Mayo ClinicMAGAZINE

Eighteen Months Later A genetic test developed by Mayo Clinic gives Andrew his life back. 2012 Annual Report Inside

2013 ISSUE 1

TABLE OF CONTENTS 2013 Issue 1

14 34 48

An imaging agent available first at Mayo A NEW HOPE Clinic detects recurrent prostate cancer earlier

An individualized medicine test developed EIGHTEEN MONTHS by Mayo Clinic gives a mother her son back

An implantable device may help people with GAINING CONTROL neurological disorders regain their lives

04 Letter from the Executive Dean 10 Dedicated to the Primary Value 26 Investing in the Future 06 Teenage Philanthropist 11 Making Surgery Safer 29 A Farmer’s Son 08 Our Symbiotic Selves 12 Twelve More Reasons 42 When Mistakes are Okay 09 Making Regenerative Medicine a Reality 20 The Race is On 52 Helping Mayo 04 Mayo Clinic Magazine 2013 Issue 1 In this issue: Making Connections to Save Lives

Mayo Clinic was founded on connections. It was the world’s first multispecialty group practice, which connected many medical disciplines to focus on the needs of a single patient. It was the first to centralize patient medical records, which allowed caregivers to coordinate care quickly and efficiently.

That same pioneering tradition drives our care today, as you will find throughout this issue of Mayo Clinic Magazine.

You will see it in a mother’s story about her son, who kept getting sicker and sicker until she brought him to Mayo, where doctors and researchers came together to administer a new genetic test developed by Mayo Clinic. It showed Andrew’s medicines were making him sick.

You will see it in our drive to cure diabetes, which more and more researchers are saying is possible. Our effort unites physicians, institutions and a number of strategies, from mechanical implantation to bioengineered stem cells.

And you will certainly see it in our benefactors, like Lawrence and Marilyn Matteson, who focused their lives on ensuring children with cancer have a better future, and Jack Long, a 14-year-old who connected his New Jersey community to raise more than $10,000 for congenital heart research.

These are only a few of the countless stories about researchers, doctors, nurses, patients and benefactors allying to save lives. Thank you for being part of this special community, and enjoy this issue of Mayo Clinic Magazine.

Michael Camilleri, M.D. Executive Dean for Development Atherton and Winifred W. Bean Professor Professor of Medicine, Pharmacology and Physiology, College of Medicine Mayo Clinic Distinguished Investigator

2013 Issue 1 Mayo Clinic Magazine 05

TeenagePhilanthropist Determined to Make a Difference

Jack Long’s goals for 8th grade: Get New Jersey Gov. Chris Christie to declare a “Congenital Heart Defect Awareness Week”

Raise $10,000 for congenital heart research at Mayo Clinic Undergo open-heart surgery to fix an anomaly Check, Check and Check

06 Mayo Clinic Magazine 2013 Issue 1 Jack is just inspiring. He understands the “ importance and power of giving. We should all try to be more like this kid.

For 14 years, Jack” Long lived with Ebstein’s Anomaly, a rare congenital heart defect that carries a one-two punch. His right valve was out of position, and its leaflets were abnormally formed. Blood leaked through the valve, and now that Jack was a teenager, it was time to fix it before serious complications arose. His family brought him from his hometown of Manasquan, N.J., to Mayo Clinic, which has more surgical experience fixing the anomaly than any institution in the world. It has performed more than 1,000 procedures over the last 40 years. Dr. Noseworthy shows off his Live LONG, Beat The surgeon for most of them was Joseph STRONG bracelet. Dearani, M.D. — Jack’s doctor. “Results with surgery have steadily improved over the last two decades, so Jack’s quality of life and future outlook letters to elected officials. Jack ordered should be excellent,” Dr. Dearani says. bracelets and T-shirts and sold them out TeenagePhilanthropist “Jack is just inspiring. He understands of his locker. His brother built a web page, Determined to Make a Difference the importance and power of giving. We livelongbeatstrong.com, that features ways should all try to be more like this kid.” to donate along with a video of Dr. Dearani Jack initially came to Mayo for a explaining the condition. consultation in the fall of 2012. When he Jack’s goal was to raise $1,000. He has got back to New Jersey, he explored with exceeded it 10 times over and is still going. classmates and a teacher the idea of And the Monday he went into surgery, raising both awareness and funds for Gov. Christie signed the proclamation congenital heart defects. They came making the next seven days “Congenital up with a slogan, “Live LONG, Beat Heart Defect Awareness Week” in STRONG,” and within days were sending New Jersey.

2013 Issue 1 Mayo Clinic Magazine 07 Our

Symbiotic As much as we would like to think so, our body is not our own. We are covered in microbes. They live Selves on and even in us. In fact, for every human cell in Harnessing the Power of Our our body, there are 10 microbial cells, covering our Microbial skin, informing our immune system and helping us Companions turn food into nutrients.

These cells form their own are comparing it with the microscopic communities, microbiome of healthy people. or microbiomes, which This will help determine are ecosystems that live whether an individual has a in symbiosis with our healthy community of intestinal cells. Unfortunately, these bacteria or one that puts them ecosystems can fall out of at an increased risk for getting balance when certain microbes Clostridium difficile. This kind of grow out of control, causing information could help get the illness and disease. For right treatment to the patient instance, one microbe in the early and spare serious life- intestine, Clostridium difficile, threatening complications. can cause dangerous colon “We have a dense inflammation, and even death population of bacteria in all if it grows unchecked. parts of our body, with the The standard protocol largest majority being in our is to give antibiotics that kill intestines and on our skin,” broad populations of bacteria, says Heidi Nelson, M.D., the including the ones making Fred C. Anderson Professor people sick. The Center for and director of the Center for Individualized Medicine is Individualized Medicine’s finding better solutions in Microbiome Program. certain cases. To treat serious “Sequencing opens the door intestinal infections, Mayo to a whole new horizon of Clinic researchers are exploring understanding what bacteria ways to harvest the healthy are there and what they’re and balanced microbiome of a doing there.” donor and use it to restore the This knowledge will microbiome in sick patients. improve both diagnostic tests With benefactor support, and treatment options. And researchers are sequencing it promises to lead to specific the genetic code of the entire probiotics — delivered through microbiome of 100 patients who pill or suppository — that will have suffered Clostridium difficile return a patient’s microbiome infection. The researchers to a healthy, vibrant state.

08 Mayo Clinic Magazine 2013 Issue 1 Making Regenerative Medicine a Reality

Patients responded favorably both in terms “ of their cardiac function and structure as well as in terms of their overall fitness. — Andre Terzic, M.D., Ph.D

Once a heart attack damages helped improve heart function following a heart attack. The Michael” S. and Mary Sue tissue, there’s no way to heal the Shannon Family Director of Mayo Clinic’s injury. This problem has vexed Center for Regenerative Medicine, Andre cardiologists for generations. Terzic, M.D., Ph.D., co-led the study, which starts the healing process by harvesting a patient’s bone marrow in the hip and They are left treating symptoms — medicines extracting its stem cells. The stem cells are to reduce built-up fluid, implanted stents to then treated with growth factors to orient increase blood flow, pacemakers to control them to become heartlike cells and injected beat rhythm. directly into the diseased heart. Many times the treatments work fine, and Every patient in the study showed the patients go on to live normal lives. Other improvement. It was the first successful times, the damage is too great. The heart can’t demonstration of the feasibility and safety of make up for the loss of functioning tissue and transforming adult stem cells into cardiac cells steadily declines. The only option for these in humans. patients is a heart transplant, which carries “Patients responded favorably both in its own risks and drawbacks, including a terms of their cardiac function and structure shortage of donor organs and a lifetime of as well as in terms of their overall fitness,” immunosuppressive drugs to keep the body says Dr. Terzic, who is also the Marriott from rejecting the new organ. Family Professor of Cardiovascular Research. One recent regenerative medicine study, Through the Center for Regenerative C-CURE, is providing new hope for patients. Medicine, Mayo Clinic will apply the study’s A collaboration spanning two continents lessons to reviving other tissues, such as the and five countries showed stem cell treatment liver, lung, nerves, pancreas and skin.

2013 Issue 1 Mayo Clinic Magazine 09 Dedicated to the Primary Value 53 Years of Serving Mayo Clinic and Its Benefactors

Mayo Clinic’s Board of Trustees doesn’t have a secret handshake. No rites of passage. But, according to Robert Smoldt, emeritus chief administrative officer, “Three words have been passed from one member to another, across the decades: ‘Call Dale Rustad.’”

Dale began working at Mayo Trustees in Rochester. In 2002, Dale Clinic the year John Kennedy was relocated to Arizona. elected president. His first job was Over his career his commitment with General Service, the frontline has earned him many professional ambassadors of the Mayo Clinic awards including recognition Model of Care. Then, after working from the National Restaurant as a respiratory therapist, he was Association, specialty training at recruited to a series of positions the Culinary Institute of America that he infused with what Robert and commendation from the U.S. Waller, M.D., president emeritus of Secret Service for supporting their Mayo Clinic, describes as “Dale’s protection of first families, heads of exceptional passion for service.” state and other prominent visitors One was managing the Mayo to Mayo Clinic. Foundation House from 1968 to “In his role Dale brought 1996. Dale gave a personal greeting the same standard of excellence and ensured white-glove service that our physician colleagues to Mayo Clinic staff, spouses do in the medical setting,” says and distinguished guests. His James Hodge, vice chair of the attentiveness earned him the extra Department of Development. responsibility of administrative “Benefactors made gifts in honor assistant to the Board of Trustees, of Dale and said his dedication where he set a record that no one inspired their support.” will likely match: the longest term Now, as he reflects on his of service — 40 years — all with retirement from Mayo Clinic — perfect attendance. the people he has known and In 1996 Dale transitioned to the values they represent — Dale development officer and manager Rustad says simply, “It’s been an of Benefactor Services and honor to serve.”

