Community engagement transcends translational science spectrum at annual conference

Dr. Gerry Moeller speaks animatedly wearing a suit in front of a mustard yellow wall
Wright Center Director F. Gerard Moeller, M.D. Photo by Kevin Morley, VCU University Relations.

By Anne Dreyfuss
VCU C. Kenneth and Dianne Wright Center for Clinical and Translational Research

At the Virginia Commonwealth University Community Engagement Institute on May 14, Wright Center Director F. Gerard Moeller, M.D., discussed how he harnesses community-academic partnerships to address the opioid epidemic.

“Virginia has succumbed to the opioid overdose epidemic just like the rest of the country, and the patterns vary significantly from one county to the next,” he said. “Dealing effectively with this is going to require a community-engaged approach. We will not have an impact without fostering partnerships with our community.”

The mantra of community members’ fundamental role in impactful translational research echoed throughout the two-day conference held on the VCU Monroe Park Campus, where more than 80 community-engaged scholars gathered to explore the power and potential of university-community partnerships.

“The Community Engagement Institute provided us with an opportunity to connect and re-establish existing connections with people who are energized about continuously improving our community engagement efforts,” said Wright Center community engagement associate Alicia Aroche, who helped plan the conference and presented on best practices for communicating about the work of community-academic partnerships.

Since May 2014, the Wright Center and the VCU Division of Community Engagement have partnered annually to host the event that unites academic and community stakeholders who share a commitment to solving challenges through community-academic collaboration. “When you have complex problems, it takes people with varying expertise from the community and academic centers to solve them,” said VCU Division of Community Engagement vice provost Cathy Howard, Ph.D. Through interactive workshops, attendees built skills around initiating and sustaining community-academic partnerships, as well as assessing and communicating the work of such partnerships.

“Partnering with our communities allows us to do better research,” said Wright Center community-engaged research co-director Alex Krist, M.D.

The three Wright Center Clinical Research KL2 Scholars smile for a photo. They are all wearing cardigans.
Wright Center Clinical Research KL2 Scholars (from left to right) Guizhi (Julian) Zhu, Ph.D.; Mario Acunzo, M.D.; and Elizabeth Wolf, M.D. Photo by Kevin Morley, VCU University Relations.

Krist is a mentor to Wright Center Clinical Research KL2 Scholar Elizabeth Wolf, M.D., who is working on a community-engagement project that aims to identify geographic and patient-level risk factors for inadequate prenatal and well-child care in the Greater Richmond Region. “I attended the Community Engagement Institute because I wanted to learn more about best principles that I could apply to my research,” Wolf said. The assistant professor of pediatrics and emergency care at VCU School of Medicine is partnering with the VCU Center on Society and Health’s Engaging Richmond program to develop strategies aimed at reducing health disparities for vulnerable women and children.

The conference was funded in-part through the $21.5 million Clinical and Translational Science Award that the Wright Center received from the National Institutes of Health in 2018. The largest NIH grant in VCU’s history allows the Wright Center to collaborate across disciplines within the university and health system, and with community partners around the region, all with the shared goal of accelerating innovative research that advances the scientific study of human health.

“Events like the annual Community Engagement Institute allow us to better mobilize existing strengths in community engagement and team science to engage stakeholder communities at every translational phase,” Krist said. “Ultimately, we want to work with community members as research partners and form collaborative clinical research translational science teams to improve the health of our communities together.”

Meet the Team: Tamas Gal

At the Wright Center, we seek to advance science and foster partnerships that accelerate translational research for the betterment of human health. Our team members come to work every day ready to transform laboratory discoveries into treatments for patients, engage communities in clinical research and train a new generation of clinical and translational scholars, all with the shared goal of bridging the gap between scientific theory and practical medicine.

Each month, we will highlight one member of our team who is contributing to our shared mission of advancing science and fostering partnerships that accelerate translational research for the betterment of human health.

For a full list of staff members, please visit cctr.vcu.edu/aboutus/staff.

