$600 millionhealthresearcheffortlaunches the Bay Area likenever before,” saidSte- ties togetherthesethree institutionsin projects. velopment, andlarge-scalecollaborative space focusedonbiotechnology-toolde- include acombinationofgrants,research the ChanZuckerberg Initiative. It will hub, isthefirstscientificinvestment by tion, calledthe Chan Zuckerberg Bio - tific community and advance progress. tools thatwillempower thewholescien- engineers towork togethertobuildnew ways of enabling scientists new and port ence research. The Initiative seekstosup- by acceleratingbasicsci- of thecentury prevent or manage all diseases by the end Zuckerberg Initiative’s goal is to cure, education forallstudents. The Chan jor initiative, alongsidework toimprove broader focusonscience,itssecondma- 21, theInitiative announcedplansfora oftheirdaughterin2015.On Sept.birth the Chan Zuckerberg Initiative after the and hiswifePriscilla Chan,MD,created Chan Zuckerberg Initiative. a $600millioncommitmentby the bioscience collaboration funded through nia-Berkeley in a new — to participate Francisco and the University of Califor- recipient of a MacArthur Foundation “genius grant.” bioengineering Manu Prakash, PhD, being named the grown by one overnight, with assistant professor of faculty whohadwonmajor internationalawards had date, andwe justmadeityesterday.” The number of slideisalreadyteaching, Minor outof quipped,“This past year’s accomplishments in research, education and associate professor of medicine, moderated the panel. Health; andMinor. Megan Mahoney, MD,a clinical Children’s Hospital Stanford andStanford Children’s topher Dawes, president andCEOofLucile Packard president andCEOofStanford Health Care; Chris- lowed by apaneldiscussionwithDavid Entwistle, and Knowledge includedanaddress by thedeanfol- flow crowd of faculty, staff and students. Stanford Medicine event on Sept. 22 before an over Dean Lloyd Minor, MD, kicked off the first State of that we have moving forward,” SchoolofMedicine on where we are today and the exciting opportunities Volume 8, No.17Volume 8, Accomplishments ofthepastyear By KathyZonana looks tothefuture accomplishments, on Stanford Medicine Leadership reflects S By AmyAdams Stanford, UCSF, UC-Berkeley funds collaborationbetween Chan ZuckerbergInitiative “The Biohub that will be the sinew “The BayThe new Area research collabora- Facebook founderMark Zuckerberg Among theyear’s Standing in front of a screen listing several of the The event at the LiKa Shing Center forLearning Calling it“a timeforustocometogetherandreflect the University ofCalifornia-San Area universities —alongwith tanford willbeoneofthree Bay inside Stanford medicine September 26, 2016 26, September See stanford medici ne, page6

will beco-directors oftheChanZuckerberg Biohub. Stephen Quake (left)andJosephDeRisiwalk throughQuake’s atStanford. laboratory The two scientists chemistry and biophysics at UCSF.chemistry DeRisi, PhD, professor andchairofbio- who willco-leadtheBiohub withJoseph bioengineering and of applied physics, phen Quake, PhD, Stanford professor of Stanford known astheStanford Biohub. sion Bay district and an outstation at intheSana headquarters Francisco Mis- research organizationwithtwolocations, Collaborative approach toresearch

The Biohub willbe anindependent - attack cancer, accordingtonewstudy Iron nanoparticlesmakeimmunecells PublishedbytheOfficeofCommunication&PublicAffairs destroy cancercells,suggestingthatthenanoparticles immune cellscalledtumor-associatedmacrophages to iron deficiency anemia. proved by the Food and Drug Administration to treat as theinjectableiron are supplementferumoxytol, ap- searchers at the School of Medicine. to attackcancercells,according toastudyledby re- A mousestudy foundthatferumoxytol promptsimmunecells called tumor-associated macrophagestodestroy cancercells. By ErinDigitale The mouse study found that ferumoxytol promptsThe mousestudyfoundthatferumoxytol which areThe nanoparticles, commercially available Iron can activate nanoparticles the immune system grateful fortheinvestment by Mark PhD, who is a neuroscientist. “We are Stanford President Marc Tessier-Lavigne, tant applicationsforhumanhealth,” said and engineeringthatcanleadtoimpor- tal research attheintersectionofbiology prove our ability to conduct fundamen- universities. able tomembersofthecollaborating nology platformsandmakethemavail- These hubs will establish shared biotech- “This initiative willdramaticallyim- “This this concept should hold in human patients, too.” sor ofradiologyattheSchoolMedicine. “We think who isthestudy’s seniorauthor andanassociateprofes- cancer cellsinmice,” saidHeike MD, Daldrup-Link, activated toattack macrophages sothattheystarted horses by sneaking chemotherapy into tumors in mice. as couldserve testing whetherthenanoparticles Trojan Nature, wasmadeby accidentwhile Nanotechnology covery, describedinapaperpublishedonlinetoday in could complementexistingcancertreatments. The dis- T yler Ma Daldrup-Link’s team “It was really surprising to us that the nanoparticles ll o ry pandemics. eases, includingemergingbiothreats and ect, devoted totacklingmicrobial dis- body, and an Infectious Disease Proj- celltypeinthecharacteristics ofevery cataloging allthebiologicallysignificant The CellAtlas, acomprehensive dataset on twolarge-scaleoverarching projects: health challenges.” promise forsolvingtheworld’s greatest ration at its best, and with tremendous Hennessy said.“It islarge-scalecollabo- cannot bereadily fundedelsewhere,” in early-stageresearch ofthetypethat ties, andalsomakesamajorinvestment the strengths ofourBay Area universi- Initiative andtheBiohub capitalizes on technologist. in hispersonalcapacityasascientistand its inception.He ontheboard willserve with theChanZuckerberg Initiative on establish the initiative, working closely nessy, inhelping PhD, wasinstrumental groundbreaking discovery.” university collaborationthatwillenable and an unprecedented Bay Area-wide and Priscilla inbothsophisticatedtools Tessier-Lavigne. cure andprevent humandisease,said mon goalofdeveloping technologiesto individual strengths around thecom- the Biohub willfocus theuniversities’ sciences. New created opportunities by in medicine,engineeringandthebasic technologies, with combined strengths ofdeveloping biomedical a longhistory Technology toimprove health Resident Biohub scientistswillwork visionfortheChanZuckerberg “The Former Stanford President John Hen- Each of the three schools partner has See Page 4 disease. artery peripheral app to study an iPhone have developed Researchers See Biohub, page6 Iron, page6 a my th o ma s School’s Grant Writing Academy honored with AAMC award By Becky Bach and postdoctoral scholars write some of the most com- class at the academy, and in the days before the deadline Success as a professional scientist is increasingly de- mon grants offered by the National Institutes of Health we helped each other as proofreaders.” termined by the ability to secure funding. Yet grant and the National Science Foundation, they are welcome So far, the academy has worked with about 180 stu- writing — the nitty-gritty work of distilling ideas into a to use it to apply for any bioscience grant, Botham said. dents and trainees, Botham said. She attributes its suc- winning pitch — is rarely taught in graduate school or Proposal boot camp cess, in part, to its use of peer mentors. “Peer feedback postdoctoral training. is really valued. There’s only one of me, and I can’t read Recognizing this gap, Stanford Biosciences launched Chandramouli Chandrasekaran, PhD, a postdoc- 100 grants, but I can train grant coaches to work with the Grant Writing Academy in 2014. Though young, toral scholar in neurosciences and electrical engineer- 100 postdocs or graduate students,” she said. the program has already boosted the number of both ing, turned to the Grant Writing Academy for assistance Lamia Wahba, PhD, a postdoctoral scholar in pa- grant submissions and funded grants, said its director, applying for a NIH Pathway to Independence Award thology, is one of the academy’s grant coaches. She said Crystal Botham, PhD. It recently earned national rec- from the National Institute of Neurological Disorders the academy has helped her refine her own grants, but it ognition as well: It was honored as the third-prize win- and Stroke. The grant can provide up to five years of has also taught her a lot about teaching. Teaching writ- ner of the Association of American Medical Colleges’ funding, but it demands as many as 30 documents ing is quite different from teaching genetics, she said. Innovations in Research Education Award. that need to be nearly perfect, Chandrasekaran said. It requires trainees to examine their research critically, Though the program specializes in helping students That seemed a bit overwhelming, so he attended the she said. Norbert von der Groeben academy’s proposal boot ‘You become a better scientist’ camp, a two-month course that meets weekly and “By being able to write and articulate your research walks a cohort of gradu- goals, you become a better scientist,” said Botham. ate students and postdocs And some of the most common mistakes inexpe- through each step of the rienced grant writers make? Many make assumptions grant-application process. about what the reviewers know, Wahba said. Even ex- The boot camp helped perts in the field may not be familiar with new or un- Chandrasekaran, who usual techniques, she said. In addition, beginning grant studies the neural mecha- writers often struggle to keep their writing concise and nisms underlying decision- to resist the temptation to include every detail, she said. making in primates, secure “The big take-home lesson is we weren’t taught one of the coveted awards. enough about writing about science,” Wahba said. Of- Now, he recommends it tentimes, trainees think they need to write grants in the highly. evenings or weekends, and think of it as not part of their “It helped demystify actual job, she said. “I really learned the importance of many aspects of the pro- having it be a part of your job. This is actually work as cess for me, and it gave me well, and it needs to be done really well,” she added. a huge boost in self-confi- The academy’s annual proposal boot camp, which dence,” he said. “I was able meets weekly, begins today. It runs to Nov. 17. The Lamia Wahba, a postdoctoral scholar in pathology, coaches participants in a workshop offered through to become good friends academy also offers periodic lectures and workshops, as the Grant Writing Academy. with another person in my well as drop-in hours with grant coaches. ISM

