R&D 2018

[2018]

LOCKING DOORS Guarding your health against hackers Body, Cure Yourself

Thinking Outside the Classroom

Georgia’s Altered Landscape

Front

BETTER TOGETHER

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he new slogan for the James M. Hull College of Business is Better Together, and one of the standout examples of this inclusive idea is the research done by a team of three undergraduate business students working under the direction of Dr. Simon Medcalfe, associate professor of finance and economics.

As part of a Center for Undergraduate Research and Scholarship Summer Scholars Program, they helped a local nonprofit tailor its product line to maximize returns and ultimately published their research in a preeminent journal.

The problem the students were presented with is a fairly common one in business: The Augusta Training Shop, a nonprofit that employs adults with mental and physical disabilities, built a fundraising program around decorative snowflakes made from the cane they were already using for furniture repair, but they didn’t know how much the snowflakes cost to produce. Without knowing that, executive director Audrey Murell didn’t know the best price to charge or whether it made sense to offer discounts to wholesalers.

The students recommended they increase the prices of a couple of the more popular smaller snowflakes, and the Training Shop followed their advice.

“I think a project like this shows just how much better we are together,” Medcalfe says. “Faculty, students and local businesses can come together and solve a problem where otherwise, the students would have been sitting in class and the business would have been struggling.”

Through the life cycle of the project, the students presented their findings to the Training Shop’s board, presented their research at a conference in Orlando and eventually published their research in the Case Research Journal, one of the top 10 journals in management education. Medcalfe now uses the project in his microeconomics classes.

“I like the fact that it’s not just research for research’s sake,” he says. “It’s helping a business out, and it’s synergistic with my teaching and what we’re trying to do here at the business college.”

PHOTO GALLERY Visit magazines.augusta.edu to see

more snowflakes.

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OUT of the LAB

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Decorative snowflakes from Augusta Training Shop

Photo by Phil Jones ma g a zi n e s. au gu sta. e d u |

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CONTENTS Front OUT OF THE LAB............................................................................... 1 THROUGH THE SCOPE..................................................................... 4 FROM THE WIRE................................................................................ 6 MINE THE PAST.................................................................................. 9

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Back ASK THE EXPERTS........................................................................... 28 HOW IT WORKS............................................................................... 30 VALUE ADDED................................................................................. 31 ON THE EDGE.................................................................................. 32

Special Insert 2017 RESEARCH ANNUAL REPORT

17 R&D [Augusta University’s Research and Discovery Magazine] Senior Vice President for Research Michael P. Diamond, MD Vice President for Communications and Marketing Jack Evans Executive Editor Karen Gutmann Editor Eric Johnson Production Assistant John Jenkins Art Director Tricia Perea Senior Photographer Phil Jones

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2018 R&D [Augusta University’s Research & Discovery Magazine]

Features LOCKING DOORS................................................................................10 Associate professor of information security Michael Nowatkowski is passionate about his research quest: safeguarding the lives of millions of patients who depend on wireless-connected medical devices to heal or survive.

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BODY, CURE YOURSELF......................................................................14 Immunotherapy and epigenetics: whether it’s giving your immune system the tools it needs to fight cancer or using the body’s genetic road map to fight chronic illnesses, the future of medicine is, quite literally, within each of us.

THINKING OUTSIDE THE CLASSROOM.......................................... 17 Far from the stereotype of dry, theoretical study, research conducted

by College of Education faculty crackles with everyday relevance and real-world application as they work to make a very real difference in the lives of students.

GEORGIA’S ALTERED LANDSCAPE............................................... 24 The beauty of the 200-mile-long Satilla River is second to none, but Augusta University researchers believe the altering of the river’s landscape is destroying the wetland’s ecosystems.

24 R&D, Augusta University’s research and discovery magazine, is produced annually by the Office of the Senior Vice President for Research, in conjunction with the Division of Communications and Marketing. © 2018 AUGUSTA UNIVERSITY

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THROUGH the SCOPE

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WILLIAM HILL

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A phase-contrast image of transplanted mesenchymal stem cells in a mouse bone.

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2018 R&D [Augusta University’s Research & Discovery Magazine]

DOWN TO THE MARROW

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r. William Hill, professor of cellular biology and anatomy in the Medical College of Georgia, is a member of a research group studying the role adult stem cells can play in repairing damage done by strokes to the central nervous system.

He’s also part of the college’s Institute of Regenerative Medicine, exploring ways to help replace bone lost during aging, and mobilize and target stem cells to help repair different injuries.

What do these two pursuits have in common? Bone marrow.

There are two basic types of stem cells found in our bone marrow: hematopoietic stem cells (HSCs), which produce all our various blood cells, and mesenchymal stem cells (MSCs), which are responsible for producing adipocytes (fat cells), chondrocytes (cartilage cells), myocytes (muscle cells) and osteoblasts (bone cells).

MSCs are also involved in controlling immune system responses and repair processes.

“If you have a bone marrow transplant, which is done to treat leukemia or sickle cell anemia, the HSCs that give rise to red blood cells, which carry oxygen, and all of the white blood cells, which are part of the immune system, transplant and grow well; however, the MSCs do not,” Hill said. “What’s always been a big challenge is trying to transplant MSCs.” What’s worse is that as we age, we’re also losing MSCs. It’s a big problem, but not an insurmountable one. More than 10 years ago, Hill and his colleagues began looking for ways to engraft and track MSCs in mice. The results speak for themselves.

“When we put these stem cells in the mouse’s marrow and have them engraft, we increase the amount of new bone formed, even in old mice,” he said.

The trick is streamlining the process, accomplished by guiding the MSCs where they’re needed most. MSCs are notoriously difficult to identify and track, though.

To combat this, he and his team use green fluorescence protein (GFP), a modified protein produced by the Aequorea victoria jellyfish, to label the MSCs. The photo (left) shows a mouse bone treated with radiation to remove existing stem cells. Hill and his team injected MSCs labeled with GFP (green) directly into the bone marrow space to bypass the stem cells’ homing mechanisms and treated them with the chemokine protein SDF-1 to help them engraft and survive in the marrow.

“Where you see green are the transplanted cells,” Hill said. “We know they transplanted and started doing one of their normal functions because they formed new bone. Importantly, we can also follow them when they leave the bone marrow to help in repair processes throughout the body.” ma g a zi n e s. au gu sta. e d u |

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FROM the WIRE

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AUTOIMMUNE KIT RECEIVES PATENT IN 2011, professional tennis player Venus Williams dropped out of the U.S. Open and revealed to the world that she had been diagnosed with an autoimmune disease, Sjogren’s syndrome.

Researchers at Augusta University recently obtained a patent for a predictive, diagnostic and prognostic kit that will help address issues surrounding the disease.

Sjogren’s syndrome is an autoimmune disease in which the body’s immune system, for unknown reasons, attacks the cells that produce saliva and tears. The result is dry eyes, dry mouth and even tooth decay, and if left untreated, it can progress to arthritis and, in rare cases, lymphoma. Patients also experience fatigue, nausea and pain.

The disease affects approximately 1 percent of the population, according to Dr. Babak Baban, associate professor in the Dental College of Georgia and the Medical College of Georgia. It also affects more women than men, and kept Williams away from her sport for almost two years.

Baban, an immunologist, partnered with Dr. Mahmood Mozaffari, professor of oral biology at DCG, and Dr. Rafik Abdelsayed, professor of oral biology at DCG and professor of pathology at MCG, to study Sjogren’s syndrome.

