Elected to National Academy of Sciences, p. 3 UMMS Professor Craig Mello spring/summer 2005, vol. 27 no. 3

Justice Served

The Magazine of The University of Massachusetts Medical School The RNAi Revolution is Here.

The Pivotal Pancreas

Neural Pioneers

Plus, the Economics of RNAi L., the plural of life The name of this magazine encompasses the lives of those who make up the UMMS community, for which it is published. They are students, faculty, staff, alumni, volunteers, benefactors and others who aspire to help this campus achieve national distinction in education, research and public service.

University of Massachusetts Medical School The University of Massachusetts Medical School was created in 1962 by an act of the Massachusetts Legislature and today is comprised of three schools. Since accepting its first class in 1970, the School of Medicine has provided students with an accessible, comprehensive and personally rewarding medical education of the highest quality, one which optimally prepares them to excel as physicians. The Graduate School of Biomedical Sciences, opened in 1979, is a faculty-initiated PhD program that trains scientists in a specialty area with a broad background in the basic medical sciences, in preparation for conducting research with direct relevance to human disease. Opened in 1986, the Graduate School of Nursing, through its master’s, post master’s, doctoral degree and Graduate Entry Pathway programs, provides professional educa- tion and training for advanced practice nurses within three specialties: adult acute/critical care nurse practitioners, adult ambulatory/community care nurse practitioners and advanced practice nurse educators.

Commonwealth Medicine Commonwealth Medicine is UMass Medical School’s innovative public service initiative, provid- ing expertise to public sector agencies so they may optimize their efficiency and effectiveness. By offering access to its unparalleled breadth of academic, research, management and clinical resources, Commonwealth Medicine assists agencies to enhance the value and quality of expen- ditures, and improve access and delivery of care to at-risk and uninsured populations.

UMass Memorial Foundation The UMass Memorial Foundation, established in May 1998, is the charitable partnership created through a merger of the former University of Massachusetts Medical Center Foundation and the Memorial Foundation. The mission of the Foundation is to support the academic and research enterprises of UMass Medical School and the clinical initiatives of UMass Memorial Health Care.

Worcester Foundation for Biomedical Research The Worcester Foundation for Biomedical Research is a nonprofit organization devoted to the support of research and the education and training of tomorrow’s scientists at the University of Massachusetts Medical School. Founded in 1944 as an independent basic biomedical research institute, with research accomplishments that include the birth control pill and the work that led to in vitro fertilization, the Worcester Foundation merged with UMass Medical School in 1997.

UMass Memorial Health Care UMass Memorial Health Care is Central Massachusetts’ largest nonprofit health care delivery system, covering the complete health care continuum with teaching hospitals, affiliated com- munity hospitals, free-standing primary care practices, ambulatory outpatient clinics, long-term care facilities, home health agencies, hospice programs, a rehabilitation group and mental health services. UMass Memorial is the clinical partner of the University of Massachusetts Medical School. Contents

News and Notes 2 Features 8 Grants and Research 21 Alumni Report 23 The Last Word 28

Justice Served 10 In psychiatry and the law, a path less traveled leads to far-reaching impact.

The Pivotal Pancreas 13 Investigators and physicians at UMass Medical School and UMass Memorial consider the importance of the pancreas in the context of devastating disease.

Neural Pioneers 17 UMass Medical School is entering new territory as researchers explore the inner workings of the nervous system.

The Economics of RNAi 8 A seminal discovery by a UMass Medical School scientist launches an industry. News and Notes Closing in on a Male Birth Control Pill UMass Medical School and SpermaTech AS of Oslo, Norway, signed a license agreement earlier this year for a promising drug target for a male birth control pill. “The world is greatly in need of a better male contraceptive that is reversible, and I’m hopeful our partnering with Jovenal San Agustin, PhD (left), and George Witman, PhD, discovered a protein within human sperm SpermaTech will help meet this need,” that affects motility, and therefore, reproduction. said George B. Witman, PhD, the George of the human body. Defects in these of Biological Chemistry. Witman and Dr. F. Booth Chair in the Basic Sciences structures can cause a variety of San Agustin subsequently found that and professor of cell biology at UMMS, disorders, including male infertility. a nearly identical protein is present in whose laboratory discovered the target, mouse and human sperm. a protein found only in sperm cells that When sperm cells form in the testes, regulates the sperm’s ability to swim. If their tails are in place but they do not SpermaTech approached UMMS to enter the protein is not activated, sperm are move. As sperm pass through the epi- negotiations to license the U.S. patent is- unable to move through the female repro- didymis, a long, coiled tube that con- sued for Witman’s foundational technol- ductive tract to fertilize an egg. “Because nects each testis to the vas deferens, they ogy as applied to the Cs protein. Through this protein is found only in sperm cells, mature and acquire the ability to swim. the agreement, SpermaTech acquired blocking its action shouldn’t have any Working with ram sperm, Witman and the right to use Witman’s technology to side effects, and that makes this a very Jovenal San Agustin, PhD, instructor in develop a male birth control pill and exciting drug target,” said Dr. Witman. cell biology, found a protein within the is beginning to screen small molecular sperm cells that is activated during the compounds to identify those that can Witman is an international leader in the passage through the epididymis. Once effectively block Cs. The company field of cell motility who has pioneered activated, the protein, which they named is also entering discussions with the application of biochemical and mo- Cs, turns on the sperm’s molecular mo- pharmaceutical companies interested lecular genetic approaches to the study tors, causing the tail to undulate, creating in partnering with it to develop a male of cilia and flagella, the tiny hair-like forward motion. This discovery was first contraceptive drug. structures that are found in many parts described in a 1998 paper in the Journal

UMMS Ranks Fourth in Primary Care Education in U.S. News

UMass Medical School ranked fourth in primary care edu- UMMS has held a spot near the top of the category since the cation among the nation’s 124 fully accredited magazine began its rankings in 1994. “This Medical School was medical schools by weekly news magazine founded by the Commonwealth to provide an affordable medi- U.S.News & World Report in its annual cal education to state residents and to train outstanding pri- review, “America’s Best Graduate Schools,” mary care physicians for its people,” said Chancellor and Dean published in April. The U.S. News rankings Aaron Lazare, noting that half of the 2005 graduating class will are based on measures of academic quality enter primary care. “The U.S. News rankings underscore our which are weighted by reputation among successes in answering the Commonwealth’s call, and I am faculty and residents, research activity, exceptionally proud of the faculty and staff.” student selectivity and faculty resources. 2 News and Notes Mello Elected to the Prestigious National Academy of Sciences

The National Academy of Sciences, a was established in 1863 by a congres- ship in the Academy and elected so private organization of scientists and sional act of incorporation signed by quickly,” said Chancellor and Dean engineers dedicated to the furtherance of President Abraham Lincoln, is consid- Aaron Lazare. “But then, Craig Mello is science and its use for the general wel- ered one of the highest honors that can an exceptional scientist whose work has fare—and an official advisor to the fed- be accorded a U.S. scientist or engineer. had a profound impact on laboratories eral government in any matter of science on this campus and around the globe. Dr. Mello, the Blais University Chair in or technology—elected UMMS Professor Many of our own colleagues employ Molecular Medicine and an Investigator Craig C. Mello, PhD, to its membership RNAi technology in their work to under- of the Howard Hughes Medical Institute, in May. Election to the Academy, which stand diabetes, HIV/AIDS, ALS, cancer, was elected to the Academy in recogni- and other diseases, and countless other tion of his distinguished work in original universities and companies worldwide research; specifically, for the discovery utilize this remarkably precise technol- of RNA interference. In 1998, Mello and ogy to expedite their work, which will colleague Andrew Fire, PhD, published ultimately be of great benefit to all of research findings in Nature demonstrat- mankind.” (Read details of RNAi’s influ- ing that a particular form of RNA, the ence in the story on page 8.) cellular material responsible for the transmission of genetic information, can Mello and Fire’s discovery has garnered silence targeted genes. The RNAi process numerous honors, including the Na- offers astounding potential for under- tional Academy of Sciences Award in standing and manipulating the cellular Molecular Biology, the Wiley Prize in basis of human disease, and RNAi is the Biomedical Sciences, the Lewis S. now the state-of-the-art method by which Rosenstiel Award for Distinguished Work scientists can “knock down” the expres- in Medical Research and the Gairdner sion of specific genes to thus define the International Award. biological functions of those genes. “It is exceptionally unusual for a young scientist to be nominated for member-

Craig Mello, PhD, was elected to the National Academy of Sciences for his discovery of the revolutionary RNAi.