New program in physician assistant studies now accepting applications

By Tracie White lisa cavin dents, the 30-month program will year community college in Los Altos. The School of Medicine will for the emphasize training alongside medical The associate degree program will no first time offer a master of science pro- students in coursework and clinical care. longer be offered once its current stu- gram designed to train physician assis- It will also require students to choose an dents have graduated. tants as both clinicians and future leaders area of scholarly The new pro- in health care. concentration gram is designed to “As health-care access improves, we within one of four “We are trying to educate meet the expand- need to equip medical practitioners with areas: community ing role of PAs in the skills to meet growing demand,” said health, health ser- the next generation today’s changing medical school Dean Lloyd Minor, MD. vices and policy of PA leaders.” health-care envi- “This new master of science program research, clinical ronment, said Su- for physician assistants helps health-care research or medical san Fernandes, PA, teams navigate that complexity and pro- education. clinical professor of pediatrics and of vide precision health: personalized treat- “With the increasing emphasis on co- medicine. ment when disease strikes and proactive ordinated, team-based care as supported “Today’s PAs practice in all areas of and preventive care that keeps people by the Affordable Care Act, it is critical medicine,” Fernandes said. “They are from getting sick in the first place.” that the School of Medicine be able to leading community health centers, they To be considered for admission to the create an integrated, team-learning envi- are front stage in the health-care pol- program in the fall of 2017, applications ronment to educate the biomedical sci- icy arena, leaders in the classroom and are due Nov. 1. entists and clinicians of the future,” said changing health-care delivery through “This program will set itself apart Robert Harrington, MD, professor and innovation and research.” from many other physician assistant chair of medicine. The role of the PA, one of the fast- programs by combining excellence in Replaces former program est growing professions, has expanded in clinical training with scholarly projects part due to a shortage of physicians na- that will help our graduates to become The master’s degree program replaces tionwide and the need to meet the grow- future leaders in their field,” said Charles the associate degree program to train ing demands of an aging population, Prober, MD, senior associate dean of physician assistants that began in 1971 Fernandes said. She and Rhonda Larsen, medical education. as a partnership between the School of PA, clinical assistant professor of pediat- Physician assistant students Liliana Camacho Designed for a class of 25 to 30 stu- Medicine and Foothill College, a two- rics, worked as consultants to help design and Edilberto Canseco learn how to scrub into an the new program. operating room. Inside Stanford Medicine is “We are trying to educate the next

d e generation of PA leaders,” Larsen said. professor of medicine and medical direc-

i published monthly in July and Stanford December and semi-monthly “No other program sets out to do this.” tor of the new program. “There is little

in s the rest of the year. ‘New direction for Stanford’ training of advanced practice providers medicine such as PAs. There is no school of nurs- is produced by Paul Costello PAs treat patients as part of a health- ing, no pharmacy school. This is an op- Office of Communication & Public Affairs Chief communications officer care team, collaborating with physicians portunity for Stanford to make a mark Stanford University Susan Ipaktchian and other providers, Fernandes said. They on this rapidly growing field.” School of Medicine Director of print & 3172 Porter Drive Web communications often provide a broad range of health-care The curriculum will emphasize train- Palo Alto, CA 94304 John Sanford services that may include conducting ing in the foundational sciences during Mail code 5471 Editor physical exams, ordering and interpreting the five quarters, followed by a year of (650) 723-6911 Robin Weiss medical tests, diagnosing illnesses, devel- clinical clerkships. There will be clerk- http://med.stanford.edu/news/ Graphic designer oping treatment plans, prescribing medi- ships in obstetrics and gynecology, in- cation and assisting in surgery. ternal medicine, ambulatory family Send letters, comments and story ideas to John “This is a new direction for Stan- medicine, pediatrics, surgery, psychiatry Sanford at 723-8309 or at [email protected]. ford, which has been traditionally a very and emergency medicine. In addition, Please also contact him to receive an e-mail version of Inside Stanford Medicine. research-heavy medical school,” said students will have several elective rota- Andrew Nevins, MD, clinical associate See PA, page 3 2 September 26, 2016 Inside Stanford Medicine 5 questions Beth Darnall on opioids and pain management an occasional feature in which an expert answers five questions on a science or policy topic Beth Darnall, PhD, is a clinical associate women undergoing surgery for breast cancer. professor of anesthesiology, perioperative and Her clinical practice, research and public-education efforts focus on empowering peo- pain medicine at the School of Medicine. She has more than 15 years of experience as a ple with chronic pain to target their daily choices, thoughts and emotions that can worsen pain psychologist treating a variety of individuals with chronic pain. For example, she has pain and harness the power of their mind-body connection to reduce their symptoms and worked extensively with patients suffering from spinal cord injuries, catastrophic burns, increase their quality of life. amputations, chronic low back pain, migraines, fibromyalgia and various types of mus- She is co-chair of the Pain Psychology Task Force at the American Academy of Pain culoskeletal pain. Medicine, and is a 2015 recipient of the Presidential Commendation from the American Darnall is co-principal investigator for a National Institutes of Medicine-funded proj- Academy of Pain Medicine. ect that is studying treatment for pain catastrophizing, which is a distressing pattern of Stanford Health Care writer Jana Chow recently spoke with Darnall about pain thoughts and emotions commonly experienced by those with chronic pain. She has also management and her newly released book, The Opioid-Free Pain Relief Kit, which in- developed a novel pain psychology treatment that can be delivered over the internet to cludes tools to equip patients to manage pain. The book includes a relaxation CD that is patients before surgery to help reduce distress and optimize post-surgical healing and re- designed to calm the nervous system. Darnall is also the author of Less Pain, Fewer Pills: covery. The treatment uses meditation and cognitive behavioral therapy to help patients Avoid the Dangers of Prescription Opioids and Gain Control Over Chronic Pain, avoid negative thought patterns that can amplify pain. This is currently being tested in which was published in 2014.