“We noticed that there are a few biomarkers which increase in the patient’s tissue and salivary glands when a person has Sjogren’s syndrome,” Baban said. “We worked on these biomarkers and looked at blood circulation and noticed that there is an increase in circulation systemically when the biomarkers increase.”

The team presented their data to Augusta University’s Office of Innovation Commercialization. Though the research was in the preliminary stages, it showed that Sjogren’s syndrome could be detected in the blood in the early stages.

They developed a method that would diagnose Sjogren’s syndrome with a simple finger prick. The protocol can also determine if a person is susceptible to the disease, if they

have it and how treatment will affect each individual.

The next step was to submit a patent application to the U.S. Patent and Trademark Office. Almost three years later the USPTO approved the application and a patent was issued.

Now, the team will focus on further advancement to develop a kit with the ultimate goal of partnering with a pharmaceutical company to produce the kit.

Baban, Mozaffari and Abdelsayed are excited that their work is receiving recognition.

“It’s a great feeling to see that your efforts have been recognized not only by the university but by the federal authority,” Baban said. “This patent means they see the importance of the discovery and the value in our research, feel that it is novel and there is a demand and a need for a diagnostic kit.

The recognition is like someone saying, ‘You have something here that is worth being addressed.’ It feels great.”

HPV VACCINE SAFE AND EFFECTIVE A DECADE OF DATA on hundreds of boys and girls who received the HPV vaccine indicates the vaccine is safe and effective long term in protecting against the most virulent strains of the virus, researchers report.

The findings support more widespread and early administration of the HPV vaccine before preadolescents and adolescents are exposed to the nation’s most common sexually transmitted infection and the most common cause of cervical cancer, they report in the journal Pediatrics.

Some 79 million Americans, most in their late teens and early 20s, are infected with human papillomavirus, according to the Centers for Disease Control and Prevention.

About half of those are infected with the most virulent strains of the virus, which are targeted by the quadrivalent vaccine given to study participants.

“The vaccine was virtually 100 percent effective in preventing disease in these young individuals,” says Dr. Daron G. Ferris, 6

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professor in the Department of Obstetrics and Gynecology at the Medical College of Georgia and at the Georgia Cancer Center at Augusta University.

The quadrivalent vaccine protects against HPV types 6, 11, 16 and 18. Types 16 and 18 account for essentially all cervical cancer and for most other HPV-related cancers like penile and anal cancers, according to the National Cancer Institute. Types 6 and 11 account for about 90 percent of genital warts as well as non-cancerous tumor growths in the respiratory tract.

No cases of disease related to these four HPV types were found in study participants, who received a three-dose regimen of the vaccine when they were ages 9-15 and sexually inactive, Ferris says.

Ferris, first author of the new study who led trials of the quadrivalent vaccine in 2002, says the earlier, shorter-term evaluation clearly indicated the vaccine worked.

“We also needed to look at long-term efficacy, safety and immunogenicity,” he

2018 R&D [Augusta University’s Research & Discovery Magazine]

says. “We needed to answer questions like if we vaccinate earlier in life, will it last. The answer is yes, this cancer prevention vaccine is working incredibly well 10 years later. A booster vaccine likely will not be needed by these young people. I think now we have come full circle.”

The study was the longest follow-up to date on the vaccine. Participants were followed at 34 sites in nine countries, including MCG and the Georgia Cancer Center in Augusta. Initially about one-third of the 1,661 study participants received a placebo; however, the placebo group also received the vaccine 30 months into the study so those individuals were followed for a shorter period of time, the researchers note.

While all participants remained disease free, the earlier vaccinations produced the most robust initial and long-term antibody response, Ferris says, of levels of the infection fighters that can be measured in the blood.

GRANT CONTINUES VISION STUDY

NOT SO SWEET

THERE IS INCREASING EVIDENCE that too many sugary drinks may set us up for rapid weight gain.

Scientists have evidence that sugary drinks, even more so than sugar-laden foods, can MILLIONS OF PEOPLE around the world quickly make rats – and likely us – resistant suffer from deteriorating vision and blindness to the satiety hormone leptin. when light-sensing photoreceptor cells in the That means rats don’t get a signal that back of the eye malfunction. Called retinal normally would prompt them to stop eating degenerative disease, the two most common and/or drinking, and they gain weight. The forms are age-related macular degeneration good news is that two days after cutting out and retinitis pigmentosa. consumption of the sugary drinks, rats once The Foundation Fighting Blindness has again start getting the message leptin is awarded a three-year, $300,000 grant sending. to Dr. Sylvia Smith, a researcher “We think this adds to the and co-director of the James and evidence that it would be a Jean Culver Vision Discovery good thing not to drink a lot Institute at Augusta University, READ MORE AT of sugar,” says Dr. Ruth B.S. to further study retinitis Harris, physiologist in the JAGWIRE.AUGUSTA.EDU/ pigmentosa. Smith’s team is Department of Physiology one of only six research teams RESEARCH at the Medical College of in the country to receive an Georgia at Augusta University. individual investigator research About a third of adults and 17 award from the foundation. percent of children are obese in the Smith, a Regents Professor and the United States, and sugary beverages are Department Chair of Cellular Biology clearly implicated in this health concern, says and Anatomy at the Medical College of Harris.

Georgia, is studying the role that a particular “When you drink a sweetened drink you’re pain medicine could play in preserving getting just the sucrose,” she says. “Whereas if vision. In an animal model with severe retinal you eat foods that are sweet, you are getting the degeneration, the drug pentazocine – a sucrose that is mixed in with other things like narcotic analgesic – enables the survival of protein and fiber.” cone cells, a type of photoreceptor, according Food must first be digested before glucose to Smith. reaches the blood, while sugary liquids are more There was a “striking” preservation of rapid-fire. cone function in affected mice treated with “When you are just drinking sucrose by itself, pentazocine, said Smith, retinal cell biologist all you have is the sucrose, which breaks down and corresponding author of the study, to glucose and fructose, which get absorbed which was recently published in the journal very quickly, so you see a very quick spike of Proceedings of the National Academy of Sciences. glucose just because it’s processed in a different In fact, cone function was essentially the same as in normal mice, while vision loss progressed way,” says Harris. She recently received a $1.6 million grant from the National Institutes of as expected in untreated mutant mice.

Health to learn more about the details of what Another finding in Smith’s study was happens when the spikes become too frequent. that mice lacking sigma 1 receptor did not When we eat or drink sucrose, or sugar, benefit from pentazocine treatment, more our body converts it to glucose and fructose evidence of the receptor’s essential role in that we can use for energy. The hexosamine retinal protection. Last summer, in the journal biosynthetic pathway, also called the nutrient Free Radical Biology and Medicine, Smith’s lab sensing pathway, helps us metabolize about 3 showed sigma 1 receptor’s clear role in a percent of our glucose so it typically doesn’t healthy retina. have a high activity level. Rather, it’s kind of The grant from the Foundation Fighting running in the background, Harris explains.

Blindness will enable Smith to bolster her But it still has a lot of impact helping control research in targeting sigma 1 receptor in whether a host of proteins are turned off or on. retinitis pigmentosa.

That includes, a little indirectly, leptin.

The pathway produces a functional piece of a carbohydrate called O-GlcNAc that attaches to a protein to turn it off or on. Logically, the more sucrose you consume, the more glucose this pathway has to handle and the more O-GlcNAc gets produced and attached to proteins. That’s where the scientists think our sensitivity to leptin gets messed up.