Jack M. Wilson, PhD, president of the University of Massachu- medical education, the past decade has seen UMMS explode setts, said, “It’s clear that UMass Medical School has earned onto the national scene as a major center for research. The its place among the top medical schools in the nation, an institution also ranks near the top among public medical achievement that reflects well on public higher education in schools in the Northeast in the amount of funding awarded by the state. The Medical School sets the standard of quality for the National Institutes of Health. Federal and private research all of the state’s universities and we extend our congratulations grants and contracts at UMMS rose from about $2 million in to Dr. Lazare and his colleagues.” 1977 to more than $167 million in 2005, making it one of the fastest-growing research institutions in the country. UMMS was also ranked 46th in the U.S. News list of top research schools. Beyond its core mission of distinction in 3 News and Notes Commencement Ceremony Celebrates Scientific Discovery and Compassionate Care

UMass Worcester awarded 156 degrees at its 32nd Commence- he earned his PhD in 1969. He has been an American Cancer ment exercises held June 5 at Mechanics Hall in Worcester. Society Research Professor at the Whitehead Institute and Chancellor and Dean Aaron Lazare presented 101 MD degrees MIT since 1985. from the School of Medicine; Dean Anthony Carruthers award- Weinberg has received numerous honors, including election ed 29 PhD degrees, including one in Biomedical Engineering to the National Academy of Sciences in 1985 and the 1997 and Medical Physics, from the Graduate School of Biomedical National Medal of Science, and is an accomplished author Sciences; and, from the Graduate School of Nursing, Dean Do- who has written or edited six books and over 300 articles. reen Harper presented 19 master’s degrees and four post-mas- ter’s certificates. Three MD/PhD degrees were awarded as well. Honorary degrees were presented to Weinberg, Syed Adibul Hasan Rizvi, MD, and posthumously to Kenneth B. Schwartz. To commemorate the 25th anniversary of the founding At the Sindh Institute of Urology and Transplantation (SIUT) of the Graduate School of Biomedical Sciences, UMMS in Pakistan, Dr. Rizvi has provided much-needed modern and welcomed Commencement keynote speaker Robert A. comprehensive health care to some of the poorest in that Weinberg, PhD, an internationally recognized authority on nation—those in dire need with virtually no access to the genetic basis of cancer. Dr. Weinberg is a founding member modern diagnostic treatment or transplantation services. of the Whitehead Institute for Biomedical Research and the His philosophy of “partnership between government and the Daniel K. Ludwig Professor for Cancer Research at MIT, where

GSBS Student’s Research Quality and Significance Garners Award

M. Weintraub Graduate Student Awards RNAi, has made the absolute most of the from the Fred Hutchinson Cancer opportunity,” said C. Robert Matthews, Research Center in Seattle. The awards PhD, the Arthur F. and Helen P. Koskinas recognize the world’s best graduate Professor of Biochemistry & Molecular students in the life sciences on the basis Pharmacology and chair of the depart- of the quality, originality and signifi- ment. “The Weintraub Award is a fitting cance of their work. tribute to her accomplishments and is likely to be followed by other awards Schwarz, who is enrolled in the Program that recognize her special talents.” in Biochemistry & Molecular Pharma- cology, focuses on the developmental Schwarz enrolled in the Graduate School process of mutated genes associated with of Biomedical Sciences in 2001 and has amyotrophic lateral sclerosis (ALS, or worked with Phillip D. Zamore, PhD, Lou Gehrig’s disease). She is currently and Zuoshang Xu, MD, PhD, both working to develop a laboratory system associate professors of biochemistry & as a means to study the genes to better molecular pharmacology. “This is a huge Dianne Schwarz is one of only 15 graduate understand how RNAi—a natural achievement for Dianne, but also for students in the world to receive the gene-silencing mechanism—may be used our department and for UMass Medical Weintraub Award in 2005. to “knock out” mutant genes. School. It is yet one more example that we really have come of age,” said Dianne Schwarz, a fourth-year Graduate “Dianne is an outstanding student who, Dr. Zamore. School of Biomedical Sciences student, when presented with a very exciting received one of just fifteen 2005 Harold project on the mechanism of action of

4 News and Notes

public sector” through the creation of the SIUT serves as an appropriate example to UMass Worcester students of a humanitarian dedicated to the needs of the underserved. Mr. Schwartz, a health care attorney who succumbed to lung cancer in 1995 at the age of 40, was remembered by his wife, Ellen Cohen, and their son, who were on hand to receive the honor. Shortly before his death, Schwartz established the Kenneth B. Schwartz Center at Massachusetts General Hospital to support and advance compassionate health care. He hoped that the lessons he learned from his illness and the empathic care he received might be studied and broadened to the benefit of future patients, their families and their caregivers. Today, the Schwartz Center sponsors medical education and training pro- Chancellor and Dean Aaron Lazare (left) and UMass President Jack Wilson (center) grams and promotes policy development and public awareness; bestow a framed citation, diploma and hood upon Ellen Cohen, widow of Kenneth it awarded its 2004 Compassionate Caregiver Award to UMass Schwartz, as part of honorary degree ceremonies. Schwartz founded the Schwartz Center prior to his death in 1995; the center and UMMS promote compassionate Memorial Medical Center oncology nurse Helen Mullen, RN. health care in education and practice. GSBS Student’s Research Quality and Significance Garners Award UMMS Vaccine Expert Tapped to Advise Defense Department

Francis A. Ennis, MD, an internationally advisory committee to the Department of dations concerning immunizations, recognized researcher into the causes Defense through the Assistant Secretary chemoprophylaxis and therapy, as well and prevention of infectious diseases of Defense – Health Affairs. For over 50 as disease surveillance, prevention and such as AIDS and smallpox, has been years, the civilian physicians and scien- control. Ennis and fellow subcommittee elected a board member of the Armed tists who have served on the AFEB have members will be particularly focused Forces Epidemiological Board (AFEB). contributed to numerous advances in the on protecting military personnel against Established in 1943, AFEB is a scientific prevention and control of diseases and infectious diseases used as potential injuries among military men and women, bioterrorism threats. Francis Ennis, MD, will serve on the Subcom- as well as advancing medical science and mittee on Infectious Disease Prevention and In 2003 the National Institute of Allergy health for the entire nation. Control/Department of Defense. and Infectious Disease, which supports A professor of medicine and molecular several of Ennis’s research programs, genetics & microbiology and director of named UMMS a “Cooperative Center for the UMMS Center for Infectious Disease Translational Research on Human Im- and Vaccine Research, Dr. Ennis will munology and Biodefense” and Ennis its serve a two-year term on the Subcom- director. Funded by a $16 million grant, mittee on Infectious Disease Prevention the center is one of five in the nation and Control. The subcommittee focuses selected to seek a better understand- on operational programs, policy develop- ing of the human immune response to ment, and research programs and needs potential agents of bioterror and rapid for infectious disease control in the development of countermeasures such as Armed Forces by providing the latest vaccines and therapies. scientific evaluations and recommen- 5 News and Notes Study Finds ‘Good’ Carbs Linked to Lower Body Weight

Seeking some clarity in the “low carb, no carb” diet craze that carbohydrates and body weight,” said Yunsheng Ma, MD, PhD, has swept the nation in recent years, researchers at UMass assistant professor of medicine, and lead author of the study. Medical School analyzed the eating habits of 572 people in Each subject in Dr. Ma’s study was followed for one year, with Central Massachusetts and found a clear link between the his or her eating patterns charted at five different times during intake of certain carbohydrate foods and higher body mass that year. The analysis was focused solely on the connection index (BMI), the standard measure for obesity. between eating various foods containing carbohydrates and The results of the study, published in the American Journal of body weight. The carbohydrates were classified based on their Epidemiology, show that people who ate more refined grains, glycemic index (GI), which is a measure of how much and starchy vegetables, white flour and similar carbohydrates were how fast a food raises a person’s blood sugar level. Foods with significantly heavier than people who ate foods with “good a high GI value rapidly spike blood sugar, while foods with a carbohydrates” such as whole grains, non-starchy vegetables, low GI value can help control blood sugar levels. Studies have nuts and seeds. “There are many factors involved in obesity, shown that when blood sugar spikes, insulin is elevated but our study found a clear association with eating certain

Summer Launch for New Dental Residency Program

In 2003 the Department of Family Medicine & Community Practice Dentistry under the direction of assistant professor Health established a program in oral health, with the objectives David Matson, DMD—begins its inaugural year this summer to integrate oral health education into the department’s teach- with the enrollment of two graduates from the Tufts University ing programs and to develop a new graduate dental residency School of Dental Medicine. They will practice at the Worcester program. This second component—the residency in General Family Health Center’s Dental Department with Director Susan C. Fiorillo, DMD. Layla da Costa receives dental care at the Quinsigamond Community “A major problem we face in oral health is that physicians of- College Clinic, which, like the Family Health Center where the residents will practice, is funded by the Central Massachusetts Oral Health Initiative. ten think the area between the lips and the tonsils is off-limits. So teaching our medical students how to deal with things in the mouth, and to make the appropriate referrals for treatment, is very important,” said Daniel H. Lasser, MD, MPH, chair of Family Medicine & Community Health. “At the community level, the issue is access to care. That’s where a residency pro- gram is so beneficial—providing a training ground for dentists with a community health component.” The one-year residency program, run in conjunction with the Medical School’s clinical partner, UMass Memorial Health Care, and other area hospitals “is a very important initiative,” said John P. Gusha, DMD, instructor in family medicine & com- munity health and a dentist in private practice who volunteers as director of the Central Massachusetts Oral Health Initiative. “The Medical School is a tremendous leader in the health care community. Bringing oral health into the school’s curriculum will educate the community at large about the crisis we face, and will drive home the message to everyone that you’re not completely healthy without good oral health.” 6 News and Notes

and that prompts the body’s fat and muscle cells to absorb the Yunsheng Ma, MD, PhD, and Barbara sugar in the blood and store it as fat. Olendzki, RD, MPH, hold PDAs that Based on the population in Ma’s study, people weighed 9.6 patients with type pounds less for every 10-point reduction in the combined 2 diabetes will use glycemic index of their diet. In other words, a person with a to document their carbohydrate intake. GI of 95 typically weighed nearly 10 pounds more than some- The PDAs are also one in the study with a GI of 85, all other factors being equal. designed to prompt “Nearly 10 pounds is a clinically significant difference,” said the user to consider a better food choice. Barbara Olendzki, RD, MPH, instructor in medicine and a co- author of the study. “One of the takeaway messages of these findings is that if people can lower the GI of their diet by choosing the best carbohydrates to eat, they should be able to lose some weight.”