10 Mayo Clinic Magazine 2013 Issue 1 Making Surgery Safer One Study Mayo Clinic Collaborated in Prevented About 135 Infections

We have to be “ continuously aware and relentless.

— Lynn Quast, R.N. ” skin preparation through the complex surgery and postoperative wound dressing. The Lynn Quast, R.N., has firsthand study developed a set of protocols that, when experience with colorectal applied consistently, reduced infections and surgery, both as a nurse and as a improved patient outcomes. patient. Almost three years ago, One key new step is called “Time Out,” she developed diverticulitis, a when the surgeon is ready to close the wound. The surgical technologist and nurse painful inflammation of the colon count and remove all contaminated sponges that, if left untreated, can cause and instruments and open a sterile set. If serious damage. needed, everyone puts on fresh gloves and changes gowns. The night before the surgery, she worried. Within a year, surgical site infection rates She had seen the effects of cutting into the at Mayo Clinic dropped from 9.8 percent bowels. She knew if all went well she’d be to 4 percent. working again in five weeks. If not, she could The study involved seven U.S. health care face a life-altering infection that might require systems, with Mayo Clinic surgeon Robert additional surgeries. Cima, M.D., leading Mayo’s participation. The And she knew the national average of collaboration estimates the project saved more ending up back in the hospital with a serious than $3.7 million by preventing 135 colorectal infection was nearly one in six. surgical site infections. Everything went fine. Today, as surgical “It’s not just about cutting costs and being nurse manager at Mayo Clinic, Quast is more efficient, though those are important working with her team to reduce the odds of considerations,” Quast says. “It’s about the infection. Recently, she co-authored a study patient not having to go through the added that evaluated each step of the colorectal risk, pain and cost of an infection. We have to surgery process, from the patient’s presurgical be continuously aware and relentless.”

2013 Issue 1 Mayo Clinic Magazine 11 12 More Reasons

There are countless reasons to choose Mayo Clinic — world-class expertise, cutting-edge research, efficiency of appointments, multidisciplinary approach — you name it. Here are just a few more.

Pancreatic cancer surgery Deep brain stimulation through a keyhole Many patients who suffer from Parkinson’s 1disease, Tourette syndrome or persistent 2 Surgeons at Mayo depression find relief from their symptoms Clinic have found that at Mayo Clinic, where physicians stimulate laparoscopic surgery neural activity through surgically implanted is equally effective to electrodes in the brain. conventional surgery for many patients with 6 pancreatic cancer. 3 Minimally invasive cardiac surgery Mayo Clinic is reducing the size and impact of incisions while maintaining high-quality outcomes. This allows patients to get back to their lives even more quickly.

Better diagnosis for women with dense breast tissue Dense breast tissue can frequently hide cancer from 5 4 mammogram screenings. Mayo clinicians are using a new BEAUTY Project technology, Molecular Breast Imaging, that makes cancer cells highly visible and permits the detection of small The Breast Cancer breast lesions. Genome Guided Therapy Study will help doctors tailor chemotherapy to breast cancer patients based on their individual genomes and the genomes of their tumors.

12 Mayo Clinic Magazine 2013 Issue 1 Revolutionary proton beam radiation therapy The Mayo Clinic Proton Beam Therapy Program, available in 72015 in Minnesota and 2016 in Arizona, will employ pencil beam scanning to more precisely target tumors, reducing damage to surrounding tissues and vital organs. (See story on page 29.) 6 8 Knowing the electrical wiring of the heart When cardiologists need to stop heart rhythm irregularities, they sometimes have to cut “wires” in the heart. To perfect our understanding of those wires, Mayo Clinic doctors studied 620 hearts. Breakthrough technology for detecting recurrent prostate cancer Hub-and-spoke telestroke networks Mayo Clinic is the first institution in North Mayo Clinic physicians and researchers helped prove the cost America approved to 9 effectiveness of Internet communications between “hub” hospitals produce and administer and outlying “spoke” hospitals while improving outcomes for patients Choline C-11 Injection, an affected by acute ischemic stroke. Telecommunications enhanced imaging agent that can evaluation and treatment — especially for patients in rural settings where detect recurrent prostate there may be limited access to neurologists. cancer much earlier. (See story on Page 14.) 10 Fixing birth defects in the womb Mayo Clinic pediatric neurosurgeons can operate on children with spina bifida in the mother’s womb to correct a defect in the coverings of the spinal cord that would otherwise result in paralysis of the legs, bladder and bowel of the newborn child.

11Prescriptions based on your genes When we know the genes that influence the way a drug is handled in the body, we can select the right drug, at the right dose, such as for antidepressants and other drug classes. (See story on Page 34.) 12 Cutting-edge clinical trials Mayo Clinic is conducting hundreds of cancer trials — often unavailable elsewhere — focusing on various methods to prevent, diagnose and treat the disease. Hundreds of other clinical trials are under way to better understand and treat conditions ranging from serious blood disorders to Alzheimer’s disease to rheumatoid arthritis.

2013 Issue 1 Mayo Clinic Magazine 13 When Mike Hawker came to Mayo Clinic, he had about a month to live. Today, a new imaging agent keeps his cancer in check so he can enjoy life as an Alaskan legislator.

14 Mayo Clinic Magazine 2013 Issue 1 A N e w Hope

An Imaging Agent Available First at Mayo Clinic Detects Recurrent Prostate Cancer Earlier

2013 Issue 1 Mayo Clinic Magazine 15 I saw my death and accepted “ my mortality.

Huddled into a ball on his airplane desk, Eugene Kwon, M.D., research seat, watching out” the window as the co-director for the Department of Alaskan landscape slowly receded, Urology and the Cancer Immunology Michael Hawker thought it was the and Immunotherapy Program, last time he’d see the Land of the happened to be walking by and Midnight Sun. overheard his name and a bit of Prostate cancer had so riddled his the conversation. body — spreading to his spine, femur, Dr. Kwon asked to speak to lymph nodes, pelvis, bladder and eye the caller. sockets — that his life expectancy was “That is remarkable in itself,” less than a month. He was flying to Michael says. “I understand doctors Mayo Clinic, Rochester, Minn., looking just don’t take cold calls.” for a miracle. Within days of that conversation, “I had come to the point where Michael and Carol boarded a plane I saw my death and accepted my headed to Rochester, Minn. mortality,” the Alaska state legislator says. The Most Miserable Week His wife, Carol, hadn’t. Fighting to of My Life give her husband one last chance, she Despite four months of chemotherapy called Mayo Clinic to find a physician in Alaska, Michael’s cancer grew with experience in widely metastatic unchecked. “My body was completely neuroendocrine prostate cancer. When debilitated, and my wife had to do she reached the urology appointment everything for me,” he says. “I hardly remember the plane ride to Minnesota.” Upon Michael’s arrival at Mayo Clinic on Dec. 1, 2010, Dr. Kwon ordered a back-to-back series of bone, pelvic, bladder and prostate biopsies Dr. Kwon asked to speak to and started Michael on hormone therapy to fight the cancer. “It was the caller. Within days Michael quite literally the most painful and worst week of my life,” he says. and Carol were at Mayo Clinic. By Dec. 8, Michael’s prostate- specific antigen (PSA) levels had dropped from 36 to six.

16 Mayo Clinic Magazine 2013 Issue 1 Michael had given up fighting his cancer, but his wife, Carol, hadn’t. She called Mayo Clinic and immediately got an appointment with Eugene Kwon, M.D.

“We just couldn’t believe it,” his cancer in line, Michael has his PSA Michael says. “This was the first time levels checked regularly with doctors in six months we received news other in Alaska, and every six months he than ‘you’re going to die.’” returns to Mayo Clinic for a thorough And so began Michael’s long- once-over. term relationship with Dr. Kwon and In Sept. 2012, Michael’s PSA level Mayo Clinic. Within a few months of increased from 0.1 to 0.2 ng/mL. receiving hormone treatment, Michael’s For most men, such an infinitesimal PSAs were nearly undetectable and increase wouldn’t cause concern. stayed that way until the fall of 2012. But for Michael, who had cancer Michael pans for gold with his throughout his body, the slightest nephew Derek Bradish. Keeping Cancer at Bay increment is a four-alarm call to action. Dr. Kwon views Michael’s cancer as a As soon as his numbers started rising, major offender on probation. To keep Michael headed back to Mayo to

2013 Issue 1 Mayo Clinic Magazine 17 Choline C-11 injection can help locate cancer when PSA levels are at least half of what traditional imaging techniques can detect.

pinpoint where the cancer was hiding Injection identified four spots of through a powerful new diagnostic prostate cancer activity. After clinical tool: Choline C-11 Injection, which can confirmation of the imaging results, help locate cancer when PSA levels are doctors quickly treated him with at least half of what traditional imaging radiation therapy, and today Michael’s techniques can detect. cancer is once again in check.