One of the proteins O-GlcNAc attaches to is STAT3, a transcription factor that makes things happen. This STAT3 is one of the key proteins normally activated by leptin. But, Harris and her team hypothesize that – and have evidence that – chronic surges in blood glucose that result from regularly drinking sugary drinks ultimately mean O-GlcNAc modifies STAT3 to the point that when leptin tries to attach to a phosphate that would make STAT3 active, it no longer responds normally.

“The leptin comes along and it can’t make STAT3 any more active,” Harris says. So the rats – and possibly us – just keep drinking the sugary drinks. More typically in response to leptin, rats would reduce their food and sugary drink intake over the next 23 hours.

Now Harris and her research team want to answer questions like what happens if the rats drink no-calorie saccharine water instead.

They also are working to learn more about how chronic activation of the hexosamine biosynthetic pathway inhibits leptin signaling and what happens when they circumvent the pathway. They also are looking directly at their intersection by exploring what happens to leptin responsiveness when they activate and inhibit the hexosamine biosynthetic pathway in the brains of control versus sucroseconsuming rats.

In her studies, some of the rats have plain water, food and sucrose water always available to them; others have the usual rodent food and plain water. “They really like the sucrose solution,” she says, and rather quickly will drink more and more, eat less food and drink almost no plain water.

By day 25, the females no longer respond to leptin; by day 31, neither do the males. After just two days without sucrose solution, both genders do respond again. When researchers tried to induce leptin resistance with a high-fat diet, it took a lot longer to happen, if ever.

“If you don’t respond to leptin, the leptin is not going to suppress food intake,” Harris says.

“That means you are at risk for overeating and gaining more weight.”

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FROM the WIRE

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CANCER TREATMENT GETS SMALL A MICROSCOPIC STRUCTURE that has been used in ketchup could be the key to revolutionizing medical procedures, including cancer treatment, according to a team of researchers from Augusta University, the Applied Research Center and Savannah River National Laboratory.

Silica has been used in some ketchup formulas to thin it out when the bottle is shaken.

In the human body, a modified version of the compound known as glass microspheres could be used to deliver medication on target, releasing the drug at will and on a schedule, according to research by Dr. George Wicks, a materials scientist at the Applied Research Center, Dr. Paul Weinberger, former otolaryngology surgeon at Augusta University, and Dr. William Hill, professor of cellular biology and anatomy at the Medical College of Georgia at Augusta University.

Based on their experiments, the three researchers founded SpheroFill, a new biotech company aimed at developing the microspheres for biomedical use. The company was created with the help of Augusta University’s Office of Innovation

Commercialization, Savannah River National Laboratory and the Applied Research Center.

Originally invented at Savannah River National Laboratory and improved upon

by Applied Research Center, work on the microspheres began as a project focused on developing an improved system for hydrogen isotope separations and national security uses.

“The main goal of our company is to improve the health and lives of people with this technology,” said Weinberger, who is also an alumnus of the university’s Medical College of Georgia. “This is another step in making the dream that started at Savannah River National Laboratory a reality. It was visionary and fantastic of the Department of Energy to let us take a technology initiated for national security into a new and exciting field.”

The uniqueness of the glass microspheres lies in their porous shell. Measuring about one-third the diameter of a human hair, the microspheres have even tinier pores, which are considered a new type of nanotechnology.

These pores are interconnected by nanotunnels that can be sealed and unsealed at will.

“This really represents a very exciting new class of composite materials developed by an

interdisciplinary team,” Wicks said. “In each of the areas of the medical profession, there seems to be a whole host of potential uses.”

Initially, the three researchers plan on using the microspheres as fillers to replace vocal cord tissue lost due to aging or nerve injury. Eventually, they plan to load the hollow structures with medication and enhance them with a bioactive coating. The microspheres can then be injected locally and programmed for a controlled release of drugs.

“It’s an innovative technology with commercial potential that was only made possible through collaboration between a team of researchers and the support and work of Savannah River National Laboratory, the Applied Research Center and Augusta University,” said Carl Clark, director of the Office of Innovation Commercialization at Augusta University. “We are ready to support this new biotech startup, and we are excited to see what this talented, interdisciplinary team of researchersis going to accomplish in the next few years and in the next few decades.”

Future applications of this new nanotechnology will include plastic surgery, muscle and bone repair, and cancer treatment.

CAN MAGNETISM CURE TOO-HOT HANDHELDS? HAVE YOU EVER noticed how hot a laptop or cell phone can get after hours of use? This is one of the biggest problems with modern-day electronics, according to Dr. Trinanjan Datta, associate professor of physics in the Augusta University College of Science & Mathematics.

When electronic devices overheat, it can cause an increase in the electric bill. This is the focus of Datta’s newest research project.

He is searching for a way to mitigate heating problems and make electronic devices work in a more efficient way.

In order to do this, Datta is researching the fundamental material properties of magnetic systems.

“I use theoretical and computational modeling to figure out how X-rays interact with magnets, and this interaction is what I try to explain from a fundamental perspective,” Datta said.

Datta partnered with Dr. Dao-Xin Yao, professor in the school of physics at Sun Yat-sen

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University in China, on this project.

“We’ve been collaborating since 2011, because my expertise is in magnetism, and he also works in the same area,” Datta said. “I’ve been providing his research group with my expertise in magnetism calculations. I have several graduate students in China and undergraduate students at Augusta University. We work in close collaboration to do these calculations.”

Datta and Yao were recently awarded a research grant from the State Key Laboratory of Optoelectronics Materials at Sun Yat-Sen University for their project. The $27,000 grant is part of an initiative to support foreign collaborators with their research efforts.

This grant will fund Datta and Yao’s efforts to create energy-efficient photo electronic devices.

The pair expects their research project will predict novel magnetic materials which can lead to energy-efficient solar cells.

“We hope this research will provide the fundamental knowledge for predicting

2018 R&D [Augusta University’s Research & Discovery Magazine]

novel and new materials that are crucial to the fabrication of the next generation of functional materials for computer storage, telecommunications technology and optoelectronic devices,” Datta said.

This project will also provide Datta’s undergraduate and graduate students with invaluable experience. In fact, Datta and Yao, together with their students, have published six papers on magnetism since 2012.

“The collaboration exposes students in the university to international collaboration between two nations who are striving for the best,” Datta said. “For undergraduates, it gives them the opportunity to see how graduate students at a top global research university function and how they perform.”

Datta is looking forward to this collaboration with Yao, as well as future projects.

“We’ll probably collaborate until both of us retire,” Datta said. “At least, that’s what the plan is right now.”

MINE the PAST

] PHIL JONES

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Dr. Joseph Hobbs

ON THE SHOULDERS OF GIANTS IN 1974, DR. JOSEPH HOBBS graduated from the Medical College of Georgia. He has since spent his entire career at Augusta University and is now the chair of the Department of Family Medicine and the senior associate dean for faculty affairs and primary care.

Medicine was not Hobbs’ first career choice. As a boy, he dreamed of a career as a scientist. Maybe he would become an astronaut and be the first man to explore some distant planet. This boyhood fascination with space flight was the basis of his growing interest in biological sciences.

However, after a summer at Harvard University doing basic science work and getting a better understanding of what a scientist does, Hobbs began to look at

medicine as an opportunity to not only explore his science interest but to teach as well. Then, during Hobbs’ junior year of college, he first heard the names John Harper and Frank Rumph. This changed everything.

