severely disabled and may die human astrocytomas—a type of slow-growing tigational drugs in the Accelerating Covid-19 Therapeutic Interventions and Vaccines (ACTIV) within 8 years of diagnosis. There currently are no glioma—and effective treatments. found tumor program. regression in ACTIV, sponsored by NIAID, is a public-private “Patients [with LBD] often appear to suffer the 60 percent partnership that creates a coordinated research worst of both Alzheimer’s and Parkinson’s dis- of the mice strategy to prioritize and speed development eases,” said NINDS investigator Dr. Sonja Scholz, treated. These of promising Covid-19 treatments and vaccines. senior author of the study. “Our results support encouraging The new agents entering the randomized, the idea that this may be because Lewy body results, placebo-controlled study are part of ACTIV-2, dementia is caused by a spectrum of problems published in an adaptive trial designed to test investigational that can be seen in both disorders.” the Journal agents in non-hospitalized adult volunteers expe- In the study, led by Scholz and NIA senior investi- of Clinical riencing mild to moderate Covid-19 symptoms. gator Dr. Bryan Traynor, investigators compared Investigation, the chromosomal DNA sequences of 2,981 LBD could be The added sub-studies will test four interventions for safety and efficacy: SNG001, an patients with those of 4,931 healthy, age-matched the first control participants. Samples were collected from step toward inhalable beta interferon delivered by nebulizer, (Synairgen); AZD7442, a long-acting monoclonal participants of European ancestry at 44 sites developing a across Europe and North America. treatment for antibody combination that will be studied as both an infusion and an intramuscular injection Artist’s rendering of a glioma this type of Initially, they found the sequences of five genes cell under attack from the brain cancer. (AstraZeneca); and Camostat mesilate, an orally from LBD patients differed from those of the immune system administered serine protease inhibitor that may controls. It was the first time two of the genes, A team of block SARS-CoV-2, the virus that causes Covid-19, called BIN1 and TMEM175, had been implicated PHOTO: ELLA MARUSHCHENKO researchers from entering cells (Sagent Pharmaceuticals). in the disease. These genes may also have ties to at the The first volunteer enrolled in the SNG001 sub- Alzheimer’s and Parkinson’s diseases. The other University of Michigan Rogel Cancer Center three genes, specifically tested inhibitors of the compound study on Feb. 10. The other agents under study are expected to begin enrolling participants soon. SNCA, APOE D-2-Hydroxyglutarate (D-2-HG), which is and GBA, produced by cancer cells, on a mouse version of If an investigational agent shows promise by had been astrocytoma carrying mutations in two genes, demonstrating safety and reducing Covid-19 implicated along with an inactivated form of a tumor-sup- symptoms through 28 days following adminis- in previous pressor protein gene. tration, the ACTIV-2 trial then moves to a phase studies, When the implanted mice were treated with a 3 study to gather additional critical data from a and thus, drug to block the production of D-2-HG along larger pool of volunteers. ACTIV-2 trials compare strengthened with standard of care radiation and temozolo- outcomes of multiple interventions with a shared the impor- mide (chemotherapy) treatments, their survival group of placebo recipients. tance of the genes in LBD. significantly improved. Looking more closely at To qualify for ACTIV-2, participants must have tumor cells grown in dishes, the researchers saw tested positive for SARS-CoV-2 in the outpatient Researchers that blocking D-2-HG caused the cells to become setting within 10 days and started experiencing replicated more susceptible to radiation treatment. However, symptoms within 8 days of enrolling. To be their initial An NIH-led genetic study the treatment also increased the amount of an eligible for the AZD7442 infusion study, partici- results, found that Lewy body “immune checkpoint” protein, which tumors use pants must be at higher risk—due to age, smoking finding patients had higher chances of developing Alzheimer’s or to turn off T-cells and evade the immune system. and/or certain co-morbidities—of progressing to differences Parkinson’s disease than age- Inhibiting this immune checkpoint protein with severe Covid-19. in the same matched controls. an additional drug resulted in an even greater five genes SCHOLZ LAB/NINDS improvement in survival, because the mouse’s Genetic Study of Lewy Body in another own immune system was able to attack the Dementia Supports Ties to study. They tumor. Importantly, this combination therapy also found the genetic profiles of the patients in also led to immunological memory against the Alzheimer’s, Parkinson’s this study had higher chances of suffering from glioma, meaning the mouse now had T-cells In an NIH-led study, scientists found that five either Alzheimer’s or Parkinson’s disease than the tailored to the specific tumor. Because gliomas genes may play a critical role in determining control subjects. almost always grow back after treatment, these whether a person will develop Lewy body demen- “We hope these results will act as a blueprint,” T-cells make the animal better prepared to fend tia (LBD), a devastating disorder that riddles the said Scholz, “for understanding the disease and off regrowth. brain with clumps of abnormal protein deposits developing new treatments.” These preclinical results produced by this called Lewy bodies. These deposits are also a combination therapy could represent a key hallmark of Parkinson’s disease. The results, pub- advance in developing an improved treatment lished in Nature Genetics, not only supported the

