Research & Scholarship Showcase Book of Abstracts 2024

Book of Abstracts

Research & Scholarship Showcase

An annual event that showcases scholarship activities from various health care programs across Manchester and Worcester campuses of Massachusetts College of Pharmacy and Health Sciences. This year fortysix abstracts submitted by students, graduate students, postgraduate residents, and fellows were accepted and will be presented in a poster format.

Showcase Planning Committee Members:

School of Pharmacy, Worcester/Manchester

Matthew Metcalf and Alok Sharma (co-chairs)

Kaelen Dunican, Helen Pervanas, Holly Baker, Darlene DiTommaso, and Eva Shqina

New England School of Acupuncture, Worcester

Stephen Cina

School of Medical Imaging and Therapeutics, Worcester

Jeff Hill and Debra Crandell

School of Optometry, Worcester/Manchester

Lawrence Baitch

Forsyth School of Dental Hygiene, Worcester

Irina Smilyanski

School of Nursing, Worcester

Deirdre Donahue

School of Physical Therapy, Worcester

Christopher Joyce

School of Physician Assistant Studies, Worcester/Manchester

Linda Martino

School of Occupational Therapy, Manchester

Heidi Robertson

Abstract: 1

Transcatheter Mitral Valve Double Repair in Chronic Severe Mitral Regurgitation

Author(s): Ashleigh M. Vargas, Maureen Grady, Katie Yiu, Yvonne Bui, and Jeffrey Hill

Faculty Advisor/Principal Investigator: Jeffrey Hill

Program/School: DMS/School of Diagnostic Medical Sonography

Affiliate(s): Southcoast Health, Fall River MA

Purpose/Hypothesis: Mitral valve regurgitation (MR) is the third most common valvular abnormality worldwide, and its prevalence increases with age. Depending on the type of mitral disease, palliative treatment for MR is surgical valve repair or replacement. Contemporary techniques now include minimally invasive transcatheter mitral valve repair (TMVR) with a clip device to alleviate the MR.

Description/Methods/Materials: We present a case where TMVR failed on the first attempt in a subject with mitral valve prolapse and severe MR, requiring two MitraClips to alleviate the MR.

Results & Conclusion/Discussion: This case study includes three sections: (1) pre-surgery monitoring, (2) intra-operative monitoring, and (3) post-procedural imaging. The MR severity did not change after the first attempt of repairing the valve. A second clip was introduced intraoperatively that significantly decreased the amount of MR. Follow-up imaging demonstrated no significant MR. However, because the opening of the valve was restricted, the patient developed a mild degree of stenosis.

Implications/Clinical Relevance: This case highlights the efficacy of TMVR in reducing the degree of MR. However, the downside of implanting two clips is that it can result in valve stenosis.

Acupuncture Revenue Analysis of BMC Primary Care

Author(s): Lace Ronald and Emilie Gerber-Kunicka

Faculty Advisor/Principal Investigator:

Emilie Gerber-Kunicka

Program/School: CAS.DAIH/New England School of Acupuncture

Affiliate(s): Boston Medical Center, Boston, MA

Purpose/Hypothesis: Improved documentation, better coding, and attention to insurance provider type will improve revenue in acupuncture clinics.

Description/Methods/Materials: The Family Medicine Acupuncture Clinic at Boston Medical Center is uniquely positioned to provide integrated care. This research provides insight into the financial health of the primary care clinic by showing the trends in denied insurance claims. The Family Medicine Acupuncture Clinic at Boston Medical Center collects revenue data for their insurance claims, but has not analyzed this data. This project took the anonymized data of insurance claims and created a pandas dataframe from an excel spreadsheet using a program in Python. We compiled the information in the data frame to determine what insurance companies were billed and what percentage of claims were denied. The information about the denied claims will be used to determine necessary steps to reduce the denial rate and increase the revenue of the clinic.

Results & Conclusion/Discussion: We found 29.67% of claims were denied between 2021 and 2023. The majority of the claims were from Boston Medical Center Healthnet Plan (30.8%), Medicare (14.6%), Commonwealth of Massachusetts (EOHHS) (10.3%), Health Plans INC (9.54%), Commonwealth Care Alliance (7.47%), Blue Cross and Blue Shield of Mass (5.1%), and United Healthcare Insurance Company (4.85%). The other 19.5% of the claims came from 25 other insurance providers. Plans with more than 4% of the total denied claims include Medicare (933 denied claims), Commonwealth of Massachusetts (EOHHS) (315 denied claims), United Healthcare Insurance Company (201 denied claims), Commonwealth Care Alliance (260 denied claims), and Blue Cross Blue Shield of Mass (181 denied claims). The amount of denied claims is not evenly proportional across insurance types. For example, 39.5% of the denied claims were from Medicare despite only 14.6% of the total claims being billed to Medicare. A targeted approach with future claims can decrease the denied claims from the insurance types with the highest denial rates.

Implications/Clinical Relevance: In 2021, Amelia Zahm published research on the profits of a health center in Northeastern Oregon. Zahm found that the clinic was 4% profitable over two years despite seeing 47.6% of commercial insurance claims, 34% of Medicaid claims, and 69.2% of VA choice claims paid (387). In BMC’s data, 80% of medicare claims were denied which is a lower approval rate than Zahm’s data; however, the overall approval rate is still nearly 70% which is promising.

Feasibility of Pointcloud-Based Ultrasound-CT Registration towards Automated, Robot Assisted Image-Guidance in Spine Surgery

Author(s): Xihan Ma, Xiao Zhang, Yang Wang, Christopher J. Nycz, Arno Sungarian, Songbai Ji, Jeffrey Hill, and Haichong K. Zhang

Faculty Advisor/Principal Investigator: Jeffrey Hill

Program/School: DMS/School of Diagnostic Medical Sonography

Affiliate(s): WPI and UMass Medical School, Worcester, MA

Purpose/Hypothesis: Intraoperative ultrasound (US) image guidance has been shown to improve spine surgery accuracy and achieve better patient outcome. Such image guidance is achieved by registering US which captures spine anatomy and surgical tools with preoperative Computed Tomography (CT) in real-time. Employing robotic US system (RUSS) allows automated acquisition of wide field-of-view (FOV) 3D US volume, facilitating more efficient and precise registration with CT. However, spine registration between CT and robotically acquired US volume remains an open research problem due to modality discrepancy between CT and US. This research addresses the challenge by presenting a novel pointcloud-based registration method which automatically aligns points densely sampled from the same anatomy (spine) across different modalities.

Description/Methods/Materials: We built a four-part lumbar spine phantom for CT and US scan with six rigidly attached imaging fiducials (ceramic ball targets) to assess the registration accuracy. The CT volume was obtained from a commercial scanner (SOMATOM Definition Flash, SIEMENS, Germany). A previously developed robotic ultrasound system (RUSS) was utilized to acquire the 3D US volume. The RUSS consists of a wireless US probe (C3HD, Clarius, Canada) and a collaborative robot arm (Panda, Franka Emika, Germany) holding the probe. During the scan, the RUSS continuously acquires spatially localized 2D US images on a predefined straight-line trajectory. The 3D US volume was generated by compounding 2D images according to their locations. Prior to the registration, two lumbar spine pointclouds were extracted from 3D CT and US, noted as pcCT and pcUS, respectively. The two pointclouds were further denoised and downsampled to assure robust and efficient registration. We employed coherence point drift (CPD) algorithm to register the pointclouds, yielding a spatial transformation which minimizes the per-point distance between pcCT and pcUS. For the sake of simplicity, the registration was considered to be rigid. Finally, the registration accuracy was evaluated by calculating the offset between the centroids of the imaging fiducials after aligning pcUS to pcCT.

Results & Conclusion/Discussion: The pointcloud-based registration method can be performed in 0.53 ± 0.02 seconds, satisfying the need for intraoperative usage. The registration accuracy was measured to be 3.57 mm in terms for fiducial registration error (FRE).

Implications/Clinical Relevance: This study demonstrates the feasibility of using pointcloud-based registration to perform US-CT guided spine surgery.

Innovation in Development of Novel Compounds for Treating Chagas Disease

Author(s): Margi Shingala and Carolyn Friel

Faculty Advisor/Principal Investigator: Carolyn Friel

Program/School: PHARMD.DPH/School of Pharmacy

Affiliate(s): WPI, Worcester, MA

Purpose/Hypothesis: Through chemical synthesis, the creation of novel compounds will be pursued with subsequent assays for anti-Trypanosoma cruzi activity. It is hypothesized that these compounds will exhibit varying degrees of efficacy, thereby initiating the foundation for StructureActivity Relationship (SAR) analysis in the pursuit of potential treatments for Chagas disease. This research aims to identify promising compounds that can potentially disrupt the life cycle of Trypanosoma cruzi, the causative agent of Chagas disease, leading to the development of more effective therapeutic interventions. The outcomes of this study could significantly contribute to the advancement of treatment strategies for Chagas disease, benefiting afflicted populations worldwide.

Description/Methods/Materials: The initial pyridinyl pyrazole compound, a crucial starting material, is provided by the Drugs for Neglected Diseases Institute (DNDi). Two positions on this compound, namely the R1 and R2 positions, will be modified to explore structure-activity relationships. The addition of the R1 group will be achieved through a reductive amination reaction using nonaromatic aldehydes in dichloroethane, with acetic acid serving as the proton source and sodium triacetoxyborohydride as the reducing agent. The introduction of the R2 group (chlorine) will involve a substitution process utilizing N-chlorosuccinimide as the chlorinating agent at a controlled temperature of 0 degrees Celsius, following established literature procedures. Thin-layer chromatography will be employed to monitor the progress of the reactions. Following completion, the synthesized compounds will undergo purification via High-Performance Liquid Chromatography (HPLC) to ensure purity. Structural confirmation will be conducted using proton and carbon Nuclear Magnetic Resonance and mass spectroscopy. The synthesized compounds will then be sent to the DNDi for high-throughput screening against Trypanosoma cruzi.

Results & Conclusion/Discussion: Three novel compounds were successfully synthesized; yields ranged from 8.2 % to 90%. They were confirmed by conducting proton NMR and carbon NMR. Biological assays will be conducted after completion of the course.

Implications/Clinical Relevance: The successful synthesis of three novel compounds holds significant clinical relevance and implications for the treatment of Chagas disease. These compounds, derived from modifications to the initial pyridinyl pyrazole compound, have the potential to advance the development of more effective therapies for this neglected tropical disease. With current treatment options limited in efficacy and associated with adverse effects, the discovery of novel compounds with promising anti-Trypanosoma cruzi activity is a crucial step forward. Further evaluation of these compounds through high-throughput screening against the parasite will provide valuable insights into their therapeutic potential. Ultimately, if proven effective, these compounds could alleviate the burden of Chagas disease and improve patient outcomes, particularly in endemic regions.

Can Death of Light Sensing Photoreceptors in Retinitis Pigmentosa Affect Inner Retinal Neurons?

Author(s): Mariem Girgis, Victoria Karalis, and Mahesh Shivanna

Faculty Advisor/Principal Investigator: Mahesh Shivanna

Program/School: OPT.OD/School of Optometry

Affiliate(s): UMASS Medical School, Worcester, MA

Purpose/Hypothesis: Retinitis Pigmentosa (RP) is a severe neurodegenerative disease characterized by degeneration of photoreceptors that are considered as light sensing cells of the retina. This disease can lead to progressive vision loss or blindness depending on the severity of the disease. Currently, the knowledge of the remodeling of inner retinal neurons due to photoreceptor degeneration is very limited. The goals of this study were to (1.)Examine the influence of deletion of Rp2, an RP-causing gene on the extent of rod and cone photoreceptor degeneration, and (2.) Ascertain inner retinal neuron remodeling in Rp2 null mice.

Description/Methods/Materials: The experiments were performed using Rp2 null (Mutant) mice and compared with normal (Wild Type) mice. Gene expression was validated by RT-PCR and immunoblotting assays were done using retinal extracts. Rod and Cone photoreceptor function was evaluated by electroretinogram (ERG) analysis. Eyes were enucleated, fixed in 4% paraformaldehyde solution and processed for cryosectioning. Sections were permeabilized, blocked for 1 hour, incubated with primary antibody for the specific marker proteins of bipolar cells namely Goalpha and PKCalpha overnight at 4C followed by incubation with appropriate secondary antibody conjugated to a fluorophore. DAPI was also used to label the nuclei and the sections were mounted under glass coverslips followed by visualization using a fluorescence microscope.

Results & Conclusion/Discussion: Gene expression analysis and immunoblotting assay confirmed significant knockdown of Rp2 gene. Constitutive loss of Rp2 in the mutant mice resulted in abnormal extension of the cone outer segment (COS). ERG results confirmed the reduced functionality of photoreceptors due to loss of RP2. Remodeling at the photoreceptor-bipolar cell synapse (outer plexiform layer) was also observed in the mutant mice that was evident through the altered expression of Goalpha and PKCalpha

Implications/Clinical Relevance: There is an ever-increasing need to address the loss of vision in Retinitis Pigmentosa patients who inherit defective genes leading to death of light sensing cells (photoreceptors) in the retina. The results from this study will enable further investigation into the possibility of rescuing or delaying the loss of vision in RP patients by gene therapy.