Fifty years ago, Harper and Rumph became the first African-American students to attend the newly integrated Medical College of Georgia.

Their attendance had a big impact on Hobbs’ decision to apply for medical school at MCG, though he still had apprehensions about the school’s commitment to AfricanAmerican students.

Those apprehensions disappeared when he received his acceptance letter — personally delivered by the dean of student affairs.

“This was the first time I got a sense that the MCG administration was serious about desegregation,” he said. “They weren’t doing it just to comply with federal laws.”

Now, Hobbs is in the position to spearhead many of the events commemorating those trailblazers, including a special hooding ceremony for Harper and Rumph.

Without their leadership, Hobbs and those who followed would not have been able to provide the foundation of support enjoyed by the generations of African-American doctors and researchers who followed.

“In the back of my mind, I’ve always had a special place for their contributions to my life,” Hobbs said. “Because they were there for me, I think it made it almost mandatory that I’m there for others.” ma g a zi n e s. au gu sta. e d u |

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PHOTO ILLUSTRATION BY PHIL JONES

Features

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LOCKING DOORS

GROWING UP, Michael Nowatkowski had a passion for building things that made his life easier.

By Arthur Takahashi Once, he built a string system in his bedroom, connecting the top of his closet door to the door frame. He then tied a counterweight to the other side of the string to automatically shut his closet door. He was only 8 — and had no internet or YouTube to consult.

“I was lazy as a kid, and it was a lot of effort to close my closet door,” he said, his eyes twinkling at the memory. “I don’t know… I always just enjoyed tinkering and building things.”

This passion for building physical systems would later define his career path. An associate professor of information security at Augusta University, Nowatkowski would eventually use his ability to solve problems to guide him through his current research quest: safeguarding the lives of millions of patients who depend on wirelessconnected medical devices to heal or survive.

A CAUTIONARY TALE ABOUT AN UNLOCKED DOOR A man in his late 60s decides to take on a stressful job despite a family history of heart disease and after surviving four heart attacks.

As a precaution, he gets a pacemaker implanted in his chest to control his heartbeat through low-voltage electrical shocks — a decision that could potentially save his life.

The problem, however, lies in the device’s wireless function, which is a door easily opened by hackers intent on causing bodily harm. By modifying the electrical pulse that controls the man’s heartbeat, they could cause a major heart attack.

The risk of this happening might seem slim for most of us, but in this case, the man in question is the vice president of the United States — and not a fictional one, but the real one.

In 2007, then Vice President Dick Cheney actually had the wireless function of his pacemaker turned off for fear of an assassination attempt.

When Cheney made this alarming revelation in an interview with 60 Minutes in 2013, Nowatkowski — like other cybersecurity professionals — already knew about the potential security flaws of medical devices.

At the time, Nowatkowski was an associate professor of electrical engineering and computer science at the U.S. Military Academy at West Point. There, displaying the same enthusiasm and ingenuity he had as a child, he taught electrical engineering courses, helping students build electric circuits through fun, hands-on projects like building nightlights that turned on automatically when it got dark or karaoke machines that could work with a standard MP3 file.

A lieutenant colonel in the U.S. Army with a doctorate in electrical and computer engineering, Nowatkowski did not want to just build electrical systems. He wanted to build chips that were secure and wanted to teach his students that concept.

“I enjoy looking at the hardware side of cybersecurity — how do we protect the devices physically and how can we configure the hardware in the system to make it more secure,” he said.

Cheney’s revelation made a powerful case for protecting these vulnerable devices.

Although Nowatkowski was not yet researching the flaws of medical devices at that time, his 2016 move from West Point to Augusta University, Georgia’s only public academic health center, would change that.

“Seeing the close relationship we have with the hospital and the health care profession — I think it really caused me to start thinking about, ‘let’s look at medical devices as a potential area of research,’” he said.

LOCKING A DOOR Once, Americans felt comfortable leaving their front doors unlocked, but times have changed.

Times have also changed when it comes to medical devices, but technology hasn’t kept pace. For most of these devices, locks don’t exist.

“These were meant to be used in a controlled environment where you wouldn’t just have somebody walk up to the device and access it,” Nowatkowski said. “But they are wireless-enabled now, so somebody could be sitting in the waiting room or the lobby and potentially get in wirelessly to these devices.”

Through a review of the literature, Nowatkowski found that these medical devices have authentication flaws, including not requiring a password to access them.

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[Medical devices] are wirelessenabled now, so somebody could be sitting in the waiting room and potentially get in wirelessly to these devices.

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— Michael Nowatkowski, PhD

Having no password is the same as never locking your front door.

In other cases, devices do have an authentication process, but the password is written on the manual and cannot be changed.

That is the same as locking your front door but leaving the key under the rug with a sign that says “The key is right here.”

What could hackers do with that key?

Best-case scenario? They could easily get into these devices and steal people’s medical information, including names, birth dates, insurance and prescription information, and Social Security numbers.

Worst-case scenario? Cyber criminals could modify the data they found in the devices, including increasing a pacemaker’s shock intensity or altering the dosage in IV pumps or the insulin amount in insulin pumps.

The result would be Cheney’s nightmare scenario: death by cyberattack.

Given the risks, Nowatkowski wants to secure the authentication door. But to fix the problem, he first needs to find the flaws in the devices — a process he first learned when he was a child.

“I remember my grandfather was always fixing things,” he said. “The TV would stop working, and he’d tear the back of the TV open and pull some of the tubes out. We’d go to the store and put them in the little tube tester machine and would figure out which one was not working.... I thought it was really neat that he was able to do something like that.”

Following that same process in his current research, Nowatkowski will first disassemble 10 single- and 3 triple-channel IV pumps, analyze and test their chips, and identify their security flaws.

Only then will he be in a position to fix the problem and make those devices more secure.

Once he identifies the flaws, he will compare his findings with the literature. If there is a match, he will use the same tools and processes to analyze other medical devices — the ones people are bringing home.

“I would hate to think that there are folks out there that would indiscriminately hack into people’s medical devices and try to kill them,” Nowatkowski said. “I would almost think that the danger is more in the bad guys trying to get in and steal information.”

By connecting their medical devices to their home network — the same one their

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PHIL JONES

Michael Nowatkowski

personal computers are already connected to — people are putting their medical information at risk.

“When they are going out and clicking on links and introducing vulnerabilities to their home computer, there’s a chance that those vulnerabilities could then extend access to their medical devices,” Nowatkowski said. “These devices are going to be sending data back to their caregiver, potentially to their insurance company, potentially to the device manufacturer, so there’s a lot of different connections that these devices will have for sending and receiving data.”

In an unsecure home network, hackers can easily intercept these connections and read people’s medical information.

Why would they want this type of information? Because it is 5 to 10 times more valuable than your credit card information, Nowatkowski said.

“You are not likely going to change your insurance company, or you are not going to change your Social Security number,” he said.

“It’s much harder to change your medical information than it is to get a new credit card.”

Securing that medical information is fundamental for Nowatkowski’s research.

Though Cheney’s concerns were valid, for most of us the risk of medical harm inflicted by hackers is far less than the risk of not relying on medical devices.

“You are better off having your medical device and being healthy,” Nowatkowski said. “I think the risk of you having serious problems because of the medical condition is higher than the risk of you being affected by a hacker that’s hacking into your medical device.”

LOCKING OTHER DOORS Because of their portability, convenience and wireless connectivity, new medical devices have become part of the Internet of Things — a network of computerized, everyday devices like smart TVs, thermostats and light bulbs that supposedly makes people’s lives easier.