What are the best tools you’ve found to reduce pain likely to use those skills, and gain good results from biopsychosocial pain care. This goes back to needing without opioids? 1 them. Part of our job as pain psychologists and health- better training for mental health professionals so that Darnall: While the term “painkiller” is common, it’s care providers in general is to help connect patients to primary care providers can easily refer their patients to a misnomer when applied to opioids for chronic pain. the right information so they can employ strategies and competent therapists in the community who will di- Studies show that when used long-term, on average, techniques to self-manage their symptoms. rectly address pain as a therapeutic target. In the pain opioids only reduce pain by about 25-30 percent. It’s psychology national needs assessment, we identified critical that other strategies be used by patients to gain What happens when patients taper off of opioids? that pain education is needed at all levels of psychol- relief. Brain-training therapies, such as cognitive-be- 2 Does their pain increase or decrease? ogy education, including undergraduate, graduate, havioral therapy, mindfulness-based stress reduction, Darnall: Many people remain on opioids out of fear postgraduate, to continuing education for community and meditation have similar pain-relieving effects, that their pain will increase if they stop taking them. professionals. with none of the side effects. By learning techniques However, the data show that when people taper off opi- that reduce attention to pain — and distress about pain oids slowly, their pain tends to remain the same or im- How does the mind impact pain? prove. If opioids are stopped too quickly or if a single 4 Darnall: The mind has a tremendous influence on ian mackey dose is missed, withdrawal symptoms are likely to oc- the experience of pain. Multiple fMRI studies show cur, along with worse pain. A good, slow opioid taper that focusing on pain or ruminating on it can cause it will help patients avoid withdrawals altogether. to worsen. Rumination is one aspect of pain catastro- phizing — when a person focuses on pain, magnifies How can medical schools better equip physicians to it and feels helpless. The good news is that pain cata- 3 treat pain without medication? strophizing is treatable, and this is the focus of much of Darnall: Most medical schools do not prepare physi- my NIH research. It’s an important therapeutic target cians to handle the complexities of chronic pain man- because catastrophizing is linked to the development of agement. A 2011 study showed that most U.S. medical chronic pain after surgery or an episode of acute pain. schools included only four to 11 hours of specific ed- I teach my patients that even though they have a diag- ucational content on pain across the entire four-year nosed medical condition, they are participating with program — and that small amount of content was their pain through their choices, thoughts and emo- fragmented by topic. Pain was addressed within dis- tions. While we can’t change the medical diagnosis, we ease education — such as cancer or diabetes — instead can target daily choices, thoughts and emotions to gain of through a dedicated curriculum on comprehensive control and change the trajectory of pain. pain treatment. Physicians and all health-care provid- How do people with psychological distress respond Beth Darnall is the author of a new book on pain management. ers need better training in the biopsychosocial model of pain treatment, and this need was identified by the 5 differently to opioids? — pain is relieved. It’s not just about teaching patients 2016 National Pain Strategy developed by the U.S. De- Darnall: Anxiety and depression are common in indi- how to cope with their pain — the techniques actually partment of Health and Human Services. viduals with chronic pain, and these conditions serve reduce pain processing in the nervous system, thereby Earlier this year, I, along with my colleagues on the to worsen pain. Research shows that individuals with directly reducing its intensity and impact. Think of it Pain Psychology Task Force at the American Academy anxiety and depression are more likely to be prescribed as mind-body medicine. of Pain Medicine, published results from a national opioids, and at higher doses. This is problematic be- Learning how to calm one’s own nervous system is needs assessment we conducted about pain psychology cause opioids may be unwittingly prescribed to treat a critical aspect of pain management. It’s vitally im- training and resources. We surveyed 2,000 individuals the psychiatric symptoms that feed into pain. Opioids portant to learn and use skills to control the cognitive, across six key stakeholder groups in the U.S. Our re- don’t just blunt physical pain, they blunt emotional emotional and physiological factors that amplify pain. sults showed that, similar to physicians, the majority of experience, too, and this can be a powerful reward to Even if opioids are prescribed, they should be just one mental health professionals and psychologists feel inad- an individual suffering from emotional distress related part of an overall, comprehensive pain care plan that equately trained to address pain in the therapeutic con- to pain or just life in general — and it can prolong includes pain psychology, self-management, movement text. Consequently, therapists may avoid the topic with opioid use. It’s critical that we address psychological therapy or appropriate exercise, and other disciplines. their patients, thereby missing a critical opportunity to distress with evidence-based treatments that empha- By learning to calm the nervous system, people help their patients better manage their pain by empha- size behavioral medicine — psychological treatment. can gain confidence in their ability to manage their sizing evidence-based behavioral skills and techniques. Emotional pain serves to increase physical pain, and own pain and related distress. We call this confidence While better education on the biopsychosocial vice versa; it is crucial that we treat both the physical “self-efficacy,” and it’s a powerful predictor for whether treatment model of chronic pain is needed in medi- and emotional experience because this yields the best people will get better or not. People who believe they cal schools, we also must give physicians and health- results, and it helps avoid overreliance on medication have tools to reduce their distress and suffering are more care professionals the resources to actually implement and addiction. ISM

PA Marius Wernig, Manu Prakash named Faculty Scholars continued from page 2 Two School of Medicine faculty mem- physics that aid in his quest to under- tions that allow them to specialize bers are among 84 early-career scientists to stand the origins of complex behavior in their area of interest. For exam- be named 2016 Faculty Scholars by three in simple animals. In addition, he de- ple, a student interested in a career philanthropic organizations. velops tools for “frugal science” — in- as a surgical PA can complete up to The five-year grants were announced expensive devices that can be used to 12 weeks of clerkship in that area. Sept. 22 by the Howard Hughes Medical tackle global health problems and that Currently there are about 150 Institute, the Simons Foundation and the also aim to democratize access to scien- accredited training programs na- Bill & Melinda Gates Foundation. The tific experience. tionwide for PAs, almost all mas- three organizations will spend about $83 Wernig was named an HHMI Fac- ter’s programs, with about 70 to million over the course of the grant period ulty Scholar. He investigates the mo- Manu Prakash Marius Wernig 80 new programs on the horizon, to support the recipients. The total award lecular mechanisms that determine cell Larsen said. for each researcher ranges from $600,000 lineage identity, focusing on reprogram- Faculty Scholar; and Jan Skotheim, PhD, The number of practicing PAs and $1.8 million, including indirect costs. ming skin and stem cells into functional associate professor of biology, who was has grown from 14,000 in 1990 to The two grant recipients from the School neurons. His work includes translational named an HHMI-Simons Faculty Scholar. about 100,000 today, according to of Medicine are Manu Prakash, PhD, as- efforts to treat an incurable genetic skin This is the first collaboration between the American Academy of Physi- sistant professor of bioengineering, and disease and various diseases of the nervous the philanthropies, which created the cian Assistants. The average salary Marius Wernig, MD, PhD, associate pro- system, such as multiple sclerosis. Faculty Scholars program in response to is about $98,000 a year. fessor of pathology. Three other Stanford faculty members growing concern about the significant Employment of physician as- Prakash was named an HHMI-Gates also received grants. They are Alex Dunn, challenges that early-career scientists face. sistants is projected to grow 30 Faculty Scholar. He studies simple animals PhD, associate professor of chemical en- Researchers with more than four, but no percent between 2014 and 2024, to better understand how a small collec- gineering, who was named an HHMI more than 10, years of experience as fac- much faster than the average for all tion of cells gives rise to a multicellular Faculty Scholar; Elizabeth Sattely, PhD, ulty members were eligible to receive occupations, according to the U.S. organism. He also develops new imaging assistant professor of chemical engineer- grants. More than 1,400 scientists from Bureau of Labor Statistics. ISM tools and techniques based on soft-matter ing, who was named an HHMI-Simons 220 institutions applied for them. ISM Inside Stanford Medicine September 26, 2016 3 IPhone app launched to study peripheral artery disease Norbert von der Groeben