Second Opportunities for Lasting Change

Dr. Moeller stands with his arms crossed in front of the VCU Medical Center Emergency Department entrance. He is wearing a white lab coat.
Wright Center Director F. Gerard Moeller, M.D., is the principal investigator on a clinical trial that is initiating long-term care for opioid overdose survivors inside emergency departments. Photo: Kevin Schindler

This story originally appeared in the MCV Foundation‘s Next magazine. To read the full story and other articles about life-changing innovations occurring on the MCV Campus, click here

Those who survive an opioid overdose usually do so because they’re found in varying states of consciousness by family members, friends, caregivers or first responders before their breathing stops completely.

These survivors gain an additional opportunity at life, but oftentimes, because of the nature of their illness, they can’t use their new opportunities for change and recovery.

F. Gerard “Gerry” Moeller, M.D., director of the VCU C. Kenneth and Dianne Wright Center for Clinical and Translational Research, began contemplating these missed opportunities one day in 2017 after hearing from colleagues in the VCU Health Emergency Department.

“They came to me and said they were seeing overdose patients time and time again, and they felt like they just weren’t accomplishing anything,” Dr. Moeller said. “They were reviving the patients, but then the survivors weren’t getting into long-term treatment.”

Dr. Moeller, who is internationally known for his translational research on impulsivity and addictions, is keenly aware of the importance long-term treatment plays in pulling people out of a deadly spiral like the one his colleagues described to him, and he wanted to help.

His preliminary data showed that opioid overdose visits to the VCU Health Emergency Department went from approximately 270 in 2015 to more than 650 in 2017, and from all of those visits, as many as one in five patients experienced a repeat overdose or died within 12 months of their initial overdose.

Dr. Moeller knew these numbers demanded action toward finding the reason survivors weren’t getting the help they needed, and, most importantly, toward identifying a new approach to helping the survivors avail the opportunities they’d been given for a new life.

Why are survivors not getting help?

After an overdose victim arrives at the emergency department, he or she is stabilized, monitored for some time and then referred to a long-term outpatient facility where appropriate follow-up treatment, usually for addiction, can begin.

Dr. Moeller believes this referral is the critical moment in the treatment paradigm that can and should be changed. That’s because the overdose medication naloxone is very effective at saving lives, but it also causes acute opioid withdrawal, leading to nausea, vomiting, sweating, diarrhea, chills, cravings, impulsivity and poor decision-making.

“One of the behavioral definitions of impulsivity is the lack of ability to delay your gratification,” Dr. Moeller said. “So, if you’re in withdrawal, you have all these symptoms and you wish you were dead. You realize that when you walk out the door of the hospital you can get something that will make you feel better — it’s heroin, or it’s oxycodone, or it’s a pill. Even though you know you just almost died from an overdose, the threat of that happening again is in the future.”

Because of this impulsivity, which is often amplified because of the lifesaving medication, many patients never go to clinics when they’re referred for long-term treatment, opting instead to seek an immediate fix.

What can be changed to better encourage long-term care?

Instead of referring overdose survivors, who are likely experiencing acute withdrawal, to long-term care after they leave the emergency department, Dr. Moeller is testing the effectiveness of initiating long-term treatment before the survivors ever leave the hospital. The goal here is to counteract withdrawal symptoms and reduce impulsivity.

For those who agree to participate, Dr. Moeller’s team, working inside the emergency department, makes contact and provides a medication called buprenorphine that reverses the withdrawal symptoms. Patients are then given a referral within 72 hours to the outpatient clinic, where they continue medication and counseling for addictions.

In addition to administering buprenorphine as early as possible before survivors leave the hospital, the long-term care component of the study is vitally important to the recovery of survivors. In Richmond, referrals to long-term outpatient care guide participants to the VCU Health MOTIVATE Clinic, where social workers, nurses and physicians monitor patients’ progress weekly, provide behavioral counseling sessions in individual and group settings, and administer buprenorphine monthly.

Improving the likelihood that overdose victims reach this long-term component of care is essential, Dr. Moeller said. “Addiction really is a chronic medical disorder. Like diabetes and hypertension, a one-time treatment is not going to solve the problem, so patients need chronic medication and behavioral treatments like group therapy to help them with lifestyle changes.”