Identification of Retinal Neuron Specific Marker Proteins for Understanding Disease Progression

Author(s): Victoria Karalis, Mariem Girgis, and Mahesh

Shivanna

Faculty Advisor/Principal Investigator: Mahesh Shivanna

Program/School: OPT.OD/School of Optometry

Affiliate(s): UMASS Medical School, Worcester, MA

Purpose/Hypothesis: Retinal tissue in the eye has special light sensing nerve cells (rods and cones) also referred to as photoreceptors. Normally, signals from photoreceptors containing visual information are transmitted via inner retinal neurons (second and third order neuorns) to the visual cortex in the brain for visual perception. Identifying these different retinal neurons via their specific markers will enable to delineate the retinal neuron abnormalities in disease conditions such as Retinitis Pigmentosa. The goals of this study were to (1.) Identify retinal photoreceptors using specific marker proteins, and (2.) Identify bipolar cells considered as second order retinal neurons using their specific markers.

Description/Methods/Materials: Retinal sections from Normal (Wild type) mice and RP2 Null (Mutant) mice were used for the study. Eyes were enucleated, fixed in 4% paraformaldehyde solution and processed for cryosectioning. Sections were permeabilized, blocked for 1 hour, incubated with primary antibody for the specific marker protein overnight at 4 degree C followed by incubation with appropriate secondary antibody conjugated to a fluorophore. DAPI was also used to label the nuclei and the sections were mounted under glass coverslips followed by visualization using a fluorescence microscope.

Results & Conclusion/Discussion: Rods were identified based on their expression of rhodopsin in their outer segments and cones were identified using PNA (Peanut Agglutinin Lectin) which stains the lectin sheath of the cone inner and outer segments. Rod bipolar cells were identified using PKCalpha, a modulator known to regulate glutamate driven signal transduction and terminationin those cells. Both the rod and cone bipolar cells were identified using Goalpha, a GTP binding protein subunit expressed in both rod and cone bipolar cells.

Implications/Clinical Relevance: Currently, there is very limited information available regarding molecular mechanisms contributing to retinal dysfunction in retinal degenerative diseases. Examining the expression of marker proteins of retinal photoreceptors as well as their connecting neurons will be helpful to investigate the course of progression of retinal disease. This study will also enable examining the option of gene therapy to correct defective genes in retinal neurons undergoing degeneration in a rapidly progressing disease such as X-linked retinitis pigmentosa.

Adventures in Medicinal Chemistry: Synthesizing Compounds to Slay Parasites

Author(s): Thi My Tien Bach, Hadeel Abdalaal, YoungHoon Chung, Kyeong Hwan Lee, Seoyoung Jang, and Carolyn Friel

Faculty Advisor/Principal Investigator: Carolyn Friel

Program/School: PHARMD.DPH/School of Pharmacy

Affiliate(s): N/A

Purpose/Hypothesis: Leishmaniasis and Chagas Disease present significant public health challenges, particularly in tropical regions. Current treatments for these neglected diseases exhibit limited efficacy, high toxicity, and are vulnerable to emerging drug resistance. Therefore, this study aims to explore the synthesis, purification, and chemical identification of three novel compounds. Our goal is to enhance the understanding of structure-activity relationships in anti-parasitic compounds, thereby contributing to the development of more effective therapies.

Description/Methods/Materials: The Drugs for Neglected Disease initiative (DNDi) Open Synthesis Network is our global partner and provided the initial compounds. Synthetic modifications were performed on the core structure of the DNDi starting pyridinylpyrazoles through reductive amination. The first group targeted cyclopropyl-containing pyridinylpyrazoles, reacting with aldehyde functional groups. The second and third groups employed reductive amination with ketones or aldehydes, combining them with DNDi starting pyridinylpyrazoles featuring chlorine substitutions. Each reaction was monitored using thin-layer chromatography plates (TLC) with optimized solvent systems. Upon completion, reactions were worked-up and purified using Isolera Prime chromatography. Further purification via recrystallization was conducted if required. Proton and carbon NMR spectroscopy were then obtained and evaluated to confirm product identity.

Results & Conclusion/Discussion: The first group successfully synthesized a novel compound with a fluoro-indazole functional group. The product is currently undergoing recrystallization to improve its purity. Conversely, the second group, yielded no detectable results (0% yield), necessitating cessation of synthesis of that compound. The third group has shown new compounds formed via TLC and is currently undergoing NMR analysis for confirmation of product. A previously synthesized difluorocyclohexyl compound (HK8-1) was further purified via recrystallization and confirmed with proton and carbon NMR. This final compound was synthesized in 6.6% yield (28.8 mg).

Implications/Clinical Relevance: The promising results from our medicinal chemistry laboratory indicate the potential for synthesizing compounds as drug discovery hits against parasites. Continued research into their anti-parasitic properties will facilitate the establishment of structureactivity relationships (SARs), guiding the progression of hits to lead development and ultimately paving the way for future anti-parasitic drugs.

Solving the Structural Puzzle: Crafting Antimalarial Innovations in the Age of Resistance

Author(s): Harpreet Kaur and Carolyn Friel

Faculty Advisor/Principal Investigator: Carolyn Friel

Program/School: PHARMD.DPH/School of Pharmacy

Affiliate(s): N/A

Purpose/Hypothesis: Malaria is a life-threatening disease caused by microscopic parasites called Plasmodium, transmitted to human beings by mosquitoes. The Malaria Libre (ML) program allows researchers to collaborate to synthesize, and test novel compounds to identify preclinical candidates for the treatment of malaria. The Medicines for Malaria Venture hosts the data repository and presents monthly meetings on drug development and parasitology. The goal of this project is to synthesize seven novel compounds for biological testing. These compounds will contribute to the structure-activity relationship (SAR) profile of antimalarials and potentially offer new compounds for treatment-resistant malaria.

Description/Methods/Materials: This project involves the chemical synthesis of 7 new antimalarial compounds. The starting material, an aminopyridinol, was provided by ML. Discussions with the ML team helped guide the selection of compounds to synthesize. Reductive amination was used to produce compounds with fluorine at the o, m, and p-position of the phenyl to explore the chemical space to improve anti-plasmodial activity. A compound with steric bulk was synthesized based on the metabolic liability of previously tested compounds. The chemical reactions were followed by thin layer chromatography. After reaction completion they were worked-up and concentrated for purification via Biotage chromatography. The chemical synthesis, percent yield and analytical confirmation by elemental analysis and carbon and proton NMR, will be reported. The efficacy of the novel compounds will be reported as the pIC50 using the erythrocyte -3D7-LDH (chloroquinesensitive) assay and the Dd2 LDH (chloroquine-resistant) assay. This will allow us to develop SARS for drug resistant malarial strains.

Results & Conclusion/Discussion: The successful chemical synthesis of 7 novel compounds will be reported. Percent yields ranged from 24 to 81%. Proton and carbon NMRs were obtained. Biological assays conducted by the MMV were completed using the erythrocyte 3D7-LDH assay and Dd2 assay with pIC50s ranging from 5.5 to 6.7.

Implications/Clinical Relevance: Open source antimalarial drug development increases the number and diversity of new molecules tested in pre-clinical models. Antimalarial drug therapy resistance is a growing problem and new treatment options are needed. Compounds synthesized during this project provide additional data points for open-source research MMV collaborations.

Abstract: 9

Rapid Plant Leaf Movement, a Viable Drug Assay?

Author(s): Songyun Liu, Meghan McGonagle, and Matthew Metcalf

Faculty Advisor/Principal Investigator:

Matthew Metcalf

Program/School: PHARMD.DPH/School of Pharmacy

Affiliate(s): N/A

Purpose/Hypothesis: Animal-based drug assays are the most common method of new drug preclinical assays, however there are ethical disadvantages associated with animal use. Here we present the development of a plant-based drug assay using the thigmonastic movement response of Mimosa pudica as an alternative drug assay.

Description/Methods/Materials: Mimosa pudica were planted from seeds. Pinnae with uniform response towards mechanical stimuli were harvested from mature plants by severing the stem at the primary pulvinus. Samples were immediately floated in Petri dishes containing different drug solutions including lysine, arginine, NSAIDs, auxin, 0.1%DMSO, and growth solution. Pinnae all close upon severance. The samples were allowed to open after harvest and the folding response was stimulated with a monofilament. The qualitative response to stimuli and time to recovery (reopening) recorded at various timepoints after harvest.

Results & Conclusion/Discussion: All Mimosa pudica plants displayed unanimous thigmonastic response. Individual pinnae or samples of 4 pinnae were responsive to stimulus but not individual pairs of pinnules. Pinnae in distilled water lost the folding response while samples maintained responsiveness for up to 7 days in the growth solution. Pinnae exposed to 0.1% DMSO failed to open after harvest. The process of stimulation and recovery in drug solutions was captured by the camera. NSAIDs (ibuprofen, indole-3-butyric acid, phenylacetic acid) dissolved in growth solution induced the tendency of weaker thigmonastic response and longer recovery time compared to growth solution alone.

Implications/Clinical Relevance: The development of plant-based assays represent an ethical alternative to animal-based drug testing. Plant based assays offer cheap, efficient, viable methods to avoid the ethical limitations and strictures surrounding animal drug testing. This improves the overall ethics surrounding overall drug development in society.

Harnessing Plant Power for Ethical Drug Testing

Author(s): Nasr Issa, Chloe

Flibbert,

Ezra

Vail, Prem Patel, Gene Om, Songyun Liu, and Matthew Metcalf

Faculty Advisor/Principal Investigator: Matthew Metcalf

Program/School: PHARMD.DPH/School of Pharmacy

Affiliate(s): N/A

Purpose/Hypothesis: This study develops plant-based alternatives for animal-based drug tests to enhance laboratory animal ethics. This work focuses on NSAID testing in a phytotoxicity measurement assay and developed a novel timelapse photo assay for bioequivalence with animal tests.

Description/Methods/Materials: To overcome NSAID solubility challenges, we formed salts of NSAIDs using lysine and arginine. We conducted rigorous control experiments to ensure that the amino acids or Beta-cyclodextrin (BCD), when individually applied at elevated concentrations, did not affect plant growth. The novel timelapse chemonastic assay assessed pea seedling growth under varying NSAID (plus lysine or arginine) concentrations and lighting conditions; evaluating multiple growth parameters including root length, early leaf unfolding and lateral root formation, development, nutation, shoot height. The results of the timelapse assay were compared to the phytotoxicity measurement assay.

Results & Conclusion/Discussion: Under low-light conditions, seedlings exposed to high lysine concentrations exhibited increases in shoot growth compared control and low lysine concentrations. However, under high-light conditions, neither Lysine, arginine nor BCD significantly impacted seedling growth across the observed variables. NSAID salts exhibited significant decreases in both root and shoot growth in the timelapse assay which was directly correlated with the measurement assay. For example Naproxen measurement at t=3 days had LD50 23.1µM (16.6-32.2) p<0.0001). In the timelapse Naproxen showed half the root length of controls at 20µM and 2/3 at 10µM t=8 days. Additionally Lysine appeared to have a qualitative negative impact on lateral root growth. Timelapse video (qualitative) results will be displayed with the poster.

Implications/Clinical Relevance: This research offers promising insights into the development of plant-based assays as ethical alternatives to animal testing in drug research. By demonstrating the feasibility of using amino acids to enhance solubility and conducting comprehensive growth assessments, this study paves the way for more extensive applications of plant-based assays in pharmaceutical testing. Adopting these assays has significant implications for improving laboratory animal ethics, reducing the number of animals used in drug testing, and ultimately enhancing the reliability and ethicality of preclinical drug evaluation.

Harnessing the Power of Interprofessional Education to Improve Research Day Participation

Author(s): Heer Patel, Kaelen Dunican, Matthew Metcalf, Alok Sharma, and Jeffrey Hill

Faculty Advisor/Principal Investigator: Matthew Metcalf

Program/School: PHARMD.DPH/School of Pharmacy

Affiliate(s): N/A

Purpose/Hypothesis: Describe an interprofessional education (IPE) student research poster presentation event (research day) to promote student scholarship at a health professions university and evaluate the attendee survey data from two years.

Description/Methods/Materials: Research and Scholarship Day is an annual event that is organized by faculty from 9 health professions programs including pharmacy, diagnostic medical sonography, optometry, physician assistant, acupuncture, occupational therapy, nursing, dental hygiene, and physical therapy. The event offers an opportunity for students from all 9 programs to share their research in a poster forum. An anonymous online, post event evaluation survey is administered to attendees, including students, faculty, administrators, and staff. The survey asks participants to provide a general evaluation of the event and the effectiveness of the event in sharing research and promoting interprofessional interactions. Three survey questions were quantitatively analyzed for this project.

Results & Conclusion/Discussion: Participation increased from 83 attendees (students, faculty, administrators, and staff) in 2022 to 121 in 2023; the survey response rate also increased from 30.1% to 40.5%. Participant evaluations of the event were positive, with 84% rating the event as excellent and 16% good in 2023 and 64% excellent and 28% good in 2022. Participants agree that the event is useful for students to share and learn about scholarship activities on campus with 88% and 92% agreeing in 2022 and 2023 respectively. Participants also agree that the event promotes interprofessional interactions among students and staff/faculty with 84% and 96% agreeing in 2022 and 2023, respectively.

Implications/Clinical Relevance: Interprofessional research days provide a valuable opportunity for students to interact and appreciate the contributions of health care professionals outside their own professional discipline. Increasing participation allows more student and faculty interactions and learning opportunities.