By Tracie White users to easily join clinical research stud- ies. Since its launch over a year ago, the School of Medicine researchers have software has been used by researchers to launched a free iPhone app designed to collect data on diseases ranging from dia- help them conduct a clinical study to betes to melanoma. Stanford researchers discover better treatments for peripheral launched one of the first of these studies, artery disease and as a convenient way MyHeart Counts, in the spring of 2015 for people with the disease to monitor to study heart disease. That study has en- their daily activity. rolled more than 54,000 people so far. “We hope to gain insights into pat- Aalami said the goal for the PAD terns of disease progression over time study is to enroll 2,000 to 5,000 partici- by collecting participants’ activity data pants, “much more than you can do with from their iPhones,” said Oliver Aalami, a traditional trial.” MD, clinical associate professor of vas- One of the study’s aims is to see if cular surgery and lead investigator of people with PAD show sudden changes the study. “We will be looking for any in activity level in the months after cer- changes in activity patterns that may in- tain common vascular procedures, such dicate disease advancement.” as the use of stents and balloons to im- Peripheral artery disease, which affects prove blood flow in the arteries. Know- about 12 million people in the United ing exactly when a sudden drop in States, is a circulatory problem caused activity occurs, rather than waiting for by a buildup of plaque in the periph- the traditional follow-up doctor’s visit, eral arteries, most commonly in the legs. could potentially provide physicians Symptoms include cramping and pain and participants with a much better in- while walking or climbing stairs. Treat- dication of when further intervention is ment is directed at reducing leg pain and needed. A sudden drop in activity level the risk of heart attack and stroke from could be a sign of claudication — pain Oliver Aalami (second from left) walks with members of his team that helped develop the app. They are Raheel Ata (far left), Neil Gandhi (second from right) and Sunaina Kongara (far right). clogged arteries. caused by too little blood flow to the ex- ‘It gets really painful’ tremities, commonly the legs, which in- dicates trouble. The app “could be a game changer,” ticipant is able to walk. To keep a daily “One of the key metrics we will look “People with PAD may be able to said Neil Gandhi, a Stanford medical tally of activity, users simply keep their at is the greatest distance that people walk five miles, but sudden pain may student and co-investigator of the study. iPhone with them during the day. with PAD can walk without stopping,” cause them to stop often,” Aalami said. “It could change the way physicians “We’ve tried to keep participation in Aalami said. “It gets really painful, and These patients can rest, and the pain goes practice. By using personalized track- this trial as simple as possible,” Aalami they have to stop and rest before con- away and they move on, often not realiz- ing, participants could get a notifica- said. “The phone will passively measure tinuing on.” ing they could be in trouble, he said. tion to come in for an ultrasound when total steps taken in a day, the number of The VascTrac app will collect activity Early detection a ‘Holy Grail’ physicians see signs of claudication. This stairs walked and the distance walked.” data using Apple’s ResearchKit, an open- could ultimately improve care.” Participants can download the VascTrac source framework that allows iPhone “Endovascular procedures such as bal- The app is an example of Stanford app from the App Store. loons or stents in the iliac or femoral ar- Medicine’s focus on precision health, the Researchers emphasize that the app Norbert von der Groeben teries are minimally invasive procedures goal of which is to anticipate and prevent is not a medical diagnostic tool and isn’t that allow patients to go home the same disease in the healthy and precisely diag- designed to provide medical advice, pro- day, and they work well, but are not that nose and treat disease in the ill. fessional diagnosis, opinion, treatment or durable,” Aalami said. “The issue is that Although the app is targeting peo- health-care services. within a year or two, 60 percent of them ple with peripheral artery disease, any All participants’ data will be stored fail because patients develop scar tissue. iPhone user 18 years or older is qualified using military-grade encryption, and We’re not perfect at predicting who is to participate in the trial. participant names will be replaced by going to have problems, and catching “Because anyone can develop periph- random codes, keeping identities and them early when these stents do go down eral artery disease, and because we need medical information confidential, the would be the Holy Grail. It’s much easier healthy subjects as controls, we’re open- researchers said. With permission from a to fix earlier.” ing the study to anyone,” said Raheel participant, his or her de-identified data Traditionally, physicians tell patients Ata, a Stanford medical student and co- may be shared with researchers at other to schedule follow-up visits at three-, six- investigator of the study. institutions approved by Stanford. and 12-month intervals after one of these Participation will include a five- to The trial is being sponsored by the The VascTrac app is designed for people who have procedures. But there’s a “black hole” in 10-minute initial survey, followed by companies Abbott Vascular, Cook Medi- peripheral artery disease. It tracks a user’s steps between visits when doctors don’t know quarterly surveys on the iPhone and oc- cal, W. L. Gore & Associates and Micro- and activity during the day. what’s happening, Aalami said. casional tests to measure how far a par- soft. ISM

Regulatory RNA essential to DNA damage response, study shows

By Krista Conger today in Nature Genetics. Chang is the senior author. “Until now, most studies have focused only on pro- Lead authorship is shared by former radiation oncology teins in this pathway,” said Chang. Knowing when to hold them, and when to fold resident Adam Schmitt, MD, graduate student Julia Fine-tuning the damage response them, is a critical skill in professional gambling. But it’s Garcia and former graduate student Tiffany Hung. also pertinent for cells assessing DNA damage. When DNA gets damaged DINO is a member of a group of RNA molecules It’s essential for the cells to quickly ascertain whether known as long noncoding RNAs, or ln- it’s possible to repair mistakes or to self-destruct for the DNA damage is a natural byproduct of cRNAs. These molecules have been im- good of the organism. That’s because cells with a dam- cell division because it is impossible to faith- plicated in a growing number of critical aged genome often begin to flaunt the standard rules of fully copy each of the 3 billion nucleotides regulatory roles throughout the cell. growth and become cancerous. that make up our genomes without mak- This is the first time that a lncRNA has Now, researchers at the School of Medicine have dis- ing at least a few errors. Damage can also been shown to be involved in this critical covered a new player in this high-stakes molecular game be caused by exposure to certain chemi- DNA damage-response pathway in living in the form of a novel regulatory RNA they’ve named cal agents, ultraviolet light and ionizing animals. DINO. This RNA molecule binds to and stabilizes a radiation. Chang and his colleagues found that well-known tumor suppressor protein called p53 that Most of the time these problems are rec- when DINO expression is artificially in- mobilizes a cell’s response to DNA damage. When mu- ognized and quickly repaired by the cell. Howard Chang creased, cells respond as if their DNA has tated, p53 is one of the most infamous bad guys in the That’s where p53 comes in. When it is doing been damaged even in the absence of any cancer world. its job, p53 recognizes and responds to DNA damage genome changes. In contrast, when DINO expression is “It’s so important for a cell to keep track of poten- by increasing the expression of genes involved in DNA inhibited, the cell responds less robustly to signals from tially dangerous changes to its genome,” said professor repair and cell division. In this way it functions as a tu- p53. of dermatology Howard Chang, MD, PhD. “But if cells mor suppressor. When mutated, however, p53 loses its “DINO expression allows the cell to fine-tune its reacted to every little ding, they would find themselves ability to modulate the cell’s response to DNA damage. response to DNA damage and respond appropriately,” responding inappropriately — they would stop grow- Mutations in p53 are among the most common causes said Chang. ing and maybe even self-destruct unnecessarily. You of many types of cancer. Because, as an RNA, DINO is made in the cell’s don’t want to do this unless the DNA damage is severe. Chang and his collaborators found that p53 also in- nucleus where p53 is active, the researchers believe it We’ve discovered that DINO is an integral part of this creases the expression of DINO. DINO, in turn, binds may provide a more rapid and precise response to DNA decision-making circuit.” to and stabilizes p53 in a kind of positive feedback loop, damage than would a regulatory protein, which would A paper describing the research was published online amplifying its signal throughout the nucleus. be synthesized See RNA, page 5 4 September 26, 2016 Inside Stanford Medicine Stanford Health Care addresses needs of an aging population

