DigestiveUCLA Division of Diseases Spring 2008 Newsletter David Geffen School of Medicine at UCLA Probiotics: In this issue page 2.....Letter from the Chief

From Bugs to Drugs page 3.....First-Rate Fellows page 5.....Why Philanthropy Matters

page 6.....Obesity and the Digestive Tract

page 7.....Passing Two Hats

page 8.....In Memoriam Specialists in Pancreatic Cancer

page 9.....Meet our Alumni

page 10...UCLA Clinic Treats Genetic Disorder

page 11...Meet a Pioneering Researcher

Grocery products containing probiotics.

ncreasingly, we see rows upon rows of refrigerated health. Probiotics are live microorganisms that, when products containing live bacteria in supermarkets consumed in proper amounts, can provide you with I and health food stores. What could live bacteria health benefits and a protective effect against potentially possibly do for you? Advertisers tout the benefits of harmful bacteria that also live in the GI tract. Including yogurt and other foods containing live cultures that you probiotics in your diet can support healthy gut flora, and can eat to shorten or prevent illness. With the myriad some can help in treating diseases. claims many commercial enterprises make, how do you There is plenty of “food for thought” as you face the know what to believe? Although “good bugs” can protect heavy advertising of probiotics. Dr. Fergus Shanahan your stomach from a variety of ills, there is more than says, “Everything has to be put in perspective. In healthy meets the eye when you look deeper into the science people, they probably aren’t necessary, but probiotics surrounding their potential use. would be helpful if you are taking antibiotics.” Dr. The gastrointestinal (GI) tract is the largest source Shanahan and his colleagues are investigating how of our immune system, and keeping it healthy is vitally to cure and prevent illnesses in the GI tract, carefully important. The human GI tract is inhabited by a conducting scientific studies and clinical trials to little more than four pounds of bacteria, representing use probiotics as an ally to treat these and other more than 400 different species. These bacteria are specific diseases. The aim is to transform “bugs to critical for normal development of the intestine and drugs” – in other words, to make sure variables such for defense against infections – and are critical for our as dosages, strains, product quality, and stability are Continued on page 4 unlike that seen anywhere in the world. From the Division Chief Our training program is thriving, and UCLA Division of Digestive Diseases we are now in the midst of a transition David Geffen School of Medicine at UCLA in leadership. Dr. Wilfred “Fred” M. Gary Gitnick, M.D. Weinstein is handing over the reins to Dr. Spiegel and Dr. Bennett Roth. UCLA, is a clinician and educator in They anticipate continued growth am proud. Once again, U.S.News general gastroenterology. and excellence in producing the next I& World Report rated the UCLA The team of seven scientists from generation of top clinicians and scientists Division of Digestive Diseases as best in Harvard headed by Dr. Charalabos in this field. the Western and among “Harry” Pothoulakis is flourishing at The progress and success in clinical the top five in the nation. This standing UCLA, having built an extremely strong care and research that come out of this reflects the remarkable and talented program. The IBD Affinity Group, which division are made possible in large part by faculty on board, who are productive has been successfully developed, includes the generosity of our donors. Their funds leaders and whose numbers continue to 12 senior investigators and their colleagues underwrite the infrastructure that allows increase. Our division has grown to the from multiple disciplines on campus. In us to thrive. Federal, state, and university point where we have expertise throughout addition, many of our faculty members resources are not available for essential the field. Moreover, our research programs have been recognized for their outstanding positions, such as secretaries and fund reflect unparalleled depth, covering work, for example, Dr. Brennan Spiegel managers, who keep the organization myriad basic science and clinical pursuits. and Dr. Emeran Mayer. strong and productive. In addition, our We have several new additions to our The advances in signal transduction donors support the largest part of our division. Dr. Kirin Bhat is an advanced of Dr. Enrique Rozengurt and his group training program budget and provide biliary endoscopist with training in are defining the basic mechanisms in the the moneys necessary to recruit new endoscopic ultrasonography. Dr. Wendy development of cancer and other chronic faculty. Thus, I am proud, as well, that Ho, from Massachusetts General diseases; their publications are among the UCLA Division of Digestive Diseases Hospital/Harvard Medical School, the most widely quoted. In addition, continues to merit the encouragement is a clinician and educator in general Dr. Peter Anton and his associates have and commitment of our friends in the gastroenterology. Dr. Daniel Cho, from built a program in mucosal immunology community and beyond. n