Detecting and Defeating A Game Changer Recurrent Prostate Cancer Until this technology became available, This new imaging technique uses a determining how to treat recurrent radioactive form of the vitamin choline, prostate cancer could be a guessing which cancer cells readily absorb. game as physicians couldn’t tell where Clinicians inject a small amount of the the cancer was. Even if a traditional agent into a patient’s vein and then use PET scan revealed a mass that early, it a positron emission tomography (PET) was very difficult to tell what the mass scanner and computer to see where the might be — Scar tissue? Arthritis? An agent collects. The result is a detailed inflammation? Cancer? Choline C-11 map of a person’s cancer. Injections help change that dynamic The FDA approved Mayo Clinic as so doctors can react more quickly and the first institution in the United States craft more targeted therapies. that can manufacture and administer Back in Alaska, Michael is healthy Choline C-11 Injection. The technical and feeling on top of the world. “I have name for the compound is 11C choline. been granted a second chance at life by The 11C denotes that a carbon atom the people who work at Mayo Clinic has been made radioactive and has a and the tools and technology they have. half-life of 20 minutes, which means I recognize this and am grateful for it. for every 20 ticks of the clock the agent Every day burns a little bit brighter. loses 50 percent of its efficacy. I only have so many days left on this Its short lifespan means 11C choline planet, and I truly want to leave a needs to be made for each patient legacy of something good. I cannot and administered within minutes of describe how happy I am to be alive.” its creation. Michael’s Choline C-11

18 Mayo Clinic Magazine 2013 Issue 1 Ping Fang prepares a dose of 11C choline for injection. Once ready, it has to be used within minutes.

The Right Thing to Do

Pharmaceutical companies have average amount a pharmaceutical manufacture and administer Choline known of 11C choline’s imaging company spends for every drug C-11 Injection to help identify power for some time, but none approved. And they didn’t want to recurrent prostate cancer. have spent precious development wait patiently the typical 10-plus resources pursuing it. From a years it takes to put a drug through “The evidence is compelling,” says profit point of view, it has three the usual approval process. Dr. Hung, director of the Mayo Clinic strikes against it: it’s not patentable; PET Radiochemistry Facility. “We it’s only good for a short amount of “We pursued this because it’s the were hoping the FDA would agree. time (20-minute half-life); and it’s right thing to do,” says Dr. Lowe, a And they did.” specialist in nuclear medicine and virtually impossible to distribute in Mayo physicians want to use mass quantities. PET imaging at Mayo Clinic. “We believe it will save more lives.” Choline C-11 Injection to investigate But Mayo Clinic’s Eugene Kwon, where prostate cancer manifests M.D., Val Lowe, M.D., and Joseph So, armed with years of research in the body and determine what Hung, Ph.D., knew it had potential and published literature, the Mayo treatments work best for which to impact the care of prostate team met with the FDA to determine forms of prostate cancer. The team cancer patients. So, with the help if Choline C-11 Injection qualified is also specifically interested in of colleagues Jeffrey Karnes, M.D., for a new drug application. The developing the next generation of and Christopher Mitchell, M.D., they FDA gave the green light to the other radioisotopes to pinpoint all pursued, on their own time, Mayo researchers and granted a priority types of cancer and other diseases, Clinic’s first New Drug Application review for the application. Within like Alzheimer’s. (NDA) with the FDA. nine months of the researchers’ application submission, the FDA They didn’t have $4 billion, which approved Mayo Clinic as the first Forbes Magazine reports is the institution in the United States to

2013 Issue 1 Mayo Clinic Magazine 19 The Race Is On

How Mayo Clinic Is Using Cutting-Edge Regenerative Medicine Technology to Find a Cure for Diabetes

20 Mayo Clinic Magazine 2013 Issue 1 Caroline can never escape her diabetes. It was there on her first day of school, at her first communion. It’s there every Halloween, every Christmas, every vacation. She’s pricked her finger eight to ten times a day since she was 3 years old, including the six Race Is On birthdays she’s had since she was diagnosed. She understands that it wasn’t her promising ideas fail when subjected fault that her body turned on itself, to rigorous scientific method. The that her immune system attacked her experience leaves most of them insulin-producing islet cells. To quote hesitant to use a certain four-letter Caroline, “Diabetes doesn’t care how word — “cure.” Instead they use cute you are. Diabetes doesn’t care euphemisms like “advancing care” how well you play soccer. Diabetes and “better treatments.” doesn’t care who your friends are or But something seems to be how much your family loves you.” stirring among diabetes researchers. From the outside, her life looks One occasionally hears whispers of perfectly normal. She plays soccer, the word. Some are becoming even It’s no longer swims with friends and goes to ball bolder with statements like, “It’s games with her family. But in the no longer if we cure diabetes, if we cure background is the relentless hum but when.” “ of type 1 diabetes, with vigilant The reason for the optimism is diabetes, blood sugar surveillance and that one proven cure already exists. but when. insulin adjustments. Patients with type 1 diabetes who Her parents, Tom and Michelle have received pancreas transplants Schlehuber, are thankful for the have seen their disease go away lifesaving medications and technologies completely. Unfortunately, the ” that keep their daughter alive, but transplant requires a lifetime of they pray for the day when Caroline immunosuppressive drugs whose isn’t one missed reading away from side effects can be more harmful the emergency room, when her life than diabetes. isn’t dominated by glucose meters The success of transplants shows and insulin pumps. a cure is possible. But how do we That day may be closer than get there without the full transplant? they imagined. Without the drugs? Researchers are making extraordinary progress New Possibilities toward answering these questions. So The road to discovery is long and much so that many believe the race riddled with ideas proven wrong. is on to find a cure. And Mayo Clinic Researchers repeatedly see the most might have the edge.

2013 Issue 1 Mayo Clinic Magazine 21 Movement Sensors: Setting Mayo Apart

Delivering the right amount of insulin at the right time requires assessing factors such as blood glucose, ambient temperature, time of day and, crucially, activity levels.

On that front, Mayo Clinic’s motion-sensing device sets its artificial pancreas apart. Developed by Mayo endocrinologist James Levine, M.D., Ph.D., Dr. Richard F. Emslander Professor in Endocrinology and Nutrition Research, the device feeds quantitative data derived from movement and exercise “I genuinely believe that now is and damage the nerves, eyes into the artificial pancreas the time for diabetes, and there is a and kidneys. system, increasing the real- time accuracy with which lot going on at Mayo that has major The artificial pancreas will free individualized insulin dosages promise,” says Stephen Russell, people with diabetes from daily are calculated. M.D., Ph.D., deputy director for preoccupations over finger pricks, “That’s potentially a very Translation in Mayo Clinic’s Center blood reads and daily shots. Many important thing,” says Yogish for Regenerative Medicine. “We diabetics have insulin pumps Kudva, M.B.B.S. “We are ahead know we can turn this new stuff into already, but the artificial pancreas of everyone else in terms of bringing this technology into clinical reality.” represents a sea change because it this area of research.” minimizes patient decision making. Building a New Pancreas for Looking to the future, Dr. Kudva Tight Glucose Control says, “We’re very excited.” Mayo Clinic’s Yogish Kudva, Working in partnership with M.B.B.S., and Ananda Basu, M.D., the University of Minnesota, Mayo M.B.B.S., hope to transform life investigators are developing a novel for people like Caroline with a continuous blood sugar sensor hands-free device called the to improve its performance and artificial pancreas. usability. Mayo investigators are Functioning just like a biological also refining the algorithm that pancreas, the artificial pancreas controls insulin delivery so it can be uses an abdominal patch that individualized for each patient. continuously measures blood sugar. In an upcoming clinical trial, A pager-sized pump then delivers Mayo researchers will use hard data exactly the right amount of insulin from humans with type 1 diabetes to at exactly the right time. Precision predict insulin needs, setting Mayo’s is critical because abnormal blood efforts apart from other studies that sugar levels can cause disabling have relied on computer simulations. and life-threatening complications By next year, Drs. Kudva and Basu such as heart attacks and strokes hope to test the artificial pancreas in the real world as patients use it to grow into glucose-responsive, for weeks at a time, integrating the insulin-producing cells in the device into their daily lives. laboratory. The iPS technology and its promise for humankind have Replacing Damaged Cells been recognized by the 2012 Nobel A New Source of Insulin The immune system wages war Prize in Physiology and Medicine. on any virus, bacteria or fungus it “Our future goal is to make Gene therapy promises to considers an invader of the body. customized islets from iPS cells and protect islets from the immune As with Caroline’s type 1 diabetes, then hopefully put them back into system, but it could also the immune system mistakenly the patient,” Dr. Ikeda said. provide a source of insulin separate from the pancreas. In targets the body’s own islet cells, Dr. Ikeda has improved blood this approach, clinicians would compromising the pancreas’s ability sugar levels in diabetic mice for inject insulin genes directly into to monitor blood sugar levels and short periods of time using this muscle tissue. release insulin. promising technology. His next steps “That gives you a source of Mayo Clinic investigator are to improve the responsiveness insulin that’s constantly coming Yasuhiro Ikeda, D.V.M., Ph.D., of the bioengineered islets to blood into the bloodstream,” says Stephen Russell, M.D., Ph.D., is investigating a cutting-edge sugar fluctuations and increase the the Richard O. Jacobson regenerative approach to replace amount of insulin they produce. Professor of Molecular Medicine. these essential islet cells in the Human trials could start in the next This therapy likely won’t be a pancreas. Tapping the body’s power three years. good fit for type 1 diabetics to heal itself, Dr. Ikeda is working because it could cause blood to generate new islets from the Stopping Diabetes in Its Tracks sugar levels to run dangerously diabetic’s own skin or blood. A problem lingers even if lost islets low. But there are many Type 2 diabetics who require The process extracts cells from can be replaced: The patient’s continuous, long-acting insulin the patient and converts them into body could reject them as the for whom this type of gene stem cells. Dr. Ikeda has taken these immune system attacks the newly therapy could have benefits. bioengineered cells — known as transplanted islets. “What this could do for type 2 is induced pluripotent stem (iPS) cells In this regard, Dr. Ikeda believes to improve the convenience of — a step further by inducing them that recent advances in gene therapy therapy,” Dr. Russell says.