All these systems have the same basic construct, so Nowatkowski’s research on medical devices has broader implications for the future of the Internet of Things.

“If we can … figure out principles for secure design of those medical devices, the long-range goal is to apply those same principles to all sorts of small embedded-system devices,” Nowatkowski said.

His research, therefore, would eventually make it more difficult for a criminal to hack into your home network and watch you through your baby monitor or security cameras or even gain control over your thermostat or smart TV. For now, however, the Internet of Things still presents a great risk to users by giving hackers multiple entry points into a home network.

“Manufacturers for these devices are trying to get these products to market as quickly as they can for as cheaply as they can,” Nowatkowski said. “The secure design of these devices is really an afterthought.”

With his research, he hopes to change this reality.

ma g a zi n e s. au gu sta. e d u | 13

BODY, CURE YOURSELF IMMUNOTHERAPY AND EPIGENETICS are reshaping the future of health care from inside your body.

PHOTO ILLUSTRATION BY PHIL JONES

By Nick Garrett The market for curing childhood cancer is tiny. The reasons why are many.

For one thing, childhood cancer is extremely rare. According to the National Cancer Institute, in 2014, there were only 15,780 cancer diagnoses in children aged 0-19 in the United States. Compare that to more than 1,685,000 total diagnoses in 2016. Second, most children survive their cancer diagnoses. According to St. Jude Children’s Research Hospital, 98 percent of children diagnosed with acute lymphoblastic leukemia go into remission within weeks of beginning treatment. Of those, 90 percent go on to be fully cured. Rates vary from cancer to cancer, but even against the most aggressive brain tumors, children typically fare better than adults. Add to that the complications involved with starting clinical trials for children — finding affordable drugs, getting informed consent — and it’s amazing anyone tries.

From a market standpoint, it’s a lot of effort for not much return.

However, for Dr. David Munn, co-founder of the Pediatric Immunotherapy Program at Augusta University, it’s more than worth it. He and his colleagues at the Medical College of Georgia and the Georgia Cancer Center have been trying to close the gap between “cured for a while” and “cured forever” in childhood cancer for the last 20 years.

An alumnus of MCG (MD ’84), Munn returned after graduation largely because of the university’s emphasis on patient-and-family-centered care.

“One of the reasons I came back is that we don’t make a distinction if you’re rich or poor, black or white,” Munn said.

Once back, he began working with Dr. Andrew Mellor, co-leader of the Cancer Immunology, Inflammation and Tolerance Program. Together, they began researching an enzyme with a great deal of immunotherapy potential: Indoleamine 2,3-dioxygenase, better known by its acronym, IDO. The foundation of immunotherapy is helping the body fight its own battles, but the process isn’t always smooth. Munn jokes with his students that the immune system is the only part of the body that will actively try to kill its host while doing its job. It’s a formidable opponent. Especially when left to its own devices.

Continued on next page

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David Munn

PHIL JONES

Debbie Layman

ma g a zi n e s. au gu sta. e d u | 15

Despite the intimate nature of medicine, the discipline is only now becoming personalized.

Advancements like those developed

by Munn and the College of Nursing are on the leading edge of health care.

And they’re only the beginning.

“The immune system spends most of its time and effort keeping itself turned off,” Munn said.

“Because of this, it needs a sort of yin and yang to function properly, to know when to attack this and when to back off and not attack that.”

In some cases, IDO is the trigger that flips that switch.

IDO expression is at its highest in the womb during pregnancy. Using this knowledge, Munn and Mellor began studying the role IDO plays in pregnant women’s immune responses. Originally researchers assumed the increased expression of IDO was a response from the mother—a sort of biological kill switch designed to keep the immune system from destroying a fetus in the early stages of pregnancy. What Munn and Mellor discovered was just the opposite.

The mother’s body doesn’t express IDO to protect its fetus; the fetus expresses IDO to protect itself from mom’s immune system. It was a remarkable discovery for many reasons, not the least of which being that some cancerous tumors also express IDO in large quantities.

“Essentially, IDO helps tumors hide behind normal tissue,” Munn said. “By expressing IDO, the tumor gives the immune system the order not to attack.”

Munn and Mellor expanded on that concept, obtaining a patent on their findings which paved the way for the development of new drugs for clinical use. Together, they partnered with biopharmaceutical company NewLink Genetics Corporation to speed up the development process. Now, one of the drugs developed, Indoximod, is being used in clinical trials for children with brain tumors — right here at home.

Along with Dr. Ted Johnson, another MCG graduate, Munn founded the Pediatric Immunotherapy Program in the hopes of discovering a more effective, less toxic front-line treatment for children with brain tumors. Drugs like Indoximod, which inhibit the expression of IDO, help kids to better fight their own cancer.

While Munn and Johnson focus on helping bodies fight their own battles, the College of Nursing is hard at work battling chronic disease in a different way.

In February 2017, the college launched its new Family Epigenetics Program (FEP) to conduct family epigenetic research and integrate it into new technologies and frontline health strategies.

Dr. Pam Shiao, associate dean for research, said the driving force behind the FEP was a new emphasis on “Omics” tech and epigenetic research. (“Omics” is a catch-all term for biology fields ending in –omics, such as genomics or metabolomics.) The goal is to help individuals and families determine how best to care for themselves on a case-by-case basis.

But what are epigenetics?

If the human body were a computer, genes would be the software that defines how it runs.

Genes govern every aspect of our lives: the color of our eyes, the way our digestive organs process fat, our likelihood of getting cancer. And, as is often the case with software, when newer versions roll out, glitches sometimes get buried inside the original code. Over the course of a lifetime, various genes can “tag” themselves to switch on or off to better adjust to conditions within the body. A child who experiences starvation in utero and early in life may have a greater likelihood of dying from obesity-related cardiac disease, for example, because certain genes which regulate fat storage may have tagged themselves “switched off” during adolescence.

The process of cataloging these on-and-off tags in an individual is referred to as epigenetics.

Research has shown these on-and-off tags can even be passed from parent to child. While this can sometimes be beneficial, it can also be dangerous as chronic conditions like heart disease, diabetes and obesity can also be passed down through family trees.

Finding these tags and using them to treat individual patients according to their own genetics is the future of personalized medicine.

“Personalized health care will benefit those living with multiple chronic health conditions that impact across generations,” Shiao said. “Using epigenetics, which are known to affect cancers, heart disease and congenital defects, the FEP envisions that new, precision-based health strategies will optimize access to healthy living globally.”

Despite the intimate nature of medicine, the discipline is only now becoming personalized.

Advancements like those developed by Munn and the College of Nursing are on the leading edge of health care. And they’re only the beginning. Whether it’s giving your immune system the tools it needs to fight cancer, or using the body’s genetic road map to fight chronic illnesses, the future of medicine is, quite literally, within each of us.

Health care — for you, by you.

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Features

THINKING OUTSIDE THE CLASSROOM

THE COLLEGE OF EDUCATION offers a wide variety of career paths for its students, ranging from mental health counseling to exercise and sports science to music education. At its core, however, the college is committed to teaching its students to make a difference in the world, and nowhere is that commitment more evident than in the research being conducted by its faculty.

Far from the dry, theoretical research many outside the education field associate with the profession, much of the research coming out of the College of Education crackles with everyday relevance and real-world application.

The following faculty members represent just a few of those making a very real difference with their research.