Dr. Moeller will serve as principal investigator on the trial and will work with Robert Lipsky, Ph.D., director of translational research in the Department of Neurosciences at Inova Fairfax Hospital, and Warren Bickel, Ph.D., professor of psychiatry and director of the Addiction Recovery Research Center at Virginia Tech Carilion Research Institute. The trial is funded in part by a $500,000 Virginia Catalyst grant from the Virginia Biosciences Health Research Corporation.

If the results show what Dr. Moeller expects, which is a significant drop in repeat overdose and death rates compared to previous data, this trial will establish a new paradigm for treatment of patients after opioid overdose that can be utilized nationally to help survivors get the help they need before it’s too late.

The MCV Foundation encourages and stewards gifts to support research like Dr. Moeller’s that fight all types of diseases. If you’re interested in learning about the tools the Foundation has available to use in making those gifts, visit their giving page.

Wright Center hosts Mentorship Academy aimed at creating a culture of mentorship at VCU

By Anne Dreyfuss
VCU C. Kenneth and Dianne Wright Center for Clinical and Translational Research

Dr. Nana-Sinkam points behind him to a screen with an infographic describing training opportunities
Wright Center KL2 program co-director Patrick Nana-Sinkam, M.D., presented on training and mentorship opportunities at the Wright Center during the 2019 Mentorship Academy. Photo by Allen Jones, VCU University Relations

At the Wright Center Mentorship Academy on May 3, nearly 50 faculty researchers from eight schools and colleges across the Virginia Commonwealth University MCV and Monroe Park Campuses gathered to discuss mentorship best practices.

“We set out to identify leadership from across the university to attend the Mentorship Academy, with the ultimate goal of using this as a starting point from which to foster a culture of mentorship at VCU,” said Wright Center KL2 program co-director Patrick Nana-Sinkam, M.D. The VCU School of Medicine professor and division chair organized the daylong conference at which attendees discussed ways to create and nurture a culture of mentorship within their schools, colleges and departments.

The workshop was facilitated by the Center for Improvement of Mentored Experiences in Research, which is a nationally recognized leader in providing mentoring and training resources. The evidence-based program was developed at the University of Wisconsin-Madison to help mentors develop skills for engaging in productive, culturally responsive research mentoring relationships that optimize the success of mentors and mentees. “We are here to help VCU faculty promote their own mentoring initiatives by thinking strategically about their mentoring practices and leveraging the experiences of their colleagues to learn from one another,” said program facilitator Kelly Diggs-Andrews, Ph.D.

Throughout the day, VCU faculty members learned skills and developed tools to help them build, increase and improve departmental mentorship infrastructure. “The culture of mentoring is complex,” said Gregory Triplett, Ph.D. The associate dean for graduate studies and research at the VCU College of Engineering attended hoping to learn mentoring strategies that he could bring back to his colleagues. “Workshops such as this provide important details for frameworks that we can further expand upon at our individual units,” he said.

While previous Mentorship Academies hosted by the Wright Center have included mostly trainees and junior faculty members, the 2019 event was targeted toward senior-level faculty members to try to increase institutional support for building a culture of mentorship at VCU. Attendees included 25 professors from VCU Schools of Medicine, Dentistry, Nursing, and Pharmacy, as well as the VCU Colleges of Engineering, Humanities and Sciences, and Health Professions, and VCU Life Sciences. Also in attendance were three School of Medicine department chairs, three members of the VCU Vice President for Research and Innovation’s Research Development Advisory Council, the School of Medicine’s associate chair for faculty development and the VCU senior vice provost for faculty affairs.

“In order to achieve our goal of fostering a culture of mentorship throughout VCU and VCU Health, we need buy in from senior leadership,” Nana-Sinkam said. “We want to help create a sustainable pool of senior faculty mentors and incentivize those mentors to create a community.”

A pyramid-shaped infographic describing mentorship and training opportunities available at the Wright Center
Wright Center training opportunities include mock study sections, grant writing seminars and biostatistics assistance.