Summer Launch for New Dental Residency Program Campus Modernization Update: Clip-On Completion

Construction of the Clip-On Office Space Addition near the future site of the new entrance to UMass Medical School’s renovated lobby, was completed in June. Comprising 60 offices and 10 conference rooms on five floors, the Clip-On adds a number of highly useful rooms to the campus. Meanwhile, the UMass Memorial Lakeside Expansion is well on its way to its scheduled 2006 opening. Much of the facility’s exterior is now covered with limestone and crews have completed the glass and steel curtainwall. Within the building, mechanical and electrical contractors are installing the major infrastructure components—air conditioning ducts, large electrical conduits and plumbing pipes. Elevator shafts, stairways and mechanical rooms are also being fully enclosed.

The Clip-On, as seen above as a series of new windows atop the new Medical School Entrance under construction, offers additional conference and office space.

The annual Walk to Cure Cancer – Sunday, September 25, 2005 – supports cancer research programs at UMass Medical School. Visit www.walktocurecancer.com for registration information. 7 The Economics of RNAi A seminal discovery by a UMass Medical School scientist launches an industry.

By Michael I. Cohen

In academic medical research, is the case with the discovery of the Institute Investigator, in collaboration the quest is always for new knowledge— gene-silencing phenomenon known as with his colleague Andrew Fire, PhD, of to fi nd that key test result, or to glean RNA interference (RNAi). the Carnegie Institution (now of Stanford University). Since their seminal paper that singular insight from the pastiche RNAi was discovered in 1998 by Craig in Nature coined the term RNAi and of fi ndings in the lab that helps further C. Mello, PhD, the Blais University Chair detailed the process for silencing genes the understanding of human biology in Molecular Medicine and professor of at will, the technology of RNAi has been and disease. On rare occasions, that molecular medicine and cell biology at widely adopted. “RNAi is now the most pursuit can launch an industry. Such UMMS, and a Howard Hughes Medical

8 talked about technology for [drug] target scientists were left to a laborious game be done in days, with very accessible validation and therapeutics,” said Girid- of trial and error, using comparatively research techniques.” har Rao, an analyst with Frost & Sullivan crude, time-consuming methods to There are now three main market seg- who tracks emerging trends in health “knock out” a single gene in an organism ments of the commercial RNAi industry: care and pharmaceuticals. “As the excite- and then study the impact of its removal. companies that supply RNAi research ment and interest in RNAi grows, the The tools of RNAi have changed all that. tools to scientists, companies that list of biotechnology and pharmaceutical “Ever since Craig Mello and Andrew specialize in testing for potential drug companies involved in the technology Fire first identified RNAi, many in the targets by using the techniques of RNAi continues to grow exponentially.” scientific community felt it was a world- (so-called target validation) and compa- changing discovery,” said University of By definition, the economic impact of nies using RNAi technologies to develop Massachusetts President Jack M. Wilson, RNAi prior to 1998 was zero because new therapies for human diseases. “The PhD. “Now we see those sentiments con- the field did not exist. In 2005, the biggest market segment today is the firmed. First, RNAi would revolutionize commercial market for RNAi-related vendors who provide the research tools,” research by giving scientists the tools products and services will reach $450 Dr. Melnikova said. “That segment will to understand and regulate gene func- million, according to The BioWorld continue to grow significantly. The target tion. Then, it would promise therapies RNAi Report, published earlier this year. validation segment will also grow, and I never before possible for a wide range “And we expect that strong growth in think may outpace the reagents segment of disease. So what we’re seeing now, the RNAi markets will continue for at some point.” with the economics of RNAi unleashed, several years,” said Michael J. Harris, is only a logical extension of their The research applications for RNAi are managing editor at BioWorld, who breakthrough discovery.” now well established, analysts agree. compiled the market study on RNAi. The potential for RNAi therapeutics to “We’re already working on the sequel The foundational Mello-Fire pat- treat human disease is still speculative, to the RNAi report because the inter- ent for RNAi has been licensed by with several challenges to be addressed, est level is so high. Right now, we’re 49 companies, including some of the such as appropriate delivery systems to projecting this to be a $1.1 billion market biggest players in the biotechnology get the drugs to their targets. The first by 2010, when we expect to see the first and pharmaceutical industries. Other clinical trial with an RNAi-based drug RNAi-based drugs coming to market.” UMMS investigators, including Phillip began in the fall of 2004, testing a new D. Zamore, PhD, associate professor of The tools of RNAi give scientists rapid therapy for macular degeneration, the biochemistry & molecular pharmacology, and precise means to understand what leading cause of blindness in people Michael P. Czech, PhD, professor and genes do in the body and to interrupt over 50. In 2005, several other RNAi chair of molecular medicine, and Tariq the way genes direct the creation of therapeutics are expected to enter clini- M. Rana, PhD, professor of biochemis- proteins that regulate metabolic func- cal trials aimed at HIV and ALS. Should try & molecular pharmacology, along tions. And because they can block the those trials prove beneficial, analysts with Dr. Mello, have all contributed effects of disease-causing genes, RNAi expect RNAi will help refill the shrink- to a steady stream of RNAi advances compositions are emerging as a new ing product development pipelines of the at UMMS that are now being used by class of therapeutic drugs aimed at many pharmaceutical industry and yield new industry. The Medical School’s RNAi conditions including cancer, diabetes, therapies for a host of human diseases. technology is also in use at nearly every and neurodegenerative diseases like “The work on RNAi by Craig Mello and major biomedical research institute and Alzheimer’s, Parkinson’s and ALS, as others at the Medical School has placed university in the developed world. “I well as infectious diseases like HIV/AIDS UMass at the epicenter of a revolution in think the wide acceptance of RNAi is a and hepatitis. both biomedical research and in prospec- testament to its quality and importance tive therapies,” President Wilson said. Prior to the advent of RNAi, demand for as a research tool,” said Irena Melnikova, “It’s a stunning example of the positive a novel technology that would allow for PhD, a senior research analyst at Life impact that UMass can have on human- rapid gene-silencing and analysis was Science Insights, an IDC company. “This ity and is fully consistent with our vast. The Human Genome Project had is clearly a great advance, a very big step. mission to be a university of distinction mapped most of the genetic elements of What used to take years, and require serving our community, our nation and human DNA, but that map said nothing highly specialized skills, can now the world.” about the function of those genes. So 9 Justice Served In psychiatry and the law, a path less traveled leads to far-reaching impact.

By Sandra L. Gray

10 It was as a young clinical psycholo- the juvenile justice system—two-thirds gist doing court-ordered evaluations of boys and almost three-quarters of girls of youth in trouble with the law that in juvenile detention centers have at Thomas Grisso, PhD, fi rst encountered least one mental disorder. As professor the problem: Many young people were of psychiatry, coordinator of the Law getting involved in the juvenile justice and Psychiatry Program, and director of system not because they were bad, the Law and Mental Health Core of the but because they suffered from mental Center for Mental Health Services disorders which sometimes led to bad Research at UMass Medical School, behavior. Dr. Grisso wanted to help, Grisso has dedicated his career to but unlike most forensic psycholo- championing the mental health needs gists, he chose not to do it one teen at and legal rights of persons with mental a time. Rather, he took an early turn disorders in the justice system. down a career path less traveled in his Grisso’s infl uence on forensic mental fi eld. “I diagnose and try to change the health concepts and practice began 30 systems that have an impact on people years ago, in an era that provided little with mental disorders—different, but in organization and few textbooks for many ways parallel to what the clinician the fi eld. Since then he has conducted does,” Grisso explained. “I am fascinated pioneering studies of youthful and adult by the translation of the law’s concerns defendants’ capacities to waive Miranda about people into clinical terms. Each rights; analyzed and developed standard- discipline describes people differently. ized methods to improve clinicians’ We need to translate in both directions assessments of legal competencies; for both legal and mental health provid- evaluated forensic mental health ser- ers to work effectively on behalf of their vice delivery systems; studied patients’ clients’ needs and rights.” competence to consent to treatment; Forensic psychiatry and psychology and assessed treatment policy regard- are at the heart of a just society’s fair ing youths in the juvenile justice system treatment of its members with mental with mental disorders. While his work disorders—often its most vulnerable and has addressed the needs of individuals at-risk members, especially when they of all ages, it is perhaps in the arenas are children. Without early and effective of legally involved youths with mental identifi cation and interventions, un- disorders where Grisso has effected the treated mental health needs can increase most change in the legal system. a child’s risk of coming into contact with

