medicine SPRING 2013 A NEW ROLE FOR A NEW TIME 12 ENDING THE BIG SLEEP putting the brakes on one woman’s endless sleeping TRANSFORMING MEDICINE IN ANOTHER GEORGIA Emory internist Ken Walker is on a mission THE HEALING HORMONE using progesterone to mitigate brain injury in stroke and brain tumor patients THE NEW DEAN 12 Christian Larsen has been a college student, medi- cal student, clinician, and contents faculty member, all at Emory. Now he takes on the deanship of the medical school. 2 EMORY MEDICINE medicine SPRING 2013 3 8 18 Editor DEAN’S MESSAGE 2 Kay Torrance IN BRIEF 3 Art Director Peta Westmaas ENDING THE BIG SLEEP 8 Graphic Designer Linda Dobson Emory doctors put the brake on one woman’s endless sleeping Director of Photography and found a new treatment for a widely misunderstood condition Jack Kearse By Quinn Eastman Production Manager Carol Pinto A NEW ROLE FOR A NEW TIME 12 Executive Director, Health Sciences Creative Services Emory transplant surgeon Christian Larsen steps up as dean Karon Schindler and has big plans to integrate the health sciences. Associate Vice President, Health Sciences Communications By Rhonda Mullen Vince Dollard TRANSFORMING MEDICINE IN ANOTHER GEORGIA 18 Dean, Emory University School of Medicine Six thousand miles away from Emory, internist Ken Walker Christian Larsen is helping to transform medicine. Please send address changes and letters to the editor to: By Dana Goldman Editor, Emory Medicine Emory University THE HEALING HORMONE 22 School of Medicine 1440 Clifton Road, NE, Suite 150 Donald Stein finds vindication in his long-held belief that Atlanta, GA 30322 progesterone is more than just a female hormone. Phone: 404-727-6799 Email: [email protected] By Martha Nolan McKenzie Email for class notes: [email protected] CLASS NOTES 24 Visit us online at emorymedicinemagazine.emory.edu Emory Medicine is published by the School of Medicine, a component of the Woodruff Health Sciences Center of Emory University, emoryhealthsciences.org. Articles may be reprinted in full or in part if source is acknowledged. Persons not on the mailing list can order a one-year sub- scription by sending a check for $20 (made out to Emory University) to the editor. © Fall 2012. 212019-2 (Not the) Dean’s Message In our backyard, a home-grown talent This space usually is reserved for a few words from the dean, but as this issue marks a transition in leadership of the School of Medicine, please allow me to borrow it to introduce our new dean, Dr. Christian Larsen. I take considerable pride in the fact that Dr. Larsen (Chris) is an alumnus of Emory. He graduated from Emory College in 1980 and from the medical school in 1984, and he completed postgraduate training at Emory, and also at Stanford and Oxford, in surgery and transplantation. I am proud too that Chris decided to pursue his career at Emory. He joined the faculty in 1991 and became founding director of the Emory Transplant Center in 2001 and chair of surgery in 2009. Dur- ing his time here, he has earned great respect not just for remarkable accomplishments (see article on page 12) but also for his collaborative spirit and ability to lead by example. Because he has seen Emory from so many perspectives—as stu- dent, resident, teacher, researcher, surgeon, and administrator—no one knows more about the school’s strengths, challenges, and potential in all its missions than Chris Larsen does. Nor is anyone better suited to help shape the school’s culture to meet present and future needs. At Emory and at other academic medical centers throughout the country, we are facing unprecedented change that will significantly affect all of our missions. We are facing financial constraints and changes in national policy that will impact the new discoveries needed to improve health as well as training for the next generation of health professionals. For our medical school to thrive, we need a visionary leader who can approach this new environment with creativity and in an integrated fashion, one who has the courage to do more with less by focusing on areas where we can have the most impact, one who can bring together teams of professionals to solve these big challenges. That person is Chris Larsen, our new dean of medicine, vice president of health center integra- tion in the Woodruff Health Sciences Center, and chair of the board of the Emory Clinic. With his passion and dedication to service, he epitomizes the principles of our benefactor Mr. Robert W. Woodruff. He is the right leader for this time. S. Wright Caughman Executive Vice President for Health Affairs CEO, Woodruff Health Sciences Center Chairman, Emory Healthcare 2 EMORY MEDICINE In Brief $8.3M grant for Autism Center of Excellence links Atlanta partners Who gets CPR? new Autism Center of Excellence (ACE), funded by Residents living in high-income an $8.3 million grant