The day included presentations and facilitated discussions on topics including maintaining effective communication, aligning expectations between mentors and mentees, addressing equity and inclusion, and promoting professional development and work-life integration.

In the afternoon, Nana-Sinkam and Wright Center Director F. Gerard Moeller, M.D., presented on training opportunities within the Wright Center, including grant writing seminars, mock study sections, and assistance with bioinformatics and biostatistics. They highlighted the Wright Center’s newest program, Faculty Mentor Office Hours, where early career faculty can sign-up to meet with senior faculty mentors and discuss topics ranging from promotion and tenure to professional development and grant applications. They also discussed several research training programs administered by the Wright Center, including the Emerging Scholars program, Translational Science Scholars program and KL2 Program, which provide early career researchers with the opportunity to participate in mentored research and career development activities. They ended the presentation with a review of the research supplements that are provided by the Wright Center through the National Institutes of Health to promote diversity and re-entry into biomedical and health-related research professions.

“There is a huge need for leadership in the biomedical research space,” said Moeller, adding that the Wright Center programs he presented on are intended to address that shortage. “We need mentors who are equipped to train the next generation of researchers because without mentorship, junior faculty are not going to succeed.”

The program was made possible through the $21.5 million Clinical and Translational Science Award that the Wright Center received from the NIH in 2018. The largest NIH grant in VCU’s history allows the Wright Center to facilitate collaboration among diverse expertise within the university.

“The Wright Center’s mission is to translate basic science to having an impact on the health of the community and we need translational researchers in the pipeline to carry that mission forward,” Moeller said. “By training a new generation of interdisciplinary clinical and translational scholars, we can work toward ensuring our vision is sustained.”

Wright Center associate director honored for his contributions toward undergraduate mentorship at VCU

By Anne Dreyfuss
C. Kenneth and Dianne Wright Center for Clinical and Translational Research

Photo by Kevin Morley, VCU University Relations.

At a study abroad program in Fondi, a city halfway between Rome and Naples in central Italy, Henrico-native Krishna Ravindra discovered a passion for clinical and translational science. “Working with Dr. Abbate allowed me to see how a background in clinical medicine and translational research can allow one to not only help patients based on the current medicine available, but also have the opportunity to explore novel therapeutic strategies to improve patient care,” Ravindra said of Antonio Abbate, M.D., Ph.D., who leads the Virginia Commonwealth University study abroad trip hosted by the Instituto San Francesco and the University Campus Biomedico of Rome. During the three-week program, undergraduate VCU Honors College students study the signs and symptoms of disease and explore clinical and translational research.

 

When they returned to Richmond in the fall of 2017, Ravindra asked Abbate if he could shadow him during his clinical rotations at VCU Medical Center and volunteer on Abbate’s research team. Abbate, who is an associate director at the VCU C. Kenneth and Dianne Wright Center for Clinical and Translational Research, serves as the James C. Roberts, Esq. Professor of Cardiology at the VCU School of Medicine, as well as a practicing cardiologist at the VCU Health Pauley Heart Center and medical director at the VCU Medical Center Clinical Research Unit. “I am always happy to open my research team to undergraduate students,” Abbate said, adding that he became involved in research when he was 20 years old and benefitted from working with mentors who shared their enthusiasm for medical discovery and innovation early in his career. “It is important to offer students an opportunity to see what gets you up in the morning,” he said.

 

In the ensuing years Ravindra continued to volunteer on research projects under Abbate’s mentorship, including working with Abbate through the VCU Undergraduate Research Opportunities Program. On April 24 Abbate was recognized for his work through that program with the VCU Undergraduate Research Opportunities Program Faculty Mentor Award, an honor that recognizes faculty members who have demonstrated a commitment to regularly go above and beyond to engage undergraduate students in research opportunities.

 

“Dr. Abbate placed an enormous amount of faith in me as an undergraduate student to complete complex chart reviews, patient analyses, and retrospective data analyses,” Ravindra said.