By Sara Wykes aging beyond physical ailments, said Dolores Gallagher- Biodesign fellows to develop Thompson, PhD, professor emerita of psychiatry and health technology for aging adults As director of Stanford Health Care’s Adult Aging behavioral sciences. Gallagher-Thompson directs Stan- Services program for more than a decade, Rita Ghatak, ford Medicine’s Older Adult and Family Center, which By Sara Wykes PhD, has guided thousands of older patients and their works to improve the well-being of family caregivers of families through the health maze that starts, at least on dementia patients, and collaborates with Aging Adult The Stanford Byers Center for Biodesign paper, at age 65. Services. Fear and loss, she said, can affect an older pa- has joined Stanford Health Care’s efforts to Traditionally, dementia support has been one of the tient’s emotions and behavior. advance care for the aging population by se- program’s most sought services. But today, a balloon- “The fear of dementia is very common,” she said. lecting aging as the clinical focus for its 2016- ing population of older patients is asking for broader “There are also lots of losses during this time — of a 17 Biodesign Innovation Fellows program. It guidance on healthy aging. “People are telling us they spouse, of friends, of function. We regularly talk with was not a hard choice. want to plan before a crisis develops,” Ghatak said. “We our aging patients about counting blessings and let- “Aging as a health issue is both an ex- are expanding our programs to help them avoid last- ting go of past hurts and resentments. When we work traordinary crisis and opportunity,” said Paul minute scrambles — and building out our services that with caregivers, we try to build their resilience and to Yock, MD, founder and director of the cen- support the prevention of age-related problems, either help them revitalize from the emotional exhaustion that ter. “It’s the single most interesting area for for the older person or an adult child.” comes with that role.” innovation we could have chosen.” The need is clear: Worldwide and nationwide, the The gift of listening It also made sense, Yock said, “because ag- aging population is growing faster than any other co- ing gives us a way to shift from just fixing dis- hort. California’s 65-and-older population already tops The center has developed a number of innovative ease to looking at health — what will it take 5 million. Four in 10 patients at Stanford Hospital are resources for aging adults and their families, she said, to keep people happy and healthy into their from that age group. It’s a patient population whose including a manual to guide therapists treating late-life later decades.” care will be complex: Being 65 typically means having depression. It is also developing a fotonovela focused Stanford Biodesign, which celebrated its at least one chronic health condition that cannot be on teaching Latino family caregivers how to effectively 15th anniversary this year, has trained more cured, but only managed. Age also greatly raises the risk manage difficult everyday behaviors in their family than 1,000 graduate students and nearly 200 of heart disease and cancer, and decreases vision, hear- members with dementia. fellows in the process of health technology ing, bone strength and joint mobility. Terese McManis, a registered nurse and the man- innovation. Those trainees have gone on to Expanding care ager of Aging Adult Services, is an expert at the delicate found more than 40 companies and develop conversations that may be needed at this stage in life. products that have benefited more than half a Stanford Health Care, in collaboration with the She and her team help families talk about decisions that million patients. School of Medicine, is expanding its systemwide health affect a patient’s independence and self-respect: when This year, all 12 fellows will follow the care for patients 65 and older. “We have made senior to stop driving, when extra help at home is needed or program’s usual process of gathering informa- care one of our priorities,” said Marina Martin, MD, when home health care is not enough. tion, identifying needs and developing solu- clinical assistant professor of medicine and and section “I try to get everyone on the same page,” McManis tions. But because research has shown that head for geriatric medicine. “We’ve done programs here said, “and remind them that they, too, are going to be in older adults generally want to stay in their and there to address gaps. Now we are going to look at the same position one day, so remember to be patient.” homes, the fellows will spend time with peo- how we can adapt the whole SHC system to care for Sometimes, staff members will make a home visit to ple in their homes and in transitional care fa- this increasingly large group of patients.” learn more about a patient and family’s circumstances. cilities, in addition to their traditional clinical Care for older adults has traditionally been one- Home visits allow them to perform clinical evaluations immersion experience at Stanford Hospital. size-fits-all, Martin said, but it needs to be tailored, Norbert von der Groeben Collaborating with Center on Longevity particularly for the oldest and frailest age group, whose health is the most precarious. The goal of SHC’s new The biodesign program is collaborating geriatrics­­-care effort, she said, will be to provide ef- with Stanford’s Center on Longevity, which fective care for everyone 65 and older, no matter their has given this year’s fellows “a treasure trove health status, and to focus on preserving their quality of of people and ideas,” said Yock, a professor of life. “We are designing a road map for change so that no bioengineering and of medicine. matter where in the system an older patient lands, we This year’s fellowship program also reflects will be able to deliver the best possible care,” she said. the biodesign program’s renewed emphasis Aging Adult Services “has filled a major gap,” Mar- on cost innovation, Yock said. “We’ll be look- tin added, providing resources, special programs and ing at areas where, as a health system, we are training. Many of Aging Adult Services’ programs are spending enormous resources in ways that are now known as national models. Its strategies include not intelligent, effective or caring. Those are building a strong continuum of care among a patient’s areas where innovation is necessary.” doctors, nurses, social workers and case managers so ev- The fellows are not told what their focus eryone understands what that patient wants from health will be before they arrive at Stanford, and care. they have responded with great enthusiasm to ‘They are vulnerable’ working on health-care innovation for older patients. “Given the magnitude of our aging “We have a lot of older medical patients who need population, both in the U.S. and abroad, I advice on healthy living and managing their chronic am thrilled to address the needs in this area,” disease,” said Candace Mindigo, a registered nurse and said biodesign fellow Eric Kramer, a mechan- longtime Aging Adult Services care coordinator. “They ical and biomedical engineer. “I believe that are vulnerable.” After a recent talk at a Palo Alto senior our focus on value innovation, combined center, Mindigo was bombarded with questions. Some Terese McManis, a registered nurse and the manager of Aging Adult with what older people can teach us, will help Services, visits Cherie Helm at her home in Santa Clara. of them illustrated just how unfamiliar the health-care us find meaningful ways to improve care.” system can be for people with little experience navigat- Vivien de Ruijter, MD, worked at an an- ing it. “They wanted to know,” Mindigo said, “who, of how well patients are following doctors’ orders and to gel investment firm before being selected as if you are hospitalized, do you talk to if you have help patients accomplish health goals. a biodesign fellow. In conversations she had questions?” Always, Mindigo said, Aging Adult Services acts as there, “the consensus was that the aging pop- Aging Adult Services personalizes its care plans for a sounding board. “The biggest part of what we do is ulation is a global concern — and that there patients and their caregivers because they face health to be a support, to navigate, to refer and to provide are broad opportunities to intervene and im- conditions and circumstances that can vary widely. resources,” she said, “but we begin by listening. That prove care.” “Every person ages differently no matter what the diag- is a gift we can give to them so they can sort things Already, Kramer said, he has begun to rec- nosis,” said Jennie Clark, a gerontologist and manager out. And if any of this eases their burden of care and ognize the nuances of discovering the needs of the service’s Memory Support Program. “We focus helps them feel connected to an advocate, it improves of an older population. “Some people need on person-centered care. Even if a patient is function- their overall quality of life. It starts with someone lis- more help, but even they wanted to keep the ally or physically impaired, they still have capabilities. tening with respect, whether or not an illness has been conversation upbeat. Finding the right way to We focus on who the person is now and how they want diagnosed.” get people to open up and tell us about things to live their life.” “You have to be a good listener,” McManis said. that may be less pleasant will be part of the That care also includes attention to the challenges of “Everybody has a story to tell.” ISM challenge.” ISM

RNA Shen, PhD, and Kun Qu, PhD; former graduate student Please give blood continued from page 4 Alexander Payumo, PhD; undergraduate student Ashwin Blood type needed: Peres-da-Silva; postdoctoral scholar Daniela Broz, PhD; B-, O- in the cytoplasm. professor of chemical and systems biology and of devel- “Positive feedback loops are used in many applica- opmental biology James K. Chen, PhD; and professor of To request an appointment, call 723-7831 tions, including engineering, to increase the sensitivity radiation oncology and of genetics Laura Attardi, PhD. or you can make an appointment online. of systems and apply thresholds for action,” said Chang. The research was funded by the National Institutes of “We believe DINO may play role in cancer development Health, the ASCO Conquer Cancer Foundation, a Su- 3373 Hillview Ave., Palo Alto and possibly premature aging by modulating how a cell san G. Komen Young Investigator Award and Stanford 445 Burgess Drive, Menlo Park, responds to DNA damage.” Radiation Oncology Kaplan Funds. 515 South Dr., Mountain View Other Stanford co-authors of the paper are graduate Stanford’s Department of Dermatology also sup- http://bloodcenter.stanford.edu student Ryan Flynn; bioinformatician scientists Ying ported the work. ISM Inside Stanford Medicine September 26, 2016 5 celerated research into the genetic basis basic research that has led to history’s process will be based on an outstanding Biohub of disease and underlies lifesaving bio- most important health advances — and idea and a record of success, with the continued from page 1 medical assays. the remarkably talented minds behind idea that people who have done well be- DeRisi, who earned his PhD in bio- it.” fore tend to do well again, Quake said. “The Biohub will provide many new chemistry at Stanford, has developed Supporting people Three Biohub programs focus on opportunities for interdisciplinary col- genomic technologies for studying infec- fostering the careers of young scientists. laboration,” said Ann Arvin, MD, Stan- tious disease such as malaria and viruses, The Biohub will fund Chan Zucker- One is a fellowship program to support ford’s vice provost and dean of research. and diseases of unknown origin. His berg Investigators to support high-im- outstanding recent graduates that gives “By bringing together basic biomedical technologies have identified drug targets pact projects that are too exploratory to those scientists a boost to their early ca- scientists, engineers and clinician investi- for infectious diseases, with drug candi- receive government support. The com- reers. Quake added that the fellowships gators from across the three universities, dates now in clinical trials. petition for these slots will open to fac- will keep elite young scientists in the Bay the Biohub will greatly expand the devel- Other advances to come out of the ulty at the three universities in October, Area ecosystem rather than losing their opment of new technologies needed to collaborating universities include re- and selections will be made by a panel of expertise to other universities. tackle major health challenges.” combinant DNA, genomics platforms independent scientists probably by the The Biohub’s scientific staff will Quake said the Biohub’s focus on and CRISPR/Cas9, among many oth- end of the year, Quake and DeRisi said. include Group Leader positions that technology makes sense, given the his- ers. Combining the strengths of the uni- The Chan Zuckerberg Initiative will not provide a new career track to young sci- tory of technological advances that have versities will accelerate the pace of new, be involved in reviewing and selecting entists who want to focus on research helped scientists understand, treat and equally groundbreaking technologies. investigators. rather than on the academic pressures of prevent disease. In his own lab, Quake “With this extraordinary commit- “We’re going to look for people who teaching or writing grants. developed a platform called microflu- ment, we are closer than ever to beating are doing things that will change the Finally, some investigator slots will be idics, which can sequence miniscule disease,” said Lloyd Minor, MD, dean of world,” said Quake, who is also Lee Ot- set aside for assistant professors, who of- amounts of DNA or analyze molecules the School of Medicine. “These resources terson Professor in the School of Engi- ten struggle to compete with more senior within drops of liquid. It has greatly ac- will support the kind of curiosity-driven neering. The streamlined application scientists for grants. ISM