Enhancing Efficacy Against Lung Cancer: Lipid-Extracted Nanoliposomes for Optimal Drug Delivery

Author(s): Mohammed Alqaryan, Rashad Allahyani, Dayeoun Lee, and Robert Campbell

Faculty Advisor/Principal Investigator: Robert Campbell

Program/School: PHARMD.DPH/School of Pharmacy

Affiliate(s): N/A

Purpose/Hypothesis: Despite the advancement in cancer treatments, lung cancer remains a challenge, ranking as one of the leading causes of cancer-related deaths worldwide. One of the major obstacles in the treatment is the development of drug resistance, which often renders existing therapies ineffective. In recent years, nanoliposomes have emerged as a promising strategy for targeted drug delivery, offering the potential to overcome drug resistance and enhance therapeutic efficacy. This study investigates the effects of nanoliposomes formulated with and without lipid extracts derived from a Non-Small Cell Lung Cancer (NSCLC) cell line on target and nontarget cell populations in different host environments.

Description/Methods/Materials: Preparation and characterization of Cellular Membrane LipidExtracted Nanoliposomes (CLENs) were prepared with DOPC and ChaGo-K-1 lipid extract. Additionally, a DPPE-rhodamine fluorescent label was included in preparations for fluorescence studies. The liposome size was reduced by bath sonication. Particle size and polydispersity index (PDI) were measured by dynamic light scattering. Zeta PALS was employed to determine the molecular surface charge. Four cell lines were utilized: ChaGo-K-1 (non-small cell lung- target), A549 (pulmonary microenvironment- non-target), 4T1 (as the extra-pulmonary- non-target), and CRL2089 (normal breast fibroblasts- off-target) cell populations. Cells were seeded at 20,000 cells/mL of growth medium. The required number of cells was then separated into vented centrifuge tubes for incubation studies. Next, cells were transferred to an incubator set at 37°C for 60 minutes under a low oscillation rate setting. Tubes containing cells were centrifuged to remove the liposome cellbound fraction, and transferred into 24-well plates for fluorescence microplate reader analysis. Fluorescence images were acquired by fluorescence microscopy.

Results & Conclusion/Discussion: The mean particle size and polydispersity index of the ChaGo-K-1 CLENs were 117 ± 0.7 nm and 0.216 ± 0.009, respectively. The mean particle size and polydispersity index of control conventional liposomes were 126 ± 0.5 nm and 0.195 ± 0.008, respectively. Both formulations fell within the optimal size range for targeted drug delivery purposes. The zeta potential of the ChaGo-K-1 CLENs was -1.75 ± 1.81 mV compared to -1.74 ± 6 mV for control liposomes. Quantification and qualification of cellular uptake using fluorescence intensity measurements revealed an increase in rhodamine-labeled ChaGo-K-1 CLENs accumulation in homologous ChaGo-K-1 lung cancer cells compared to conventional liposomes without ChaGo-K-1 lipid extracts.

Implications/Clinical Relevance: The findings suggested that CLENs may significantly enhance targeted drug delivery in NSCLC, offering a potential pathway to enhance the drug effects, mitigate drug resistance, and potentially improve clinical outcomes in lung cancer therapy.

Utilizing U87-MG Membrane Lipid-Modified Nanoliposomes for Targeting Cellular Models of Glioblastoma Versus Non-Target and Off-Target Cell Populations

Author(s): Aesha Patel, Duha Baamir, Kaylee Janton, Sheren Boca, and Robert Campbell

Faculty Advisor/Principal Investigator: Robert Campbell

Program/School: PHARMD.DPH/School of Pharmacy

Affiliate(s): N/A

Purpose/Hypothesis: Glioblastoma Multiforme (GBM) is an aggressive and malignant form of brain cancer known for its invasiveness and significant heterogenicity. The majority of GBM cases are associated with genetic mutations such as TP53, EGFR, and PTEN that disrupt the normal regulation of cell growth and division, leading to uncontrolled cell proliferation. Utilizing nanoparticles offers a promising approach for addressing the complexities associated with selective drug delivery to GBM and its treatment. The aim of the study was to investigate the in vitro effect of utilizing U87-MG membrane lipid extracts in nanoliposomes using target, non-target, off-target, and normal healthy cell populations.

Description/Methods/Materials: The nanoliposomes utilized for the experiments included various ratios of U87-MG lipid extracts (lipids derived from U87-MG cells), DOPC, Cholesterol, and DPPERhodamine for fluorescence studies. Particle size and zeta potential values were measured and monitored for consistency throughout the experiments. Fluorescence intensity values (arbitrary units) were used to assess the extent of cell binding and cellular uptake at various time points. In vitro, studies were conducted to evaluate the cellular uptake of U87-MG-modified nanoliposome preparations using mixed ratios and compositions of lipid materials. Cell lines used included LN-18 (human glioma), T98G (human glioma), U87-MG (human glioma), Panc-1 (pancreatic cancer) and HBEC-5i (normal healthy brain) cells.

Results & Conclusion/Discussion: Nanoliposomes, both with and without lipid extract, exhibited an average size ranging from 110 to 220 nm, and the zeta potential of the CLENs was negatively charged. In vitro, investigations demonstrated that incorporating U87MG lipid extract into nanoliposomes enhanced cellular uptake in glioma cells compared to the control group. There was an observable uptake in LN-18 and T98G cells, although, lower than observed in U87MG cells. Nevertheless, cellular uptake was minimal in Panc-1 and HBEC-5i cell lines.

Implications/Clinical Relevance: Treatments utilizing nanoliposomes as the drug-delivery system showed enhanced cellular uptake and target specificity to GBM, suggesting a promising approach in cancer treatment.

4T1-Lipid Extract-Modified Nanoliposomes Enhanced Targeting of Triple-Negative Breast Cancer: Highly Selective and Organ-Specific

Author(s): Parmida Amid, Christiana Ayertey, Mohammed Almozain, and Robert Campbell

Faculty Advisor/Principal Investigator: Robert Campbell

Program/School: PHARMD.DPH/School of Pharmacy

Affiliate(s): N/A

Purpose/Hypothesis: Breast cancer is the most frequently diagnosed life-threatening cancer and the leading cause of cancer death among women. Triple-negative breast cancer (TNBC) is the type that has a highly aggressive phenotype characterized by a rapid growth rate profile, increased risk of metastasis and recurrence. The disease is devoid of epidermal growth factor receptor 2, estrogen, and progesterone receptors. All three are commonly present in other forms of breast cancer disease. The objective of this study was to develop a cell membrane lipid-extracted nanoliposomes (CLENs) for selective targeting compared to conventional nano-liposomal varieties. Also explored was the role of microenvironment in targeting using a cellular model of TNBC, and representatives of non-target tissue environments.

Description/Methods/Materials: 4T1 mammary carcinoma lipid extracts (LE) was used to produce a 4T1 CLENs (cell membrane lipid-extracted nanoliposomes with different ratios of 1,2-dioleoyl-snglycero-3-phosphocholine (DOPC), a phospholipid used in most conventional drug delivery liposomes. Different lipid compositions and ratios were employed to evaluate cellular uptake in target, non-target and off-target cells. The target cell line, 4T1, off-target and non-target cell populations included CRL-2089, normal breast fibroblasts, SKBR3 a (human breast cancer), and A549 a (lung cancer) cell lines. Other studies involved determination of molecular charge and zeta potential of various nano-liposomal preparations and corresponding fluorescence studies in vitro.

Results & Conclusion/Discussion: The physicochemical properties of CLENs such as particle size and surface charge characteristics were vital when assessing benefit of the lipid-based preparations. The size of the CLENs typically ranged between 130 – 165 nm and and zeta potential values approximately ranged between -2 to -4mV. The inclusion of 70 mol% of LE in preparation of 4T1CLENs demonstrated increased cellular uptake and binding by the 4T1 target cells compared to the control DOPC (100%). The highest degree of selectivity was observed in early cell binding events, and with studies involving more extended incubation time points under different experimental conditions. Off-target cells demonstrated reduced uptake by comparison. Overall, 4T1-CLENs was most efficient when applied against intended target 4T1 cells, when compared to relevant control cell populations.

Implications/Clinical Relevance: Future research should focus on optimizing formulation parameters, conducting in vivo studies to assess pharmacokinetics and efficacy, exploring encapsulation of diverse therapeutic payloads, and understanding tumor microenvironment interactions.

MS1-VEGF Lipid Extracts Enhanced Targeting of MS1-VEGF Target Cells Compared to Non-Target & Off-Target Cellular Populations Derived from Different Organ Locations

Author(s): Khaznah Alshammari, Sergio Verdery, Sujin George, and Robert Campbell

Faculty Advisor/Principal Investigator: Robert Campbell

Program/School: PHARMD.DPH/School of Pharmacy

Affiliate(s): N/A

Purpose/Hypothesis: Pancreatic cancer is challenging to treat with a 9% 5-year survival and a high rate of mortality. Nanoparticles is a revolutionary treatment method due to cellular absorption, boosting therapeutic effectiveness, and mitigating side effects. For nanomedicine, optimizing liposome formulations is crucial for achieving specificity in drug targeting. The objective of this study was to evaluate the interaction of pancreatic cancer lipid-extract modified nanoliposomes when compared to non-target and off-target cells.

Description/Methods/Materials: Cell membrane lipid-extracted nanoliposomes (CLENs) were prepared via the thin film evaporation technique. The composition included various compositions and ratios of DOPC, DOTAP, Cholesterol, DPPE-PEG-5000, and lipid extracts derived from MS1-VEGF target cells. MS1-VEGF was the cellular model of pancreatic cancer used for this study. Cellular binding studies were performed using cellular suspension and adherent cells. Studies were performed in 48-well plates under different experimental conditions including alterations in time of incubation, and periods of cellular exposure to dual humidified and oscillation environments in the presence of lipid-extracted (LE) nanoliposomal preparations and conventional controls.

Results & Conclusion/Discussion: The particle size for nanoliposomes in this study was 115 ± 0.7 nm for control and 128 ± 3 nm for experimental nanoliposomes. Following exposure to various lipid extract concentrations (typically 0 to 100 nmoles per ml of growth medium), the fluorescence values showed increased cellular uptake with greater LE content for floating and adhered MS1-VEGF cell populations. With the floating cells, LE-modified nanoliposomes demonstrated significantly higher fluorescence intensity values compared to conventional nanoliposomes. Similarly, LE-modified nanoliposomes targeted MS1-VEGF adherent cells to a greater extent compared to controls. Overall, the inclusion of the LE derived from the MS1-VEGF cells formed nanoliposomes that have beneficial features for targeting. These include enhanced targeting of target cell populations compared to conventional liposomes, the ability to distinguish between non-target and target cell populations, and targeting is microenvironment-specific.

Implications/Clinical Relevance: Further research is needed to explore the potential use of CLENs for targeting and treatment of pancreatic cancer.

Drosophila a New Alternative for High Throughput Screening of Antidepressant Drugs

Author(s): Anusha Chinadam, and Prashant Mandela

Faculty Advisor/Principal Investigator: Prashant Mandela

Program/School: PHARMD.DPH/School of Pharmacy

Affiliate(s): N/A

Purpose/Hypothesis: Chronic application of mild and varied stressors will induce behaviors akin to human depression in D. melanogaster and their onset can be prevented by treating with SSRIs and DAT inhibitors.

Description/Methods/Materials: Fruit Fly Culture: D. melanogaster, Canton S, strain will be obtained from the fly stock center, Bloomington, Indiana, and will be cultured in polystyrene tubes. Fly stocks will be maintained in a drosophila incubator (Geneva Scientific) in 12 hour light and dark cycle and at 23oC with constant humidity. All flies and mating pairs have unlimited access to food. D. melanogaster will be fed the instant drosophila feed (Formula 4-24®) obtained from Carolina biologicals, Burlington, North Carolina. Drug treatments: Male flies will be divided into seven groups with each group containing 40 flies. The groups include: 1) control, 2) Chronic mild stressed, 3) chronic mild stressed + Fluoxetine, 4) chronic mild stressed + Desipramine, 5) Chronic mild stress + Fluoxetine + Desipramine, 6) Fluoxetine alone, 7) Desipramine alone, and 8) vehicle groups. All the drugs (SSRIs and DAT inhibitors) will be administered by adding them to the food. Chronic Mild Stress Protocol: Male flies will be separated from female flies after 2 days of birth under CO2 anesthesia. Male flies will be given two days to recover from anesthesia and then will be subjected to random chronic mild stress over a period of 10 days. Some of these stressors are already established and some are novel. Temperature changes, starvation, and sleep deprivation stress were previously described (14, 15). Exposing to the olfactory repellant environment, and disorientation are novel stressors that are not previously described in the literature.

Results & Conclusion/Discussion: Our results indicate that CUMS protocol significantly alters the Drosophila behavior that can be corrected by antidepressant treatment.

Implications/Clinical Relevance: Drosophila could be an excellent model for testing novel antidepressant drugs.

Image-Based Medication Guidance: Analyzing the Accuracy of ChatGPT's Instructions Against Manufacturer Data

Author(s): Krishna Panchal, Yusef Yassin, Thien Nguyen, Katharine Nault, and Timothy Aungst

Faculty Advisor/Principal Investigator: Timothy Aungst

Program/School: PHARMD.DPH/School of Pharmacy

Affiliate(s): N/A

Purpose/Hypothesis: With the advent of image recognition capabilities within AI programs, patients can now upload a medication image and instantly receive instructions for use. It is unclear the accuracy level of these instructions when compared with those provided by the manufacturer. The objective is to evaluate the accuracy and safety of medication instructions for use generated by ChatGPT answers from self-taken drug images versus the manufacturer instructions across several different routes of administration.