 

Through UROP, Ravindra worked with Abbate on a retrospective analysis of patients who were treated at VCU Medical Center for Takotsubo cardiomyopathy, a complex clinical condition in which a person suddenly develops heart failure after emotional or physical stressors. Ravindra also worked on another research project aimed to predict the degree of cardiorespiratory fitness impairment in heart failure patients across a wide range of ejection fraction measurements, which indicate how much blood the left heart ventricle pumps with each contraction.

 

For four months Ravindra worked with Jessie van Wezenbeek, a graduate student from Amsterdam, on data collection and statistical analysis, which informed a manuscript detailing their findings. The manuscript published in the peer-reviewed journal Frontiers in Cardiovascular Medicine late last year and in November Ravindra presented the results of the pair’s research projects at the American Heart Association Scientific Sessions conference in Chicago.

 

“I would never have dreamed of getting to present at such a large conference as an undergraduate student before working with Dr. Abbate,” Ravindra said. “Working with Dr. Abbate opened that door for me, as he constantly pushed me out of my comfort zone and took time to teach me one-on-one.”

 

Ravindra said Abbate inspired him to pursue a career in clinical and translational science. In the fall he will start medical school at VCU. “Dr. Abbate has shaped my view of what it means to be a physician and has illuminated the benefits of being a physician-scientist,” he said. “He emphasized the bench-to-bedside process of clinical and translational research. Further, he showed me that the process of discovery is never-ending and that we can always strive to do more for our patients.”

 

Abbate has devoted a significant amount of effort toward training the next generation of clinical and translational scholars since joining VCU in 2007. In 2016, the School of Medicine awarded him with the Distinguished Mentor Award, an honor that recognizes significant contributions to the career development of others.  In February, he was awarded the inaugural Thames-Kontos Mentoring Award from the VCU School of Medicine Department of Internal Medicine.

 

The Wright Center has funded two faculty-mentored undergraduate clinical and translational research projects through UROP every year since 2014. This summer, the Wright Center will fund biomedical engineering student Yasmina Zeineddine to research spinal cord injuries with mentor Carrie Peterson, Ph.D., who is an assistant professor in the Department of Biomedical Engineering at VCU College of Engineering. The Wright Center will also fund mechanical engineering student Sam Cole’s research on bioreactors for mechanical training of engineered tissues with mentor Joao Soares, Ph.D., who is an assistant professor at the VCU College of Engineering.

 

“The Wright Center is committed to fostering cross-campus collaborations with the VCU College of Engineering and other units on the VCU Monroe Park Campus with an aim of developing an interdisciplinary clinical and translational workforce that will be equipped to address emerging health care challenges,” said Wright Center Director F. Gerard Moeller, M.D. “We are happy to partner with the VCU Undergraduate Research Opportunities Program to help inspire an early interest in clinical and translational research among undergraduate researchers.”

VCU’s Jordana Kron is searching for answers to a mystery disease

By Anne Dreyfuss
C. Kenneth and Dianne Wright Center for Clinical and Translational Research

Jennifer Jordan, Ph.D, left, and Jordana Kron, M.D., are working on a new treatment for sarcoidosis, an inflammatory condition that can lead to cardiac failure when it affects the heart. (Photo by Thomas Kojcsich, University Marketing)

A disease that has no cause or cure, sarcoidosis affects people of all ages throughout the world. Once considered a rare disease, the inflammatory condition now affects about 40 in every 100,000 African Americans in the U.S. and about five in every 100,000 white people. It occurs in all races and in men and women, but is most common among African American females ages 20 to 40.

The disease most commonly affects the lungs, but can involve almost any organ system including the skin, eyes, joints and heart. Cardiac involvement, which occurs in up to 25% of patients with sarcoidosis in other organs, can lead to life-threatening heart rhythm problems and heart failure.

“The field of cardiac sarcoidosis, and sarcoidosis in general, really needs new mechanistically driven therapies,” said Jordana Kron, M.D., an associate professor in the Virginia Commonwealth University School of Medicine and a cardiologist at the VCU Health Pauley Heart Center.