Stories by Brennan Meagher Photos by Phil Jones

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DR. MEREDITH RAUSCH:

RESILIENCE AND THE MILITARY Much of Dr. Meredith Rausch’s research focuses on the military, and it is intensely personal.

“I come from a military family,” said Rausch, assistant professor in the Department of Advanced Studies and Innovation. “My dad, uncle and grandfather were all military, but I was unable to join the military because I was born with a heart issue. So, I feel like I can serve my country by serving those who have served us.”

Rausch recently completed a research project in partnership with Dr. Megan Buning, assistant professor of research.

Together, they surveyed students on the Augusta University campus who are using military benefits in an effort to learn what Augusta professors are doing that is helpful for this group of students as well as what is making it harder for these students to transition to the civilian classroom.

“We discovered transitioning students tend to have more responsibility than traditional undergraduate students,” she said. “Therefore, group projects tend to be a problem.”

In addition, their maturity levels are also different, so they tend to struggle in classrooms where teachers don’t keep strict control of the classroom environment.

“It makes them feel unsafe because they’re not used to that culture,” Rausch said.

According to Rausch, it’s also important for professors to realize that not every military student has PTSD or a traumatic brain injury, but they do have a rich history and can bring a lot to the classroom.

Other research projects Rausch is working on include mentorship of women, lesbian and queer women going through the fertility process, and improv comedy.

“

I feel like I can serve my country by serving those who have served us.

“

— Dr. Meredith Rausch

Dr. Meredith Rausch and Augusta University ROTC

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DR. MALEAH HOLLAND:

KETOGENIC DIET

While in college, Dr. Maleah Holland, assistant professor in the Department of Kinesiology, was both a field hockey and track and field athlete. Her participation in sports led to a few injuries, particularly head injuries.

Holland eventually transitioned from an athlete to a researcher, electing to study the ketogenic diet in rats for her dissertation because of her personal association with the diet.

“I ended up deciding to try the ketogenic diet,” she said. “It helped my brain energy levels. I felt completely different, and thought ‘I want to study this.’”

The ketogenic diet, often called a low-carb diet, and ketones, produced when the body converts fat to energy, are now the focus of much of Holland’s research.

Ketones have proven beneficial for conditions such as brain cancer, Parkinson’s, Alzheimer’s and epilepsy, according to Holland. Holland’s research explores the benefits of ketones in cognitive development and exercise fatigue.

“Most people take in sugar for energy,” she said. “This is a different source, but provides the same type of energy for the brain. It’s supposed to be a clean-burning energy for the brain.”

Holland’s next project will focus on the ketogenic diet and patients with post-traumatic stress disorder (PTSD).

She plans to compare patients with PTSD who take ketone supplements for six weeks with patients who eat ketogenic meals for six weeks.

“The ideal outcome is that there will be great benefits from ketone supplements,” she said. “I believe the benefits will mainly be cognitive. We may also see patients experience weight loss or less oxidative stress.”

“

[A ketogenic diet is] supposed to be a cleaner burning energy for the brain.

“

— Dr. Maleah Holland

Continued on next page

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Dr. Maleah Holland poses with ketogenic diet-friendly foods at Good Earth Produce & Garden Center. ma g a zi n e s. au gu sta. e d u | 21

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DR. ASHLEY GESS:

INTEGRATIVE STEAM/STEM EDUCATION

Dr. Ashley Gess (left) and students from the Jessye Norman School for the Arts

According to Dr. Ashley Gess, integrative STEAM/STEM education is an educational approach where teachers intentionally design opportunities for their students to engage in the design process and transfer knowledge from one context to another.

In her approach to this type of learning, Gess intentionally removes the period from the acronyms.

“We take the dots out so it becomes more than just talking about subjects,” she said. “It becomes an educational approach in the classroom.”

When Gess first arrived at Augusta University, she conducted a needs assessment in public schools within the Central Savannah River Area.

“There were no Georgia STEM-certified schools when I arrived, and I wanted to understand why,” she said.

Now, in one initiative she has named STEAMteams, approximately 120 teachers from six counties work with Gess and her colleagues once a month. The teachers are tracked throughout the year with regard to self-efficacy, inquiry teaching and their interest in teaching using a STEM approach. An additional 44 teachers are working to obtain nine graduate credit hours toward the newly approved STEM endorsement.

Gess has also partnered with the Jessye Norman School for the Arts to bring science theater into schools and communities.

“Part of what plagues our schools, especially rural schools or those with higher incidence of families in poverty, is that they can’t get to places like museums,” she said. “We’re trying to develop science theater and bring it to them. The goal is to promote student interest and, by extension, improve students’ persistence in STEM disciplines.”

Gess is hoping to specifically target women and minorities with the partnership.

“A lot of STEM research has shown that women achieve at the same rate as men, and sometimes exceed men, but don’t persist in STEM subjects,” she said.

At the heart of Gess’ love for STEAM/STEM education is the desire for students and teachers alike to receive the opportunity to chase their dreams.

“So many people, including women, under-represented minorities and folks with disabilities get locked out of going after their dreams,” she said. “However, with a STEAM classroom, everyone wins.” ma g a zi n e s. au gu sta. e d u | 23

PHOTOS BY PHIL JONES

Jessica Reichmuth (front) and students from a 2015 trip 24 | 2018 R&D [Augusta University’s Research & Discovery Magazine]

GEORGIA’S ALTERED LANDSCAPE THE BEAUTY of the 200-mile Satilla River is second to none, but Augusta University researchers believe the altering of the river’s landscape is destroying the wetland’s ecosystem.

By Danielle Harris From the enchanting Callaway Gardents to the breathtaking waterfalls in the Chattahoochee National Forest, Georgia has no shortage of stunning locations.

One of Georgia’s hidden gems is the Satilla River, which stretches over 200 miles. Numerous species of fish, amphibians, reptiles, birds and mammals call this basin home. The diversity of the river’s wildlife includes common species, but among them are endangered animals such as the indigo snake, the wood stork and the redbreast sunfish.

Although the river’s beauty is often described as being second to none, Augusta University researchers believe the altering of the river’s landscape is destroying the wetland’s ecosystems.

PLUNGING INTO CRISIS Over the last 100 years, the Satilla River has been cut eight times for industry purposes. However, the most notable passage is Noyes Cut, which was originally opened in 1910 for log transport and then expanded in the 1930s by the U.S. Army Corps of Engineers.

Since its expansion, Noyes Cut has not been maintained or managed, said Augusta University biology professor Jessica Reichmuth. This has resulted in an increase of sedimentation downstream as well as changes in the water’s flow and dissolved oxygen level more than likely caused by altered tidal exchange.

“With these changes to the water column, we are now beginning to see a potential impact in the area’s estuarine community,” Reichmuth said. “Research is showing a change in distribution of resident and migrating fish species in addition to commercial species including white shrimp, American oyster and the blue crab.”

The first complaints about the river’s sedimentation levels were made in 1935 by Dover Bluff Club landowners, after which scientists began researching the property. However, Reichmuth says these past studies primarily focused on the water chemistry, noting changes in salinity, dissolved oxygen and water flow. The goal of her study is to provide a more holistic assessment of the area by combining an analysis of the water quality and chemistry as well as the biology and ecology of the river’s estuary.

For over three years, Reichmuth and other faculty from Augusta University’s Department of Biological Sciences (in addition to faculty from Georgia Southern University) have studied the river’s estuarine systems by pulling samples from four sites, including Piney

Bluff Node and Noyes Cut, to study the area’s fish assemblages, invertebrate and plant communities, soil microbiology and water chemistry.

