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Triple Threat Research
The unique work of three scientists has one goal: healthier North Dakotans.
By Debra Sorvig Pedraza and Juan Pedraza
It’s the most vital biomedical research establishment in
North Dakota—the leader in the region in focusing efforts
on directly addressing the state’s major health issues.
The University of North Dakota School of Medicine and
Health Sciences—one of only 11 federally selected sites in the
nation to receive the most advanced technology—is home to
some of the country’s most forward-looking research into health
challenges such as Parkinson’s and other neurodegenerative diseases, in issues affecting aging Baby Boomers, and of the many cancers that commonly strike North Dakotans.
Among other large grants, the UND SMHS has been awarded close to $30 million over the last 10 years to advance investigations into diseases of the brain. Several other federal grants fund research in cancer, diabetes, eating disorders, alcoholism, and many other diseases of both national interest
and of special concern in North Dakota.
Several dozen researchers at the SMHS work across this spectrum, tackling solutions, not just the causes, of such diseases. Scientists call it “translational research,” and it means more therapies sooner reaching the bedside. We focus in this article on the work of three key researchers (pictured left to right):
- Gary Schwartz, PhD, MPH, PhD, an epidemiologist and expert in the causes, triggers, history, and distribution of various cancers.
- Donald Jurivich, DO and an expert on health challenges among older people.
- Jau-Shin Lou, MD, PhD, MBA, chair of neurology at both the UND SMHS and at Sanford Health in Fargo and an expert in neurodegenerative diseases.
Who is Gary Schwartz, PhD, MPH, PhD?
Gary Schwartz is professor and chair of the SMHS Dpartment of Population Health.
Schwartz’s research interest involves epidemiologic and translational studies—of screening and therapeutic trials—about the roles of Vitamin D and calcium in the natural history of prostate and other cancers. His other interests include the investigation of cancers of unknown etiology, for example, prostate and ovarian cancer and chronic lymphocytic leukemia.
Schwartz, an epidemiologist who holds two PhD degrees, studies how the biology and natural history of cancers can be used to design better screening or triage tests that can help in personalized medicine. At a recent presentation at Altru Health System, he explained that, “Men with higher calcium levels in their blood are three times more likely to die of prostate cancer, and women with higher calcium levels have a higher risk of diagnosis of and dying from ovarian cancer.” For example, during their lifetime, about 1 woman in 10 seeks surgical evaluation for a mass in her abdomen, which may be ovarian cancer. Most of these masses are not cancer, but the ones that are should be treated by a surgical specialist, since women with cancer who are treated by a surgical specialist have improved survival. Recently, Schwartz has found that calcium levels that are high predict which women with a mass have a mass that is malignant, enabling referral to specialist surgery. This is a case of “new lamps from old”—where data already in a patient’s medical chart can be used to inform key medical decisions.
Schwartz is especially interested in cancers of unknown cause that differentially affect North Dakotans. For example, for reasons that are not understood, chronic lymphocytic leukemia rates in North Dakota are among the highest in the nation. Discovering the reason behind this problem is important, not only for North Dakotans but also many others, because chronic lymphocytic leukemia is the most common leukemia in the Western world. One possible reason for the high rates in North Dakota is that levels of residential radon, a natural gas that is the product of uranium in rocks and soils and is a known cause of lung cancer, is particularly high in North Dakota. Working to educate
individuals about the potential health risks of radon and how to reduce them is one of
Schwartz’s goals for the Department of Population Health. This is just one example in which population health research at the UND School of Medicine and Health Sciences not only serves North Dakotans, Schwartz notes, but can improve health for individuals globally.
Who is Donald Jurivich, DO?
Donald Jurivich, DO (Doctor of Osteopathy), is the founding
Eva L. Gilbertson, MD, Distinguished Chair of Geriatrics at the
SMHS. He is a nationally known and respected clinician who
has conducted extensive research on aging and age-related
diseases and their treatment. All of his research is collaborative—he works with faculty and institutional leaders in the new Department of Geriatrics. This division of the SMHS
develops and provides oversight of education, research, clinical care, training, and service programs. As chair, he works with the SMHS’s clinical partners to innovatively meet the need for education and training of current and future health professionals to effectively serve an aging population. A graduate of Harvard University, Jurivich focuses on chronic ailments of the aged, including Alzheimer’s disease.
This is important to the state of North Dakota, which has an above-average life expectancy, resulting in a greater proportion of senior citizens and elders among the state’s population, according to Joshua Wynne, MD, MBA, MPH, UND vice president for health affairs and dean of the U ND School of Medicine and Health Sciences.