DDD Faculty Inform Patients in the Community

hysicians in the UCLA Division of Digestive Diseases, been growing every year. Psuch as Dr. Sammy Saab and Dr. Eric Esrailian, dedicate The presenters try to tell the story about the liver: what themselves to community service in the normal course of it does, how it functions, how to know when it’s damaged their careers in medicine. (based on blood test results), and how to take care of it when Seminars for Patients with Liver Disease being treated. Soon after Dr. Sammy Saab, Associate Professor of IBD Hot Topics Medicine and Surgery and a former Fellow in the Division, Among his many other community involvements, Dr. came to UCLA eight years ago, he established a yearly Eric Esrailian is co-chair of a yearly symposium for several seminar for patients and families to discuss problems they hundred patients with Crohn’s disease and ulcerative colitis. are having with liver disease. The seminars are taught The half-day course is free, and the lectures highlight in English and Spanish, and he looks forward to plans the latest on inflammatory bowel disease (IBD) treatment, to expand into Arabic and other languages, as well. The management, research, psychosocial support, and patients’ half-day meetings are conducted at UCLA and are free for rights. Also, health professionals get an up-to-date all attendees, with breakfast provided. The presenters are education on these diseases. doctors, surgeons, and oncologists from UCLA, The Greater /Orange County Chapter of and other high-profile individuals. From 150 to the Crohn’s and Colitis Foundation of America (CCFA) 200 people usually attend, and the numbers have sponsors the yearly symposium, as well as walks and other 2 events. Patients can go to the CCFA Website UCLA Division of Digestive Diseases - Spring 2008 First-Rate Fellows Aspire to Make an Impact in Treating Digestive Diseases

xemplary doctors Karen Simon and Omid Shaye aim high to E shape the future treatment and prevention of digestive diseases with the skills they have learned through their experience in basic science and clinical research at UCLA. Omid Shaye, M.D. Dr. Karen Simon Dr. Shaye attended the UC San Diego Dr. Simon thought she would become School of Medicine. He developed a a doctor like her father but wanted to passion for Gastroenterology “because experience the work world first. She grew it is an area with a wide variety of up in Ohio outside of Cincinnati and then different diseases and does so much. The went to Stanford University, where she intellectual aspect of medicine mixes with majored in Art History. She taught for a the technical, surgical, and anatomical year in Santa Barbara and then decided to Karen Simon, M.D. approach to fixing things.” Dr. Shaye is apply to medical school. After graduating dedicated to improving care in medicine, practically no female role models in from Northwestern University Medical and “being in research allows you to affect General Gastroenterology. “Nowadays, School, Dr. Simon came to Los Angeles the lives of countless people.” private practices are becoming more for her residency. She joined the UCLA He recognizes that almost every aware that they are behind the times, Division of Digestive Diseases Fellowship GI disease is affected by obesity, and with numerous patients asking for a Program in July 2005, pursuing her wants to focus on halting it through woman to handle their cases.” Regarding interest in inflammatory bowel disease effective treatments. Dr. Shaye points her journey in medicine, Dr. Simon (IBD). She says that training at UCLA out, “In recent decades, all innovations reflects, “From the time you decide to provides a lot of opportunity to work with in technologies have been because of the apply to med school to the start of your the “big names in the field” in a cutting- Baby Boomers. Now that age group of career is a dozen years, and now I am edge environment. 80-million people between 40-60 years here, ready to follow in my father’s firmly A pivotal experience in her patient old wants to prevent diseases, prolong life, established footsteps after all.” and know how to live better. We cater to relationships came three years ago, when Dr. Omid Shaye Dr. Simon’s one-year-old daughter had their needs.” From the revolution in Tehran to the open-heart surgery. Being the family or It is important to Dr. Shaye to be basketball courts at UCLA, Dr. Omid patient as opposed to a doctor for the first a positive role model for the doctor/ Shaye has quite an interesting background. time made her realize what it feels like to patient relationship. He would like to Born in Tehran shortly after the revolution, be a patient hanging on a doctor’s every inspire patients to take more active roles he and his family were smuggled out of word. A phrase like “Everything will most in their own health. “It also makes our Iran in 1982 when he was age five. After a likely be fine” does not give patients much job more fun, since they get healthier two-week journey in which they ran out of confidence, when there are numerous and better in a positive environment.” food and were shot at and ambushed, they medications and possible complications. After his fellowship ends in another finally arrived in Israel, where they lived for When she talks to patients, she gives as year, Dr. Shaye intends to pursue 3-1/2 years before coming to Los Angeles. much information as she can, such as, academics and do clinical GI and A product of local public schools, Dr. “We will take every precaution to make clinical research. He wants to teach Shaye says, “Growing up, UCLA was like a sure you do fine on this medication.” and get involved in many aspects of second home. I practically lived at the John In September, Dr. Simon will start medicine. “I love building and creating Wooden Center, on the men’s basketball her career as a gastroenterologist – the things, and I have great court.” He naturally gravitated to UCLA, only woman in a private practice in energy,” states Dr. Shaye – where he majored in Neuroscience with a Camarillo. Up to now, there were even off the basketball court. minor in Education. 3 UCLA Division of Digestive Diseases - Spring 2008 Bacteria continued from page 1 and unsubstantiated claims for the study conducted in Utrecht, Holland, effectiveness of probiotics. These using probiotics vs. placebo in the claims cannot be justified or validated treatment of pancreatitis, generated at the present time and can sometimes results suggesting that the particular obscure or retard the progress made probiotic mixture was actually by established scientists and studies.” harmful and was associated with a Dr. Shanahan reports that there is higher mortality rate than in the solid evidence for the effectiveness of placebo-treated patients. This work some probiotics in certain conditions. underscores the importance of being By far, the best is in the treatment specific about the type of probiotic or prevention of acute diarrheal used and conducting more research. infections, such as childhood Once normal host-flora gastroenteritis and antibiotic- interactions in the gut and the associated diarrheal disease. Another molecular mechanisms of probiotic emerging indication for probiotic action in IBS and other disorders are usage is in the prevention of a serious better understood, the move from bacterial overgrowth syndrome called “bugs to drugs” will become a reality. necrotizing enterocolitis (NEC) that Are probiotics the latest magic affects premature babies weighing less potion that promises good health Dr. Fergus Shanahan than 3.3 pounds at birth. Also, some for all? According to Dr. Shanahan, – but not all – probiotics have been the message to clinicians is to “select more predictable. Standardization shown in rigorous controlled clinical pharmabiotic strategies only on the and regulation are also of utmost trials to be effective in irritable bowel basis of solid science. Consumers importance. syndrome (IBS). In the largest clinical should avoid products that lack true Dr. Shanahan received his trial of any probiotic in any setting scientific backing.” In other words, be training at UCLA as a Fellow in the conducted to date, it has been shown sure to follow that “gut feeling” the Division of Digestive Diseases and that Bifidobacterium infantis 35624 next time you are at the supermarket is now a world-renowned expert on was clinically superior to the placebo. or health food store. n inflammatory bowel disease (IBD). A molecular mechanism is shown He has conducted extensive research in some probiotic effects. Listeriosis in the area of probiotics in treating is a rare but very serious food-borne patients with a wide range of clinical infection that has a high mortality Faculty Awards & disorders. Dr. Shanahan is now Chief rate. One particular probiotic of the Department of Medicine at (Lactobacillus salivarius UCC118) has Presentations University College Cork and Cork been shown conclusively to protect • Dr. Dennis Jensen will University Hospital. against infection by producing an receive a new award from “Probiotics are most simply antibacterial molecule (a bacteriocin the American Society of defined as bacteria that can be named salivaricin) that kills listeria; Gastrointestinal Endoscopy harnessed for therapeutic benefit,” however, this mechanism is not how (ASGE), the Distinguished Dr. Shanahan explains. The most probiotics protect against other Endoscopic Mentoring Award. commonly used probiotics are infections, such as that caused by It will be presented at the lactobacilli and bifidobacteria. Salmonella organisms. Moreover, in national Digestive Diseases Some products have exaggerated reference to IBD, Dr. Shanahan says, Week conference. He also has and unproven claims attached to “We all thought the use of probiotics received funding for a new five- them. More of a good thing is not would help in Crohn’s disease, but year Veterans Administration necessarily better: Eating seven so far it hasn’t.” Also, findings with Merit Review Randomized containers of yogurt per day will not ulcerative colitis have been mixed; Controlled Trial (Doppler cure your GI problem. Dr. Shanahan those trials are continuing. Ultrasound Probe for Blood emphasizes that good science is “There is no such thing as zero Flow Detection in Severe UGI important in evaluating the positive risk,” Dr. Shanahan states. “While Bleeding). This study will be aspect of probiotics. He says, “It is probiotics are generally and correctly conducted with UCLA’s CURE important to separate the regarded as being relatively safe, there Hemostasis Research Group. science from the commercial is always the potential for hazard 4 ventures that make wild depending on the setting.” Recently, a UCLA Division of Digestive Diseases - Spring 2008 Why Philanthropy Matters