Description/Methods/Materials: Twelve medications were photographed three different ways, including by themself, with packaging, or packaging alone. Images were uploaded to ChatGPT4 (Version Jan 2022) in September-October 2023 to generate instructions with the prompt “How do I take this medication.” Responses were collected, and the text was prepared to be compared with the PI from DailyMed. Text similarity was tested based on Cosine Similarity under Count Vectorization and TF-IDF Vectorization providing a similarity percentage to either the medication instruction for use (IFU) or MedGuide. The ChatGPT generated medication instructions were then clinically evaluated for their accuracy based on meeting acceptable patient instructions.

Results & Conclusion/Discussion: ChatGPT identified all 12 medications and produced patient text instructions on administration. Between the two similarity comparison methods, Count Vectorizer demonstrated a better similarity performance than TF-IDF with an average difference of 8.75%. Average text similarity of ChatGPT instructions to IFU and MedGuides was 76.24%. Clinical review scores were lower, with a 59.75% match. ChatGPT was found to provide more patient friendly instructions than the PI. Medications with more complicated routes of administration (e.g. injectables) or steps were found to have lower Count Vectorization match rates and clinical review scores. Medications that were administered orally or with fewer steps to use were found to have higher match scores.

Implications/Clinical Relevance: Our research opens the conversation regarding the use of LLM by patients to understand how they use their medications by image capture. Our initial findings demonstrate some utility but will require further research in LLM engineering.

A Pilot Feasibility Study of a Novel Functional Electrical Stimulation Fall Risk Assessment

Author(s): Alexandra Duddy, Jenny Yan, Madison Dacey, Rachel Ciulla, and Shannon Mathews, Christopher Joyce, and Erin Faraclas

Faculty Advisor/Principal Investigator: Christopher Joyce

Program/School: PTH.DPT/School of Physical Therapy

Affiliate(s): Evolution Devices, Inc., Berkeley, CA

Purpose/Hypothesis: The purpose of this project is to establish a pilot feasibility study for validation of a novel electrical stimulation device, the EvoWalk, to determine if its composite fall risk score is in correlation with gold standard fall risk scores.

Description/Methods/Materials: Subject(s): Two women, both 56 years-old, with relapsingremitting multiple sclerosis. A pilot feasibility study with the inclusion criteria: a diagnosis of multiple sclerosis, over 18 years of age, ability to ambulate independently for at least 50 feet with or without an assistive device, experience foot drop or foot slap, lower extremity weakness at the foot, ankle, or knee due to MS, and anterior tibialis weakness or paralysis. Exclusion criteria: a recent lower extremity injury that impacts walking, history of malignancy, pregnancy, pacemaker, metal in the lower extremity, deep vein thrombosis, pulmonary embolism, tuberculosis, peripheral arterial disease, lower extremity fracture, seizures, or epilepsy. Participants underwent a series of standardized tests at MCPHS University including: the Timed Up and Go (TUG), Ten Meter Walk Test (10MWT), Berg Balance Scale (BBS), Activity-Specific Balance Confidence Scale (ABC), and then the EvoWalk Gait Analysis. The results from each participant's ABC, BBS, TUG, and 10MWT assessments will be evaluated alongside the EvoWalks composite score to show comparable accuracy between pre established and the novel measure.

Results & Conclusion/Discussion: Participant one’s self-selected pace 10-MWT speed was 0.543 m/s indicating a high fall risk. Their TUG average score was 29.3 seconds which is above the fall risk threshold for community dwelling adults and frail elderly. Participant one’s BBS score was 33/56 indicating high fall risk. Her ABC score of 57% does not indicate risk for falling but instead moderate level of physical functioning. Conversely, the Evowalk calculated participant one as a low fall risk. Differences were found with the EvoWalk predicted gait speed (0.28 m/s) and calculated gait speed from the self-paced 10MWT (0.54 m/s) for participant one.

Implications/Clinical Relevance: As clinical utilization increases, the validation of this device will become more important to ensure the safety and accuracy of the prescribed treatment.

Meta-Analysis of Randomized Controlled Trials on Acupuncture for Bell’s Palsy: Clinical Effectiveness and Safety

Author(s): Ramon Andres Rodriguez Meza, Shalin Lakhani, and Stephen Cina

Faculty Advisor/Principal Investigator: Stephen Cina

Program/School: CAS.CHM.MAOM/New England School of Acupuncture

Affiliate(s): N/A

Purpose/Hypothesis: Bell’s palsy (BP) is an idiopathic condition that consists of one-sided facial nerve paralysis resulting in overall weakness of the affected side facial muscles. Several studies have shown acupuncture as an effective therapy that reduces BP symptoms, but the literature is still inconclusive. The purpose of this study is to extend the research of Bell’s Palsy (BP) treatment with acupuncture by analyzing several research studies and determine the reliability of studies. Acupuncture has been shown to be effective at reducing BP symptoms regardless of duration (acute or chronic). However, previous meta-analyses have been deemed unreliable due to heterogeneity of the studies, small sample sizes, and little information about potential adverse effects. The present meta-analysis aims to evaluate the most current literature on the treatment of BP with acupuncture displayed on reliable databases to provide proper evaluation of the treatment protocols, determine its effectiveness, and assess the safety of the procedures.

Description/Methods/Materials: Retrospective clinical data was gathered from three different databases, The Cochrane Library, Embase, and PubMed between 2014 and 2024. Only randomized controlled trials (RCTs) were selected for the analysis of their content. All studies were included if they were RCTs submitted within the last 10 years, used acupuncture needling techniques and adjunctive TCM therapies to treat acute or chronic BP symptoms, and full-text access was available. Some of the tools used in the articles to measure the outcome of the treatments were: Facial Disability Index (FDI), House-Brackmann Grading System (HBGS), Facial Nerve Scale Questionnaire (FNSQ), Facial Nerve Grading System 2.0 (FNGS 2.0), Sunnybrook Facial Grading System (SFGS), and other objective measurement scales were compared for degree of overall treatment effectiveness.

Results & Conclusion/Discussion: Data were collected from 9 articles meeting inclusion criteria, with a total of 1550 participants. Acupuncture, along with adjunctive therapies like moxibustion and electroacupuncture, demonstrated effectiveness in reducing BP symptoms, as indicated by outcome measurement scales such as FDI, HBGS, and FNGS 2.0. Across all studies, mild adverse effects were reported, underscoring the safety profile of acupuncture treatments.

Implications/Clinical Relevance: Even though, acupuncture has yielded positive results at reducing BP symptoms, the future research should take into account the subjects’ constitution, underlying conditions, and duration of the disease from a traditional Chinese medicine (TCM) standpoint to increase the efficiency of the treatments, thus, increasing the value of acupuncture treatments due to their low report of side effects and safety when compared to conventional treatments.

Abstract: 20

Calcification Mapping and Gallbladder Disease

Author(s): Sonora Shelton and Debra Crandell

Faculty Advisor/Principal Investigator: Debra Crandell

Program/School: DMS/School of Diagnostic Medical Sonograghy

Affiliate(s): N/A

Purpose/Hypothesis: To determine the calcification patterns and implications in the gallbladder to determine the treatment plan

Description/Methods/Materials: Review of literature in conjunction with a case study of a porcelain gallbladder.

Results & Conclusion/Discussion: This study explores the potential utility of calcification patterns as a data point in managing porcelain gallbladder, shedding light on its implications for clinical practice and future research endeavors.

Implications/Clinical Relevance: Recognizing patterns of calcifications in the gallbladder wall and the progression of disease can result in effective management and treatment of the disease.

Cylinder Frenzy

Author(s): Farjana, Khaled, Marufa, Khandaker, and Justin Carrion

Faculty Advisor/Principal Investigator: Justin Carrion

Program/School: OPT.OD/School of Optometry

Affiliate(s): N/A

Purpose/Hypothesis: N/A

Description/Methods/Materials: In a model eye, the cornea or lens are shaped with a spherical curvature so that incoming light is refracted equally across all meridians to form a clear image on the retina. However, in cases where the cornea or lens is shaped with mismatched curves, refracted light is bent differently across the meridians, creating two images instead of one and resulting in a blurred image on the retina. Astigmatism is a type of refractive error that is due to either the cornea or lens, or both, being curved more steeply in a specific meridian. Mild astigmatism is considered to be less than 1.00 diopter of cylinder power, moderate astigmatism ranges from 1.00-2.00 diopters, severe astigmatism ranges from 2.00-4.00 diopters and extreme astigmatism is greater than 4.00 diopters. Signs and symptoms presented in patients with astigmatism are blurry vision, nyctalopia, eye strain, headaches and squinting. Generally, astigmatism can be corrected with prescribing spectacles, contact lenses, or in dire situations, refractive surgery.

Results & Conclusion/Discussion: A 36 year old Hispanic male presented for a comprehensive eye exam. He complained of blurry vision at distance and near. He also complained of headaches. Medical history was significant for a 2-month coma due to a head injury a few years ago. Patient also had arrhythmia. Medical history otherwise was unremarkable. His entering uncorrected VA for OD was 20/200, OS was 20/125 and OU was 20/80^-1. Pinhole was performed and his VA for OD was 20/80 and OS was 20/50^-2. For his near VAs, OD was 20/80, OS was 20/60^-1, and OU was 20/60^-1. For confrontation visual fields, there was constant inferior and nasal restriction for both OD and OS. All other entrance exams were unremarkable. Refraction was performed and the final prescription for OD was -3.00 - 5.00 x 017 with BCVA of 20/25, and for OS, it was -1.25 - 5.00 x 163 with a BCVA of 20/20. Slit lamp examinations revealed some trace injection, trace SPK OS, and mild chemosis nasally OS. Angles were 1/2:1 OD and OS. IOP was 11 mmHg OD and 12 mmHg OS. DFE revealed white without pressure superior nasally in OD. Optic nerve and retina were otherwise unremarkable. Patient was trial-framed with prescription and felt comfortable with his vision. It was concluded that the patient's symptoms were due to extreme astigmatism OU, and the patient was informed to return for a 30-2 visual field exam to monitor results from CVF and case history of head trauma.

Implications/Clinical Relevance: N/A

A Shocking Exam

Author(s):

Riley Janke, Steven Kaufman, Shirmarie Starks, and Jami Parsons-Malloy

Faculty Advisor/Principal Investigator:

Jamie Parsons-Malloy

Program/School: OPT.OD/School of Optometry

Affiliate(s): N/A

Purpose/Hypothesis: Background: Cataracts often are a result of natural aging processes but can develop secondary to trauma or other conditions. The purpose of this case is to highlight a less common presenting secondary cataract due to electrical shock and the effects of future treatments.

Description/Methods/Materials: Clinical Case: A 71-year-old Hispanic male presents with complaints of blurred vision OU at both distance and near. This exam was a follow-up post-cataract surgery OS, and the patient said his vision improved post-surgery but remained mildly blurred. In the visit before his cataract surgery, the patient’s uncorrected visual acuities on Snellen’s chart were light perception in the OD and 20/40 +2 in the OS. Upon slit lamp examination, a traumatic cataract from electrical shock was noticed preventing a clear view into the posterior of the eye. B scan with OCT was performed showing vitreous hemorrhaging and complete retinal detachment OD. For the left eye, there was a 3+ cataract which prompted a referral to the cataract surgeon for removal. The surgeon inserted a PC IOL in the left eye but did not perform cataract surgery on the right eye due to posterior conditions limiting any improvement in visual acuity. The cataract surgery went unremarkably OS. Further investigation into the case history, the patient reports “possibly” being electrocuted as a child but is unsure of his age when it happened or if he was certainly electrocuted. The state of the cataract with its unusual appearance was likely due to trauma, from the presumed electrical shock. Due to the patients’ lack of past medical history and lack of health care, it can’t be confirmed. The retinal detachment is also long standing and onset is unknown due to the patient being a poor historian. Systemic history since moving to the United States is quite extensive. He is a moderately controlled type II diabetic with an A1C of 8.0 last taken 6 months prior to exam date. Patient is also positive for cardiovascular events and reports open heart surgery one year prior.

Results & Conclusion/Discussion: The patient was given new Rx for OS correcting to 20/25+ with OD remaining at light perception. Given there is no viable vision remaining in the right eye, comfort is prioritized over improved vision, so the patient will be monitored for any pain and discomfort developments.

Implications/Clinical Relevance: The purpose of this case is to highlight a less common presenting secondary cataract due to electrical shock and the effects of future treatments.

The Pigmentary “Storm”: A Case of Glaucoma Suspicion

Author(s): Mariem Girgis, Jaspreet Purba, Summer Chaudry, Jami Parsons Malloy, and Kathleen O’Leary

Faculty Advisor/Principal Investigator: Kathleen O’Leary

Program/School: OPT.OD/School of Optometry

Affiliate(s): N/A

Purpose/Hypothesis: N/A

Description/Methods/Materials: Glaucoma leads to slowly progressive optic nerve damage and eventual vision loss. A variety of factors may predispose an individual to developing glaucoma: being over age 60; African American race; a family history of glaucoma; and/or having systemic conditions such as DM, HTN, and heart disease. In this work, we describe an atypical case where a younger patient presents with suspicious ocular findings, suggesting possible future glaucoma development.