Iron for body weight, similar to those approved by the FDA are some tumor cells left after surgery, the situation that continued from page 1 for anemia treatment. Prior studies had shown that the cancer surgeons call positive margins, we think it might nanoparticles are metabolized over a period of about work to inject iron nanoparticles there, and the smaller conducted an experiment that used three groups of six weeks, and the new study showed that tumor seeds could potentially be taken care mice: an experimental group that got nanoparticles the anti-cancer effect of a single dose of of by our immune system,” Daldrup-Link loaded with chemo, a control group that got nanopar- nanoparticles declined over about three said. ticles without chemo and a control group that got nei- weeks. The fact that the nanoparticles are already ther. The researchers made the unexpected observation The scientists also tested whether the FDA-approved speeds the ability to test that the growth of the tumors in control animals that nanoparticles could stop cancer from these applications in humans, she added. got nanoparticles only was suppressed compared with spreading. In a mouse model of small-cell The new findings will also help cancer the other controls. lung cancer, the nanoparticles reduced tu- researchers conduct more accurate evalua- Getting macrophages back on track mor formation in the liver, a common site tions of nanoparticle-drug combinations, of metastasis in both mice and humans. In a Daldrup-Link said. “In many studies, re- The researchers conducted a series of follow-up separate model of liver metastasis, pretreat- Heike Daldrup-Link searchers just consider nanoparticles as drug tests to characterize what was happening. Experiment- ment with nanoparticles before tumor cells vehicles,” she said. “But they may have hid- ing with cells in a dish, they showed that immune cells were introduced greatly reduced the volume of liver den intrinsic effects that we won’t appreciate unless we called tumor-associated macrophages were required for tumors. look at the nanoparticles themselves.” the nanoparticles’ anti-cancer activity; in cell cultures Potential clinical applications The study’s lead author is Saeid Zanganeh, PhD, without macrophages, the iron nanoparticles had no ef- postdoctoral scholar in radiology. Other Stanford co- fect against cancer cells. The study’s results suggest several possible applica- authors are Gregor Hutter, MD, PhD, visiting instruc- Before this study was done, it was already known tions to test in human trials, Daldrup-Link said. For in- tor in neurosurgery; Ryan Spitler, PhD, senior research that in healthy people, tumor-associated macrophages stance, after surgery to remove a potentially metastatic scientist in radiology; Olga Lenkov, life science research detect and eat individual tumor cells. However, large tumor, patients often need chemotherapy but must assistant in the Molecular Imaging Program at Stanford; tumors can hijack the tumor-associated macrophages, wait until they recover from the operation to tolerate Morteza Mahmoudi, PhD, a visiting scientist in cardi- causing them to stop attacking and instead begin secret- the severe side effects of conventional chemo. The iron ology; Jukka Sakari Pajarinen, MD, PhD, postdoctoral ing factors that promote the cancer’s growth. nanoparticles lack the toxic side effects of chemother- scholar in orthopaedic surgery; Hossein Nejadnik, MD, The study showed that the iron nanoparticles switch apy, suggesting they might be given to patients during PhD, clinical science research associate in pediatric ra- the macrophages back to their cancer-attacking state, the surgical recovery period. diology; Stuart Goodman, MD, PhD, professor of sur- as evidenced by tracking the products of the macro- “We think this could bridge the time when the pa- gery; and Michael Moseley, PhD, professor of radiology. phages’ metabolism and examining their patterns of tient is quite sick after surgery, and help keep the cancer Scientists at the Oregon Health and Science Univer- gene expression. from spreading until they are able to receive chemother- sity also co-authored to the study. Furthermore, in a mouse model of breast cancer, apy,” said Daldrup-Link. The research was funded by the National Cancer In- the researchers demonstrated that the ferumoxytol in- The nanoparticles may also help cancer patients stitute. Stanford’s Department of Radiology also sup- hibited tumor growth when given in doses, adjusted whose tumors can’t be completely removed. “If there ported the work. ISM

Norbert von der Groeben Stanford Medicine Packard Children’s Hospital Stanford, continued from page 1 scheduled to open in fall 2017, will require hiring 400 to 500 new people. “The cost other milestones, Minor said, was the opening of the of living is going to be one of our biggest Laboratory for Cell and Gene Medicine, which man- challenges,” Dawes said. ufactures cell and gene therapies for use in humans. Advancing precision health “When you have a will, when you have a vision, when you’re blessed with having resources, we’re able to bring In the year and the decade to come, the together enormous talent, and to enable those very tal- panelists expect to continue advancing pre- ented people to accomplish truly unique things,” he cision health. “Precision medicine, which said. “Already there are four first-in-humans clinical tri- we do here every day, is about taking ge- als approved or in the final stages of being approved.” nomics, big-data science, personalization Minor also highlighted the Chan Zuckerberg Bio- of care, and bringing those to the benefit of hub, a recently announced research collaboration David Entwistle, Lloyd Minor and Christopher Dawes take part in a panel discussion each individual patient with a severe acute among scientists at Stanford, UC-San Francisco and during the Sept. 22 State of Stanford Medicine event. disease,” said Minor. “We have no inten- UC-Berkeley. “The goal of the Biohub is to develop tion of backing away from that. What we the innovative technologies, the innovative scientific mitment to diversity and inclusivity. “It’s not just the see the opportunity to do is to take ge- approaches that are going to propel biological medical pipeline. It has to also be nurturing and providing the nomics, big-data science and personalization and apply research forward in the coming decades,” he said. The opportunities for those students as they finish their those in a predictive and proactive way. Ten years from Biohub is funded by the Chan Zuckerberg Initiative, training to enter into faculty jobs and then to succeed now, the need for personalized medicine will be much which aims to cure, prevent or manage all diseases by once they’re in the faculty jobs,” he said. “And that’s less, because we will have diagnosed diseases earlier, and the end of the century. something I know we can do here.” therefore been able to treat them more effectively. We These are the types of big problems Stanford Medi- The panelists discussed how they are responding to will even have been able to prevent diseases.” cine scientists love to dig into, Minor said. “What really trends in health care. One notable tendency: patients’ Crucial to realizing the precision health vision, the motivates us here is when someone tells us that some- use of internet-enabled devices to research and monitor panelists said, was continuing to build strength in pri- thing can’t be done. We are attracted to the problems their health. “We’re very happy that consumers have ac- mary care. “Not too long ago, we had seven faculty in that to others appear intractable.” cess to data,” said Dawes, “but that also means we have primary care, and now we have about 80,” said Dawes. Seizing opportunities a very informed patient population, and that creates “It really comes back to what we are here for, and that is both opportunities and challenges.” Among them, said to help people — not only to get them well but to help Minor emphasized that although the School of Entwistle, is making sure “we have solutions that allow them not to get get sick in the first place.” Medicine has become more diverse over time — this people to navigate with us easily.” “We want Stanford to be known as the academic year, about 25 percent of the incoming MD and PhD As Stanford Medicine expands, its leaders are also medical center where we translate fundamental research students are members of underrepresented minority grappling with how to attract and retain top-notch staff to the care our patients are receiving,” said Minor. groups — he sees an opportunity to deepen its com- in the Bay Area. For example, the extension of Lucile “This is the place where it happens.” ISM 6 September 26, 2016 Inside Stanford Medicine o b it ua ry Graduate student Maria Birukova dies in climbing accident

