Patient-Centered Research Improves Care at CPMC
By George Nevin
Dozens of research efforts are under way at the California Pacific Medical Center Research Institute, where patient-centered research focuses on developing faster, safer, more effective, less painful means of treatment.
“At CPMCRI we are dedicated to improving patient care,” says Michael Rowbotham, M.D., the institute’s scientific director. In contrast, university-based research programs often focus more on advancing scientific knowledge than on improving patient care.
Dr. Rowbotham explains: “We have 13 basic science labs and about 30 clinical research programs; for all, the goal is improving outcomes at the bedside.”
Here is an update on three active research programs at CPMCRI:
Stroke, in which a blood clot or other blockage cuts blood flow to the brain, affects 800,000 Americans every year. Often, the result is severe paralysis, speech and cognitive problems, or death.
Since 1996, a powerful blood clot dissolver – tPA – has been available for treating the most common type of stroke. Although this drug is very effective, less than 5 percent of stroke patients receive it, because under current guidelines it is administered only to those patients who arrive at a hospital within four and one half hours of the onset of symptoms.
At CPMC, a study is under way to determine if the time window for tPA can safely be expanded to six hours by using a type of X-ray called a CT perfusion scan. This scan can quickly determine the amount of blood flow to the brain, a critical determinant of whether brain tissue lives or dies.
Validating the effectiveness of the CT perfusion scan would give physicians a powerful new tool for determining whether tPA would be helpful even after the four-hour window has closed. “If our research determines that we can safely expand the treatment time window, we could help many more patients recover from a stroke, and improve the standard of stroke care across the country. The impact on patients, their families, and society would be enormous,” explains stroke neurologist Nobl Barazangi, M.D., Ph.D., who is leading the study.
Dr. Rowbotham is directly involved in a study examining why some patients undergoing chemotherapy for cancer develop painful nerve damage from the cancer-fighting chemicals.
Dr. Rowbotham, who received the Wilbert E. Fordyce Clinical Investigator Award from the American Pain Society in 2011, says, “We are using specialized sensory testing methods and skin biopsies to look directly at nerve endings in the topmost layers of the skin to determine exactly how they are affected by chemotherapy.”
His research group has used many of these same methods to develop new treatments for chronic post-herpetic neuralgia pain following herpes zoster (shingles).
Kidney Disease Treatment
Earlier this year, the highly productive Sarwal Lab, headed by Minnie Sarwal, M.D., Ph.D., relocated to CPMC from Stanford University, where Sarwal was a professor and directed the Pediatric Kidney Transplant Program.
At CPMCRI, the lab’s 15 researchers will develop personalized medical approaches to kidney disease and transplantation. The new research initiative is called The BIOMARCC (Biomarkers in Medicine for Assessing Risk and Customizing Care) Program.
Dr. Sarwal, an award-winning researcher and physician specializing in molecular genetics, immunology, pediatrics and nephrology (kidney disease), has headed her lab for 15 years and is the recipient of multiple grants from four different National Institutes of Health.
This lab has published groundbreaking research in medical journals in the fields of transplant rejection and the body’s tolerance for transplanting kidneys and livers.
“One of our main focuses is on developing customized treatments for a patient’s specific metabolism,” she says. These treatments are based on detailed profiles created by sophisticated diagnostic tests that look at biomarkers – proteins, genes and antibodies in the body that signal the existence of a disease.
Done correctly, customized treatment not only is more effective, “it allows us to predict which treatments to avoid because of the risk of damaging side effects,” she says.
“Our goal of the BIOMARCC Program at CPMC is to take our success at developing customized treatments and apply our experience to other diseases,” she says. “Many diseases could benefit from earlier diagnosis, improved disease prediction and treatment stratification to manage patients with shared biological characteristics.”