Results & Conclusion/Discussion: A 27-year-old African American female graduate student was referred to the MCPHS Eye and Vision Center primary care clinic after findings of pigment on the cornea in both eyes. No ocular symptoms were reported. No ocular medications were reported. Systemic health was remarkable for anxiety, seasonal allergies, and dry scalp. Systemic medications included guanfacine, Allegra, and ketoconazole shampoo. No drug allergies were reported. The patient’s family medical history was positive for T2DM and HTN. In terms of family ocular history, the patient’s father is a 10-year glaucoma suspect, with no confirmed diagnosis of glaucoma. Entrance testing was unremarkable. Ocular examination revealed unremarkable lashes, palpebral conjunctiva, and iris findings (including no transillumination defects) OU. There were 2+ capped Meibomian glands on the lower lid OU. Racial melanosis at 5:00 was noted OS. Interestingly, there were 2+ pigment cells with clumping in the inferior nasal quadrant of the posterior corneal surface OD & in the inferior temporal quadrant of the posterior corneal surface OS. The patient had a Hudson-Stahli line and mild arcus OU. The anterior chamber was deep and quiet, with no cells/flare OU. IOPs were 18 mmHg OU. Gonioscopy revealed 4+ pigmentation of the posterior TM, 4+ iris processes, prominent Sampaolesi line, and flat iris approach, in all four quadrants (inferior, superior, nasal, and temporal), OU. The most posterior structure was CBB in all four quadrants OU, indicating open angles. No angle recession, PAS, nor NVA/NVI were noted. DFE revealed an unremarkable lens and 360 degrees of WWOP OU. C/D ratios were 0.6:1 H/V OD and 0.5:1 H/V OS. Optic disc findings included an OD temporal choroidal crescent and OS scleral ring 360 with a pigmented spot on the disc margin at 5:00. The patient had deep cups, a venous pulse, but no PPA, OU. OCT and fundus imaging were unremarkable OU.

Considering the patient’s history and ocular findings, mild suspicion for future glaucoma development was determined. The patient was educated on her findings and scheduled to return to the clinic in 6 months. This follow-up visit will include re-evaluating the posterior corneal pigmentation, repeating gonioscopy, OCT, and fundus imaging, and conducting a 24-2 HVF.

Implications/Clinical Relevance: N/A

Meibomian Gland Dysfunction, NO CAP

Author(s): Jessica Peterson, Veena Patel, Linda Dam, Heather Bell, and Kathleen O’Leary

Faculty Advisor/Principal Investigator: Kathleen O’Leary

Program/School: OPT.OD/School of Optometry

Affiliate(s): N/A

Purpose/Hypothesis: N/A

Description/Methods/Materials: Meibomian glands are present in a row behind the lashes. They produce an oily substance that enhances the function of the other tear layer to reduce the evaporation of tears. Normally, they appear clear and unblocked. Meibomian gland dysfunction is a condition when the meibomian glands are unable to function properly because they become blocked or capped. As a result, the patient can develop dry eyes from not enough secretion, inflammation, and the glands to appear abnormal in color and size. Because of the poor tear film that results, patients may experience blurry vision.

Results & Conclusion/Discussion: A 33 year old African American female presents with constant blurry vision in the right eye. It started six months ago. The blurry vision lasts for seconds to minutes and clears with blinking. Slit lamp examination revealed two nevi on the right lower lid , a few capped meibomian glands in both eyes and no debris on the lids and lashes. The Van Herick angles were 1:1 temporally and nasally in both eyes, with a deep and quiet anterior chamber in both eyes. Tear breakup time was found to be 5 seconds. All other anterior segment structures were unremarkable with no pathologies. The dilated fundus examination revealed a pink and healthy optic nerve with distinct margins, rim intact, no peri-pappilary atrophy and follows the ISNT rule in both eyes. The cup to disc ratio was 0.3 horizontally and vertically in both eyes and the artery/vein ratio was ⅔ with a normal caliber in both eyes. The vitreous was clear and the macula was flat and intact with a positive foveal reflex in both eyes. During binocular indirect ophthalmoscopy, the posterior pole was flat and intact 360 in both eyes, and in the periphery there was no holes, no tears, and no breaks 360 in both eyes.

Implications/Clinical Relevance: N/A

Proliferative Diabetic Retinopathy: A Case Study

Author(s): Alyssa Todd, Abby Taylor, Robert Gigliotti, and Kathleen O’Leary

Faculty Advisor/Principal Investigator: Kathleen O’Leary

Program/School: OPT.OD/School of Optometry

Affiliate(s): N/A

Purpose/Hypothesis: N/A

Description/Methods/Materials: Proliferative diabetic retinopathy is a chronic, advanced ocular manifestation of uncontrolled diabetes. Diabetic retinopathy is characterized by damage to retinal blood vessels when blood sugar levels are elevated. Over time, damaged retinal vasculature will rupture, primarily due to continual atherosclerotic damage caused by the increase of blood glucose. As the blood sugar builds, there is a continual sinister cycle of plaque formation, rupture, and reformation in attempt to repair the hemorrhage. This can be further exacerbated by diseases such as hypertension or hypercholesterolemia due to their progressive damage of blood vessels as well. Furthermore, vasculature damage can occur even in those with well controlled diabetes. This is because the most critical risk factor for developing diabetic vascular damage, including diabetic retinopathy, is the duration with which the patient has had the disease. Surely acceptable treatment and mitigation of other risk factors help in delaying the progression of the disease, yet there is no permanent halt. It is not uncommon for diabetes to first be diagnosed by an optometrist. This is due primarily to the small vasculature in the eye, accompanied by the fact that diabetes is a largely asymptomatic disease.

Results & Conclusion/Discussion: This study focuses on a 49 y/o male who presented with proliferative diabetic retinopathy on his annual eye exam. Diagnosed over 15 years prior with diabetes, the patient reported a last blood sugar level of 110mg/dl and no knowledge of his last A1C at the time of the examination. Additionally, the patient reported that he had little to no vision in his right eye due to a bleeding episode two years prior. Visual acuity confirmed this testament with hand motion appreciated in the right eye while the left eye yielded 20/40 with little improvement on pinhole. A dilated fundus examination revealed a multitude of diabetic changes including trace hemorrhages, atrophy, and pigmentary changes in both eyes. Furthermore, vascular sclerosis was appreciated in his right eye, a clear sign that the diabetic retinopathy has progressed to the proliferative form. Further testing confirmed that the patient is suffering from Type II Diabetes Mellitus with bilateral proliferative diabetic retinopathy, however, no macular edema was present at the time of the examination. The patient was referred to a retinal specialist and his primary care physician in order to regain control of both his ocular and systemic diabetes.

Implications/Clinical Relevance: N/A

Patient Motivation and Its Impact on Diabetic Ocular Complications: A Case Study

Author(s): Viveahan

Sanganethy, Mohamed Qarni, Jillian Camara, and Kathleen O’Leary

Faculty Advisor/Principal Investigator: Kathleen O’Leary

Program/School: OPT.OD/School of Optometry

Affiliate(s): N/A

Purpose/Hypothesis: N/A

Description/Methods/Materials: Proliferative diabetic retinopathy (PDR) is an advanced form of neovascularization that occurs in patients with diabetes. It is characterized by the formation of new blood vessels that extend beyond the retina and into the optic disc, iris, and angles. As with any form of neovascularization, these new vessels are fragile and leaky which put the patients at increased risk of edema, exudates, and hemorrhaging. The vitreous contains angiogenic factors which exacerbate the effects by promoting the formation of these vessels. As the vessels proliferate, they can begin extending into the space between the posterior hyaloid membrane and the retina. Over time, a fibrinous environment develops in this space that is able to produce both localized traction and contractions. As a result, in more advanced cases of PDR the traction on the retinal vessels and tissue create a vitreous hemorrhage. If left untreated there is a risk of continued contraction and development of a retinal detachment. Current treatment options include panretinal photocoagulation, anti-VEGF injections, and a vitrectomy. Proper management of diabetes is crucial in prevention of PDR and therefore emphasizes the importance of physician follow ups, patient education, and proper treatment adherence. Diabetes is a chronic disease that requires lifelong management. It demands a compassionate and trustworthy team of healthcare providers to ensure the patient feels both empowered and supported in overcoming its challenges and complications. In this case study we explore the progression of systemic and ocular diabetes when there is a multidisciplinary failure in patient education.

Results & Conclusion/Discussion: Prior Medical Hx:

Multiple digital amputations in hands and feet

Entrance Testing

VA: 20/40 -2 OD; LP OS

CVF: FTFC OD; Restricted OS

Anterior Segment

Cornea: Central rust spots OD

AC: <1:4 T/N OU

Lens: Anterior Cortical Cataract, 1+ NS Cortical spoking OU

Posterior Segment

Vitreous: Moderate Vitreous Heme OD, Dense Vitreous Heme OS

Optic Disc + Retina limited or no view secondary to vitreous heme

Implications/Clinical Relevance: N/A

A Can of Worms

Author(s): Daidania Borges, Shelby Jarrett, Jamie Lam, and Kathleen O’Leary

Faculty Advisor/Principal Investigator: Kathleen O’Leary

Program/School: OPT.OD/School of Optometry

Affiliate(s): N/A

Purpose/Hypothesis: N/A

Description/Methods/Materials: This case represents the importance of understanding various presentations of specific patient demographics, previous ocular history, and methods of coordinating patient care in the event of complications to exam conduction. Diagnoses of presbyopia, Toxoplasma chorioretinitis, blepharitis, dermatochalasis, and pinguecula in Patient A, presenting with bilateral Multifocal IOLs due to prior phacoemulsification, were concluded following completion of a challenging comprehensive eye exam, in which complications included patient compliance with procedures and testing. Presbyopia can essentially be summarized as age related loss of accommodation and decreased Near VA due to involutional loss of crystalline lens and ciliary muscle function. In the case of presentation status post cataract surgery and Multifocal IOL implantation, diagnosis of presbyopia primarily encompasses the lasting complications with near VA rather than the typical presentation. Toxoplasmosis is caused by the parasite known as Toxoplasma gondii, transmitted by ingesting contaminated food. It has an active and dormant phase. Active inflammation within the eye can be seen based on cystic formations from the host’s immunological response to the parasite. Rupturing of the cystic formations lead to focal retinochoroiditis and scarring which are the most common retinal sign. Reactivation of a toxoplasmic scar usually has fuzzy indistinct borders around the lesions Blepharitis and Dermatochalasis are commonly seen in patients of increased age, with blepharitis encompassing lid margin inflammation by various causes, and dermatochalasis referring to involutional loss of skin and connective tissue elasticity primarily observed in the superior lid. Pinguecula are related to high sun areas and extensive UV exposure, thus are expected in patients with history of such exposure. Complications range from asymptomatic, to symptoms of dry eye, to inflammation.

Results & Conclusion/Discussion: This patient had an ocular surgical history which was performed overseas. She presented with a chief complaint of blurry vision at near however, during the fundus evaluation multiple choroidal lesions were observed, ultimately diagnosed as toxoplasmosis. The patient did not report symptoms or disturbances to her vision from this condition. Diagnosis for this patient are as follows:

Toxoplasmosis in both eyes, with no active inflammation or edema, asymptomatic.

OD: large choroidal retinal scar at 6 o’clock 4 DD away from the Optic nerve.

OS: 2 circular choroidal retinal scars at 6 o’clock 4 DD away from the Optic nerve, 1 DD away from the optic nerve.

Presbyopia: provided with a reading Rx of +0.75 DS OU.

Blepharitis OU, mild, asymptomatic.

Dermatochalasis OU, mild, asymptomatic.

Pinguecula OU, mild, asymptomatic.

Implications/Clinical Relevance: N/A

Glasses On or Glasses Off?

Author(s): Zahrak Farese, Belle Albert, Caitlyn Phillipsen, and Kathleen O’Leary

Faculty Advisor/Principal Investigator: Kathleen O’Leary

Program/School: OPT.OD/School of Optometry

Affiliate(s): N/A

Purpose/Hypothesis: N/A

Description/Methods/Materials: Description: A 29-year-old African American male came in for a routine eye exam complaining of blur at both distance and near with OS feeling worse. Pt denies any flashes, floaters, and HA. Pt is being monitored by his PCP because of his high cholesterol. We performed the following:

o VA’s at both distance and near

o CT at both distance and near

o Randot Stereopsis (global and local)

o Color vision test (HRR)

o CVF

o EOMS

o Pupils

o Retinoscopy

o Refraction/Binocular Balance

o Slit lamp examination

o Tonometry

o DFE (BIO/78D/90D)

o Pt’s entering VA’s were ODsc: 20/20 and OSsc: 20/40 (did not improve with pinhole) at distance. Whereas the pt’s entering VA’s at near were ODsc: 20/25 and OSsc: 20/40.

o CT, Stereo, color vision, and pupils were all unremarkable.

o The patient was put in trial frame and was comparing his vision if it was better with the trial frame on or off while he was walking in the hallway.