example, patients – not just physicians – are invited to seminars and luncheons, where they gain knowledge of cutting- edge research and applications in such UCLA Division of areas as nutrition and diet, irritable bowel Kelsey and Camille Grammer syndrome (IBS), inflammatory bowel Digestive Diseases disease (IBD), hepatitis, transplantation, and more. In addition, she enjoys the Mission Statement heers to the quote that rolls semiannual newsletters that highlight of the tongue of Kelsey Division people and programs. Our mission is to advance Grammer: “I believe that every The couple realize that teaching by scientific knowledge and C right implies a responsibility, example will motivate the next generation understanding that lead to cures every opportunity an obligation, every of donors, who witness how the “circle of and improved patient care for possession a duty.” It is part of the plaque giving” makes a difference for both the gastrointestinal disorders and to quotation by John D. Rockefeller, Jr., at supporter and the charitable organization. provide advanced training for Rockefeller Center. This mutually rewarding relationship calls future generations of clinicians Camille and Kelsey Grammer firmly to mind the poetry of W. H. Auden, Mr. and scientists. believe that the privilege of success from Grammer’s favorite writer. Mr. Grammer their own efforts imparts an obligation points out that Auden’s body of work to give back to the world – and they reflects love, religion and morals, and the do. The Grammers are philanthropic, relationship between human beings in a You Can Make often preferring to be anonymous and tumultuous world. The Grammers have to contribute without any reward. been able to experience the value of the a Difference! Moreover, what would we do without human experience and wish to share their the “gifts” that Mr. Grammer provides good fortune with others. The UCLA Division of Digestive as an accomplished actor, producer, In addition to supporting the Division Diseases has many pressing director, writer, voice artist, and family of Digestive Diseases, Mrs. Grammer needs to continue our mission. man and those that Mrs. Grammer offers also contributes to such causes as ovarian You can direct your charitable as a devoted wife, mother, and friend of cancer and breast cancer because of a family gift of cash, securities, real Digestive Diseases? history with these diseases. Early on, Mr. estate, art, or other tangibles Mr. and Mrs. Grammer readily Grammer became involved with Toys for to our greatest needs, under note that their lives have been changed Tots due to its upbeat nature, and he also the direction of Dr. Gary through the services available at the gives to Teach for America in gratitude for Gitnick, Chief of the Division, UCLA Division of Digestive Diseases. what his education meant to him. or to specific research, training, The doctors and staff are not only They sum up their involvement with laboratory, or recruitment experts in the field, but they also express the Division of Digestive Diseases as being programs. For more information, an energy and enthusiasm that patients part of “a wonderful family at UCLA.” please contact Patricia Roderick, eagerly embrace. Among them is Dr. Eric They are pleased to lend their support, Director of Development – Office Esrailian, Director of UCLA’s General knowing where each donation is being # 310.267.1837 or Gastroenterology & Digestive Diseases directed and how it is being realized. For # 310.825.7501, or email at Center, who states, “Mr. and Mrs. themselves, for this field of medicine at [email protected]. Grammer are true friends of the Division UCLA, and for everyone else, Camille and on every level, and we appreciate their Kelsey Grammer assure us that “as big as continued support and encouragement.” you can dream is as big as you can get.” Regarding the Division’s outreach Just don’t let your eyes get bigger than activities, Mrs. Grammer finds that they your stomach… have a particular impact, as well; for —Ginny King Supple 5 UCLA Division of Digestive Diseases - Spring 2008 Obesity and the Digestive Tract: What’s Your Risk?