Thomas Grisso, PhD 11 His investigations and advocacy have now chair of the department, to help es- other mental health professionals, chart a paralleled the trajectory of juvenile jus- tablish the fledgling Law and Psychiatry rational course for addressing the mental tice policy over more than three decades, Program. Coordinated by Grisso under health needs of incarcerated youth. from rehabilitative to punitive, with its Dr. Appelbaum’s directorship, the now Most recently, Grisso was presented current trend to refocus on rehabilita- sought-after post-doctoral Law and Psy- with the 2005 American Psychiatric tion informed by the research of Grisso chiatry Program is an interdisciplinary Association’s Isaac Ray Award, the APA’s and others regarding youths’ immaturity collaboration of UMMS faculty devoted highest honor for distinguished careers compared to adult offenders. In one to training and clinical services at the in- in forensic mental health, recognizing recent and dramatic example, Grisso’s terfaces of medicine, behavioral science outstanding contributions to forensic was amongst research cited in the federal and the law. “Few medical schools and psychiatry and the psychiatric aspects case of Roper v. Simmons, in which the psychiatry departments in the United of jurisprudence. The award will again Supreme Court ruled that individuals States have law and psychiatry programs, enable Grisso to reach out nationally, convicted of crimes committed while even fewer have research strengths that by creating and delivering the Isaac Ray they were under the age of 18 can no match their clinical strengths, and fewer Lecture Series to forensic mental health longer be put to death. yet are as interdisciplinary as ours, practitioners around the country. which includes psychiatrists, psycholo- Another of Grisso’s recent, far-reach- gists, sociologists and lawyers as full- Grisso is grateful for the opportunities ing projects is the Massachusetts Youth time medical school faculty,” Grisso and accomplishments realized during Screening Instrument (MAYSI), now in enumerated with pride. his long and fruitful association with use statewide by juvenile justice sys- UMMS. “It was the vision of Paul Ap- tems in 35 states. Commissioned by the A prolific writer as well as researcher, pelbaum and Aaron Lazare that led to MacArthur Foundation to improve the educator and advocate, Grisso has the departmental support that made ev- identification of youths entering the juve- contributed significantly to the literature erything I’ve done here a possibility. As nile justice system with immediate men- on psychiatry, psychology and the law. long as my ideas have had some promise tal health needs, Grisso and colleagues His 1986 book Evaluating Competencies: to benefit persons with mental illnesses developed the MAYSI as a low-cost, Forensic Assessments and Instruments who were involved in the legal system, scientifically valid, 10-minute triage tool (Plenum Press) became a landmark text and to benefit our academic and public that can be administered by non-clini- in forensic mental health research and service missions, the institution has cians to every youth entering a juvenile practice. He wrote the 2004 Double been helpful and encouraging. I could detention or corrections facility. Jeopardy: Adolescent Offenders with not have had a better milieu in which Mental Disorders (University of Chicago Grisso was recruited to UMMS from to achieve my objectives during the Press) to help government administra- St. Louis University in 1987 by Paul past two decades.” Many young people tors, judges, lawyers, and juvenile justice S. Appelbaum, MD, then the Arnold F. who have benefited from his work will policy makers, as well as clinicians and Zeleznik Professor of Psychiatry and likewise agree.

Forensic psychiatry and psychology

are at the heart of a just society’s

fair treatment of its members

with mental disorders…especially

when they are children.

12 The Pivotal Pancreas Investigators and physicians at UMass Medical School and UMass Memorial consider the importance of the pancreas in the context of devastating disease.

By Kelly A. Bishop and Alison M. Duffy

13 Just over six inches long and tucked up against the spine in the rear of the upper abdomen, the pancreas seems to receive less attention than, say, the heart or brain. Yet this little organ is responsible for the production of insulin and digestive enzymes, both of which are vital to health and physical function. Unfortunately, it can also be the site of chronic and deadly disease. Here, we take a closer look at the pancreas and three areas in which medicine and science face both challenge and opportunity.

The islet inventory in on this proliferation in the mouse model, finding that a dramatic upsurge in production begins precisely on day 15 Much has been written about diabetes research at UMass of the animal’s 21-day gestation and continues until the Medical School as the institution and its faculty have second day of lactation. Rastellini demonstrated that not established a national reputation for excellence in the field. only was the volume of beta cells greatly increased, but the One intriguing new area being explored by Cristiana Rastellini, capacity of the resulting islets to produce insulin when MD, associate professor of surgery and director of Cellular transplanted seemed far superior as well. Transplantation, is the genetic mechanism behind the proliferation of beta cells, which compose 90 percent of islets, (Conversely, gestational diabetes—based on what is known the cellular pancreatic clusters responsible for the production now—could be associated with a lack of beta cell of insulin. proliferation usually occurring during the third trimester of pregnancy. Rastellini is also testing male islets in female In 1996, as a research fellow at the renowned T.E. Starzl Trans- recipients to see if the islets proliferate later during plantation Institute at the University of Pittsburgh School of pregnancy, to determine—or rule out—a hormonal link.) Medicine, Dr. Rastellini was practiced at isolating islets from donated pancreases for transplant into severely diabetic pa- “These are crucial findings for us,” said Rastellini, whose study tients. She was nonetheless stunned by the number and quality abstract has been accepted by the American Transplant Con- of islets obtained from a pancreas that came from a woman gress. “A major problem in islet transplantation is the limited who died tragically during her ninth month of pregnancy. volume of islets we can obtain from a single pancreas.” A dia- “We’d never seen anything like it before,” Rastellini said of betic patient requires at least 10,000 islets per kilogram of body the isolation. “We had twice the healthy islets we would have weight to successfully reverse their dependence on artificial expected, millions of them.” insulin. A person weighing 80 kilograms, or approximately 175 pounds, for example, would need some 800,000 islets; a typical Medical literature had previously documented that during isolation yields 400,000 to 600,000. “It would be ideal if we the third trimester of pregnancy, a woman’s pancreas has the could find the trigger to increase not only the number but the capacity to proliferate beta cells, although it was not clear quality and capacity of the islets,” Rastellini said. how. Rastellini, who joined UMMS in 2002, recently zeroed

Cristiana Rastellini, MD (below), is seeking the trigger that will increase the number, quality and capacity of pancreatic islet cells, with ramifications for diabetes treatment. On page 13: Brian Lewis, PhD, has worked to develop better research models for pancreatic cancer using the most advanced technology; see page 16.

14 Cystic fibrosis: everything else, he added, is disheartening for some patients A lung disease with a pancreatic origin and frustrating for care providers and CF researchers as well. Furthermore, the poor control of blood sugar brought upon by In the late 1930s, when CF was first identified as cystic fibro- destruction of the pancreas worsens both the patient’s nutri- sis of the pancreas by a pathologist at Babies Hospital in New tional and pulmonary conditions. York, 90 percent of CF infants died of malnutrition. The dis- Because there is a wide spectrum of clinical manifestations of covery of cysts and fibrosis that blocked the flow of digestive CF, not all patients exhibit the same symptoms and it’s difficult juices from the pancreas to the intestines led to the introduc- to predict which patients will develop further illness. And tion of oral replacement enzymes that allowed for more normal although the vast majority of CF patients are identified by age digestion and absorption of food. Children soon were living three, experts have recognized since the late 1990s that very longer, only to develop the thick, sticky mucus in their lungs mild mutations of the CF gene could unexpectedly present that has become the recognized hallmark of CF. later in life. CF has been diagnosed in teens and adult patients, The pancreas has remained a central focus for CF researchers often masquerading as chronic pancreatitis, an inflammation of and clinicians; in several states newborns are screened for the the pancreas caused by overactive digestive juices that slowly disease at birth and provided early nutritional intervention to destroy the organ. In such patients, CF is manifested in pancre- stave off symptoms. Despite improved nutritional and atic insufficiency severe enough to disrupt digestion and cause respiratory therapies, the pancreas’s dual roles of producing pain, but not enough to create the cysts and fibrosis commonly both digestive enzymes and insulin tend to collide. Nearly associated with the disease. “Teens and adults who have recurrent acute pan- creatitis or chronic pancreatitis should be screened for CF,” suggested Dr. O’Sullivan. “Internists and adult GI specialists ought to think of CF as part of the differential diagnosis.” Enzyme replacement can often help decrease the stress on the pancreas and reduce the number and severity of bouts of acute pancreatitis, although patients must take enzymes prior to every meal. Currently, management for acute pancreatitis is episodic and symptomatic, according to Wahid Wassef, MD, clinical associate professor of medi- cine and Director of Endoscopy in the Department of Gastroenterology at UMass Memorial. Various therapies can be employed, ranging from hydration and pain medication to aggressive antibiotic pro- Brian O’Sullivan, MD (left), treats patients who have cystic fibrosis, which often phylaxis or total parenteral nutrition. (In extreme masquerades as chronic pancreatitis. His colleague, Wahid Wassef, MD, explores pancreatitis as a genetic disorder, lending it to more specific treatment options. cases, pancreatectomy and islet transplant might be the only option.) Once the episode resolves, 25 percent of patients develop CF-related diabetes in their Dr. Wassef said, “every attempt must be made to look for the late teens and 20s as enzymes trapped in the pancreas by triggering factors,” such as alcohol consumption, autoimmune clogged ducts autodigest the organ itself, along with its disease, gallstones, or elevated triglyceride or calcium levels. insulin-producing cells. If no etiology is found, genetic screening may identify genes linked to CF and pancreatic cancer or genes that code for “For our patients, it’s a continual struggle to stay ahead of CF proteins known to inappropriately increase pancreatic and not lose ground to the nutritional or respiratory symp- enzyme activity. toms,” said Brian P. O’Sullivan, MD, professor of pediatrics, whose study of infant formula supplemented with DHA (doco- “Pancreatitis used to be a black box,” explained Wassef. “Now sahexaenoic acid) was designed to give CF infants a nutritional we recognize it as a genetic disorder and hope to soon have head start against the disease. Developing diabetes on top of more specific treatment options.”