Results & Conclusion/Discussion: During the comprehensive eye exam, the following were found:

o Final Rx- Prescribed after trial frame:

 OD: +0.25 - 0.50 x 060 VAs: 20/20

 OS: +1.75 - 0.75 x 080 VAs: 20/30

o Goldmann Tonometry: 17 mmHg OU

o Slit lamp: Mattering/greasy was found on the upper lid OU. Capped glands on lower lids OU in addition to injection on the lower palpebral conjunctiva OD. Racial melanosis and injection inferiorly OU. Sclera was white and quiet OU. An arcus that is starting to develop inferiorly OU. The iris was flat and brown, and the lens had no opacites OU. The anterior chamber was deep and quiet. In addition, we found PPA temporally OU, the optic disc follows ISNT rule OU, and the optic disc appeared pink and healthy OU. But OS had a tilted disc. The C/D ratios estimated to be 0.4H/0.45V OU. The macula appeared flat, even pigmentation, and (+) FR OU. Retina had no pathologies, and the A/V ratio was 2/3 with congenital tortuosity OU. No holes, tears, or breaks 360 OU and no cells were present in the vitreous OU.

Abstract:

39 Year Old Struggling at Near… Presbyopia or Hyperopia?

Author(s): Elise Nguyen, Sierra O'Keefe, Kelsie Wilson, Kathleen O’Leary

Faculty Advisor/Principal Investigator: Kathleen O’Leary

Program/School: OPT.OD/School of Optometry

Affiliate(s): N/A

Purpose/Hypothesis: N/A

Description/Methods/Materials: Hyperope OU with against the rule astigmatism OD and oblique astigmatism OS, no signs of presbyopia

Results & Conclusion/Discussion: The patient's entering visual acuity uncorrected at distance were 20/20 OD and 20/20 OS. At near, her uncorrected visual acuities were 20/40 OD and 20/25 OS. All additional entrance testing was unremarkable including pupils, color vision, cover test, extraocular muscle movement, confrontation visual field and stereopsis. Refractive testing revealed compound hypermetropia with against the rule astigmatism OD and oblique astigmatism OS. The patient’s anterior segment findings were unremarkable besides pinguecula nasally in both the left and right eye, along with pannus located inferior nasally in the right eye. Pannus was due to dry eye. Intraocular pressures were within normal limits at 15 mmHg OD and OS. The patient returned two weeks later for a dilated fundus exam due to personal time constrictions at the first visit. The posterior segment exam revealed drusen at the macula OD. The patient’s cup/disc ratio was 0.20 OD and OS. The rest of her posterior findings including blood vessels, macula, and periphery were unremarkable.

Implications/Clinical Relevance: N/A

Abstract: 30

Vortex Keratopathy as an Ocular Manifestation of Amiodarone

Author(s): Madeline Padron, Kylie Erickson, and Kathleen O’Leary

Faculty Advisor/Principal Investigator: Kathleen O’Leary

Program/School: OPT.OD/School of Optometry

Affiliate(s): N/A

Purpose/Hypothesis: N/A

Description/Methods/Materials: Amiodarone, a common anti-arrhythmic drug, is known to cause Vortex Keratopathy in the majority of patients prescribed this medication and typically appears 8 months after initiation of therapy. Vortex Keratopathy typically does not cause any visual disturbance; however, it is important to monitor for visual changes over time with usage of Amiodarone, as it can cause several other ocular manifestations including blurry vision, lenticular and retinal changes, and madarosis. These ocular manifestations require monitoring but are generally not significant enough to warrant discontinuation of the drug.

Results & Conclusion/Discussion: VA’s 20/25 OD and OS at distance and near. Other entrance testing findings were unremarkable. Slit lamp examination revealed actinic keratosis OD, senile ectropion OU, dermatochalasis OU, conjunctivochalasis OU, concretions of lower palpebral conjunctiva OU, pinguecula of temporal bulbar conjunctiva OU, Nuclear sclerotic cataracts OU, and vortex keratopathy of inferior cornea OU. Fundus evaluation showed no retinal tears, and a choroidal nevus OS with no signs of malignancy.

Implications/Clinical Relevance: N/A

Posterior Vitreous Degeneration

Author(s): Nour Moughnyeh, Zubia Haque, and Kathleen O’Leary

Faculty Advisor/Principal Investigator: Kathleen O’Leary

Program/School: OPT.OD/School of Optometry

Affiliate(s): N/A

Purpose/Hypothesis: N/A

Description/Methods/Materials: The vitreous is a key gel-like structure of the eye responsible for supporting the retina, absorbing shock from any trauma to the eye, and creating a diffusion barrier between the anterior segment and the posterior segment of the eye. The vitreous is also key in maintaining the optical transparency of the eye to allow the unhindered pathway of light and thus allow sight to remain unhindered. As aging occurs the vitreous will begin to liquefy and shrink due to the separation of liquid and solids causing the formation of aggregates of fibers or floaters to appear in vision. Posterior vitreous detachment (PVD) refers to the collection of fluid between the posterior hyaloid of the vitreous and the inner limiting membrane of the sensory retina. As the fluid continues to accumulate the vitreous will detach from the sensory retina and form a complete PVD. The issue arises with incomplete PVD, which can cause a significant amount of traction on the retina and lead to a variety of ocular symptoms ranging from floaters to retinal detachment.

Results & Conclusion/Discussion: A 70-year-old Caucasian male presented to the clinic with a darkened oval spot in the center of his vision in his right eye. The patient has noticed this spot for several weeks and blurry vision OU at near with significant blur in the right eye. The preliminary findings for the patient were floaters and a retinal tear in the right eye. The patient had previously undergone focal laser surgery for the retinal tear. Binocular indirect ophthalmoscopy revealed a scar in the inferior peripheral retina of the right eye and superior and inferior pigment clumping in the left eye. Both eyes had a Weiss ring present indicating a complete PVD.

Implications/Clinical Relevance: N/A

A1C of 15

Author(s): Marietta, Richman, Cameron, Rediker, Lily, Masternak, and Kathleen O’Leary

Faculty Advisor/Principal Investigator: Kathleen O’Leary

Program/School: OPT.OD/School of Optometry

Affiliate(s): N/A

Purpose/Hypothesis: N/A

Description/Methods/Materials: Hypertensive Retinopathy (HR) and Diabetic Retinopathy (DR) are ocular manifestations of systemic disease. HR can occur at different stages of hypertension and are exacerbated by concomitant factors such as diabetes and smoking. As HR progresses, it often leads to endothelial damage in the retina, resulting in a breakdown in the blood-retinal barrier. The clinical findings are seen in the retinal vasculature and can present with flame shaped hemorrhages, macular edema, hard exudates, and cotton-wool spots. DR risk factors include duration of diabetes, A1C and hypertension. This occurs from the insulin deficiency which stimulates hematological and biochemical changes leading to a breakdown of the blood-retinal barrier also. The clinical signs of diabetic retinopathy include microaneurysms, dot blot hemorrhages, and hard exudates. Soft/Confluent drusen are the accumulation of extracellular deposits of lipids, proteins, and cellular debris. These occur with intermediate dry macular degeneration and have a higher risk of progressing to wet macular degeneration.

Results & Conclusion/Discussion: 81-year-old white female presents with chief complaint of vision changes and film on conjunctiva. Visual changes started one month ago and the patient notices fluctuations in vision when blinking. She had previously been diagnosed with type II diabetes and hypertension. The patient’s self-reported A1C was 15% and she was a daily smoker. Entrance Tests: The entering visual acuities (VA) at distance were 20/40-1 with correction for the right and left eye and 20/20-2 with both eyes. Due to the VA’s being worse than 20/40, pinhole was performed with no improvement. Entering visual acuities at near with correction were 20/30 for the right and left eye and 20/20 with both eyes. Other entrance testing was unremarkable. Her refraction showed minimal changes from the previous spectacle Rx. Anterior Segment: Upon slit lamp examination, it was found that the patient had multiple conjunctival cysts, conjunctivochalasis, and ectropion of both eyes. On the left eye, there was a small inferior subconjunctival hemorrhage. Patient has history of previous cataract surgery in both eyes and had posterior capsular opacities on both implants. All other anterior segment findings were unremarkable including corneal integrity and intraocular pressures were within normal limits. Posterior Segment: Both optic nerves were pink with distinct borders and normal rim tissue. The C/D ratio was 0.2/0.2 in both eyes. The right eye had one flame shaped hemorrhage inferior nasal to the optic nerve, and no hemorrhages in the left eye. When examining the macula, both eyes had soft/confluent paramacular drusen, which was greater inferiorly. Vessels had a ratio of 2:3, and the peripheral retina had no holes, breaks, or tears present in either eye. This patient was diagnosed with hypertensive retinopathy, Uncontrolled type II diabetes without retinopathy, and drusen of macula (bilateral).

Implications/Clinical Relevance: N/A

Abstract: 33

Ectoparasite Infestation - The Case of Demodex Blepharitis

Author(s): Minh Cong Luong, Samantha Marcil, Joseph Stamm, and Kathleen O’Leary

Faculty Advisor/Principal Investigator: Joseph Stamm and Kathleen O’Leary

Program/School: OPT.OD/School of Optometry

Affiliate(s): N/A

Purpose/Hypothesis: N/A

Description/Methods/Materials: Demodex are microscopic ectoparasites that naturally live within the hair follicles and sebaceous glands of the skin. While they are the most common ectoparasite found in humans, their growth can become uncontrolled, which results in the ocular manifestation named Demodex blepharitis. The pathognomonic presentation is characterized by collarettes, which are waxy, cylindrical debris at the root of the eyelashes.1 A 37 year-old Hispanic female patient presented for a problem-focused examination with complaints of dryness, redness, and burning sensation on her left eye. The patient reported the use of Thera Tear for relief without improvement of symptoms. Entrance testing was unremarkable, with the previous history of LASIK performed in Argentina 8 years ago and states she has experienced dryness since

Results & Conclusion/Discussion: Upon slit lamp examination, collarettes were substantial and occupied nearly every lash on the upper lid. In addition, pingueculitis was identified on the patient’s nasal conjunctiva of the left eye, which was suspected to be an incidental finding unassociated with the blepharitis. The patient was prescribed Fluorometholone FML Liquifilm 1% topically in her left eye for four times a day for seven days as an initial treatment for pingueculitis. The patient was educated on lid hygiene for Demodex blepharitis and scheduled for a follow-up appointment. Upon follow-up for the pingueculitis, which showed complete clearance of inflammation, the patient was prescribed Xdemvy (lotilaner 0.25%) with one drop in each eye twice a day for six weeks to eradicate the excessive Demodex.

Implications/Clinical Relevance: N/A

Implementing a Primary Prevention Plan to Target Adolescents Experiencing Mental Health Issues in Worcester, Massachusetts

Author(s): Jenna Mangan, Samantha Febus, Rachel Amankwah, Sidney Brastad, Amy Adomah, Carrie Graham, and Colleen Massey

Faculty Advisor/Principal Investigator: Carrie Graham and Collen Massey

Program/School: PHARMD.DPH/School of Pharmacy

Affiliate(s): N/A

Purpose/Hypothesis: To design an evidence-based primary prevention program to address the rising mental health concerns among adolescents living in Worcester, MA.

Description/Methods/Materials: A review of secondary data revealed that mental health related events among adolescent youth is a growing issue in the United States and Worcester, Massachusetts. According to the Massachusetts Youth Health Survey 2021, 30% of high school students reported feeling sad or hopeless for a prolonged period of time, with approximately 12% of students reporting serious consideration of suicide within the past year.1 To address this problem, research was conducted to identify an evidence-based intervention that could be implemented at the local Boys and Girls Club. The Group Health Cooperative’s Reach Out 4 Teens program was found successful at improving the willingness of adolescents to seek treatment for depression. After providing participating teens with an appropriate treatment plan, proper patient education about warning signs, and an array of resources to use when experiencing a depressive episode, approximately 67% showed positive responses.2 Although this program was successful, the local community still lacks a program that is adapted to its needs. An educational program plan would be implemented using a preliminary survey to analyze the current emotional, social, and psychological stress that the participants are experiencing. The survey would include standardized depression screening tools such as the Patient Health Questionnaire (PHQ-9). Survey data will provide information regarding the participants' needs. A child psychologist would then hold a focus group where members will take part in an engaging presentation outlining how to define mental health, when to seek help, where to go when help is needed, and other beneficial information. Focus group participants will be encouraged to ask questions, but will also have the opportunity for confidential conversation with the psychologist if they would prefer a more private setting. Informational sessions and educational activities will be incorporated into the club’s structural framework by the staff members at least once every two weeks thereafter. A follow up assessment will be conducted after one year using the same surveys utilized during the preliminary screening and results will be analyzed.

Results & Conclusion/Discussion: The primary result is development of a program that targets the needs of a specified population. The anticipated outcome is reduction in the incidence of depressive symptoms among the adolescent group by at least 20%. Increasing access to mental health resources for underserved adolescents in the Worcester area may prove to be extremely influential for our community’s young adults.

Implications/Clinical Relevance: There is currently a lack of accessible mental health programs for teens in Worcester, Massachusetts. By implementing an educational program that targets mental health in adolescents, the potential to reduce suicide rates in our local community would remain optimistic. This program plan was focused around only one of four Boys and Girls Clubs locations in Worcester. If proven to be successful one year after initiation, the educational program could potentially be implemented at the other locations as well. There are over 5,000 active Boys and Girls Clubs in the United States.