A clue to the mystery of Alzheimer’s—that is what Jurivich believes he and his research associates have found.
Jurivich’s most recent discovery involves a stress protein that is important in the regulation of amyloid. This starch-like protein is naturally found in the body, but sometimes gets processed the wrong way and accumulates. This aggregated form is thought to be toxic.
The body then struggles to remove the aggregated (bad) amyloid while producing the good, but sometimes producing the bad. These stress proteins resemble antibodies in the way they work—they recognize other proteins but can fight amyloid.
Jurivich studies the “master switch” of these stress proteins called HSF1 and notes that this factor is also thought to be a longevity factor that declines with age and even more so with Alzheimer’s disease.
Thus, he says, this new observation may be the first opportunity to explore a test to screen an individual’s risk for developing Alzheimer’s, as well as determining the effectiveness of treatments by monitoring HSF1 levels in white blood cells.
Because stress proteins resemble antibodies, vaccination against amyloid is considered another possible therapy for Alzheimer’s. Initial vaccination studies were unsuccessful because of adverse side effects such as brain swelling. There was too much amyloid and too much damage to have the immune system clear the amyloid “junk.”
However, new research that targets people destined to get Alzheimer’s because of their genetic predisposition indicates this treatment may prevent the onset of familial and genetically inherited Alzheimer’s before symptoms appear. Once diagnosed, Alzheimer’s patients have an 8- to 12-year life expectancy.
Dementia in general is a collection of different etiologies as to what causes memory loss. Alzheimer’s has a specific pathology, identified by plaques and tangles, found in brain biopsies. The parts of the brain selectively destroyed by disease varies with each patient. Progression or rate of deterioration with the different types of dementia varies depending on the type of dementia the patient has. Short-term memory loss, spatial awareness, and the ability to use numbers are some of the challenges that patients and their families will need to deal with—when to pull a driver’s license, take control of banking, make alternative living arrangements, and related life-altering decisions.
Jurivich and his UND colleagues are interested in identifying longevity factors that protect individuals from aging and chronic conditions.
The good news, says Jurivich, is that simple things like adequate exercise and proper nutrition such as the Mediterranean diet may promote these longevity factors and strengthen our resiliency.
Who is Jau-Shin Lou, MD, PhD, MBA?
A prominent neurologist, he’s founding chair of the Dr. Roger
Gilbertson Endowed Chair of Neurology at the University of
North Dakota School of Medicine and Health Sciences and
chair of neurology at Sanford Health, Fargo. He’s both a clinician with a growing practice at his Fargo-based neurology practice and an active researcher, delving into new and much more advanced therapies to treat Parkinson’s disease. He was voted one of U.S. News & World Report’s Best Doctors 2011–12. In addition to his clinical practice and research work, Lou teaches medical students and post-MD residents in addition to his administrative responsibilities in neurology.
In its declaration of Parkinson’s Awareness Day last spring, the North Dakota Office of the Governor noted that Parkinson’s is the second-most common neurodegenerative disease in the United States, affecting upwards of 500,000 and as many as 1.5 million people annually. The prevalence of Parkinson’s is expected to double in the next 25 years.
Parkinson’s disease is the 14th-leading cause of death in the United States, according to the Centers for Disease Control and Prevention, with an economic cost of at least $14 billion.
North Dakota is third in the nation for per capita incidence of Parkinson’s—making Jau-Shin Lou’s research program into the disease and effective treatments for it all the more compelling.
“We’re studying the use of transcranial direct current stimulation in patients with mild cognitive impairment underway to see if such treatment will improve cognitive function,” said Lou. He notes that the big promise of this technology is that it can be used by patients themselves at home, and it’s minimally invasive.
“It only takes a very small current to stimulate the brain; the patient barely feels it,” Lou said. “Another important factor is that it’s not expensive—and it can easily be used at home.”
“It’s not a magic bullet, but it’s promising,” Lou said. “Right now there’s only one device, and we’re using it in our research program.”
Once it is proved effective and safe, Lou said, the technology is designed to be a single push-button machine the patient can use at home, but it needs to be programmed by a physician.
“For Parkinson’s and other neurodegenerative diseases, this research is leading us to a noninvasive, nonpharmacological way to manage and improve the function of our patients,” Lou said. “Not all treatments need medicine. Basically, this technology is about
improving a patient’s quality of life.”