By Simon Beaven, M.D.

atural selection clearly We don’t know which favors the accumulation people with fatty liver N and storage of fat in will go on to develop liver humans. In his 2004 award- inflammation and scarring, winning documentary, “Super even cirrhosis. Even a small Size Me,” Morgan Spurlock percentage – say 5% – puts personally demonstrates how 3.5-million people at risk, easy it was to gain weight, and 1% (35,000) might decimate a good cholesterol experience liver failure and profile, and inflict damage on need liver transplantation. In his own liver after just a few 2001, the waiting list for liver days of eating nothing but fast transplantation in the U.S. food. The reverse process – peaked at 14,897, and while losing weight and improving the number of operations cholesterol – is substantially increases every year, there more difficult. Fat-laden foods were just 6,441 transplants in taste great. Cholesterol is 2005. Moreover, new reports plentiful in diets derived from show that cirrhosis from fatty animal products. High fructose liver has surpassed alcoholic corn syrup (along with other liver disease as the second additives) in our food supply most common indication makes our meals calorie-dense. for liver transplantation. It is Average portion sizes are bigger clearly only a matter of time than ever. Lack of exercise and before it meets and beats inactivity are rampant, too. chronic hepatitis C as the These and other forces are number-one cause. aligned against us in the “Battle Obesity predisposes you of the Bulge.” to developing acid reflux The ongoing National disease, which can make Health and Nutrition the existing heartburn even can directly affect your digestive health. Examination Survey (NHANES) worse. Excessive weight also negatively First, the liver can become fatty just estimated the prevalence of obesity in affects the organs outside the digestive like the rest of the body. In the United the United States at one in three adults tract, raises your overall risk of dying States, fatty liver has emerged as one of in 2003-2004 – three times the 1970 prematurely, and puts you at extra risk the most common reasons to consult a level, and almost one in five children for any procedure involving anesthesia. liver doctor (hepatologist). It is usually is, at least, overweight. Obesity is no It is associated with the development of asymptomatic and may present as simple longer a disease of the aging population; obstructive sleep apnea, which disturbs abnormalities in blood tests. Strikingly, it is happening to more people and at your sleeping patterns and may lead fatty liver may be as common as obesity younger ages. to cardiopulmonary complications itself. A recent large study pegged the The complications of obesity later in life. The most ominous point prevalence at 34 percent (one in three) include diabetes, high blood pressure, is that obesity has been firmly linked of U.S. adults. A different study that poor cholesterol profiles (known with cancers of the digestive tract: looked at liver biopsies of 100 healthy as dyslipidemia), and colon, esophagus, pancreas, liver, and people being evaluated as living donors susceptibility to heart disease gallbladder. for transplantation found significant fat and atherosclerosis. Other, Doctors now recognize that in one-third of the samples. 6 less obvious consequences common obesity-related conditions are UCLAUCLA Division Division of of Digestive Digestive Diseases Diseases - -Spring Spring 2008 2008 interconnected, often going hand-in-hand to make up the • eat smaller, less-processed meals that are balanced in the “super disease” we call the metabolic syndrome (previously food groups and minimal in cholesterol and trans fats; syndrome X). Of course, these diseases can exist by themselves, • keep the total calories down; and not everyone with obesity has diabetes or vice versa. More • exercise more and turn off the television; than ever before, physicians trained in Gastroenterology, • avoid high-sugar soft drinks and juices. Cardiology, Endocrinology, and Nutrition have to think Many professionals already have dedicated themselves to outside the confines of their respective specialties and learn to the obesity problem, but all doctors need to be diligent in recognize and manage the metabolic syndrome and its links to addressing it with their patients. Hospitals and health plans metabolism, inflammation, and cancer. have implemented exercise and nutrition classes and promote It has been known that 1) fat-derived compounds (lipids) healthy living in advertising and mailings. The requirement to are important for normal cellular processes and interactions publish nutrition facts on the labels of food items is important, throughout the body, 2) lipid signaling pathways are often but further research is needed into the effects of food additives, deranged in the chronic diseases related to obesity and aging, preservatives, and sweeteners. Such data will take time to and 3) fat tissue is not just inert, extra baggage but rather a accumulate and analyze, requiring substantial research funding complex endocrine organ, making and secreting factors that and personnel. communicate with the liver, muscle, and brain. Even our At present, there are no blockbuster medical therapies for dietary behaviors are linked to factors secreted by fat tissue fatty liver or obesity itself; however, a recent premier review and the stomach, and our individual cells are programmed on fat signaling lists at least 63 individual drugs that are in to recognize and respond to our diet’s basic nutritional preclinical or clinical trials to target the metabolic syndrome components, meaning that there are specific fatty acid and and its related inflammatory state. Our healthcare system is cholesterol sensors. increasingly taxed with the chronic diseases of aging: obesity, In the laboratory, I study the mechanisms and actions of diabetes, heart disease, and cancer – perhaps the toll we pay the body’s cholesterol sensor, known as the liver X receptor for having greater longevity. I firmly believe that the key to (LXR). We are working to reveal the relationships between making further advances requires an understanding of the cholesterol and the development of diabetes, obesity, and liver molecular basis of metabolic processes in health and disease. disease and to uncover new targets to treat metabolic diseases. At UCLA, the Division of Digestive Diseases is committed to You may wish to talk to your doctor about specific risk being at the forefront of these discoveries and bringing them to factors for metabolic syndrome, but in the meantime: our patients. n