This month, which is National Sarcoidosis Awareness Month, Kron was awarded a $50,000 Pauley Pilot Research Grant to investigate a new treatment protocol for cardiac sarcoidosis. The 15-month grant will be used to evaluate the efficacy and safety of using an interleukin-1 blockade to treat patients who present with cardiac sarcoidosis. The study is the first of its kind to explore the new treatment paradigm.

“A new, safe and effective treatment could be life-altering for patients with cardiac sarcoidosis. It may also open the door for new therapies for cardiac sarcoidosis and other inflammatory heart diseases in the future,” said Kron, a translational science scholar at the VCU C. Kenneth and Dianne Wright Center for Clinical and Translational Research.

Interleukin-1 is a protein whose presence indicates inflammation in the body. Kron’s research aims to evaluate if using medication to block the protein will help treat cardiac sarcoidosis.

“Corticosteroids are the most commonly used treatment for sarcoidosis, but there is little data showing their efficacy and they have significant side effects,” Kron said. “Interleukin-1 is the prototypical cytokine that plays a role in most inflammatory processes. Blockade of the protein has been shown to be effective in many types of heart disease.”

While cardiac sarcoidosis is the focus of Kron’s research, she is optimistic that — if shown to be effective — the blockade could be used to treat other forms of heart disease.

Tackling cardiac sarcoidosis

VCU has led clinical and translational research of cardiac sarcoidosis for nearly a decade and VCU Health is home to the Multidisciplinary Sarcoidosis Clinic, the only center of its kind in Virginia. At the clinic, located at the VCU Health Stony Point Campus, patients are able to meet with specialists in pulmonology, cardiology, electrophysiology and rheumatology during a single appointment.

In 2011, VCU researchers teamed with researchers at the University of Michigan and the University of Colorado to start the international Cardiac Sarcoidosis Consortium. Kron is a founding member. The consortium is a prospective, multicenter registry that tracks cardiac sarcoidosis patients worldwide. It includes demographic, clinical, medication and imaging data from more than 25 contributing centers in the U.S., Europe and Asia.

Kron attributes much of the headway she has made in researching sarcoidosis to support from the Wright Center, Virginia’s first institution to receive a Clinical and Translational Science Award from the National Institutes of Health. Antonio Abbate, M.D., Ph.D., associate director of the Wright Center, has served as a mentor and co-investigator on Kron’s research. Abbate, a cardiology professor at the VCU School of Medicine and a cardiologist at the Pauley Heart Center, also will share his expertise on cardiac inflammation and interleukin-1 blockers throughout the study. F. Gerard Moeller, M.D., director of the Wright Center, and Patrick Nana-Sinkam, M.D., the center’s KL2 program co-director, provided mentorship, support and feedback on grant writing for the project as well.

“Support from the Wright Center has enabled me to build on existing relationships and create new collaborations to help advance our understanding and treatment of this complex disease,” Kron said.

Kenneth Ellenbogen, M.D., chair of the Pauley Heart Center’s Division of Cardiology, also provided significant support for Kron’s research.

“I would not be where I am today without Dr. Ellenbogen’s mentorship,” she said. “He has played an invaluable role in my research career.”

Gathering critical data

Kron, who last October was awarded an endowment fund through the Wright Center to further support her research, is joined in the study by Jennifer Jordan, Ph.D., an assistant professor in the VCU College of Engineering Department of Biomedical Engineering and director of the Cardiovascular MRI Core Lab at the Pauley Heart Center. Jordan’s research focuses on translational and clinical cardiovascular MRI techniques and cardiac magnetic resonance tissue characterization in patients who have received chemotherapy for breast cancer. For this study, she will be using her expertise in cardiac magnetic resonance to help assess inflammation in cardiac sarcoidosis and evaluate responses to treatment.

The Pauley Pilot Research Grant Program, which is made possible entirely by philanthropy, supports early stage research by physicians and scientists working to advance heart health. The program allows investigators to test novel ideas and gather enough data to apply for major research grants from institutions such as the NIH.

Kron plans to submit a proposal for external funding by February 2021.

“The results of this research will help me gather critical data to inform applications for larger grants later,” she said.