15 An ideal model for studying pancreatic cancer target pancreatic duct cells. Since joining UMMS as an assis- tant professor of molecular medicine in 2003, he has worked to In the fall of 1998, current UMass Medical School researcher develop better research models for pancreatic cancer utilizing Brian Lewis, PhD, was seeking a challenging research project the most recent technology. He is particularly enthusiastic to conduct as a postdoctoral fellow in the National Institutes about two aspects of his current models. First, Lewis and his of Health laboratory of Nobel Prize-winning cancer researcher team introduce genetic alterations after birth. “The current Harold E. Varmus, MD. Dr. Lewis, interested in the efforts to understanding in cancer biology is that, with the exception generate quality animal research models for different tumor of persons who have inherited predispositions to cancer, the types, quickly discovered that pancreatic cancer was an ideal genetic changes leading to tumor formation tend to occur after target, since it was the most devastating disease without a good birth. We believe that our models more closely mimic the research model. situation in human tumor development.” Although it is ranked as the 11th most common of cancers, The second unique characteristic of Lewis’s models is the pancreatic cancer is the fifth leading cause of cancer death system by which genetic changes are introduced. Lewis and in the United States. Approximately 30,000 cases are newly colleagues deliver genetic information via an avian retrovirus diagnosed each year, with an equal number of deaths from the that does not normally infect mammals. This system is inef- disease in the same timeframe; 80 percent of pancreatic cancers ficient, yet, as Lewis knows, in this case inefficiency is a good have metastasized at the time of diagnosis and survival in thing. “Although we target all pancreatic duct cells, because untreated patients is poor. the process is inefficient it only successfully happens in a few While the high mortality rate and rapid decline of patients with cells. So what we have is a genetically modified cell surround- pancreatic cancer was enough to encourage Lewis’s scientific ed by cells that are relatively normal,” said Lewis. “We under- endeavors, he was also interested in the fact that there had stand from human tumor development that most tumors arise not been a new mouse model generated for pancreatic cancer from the transformation of a single cell. Our hope then is that since 1993, and the existing models had several deficiencies. tumors in our models will arise, and progress, through a series With improved tools, Lewis set out to develop a more useful of events that are more closely aligned with what occurs during research model for this deadly cancer. the human disease.” Pancreatic ductal adenocarcinoma is the most common form Quality models that closely represent the development of of the multitude of pancreatic cancers, accounting for nearly pancreatic cancer in humans are essential to Lewis’s primary 90 percent of all diagnoses. Lewis’s initial attempts to create a research goal to understand how the genetic mutations present promising animal model—conducted during the remainder of in a tumor dictate its behavior. “What are the proteins that act his postdoctoral studies at the NIH and subsequent research at downstream of these genetic changes to carry out this work?” Memorial Sloan-Kettering Cancer Center—focused on target- he asks. Lewis believes that, once they are better understood, ing not ductal cells, but rather their neighboring cells in the these proteins would be appropriate therapeutic targets. “These pancreas. He believed that by manipulating these cells early in targets are going to be different based on what the initiating their development he could coax them to become pancreatic genetic mutations are in a tumor. In order to come up with a duct cells and, therefore, develop pancreatic duct tumors. therapeutic strategy for a patient, you need to understand what their genetic mutations are and what are the best strategies to Although this method worked fairly well, Lewis was innovate the most targeted and effective treatment.” committed to refining his approach to more specifically

“Genetic changes leading to tumor formation tend to

occur after birth. We believe that our models more closely

mimic the situation in human tumor development.”

16 - Brian Lewis, PhD Neural Pioneers UMass Medical School is entering new territory as researchers explore the inner workings of the nervous system.

By Lynn C. Borella

You could say they’re pioneers. One has paved the in the Department of Neurobiology—a hub of neuroscience way for advancements in the understanding of the synapse from research at UMass Medical School that appears destined to work conducted in the common fruit fly , an often misunderstood make significant contributions to the field through its investiga- model system that provides study in a range not yet available in tions into the roles that genes and their proteins play, both in any other. The other is investigating a neurological tissue with normal and abnormal nervous system function. workings that remain a mystery to many. And, both are here

17 Promise revealed model for synapse development. Now gene comparable to human APP, which we’re at a level where many people use it plays a key role in the development of Considered by many as “science fiction” because it’s simple and you can directly Alzheimer’s disease. Investigators have only a few years ago, neuroscience is look at the synapses in vivo. Its promise found that this protein is normally pro- becoming a well-established discipline, is finally coming to fruition.” cessed by being split into several pieces its practical importance staggering. And, and, if one piece is overproduced, the the contribution of the fruit fly (Dro- Budnik’s most pioneering discoveries result is lesions and cell death character- sophila) to this complex biological study have been focused on the molecular istic of Alzheimer’s. “The problem was has, in many ways, been aided by the mechanisms by which synapses are that no one knew the normal function of work of Professor of Neurobiology Vivian formed and modified. In the nervous sys- this protein; we only knew the disease Budnik, PhD. Introduced to Drosophila tem, the basic means of communication that is caused by its abnormal process- while pursuing her doctoral degree at between cells is synaptic transmission. ing,” said Budnik. “We have found that Brandeis University, Dr. Budnik was as- Essential to the speed and efficiency of APPL is important in the earliest stages tonished at how much could be done in this communications vehicle is the mo- of synapse formation, the first demon- this simple model system that exhibited lecular organization that takes shape on strations in vivo of what this protein con- an amazing “conservation” (i.e., shared) either side—the “pre- and post-synaptic” tributes to normal neural function.” She number of genes with humans. It was apparatus. Once synapses are formed, continued, “We have made significant this insight that she found compatible it is the ability of these connections to contributions to the understanding of with her interest in the study of neural strengthen or weaken that is central to certain aspects of synapse development synapses. “When organisms learn, there the processes of learning and memory using this model system, but I firmly is this ‘flexibility’ that allows synapses to and the restoration of synaptic connec- believe that major advances in the field become stronger or weaker, or to grow. It tivity after a traumatic injury. can only be made by putting together the is this phenomenon of plasticity in com- Budnik’s ongoing investigations have knowledge you gather in one organism munications mechanisms in which I’m included identifying proteins required to with another. It’s this combined effort most interested.” “scaffold” or support this vital connec- that makes things happen and that will According to Budnik, who was recruited tion and regulate its shaping. She was lead to significant advances in the field.” to UMass Medical School from UMass the first to uncover several proteins with Amherst in 2003, the same genes that fundamental roles in synapse formation On page 17: The UMMS Department of Neurobiology is fortunate to have in its labs Vivian Budnik, PhD (left), and Marc Freeman, PhD. She was the first to uncover several proteins with fundamental roles in and dynamics, including “Disc large” or synapse formation and dynamics. He conducts novel research into brain glial cells and their connection to disease states. Below, left, microscopic images from Dr. Freeman’s lab show acute neuron injury have been found to be important to this and reactive gliosis in the fruit fly (Drosophila). Within two hours after neurons (green) are severed, much like after spinal cord injury, glia (red) extend membranes specifically to the injured neurons, help destroy plasticity are also involved in many Dlg, a tumor suppressor gene also found them, then clean up cellular debris. Work in Drosophila should help to rapidly dissect the mechanisms driving these events. disease processes. The first step in in fly epithelial cells that promotes the understanding disease, however, is to formation of junctions. “This was the achieve a firm grasp of normal function. earliest gene we characterized in the This is attainable in a model system that fly that was also found in mammalian shares a high percentage of its genes synapses,” Budnik said. “Prior to this with humans but is simple enough upon time, nobody understood how certain which to perform genetic screenings that chemical channels became anchored to demonstrate varied effects on brain specific regions of the synapse; this pro- function and development—a system tein clustered these channels at synaptic like Drosophila. sites, making it a critical part of synapse formation and beautifully exemplified Capitalizing on the strengths of this how these scientific findings—suggested system, Budnik was one of the first to in mammals—could be demonstrated in characterize, record and create markers a living organism like the fly.” for the fly’s neuromuscular junction— findings later related to the synapses of Since these elucidating results, Budnik the mammalian central nervous system. has investigated a number of additional “When I first entered the field, I was just scaffolding proteins critical to synap- one of two people worldwide to use the tic formation. Another key discovery fruit fly neuromuscular junction as a was that of the role of “APPL,” a fly 18 Enigmatic glia despite many decades of work de- was too exciting to deviate from—the scribing its roles in the nervous system, Like the model system Drosophila, criti- we know surprisingly little about the mo- Freeman has found that cal portions of brain tissue that make up lecular pathways mediating its biology in the highly complex nervous system have any organism.” disease processes compa- also remained uncharted until recently. For example, the glial cells—which com- Freeman joined UMMS in 2004 with prise 90 percent of brain and nervous the intention of continuing his studies rable to spinal cord injury or tissue and are central to many disease of glial development and function at states—are not the focus of even one the molecular and cellular levels, using neurodegenerative disease chapter in contemporary neuroscience markers he established while completing textbooks and were considered “filler his postdoctoral training. Consequently, cells of the nervous system” just 10 much of his lab is devoted to identify- in the fly incite reactive glio- years ago. It’s this contradiction that ing signaling pathways mediating such makes their study so fascinating to neuron/glia communication. He’s also sis. In a secondary wave of Assistant Professor of Neurobiology collaborating with David Rowitch, MD, Marc R. Freeman, PhD. PhD, a pediatric oncologist and inves- tigator at Dana-Farber Cancer Institute, this process, glia destroy “Glia can regulate when a neuron to uncover which of these pathways divides, whether it survives, where it are present and functioning similarly additional cells or partly wires to and how it fires,” explained in mouse glia. (Thus far, the answer ap- Dr. Freeman, who began his novel work pears to be the majority; such pathways with glia while fulfilling his postdoctoral are likely to be important in human glia damaged cells, that if left fellowship at the Institute of Molecu- development and disease as well.) Free- lar Biology and Neuroscience at the man, however, soon took the opportunity alone, might heal. University of Oregon. “It’s important to follow another avenue of inquiry that to all aspects of neural function, yet,

On page 17: The UMMS Department of Neurobiology is fortunate to have in its labs Vivian Budnik, PhD (left), and Marc Freeman, PhD. She was the first to uncover several proteins with fundamental roles in synapse formation and dynamics. He conducts novel research into brain glial cells and their connection to disease states. Below, left, microscopic images from Dr. Freeman’s lab show acute neuron injury and reactive gliosis in the fruit fly (Drosophila). Within two hours after neurons (green) are severed, much like after spinal cord injury, glia (red) extend membranes specifically to the injured neurons, help destroy them, then clean up cellular debris. Work in Drosophila should help to rapidly dissect the mechanisms driving these events.