2013 Issue 1 Mayo Clinic Magazine 23 A Center Dedicated to hold great promise in preventing the immune system gradually decimates Diabetes Research autoimmune response to islets that islets in the pancreas. mark the progression of diabetes. If diabetes can be stopped early Highlighting its leadership role in fighting diabetes, Mayo “If we can suppress enough, Dr. Ikeda believes a critical Clinic is home to a Diabetes autoimmunity, we should be able to mass of islets will be preserved to Research Center. suppress the disease,” he says. maintain necessary insulin levels. He To reach islets with tremendous hopes clinical trials focused on this Under the leadership of John Miles, M.D., the Earl precision, Dr. Ikeda uses a mild, non- approach to gene therapy can and Annette R. McDonough disease-causing virus called adeno- start soon. Professor, the center focuses associated virus (AAV), which travels on translational research and Rebooting the System facilitates the application of through the bloodstream to deliver scientific discoveries for the a gene that suppresses the immune Another possible treatment for ultimate purpose of preventing, system’s attack in a localized area. diabetes, called cell therapy, is also treating and curing diabetes. Dr. Ikeda has already used the aimed at protecting islets from the The Center is structured to gene, called Interleukin-10, to prevent immune system. promote interactions among the onset of diabetes in diabetes- “My hope is we reset the system: investigators, collaboration prone mice. That success drove him that you prevent the cells from killing between disciplines, and shared resources among all to pursue an even more challenging the islets, the islets repair, participants — individuals, discovery: How do you stop diabetes and you go on with your life,” says departments and institutions. in its tracks once islet destruction Allan Dietz, Ph.D., an investigator begins? in Mayo Clinic’s Human Cellular “Once the immune response kicks Therapy Laboratory, which is integral in, it’s very hard to reverse it,” to Mayo Clinic’s regenerative he says. medicine endeavors. In pursuit of a landmark Cell therapy involves the use of discovery, Dr. Ikeda is focused on mesenchymal stem cells, which can stopping the progression of diabetes be produced in large quantities during its so-called “honeymoon” from a fat biopsy and implanted stage. This is the critical period — back into a patient. roughly two years in humans but “When you get wounded or much shorter in the lab mice Dr. have an injury, these are the cells that Ikeda is testing — during which the mediate repair,” Dietz says.

24 Mayo Clinic Magazine 2013 Issue 1 The Biotrust: Focusing If we can suppress the Power of Regenerative Medicine The stem cell approach is the heart of regenerative the autoimmunity, medicine. In the past few years its promise has “ started to become reality with Mayo Clinic delivering we should be regenerative treatments for osteonecrosis, tendonitis and reconstructive surgery. The mesenchymal stem cell strategy that holds so much hope for diabetes treatment able to suppress is already being tested in many other diseases, including amyotrophic lateral sclerosis (ALS) and the disease. heart disease.

Two assets uniquely position Mayo Clinic to focus this momentum on diabetes — the best endocrinology and ” diabetes program in the country (as ranked by U.S. News & World Report) and the Center for Regenerative There’s a good chance that Medicine, a catalyst in advancing new knowledge into mesenchymal stem cells can suppress delivery of next-generation cures.

the immune system safely in a With the growing interest in regenerative medicine targeted area to prevent the destruction research and treatment, Mayo Clinic established of islets while helping islets repair the Regenerative Medicine Biotrust, which will help researchers more efficiently collect samples, process themselves, Dietz said. He noted that cells and share results. new trials could start soon if funding were available. “The process of harvesting a cell, differentiating it into specialized tissues, expanding it into big numbers, then Working Toward a Cure using them for real applications in research, clinical applications, clinical trials, etc. – that’s complicated,” says Though Caroline’s family began Dennis Wigle, M.D., Ph.D., director of the Regenerative praying for a cure the day they learned Medicine Biotrust. “You need an infrastructure to be able to do that.” she had diabetes, they began working toward it almost as soon. Building on Mayo Clinic’s expertise in biobanking, the Within months of the diagnosis, Regenerative Medicine Biotrust will give researchers and clinicians access to living cells. The approach will fast- the family formed Team Caroline track discovery in areas like diabetes, accelerating the and participated in Juvenile Diabetes time-consuming processes of specimen collection and Research Foundation’s Walk to Cure conversion. In this way, teams of scientists and clinicians will develop focused questions and go right to the Diabetes in San Diego. About 15 friends prepared cells to find the answer. and family members joined in. Over the past six years, their involvement has And as soon as an answer is found, the Regenerative grown, and last year about 100 people Medicine Biotrust will accelerate the translation to clinical application. donned bright green shirts and walked with them through Mall of America “The Biotrust puts Mayo at the cutting edge in in Minnesota to raise awareness and investigating how fast we can make new technologies, apply new technologies and do it for real clinical care,” Dr. funds to support research. Wigle says. “This will advance regenerative solutions for Their goal was $15,000. They our patients.” exceeded it by more than 20 percent.

2013 Issue 1 Mayo Clinic Magazine 25 Investing IN THE FUTURE Parents Inspired Him to Help Others

26 Mayo Clinic Magazine 2013 Issue 1 Gordon Gunnerson hated what his parents had to go through at the end of their lives. First his father fought heart disease, then developed dementia. It became so bad he eventually reverted back to childhood.

About four years later, when Gordon was of experience in the assisted-care facility succeeding in real estate in Lake City, Mich., business. But in 2002, a new bank in his mother developed cancer. After watching Traverse City, Mich., opened. He presented his father’s decline, he knew his mother his data and convinced them to give him a needed him, so in 1996 he left behind a client $5 million loan. list that took decades to build. Gordon took Gordon oversaw the construction of care of her, watching the cancer slowly take the high-quality assisted living facility her body and eventually her mind. and named it Belle Oakes in honor of his “It really bothers me to see people forget, mother, Isabele. For the next six years, he and they don’t seem to know where they ran it himself, making sure clients were are,” Gordon says. “It’s a real shame.” surrounded by people who cared and The experience led Gordon to make a understood the needs of older people difference in the larger community. Shortly with dementia. after his mother died, a social worker and a group of nurses showed him the need for an Giving Back assisted living facility in Lake City. He saw it In 2007, Gordon’s blood pressure became as a perfect opportunity to help people who worrisomely high. He sold Belle Oakes and have nowhere to turn when it isn’t safe or slowed his pace of work, spending more feasible for them to live alone anymore. time at his cabin on Round Lake, which “I traveled for a year studying facilities, he calls a bit of paradise. But he wanted to talking with people, asking about costs,” continue making a difference for people with Gordon says. “And I hired someone to do a dementia. So he turned to Mayo Clinic. feasibility study on the idea.” Gordon first came to Mayo Clinic as He processed all that hard data, which a young man seeking help for his blind showed his community could support a brother. Gordon remembers teams of experts 90-bed facility, but it didn’t show where the focusing on his brother, trying to help. money would come from. “They charged my brother $50 for the Gordon’s mother had raised him to be weeklong visit,” Gordon recalls. “And pennywise, to not buy anything unless he because they knew he didn’t have a job, they had the cash. He had never borrowed money. offered him the option of paying 50 cents a Not for his first car, not for his house, not month, to our local bank, so he didn’t even for anything. Ever. Getting past this point need to buy a stamp.” of pride was a very big step. Unfortunately, Over the years, Gordon turned to Mayo every local bank rejected him, citing his lack Clinic time and again. Each time, he came

2013 Issue 1 Mayo Clinic Magazine 27 The only thing I’m hoping for is “ a solution for Alzheimer’s.

away grateful for the kindness and dementia. The solution was a charitable care shown to him and his family. He is gift annuity, which pays back in cash a especially thankful for Chris Batchelder, percentage of a philanthropic” gift. So a development officer who became a with the proceeds from the sale of Belle close friend. At one point, Chris visited Oaks, Gordon established a $1 million Gordon’s dad every day for weeks while charitable gift annuity to advance Mayo he was hospitalized in Saint Marys. Clinic’s Alzheimer’s disease research. “I learned a lot from that man,” “I want Mayo Clinic to have money Gordon says. “He worked long hours and to do more experiments to solve more always put people first.” problems and help more people, Chris helped Gordon realize he especially people with Alzheimer’s,” could maintain financial stability while Gordon says. “The only thing I’m hoping advancing his goal to help people fight for is a solution for Alzheimer’s.”