Development of a Tool to Improve Pain Assessment for Adults with Cerebral Palsy in Outpatient Physical Therapy

Author(s): Jillian Coughlin, Bailee Duquette, Emma Favreau, Theresa Tremblay, Genessa SpangHanson, Camden Marcotte, Haley Stack, Alyssa Bissonnette, and Danielle Bellows

Faculty Advisor/Principal Investigator: Danielle Bellows

Program/School: PTH.DPT/School of Physical Therapy

Affiliate(s): Bay State Physical Therapy, Shrewsbury, MA

Purpose/Hypothesis: The pediatric physical therapist (PT) encounters patients with cerebral palsy regularly, and research on pain interference in children and adults with it is plentiful. However, caregivers and adults living with cerebral palsy report a lack of knowledge and resources among outpatient PTs for this population.1,2 Clinicians in outpatient clinics may not know how to gather accurate information during the patient history and systems review to inform assessment and intervention. Research is also lacking regarding pain assessment and key phrases to guide physical therapists in differential diagnosis of pain in adults with CP (AwCP). To create an educational guide and pain assessment tool for outpatient orthopedic physical therapists specific for AwCP.

Description/Methods/Materials: Four physical therapy students and one MCPHS faculty member collaborated with four outpatient therapists to co-develop The Novel Pain Assessment Tool for Adult Patients with Cerebral Palsy. First, available research was synthesized on pain characteristics and the subjective terminology commonly used by adults with cerebral palsy to describe their symptoms. The most relevant outcome measures, pain descriptors, and history questions were consolidated using a consensus discussion process over 7 months in 5 virtual meetings. The MCPHS research team generated an intake form for outpatient PTs tailored to AwCP. Initial evaluation and verbal feedback were provided by the four collaborators. A PowerPoint was created to orient PTs to the purpose and use of the tool. The educational material, novel pain assessment tool, and a brief online feedback form were then provided to two additional outpatient PTs, one with and one without experience treating AwCP for additional feedback on usability and usefulness in the outpatient clinic setting.

Results & Conclusion/Discussion: Limited feedback was provided via virtual meetings and was received from two clinicians regarding the tool's format. Other clinicians with a mixed outpatient caseload including patients with orthopedic and neurologic conditions agreed to provide feedback but did not complete the feedback form after multiple communications over 5 months due to time constraints and other organizational changes occurring at the same time as this project.

Implications/Clinical Relevance: Creating a toolkit to bridge the gap for PTs with limited experience with treating AwCP when transitioning to adult services to allow for improved confidence in their assessments and treatments for their patients with CP.

Unique Attributes of Generation Z and Modifications to Current Health Care Professions Education

Author(s): Megan Lynch, Robert Pedersen, Brendan Coyle, and Danielle Bellows

Faculty Advisor/Principal Investigator: Danielle Bellows

Program/School: PTH.DPT/School of Physical Therapy

Affiliate(s): N/A

Purpose/Hypothesis: Generation Z is the first generation of graduate students who are digital natives. Due to the large exposure of technology Generation Z has experienced, they have acquired attributes unique to them. Some of these attributes may have a negative impact on Generation Z’s education such as lack of face-to-face communication skills and decreased attention spans. Current healthcare curricula should be adjusted to foster the best learning environment for Generation Z and specifically target areas in which they are lacking compared to previous generations.

Purpose: To bring awareness to the unique attributes that Generation Z possesses which impact their education and make recommendations for current health care educators to best prepare this generation of students for a career in healthcare.

Description/Methods/Materials: A literature review was conducted to identify the preferences and characteristics of Generation Z in health care education. Once the literature review was completed, an infographic was created with recommendations for modification of teaching approaches to maximize educational outcomes for Generation Z graduate healthcare students. The infographic was distributed to 5 Doctor of Physical Therapy educators who volunteered to provide feedback on its content via a 20-question feedback form. The infographic was revised based on feedback.

Results & Conclusion/Discussion: Generation Z unique attributes and educational desires include increased technology use, decreased attention span and collaborative skills, desire for mentorship, need for synchronous lectures, and honest and quick feedback. Three full-time and two adjunct faculty from X number Doctor of Physical Therapy programs completed the feedback form. All educators were familiar with the learning styles of Generation Z and employing many of the teaching strategies outlined in the infographic. Educators find it easy to use alternative forms of media and real-world examples in their teaching. Teaching strategies that are more difficult to incorporate include flexible learning pathways and methods of assessment. Open response feedback suggests that implementing self-directed learning and immediate feedback can be difficult due to time constraints and teaching load. Giving students flexibility in how they learn, are assessed, and provided feedback is constrained by time in a semester and the amount of material in which to be taught.

Implications/Clinical Relevance: Implementation of teaching techniques that foster positive personal and professional growth for Generation Z students in health care professions.

Development of a Strength Training Guide for Adults with Cerebral Palsy

Author(s): Ethan

Clary, John Finn, Zachary Reiner, Rory Wise, and Danielle Bellows

Faculty Advisor/Principal Investigator: Danielle Bellows

Program/School: PTH.DPT/School of Physical Therapy

Affiliate(s): N/A

Purpose/Hypothesis: Ambulatory adults with cerebral palsy (CP) are more sedentary and have more challenges participating in community-based physical activity than their peers. Participation in physical activity is important to maintain fitness and functional mobility in daily life. There is mounting evidence on the importance of strength training for people with cerebral palsy (CP). However, most research that supports this claim is targeted toward children and adolescents. Existing research and a national database for adults with CP suggest that more support is needed to integrate evidence on strength training into community fitness programs for this population.

Purpose: To develop and pilot a strength training guide for ambulatory adults with CP that provides users with comprehensive recommended exercises to promote and preserves functional strength.

Description/Methods/Materials: Four doctor of physical therapy students conducted a literature review to investigate general strength-building protocols for adults with CP (GMFCS levels 1-3). A list of exercises was compiled from existing research with frequency, time, type, and progressions appropriate for this population and organized as a strength training guide. A brief feedback form was created with 5 Likert-scale items on the usefulness and usability of the guide. The strength training guide and feedback form were then provided to the owner of a local integrated fitness center to disseminate to adults with CP who attend a group exercise class.

Results & Conclusion/Discussion: Despite the interest of the gym owner in this patient-focused application of strength training exercise guidelines to ambulatory adults with cerebral palsy, there were no responses from adults with CP to the feedback form. A barrier to piloting this strength guide was a lack of ambulatory adults with CP at our partner’s inclusive fitness facility. All individuals with CP participating in the exercise group used a wheelchair as their primary mobility. The lack of direct contact of the project team with ambulatory adults with CP was also a barrier.

Implications/Clinical Relevance: Implementation of strength training guidelines for ambulatory adults with CP may serve as a tool for encouraging and educating this population in safe and effective exercises that translate to functional activities and improve overall physical activity and health-quality of life

Advancing DEI in Medical Education: A Comprehensive Project Integrating StudentGenerated Bulletins on Critical Healthcare Topics

Author(s): Caroline Bates, Autumn Nudd, and Kasey Dillon

Faculty Advisor/Principal Investigator: Kasey Dillon

Program/School: MPA/School of Physician Assistant Studies

Affiliate(s): N/A

Purpose/Hypothesis: The purpose of this project was to educate emerging medical professionals on critical topics that could impact the populations they work with. This is also aimed at starting conversations amongst students from a variety of perspectives as this is needed in our global community.

Description/Methods/Materials: Through this project, we sought to provide students in the Accelerated Physician Assistant program at both the Worcester and Manchester MCPHS campuses with the opportunity to aid in the curation of bulletins on critical DEI medical topics. Students were able to partner with the SAAPA DEI representatives on both campuses in this project by utilizing a sign-up document. Within this document, students were offered a variety of DEI issues based on the specific heritage months, with the ability to select one that aligned with their personal interests and experiences. Along with selecting a topic, students were able to contribute their additional ideas on issues they would like to know more about in the future. Upon selection of an issue, students furthered their knowledge on their topic and then provided the research to the SAAAPA DEI representatives. After the research had been collected, the SAAAPA DEI representatives used Canva to curate the educational bulletins for distribution on both the Worcester and Manchester MCPHS campuses. Furthermore, the bulletins were posted on the MCPHS Manchester Instagram page to extend the conversation into the MCPHS community.

Results & Conclusion/Discussion: Up to date, we have been able to publish four bulletins in February that have highlighted important people or issues, in the African-American community, in honor of Black History Month. Going forward, students have committed to researching issues on Women’s History for March, as well as Sexual Assault Awareness for April, as these are the corresponding heritage months. Since the publication of these bulletins, there has been constructive conversation regarding these issues noted within our Physician Assistant cohort.

Implications/Clinical Relevance: This project has been impactful to our community as it has fostered conversations on race and socioeconomic diversity. As future clinicians, there will be patient interactions with people from broad backgrounds. As students, there has been evidence that we do not receive enough educational materials to fully be prepared for the diversity of our patients. There is always more to know, and this project was meant to begin to fill gaps for ourselves, our cohort, and our community.

Breast Cancer Screening Awareness In The Community

Author(s): Ditya Belwal and Linda Martino

Faculty Advisor/Principal Investigator: Linda

Martino

Program/School: MPA/School of Physician Assistant Studies

Affiliate(s): N/A

Purpose/Hypothesis: To increase awareness of the importance of regular screening for breast cancer and the change in guidelines of starting screening at age 40 every two years vs. the previous 50 years. Give resources of nearby breast cancer programs and educate about the concerning changes in the breast. According to the National Cancer Institute, when breast cancer is detected early, in the localized stage, the 5-year survival rate is 98%. Our aim was to educate and give resources to our community for earlier detection.

Description/Methods/Materials: Flyers and a poster board with information on breast cancer awareness were made for the local health fair at the YMCA in Manchester, NH, on 05/23/23. It focused on the incidence of breast cancer, the importance of regular screening, changes in guidelines, resources on where to get mammograms, and illustrations of changes in breasts to watch for. Verbal discussions were also made, emphasizing how earlier and regular mammograms can detect breast cancer early, even before a tumor can be felt, and can lead to a better prognosis. For women concerned with the discomfort during the mammogram, we showed an educational animated video on the process of a mammogram to ease these concerns.

Results & Conclusion/Discussion: We talked to approximately 40 women and five men and distributed 50 flyers. During our conversations with the participants, we found many women were worried about breast cancer and were happy to learn about the change to the guidelines and that their insurance would cover the cost. We also discussed not having any screening done due to a lack of insurance or awareness of nearby centers. Providing the names, addresses, and contact information of these centers where they could qualify for a free mammogram was the focus of these participants. Three out of the five men we talked to were unaware that breast cancer can occur in males, too. We discussed this and gave them flyers with images of the signs they could look out for and reach out to a provider if they were concerned.

Implications/Clinical Relevance: Early detection and treatment are key in the fight against breast cancer. Early treatment saves lives, as demonstrated in a landmark article from the American Cancer Society journal, Cancer, in which women aged 40 to 69 underwent organized mammography screening. They had a 60 percent lower risk of dying from breast cancer within ten years of diagnosis and a 47 percent lower risk of dying from breast cancer within 20 years of diagnosis compared with women who did not participate in screening. There is a need to keep educating on the importance of regular mammography, which is essential in decreasing the risk of breast cancer death.

Abstract: 40

Implementing Acupuncture into the Hospital Setting, a Literature Review

Author(s): William Martin, Maria Broderick, and Emilie Gerber Kunicka

Faculty Advisor/Principal Investigator: Maria Broderick, and Emilie Gerber Kunicka

Program/School: CAS.DAIH/New England School of Acupuncture

Affiliate(s): N/A

Purpose/Hypothesis: Conduction of a retrospective literature review on acupuncture services implemented into a hospital setting, to seek to better understand hospital acupuncture protocol, scope of practice and set up of services.

Description/Methods/Materials: Literature review of the past 10 years was conducted with selection to only American based studies. Search terms: ex. “hospital acupuncture” “acupuncture protocol” ‘’acupuncture inpatient services” “hospital Chinese medicine” “hospital acupuncture scope of practice” Search databases: Google scholar primary search engine. MCPHS (Massachusetts College of Pharmacy and Health Sciences) research database. 18,300 total results were available over the past 10 years, with 20+ papers being selected for review. Different tabulation of hospital methods: Three primary methods were used with effectiveness in the reviewed articles: telephone surveys, systematic review, and interviews with qualitative studies. These methods found that readily accessible acupuncture services are lacking in the hospital setting, denying patients alternatives to holistic medicine. These articles however did identify positive means to starting an acupuncture service in the hospital setting, some of these being: patient-provider education on acupuncture, grand rounds participation, regular hospital staff meetings and hospital based CEUs.

Results & Conclusion/Discussion: According to the literature review, several core components were identified as necessary resources for implementing an acupuncture service in the hospital setting. A strong integrative medicine team, coalition with billing departments, regular hospital staff meetings, patient and provider education and continuing education for acupuncturists, with a focus on hospital-based medicine, were some of the indicates for a successful hospital-based acupuncture practice.

Implications/Clinical Relevance: N/A

A Review of the Approval Process for the Biologic CYFENDUS, a Vaccine for Anthrax

Author(s): Madison Conneely and Fred Frankhauser

Faculty Advisor/Principal Investigator: Fred Frankhauser

Program/School: PHARMD.DPH/School of Pharmacy

Affiliate(s): Boston Children's Hospital, Boston, MA

Purpose/Hypothesis: While an anthrax vaccine has already been on the market for some time, CYFENDUS (Previously known as AV909) was developed to provide a post exposure prophylactic vaccine using two doses over fourteen days as opposed to the prior standard of three doses over twenty-eight days. The purpose of this review is to examine the approval process for the biologic CYFENDUS to investigate any issues that may have made an impact on the timeline of the approval process.