19 was too exciting to deviate from—the degeneration of injured axons. Amaz- great efficiency and incisiveness in the role of glia in neurodegeneration and ingly, the expression of WldS in mouse fruit fly. Nearly all questions we address trauma. He has found that disease pro- models of Alzheimer’s and amyotrophic are relevant to human neurobiology, so cesses comparable to spinal cord injury lateral sclerosis (ALS) actively sup- we expect our work in flies will continue or neurodegenerative disease in the fly presses disease progression; Freeman’s to contribute meaningfully to the neuro- incite something called reactive gliosis, lab has now shown that mouse WldS science community.” where the glia drive formation of scars, also protects fly neurons after injury, Working collaboratively and with other promote inflammation and both recruit which allows the lab to rapidly explore scientists in the Department of Neuro- and become macrophages—cells that in- the question of WldS molecular action in biology, Budnik and Freeman hope to gest bacteria or cell debris as part of the the genetically tractable fruit fly. unlock the mysteries that could inevita- immune response to infection or trauma. According to Freeman, no one fully un- bly lead to cures for neurological trauma, Then, in a secondary wave of action, derstands how the WldS protein works, disease and disability. “That’s one of the these glia destroy additional cells that but all recognize its promise as a potent great things about being in close proxim- are only partially damaged—cells that if neuroprotective agent. “Given that this ity to so many people who are interested left alone, might heal. “It’s this second- molecule guards both fly and mouse in using Drosophila and who have ary wave, including the formation of glia neurons from injury, it is likely acting complementary interests,” said Freeman. scars which are highly inhibitory to neu- via the same mechanism. If we can figure “You can quickly get things done.” ral regrowth, that produces a significant out how it actually blocks destruction Budnik added, “I don’t think there’s part of the damage after injury,” Freeman of axons, it could mean a potential another group of people anywhere in explained. “It would be of great interest treatment for neurodegenerative disease the country using the fruit fly as a neu- to uncover the signaling pathway that or traumatic injuries of the central robiological model system at the many drives this glial response and, ultimately, nervous system.” different levels we are at UMass Medical glial-mediated destruction.” School. We’re becoming something of a Freeman has high hopes for his labora- In this same vein, Freeman is also inves- unique place.” tory and couldn’t be happier in the tigating the neuronal protective proper- UMMS Department of Neurobiology. Or a pioneer, you might say… ties of Wallerian degeneration slow gene “There are vast areas that are unexplored or WldS, a protein first discovered in in neuroscience. In this department, we mice that is capable of blocking can—and do—study many of these with

Both Drs. Budnik and Freeman look to the tiny fruit fly, magnified many times here, to promote discoveries in neuroscience because of the number of genes the fly shares with the human. Dr. Budnik was one of the first to characterize, record and create markers for the fly’s neuromuscular junction—findings later related to the synapses of the mammalian central nervous system.

20 Grants and Research

New and competitive renewal grants of $100,000 or more are listed here according to department and funding sources.

BIOCHEMISTRY & MOLECULAR CELL BIOLOGY MEDICINE PHARMACOLOGY National Institutes of Health National Institutes of Health Juvenile Diabetes Research Roger W. Craig, PhD, professor: Jason J. Chen, PhD, assistant professor: Foundation Structural Basis of Muscle Regulation, HPV E6 Inhibitors for AIDS-associated Charles G. Sagerström, PhD, one year, $368,550; recommended for Malignancies, one year, $218,025; rec- assistant professor: Identification of four more years, $1.5 million. ommended for one more year, $218,700. Novel Genes Regulating Endoderm Stephen N. Jones, PhD, associate Douglas T. Golenbock, MD, professor: Patterning, $165,000; recommended professor: Role of Mdm2 in Cell Growth Phagocyte Receptors for Lipid A, one for two more years, $230,000. and Tumorigenesis, one year, $326,532; year, $461,912; recommended for three recommended for four more years, more years, $1.4 million. National Institutes of Health $1.3 million. TLR-Based Therapeutic Vaccine for P Nicholas R. Rhind, PhD, assistant pro- Maria A. Morabito, PhD, assistant pro- Falciparum Malaria, one year, $223,750; fessor: The Role of MRN in the S-Phase fessor: Regulation of Synapses by cdk- recommended for one more year, DNA Damage Checkpoint, one year, 5-dependent Phosphorylation, one year, $169,250. $275,400; recommended for four more $280,990; recommended for four more Stephenie C. Lemon, PhD, assistant years, $1.1 million. years, $1.2 million. professor: Active Living and Healthy Charles G. Sagerström, PhD, assistant George B. Witman, PhD, the George F. Diet at the Workplace, one year, professor: Specification and Positioning Booth Chair in the Basic Sciences and $516,885; recommended for three more of the Pancreas, one year, $162,000; rec- professor: Cell and Molecular Biology years, $1.8 million. ommended for one more year, $162,000. of Reproduction, one year, $104,130; Daniel H. Libraty, MD, assistant profes- recommended for four more years, Zuoshang Xu, MD, PhD, associate pro- sor: Cellular Immune Response to the $430,000. fessor: Developing Models for Diseases SARS Human Coronavirus, one year, Using RNAi, one year, $157,463; recom- $291,600; recommended for one more mended for one more year, $189,540. FAMILY MEDICINE & COMMUNITY year, $309,120. HEALTH Yunsheng Ma, PhD, MPH, assistant CANCER BIOLOGY Department of Health & Human professor: Dietary Glycemic Load, Body Services National Institutes of Health Weight and Body Lipids, one year, Dario C. Altieri, MD, the Eleanor Eustis Robert A. Baldor, MD, professor: $159,000; recommended for one more Farrington Chair in Cancer Research: Predoctoral Training in Primary Care, year, $159,000. one year, $205,920; recommended for Molecular Pathology of Vascular Injury, Pranoti Mandrekar, PhD, research assis- two more years, $375,000. one year, $324,000; recommended for tant professor: Heat Shock Proteins and four more years, $1.3 million. Alcohol-Induced Liver Injury, one year, National Institutes of Health Steven R. Grossman, PhD, MD, $149,063; recommended for two more professor: p300 and hHR23 Proteins Roger S. Luckmann, MD, assistant pro- years, $298,126. in p53 Regulation, one year, $211,476; fessor: Telephone Counseling to Support Ira S. Ockene, MD, the David J. and recommended for four more years, Colon Cancer Screening, one year, Barbara D. Milliken Professor of $1.1 million. $161,500; recommended for one more Preventive Cardiology and professor: year, $162,000. Michelle A. Kelliher, PhD, associate Lawrence Latino Diabetes Prevention professor: Mechanism(s) of TAL-1/SCL- Project, one year, $666,312; recommend- mediated Leukomogenesis, one year, ed for three more years, $2 million. $332,100; recommended for four more years, $1.3 million. 21 Grants and Research

Milagros C. Rosal, PhD, assistant pro- $283,500; recommended for four more Evgeny I. Rogaev, PhD, professor: fessor: Diabetes Management for Low- years, $1.6 million. Regulation of Presenilin Gene, one year, Income Hispanic Patients, one year, $325,693; recommended for four more Craig C. Mello, PhD, Howard Hughes $504,001; recommended for three more years, $1.2 million. Medical Institute Investigator and the years, $2 million. Blais University Chair in Molecular Steven N. Treistman, PhD, professor: Aldo A. Rossini, MD, the William and Medicine: Cell Polarity Signaling in C. Ethanol Action on Ion Channels in Doris Krupp Professor of Medicine: elegans Embryos, one year, $286,200; Artificial Bi-layers, one year, $266,016; Experimental Juvenile Type Diabetes, recommended for four more years, recommended for four more years, one year, $380,700; recommended for $1.1 million. $1.1 million. four more years, $1.5 million. Jennifer P. Wang, MD, instructor: PATHOLOGY RADIOLOGY Macrophage Defense Against M. National Institutes of Health National Institutes of Health Tuberculosis, one year, $113,103; recom- Kenneth L. Rock, MD, professor and Donald J. Hnatowich, PhD, professor, mended for four more years, $484,000. chair: Adjuvants and Toll-like Receptors Imaging Survivin in mRNA for Cancer Danny Zipris, PhD, assistant profes- in Vaccine Development, one year, $1 Detection, one year, $178,875; recom- sor: Modulation of CD4+cd25+ Cells million; recommended for four more mended for one more year, $178,875. in Autoimmune Diabetes, one year, years, $4.3 million. Michael A. King, PhD, professor: $282,625. Raymond M. Welsh, PhD, professor: Improved Accuracy for SPECT Cardiac Virus Induced Immunopathology, one Perfusion Imaging, one year, $405,000; MOLECULAR GENETICS & year, $366,844; recommended for four recommended for three more years, MICROBIOLOGY more years, $1.4 million. $1.2 million. National Institutes of Health Guozheng Liu, PhD, research assistant Michael R. Volkert, PhD, professor: PHYSIOLOGY professor: Pretargeting Mouse Tumor Human Oxidation Resistance Genes, one National Institutes of Health with Anti-PSMA Antibody-MORF, one year, $327,726; recommended for three year, $178,875; recommended for one Ronghua Zhuge, PhD, research assistant more years, $1 million. more year, $178,875. professor: Ca2+ Sparks as Regulators of Robert T. Woodland, PhD, associate pro- Airway Contractility, one year, $343,000; fessor: Human B Cell Homeostasis in a recommended for three more years, SURGERY New Transgenic Xenochimera, one year, $1 million. National Institutes of Health $251,700; recommended for one more Shuk-Mei Ho, PhD, professor: year, $236,950. PSYCHIATRY Prostatic Differentiation and Sex National Institutes of Health Hormone Metabolism, one year, MOLECULAR MEDICINE $328,050; recommended for four more Charles W. Lidz, PhD, research pro- National Institutes of Health years, $1.3 million. fessor: Competition Between Science Paul R. Clapham, PhD, associate pro- and Care in Clinical Trials, one year, fessor: Divergent Narrow and Broad $235,638; recommended for two more Tropisms in HIV-1 R5 Viruses, one year, years, $471,276. $403,750; recommended for four more William J. McIlvane, PhD, profes- years, $1.6 million. sor: Behavioral Studies of Mental Nathan Lawson, PhD, assistant pro- Retardation and Depression, one year, fessor: Transgenic Screen for Artery $325,125; recommended for three more Development Mutants, one year, years, $1 million.

