Week 40: Running the Gamut
This week, I reflect on the some of our department’s activities that illustrate achievement across the entire academic spectrum.
I start with a medical student.
It goes without saying that department of medicine (DoM) faculty play an outsized role in training the next generation of physicians, ensuring that they develop core skills that equip them for successful careers in the specialty of their choosing. When I learn about a student who has pushed the envelope further to publish their work in a peer reviewed journal under mentorship of DoM faculty and residents, I get an additional dose of satisfaction. This past week, I was pleased to learn that David Geffen School of Medicine (DGSOM) student Nikitha Kosaraju published her first manuscript, "Impact of frailty on mortality and quality of life in patients with a history of cancer undergoing transcatheter aortic valve replacement" in Clinical Cardiology. Her achievement is a product of the DoM’s Internal Medicine Chief Residents DGSOM Medical Student Research Fellowship. Through this fellowship, medical students are paired with faculty and resident mentors who guide them through a structured research program that includes lab placement and navigating the research process.
When Nikitha arrived at DGSOM, she knew she wanted to study cardio-oncology and therefore partnered with Dr. Eric Yang, director of UCLA Cardio-Oncology Program and Dr. Perry Wu, a former resident and current cardiovascular fellow at UC Irvine. They launched a retrospective single center cohort study to determine how frailty impacts health outcomes for patients who receive a transcatheter aortic valve replacement (TAVR) and have a history of cancer. Nikitha and her colleagues collected data on 600 patient records and determined frailty by measuring serum albumin, hemoglobin, gait speed, functional dependence, and cognitive impairment. The primary health outcome was determined by a composite of all-cause mortality and quality of life at one year. After stratifying their patient population into active/recent cancer, remote cancer, and no history of cancer, a multivariate analysis found that frailty metrics have a greater impact on patient health outcomes post-TAVR. The study is significant, as it will inform shared decision making regarding risks versus benefits of this procedure in elderly patients with active or prior cancer.
"I lucked out with Dr. Yang and Dr. Perry Wu who were supportive mentors throughout this project. It is great that DGSOM has the type of culture that highlights their trainees, supports mentorship, and it’s nice to know that our hard work is recognized,” states Nikitha.
In addition to her immediate faculty and resident mentors, Nikitha had the opportunity to receive essential input from DoM faculty from other divisions who were co-authors on this work. They include Mei Leng (DoM Statistics), Dr. Marielle Bolano (former chief resident and currently fellow in geriatrics), Dr. Asim Rafique (cardiology), Dr. John Shen (hematology-oncology), Jeanne Huchting, NP (cardiology), and Dr. Olcay Aksoy (cardiology).
Next, on to our residents
On Friday our Internal Medicine Residency Program held their Fall Retreat. Three months into a new academic year, our interns and residents are thriving. The retreat focused on many practical issues related to their training, while providing an opportunity for bonding and team building in a relaxed atmosphere. In my remarks to the participants at the beginning of the retreat, I encouraged the residents to consider how they can contribute as influencers and game changers in medicine after their training is completed. We recruit and are committed to developing leaders who will shape the future of our profession no matter what specific path they take after they leave our training programs. I reminded our residents of our commitment to nurture their growth to ensure that they have a meaningful impact on the field of medicine, society, and the communities they serve. I encouraged them to seek effective mentorship and cultivate a team of mentors that includes peer mentorship, professional and career mentorship and mentors who will help them navigate critical steps throughout their unique journeys. It is abundantly clear to me that there is a strong sense of community, love and pride within this program. Those traits were evident in the planning and execution of the day-long retreat which provided residents with an agenda that included an introduction to pathways, the state of the program address from Dr. Lisa Skinner, our chief resident’s recruitment strategies for AY 22-23, and a solutions-oriented brainstorm, focused on providing feedback to program leadership on multiple rotations in various breakout groups.
We also shared the news that Dr. Kristin Schwab Jensen would be the incoming internal medicine residency program associate program director. In her new role, Dr. Schwab Jensen will mentor internal medicine residents, innovate curriculum, and lead initiatives to advance the strategic goals of the residency program. Welcome Dr. Schwab Jensen.
It truly was an inspirational day that culminated with outdoor team building activities. As evidenced by these pictures, I would say the retreat was a success.
And now our faculty.
Our faculty are advancing knowledge that impact clinical care of patients across all diseases. This week I will highlight a mid-career and a senior faculty member.
Dr. Kara Chew
Since the onset of the COVID-19 pandemic, Dr. Kara Chew, a clinical investigator at the UCLA Center for Clinical AIDS Research and Education (CARE) and division of infectious diseases, has been leading COVID-19 clinical trials focused on developing promising outpatient treatments. She is currently the protocol co-chair of the NIH-funded Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV)-2/AIDS Clinical Trials Group (ACTG) A5401 and ACTIV-2d/A5407/SCORPIO-HR, both randomized controlled trials testing treatments for non-hospitalized adults with early COVID-19. Findings from ACTIV-2, a phase 2/3 adaptive platform trial that has evaluated seven investigational agents across 10 active treatment arms, are now being published. Let me share one of their earliest trial results, which was recently published in Nature Communications.