A Win-Win-Win Gift A CHARITABLE GIFT ANNUITY IS A TAX-DEDUCTIBLE GIFT THAT ALSO PRODUCES INCOME FOR THE GIVER. Advantages for the benefactor: • A steady income (an annuity) unaffected by market performance. – Income is determined by the percentage of the original gift. The percentage is set by age, with older individuals receiving higher percentages. • A reduced tax burden. Advantages for the institution: • The ability to start work earlier. • Long-term support. Advantages for both: • A strong, lasting partnership. • Advancing the goal to improve health care.

If you have questions, contact Mayo Clinic Office of Gift Planning at 1-800-297-1185 or [email protected]. Or visit our new website: plannedgiving.mayoclinic.org.

28 Mayo Clinic Magazine 2013 Issue 1 A FARMER’S SON Leveraging Success to Help Children Fight Cancer Not many men know how to skin a skunk and sell the hide, overhaul a tractor, cut commercial timber, milk a cow, dredge a lake, build a winch and remember to call his wife every single day.

But Lawrence Matteson does.

e remembers walking trap mother could cook just about anything lines along the Skunk River we brought home. Squirrel. Rabbit. She as a kid. Every morning he was a remarkable woman.” Hand his brother followed its Growing up in southern Iowa winding banks, shooting and collecting along a Mississippi tributary, exploring game on the way. At the end of the the countryside for hours on end, line was their one-room schoolhouse, Lawrence and his brother Gene and each morning the boys’ teacher experienced freedom that few kids gathered their guns and game to hold understand today. in the woodshed until the day’s lessons “We entertained ourselves,” were over. Lawrence says, recalling that his Back then, Lawrence couldn’t mother always knew that her sons fathom his life’s journey and how the were by the tracks when she heard the skills he learned working the family blast from a train whistle blowing in farm played into his future. He was the distance. more focused on selling the hide that he skinned and the nightly dinner Hard Work Pays Off his mother made from her sons’ And although Lawrence fondly recalls hunting excursions. blue summer skies and roaming the “We ate a lot of blackbird pie,” land, he also remembers hard work Lawrence reflects, his past glimmering and fickle machinery. In high school, in his now 83-year-old eyes. “My the brothers took over the farm chores

30 Mayo Clinic Magazine 2013 Issue 1 CONQUERING CANCER

We all know someone with and most vulnerable to the cancer. Whether a father or a side effects of radiation — will friend. A neighbor or coworker. benefit the most. Cancer has a devastating reach, indifferent to age, race The Richard O. Jacobson or gender. Building on Mayo Clinic’s campus in Rochester, Minn., when their father went to work for the Banishing cancer from a body will begin treating patients in railroad, and it was up to them to keep can be difficult, especially mid-2015 and patients will the equipment running smoothly. “We when it entrenches itself in or receive treatment in the spring near organs where surgery, of 2016 on Mayo Clinic’s overhauled the tractors — removing chemotherapy and radiation Phoenix, Ariz., campus. The pistons and rods — and completely risk damaging vital tissue. Rochester building is named rebuilt them from the ground up,” in Mr. Jacobson’s honor in Mayo Clinic Cancer Center recognition of his generous gift Lawrence remembers. is fighting back with proton to Mayo Clinic and the Proton Later, when the brothers took beam therapy. Beam Therapy Program. over the family farm, they built their Proton beam therapy using Generous benefactors like own logging equipment and started pencil beam scanning Mr. Jacobson and Lawrence a timber company in the off-season. safely passes through and Marilyn Matteson are sensitive organs and delivers Looking for a way to leave the allowing Mayo Clinic to concentrated radiation to a offer proton beam therapy farming business and capitalize on his tumor. This keeps healthy to patients, providing hope mechanical abilities, Lawrence started tissue safe, reduces health and healing to those with care costs because it creates working on heavy machinery at a local cancer. Currently we are 60 fewer side effects and lowers percent toward achieving our fertilizer plant. When the company the incidence of recurrent fundraising goal. suggested he buy a dredge and dig up cancer. Children — still growing the harbor, Lawrence did what he’d been doing all along, put new life into an old machine and went to work. Before long, he bought another dredge To learn more, please visit: and expanded his business. www.mayoclinic.org/proton-beam-therapy

2013 Issue 1 Mayo Clinic Magazine 31 “It just grew,” Lawrence says. And shoulder to shoulder with the mechanics. grew. The L.W. Matteson Company became “I had a lot of good people working with one of the largest freshwater dredging me,” he says. “It helps a lot in business if and marine construction companies in the the guys know I can do everything with the United States. About 40 years after buying equipment that they can.” his first dredge, Lawrence, along with his An innovator at heart, Lawrence often son Larry, sold the company for $45 million. designed and built machinery to tackle monumental jobs and problems as they Innovate and Work the Trenches arose. He and his crew worked 12-hour Looking back, Lawrence attributes much days up and down the Mississippi. The of his success to a combination of the skills long hours didn’t leave a lot of time for and work ethic he gained on the farm family, though when counting his blessings, and taking chances on high-risk jobs that Lawrence always includes his wife of more many contractors avoided — like removing than 30 years, Marilyn, their three children, millions of cubic yards of sand and silt by seven grandchildren and seven great- pushing it through huge portable pipes over grandchildren. a mile long. “My biggest asset in dredging was that And Always Call Your Wife I didn’t know a thing about it,” Lawrence Even though Lawrence sold his company, says. “So I didn’t have the limitations that he remains involved as a consultant. Just others put on themselves when they think like he’s done for his entire career, Lawrence something can’t be done.” leaves for work every Monday morning “Fortunately,” he adds grinning, “it and comes home Friday afternoon. “That’s worked out.” what keeps us married,” Marilyn teases. Often Lawrence worked on equipment Although distance may make the heart

32 Mayo Clinic Magazine 2013 Issue 1 This technology will greatly benefit children “ who are fighting terrible cancers. ”

grow fonder, a loving call from the husband steel to equal the weight of nearly 10 Statue of every night doesn’t hurt. Liberty sculptures. In 2009 Lawrence’s work schedule came to The Matteson’s gift to the program — a halt when he was diagnosed with prostate launching in 2015 in Rochester and 2016 in cancer. Longtime Mayo patients, the couple spent Arizona — helps deliver the most precise nine weeks in Rochester while Lawrence received form of radiation therapy. Unlike conventional treatment at Mayo Clinic Cancer Center. radiation, proton beam spares healthy tissue Smiling, he says, “It’s the most time we from harm while safely treating cancer next have spent together.” to critical organs. It’s especially beneficial Placing her hand on his, Marilyn winks to children, whose bones and tissues are and says, “It even worked out, too.” She adds, still growing. “One of the things that impressed me the most “This technology will greatly benefit at Mayo was that Larry would have a test and children who are fighting terrible cancers,” results by the end of the day. We never had to Marilyn says. “They won’t have the residual wait for a specialist or an answer.” effects that could affect them for the rest of their lives as they might with conventional Taking Aim at Cancer radiation. That’s something we want to support.” The Mattesons’ experience at Mayo Clinic Thanks to generosity and donors like the Cancer Center and Lawrence’s innate Mattesons, benefactors are providing hope and understanding of powerful machinery healing. To learn more about the Mayo Clinic and complex construction attracted the Proton Beam Therapy Program, please visit: couple to Mayo Clinic’s Proton Beam mayoclinic.org/proton-beam-therapy Therapy Program — which will house two particle accelerators on two campuses. The Rochester project alone uses enough structural

2013 Issue 1 Mayo Clinic Magazine 33 Eighteen MONTHS LATER

An Individualized Medicine Test Developed by Mayo Clinic Gives a Mother Her Son Back

34 Mayo Clinic Magazine 2013 Issue 1 Written by Susan McKeague Karnes When my parents became Major Benefactors of Mayo Clinic, they did so selflessly. They aimed to help others, to support research, to fund efficacious medicine — and to save lives. I am certain that my father, who died a few weeks before my son Andrew went to Mayo, never dreamed that the generosity of Mayo benefactors, and a test developed by Mayo’s scientists, would save one very precious life.

2013 Issue 1 Mayo Clinic Magazine 35 18 months ago, our youngest son did not “ want to live. Today, Andrew truly lives a rich, happy and fulfilling life.”

Andrew and Susan Karnes hike near Shaw Mountain outside of Boise, Idaho. Andrew came to Mayo Clinic for answers after struggling for 16 years with a variety of health issues.