By Krista Conger laboratory of assistant professor of chemistry Yan Xia, PhD, to design polymers and antibodies to disrupt biofilms with the aim of treating patients with deadly Maria Birukova, a fourth-year graduate student in the MD-PhD program at infections. the School of Medicine, died in a climbing accident near Bear Creek Spire in the “The medical school community has suffered a tremendous loss,” said Lloyd eastern Sierra Nevada Mountains. She was 26. Minor, MD, dean of the School of Medicine. “Maria’s interdisciplinary approach The accident occurred on Sept. 18 and was witnessed by her climbing part- to the treatment of antibiotic-resistant biofilms brought to bear insights from ner, Ian Isaacson. Her body was recovered on Sept. 20 by members of the Inyo both chemistry and immunology in an attempt to devise new treatments for County Sheriff’s Office, Inyo Search and Rescue and the California Highway patients with few other options. Her work was a wonderful example of Stanford’s Patrol. focus on translational medicine, and she will be greatly missed, both Birukova, an avid mountaineer and climber, earned a bachelor’s professionally and personally.” degree in biomedical engineering at Yale University. She came to In addition to finding time to climb, Birukova was a consulting Stanford in 2013 and was working in the laboratory of immunologist project manager for the Stanford Healthcare Consulting Group, a Paul Bollyky, MD, PhD. Earlier this year, she was awarded a Bio-X nonprofit, volunteer-run organization devoted to improving patient Bowes graduate student fellowship in honor of her groundbreaking care through quality- and performance-improvement projects. Biru- interdisciplinary research. kova was also a 2015-16 Graduate Voice and Influence Program Fel- “Maria was one of our superstars,” said professor of medicine PJ low through Stanford’s Clayman Institute for Gender Research. She Utz, MD, who directs Stanford’s Medical Scientist Training Program, was a native Russian speaker and, while at Yale, spent time transcrib- in which students work toward both a medical degree and a doc- ing taped oral interviews with Russian oil workers into written Rus- toral degree. “She had a background in engineering and an interest Maria Birukova sian documents. in chemistry, and we were very excited to welcome her into our program. But it “Maria was a very dynamic, interested and interesting person who really en- was clear from the moment I met her that climbing was a major part of her life. gaged with the Stanford community in a number of ways,” said Bollyky, an as- In fact, she struggled to choose whether to attend Stanford or the University of sistant professor of medicine and of microbiology and immunology. “In addition, Utah for her graduate training because in Utah the mountains are so close. We in she was an outstanding scientist. Her research focused on the intersection be- the program are devastated that she won’t now be able to fulfill her other dream tween microbiology, structural biology and physical chemistry in biofilms. It was of becoming a physician-scientist.” very novel, and she was incredibly energetic and passionate about developing new Research on biofilms therapies for patients with chronic wounds. Her loss leaves a hole in her graduate class, as well as in my lab.” Birukova’s research in the Bollyky lab focused on the role played by a virus Birukova was born on May 31, 1990, in Moscow, Russia. She attended the called a bacteriophage in the formation of biofilms — viscous communities of University of Chicago Laboratory Schools in Chicago. She is survived by her bacteria, resistant to antibiotics and immune responses, that can colonize chronic parents, Konstantin Birukov, MD, PhD, and Anna Birukova, MD, who are both wounds or coat medical equipment. She collaborated with researchers in the on the faculty of the Pritzker School of Medicine at the University of Chicago. ISM

Manu Prakash wins prestigious grant from MacArthur Foundation

By Amy Adams applying scientific principles has been more than 50,000 people in 135 coun- the toy — with its tiny wheel spinning recognized as true genius by the MacAr- tries who use the tool in research and pins of various sizes — could be used to Manu Prakash, PhD, an assistant pro- thur Foundation.” education. drive a miniature chemistry kit akin to fessor of bioengineering at Stanford, has Prakash almost didn’t pick up the “What the community has done how old mechanical computers used to been named one of the 2016 fellows of phone when the MacArthur Foundation with the Foldscope is phenomenal,” work. That kit won him the Science Play the John D. and Catherine T. MacAr- called. He was caring for his 4-month- said Prakash, who requests that people and Research Kit (SPARK) competition, thur Foundation. old twins at the time. “I was very sleep- who receive Foldscopes share back on jointly sponsored by the Gordon and The fellowships, popularly known as deprived when the phone rang,” he what they’ve learned with the Foldscope Betty Moore Foundation and the Society “genius grants,” are awarded to scholars said. “My main reaction is that it is a community. for Science & the Public. The award was who show exceptional creativity in their very humbling experience because there People around the world have used for the device’s possibility as a child’s toy, work and the prospect for still more in are so many people in the world doing Foldscopes for projects exploring dis- but it could also run chemical assays in the future. It includes a $625,000 sti- amazing work.” eases in bees, documenting pollen grains remote locations, such as testing water pend over five years, designed to provide Driven by curiosity in urban landscapes, mapping biodiver- purity or running diagnostics tests. recipients with the flexibility to pursue sity of microscopic organisms, detecting “Often a challenge in technology de- their activities in the absence of specific Prakash said his research has been cervical cancer, and teaching hygiene and ployment is building engaged local com- obligations. driven by curiosity about the world sanitation and in hands-on education, munities that take ownership of ideas The MacArthur Foundation recog- rather than answering a particular ques- among many other projects. and deployment. I’d started thinking nized Prakash for his research that is tion. “I’ve done science the way I’ve “Manu’s work could help solve some about this connection between science “driven by curiosity about the diversity wanted to do science,” he said. “Some- of the biggest issues facing us in global education and global health,” Prakash of life forms on our planet and how they times it’s hard to convince others that health,” said Lloyd Minor, MD, dean of said. “The things that you make for kids work, empathy for problems in resource- we are taking the right approach. This the School of Medicine. “His creativity to explore and experience science are also poor settings, and a deep interest in de- award gives me the flexibility to not has led to powerful, low-cost technolo- exactly the kind of things that you need mocratizing the experience and joy of think about those bounds.” gies that people in remote locations can in the field because they need to be ro- science globally.” Prakash’s studies problems in organis- use to study and treat disease in their bust, scalable and they need to be highly “Manu Prakash is not only one of the mal biology through the lens of physics. communities. These are the kinds of versatile.” most innovative scientists of our day, he He also builds tools and approaches to solutions that will bring real change to Another series of projects that began is also using his interdisciplinary exper- do field science that are both low-cost health-care challenges.” with his PhD work pioneering micro- tise to improve human health around and extremely powerful, bringing science An eye toward global health fluidic bubble logic involves the dynam- the world,” said Stanford President Marc out of the lab and to parts of the world ics of water droplets, whose mysterious Tessier-Lavigne, PhD. “He harnesses a where traditional tools aren’t feasible. Prakash said that many of his ideas movement had captivated Prakash. He wide array of technologies, including op- One example of this approach is a mi- come from his travels and from his child- figured out how the surface dynam- tical physics, computer science, fluid dy- croscope made out of paper with a glass hood growing up in India. “Being in the ics of droplets result in their dancelike namics, biology and chemistry, to solve bead for a lens, called the Foldscope. field gives meaning to working in global interactions. tangible human and scientific problems. It costs less than a dollar to make and health,” Prakash said. “It teaches you He then went on to apply what he’d It is fitting that his creative approach to has now been distributed by his lab to empathy, a driving force so strong that it learned about manipulating water drop-