This report evaluated the safety, antiviral activity, and clinical efficacy of the drug bamlanivimab, a neutralizing immunoglobin G (IgG)-1 monoclonal antibody (mAb) that binds to the SARS-CoV-2 spike protein. Early in the pandemic, this was the first therapy to receive US Food and Drug Administration (FDA) Emergency Use Authorization (EUA) for the treatment of persons with COVID-19 to prevent progression to hospitalization and death. Within ten days of developing COVID-19 symptoms, participants were randomized 1:1 to bamlanivimab or a placebo in two dose cohorts (7000 mg, n=94; 700 mg, n = 223). No differences were found in the primary qualitative virologic and symptom outcomes between the two groups. However, bamlanivimab was associated with lower quantitative nasopharyngeal viral levels on day three, and a faster decrease in inflammatory markers and viral decay by modeling. As we continue to explore effective treatments for COVID-19, this study helps us understand the clinical benefits of SARS-CoV-2 mAbs and the strengths and limitations of nasopharyngeal viral measures when used in clinical trials to test SARS-CoV-2 antivirals. This was the first primary publication from the ACTIV-2 trial and I invite you to explore their follow-up studies which include:
"Monoclonal antibody treatment drives rapid culture conversion in SARS-CoV-2 infection"
In addition to their COVID-19 work, Dr. Chew and her colleagues continue to work towards improving outcomes for people with HIV (PWH). Most recently, her other recent published work includes clinical studies of therapeutic vaccination for HIV remission (cure) and highlights metabolic disease in PWH:
"Liver inflammation is common and linked to metabolic derangements in treated HIV"
Dr. Antoni Ribas
Congratulations to Dr. Antoni Ribas, professor of medicine, surgery, molecular and medical pharmacology, who was recently awarded a renewal of his National Cancer Institute (NCI) Outstanding Investigator Award in support of his metastatic melanoma research. Over the next seven years, the $4.2 million dollar award will support research aimed at evaluating the response and resistance mechanisms of cancer immunotherapy. The study will seek how to overcome resistance mechanisms and prolong antitumor activity in the immune system. This research builds upon his previous seven-year R35 award funded by the NCI which supports demonstrated outstanding productivity in cancer research. Dr. Ribas is the director of the Tumor Immunology Program at the Jonsson Comprehensive Cancer Center and director of the Parker Institute for Cancer Immunotherapy Center at UCLA.
Interdisciplinary Initiatives
I learned more about The Center for HIV Identification, Prevention, and Treatment Services (CHIPTS) when I came across one of their recent publications describing pre-exposure prophylaxis for HIV prevention in South Africa.
Dr. Dvora Joseph Davey
The study by Dr. Dvora Joseph Davey is part of CHIPTS effort that focus on the prevention and treatment of HIV in peri-conception, pregnant women, couples, and vulnerable populations. The study "Low prevalence of hepatitis B virus infection in HIV-uninfected pregnant women in Cape Town, South Africa: implications for oral pre-exposure prophylaxis roll out" was recently published in BMC Infectious Diseases.
Dr. Davey shares that the current recommendations for HIV prevention for individuals at high-risk for infection includes oral daily preexposure prophylaxis (PrEP) using emtricitabine (FTC)/tenofovir disoproxil fumarate (TDF). FTC/TDF is also used against the hepatitis B virus (HBV).
Alongside researchers from the University of Cape Town, Dr. Davey and UCLA colleagues set out to determine if PrEP use by individuals infected by HBV was associated with hepatitis flares and liver injury. They evaluated the field performance of a point of care test (POCT) for diagnosis of hepatitis B surface antigen (HBsAg) in a maternity setting and found that the prevalence of HBV was very low in pregnant women not living with HIV and was evident in women born before the HBV vaccine was included in the Expanded Program of Immunization. They observed that the overall prevalence of HBV was 0.67% (95% CI=0.34, 1.32%). In women born before 1995, the prevalence was 1.29% (95% CI=0.65, 2.52%), and in women born in 1995 or after (n=572); the prevalence was 0% (95% CI=0.0, 0.67%). They concluded that HBV screening should not be a barrier to starting PrEP in the context of high HIV risk communities. The researchers also found that screening may not be required prior to starting PrEP in a younger population.
CHIPTS is a collaboration of diverse, multi-disciplinary HIV researchers from UCLA, Charles Drew University of Medicine and Science, Friends Research Institute, and the RAND Corporation. Funded by the National Institutes of Mental Health, CHIPTS promotes collaborative research, fosters networking, and supports capacity building among communities and agency partners in efforts to eliminate new HIV infections and health disparities among key populations with HIV-associated comorbidities. The co-directors of CHIPTS are Steve Shoptaw, Ph.D. in the department of family medicine and psychology and Raphael J. Landovitz, MD, MSc in our division of infectious diseases.
Keeping up with all of this, while focusing on operations and shaping the strategic future of the DoM, that will influence the DGSOM, UCLA and ultimately the practice of medicine worldwide requires a robust senior leadership team. As such, I am pleased to announce and introduce the two new senior vice chairs of the DoM. Please welcome our newly appointed senior academic vice chair Dr. Gregory A. Brent, and senior clinical vice chair Dr. Tisha S. Wang as they assume their new leadership positions within the DoM.
Their new roles will support our continued strategic growth across the pillars of our academic mission. I look forward to working closely with them to advocate for the needs of our department and ensure that we achieve our greatest impact in the lives of our patients, faculty, staff and trainees. In case you missed the announcement that was sent out last Friday, you can learn more about Dr. Brent and Dr. Wang’s roles and achievements by visiting DoM Connect.
Dale
P.S.
Albert Haro our fearless chief financial officer turned 5 this week. The evidence is on the cake. Albert eats a healthy diet, so we went with a fruit tart. Note how he deftly extinguished the candles with his hands, while keeping his mask on. I have nothing but praise for his analytical skill and deep knowledge of our department’s finances despite occasional complaints from faculty when perceptions collide with the data. Albert is a wiz with numbers, as such I am 99.8% confident that his actual age is very close to being a derivative of 5.
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