On a brilliant autumn afternoon last October, mundane for most families, but for ours it was my son sent a text message, a 17-second nothing short of a miracle. A miracle created video taken atop a mountain that he had just by Mayo Clinic. climbed with his dad. Eighteen months ago, Andrew was a As the camera panned, I glimpsed my psychiatric patient in the death grip of smiling husband and Idaho’s stunning suicidal depression, the frightening nadir Sawtooth Mountains. The final frames remain of a 16-year struggle that began with a simple forever etched on my heart: my son Andrew’s strep infection. steady hand emerged in the foreground and Our youngest child was a fairly typical formed a “thumbs up.” 10-year-old Texan — happy and energetic. But Ordinary moments like that one, a happy then during the second week on a regimen father-and-son hike in the wilderness, may be of antibiotics, cough suppressants and

36 Mayo Clinic Magazine 2013 Issue 1 decongestants, Andrew exhibited a puzzling and seems to take us very seriously.” I wrote set of behaviors consistent with obsessive- those words as a sigh of relief as I felt the first compulsive disorder (OCD). delicate sprig of hope. Within a year, his hands developed a Dr. Fleming and his colleagues proved mild tremor. A medication was prescribed. In thorough indeed. Within weeks, they junior high, he was diagnosed with anxiety; eliminated numerous conditions. Yet medications were adjusted. Two years later, EEG, MRI and EMG results seemed to he was diagnosed with depression. At 17, he propel us toward serious treatments — began to battle poor sleep and fatigue. deep brain stimulation for the tremor and For 16 years, medications were added, electroconvulsive therapy for the OCD. adjusted, changed. Andrew grew quieter and Before implementing the therapies, we visited lost his characteristic optimism. My husband psychiatrist Dr. Shirlene Sampson for and I consulted with his specialists and another consultation. expressed concern. Physicians cited studies and family members with benign tremor or A Consultation Changes Everything mild anxiety, and convinced us to continue Listening to my concern about Andrew’s the course of treatment. I was admonished to numerous medications and noting my accept my son’s psychiatric diagnoses rather husband’s sensitivity to certain drugs, than question them. Dr. Sampson suggested Andrew undergo a In 2011, Andrew’s condition deteriorated. cytochrome P450 test that Mayo scientists His OCD, anxiety and depression grew severe developed. The results measured Andrew’s — all exacerbated by profound fatigue and ability to metabolize medications. the tremor in his hands, now too debilitating Days later, a smiling Dr. Sampson greeted for him to easily eat or use a cell phone. us. Test results proved that Andrew poorly Traditional treatments were failing. metabolized medications through two When hospital lab tests indicated enzymes, 2D6 and 2C19, common pathways abnormal thyroid function, Andrew’s for many drugs — in Andrew’s case, for the psychiatrist recommended we take him to exact ones he took. Mayo Clinic. In fact, I had already begun Intermediate metabolizers like Andrew arrangements. My parents had been do not process medications at the same rate benefactors and patients for years. Given as normal metabolizers. His symptoms, Andrew’s baffling array of symptoms, we Dr. Sampson explained, were likely the result urgently needed Mayo’s interdisciplinary of toxicity. In other words, he had too much approach and exemplary level of care. medicine built up in his system. In early July, we traveled from our home In mid-August, we returned home and, in Texas and met Andrew’s primary physician under medical supervision, began the slow at Mayo, internist Dr. Kevin Fleming. My and difficult process of weaning Andrew from journal noted, “He is extremely thorough his medications. Because of his metabolism

2013 Issue 1 Mayo Clinic Magazine 37 A Fairy-Tale Life

A wide smile crosses Marea In 2005, the McKeagues were McKeague’s face as she sits in her inspired to become Major Benefactors daughter’s home in Eagle, Idaho, after quietly watching the interaction and talks about her family — she’s between Mayo staff and pediatric still smitten. patients. Their gift created the “Gordon was my best friend,” Gordon and Marea McKeague she says. “Everything we did, we did Endowed Fund to Support Children’s together. It really has been a fairy- Cancer Research. tale life.” Gordon and Marea attended the same high school (Hyde Park in Chicago) but never met. They certainly knew of each other in the neighborhood, and family members still recall Gordon’s stories of Gordon was my best friend. Marea’s red hair and wide smile, but it wasn’t until after Gordon Everything we did, we did returned from World War II that they became friends. In 1948 they “ married and spent nearly 63 years together. It really has been together, raising three daughters and a son. Marea says they constantly a fairy-tale life. — Marea McKeague challenged each other to learn, explore and achieve. Like many of his generation, Gordon served in the military before entering the private ” sector. During his 32-year career in the energy industry, he generously supported historical, environmental and educational organizations. “It truly broke their hearts to see Scan the QR code to view a video of Over the years, the couple began vulnerable children and their loving Andrew’s story and learn more about receiving care at Mayo Clinic and parents suffer through prolonged Individualized Medicine came to trust its commitment to and often ineffectual treatments or visit putting the needs of the patient first. when they knew science could http://mayoresearch.mayo.edu/center-for- “Gordon loved Mayo Clinic,” develop more effective protocols individualized-medicine/ Marea says. “He just loved it. He was and eventually cure cancer if given so amazed at everything they did. sufficient funding,” says daughter They were so thorough.” Susan McKeague Karnes. “Mom Gordon and Marea began and Dad understood that every cent contributing to Mayo Clinic in 1999, counted. They were proud to support long before their grandson, Andrew Mayo’s research.” Karnes, would eventually find Though Gordon passed lifesaving answers there. away in 2011, the McKeagues’ “Andrew has become a whole generosity continues with Marea’s new person,” Marea says. “I’m so recent commitment to advance pleased — we’re all so pleased — at cardiovascular research. the care he received from Mayo.”

38 Mayo Clinic Magazine 2013 Issue 1 Susan Karnes, Andrew Karnes and Marea McKeague play with Baron in the Karnes’ home in Eagle, Idaho. Susan wondered if Andrew would ever overcome his symptoms before his trip to Mayo Clinic.

profile, we reduced drugs in small increments with his clean bill of health. over many days and weeks — at less than half Eighteen months ago, Andrew was on the rate of a normal metabolizer. medical leave. Today, he enjoys a job with Within a month, Andrew’s OCD a national company and volunteers at Zoo dissipated. His psychiatrist in Texas said Boise. Eighteen months ago, Andrew napped he no longer met the clinical criteria for the frequently throughout the day, awoke 38 diagnosis. A month later, his doctor scratched times an hour and never felt rested. Today, the diagnosis of depression. Andrew also has he sleeps well, wakes refreshed and enjoys learned new skills — including how to avoid hiking and mountain biking. Eighteen months moderate anxiety through tapping and using ago, our youngest son did not want to live. a light to help regulate his sleep cycle. My Today, Andrew truly lives a rich, happy and husband and I marveled at the change fulfilling life. in our son. His mood and tremor improved Talk about a “thumbs up.” The vista on a daily basis. for Andrew is limitless, as is our gratitude Today, life is redefined. In early 2012, for Mayo Clinic’s benefactors, scientists my husband and I moved to Idaho. Andrew and physicians. opted to move, too, and start life over

2013 Issue 1 Mayo Clinic Magazine 39 Finding the Right Drug

AT THE RIGHT DOSE AT THE RIGHT TIME FOR EVERY PATIENT

Mayo Clinic’s Richard Weinshilboum, M.D., is often called the father of pharmacogenomics.

It’s a question that has to specific drugs and drug leadership in the field. His interactions before it occurs. research set the stage for troubled physicians “Modern drugs are very applying genetic variation to since the invention of powerful agents that can do individualized drug treatment, great good but also great harm,” and his mentorship has built one medicine: Why does says Richard Weinshilboum, of the best pharmacogenomics a drug work for one M.D., director of the Center teams in the world. patient but not for for Individualized Medicine’s “Mayo is perceived as a Pharmacogenomics Program and leader because of a group of another? the Mary Lou and John H. Dasburg talented people here,” says Professor of Cancer Genomics. Dr. Weinshilboum. “Our The answer lies in our genetic Dr. Weinshilboum is often called collaborations include an entire makeup, and pharmacogenomics “the father of pharmacogenomics,” network across the United helps uncover those answers. It’s though the scientist demurs: “The States, including most of the a complicated word with an easily only thing that I’m father of is my National Institutes of Health, understood premise — finding you two children.” as well as international the right drug at the right dose Supported by benefactors, his collaborations with Canada, every time. It allows physicians efforts laid the groundwork for Germany and Japan.” to determine your response three decades of Mayo Clinic’s With continued support,

40 Mayo Clinic Magazine 2013 Issue 1 Modern drugs “ are very powerful agents that can do great good but also great harm.

— Richard Weinshilboum, M.D., Director of the Center for Individualized Medicine’s Pharmacogenomics” Program

Dr. Weinshilboum and the team are taking pharmacogenomics to the next stage — developing studies in areas of breast cancer (BEAUTY), prostate cancer (PROMOTE) and Gene Gumshoe cardiovascular disease (TAILOR- “Pharmacogenomics has great PCI). The studies are using potential,” says John Black, M.D., a genotyping and Whole Genome psychiatrist and lab director whose Sequencing to determine treatment team in the Department of Laboratory options both before care starts and Medicine and Pathology developed the after, tailoring the process to genotype test that identified Andrew as each individual. a poor metabolizer of his medication. And it’s just the start. Recently, the Center for Individualized “These types of tests are helping Medicine launched a pilot program physicians individualize drug treatment placing genetic information in for many people with a broad array a limited number of patients’ of illnesses. We already have 22 tests electronic medical records. The available with many, many more in data will give physicians a deeper the pipeline.” understanding of the patient

to ensure the best possible clinical decisions. With benefactor support, his team is “Eventually, every patient at making a foray into next-generation Mayo will have this information sequencing, which will add another 65 embedded in their medical to 70 genes that clinicians can use in record,” says Gianrico Farrugia, tailoring treatment once they have been M.D., director of the Center for shown to be clinically relevant. Individualized Medicine. “It’s the intersection of genomics, “Mayo does a lot of gene testing for computerized learning and patients, about 300 samples per week,” physicians. It means even more Dr. Black says. “That’s more than individualized care for every 15,000 results a year to help patients Mayo Clinic patient.” with their medications.”

2013 Issue 1 Mayo Clinic Magazine 41 When Mistakes Are Okay Mayo Clinic’s Simulation Centers Replicate Reality to Prepare Caregivers for Any Situation

42 Mayo Clinic Magazine 2013 Issue 1 Code Blue is as serious as it gets in a hospital. A patient is in cardiac or respiratory arrest and needs immediate, lifesaving care.