l.a. cicero transforms ideas into actions.” lets to develop a computer powered by An example of this is his work design- the motion of droplets. “Our goal is not ing tools to track and detect mosquito to compete with electronic computers species by people around the world. This or to operate word processors on this,” work would allow communities to survey Prakash said. “Our goal is to build a mosquitoes at large scale and track the completely new class of computers that vectors for some of the most deadly dis- can precisely control and manipulate eases. In a few months, the Prakash lab physical matter at mesoscale.” will start testing some of these tools in a Prakash said that he doesn’t know ex- field site in Madagascar. actly what research he will pursue with “Manu’s contributions to global his award. “I can’t say what this will health are an inspiration to us all,” said mean to my science as yet, but I know Persis Drell, PhD, dean of the School of for sure we have a lot of ideas brewing,” Engineering. “It is through precisely the he said. kinds of creative innovations in technol- Prakash is also a member of the in- ogy that Manu is developing that we can terdisciplinary institutes Stanford Bio- have significant impact on the world’s X, Stanford ChEM-H and the Stanford urgent challenges.” Woods Institute for the Environment. Some of his other work is more whim- Stanford’s Department of Bioengineer- sical in origin. When Prakash’s wife gave ing is jointly operated by the School of him a mechanical music box as a gift, Medicine and the School of Engineering. Manu Prakash, a bioengineer, will receive $625,000 over five years from the MacArthur Foundation. he realized that the inner workings of ISM Inside Stanford Medicine September 26, 2016 7 p eo p le Physician, author Abraham Verghese awarded humanities medal By Tracie White Cheriss May / Ndemay Media Group ents include writers I most admire. It’s a Abraham Verghese, MD, professor wonderful affirmation of a path that in of medicine at the Stanford School of the early years I wasn’t sure was the right Medicine, received a National Humani- path, even though it was one I felt com- ties Medal at a White House ceremony pelled to follow.” Sept. 22. The human touch “Abraham Verghese is not only an exemplary clinician, he is an exemplary Verghese is a critically acclaimed, best- humanist,” said Stanford President Marc selling author and a physician with an Tessier-Lavigne. “Every day in the class- international reputation for his empha- room, he teaches his students that pro- sis on empathy for patients in an era in fessions such as medicine benefit from which technology often overwhelms the an understanding of the human condi- human side of medicine. tion. We are so proud that his breadth “This is a special honor for a physi- of scholarship has been recognized with cian,” said Lloyd Minor, MD, dean of this honor.” the School of Medicine. “Through his Inaugurated in 1997, the National writings and his work as a physician, Humanities Medal “honors individuals Abraham has worked to battle what he or groups whose work has deepened the has seen as a lack of humanism in mod- nation’s understanding of the human ex- ern medicine. The courage to follow perience, broadened citizens’ engagement his own path, and the compassion he with history, literature, languages, philos- has brought to his work, have made the ophy, and other humanities subjects,” ac- world a better place.” cording to the National Endowment for In his first book, My Own Country: A President Barack Obama presented Abraham Verghese with a National Humanities Medal on Sept. 22. the Humanities website. As many as 12 Doctor’s Story, Verghese focused on his medals are awarded each year. early years as an orderly, his caring for The organization said Verghese is re- terminal AIDS patients and the insights interdisciplinary center, Presence, which and provides recommendations to the ceiving the medal “for reminding us that he gained from the relationships he reflects these interests. president, who selects the recipients. the patient is the center of the medical formed and the suffering he witnessed. The National Endowment for the Joining Verghese as medal recipi- enterprise. His range of proficiency em- “I felt strongly then and now that Humanities manages the nomination ents this year were two other writers bodies the diversity of the humanities; what I was writing about, and my in- process for the National Humanities with Stanford connections: poet Louise from his efforts to emphasize empathy in terest in the human experience of be- Medal on behalf of the White House. Glück, a visiting faculty member in the medicine, to his imaginative renderings ing ill or caring for the ill, was as much Each year, the NEH invites nomina- Department of English; and Elaine Pa- of the human drama.” a part of medicine as knowledge of the tions from individuals and organizations gels, a religious historian and author of “I am humbled and excited by this function of the pancreas, for example,” across the country. The National Coun- the Gnostic Gospels and Beyond Belief: The honor,” said Verghese, who is the Linda said Verghese, who is also a vice chair of cil on the Humanities, NEH’s presiden- Secret Gospel of Thomas, who earned both R. Meier and Joan F. Lane Provostial Stanford’s Department of Medicine. In tially-appointed and Senate-confirmed bachelor’s and a master’s degrees from Professor. “The names of previous recipi- addition, Verghese directs the Stanford advisory body, reviews the nominations Stanford. ISM

Leonore Herzenberg, D.Sc-equivalent, professor of Heart Association. As president, he plans to advocate of note genetics and the Department of Genetics Flow Cytom- for healthy habits, particularly in children; enhanced reports on significant honors and awards etry Professor, was named an honorary fellow of the regulation of tobacco and e-cigarette sales; expanded ac- for faculty, staff and students Royal Microscopical Society. She was recognized for her cess to CPR training; and mandating healthy foods in contributions to the development of the fluorescence- schools. Leah Backhus, MD, associate professor of cardio­ activated cell sorter, which is used to diagnose leukemia Sarah Madison, MD, was appointed assistant pro- thoracic surgery, was selected to serve a three-year term as and in stem cell transplantation. fessor of anesthesiology, perioperative and pain medi- a member of the Patient-Centered Outcomes Research William Hiesinger, MD, was appointed assistant cine, effective Feb. 1. Her research focuses on regional Institute’s Advisory Panel on Improving Healthcare professor of cardiothoracic surgery, effective Aug. 1. His anesthesia and on treating acute pain during surgery. Systems. The panel advises the institute on research-­­­ clinical interests include thoracic transplantation, medi- Lei Stanley Qi, PhD, assistant professor of bio­ funding decisions. Backhus is the chief of thoracic cal circulatory support and endovascular aortic surgery. engineering and of chemical and systems biology, was surgery at the Veterans Affairs Palo Alto Health Care Laurence Katznelson, MD, professor of neuro­ named to the 2016 class of Pew biomedical scholars, System. Her research focuses on imaging following surgery and of medicine and associate dean of graduate a program that supports exceptional early-career scien- treatment for lung cancer and on cancer survivorship. medical education, has received the 2017 Outstanding tists. He will receive $60,000 a year for four years. His Educator Laureate Award from the Endo- research focuses on CRISPR development for transcrip- crine Society. The honor, which includes tion and epigenetic regulation and on genomic repro- a $3,000 prize, recognizes exceptional gramming of immune cells to identify and kill cancer achievement as an educator in endocri- cells. nology and metabolism. Katznelson is Holly Tabor, PhD, was appointed associate profes- also the medical director of the Stanford sor of medicine, effective June 1. She is the associate Pituitary Center. director for clinical ethics and education at the Stanford Paul Kwo, MD, was appointed profes- Center for Biomedical Ethics. Her research focuses on sor of medicine, effective Aug. 1. His re- ethical issues related to genetics and genomics. search focuses on therapy for hepatitis B PJ Utz, MD, professor of medicine, has joined the Leah Backhus Leonore Herzenberg Laurence Katznelson and C and on liver transplant outcomes. scientific advisory board of the Arthritis National Re- Richard Lafayette, MD, was pro- search Foundation, which provides grants for research moted to profes- on arthritis and other autoimmune disorders. He di- sor of medicine, rects Stanford’s Medical Scientist Training Program and effective July 1. is the founder and director of the Stanford Institutes of He directs the Medicine Summer Research Program for high school Stanford Glo- students. His research focuses on improving the under- merular Disease standing and treatment of autoimmune disorders. Center. He in- Cornelia Weyand, MD, professor of medicine and vestigates new chief of immunology and rheumatology, was named a therapies for re- Notable Woman in Science and Medicine by the Max nal disease and Delbrück Center for Molecular Medicine in the Helm- performs collab- holtz Association in Berlin, Germany. She delivered a Paul Kwo Richard Lafayette David Lee Lei Stanley Qi orative studies lecture in July on protective and pathogenic immune of the immu- responses and provided mentoring sessions for students, nological basis fellows and junior faculty. of glomerular Sean Wu, MD, PhD, was promoted to associate pro- injury. fessor of medicine, effective April 1. He treats patients David Lee, with cardiac diseases, and his research uses stem cells to MD, associ- try to develop treatments for heart failure and cardiac- ate professor of rhythm disorders. medicine, was Jiangbin Ye, PhD, was appointed assistant professor elected president of radiation oncology, effective Aug. 1. His research fo- of the Western cuses on tumor cell metabolism, with the goal of target- States Affiliate ing metabolic pathways to improve cancer treatments. PJ Utz Cornelia Weyand Sean Wu Jiangbin Ye of the American ISM 8 September 26, 2016 Inside Stanford Medicine