Passing Two Hats: Fellowship Program Director Dr. Fred Weinstein Steps Down

t the end of June, Dr. Wilfred “Fred” M. Weinstein will into a book to be published this year. Even more important, he Astep down from wearing his two leadership hats in the has served as a mentor for 18 students in the past four years and UCLA Division of Digestive Diseases – as Training Program published papers with 10 of them. Dr. Gitnick says, “I know Director and Chief for Training and Education. Dr. Gary that he will bring to our division a unique perspective that will Gitnick says, “Because of Fred, our program is certainly among further enhance our overall program in training and education.” the best in Digestive Diseases in the world. He has built an Dr. Bennett Roth has accepted a one-year appointment as integrated program that is exemplary and one of which our Director of the UCLA Integrated Training Program in Digestive faculty and fellows can be proud.” Thanks, Dr. Weinstein, for Diseases. He has served the Division in many capacities and doing so much and for devoting your personal time, as well, to has consistently done an outstanding job in building programs this effort! and acting as a leader in many areas and activities. In addition, Dr. Brennan Spiegel will become Chief for Training Dr. Roth has undertaken significant roles in the Department and Education. Bringing a new perspective and remarkable of Medicine, the School of Medicine, and UCLA Medical background in evidence-based medicine, Dr. Spiegel will greatly Center. His exceptional skills as a clinician and educator qualify enhance the needs of our growing education effort. He was the him to lead the Training Program in a creative fashion and as creator of a core curriculum lecture series for Internal Medicine a role model. “Together, Dr. Roth and Dr. Spiegel will carry residents at the Greater Los Angeles Veterans Administration on Dr. Weinstein’s tradition of excellence in promoting a great Medical Center. In 2005, he also developed a curriculum in training and educational effort for all of our fellows,” says Dr. outcomes research for fellows in the UCLA Affiliated Program Gitnick. “We commend them for their willingness to take on in Gastroenterology. He has presented his annual board review these important new responsibilities and look forward series, developed for fellows in Gastroenterology, since 2004. to working with them in helping to build a training At the request of a publisher, he has now converted this series program for the future.” n 7 UCLA Division of Digestive Diseases - Spring 2008 UCLA Division- of Digestive Diseases - Spring 2008 In Memoriam