22 Grants and Research Alumni Report

Our ranking this year as fourth in the nation in primary care education by U.S.News & World Report reflects our long-stand- ing commitment to distinction in education, fueled by inno- vative faculty and programs. The development of our medi- cal students’ communication skills as they relate with their patients, for example, has been a hallmark since the school’s founding three decades ago. MESSAGE FROM THE CHANCELLOR/DEAN

In the classroom, clinic and laboratory, technology has transformed how our students are taught and how they learn. In the classroom, computers provide instant access to informa- tion, images and multimedia resources that can be combined to form powerful educational modules, replacing notes, blackboards, handouts and textbooks. In the clinic, hand-held computers allow students to carry a virtual library of informa- tion in their white coat pocket. They can apply it right at the bedside, or while they are conducting their patient write-ups. these teaching advances we will never lose sight of the human And in the lab, students learn by practicing their skills of dimension of the doctor-patient relationship, an aspect that has observation, communication, data interpretation, eye-hand always been at the heart of our teaching efforts. coordination and other fundamental clinical skills essential for all physicians. In the following pages, you’ll read about Medical School alumnus Dr. David Liberman, who combined his love of We are currently teaching many of these skills using our long- technology with medicine by founding a software company standing, successful Standardized Patient Program. Students whose programs aid hospitals and laboratories nationwide. interact with standardized patients—highly trained patient actors—and practice communication and interview skills, Rich Boyajian entered the Graduate School of Nursing to pur- physical diagnosis, problem solving and professional sue its unique subspecialty in cancer prevention and control. A behaviors. Technology is now expanding the use of the cancer survivor himself, he’s making a difference for others at standardized patient model to simulated patients. These the Dana-Farber Cancer Institute’s new Lance Armstrong Adult simulators are electronic mannequins that are programmed Survivorship Clinic. to replicate a wide array of biomedical processes—they blink, And, in a special parent profile, we learn about the admira- breathe, cough and even talk. They develop rashes, high or low tion Roger and Sally Sullivan have for UMass Medical School blood pressure, and experience seizures. They “suffer” frac- as their daughter, Elizabeth, progresses through her course of tures and lacerations and can even “give birth.” study here. “In many ways UMass Medical School is like Liz’s Simulation technology, represented by these mannequins, second family,” say the Sullivans. “The professors and admin- provides “experiential learning” to students, preparing them istration… care about her career in medicine and listen to her. before they venture into the real world of the hospital wards, If a medical school actually does what it preaches—listens to clinics and operating rooms. Research has proven that this the students—then it is likely that it will train doctors that will training improves performance and reduces errors. We hope listen to their patients.” to begin to implement simulation technology efforts in the fall and in the future, we plan to establish a Center for Experien- tial Learning that will house this and other technologically advanced learning programs. Rest assured that even with all of Aaron Lazare, MD 23 Alumni Profiles

Richard Boyajian, MS, APRN-BC ’01

Richard Boyajian didn’t despite his two-hour commute to attend classes, coupled with always intend to be a nurse. working nearly full-time, he excelled in his class work. “In my When he entered Fitchburg undergraduate career, my grades tended to fluctuate with the State College in the late 1980s, seasons; here I had a goal in mind and set out to achieve it.” his goal was to pursue a degree Boyajian’s goal—to work at Dana-Farber full-time—was ful- in business management. But filled six months after graduation when he began working in he became disenchanted with the institute’s immunology division. There he was able to not his coursework and, surrounded by family and friends who only assist in patient care, but also participate in bone marrow were nurses, he changed his major. “It’s the best decision I transplants and donor screenings, fully applying the knowl- ever made,” he said. edge gained through the GSN coursework, which focused on Following receipt of his undergraduate degree in 1992, Boya- designing interventions, measuring outcomes and participating jian worked for several years in various positions as a visiting as an essential member of a research team. nurse. Although fulfilled by his chosen vocation, he felt rest- Now, the next chapter in Boyajian’s story of achievement less. “Nursing is very task-oriented and once I master a task, begins, as he assists in the development of the new Lance I tend to look for new challenges.” Armstrong Adult Survivorship Clinic at the institute. In 1996, the new challenge facing Boyajian became all too Established in January 2005, the clinic will focus on improving personal when he was diagnosed with chronic myelogenous treatment for survivors, as well as the challenges they may face leukemia. After successful treatment, including a life-saving following therapy, such as infertility, cardiovascular disease, bone marrow transplant at the Dana-Farber Cancer Institute, osteoporosis, future cancer risk and post-traumatic stress. Boyajian was unable to return to nursing immediately. So he Now eight years cancer-free, Boyajian said, “This is my dream took a position as a peer counselor on a research study involv- job. Not only is the research that is being conducted fascinat- ing smoking cessation in pediatric cancer survivors. This posi- ing, but I also feel we’re all making a real difference in the lives tion proved pivotal, and Boyajian found the nursing challenge of these patients. That’s why I went into nursing—I’ve come he was seeking—the treatment of cancer patients. full circle.” –LCB Boyajian applied to the Graduate School of Nursing to pursue its unique subspecialty in cancer prevention and control. And,

Parent Profile Although they admit they had little impact on their Roger and Sally Sullivan couldn’t have been more thrilled with 30-year-old daughter’s selection of a medical school, her choice. Elizabeth (Liz) Sullivan has completed her second year at UMass Medical School and her parents say that they have never seen her happier. “UMass Medical School has been better than we could have ever imagined. For us, it’s really about Liz’s happiness, and we believe it’s the best thing that ever happened to her.” The Sullivans knew something about UMMS before Liz began her first year—good friends who had children enrolled shared several positive experiences. “One friend found the school Roger and Sally Sullivan, parents of Elizabeth Sullivan, 24 School of Medicine Class of 2007 Alumni Profiles

David Liberman, MD ’82

Inspired by the unfulfilled the coveted Harvard residency; though it was something he dream of his father’s, Dr. David had strived for, he realized that simply being accepted pro- Liberman knew at age 5 that vided ample satisfaction. Finally, when his father passed away, he wanted to be a doctor. He Liberman knew he could no longer continue computer consult- entered UMMS in 1978, a ing and working part-time as an emergency physician. “I was well-rounded individual who now faced with my own mortality and realized that working loved computers, mathematics in these two diverse arenas part-time would do a disservice to and Latin as much as the idea of practicing medicine. my patients and to me. I decided that I had to pursue medical computing exclusively.” Liberman excelled in his studies after a challenging first year that taught him that he needed to approach his coursework in Liberman says the initial years following his definitive move a new way. And he realized that his passion for computers—he involved founding and funding a corporation; selecting and had been funding his education by computer consulting in developing a product; and mastering new areas such as sales, the summer—equaled his interest in medicine; he hoped to finance and management. All the while he kept in mind an meld academic medicine with medical computing research in important lesson he learned here: “UMass prepared me well to a meaningful way. His hope dimmed a bit, however, when fed- adapt and excel in the face of change. In medicine, failure, or eral health care research funding declined in the early 1980s. even mediocrity, is unacceptable.” Liberman completed an internship and set his sights on Today, Liberman is president and CEO of Computer Trust Harvard Medical School’s anesthesia/critical care residency Corporation and has designed and installed his software program. Then, he says, he experienced three “epiphanies” “WinSURGE”— which analyzes tissue, biopsies and pap that would gradually lead him away from pursuing the day- smears—at more than 50 hospitals, reference laboratories and to-day practice of medicine toward an entrepreneurial life that multi-site pathology enterprises, nationwide. The company has could still have an influence on health. The first came when a been profitable since its founding in 1986. “Although I remem- medical school graduate Liberman knew decided to leave the ber my patients with warmth, I discovered that I didn’t need computer lab in which they had both worked to pursue clinical the direct patient care to feel fulfilled. I take greater satisfaction medicine full-time—his friend’s commitment to a single path in the broader impact I am making—albeit indirect—through got Liberman thinking. our medical software, and feel I’m creating something that will be of real value after I’m gone.” –LCB The second revelation came when he received acceptance to

Parent Profile wonderfully accommodating when tragedy struck the family; ing up with her own primary care physician. “Liz’s physician the school adjusted their child’s schedule and generally helped established a trusting, interactive relationship with her and Liz him to cope,” they said. “Liz also spent a day with the daughter wanted to be that kind of doctor.” of another friend during her application process and was espe- Both of the Sullivans understand the importance of a positive cially enthusiastic that students see patients so early in their educational experience. Roger attended Harvard and Harvard medical school careers.” Business School, and has worked in the investment industry It was the opportunity for early patient/student interaction for his entire career, now serving as a portfolio manager for that originally drew Liz to UMMS. According to her parents, Columbia Management, a subsidiary of Bank of America. Sally she was looking for a curriculum that emphasized the doctor- completed her undergraduate degree at Harvard; pursued a patient relationship given the great experience she had grow- master’s in social work when their children were grown; and Continued on next page 25 Class Notes