The team of doctors, nurses and other personnel must make split-second decisions while racing to perform CPR, start IVs and hooking up monitors.

Despite what we see on television, Code Blue is fairly uncommon, with most hospitals averaging one a month. Yet, when only 15 percent of patients survive a cardiac Code Blue nationwide, practice can mean the difference between life and death.

2013 Issue 1 Mayo Clinic Magazine 43 “You can read that stuff all day in three patients. They administered a book, but until you have to do nearly 15,000 chest compressions, it in the moment, you don’t really three airway intubations and 14 know it,” says internal medicine heart shock treatments. resident William Palmer, M.D., The team saved every who knew his skills were up to patient. He credits the success to snuff during one harrowing night simulation training. in the hospital at Mayo Clinic “The mock code simulation in Florida. courses have made our codes He and his team faced four drastically more efficient and cardiac arrest Code Blues with organized,” Dr. Palmer says.

The mock code simulation courses have made our codes drastically “ more efficient and organized.

44 Mayo Clinic Magazine 2013 Issue 1 ” Safe to Make Mistakes Some “patients” are advanced technology simulates robotic surgery, Today’s simulation education is mannequins that talk, sweat, bleed, colonoscopy, complex laparoscopic stunningly realistic. change pupil size and exhibit surgery, ultrasound, fluoroscopy Mayo Clinic’s simulation medical symptoms that may occur and other imaging techniques. centers are filled with rooms that with a variety of conditions, from The lifelike environment allows are exact replicas of clinical spaces heart trouble to dehydration. staff members to rehearse again — operating rooms, intensive care Other patients are trained actors and again, to make mistakes in a units, emergency departments, who work with staff to accurately safe environment. Without ever and even patient rooms. portray scenarios. State-of-the-art talking with a patient, they can

2013 Issue 1 Mayo Clinic Magazine 45 gain experience with the most complicated scenarios, such as four Code Blues in one night. “In our simulation center, we can replicate any scenario or situation you can imagine,” says David Thiel, M.D., medical director of Florida’s new J. Wayne and Delores Barr Weaver Simulation Center. The facility can link with Mayo’s other two simulation training centers in Minnesota and Arizona to efficiently run drills that impact all three sites. However, despite medical simulation’s ability to help surgeons, nurses and housekeepers become better and faster, no grants or industry sources of funding are available. Mayo Clinic partners with generous benefactors to integrate simulation into its medical education. “Simulation provides an environment where we can push ourselves in complicated cases and practice so we minimize risk for the patient,” Dr. Palmer says.

46 Mayo Clinic Magazine 2013 Issue 1 A Wider Impact J. Wayne and Delores Barr Weaver’s Gift to Mayo Clinic Advances Their Community

On a bright Saturday afternoon, about 50 students by improving collaboration and access to advanced from northeast Florida high schools cluster around IV training throughout the Jacksonville area. drips, heart monitors and tracheal tubes. There’s no “Delores and I believe simulation training will have need to grab the teens’ attention. They are eager to try a tremendous impact on improving the quality of health their hand at performing complex heart procedures, care in Jacksonville,” J. Wayne Weaver says. gastrointestinal surgeries and more. The Weavers understand that their gift will not Luckily the patients aren’t real, though they only help Mayo become better by enabling its staff to breathe, sweat, talk and even die. They’re mechanical rigorously train in a safe environment, but it will help mannequins in Mayo Clinic’s J. Wayne and Delores Barr caregivers throughout the area become better as they Weaver Simulation Center in Florida. The students are train in Mayo’s Model of Care. here as part of a free, daylong medical “boot camp” Bobbi Logsdon, an advanced registered nurse provided by the Mayo School of Health Sciences. practitioner and assistant professor at Jacksonville “It’s very cool because you get to see all the University, teaches her nursing students basic and different things that go on in a hospital,” said Alexandria advanced skills in the simulation center. Like many Sample, a 9th grader at Bishop Kenny High School in colleges and universities, Jacksonville University Jacksonville. “I wanted to go into a neonatal care unit, doesn’t have a teaching resource like this. but now I really like the cardiology unit.” “Simulation compresses the learning curve, so Arianna Cotton, 10th grader at Orange Park High students can become proficient and efficient at skills School in Orange Park, Fla., surveys the world of like setting up an IV pump,” Logsdon says. “Students medical options at the semiannual boot camp, which can learn sterile technique without breaking it in the has a waiting list to participate. “There’s a lot you actual operating room.” could do,” she says. “There’s so much they have to By opening their simulation center to others who teach you.” train caregivers, the Weavers know that their gift will The experiences of these students meet at least have the widest impact possible. one goal set by the Weavers when they provided $7 “We look forward to seeing organizations in the million to help construct the new 9,600-square-foot community sharing this resource and benefiting from facility. The former owners of the Jacksonville Jaguars Mayo Clinic’s expertise,” Delores Barr Weaver says. wanted to advance health care beyond Mayo’s walls

2013 Issue 1 Mayo Clinic Magazine 47 Gaining Control

An Implantable Device May Help People With Neurological Disorders Regain Their Lives

48 Mayo Clinic Magazine 2013 Issue 1 “Can I show you something?” the researcher asks. Before anyone responds, his fingers quickly tap away at the computer.On his screen, a video frame paused on a lab rat appears.

“It’s been paralyzed for weeks,” explains Kendall Lee, M.D., Ph.D., a Mayo Clinic neurosurgeon. He clicks the play button, and the rat’s right leg jolts to life. He plays more clips. In one, a leg slowly rises and falls. In another, both legs alternate movement, mimicking a swimmer’s kick.

“It’s not just twitch,” he says. “We’re controlling this wirelessly.”

Resuming Communication Though often successful, the therapy Imagine losing control of your body. Your has some drawbacks. During the surgical limbs twitch. Your face contorts. You pick procedure, for instance, the patient must up a glass of water for a drink, but your remain awake, and many patients are hand shakes it empty. Unfortunately, for understandably hesitant to undergo brain people with neurological disorders and surgery while conscious. But current DBS psychiatric disorders, lack of control is systems are an open loop, meaning that central to their everyday lives. during surgery and follow-up recalibration One treatment strategy to help people sessions, physicians must rely on visible with neurological-based movement symptoms and the patient’s subjective disorders, such as Parkinson’s disease, feedback — when I apply this stimulation, regain control over their bodies is “deep does speech improve? Do tremors lessen? brain stimulation” (DBS). Electrodes No? Then let’s try this… implanted deep within the brain deliver This inexactness and inefficiency mild pulses that stimulate the release stand between DBS and its use for other of neurotransmitters, or chemicals, that neurological and psychiatric disorders, activate neurons, the brain’s message carriers. especially those that cause pain, mental and “It’s as if DBS is controlling the brain’s emotional distress, and other nonvisible pharmacology, the neurotransmitters in conditions that are difficult to measure. your brain that you’re already making,” Dr. Lee and his colleagues in Mayo Clinic’s explains Dr. Lee, a specialist in DBS. After DBS Neural Engineering Lab think they have helps neurons resume normal communication found a better answer. The team is developing with each other, disease symptoms subside. a “smart” DBS system that wirelessly

2013 Issue 1 Mayo Clinic Magazine 49 monitors and measures neurotransmitters and Processor Development Group, led by Barry uses concrete biological feedback to deliver Gilbert, Ph.D., the Rose M. and Morris precise stimulation. Eisenberg Professor. “We’re now combining the technology with The collaboration already reached a our knowledge of biology, and making the significant clinical milestone last year with biology better,” Dr. Lee says. its Wireless Instantaneous Neurotransmitter Concentration Sensing (WINCS) system, a Stimulus, Response device that tracks real-time neurostransmitter The challenge is building implantable changes in the brain. In an early phase clinical wireless circuitry advanced enough to trial, it successfully recorded, wirelessly, the match the brain’s sophistication. But Mayo’s release of neurotransmitters in 15 Parkinson’s interdisciplinary approach is uniquely poised and essential tremor patients undergoing to succeed. It combines the neurosurgery DBS surgery. team’s medical skill with Mayo’s expertise in “With WINCS, we’re now seeing for the engineering and microchips. Not many people first time what is changing in the brain,” realize that Mayo Clinic has its own Division Dr. Lee says. “It’s really exciting, because of Engineering, chaired by Kevin Bennet, now imagine — if we could take advantage whose job is to design devices, systems and of that knowledge — the type of things we instruments that aren’t available commercially. can do with deep brain stimulation.” In other words, they custom-make tools to Dr. Lee’s group is already finding out with help patients. Working with Dr. Lee and his the Mayo Investigational Neuromodulation group, the engineers are developing wireless Control System (MINCS), a wirelessly sensor and neurostimulator prototypes, controlled neurostimulation device optically which will use integrated circuitry linked to WINCS. Researchers are using custom-designed by Mayo’s Special Purpose the implantable device in animal models to

The challenge is building implantable wireless circuitry advanced enough to match the brain’s sophistication.