The research team’s combined analysis of sediment metal and sediment grain size revealed the highest levels of silt and metals are found at the river’s Piney Bluff Node, which sits downstream of Noyes Cut. This area also showed a decrease in salinity and fish assemblage diversity, including the absence of long-distance migrators and diadromous fish such as American eel and striped bass.

These changes in the river’s ecosystem support Reichmuth’s hypothesis that Noyes Cut has altered the flow in that portion of the Satilla River.

“Our data continues to show evidence that the altered landscape has impacted the wetland environment, and the accumulation of metals and silt is having a profound effect on the microbial community as well as the carbon cycling and other important biogeochemical cycles,” Reichmuth said.

Reichmuth’s research team has been working closely with the U.S. Army Corps of Engineering on this crisis, and even when the Corps concludes its modeling efforts later this year, Reichmuth’s team plans to continue assessing the interactions between the area’s structural development and the wetland’s ecosystem.

TURNING OF THE TIDES Accompanying Reichmuth’s research team on this project are students enrolled in her biology undergraduate research course, and they have volunteered nearly 2,500 hours to the study. Reichmuth says she is using this project to help them think outside of the classroom and apply what they learn in lectures to real-world problems.

Senior cellular molecular biology major Alexander Leach has been studying the Satilla River’s soil bacteria since 2015, and he hopes to present his results by the end of the year.

“I have learned so much by working on this study, and the firsthand experience has made me more conscious of what I am doing with my own work in class,” Leach said. “The opportunity of working with professionals and faculty has been an eye-opening experience, and I have considered pursuing a graduate degree in ecology and research.”

Senior ecology major Elise Thomas and senior cellular molecular Continued on next page

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The research team during a 2015 trip

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Students from a 2015 trip

biology major Keturah Mingledolph have also worked on this project for two years and share similar stories.

“Since working on this project, I have studied the genetic diversity of the river’s crabs and sampled the stomach contents of over 200 blue crabs to learn more about their diet,” Mingledolph said. “This has been such an amazing experience, and it feels good to know that our work will help to make things better for those living near the Satilla River.”

“We learn about so many organisms in zoology, and to get a chance to see them in person is mind-blowing,” Thomas said. “For the last year and a half, I have visited the river every month studying diatoms, and I plan to continue this research even after I graduate next spring.”

Oftentimes, undergraduate research is viewed as beneficial only for the students.

However, Reichmuth says seeing her students participate in this study is a full-circle moment for her.

“I see myself in these students because it was undergraduate research like this that inspired my career path” Reichmuth said. “I feel like I’m passing the baton to the next generation of scientists, because when our students succeed that means we succeed.”

Many of the students who have participated in the Satilla River study have presented their results at various conferences throughout the country, and some will have their work published in peerreviewed journals.

This study was initially funded for the first year through Augusta University’s Center for Undergraduate Research and Scholarship Summer Scholars Program in addition to the Small Grants Program. The previous two years were funded by the Georgia Department of Resources Coastal Incentive Grant Program. Reichmuth is currently applying for more funding and hopes to have a complete ecological assessment soon.

Students from the 2017 class measure a blue crab. ma g a zi n e s. au gu sta. e d u | 27

Back

WE ASKED TWO EXPERTS AT THE GEORGIA CANCER CENTER …

How does research at the Georgia Cancer Center benefit patients in Georgia and beyond?

Not only do they treat patients with current standard of treatment options for cancer patients, Dr. Anand Jillella, J. Harold Harrison, MD, Distinguished University Chair in Medical Oncology and Dr. Sharad Ghamande, director of Gynecologic Oncology and the associate director for Clinical Trials and Research for the Georgia Cancer Center at Augusta University, have also done a lot of work in clinical research studies looking for what will be tomorrow’s standard of care. Jillella’s area of focus is acute promyelocytic leukemia (APL) and Ghamande’s expertise is in gynecological cancers, especially recurrent ovarian and cervical cancer.

GHAMANDE: Clinical research is a very important part of what we do at the Georgia Cancer Center. It is one of the three pillars of our mission, the other two being basic science research and clinical care. One of the big research projects we have going on right now is the National Cancer Institute Community Oncology Research Program (NCORP). We are one of 12 sites in the United States awarded this five-year grant focusing on getting minority and underserved patients to enroll in cutting-edge clinical trials.

JILLELLA: When I came back to the Georgia Cancer Center, one of my goals was to build a stronger network with hospitals, doctor’s offices and clinics across the state. We want those institutions to know they can send their patients to see our doctors and take part in their clinical trials. I truly believe we have one of the most well established networks in the state. We made it our business to go to Albany, Macon, Savannah

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and other communities to meet the staff, the nurses and the doctors.

They need to know there is another option available here at the Georgia Cancer Center when their patients want to know if there is something that could save their lives after the current “standard of treatment” options for their type of cancer fail.

[ GHAMANDE: Through the NCORP grant, we have partnered with five different hospitals and institutions in Georgia to recruit patients for new cancer drug trials as well as health care delivery research. They include Morehouse School of Medicine, DeKalb Medical, the University Cancer & Blood Center in Athens, the JiannPing Hsu College of Public Health, and Phoebe Putney Memorial Hospital in Albany. We are also working with Augusta Oncology to make them our sixth partner. The percentage of total patients taking part in clinical trials in the United States is less than 5 percent. Of those patients, less than 5 percent are minorities. The enrollment for this NCORP trial is growing each year, and I’m very proud to say this year our minority accrual is a whopping 45 percent.

JILLELLA: Between 2005 and 2009, we treated 19 cases of APL, and the mortality rate was 39 percent. After a trip to a research seminar, a colleague challenged me to bring that rate down. I started reviewing the charts and findings from those patients who lived and comparing them to the charts from those who lost their lives. In the spirit of partnership, I asked a doctor at Johns Hopkins for his thoughts. Working together, we determined that there were three factors that could play a role in death, including blood loss, death from complications associated with the medications they were taking, or dying from an infection not associated with their APL. We developed a two-page checklist that we shared with doctors in Georgia to help them give their patients the best chance at survival.

I’m happy to say that after seeing 23 patients, we had zero deaths. We worked with the Leukemia & Lymphoma Society to bring in other doctors in the region. The early data was so compelling, the National Cancer Institute let me expand the research project to the entire country. As of September 2017, the team of seven APL experts had handled 163 patient cases, and we brought the mortality rate down from 39 to 6.7 percent.

GHAMANDE: Apart from our cooperative group trial through the NCORP grant, we have several promising clinical trials, including phase 1 trials (first in human) and immunotherapy trials targeting specific cancers.

We are now getting patients from across the state and even the country for some of these trials. For women with gynecologic cancers, we are becoming one of the powerhouses in the southeastern United States. For one phase 1 cervical cancer vaccine study, we have accrued patients from California, Alabama, Texas and even Canada.

JILLELLA: We are a research center and a resource center to medical centers across the state. So far, we have had one team take their basic science research and turn

ASK the EXPERTS

it into a first-in-human clinical trial. That team of Dr. David Munn, Dr. Andrew Mellor and Dr. Ted Johnson has gained international attention. Early data provides hope for a breakthrough treatment option for devastating brain cancers. Now, we want to find the next story like that. If those trials don’t currently exist, then we need to create them. We want to challenge our talented teams of researchers to find the gaps in treatment and start the process necessary to fill those holes.