Description/Methods/Materials: Materials such as clinical trial data, the summary basis for regulatory action, and the clinical review memo were reviewed.

Results & Conclusion/Discussion: One such hold up was due to issues with the data from clinical trials. This required a major amendment that delayed the approval date. Other important considerations due to the nature of anthrax had an impact on the approval process.

Implications/Clinical Relevance: The need for continuous efforts to improve upon current treatment of anthrax can be attributed to the growing concern over the potential use of anthrax as a bioterrorism weapon.

Overview of the FDA Approval of Biosimilar Alymsys

Author(s): Heer Patel, Prem Patel, Riya Patel, and Frederick Frankhauser

Faculty Advisor/Principal Investigator: Frederick Frankhauser

Program/School: PHARMD.DPH/School of Pharmacy

Affiliate(s): N/A

Purpose/Hypothesis: This research aims to understand the U.S Food and Drug Administration (FDA) approval process for biosimilars. The FDA defines a biosimilar as a biological product that is highly similar with no clinically meaningful differences from an already approved FDA-reference product. Biosimilar products provide safe, effective, and more affordable treatment options for patients. For the purpose of this research, a recently FDA-approved biosimilar, Alymsys (bevacizumab-maly) is studied and compared to its reference product Avastin (bevacizumab). Both Alymsys and Avastin are used in combination with other therapies for various health conditions such as metastatic colorectal cancer, first-line non-squamous non-small cell lung cancer, recurrent glioblastoma, metastatic renal cell carcinoma, persistent, recurrent, or metastatic cervical cancer, and epithelial ovarian, fallopian tube or primary peritoneal cancer.

Description/Methods/Materials: To compare the FDA approval of Alymsys and Avastin, various online FDA resources were utilized. The specific information of Alymsys is derived from the biosimilar’s respective package insert. The Biosimilar Multidisciplinary Evaluation and Review (BMER) through the Center of Drug Evaluation and Research (CDER) which includes the summary, clinical, non-clinical, statistical, and clinical pharmacology review of Alymsys is also utilized.

Results & Conclusion/Discussion: The Alymsys biosimilar application was submitted on April 13, 2021, and was approved for use in the US in April 2022. As of March 2024, over 60,000 patients have been treated with Alymsys worldwide. Various analytical, preclinical, and clinical studies have demonstrated Alymsys functions similar to Avastin in treating patients with metastatic colorectal cancer, first-line non-squamous non-small cell lung cancer, recurrent glioblastoma, metastatic renal cell carcinoma, persistent, recurrent, or metastatic cervical cancer, and epithelial ovarian, fallopian tube or primary peritoneal cancer.

Implications/Clinical Relevance: Introducing Alymsys into the healthcare system provides a less expensive option for cancer treatment which enhances patient access to necessary medications. In addition, it is a step towards reducing healthcare costs associated with cancer care as it alleviates some of the financial burdens on the healthcare system. Lastly, it creates competition within the biopharmaceutical industry that results in innovation and the development of more effective treatment options for patients.

Understanding the Role of Type-O Glycosylation in Chronic Myeloid Leukemia & Therapy

Author(s): Norymar Ayala Concepcion, Zein Dib, Najlaa Hussain S Alsini and Robert Campbell

Faculty Advisor/Principal Investigator: Robert Campbell

Program/School: PHARMD.DPH/School of Pharmacy

Affiliate(s): N/A

Purpose/Hypothesis: To utilize relevant clinical databases to investigate the use of glycosylation inhibitors in the study and potential treatment of chronic myeloid leukemia (CML).

Description/Methods/Materials: A comprehensive literature review was conducted to determine the impact of various glycosylation inhibitors on CML. A systematic search and screening for pertinent articles from the PubMed database (1946-February 29, 2024), utilizing keywords such as 'CML,' 'Glycosylation,' and 'Inhibitors' with the Boolean operator 'AND,' resulted in the identification of 21 articles related to the subject matter. The review focused on articles exploring the use of glycosylation inhibitor drugs in the treatment of CML. Specifically, the articles that investigated Oglycosylation as a potential obstacle to drug delivery and those that inhibited its expression were given priority. Moreover, the relevance of articles involving the CML-specific cell line K562 was also considered for further review. Notably, supplemental research on Google Scholar expanded the scope, discovering additional articles using the search terms ‘chronic myeloid leukemia’ and ‘glycosylation inhibitors.’

Results & Conclusion/Discussion: Studies involving the CML cell line, K562, showed that imatinib suppressed O-glycan expression and related glycosyltransferases, thus normalizing O-glycosylation. Tunicamycin inhibited N-glycosylation by blocking saccharide transfer, while Swainsonine targeted alpha-mannosidase. Cell-penetrating peptides GO-201 and GO-203 exhibited diverse effects, inhibiting MUC1-C oligomerization, downregulating BCR-ABL, and suppressing cell growth.

Implications/Clinical Relevance: CML is a hematological malignancy that originates in the bloodforming cells of the bone marrow and spreads to the blood. CML constitutes approximately 20% of leukemias found in adults. Investigating the role of glycoproteins, particularly the extracellularbound MUC-1 of CML cells, could give rise to the development of novel therapeutic approaches for the treatment of chronic myeloid leukemia.

Exploring MUC Inhibitors for Better Drug Delivery in Multiple Myeloma Cells

Author(s): Sharnett Riley, Hiral Kapadia, Heni Patel, and Robert Campbell

Faculty Advisor/Principal Investigator: Robert Campbell

Program/School: PHARMD.DPH/School of Pharmacy

Affiliate(s): N/A

Purpose/Hypothesis: MUC-1 inhibitors shows proven efficacy in inhibiting glycosylation on multiple myeloma cell lines to improve overall drug delivery.

Description/Methods/Materials: PubMed (1996-February 21, 2024) was searched using the MeSH terms "multiple myeloma" and "glycosylation inhibition," and the terms were combined using the Boolean operator AND. This resulted in 24 articles, with an additional limit of full free text availability, filtering the results to 19 articles. The resulting articles were examined to determine a particular inhibitor used to decrease the glycosylation patterns on multiple myeloma cell lines. A secondary search was performed using the PubMed database (1996-February 21, 2024) using the keywords "multiple myeloma" and "MUC1." These terms were combined using the Boolean operator AND. This resulted in 79 articles, with further additional limits of full free text availability resulting in 66 articles. Articles were examined to find clinically relevant MUC1 inhibitors that have shown efficacy in the inhibition of MM cell lines to improve overall drug delivery. Additionally, reputable cancer-based resources were used to obtain background information involving multiple myeloma.

Results & Conclusion/Discussion: The literature review revealed that BMI1, a part of the polycomb repressive complex 1, is required for the survival of MM cells. MUC1-C oncoprotein is aberrantly expressed by MM cells and is essential for their survival by activating BMI1 expression. Targeting MUC1-C with a pharmacologic inhibitor such as GO-203 can block its function. GO-203 targets the CQC motif of MUC1-C, which is essential for homodimerization, nuclear localization, and function. By blocking these functions, the MM cell is unable to survive, resulting in the cell’s death. Treatment of RMPI8226 with GO-203 has been shown to induce a significant decrease in BMI1 mRNA and protein. These findings support targeting MUC1-C as a potential target when treating patients with MM. The article discussed the induction of Cytotoxic T-lymphocytes (CTL) targeting MUC1, a tumorassociated antigen in MM cells. The findings suggested that treatment of the multiple myeloma cell line RPMI8226 showed clear MUC1 inhibition with Benzyl-α-GalNac, making the cells more susceptible to CTL-mediated immune responses.

Implications/Clinical Relevance: Treatment of the multiple myeloma cell line RPMI8226 showed clear MUC1 inhibition with Benzyl-α-GalNac and GO-23. Benzyl-α-GalNac makes the cells more susceptible to CTL-mediated immune responses whereas GO-23 causes reduction in BMI1 mRNA and protein.

Unlocking Therapeutic Potential: Glycosylation Inhibitors as Novel Enhancers in Lymphoma Treatment

Author(s): Shayan Mosaffa, Nasr Issa, Thao Nguyen, and Robert Campbell

Faculty Advisor/Principal Investigator: Robert Campbell

Program/School: PHARMD.DPH/School of Pharmacy

Affiliate(s): N/A

Purpose/Hypothesis: Lymphoma, impacting individuals across all age groups with a preference for younger males, presents challenges in drug target selectivity. Mucin glycosylation is being investigated as a potential cellular barrier in the treatment of lymphoma. This review explores glycosylation inhibitors as potential enhancers of therapeutic agents for lymphoma treatment.

Description/Methods/Materials: A comprehensive literature review identified glycosylation inhibitors and evaluated their efficacy, affordability, and commercial availability in lymphoma therapy. Three PubMed (1946-July 29, 2023) searches were conducted to explore glycosylation inhibition in lymphoma using certain key words and Boolean operators. The first search identified an article investigating global glycosylation inhibition of lymphoma (U937) cells. Another search focused on O-glycosylation inhibitors, resulting in one relevant article. A final search targeted galactosaminyl-transferase inhibition, yielding one pertinent article.

Results & Conclusion/Discussion: The literature review identified five potential compounds and their mechanisms of glycosylation inhibition of lymphoma cell lines: Benzyl-α-GalNAc, tunicamycin, peracetyl N-thioglycolyl-d-galactosamine (Ac5GalNTGc), compounds 1-68A, and 2-68A. Benzyl-αGalNAc desalylates O-glycans, enhancing cell adhesion to fibronectin. Tunicamycin decreases N-type glycosylation by reducing lectin-reactive oligosaccharide expression and enhances cell adhesion to fibronectin. Ac5GalNTGc inhibits global glycosylation, inducing homotypic clumping. Synthetic uridine-based inhibitors, 1-68A and 2-68A, prevents glycosylation through competitive inhibition of N-acetyl-α-galactosaminyltransferase, and induced apoptosis of T-lymphocyte (Jurkat) cells.

Implications/Clinical Relevance: Glycosylation inhibitors present promising avenues for enhancing lymphoma therapy. Benzyl-α-GalNAc offers cost-effective improvements in drug delivery, while synthetic inhibitors show potential despite availability challenges. Collaboration is essential to overcome barriers and optimize lymphoma treatment strategies.

Abstract: 46

O-Linked Glycosylation Patterns and Inhibition in Acute Lymphoid Leukemia

Author(s): Ghada Alhafez, Daniel Muteba, Kenny Pham, and Robert Campbell

Faculty Advisor/Principal Investigator: Robert Campbell

Program/School: PHARMD.DPH/School of Pharmacy

Affiliate(s): N/A

Purpose/Hypothesis: Acute lymphoblastic leukemia (ALL) is a heterogeneous hematologic disease characterized by the proliferation of immature lymphoid cells in the bone marrow, peripheral blood, and other organs. There are an estimated 5,000 newly diagnosed cases per year, as well as 1500 deaths. Among those diagnosed, 75-80% are children. O-linked glycosylation patterns on lymphoid cells are common modifications located on the hydroxyl groups of serine or threonine residues. The glycosylation patterns are associated with key functions including cellular uptake, regulation and signaling of immune cells, as well as adhesion and migration. Aberrant expression of O-glycans have also been associated with leukemic malignancies. This has given rise to the development of novel Olinked glycosylation inhibitors. The objective of this study was to perform a literature-based investigation of the influence of O-glycosylation in ALL using O-glycan inhibitors.

Description/Methods/Materials: An extensive literature database search for Acute Lymphoid Leukemia glycosylation patterns and inhibitors was performed to compile an evidence-based list of inhibitors. The following databases were used to search for relevant articles: PubMed, Scopus, and Google Scholar. Pubmed database (1946-February 2024) was used via advanced search utilizing Boolean operator "AND" to yield 42 articles relating to leukemia and O-glycosylation, as well as, 9 articles about leukemia, O-glycosylation, and inhibitors. Articles considered for review and inclusion were limited to their use of glycosylation inhibitors in Lymphoid Leukemic cell lines.

Results & Conclusion/Discussion: The literature review confirmed the frequent observation of aberrant O-glycosylation patterns in ALL cells. The research identified three glycosylation inhibitors effective in inhibiting O-glycosylation in various lymphoid leukemia cell lines. Among these, Ac5GalNTGc was the most researched. O-glycosylation inhibition was achieved in HL-60, K562, U937, Jurkat, and THP-1 lymphoid leukemia cell lines by exposing the cells to 10-100μM Ac5GalNTGc for 24-48 hours. Additionally, the literature review identified Benzyl-GalNAc as another effective glycosylation inhibitor, with a concentration of 5mM showing efficacy in inhibiting Oglycosylation in lymphoblastic cells (K562, RPMI 1788, and CEM) when exposed for 5 days or 120 hours. The research uncovered Imatinib as another commonly used glycosylation inhibitor for the K562 cell line at concentrations ranging up to 0.3μM at 24 hours.

Implications/Clinical Relevance: Conventional chemotherapeutic approaches are associated with toxicities leading to reduced efficacy over time due to its systemic approach to drug delivery. The knowledge gained from this research will assist with understanding the potential role of O-linked glycosylation patterns in hematological cancers and disease management. Our research suggests that O-linked glycosylation patterns expressed on acute lymphoid leukemia cells may serve as a potential barrier to drug therapy. Therefore, inhibition of these O-linked glycosylation patterns may lead to therapeutic gain by increasing cellular uptake.