from the National Institutes white and high-income integrated of Health (NIH), will create a comprehensive neighborhoods were more likely to Aresearch effort among the Marcus Autism Center at receive bystander CPR during an out- Children’s Healthcare of Atlanta, the medical school’s of-hospital cardiac arrest than arrest Department of Pediatrics, and Yerkes National Primate victims in low-income black neighbor- Research Center at Emory. The ACE is one of only three such cen- hoods, according to a publication in ters nationwide and brings together more than 25 researchers and phy- the Oct. 25 issue of the New England sicians in eight laboratories in the three Atlanta institutions, along with Journal of Medicine. Arrest victims in low- collaborators at Florida State University. income white, low-income integrated, and The ACE will study risk and resilience for autism in infants and high-income black neighborhoods were also toddlers and develop new screening programs in early infancy. The less likely to receive bystander CPR. ACE also will create new community-based health care for infants and In an effort to look at future CPR train- toddlers with autism spectrum disorders (ASD). ing processes, researchers from Emory The first two ACE research projects will focus on social visual University, the University of Colorado, and engagement and social vocal engagement in ASD, building on earlier several other institutions wanted to better research first conducted by ACE director and Georgia Research Alliance understand the effects of different neigh- scholar Ami Klin and collaborators Warren Jones and Gordon Ramsay, borhoods on the probability of receiving both of Emory’s Department of Pediatrics. Eye-tracking studies of social bystander CPR in out-of-hospital cardiac engagement and biological motion in adolescents, toddlers, and infants arrests. More than 300,000 out-of-hospital have already uncovered factors that are predictive of ASD in the first six cardiac arrests occur in the United States months of life. each year. Recent work with social visual engagement compared typical Using surveillance data submitted from infants and infants at risk for ASD. Marcus Autism Center will fol- 29 U.S. sites to the Cardiac Arrest Registry low these infants from birth with new tests of social visual and vocal to Enhance Survival (CARES), the research- engagement measured through “growth charts” comparing normal ers looked at data from 2005 through social engagement and deviations in the first year of life. 2009. Out of 14,225 usable cardiac arrests Another research project, at Yerkes Research Center, registered in CARES, bystander CPR was will study behavior in rhesus macaques, connecting provided to 4,068 patients. eye-tracking behavioral studies of social visual The CARES program was developed by engagement and growth charts of social engage- Emory’s Department of Emergency Medicine ment along with genetics, behavioral, and brain and has been funded by the Centers for imaging studies in nonhuman primates. Disease Control for the past eight years. SPRING 2013 3 In Brief Overcoming ‘original sin’ cientists studying flu vaccines have identi- range of hosts, such as pigs and birds, and because its genome fied ways to overcome an obstacle called is flexible, says Joshy Jacob, an Emory microbiologist. “original antigenic sin,” which can impair “Original antigenic sin is really a reflection of the Simmune responses to new flu strains. agility of the influenza virus,” he says. “OAS becomes a factor Original antigenic sin (OAS) occurs when the immune when the new circulating strain is a ‘drifted’ version of what system encounters one viral strain and then a related came before. The old antibodies can’t neutralize the new one, but can only respond by making antibodies new virus, and that helps the new virus survive.” against the first strain, resulting in a less effective Jacob and colleagues demonstrated that com- defense. bining the immunization with a vaccine addi- Researchers at the Emory Vaccine Center have tive allows mice to respond better to the live demonstrated in experiments with mice virus. The adjuvant is a squalene oil-in- that OAS can be overcome by using a water emulsion. Squalene is a vaccine vaccine additive or by repeated immuni- additive licensed in European countries zation with the second viral strain. since the 1990s but is not approved for The findings could be important use in the United States. in vaccination of people with weaker “It appears that the adjuvant is mak- immune systems, such as those with ing the immune responses to the first chronic infections, young children, viral strain broader, so that a wider or the elderly. range of antibody-producing cells are The influenza virus has become so able to respond to the second strain,” widespread because it can infect a wide Jacob says.