April 28, 2005: Chancellor’s Breakfast for Alumni, Worcester—from left to right: Andrew Miller, MD ’79, Paul Darcy, MD ’78, Abigail Adams, MD ’80, Frank McCabe, MD ’95, Chancellor and Dean Aaron Lazare, Richard Breed, MD ’79, Minzhen Xu, MD, PhD ’91, Bruce Karlin, MD ’76 and Irvin Heifetz, MD ’79

Class of 1975 30th Reunion depression an individual suffers from contributes to their vulnerability to discontinuation symptoms. The incidence Margaret Newman, MD, and Lawrence Newman, MD, are of these symptoms, and brain regions affected by treatment hosting the 30th reunion for the class on Saturday, August interruption, will be compared to prior results using fluorine 6, 2005, at 7 p.m. in their home in Andover, Mass. All magnetic resonance spectroscopy. classmates are welcome to attend. For more information, contact Dr. Margaret Newman at [email protected]. 1992 The organizers are seeking these “missing” classmates: David DiBenedetto, MD, traveled to Colombia in May with Drs. Stanley Cole, Diane DeBenedetto, Susan Hou, Frederick Healing the Children, a charitable organization providing Poulin and Paul Sweeney. If you have any information, care to impoverished children. The spring trip was Dr. please e-mail Dr. Newman. DiBenedetto’s third to Colombia with the organization to 1987 provide anesthesia care to approximately 70 children and infants, largely for the repair of cleft lips, palates and burn Michael E. Henry, MD, is director of the Affective Disorders reconstruction. He writes: “Our workday is 12-14 hours long Laboratory at McLean Hospital in Belmont, Mass. His and we work in rather primitive conditions in which two current research explores how the sudden discontinuation operating teams are in a single operating room at the same of a selective serotonin reuptake inhibitor (SSRI) in healthy time. The organization always needs other physicians and volunteers might provide clues as to whether the type of nurses to travel on medical trips. I would also be happy to

Parent Profile, con’t most recently, received her law degree from Northeastern the importance of personal relationships, both between faculty University. She is currently clerking for the Massachusetts and student and between doctor and patient.” Superior Court. “In many ways UMass Medical School is like Liz’s second For other parents considering UMMS with their children, the family,” they added. “The professors and administration are Sullivans would note the school’s continued top ten ranking very approachable, know our daughter, care about her career among the nation’s medical schools for primary care education. in medicine and listen to her. If a medical school actually does More importantly, however, both emphasize the nature of the what it preaches—listens to the students—then it is likely that education students receive. “There is a real understanding of it will train doctors that will listen to their patients.” –LCB

26 Class Notes

share my experiences with any alumni or faculty recently was a vitreoretinal surgeon at Scheie Eye Institute in interested in humanitarian missions abroad.” E-mail Philadelphia, affiliated with the University of Pennsylvania, [email protected]. where he served as an assistant research professor. 1993 1994 Eric Alper, MD, Physician Safety Officer at UMass Memorial Stephen P. McElroy, MD, is the author of Emergency Medicine: Medical Center, was appointed to the National Patient Safety The Essentials (Health Emergency Publishing), a comprehen- Improvement Corps, a program sponsored by the Agency for sive pocket guide to the diagnosis and treatment of emergency Healthcare Research and Quality that provides extensive medical conditions. The guide covers such areas as anesthesia, training to develop physician and health care leaders and dermatology and hematology/oncology and is designed to be seeks to build a culture of safety and establish principles used by emergency or internal medicine attendings, residents and best practices. or students. A companion guide, Pediatric Emergency Medi- cine: The Essentials, provides information for the diagnosis Michael L. Rich, MD, MPH, was quoted in an article in the and treatment of pediatric emergency medical conditions and April 3, 2005, issue of Parade magazine titled “Because We includes growth charts, normal ECG values and other helpful Can, We Do.” The article profiled several physicians who have references. Dr. McElroy is on the emergency medicine staffs at chosen to take on the world’s ills, “patient by patient.” Dr. the Boston Medical Center and Quincy Medical Center. Rich described his experience in Cameroon during his stint in the Peace Corps after college and how he resolved to become 1998 a doctor after seeing children there dying from infectious dis- Matthew Russell, MD, was appointed to the Quincy Medical eases easily treated in more prosperous countries. The article Center staff as a board certified geriatrician and internal medi- noted that Dr. Rich has spent recent months in Siberia treating cine physician. He will lead an outpatient practice in geriatrics prison inmates with a drug-resistant form of tuberculosis; he’s and treat primary care patients as part of the Boston University responding to a “desperate situation the world is inclined to Medical Group—Internal Medicine Practice at the Medical Cen- shrug,” the article’s author, Tracy Kidder, wrote. Dr. Rich is ter. Dr. Russell received a master’s degree in clinical epidemiol- quoted in the article: “I don’t believe that there is nothing we ogy from Boston University. can do about the 8,000 people who die of AIDS every day. We can greatly reduce poverty, suffering and sickness.” Michael J. Tolentino, MD, practices ophthalmology at Vitreous Alumni of the School of Medicine, Graduate School of and Retina Consultants of Lakeland, Winter Haven and Se- Biomedical Sciences and the Graduate School of Nursing bring, Florida. He specializes in treatments for diabetic reti- are encouraged to send their latest news to nopathy and wet age-related macular degeneration, and most [email protected].

May 12, 2005: Chancellor’s Breakfast for Alumni, Newton, Mass.—from left to right: Daniel Sullivan, MD ’86, Ann Wang Dohlman, MD ’79, Lena Dohlman- Gerhart, MD ’77, Janice Powell, MD ’78, Robert Leone, MD ’77, Vice Dean for Undergraduate Medical Education Michele Pugnaire, MD, Michael Foley, MD ’76, Parent Profile, con’t Erica Johnson, MD ’75, William Holgerson, MD ’75, Norman Zarsky, MD ’86, Irvin Heifetz, MD ’79 and Harvey Mamon, MD ’93

27 The Last Word By Carol Bova, PhD, RN, ANP, Assistant Professor of Nursing and Medicine, Graduate School of Nursing, and Carol Jaffarian, MS, RN, ANP, Nurse Manager, UMass Memorial Medical Center– University Campus HIV Clinic

Dr. Carol Bova (below, left) and Carol Jaffarian were invited to present data from their Armenian HIV/AIDS Education and Prevention Project last September at the United Nations’ 57th Annual Department of Public Information/Non-Governmental Organizations Confer- ence. Attended by more than 2,700 representatives from 90 countries, the conference focused on progress toward achieving the UN’s Millennium Development Goals, including halting and reversing the spread of HIV/AIDS by 2015. Inclusion in this international conference was a great honor to our academic and clinical institutions, as well as a career highlight for both women. Here they share reflections on this and their equally memorable experiences in Armenia.

efforts can curb the spread of infection the number of participants we anticipat- before it reaches crisis proportions. The ed. In May 2005, we returned to Armenia data that we presented at the UN is from to conduct advanced HIV training for our HIV/AIDS Education and Prevention local health care providers. Project, implemented at the ARS Mother Our experiences in Armenia and at the and Child Clinic in Akhourian, Armenia. UN were personally as well as profes- We believe this project can serve as a sionally transforming. Any trepidation model for the effectiveness of decentral- we had about going to Armenia without ized programs in other countries with fluently speaking the language was put to developing HIV/AIDS epidemics. rest by our enthusiastic reception. There Funded by the ARS and with the support was standing room only at many of our of the Graduate School of Nursing and sessions, and our educational materials the Division of Infectious Diseases, we were quickly scooped up. Further, the launched our project in 2002 with an entire village embraced us, constantly Working together for over 15 years at initial needs assessment conducted with amazing us with their willingness to the UMass Memorial HIV/AIDS clinic, clinic patients, community members, share their limited resources. And by we learned firsthand the important role health care providers, nursing students, sharing our work with an international patient education and support play in teachers, government officials and repre- audience actively engaged in achieving successful diagnosis and treatment, and sentatives of non-governmental organi- mutual goals at the UN, we were in preventing further spread of infection, zations. Having confirmed there was, rewarded to have reached more like- especially among women and children indeed, great potential for an increasing minded colleagues in more countries with low incomes and limited access to number of cases of HIV in Armenia in than we ever dreamed possible. health care. When the Armenian Relief the next ten years, we teamed up with Society, Inc. (ARS) approached us to We are grateful to the Graduate School the leadership of the Mother and Child bring HIV/AIDS education and preven- of Nursing, the Division of Infectious Clinic to secure a grant from the World tion tactics to Armenia, we jumped at Diseases and the ARS for supporting us AIDS Foundation. Our goals included the opportunity. in fighting HIV/AIDS beyond our borders delivering HIV education to the general as well as here at home. We are proud to Why Armenia? And, why address a community and health care workers have achieved so much so far, but, as our “developing” epidemic when the needs living and working in the rural regions visit to the UN confirmed, much remains are so overwhelming in Africa, where surrounding the clinic, as well as begin- to be done. With continuing support the HIV/AIDS epidemic is full-blown? ning the process of setting up an infra- from our institutions and the funding Because it is in countries like Armenia, structure for HIV testing, counseling and community, we look forward to making where incidence of the disease is not yet treatment. Begun in September 2003, the greater inroads in halting one of the most at the epidemic level, that grassroots program trained three times more than devastating diseases of our time. 28 The Last Word

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