Mary Gianopulos passed away Georgia R. Frontiere, the owner Roland Arnall, founder of on December 16, 2007. She pursued of the National Football League’s Rams Orange-based a successful career in women’s fashion for nearly three decades and the first Co., passed away on March 17, in New York, working on collections woman to take control of a league 2008, at the age of 68. Mr. Arnall, for couture designer Mary McFadden. franchise, passed away on January who recently resigned as U.S. Throughout her youth and adult life, 18, 2008. A sometime night-club Ambassador to the Netherlands, died Mrs. Gianopulos also was active in singer and chorus-line performer who of cancer at UCLA Medical Center. Greek cultural and church activities. hoped to become an opera singer, Mrs. A Jewish native of , he and his She retired in 1986, spending time Frontiere was thrust into the football family moved to the United States after with her husband, Nicholas, before world when her husband, Carroll surviving World War II. He sold flowers his passing in 1996. Mrs. Gianopulos Rosenbloom, died and left most of the on the streets of Los Angeles and then moved to Los Angeles in 2003 to Rams’ ownership to her. She put her went into real estate in the 1970s, be near her grandchildren, with personal stamp on the franchise when before founding Long Beach Savings whom she adored spending time and she moved the team to St. Louis, her in 1979. That banking institution split cooking their favorite Greek food. home town, and received wide media into Ameriquest and a publicly traded She is survived by her children James, attention as a woman running a football subsidiary that was sold in 1999 to Despina, and Peter and grandchildren team. She was divorced from her become a part of Washington Mutual. Mimi, Alexa, Niki, and Sophia. The husband, Dominic Frontiere, in 1980. One of his senior vice presidents Gianopulos and Landers families set She is survived by son Dale, daughter from the 1990s praised Mr. Arnall’s up the Mary Gianopulos Memorial Lucia Rodriguez, six grandchildren, philanthropy, which included support Fund (fund # 618060) for the UCLA and her companion Earle Weatherwax. of the Simon Wiesenthal Center in Division of Digestive Diseases. Her In the spirit of Mrs. Frontiere’s history Los Angeles, the Fulfillment Fund, and warm presence, embracing hospitality, of extensive charitable donations, the the family’s long-time support of the and her many kindnesses to family and Rosenbloom and Rodriquez families UCLA Division of Digestive Diseases. friends will be greatly missed. established a fund in her memory (fund Mr. Arnall also served 16 years as a # 618210) to benefit the UCLA Division trustee of the State University of Digestive Diseases. system. He is survived by his wife

UCLA Specialist in Pancreatic Cancer Leads Multi-Site Clinical Trial

r. James Farrell of the Division of Digestive Diseases A twofold goal is to find the most sensitive screening heads a multi-center screening study that focuses procedures for very small precancerous pancreatic lesions and to Don the early detection of pancreatic cancer. The treat these lesions before they turn into cancer. Another goal is to first of its kind in the United States, the Cancer of the search for a gene mutation that is linked with the development Pancreas (CAPS3) Screening Study is being conducted at five of pancreatic cancer. The study covers the cost of a genetic institutions – UCLA Medical Center, The Johns Hopkins counseling session and pancreatic screening for participants. Hospital, Mayo Clinic, The University of Texas M. D. Subjects included in the study are patients (ages 30-80) Anderson Cancer Center, and Dana Farber Cancer Institute. diagnosed with Peutz-Jeghers syndrome; patients (ages 40-80) The CAPS3 study will screen for pancreatic cancer and with verified BRCA 2 or FAMMM/p16 gene mutations with at its precursors, using state-of-the-art imaging tests – MRI, least one first-degree or second-degree relative with pancreatic CT, and endoscopic ultrasound. It will help determine cancer; and patients with a verified family history of pancreatic which screening test is the best, which individuals are likely cancer involving two first-degree relatives, or if three relatives to benefit most from screening, and what biomarkers in have the disease, at least one must be a first-degree relative and pancreatic secretions (containing a variety of enzymes) and the others a cousin, aunt, uncle, niece, nephew, or grandparent blood may be helpful in diagnosing early, curable pancreatic on the same family side. cancer or its precursors. Dr. Farrell predicts Early detection is the key to fighting pancreatic cancer, and that in 2008, there will be 37,680 new cases of the CAPS3 Screening Study will go a long way toward improving 8 pancreatic cancer and 34,290 deaths. the treatment of and finding a cure for this disease. n UCLA Division of Digestive Diseases - Spring 2008 GRACIOUS PHILANTHROPIST

T amar and Robert Manoukian’s philanthropy is a very important part of their lives. Mr. Manoukian is a successful businessman and a true citizen of the world. He is Armenian by birth, Lebanese by nationality, and British by residence and spends significant time at their home in Beverly Hills. Recently, Mr. Manoukian made a $1,000,000 pledge to the UCLA Division of Digestive Diseases to be allocated under the direction of Dr. Gary Gitnick for projects in greatest need. “Our Division is very grateful to Mr. Manoukian for these unrestricted funds. Due to the cutbacks in federal and state funding, unrestricted gifts are invaluable to our division” says Dr. Gitnick. n Dr. Gary Gitnick and Mr. Robert Manoukian Meet Our Alumni: Dr. Michael Jones any esteemed graduates of the Fellowship world. The faculty Program in the UCLA Division of Digestive taught us to think M Diseases have gone on to careers in far-flung critically about places, from Ireland to Nebraska. One of the most the literature and important results of this program has been to produce the care.” Two outstanding community clinicians, who have applied their faculty members training and expertise in treating and educating patients. in particular made Dr. Michael Jones of Omaha is an excellent example of an impression on a UCLA graduate, who went back to his home state for Dr. Jones with clinical practice. He did his undergraduate work at Southern their “extraordinary Michael Jones, M.D. Methodist University in Dallas, Texas, and then went to the bedside manners” – Dr. Gary University of Nebraska for medical school. After serving Gitnick and Dr. Sherman Mellinkoff, Dean Emeritus of his fellowship at UCLA from 1978-80, Dr. Jones began his UCLA’s medical school (1962-1986). Dr. Jones remembers, practice in Omaha as a solo practitioner. He now has 12 “Dr. Mellinkoff was a master. He had an uncanny ability partners and will add three more in another year. to come into a patient’s room, introduce himself, and in a Specializing in General Gastroenterology, Dr. Jones sweet way put the patient and family at ease. Getting to see follows a large number of patients with inflammatory bowel that grace and compassion from those doctors was pretty disease (IBD). He is on the board of the local Crohn’s and amazing.” Colitis Foundation of America (CCFA) and through it With many fond memories of his tenure at UCLA, Dr. participates in patient education conferences. His next big Jones continues to work with people from the Division push is to establish a GI wellness center for patients, as well and keeps in touch with others. He notes that while he was as a specific IBD clinic. “We want to see the patient as a developing and growing his practice in Gastroenterology, “I whole, taking into consideration the patient’s physical and always tried to set the highest standard of care, which was emotional needs together,” he says. instilled during my fellowship training at UCLA.” Of his experience as a fellow, he says, “There was no Maybe Omaha isn’t so far-flung after all. n question in my mind that it was the best program in the 9 UCLA Division of Digestive Diseases - Spring 2008 Friends of Digestive Diseases Luncheon: “Good Bacteria”