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NICHD’s Basser Honored for Retired NEI Senior Investigator anti-cataract drug treatment for use in many Developing Imaging Techniques Datiles Mourned parts of the world where cataract surgery is not available. This was Datiles’ most import- BY PAUL COPPOLA Dr. Peter Basser of NICHD is a co-recipient ant professional goal. of the 2021 Technology Award from the Retired NEI senior investigator, eye physi- Datiles also helped care for hundreds Eduard Rhein cian-scientist and medical officer Dr. Manuel of NCI and NHLBI patients who received Foundation. “Manny” Datiles III passed away on Feb. stem cell transplants. He led a clinical trial According 12. In his nearly 40-year career at NEI, he of blood serum eye drops for patients who to the award worked to find developed severe dry eye as a consequence citation, the causes and of therapy. Basser, who possible cures He published more than 100 peer-re- leads NICHD’s for blinding viewed papers, reviews and book chapters. section on cataracts. He He helped train many young eye physi- quantitative was recognized cian-scientists from around the world who imaging and around the are now senior faculty and leading clinicians tissue science world for his and scientists. and Division of expertise He received awards from the Translational in cataract Department of Health and Human Imaging and Services, the American Academy of Dr. Peter Basser of NICHD documentation, Genomic pathogenesis Ophthalmology, NEI, NIH, Johns Hopkins Integrity, was and medical University, University of Santo Tomas and honored for developing diffusion tensor treatment and the University of the Philippines as well as magnetic resonance imaging (DT-MRI), prevention. many civic and charitable societies for his which has implications for planning Datiles Dr. Manny Datiles receives contributions. surgery and radiotherapy, characterizing trained as an HHS Innovation Award After retirement he served as a special in 2011. brain disorders and visualizing nerve fiber a basic eye volunteer at NEI, a member of the NIH pathways (tractography). The technique researcher at PHOTO: CHRISTOPHER SMITH institutional review board, and as an allows researchers and clinicians to make NEI and as an adjunct associate professor of ophthalmol- detailed three-dimensional maps of brain eye clinician and surgeon at Johns Hopkins ogy at Johns Hopkins University School of pathways that could not be detected with Hospital, sub-specializing in cataract and Medicine. earlier imaging techniques. corneal diseases. He became NEI’s primary He is survived by his wife, Jacqueline, 6 With DT-MRI, radiologists can now cornea and cataract clinical investigator, children and 4 grandchildren. diagnose and assess many diseases and serving as chief of the cataract and cornea disorders and help neurosurgeons better section of the Ophthalmic Genetics and plan operations to target diseased tissue Clinical Services Branch in 1992. He helped while sparing healthy tissue. open the NIH operating room for eye VOLUNTEERS Tractography provides a wiring diagram surgery and performed hundreds of complex of the brain, allowing neuroscientists to anterior segment eye procedures on research study anatomical connections between patients from around the world. different brain areas. In the lab, he worked with the late Dr. Jin Volunteers Needed for Asthma Study The Germany-based foundation was Kinoshita to demonstrate that aldose reduc- People of African ancestry have a higher established in 1976 by Rhein, an inventor, tase inhibitor (ARI) drugs could prevent incidence of asthma and allergic diseases publisher and author. Its goals are to cataracts in animal models. ARIs are now compared to other population groups. promote scientific research, learning, arts used to prevent cataracts in diabetic dogs. Researchers at NHGRI are investigating and culture by granting awards for achieve- whether there is a genetic cause for this. He also co-discovered a novel lens protein Understanding the role that genes play may ments in radio, television and information in guinea pigs, the zeta-crystallin, with NEI someday lead to better treatments for these technology. protein chemist Dr. Sam Zigler. conditions. Consider volunteering, if you are Basser shares the award with Dr. Denis In collaboration with NASA physicist at least 18 years of age and self-identify as LeBihan, who co-developed DT-MRI. The Rafat Ansari, Datiles co-developed a Black, African, African American or African two will receive the award in November at Caribbean—both healthy volunteers and special clinical device based on a dynamic adults diagnosed with asthma are needed. a ceremony in the Hall of Fame Deutsches light-scattering technique and used it to For more information, contact the Office of Museum in Munich. show that oxidation-caused loss of a lens Patient Recruitment at (866) 444-2214, (800) protein—alpha-crystallin, a molecular 877-8339 TTY/ASII or [email protected]. Refer chaperone—leads to the formation of human to study #19-HG-0092. Online https://go.usa. gov/x7RXQ. age-related cataracts. This finding will help hasten the development of non-surgical

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A program officer at NICHD shared photos (clockwise from above) of the Ottauquechee River in Hartford County, Vermont, taken last August at various levels of the river, in and around the village of Quechee.

PHOTOS: DEBORAH HENKEN

Nature Springs Forth A while back, the Record asked readers for images found in nature, as the pandemic made the Great Outdoors even more attractive. As we move into March, thoughts of spring make these photos a timely sight. To share your images, send hi-resolution photos with short captions to [email protected].

Winter Color at Great Falls. Above, Dr. Michael Bender, program director, NIGMS Division of Genetics and Molecular, Cellular and Developmental Biology, captured a painted bunting near the Great Falls Visitor Center on the C&O Canal in late January.

Busy Bees Offer Respite in Pandemic. At right, Mary Dunne of the OD Office of Management, found solace in photographing her garden in the early days of the pandemic.

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