50 Mayo Clinic Magazine 2013 Issue 1 deliver precise brain stimulation wirelessly. It grandmother, my way of honoring someone was the MINCS device that moved the leg of who’s caring.” Dr. Lee’s paralyzed rat. It’s an apt distinction. Technological wizardry aside, WINCS Harmoni is meant The Next Generation to treat people and in many cases provide “Isn’t that gorgeous?” Dr. Lee asks, admiring a relief to families. Through smart DBS therapy, picture of WINCS Harmoni. people with complex psychiatric disorders, It’s the observation of a true scientist. To the unmanageable pain, spinal cord injuries, untrained eye, WINCS Harmoni resembles a memory loss and a host of other difficult-to- small circuit board pulled from a cell phone, treat disorders have hope — all because, as Dr. but Dr. Lee sees its limitless possibilities — a Lee puts it, Mayo has the tools to understand smart, self-contained, implantable DBS system. and control what’s happening in the brain and Now in prototyping stage, WINCS Harmoni spinal cord. combines WINCS, MINCS and a complex “My hope,” he says, “is that this will open algorithm that translates the biological up a new era in medicine. If you look at all the feedback from WINCS into precise stimulation medications we use that somehow affect the patterns delivered by MINCS. chemistry in the brain, we are now in an era As Dr. Lee describes the relationship where we can control the systems even better. between sensors, circuitry and science, he So rather than going the shotgun approach of oddly passes on describing their interplay as medicine, we can go with the smart systems “harmonious,” an expected riff on the system’s of DBS.” name. Realizing this, he pauses. Mayo’s Neural Engineering Lab hopes to “By the way,” he says, “Harmoni is not test WINCS Harmoni in patients this year. for ‘harmonious.’ It’s the Korean word for

2013 Issue 1 Mayo Clinic Magazine 51 Helping Mayo GET CLOSER TO THE ULTIMATE GOAL

“This was one of the easiest commitments that we have had to make in our lives. Mayo Clinic gave David a chance in 1998 to get his life back. Since then we have felt the need to do what we can to donate to such a special place and great hospital.

“Our goals, by working with Mayo to start the Mayo Clinic Advanced Epilepsy Imaging project, are to have a future where people with epilepsy have a cure available to them, a cure that results in a life free of seizures and side effects. We feel Mayo’s greatest resource in its epilepsy department is the commitment and experience of its physicians and its wonderful approach to the care of patients with seizures.

“It will bring us great satisfaction over the next years watching Mayo get closer to our ultimate goal: no seizures, no side effects.”

David and Megan Hawk Omaha, Nebraska

52 Mayo Clinic Magazine 2013 Issue 1 Thank You Gifts of all sizes strengthen health care for people everywhere. Mayo Clinic is deeply grateful for each one and finds inspiration in such personal demonstrations of support.

Making an Impact CUMULATIVE PHILANTHROPY Each benefactor is recognized for philanthropic giving of $100,000 to $10 million or more in the Philanthropic Partners $10 million or more Hall of Benefactors at Mayo Clinic in Rochester, Principal Benefactors $1 million to $9,999,999 Minn. Those who support our work in Florida Major Benefactors $100,000 to $999,999 and Arizona are also recognized in the Hall of

Benefactors on the respective campus. Recognition Levels

Leaving the World a Better Place PLANNED GIVING Committed benefactors who want to make a difference beyond their lives can do so through planned gifts. Benefactors who support Mayo Clinic through a bequest in their will or another type of planned gift become members of The Mayo Legacy and are recognized in electronic recognition kiosks in the Halls of Benefactors at all Mayo sites.

ALUMNI PHILANTHROPY Having seen and felt the direct impact of philanthropy, Mayo Clinic alumni know the difference it makes better than anyone. Many become benefactors of Mayo to help maintain the highest quality of patient care, research and education. Their generosity is recognized in electronic recognition kiosks in the Halls of Benefactors at all Mayo sites.

Mayo Alumni Laureates $100,000 or more Doctors Mayo Society $10,000 or more; bequest of $25,000 or more Edith Graham Mayo Society $1,000 (Mayo School of Health Sciences)

Giving Back ANNUAL GIVING Mayo Leadership Circle $50,000 to $99,999 Some benefactors choose to support Mayo Clinic’s Mayo Ambassadors $25,000 to $49,999 work with yearly gifts and are recognized in electronic Mayo Sponsors $10,000 to $24,999 displays at Mayo Clinic in Rochester, Florida and Mayo Stewards $5,000 to $9,999 Arizona. Six levels honor benefactors for annual Mayo Patrons $2,500 to $4,999 philanthropy of $1,000 to $99,999. Mayo Friends $1,000 to $2,499

For more information about philanthropy at Mayo Clinic, please call 1-800-297-1185 (toll-free) or visit www.mayoclinic.org/development.

2013 Issue 1 Mayo Clinic Magazine 53 2013 Mayo Clinic Board of Trustees

EXTERNAL TRUSTEES Ronald L. Olson Lois E. Krahn, M.D. Ambassador Howard H. Baker Jr. Partner Consultant, Psychiatry Barbara M. Barrett Linda G. Alvarado Munger, Tolles & Olson, LLP Mayo Clinic in Arizona Barbara P. Bush President and CEO Los Angeles, Calif. Richard B. Cheney Alvarado Construction, Inc. Dawn S. Milliner, M.D John H. Dasburg Denver, Colo. Aulana L. Peters Consultant, Nephrology Senator Thomas A. Daschle Retired Partner Mayo Clinic A. Dano Davis Bradbury H. (Brad) Anderson Gibson, Dunn & Crutcher, LLP Allan R. DeBoer Retired CEO and Vice Chairman Los Angeles, Calif. Robert E. Nesse, M.D. George C. Dillon Best Buy Co., Inc. CEO Frances D. Fergusson, Ph.D. Richfield, Minn. Michael K. Powell Mayo Clinic Health System Bert A. Getz President and CEO Louis L. Gonda James L. Barksdale National Cable & John H. Noseworthy, M.D. Hanna H. Gray, Ph.D. Barksdale Management Telecommunications Assn. President and CEO Robert A. Hanson Corporation Washington, D.C. Mayo Clinic W. Thomas Johnson Jr. Ridgeland, Miss. Sister June Kaiser Lee R. Raymond, Ph.D. Kerry D. Olsen, M.D. Thomas J. (Tom) Brokaw Richard L. Knowlton Retired Chair of the Board Consultant, Otolaryngology Philip R. Lee, M.D. Special Correspondent ExxonMobil Corporation Mayo Clinic NBC News Whitney MacMillan Irving, Texas Joan D. Manley New York, N.Y. Veronique L. Roger, M.D. J. Willard Marriott Jr. Randolph Steer, M.D., Ph.D. Consultant, Cardiovascular Ambassador Donard F. McHenry France A. Córdova, Ph.D. Diseases Biotechnology Consultant Newton N. Minow President Emeritus Mayo Clinic Desert Health Enterprise Honorable Walter F. Mondale Purdue University Rancho Mirage, Calif. West Lafayette, Ind. William C. Rupp, M.D. Luis G. Nogales Hugh B. Price Anne M. Tatlock Vice President, Mayo Clinic Frederick W. Smith Samuel A. Di Piazza, Jr. Retired Chair and CEO CEO, Mayo Clinic in Florida Edson W. Spencer Vice Chairman, ICG Fiduciary Trust Company Donald M. Stewart, D.P.A. Citigroup International Shirley A. Weis Paul A. Volcker New York, N.Y. New York, N.Y. Vice President and CAO Mayo Clinic Rawleigh Warner Jr. Michael E. Dougherty Charles B. Tomm Robert C. Winters Chairman President and CEO Mary J. Williamson Elias A. Zerhouni, M.D. Dougherty Financial Group LLC The Brumos Companies Administrative Director Minneapolis, Minn. Jacksonville, Fla. Affiliated Practice Network Mayo Clinic Magazine Mayo Clinic William W. (Bill) George INTERNAL TRUSTEES Published biannually for Professor of Management Practice ADDITIONAL OFFICIALS benefactors and friends Harvard Business School of Mayo Clinic. Daniel J. Berry, M.D. Michael Camilleri, M.D. Cambridge, Mass. Consultant, Orthopedic Surgery Executive Dean for Development Mayo Clinic Executive Editor: Roy A. Herberger, Jr., Ph.D. Mayo Clinic Brett C. Vermilyea President Emeritus Jeffrey W. Bolton Cheryl Hadaway Thunderbird School of Design: Chief Financial Officer Chair Global Management Morsekode Chair, Department of Finance Department of Development Phoenix, Ariz. Mayo Clinic Mayo Clinic Please address comments to: Patricia E. Mitchell Brett C. Vermilyea Steven J. Buskirk, M.D. Jonathan J. Oviatt, J.D. President and CEO Mayo Clinic Magazine Consultant, Radiation Oncology Secretary The Paley Center for Media Siebens 9200 First Street SW Mayo Clinic in Florida Chief Legal Officer New York, N.Y. Rochester, MN 55905 Chair, Legal Department Wyatt Decker, M.D. (507) 284-8540 Mayo Clinic Marilyn Carlson Nelson Vice President, Mayo Clinic [email protected] Chair, Mayo Clinic Board CEO, Mayo Clinic in Arizona EMERITUS PUBLIC www.mayoclinic.org/development of Trustees TRUSTEES Co-Chair Richard L. Ehman, M.D. Mayo is a not-for-profit 501(c)(3) Carlson Holdings, Inc. Consultant, MRI Research Lilyan H. Affinito charitable organization, and Minneapolis, Minn. Mayo Clinic Robert E. Allen contributions are tax-deductible H. Brewster Atwater Jr. to the extent allowed by law.

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