he UCLA Division of Digestive Diseases counteract harmful germs, speed the digestion Theld its quarterly luncheon on Tuesday, of food, and keep your immune system April 29, 2008. The luncheons honor Division functioning properly. supporters and their families and feature Good bacteria, in the form of probiotics, Agi Hirhberg, presentations on current topics in medicine and also can be used for treatment. Dr. Shanahan’s Mitch and Sheri Stein patient care. The featured guest speaker was main concerns are that researchers conduct Dr. Fergus Shanahan, who gave a presentation careful studies and scientific trials in this on “Making Bacteria Work for You.” Dr. area, because different strains of bacteria react Shanahan, a former Fellow in the Division of differently with various diseases of the digestive Digestive Diseases and an acclaimed expert on tract. Dr. Shanahan cautions that, “Not all inflammatory bowel disease (IBD), heads a probiotics are the same. In the same way that team of scientists and postgraduate students at one would never think of saying that pills are ‘good for you’ without specifying the particular Eric Esrailian, Mr. Hugh Cassar the Alimentary Pharmabiotic Centre (APC) in and Mrs. Keets Cassar. Ireland, studying how to harness the benefits of pill and the particular ailment for which it the natural gut flora for use in the treatment and might be required – so too, one should not prevention of disease. speak of probiotics as some form of panacea for It is known that the beneficial bacteria all things or for all people. Different probiotics found in the digestive tract help to keep the have different properties.” More investigations “bad” bacteria at bay. The natural, or “good,” must be conducted on how to standardize and n bacteria that live in your gut help crowd out or use probiotics for medical applications. Mr. and Mrs. Oppenheimer UCLA Clinic Treats a Genetic Disorder Familial Mediterranean Fever by Terri Getzug, M.D.