GHAMANDE: In fact, we have a new clinical trial that launched around the end of 2016 that came from the lab of Dr. Esteban Celis. It uses polyinosinic: polycytidylic acid, also known as poly I:C, in combination with a checkpoint inhibitor to offer cancer patients a novel, promising immunotherapeutic treatment combination in a phase 1 study that has effectively eradicated tumors in mice. This will be a great example of bench-to-bedside research, which is phenomenal.

JILLELLA: Doing bench-to-bedside research and developing new clinical trials will benefit the patients within driving distance of the Georgia Cancer Center, patients living in other states and other countries.

GHAMANDE: While finding new therapies and new treatments for the various forms of cancer drives our research efforts, the core mission is finding ways to prevent cancer in the first place. The Cancer Community Awareness & Access Research Education (c-CARE) initiative is one of our programs that has done an outstanding job with that mission. We started the program by focusing on lung cancer because our rates of lung cancer are very high. And the mortality rates are disproportionately high with higher stages of cancer in African Americans, as opposed to Caucasians. Workers with the c-CARE program train leaders in churches, and train community leaders and others who can then use their training to educate people about the risks and prevention of lung cancer. Dr. Martha Tingen’s tobacco cessation program is a big part of this effort.

JILLELLA: While working with those community leaders is important, it is also critical to reach out to hospitals across our catchment area. When you have a network, you end up being a resource. We are a research center, and the teams working in our labs are developing treatments that could be offered to patients across Georgia. We already have clinics calling for assistance after they tried every standard treatment for their patients. Those patients will ask their doctors about next steps, and those doctors will reach out to us to see what clinical research we have going on that could be that next step.

]

BIOGRAPHIES

Dr. Sharad Ghamande is chief of the Section of Gynecologic Oncology at the Medical College of Georgia. He is also the associate director for clinical research at the Georgia Cancer Center at Augusta University.

Dr. Anand Jillella is the J. Harold Harrison, MD, Distinguished University Chair in Medical Oncology at the Medical College of Georgia.

He is also the associate director of Medical Oncology Services at the Georgia Cancer Center.

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[

HOW it WORKS

]

EXPLORING TECH SOLUTIONS FOR ELDERLY PATIENTS live-action

computergenerated

Can live-action 360 video and computer-generated virtual reality improve the lives of the elderly?

If so, which one is more effective?

To try to answer these

questions, researchers in the College of Allied Health Sciences are using headsets and tablets to display those videos to participants.

RESEARCHERS Gianluca De Leo (center) Chair of the Department of Clinical and Digital Health Sciences, Erica Cousa (left) and Eleanora Brivio (right), graduate students

Their research is divided into two studies: • Can technology help the elderly improve their memory?

• Can technology help the elderly relieve stress?

If researchers find that in fact this technology helps improve people’s memory and relieve stress, they can use that knowledge to treat elderly patients. For example, they can treat Alzheimer’s patients by creating memory games using computer-generated environments or live-action 360 videos. They can also treat elderly patients with depression by helping them “go” to familiar places or by recreating happy moments from a distant past.

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VALUE ADDED

] PHIL JONES

[ COORDINATING THE RESEARCH ACCORDING TO the Centers for Disease Control and Prevention, diabetes affects nearly 10 percent of the U.S. population, and the number of those affected continues to increase, particularly in the Southeast. But thanks to a $12.8 million grant received by Dr. Richard McIndoe, associate director of the Center for Biotechnology and Genomic Medicine at the Medical College of Georgia at Augusta University, research into diabetic complications continues to move forward.

The grant allows McIndoe to continue to oversee coordination and administrative research activities for the Diabetic Complications Consortium of the National Institute of Diabetes and Digestive and Kidney Diseases.

Currently, the consortium supports four funding programs: a pilot and feasibility program, a conference support program, a summer student program and a collaborative funding program, all of which are geared toward improving the understanding and treatment of diabetic complications.

By providing travel funding for students and postdoctoral students attending diabetic complications meetings — and by funding investigators to give talks at such meetings — the consortium furthers the dialogue and understanding of diabetic complications.

Matching first- and second-year medical students with diabetes centers around the nation for summer research projects, the program hopes to expand the knowledge base and increase the number of researchers focusing on diabetic complications.

“Basically, the idea is to encourage these students to take the physician scientist path,” McIndoe says. “We want to create more scientists in general, but of course we’re interested in getting more diabetic complications physician scientists, and considering how enthusiastic these students are about their research, my intuition tells me there’s probably going to be a fairly good fraction that will probably make the decision to go into research.”

Dr. Richard McIndoe

As for the pilot and feasibility studies, the relatively small one-year grants have the opportunity to dramatically turn the tide.

“These are usually high-risk, high-reward situations that you’d never get through the normal National Institutes of Health (NIH) mechanism,” he says. “That’s why these are very short, one-year projects that prove a principle. They make sure that what you think is supposed to be happening is happening and that you get enough data to try for the larger research project grant.”

And according to McIndoe, the projects

have been effective in doing just that. Metrics looking out five years from the initial pilot and feasibility grants show that 60 percent of awardees do submit to the NIH and of those, 37 percent are actually successful.

“That’s pretty amazing to me and actually much better than the normal research project grant route,” McIndoe says. “The return on investment is really quite good.”

The ultimate return on investment, of course, comes with better understanding and ultimately better treatments for diabetic complications. ma g a zi n e s. au gu sta. e d u |

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ON the EDGE

]

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LOOKING WHERE NO ONE ELSE IS

B

Respiratory therapist Reva Crandall, Dr. Ryan Harris, vascular technologist Marsha Backburn, study participant Damon Jenks, and research associate Jacob Looney

Photo by Phil Jones

ack in the 1950s, children with cystic fibrosis (CF), a genetic disease that attacks the lungs and digestive system, rarely survived beyond elementary school. Now, thanks to advances in treatment and research, the median predicted survival age is around 47 years. But the additional lifespan has added its own complications.

Cystic fibrosis patients exhibit an inability to exercise, which has proven to be detrimental to their overall health and lifespan. But what Dr. Ryan Harris, director of the Laboratory of Integrated Vascular and Exercise Physiology at the Georgia Prevention Institute, is uncovering in his research is that the inability to exercise is not fully a result of impaired lung function.

And if impaired lung function isn’t preventing patients from exercising, Harris wants to know what is. And right now, he’s the only one asking the question.

“No one is looking at it from our perspective,” he says. “If we can understand what’s contributing to their inability to exercise, we can develop lifestyle modifications and maybe nonpharmacological interventions. We’re even working on a pharmacological intervention to improve exercise ability.”

If they can do that, Harris says, they’ll be able to increase the survival rate even more, decrease hospitalizations and improve the quality of life in patients with CF. So far, Harris’ findings are confined to his own research population, but he recently submitted a grant proposal to expand his research to a multi-center study. Collaborating with another center, he can expand the numbers in a different region and see if the outcomes hold true.

If they do, it becomes more accepted to start changing regimens and altering treatment paths for patients worldwide.

Harris works closely with Augusta University’s Cystic Fibrosis Center, one of only two centers in Georgia accredited by the national Cystic Fibrosis Foundation.

“They really provide that link from the clinical service to the investigational paradigm,” Harris says. “They’re a treatment center, but they also provide the bridge to me as a researcher.”

And that bridge puts him face-to-face with the patients he’s working to help.

“Being hands-on with the patients is my passion,” Harris says.

ONLINE EXTRA Visit magazines.augusta.edu to read more about the cystic fibrosis trials.

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