or more than 500 registered patients manner, meaning that the likelihood for cavities. The pathogenesis of FMF is F at the UCLA Familial Mediterranean offspring of an asymptomatic couple unclear but relates to a self-limited Fever (FMF) clinic, Dr. Terri Getzug, carrying the gene to be affected is one dysregulation of the inflammatory Director, is a source of information and in four (25%) with each pregnancy. response in the body (inflammation inspiration. The facility is one of the only One of the key problems is that FMF running unchecked). Symptoms include such clinics in the country, and since often is not diagnosed, and there can recurrent bouts of fever and severe its inception in the early 1960s, has be confusion between peritonitis from abdominal, chest, or joint pain usually served as a major referral center for this FMF and other disorders. Patients may lasting no more than three days. In under-recognized, prevalent, and very undergo unnecessary operations such between attacks, patients are generally treatable condition. as appendectomies and gallbladder completely well and without symptoms. FMF is a genetic disorder that affects removal as a result. The disease Attack frequency is extremely variable, primarily ethnic groups of Middle can be quite disabling, especially if ranging from just a few times a year to Eastern and Mediterranean origin, undiagnosed and untreated. Children weekly. The onset of symptoms in 90% mainly , Armenians, Turks, and can have growth retardation, failure to of individuals is before age 20. Arabs. Although the disease is highly thrive, and multiple school absences. If untreated, besides having a prevalent among Sephardic Jews and Adults can miss many days of work negative effect on one’s lifestyle and Armenians, it also has been reported and have problems with fertility, pain potential unnecessary surgeries, certain rarely in Japanese medicine addiction, and depression. FMF patient populations are prone to and other groups. FMF is characterized by sporadic the development of amyloidosis. With FMF is inherited in an attacks of inflammation affecting the this condition, a special type of protein 10 autosomal recessive serosal surfaces, or linings, of body is deposited in the kidneys and other UCLA Division of Digestive Diseases - Spring 2008 organs including the digestive tract, liver, spleen, and thyroid. It can lead to end-stage renal disease with the Meet a Pioneering subsequent need for hemodialysis and kidney transplantation, as well as cause Researcher malnutrition through malabsorption of nutrients and diarrhea. Amyloidosis is r. Adrian Lunn’s passion for generally irreversible, but in FMF it has research has led him to a unique the unique feature of being reversible if D way of studying cancer. He caught and treated early. Additionally, focuses on using good cells to mobilize this form of amyloidosis can be and kill cancer cells by revealing how prevented or arrested by the proper normal cells are policing other cell treatment of FMF. Interestingly, the growth. frequency of amyloidosis differs among A gastroenterologist and Assistant various ethnic groups, with FMF being Professor in the UCLA Division of highest in Turks and North African Jews Digestive Diseases, Dr. Lunn also and less common in Armenians (in the serves as a clinical instructor in the United States) and Ashkenazi Jews. J. Adrian Lunn, MD Division. He came to the United States Usually it develops before age 40. in 1997 from the Bahamas in search Since 1972, colchicine, an old drug a role in killing off abnormal ones. In the of combining a medical degree with a used to treat gout (a form of arthritis), lab, he looks at how cancer cells invade Ph.D. in research. After being a foreign has been the first-line treatment for tissue and is attempting to see how he exchange pre-med student at Columbia patients with FMF. Colchicine use can stop that process. Instead of growing prevents attacks in greater than 90% College in New York, he was accepted cells in plastic dishes, Dr. Lunn is placing of patients and prevents amyloidosis. at the Yale School of Medicine, where them in three-dimensional containers It is a very safe and effective remedy, he received his M.D. degree and Master in substances resembling Jell-o. He cuts which, for the majority of patients, has of Science degree in Experimental the cells in half to observe them for major beneficial effects. In the absence Pathology. He then returned to movement and programmed cell death. of amyloidosis, the life expectancy of Columbia-Presbyterian Hospital in By studying stomach and intestinal patients with FMF is normal. Internal Medicine before applying to cancers, Dr. Lunn wonders if distortion An exciting development in FMF UCLA to specialize in Gastroenterology of the cell structure – not chronic research has been the identification under Dr. Enrique Rozengurt, who inflammation – causes cancer. He of the genetic defect responsible – the directs research in the Division. provides the example that cirrhosis of MEFV gene that has been mapped to Dr. Lunn earned his Ph.D. in the liver can cause the destruction or chromosome 16. Since the MEFV gene’s Molecular Biology in UCLA’s Specialty distortion of cells; cirrhosis itself is a discovery in 1992, more than 30 Training and Advanced Research key but elusive player in cancer. There is genetic mutations have been described (STAR) Program. It was created in also a link between inflammatory bowel and can now be detected through 1994 to enable young academicians to disease (IBD) and cancer. “If you remove blood testing. Future research into the complete clinical training in Internal a polyp and send it to a pathologist, you function of the MEFV gene product will Medicine or a subspecialty and to can see the difference between normal lead to a better understanding of the obtain a Ph.D. degree or postdoctoral cells and cancer cells, which have big pathogenesis of FMF and its treatment fellowship. Dr. Lunn comments that nuclei and are distorted structurally. and ultimate prevention. “STAR graduates serve as a bridge Cancer is part of the distortion. We Because there are no definitive between the two worlds of the clinic and do not yet have the proper tools to diagnostic tests for FMF, the diagnosis the laboratory.” understand this mechanism,” he says. is primarily a clinical one. Refreshingly, “I think a lot about the spread of As a researcher, Dr. Lunn is an accurate patient history with specific cancer and how tissue structure controls concerned that the National Institutes questioning related to current and past cell behavior,” states Dr. Lunn. He says of Health recently funded only 8% of symptoms, family history, and ethnic that the bulk of cancer research has been scientists who applied for grants, down background is the key to making the focused on the cells themselves and less 33% from a few years ago. If more proper diagnosis! Supportive genetic on how cancer cells interact with normal private support were available, he also testing also can be helpful in selected cells. “People think that once cancer cells would like to do clinical individuals. Dr. Getzug welcomes encounter normal ones, the normal cells work. He enjoys caring for questions about the disease and is then turn bad.” He thinks normal cells patients, noting that “they n available for patient referrals. keep cancer cells in check and may have force you to be humble 11 UCLA Division- of Digestive Diseases - Spring 2008

Division of Digestive Diseases Alumni Directory: Gary Gitnick, MD Good things are worth waiting for. The UCLA Chief, Division of Division of Digestive Diseases’ first Alumni Digestive Diseases Fellowship Directory has arrived. Our goal was to create a way for our outstanding Eric Esrailian, MD Chief of Developement graduates of the Gastroenterology Fellowship Section Head, General Pprogram to reconnect. The directory lists Gastroenterology graduates from 1960-2008 and from six Division of Digestive Diseases countries and more than 33 states. Patricia Roderick All alumni who submitted information to the Director of Developement directory will receive a complimentary copy Pam Wilkes by mail. If you are an alumnus interested Editor in receiving a copy, please contact Patricia Roderick at # 310.267.1845 or by email at Ginny King Supple [email protected] . Contributing Editor

Michelle Moeck Graphics/Production

UCLA Division of Digestive Diseases NON-PROFIT David Geffen School of Medicine at UCLA ORGANIZATION 10833 Le Conte Avenue U.S. POSTAGE 44-138 Center for the Health Sciences PAID Los Angeles, California 90095-1684 TR23 UCLA