Pathways to Excellence | Summer 2020

Pathways to Excellence URMC DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE | WWW. PATHOLOGY. URMC. EDU | SUMMER 2020 Medical technologists in Microbiology have worked tirelessly during the pandemic, faced with unique new challenges.

put to the test Clinical Microbiology Team Shines in Wake of Pandemic Necessity is the mother of invention, and in the case of COVID-19, grit and innovation. One great necessity in this fight has been the push to make more testing available. Like clinical laboratories across the nation, our Clinical Microbiology Laboratory has overcome a series of obstacles to successfully establish PCR and antibody testing for SARS-CoV-2, the virus that causes COVID-19. Thanks to a dedicated team of scientists and collaborators, the team went from having zero testing in place to providing results for 1,000 people a day in just two months.

ANSWERING THE CALL

Flu season is one of the busiest for the lab, and it was just beginning to wind down in early March. But then, “COVID-19 didn’t give us much warning or time to prepare,” said Dwight Hardy, Ph.D., Director of Clinical Microbiology.

At the onset of the pandemic, the Micro team was asked to develop a molecular test for detecting the virus. The effort was led

by Nicole Pecora, M.D., Ph.D., the lab’s associate director, along with postdoctoral fellows, Andrew Cameron, Ph.D. and Jessica Bohrhunter, Ph.D., Hardy, and a group of medical technologists.

The team faced some immediate obstacles, like shortages in chemical reagents needed for testing, and lack of equipment. But after many days of long hours, they created a manual laboratory developed test (LDT) modeled after the CDC’s emergency use authorization. On March 16, the lab started testing and reporting its first patient results.

Due to instrument and reagent shortages and the manual nature of the LDT, the lab was only able to provide results for about 200 patient specimens per day. This limited testing capacity presented a stark dilemma: Who would get a test?

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IN THIS ISSUE From the Chair.................................................................. 3

Research News.................................................................. 5

Meet the Residents............................................................. 4

Focus on Faculty................................................................ 6

PUT TO THE TEST

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To address that challenge, URMC leadership brought why people were so willing to step up to the plate, to be flexible together the Micro team and a host of other groups including and work long hours without being asked. They were dedicated Infection Prevention, Intensive Care, Emergency Medicine and to patient care and wanted to do their part in this unusual others to develop testing criteria. They decided that testing would circumstance.” be prioritized for symptomatic inpatients and health care workers WHAT’S NEXT? (whether or not they showed symptoms). The goal? To help stop Strong Memorial Hospital now requires all asymptomatic the spread of the disease by identifying the COVID status of inpatients to be tested for COVID-19. It’s one thing to keep patients at the hospital for care, as well as any workers who were up with heavy clinical volumes as specimens for testing continpotentially exposed. ue to increase. Lab teams are In about two weeks, the lab “All of us in the laboratory feel compassion for patients, accustomed to this, even in gradually increased the number non-pandemic times. But it’s of specimens it could test. Then their families and their loved ones and want to do the another thing to do this work good news came in the first best we can as quickly as we can, to do our part in either while under pressure to develop week of April as the FDA gave the diagnosis or management of this particular disease.” new and effective testing for the approval to have SARS-CoV-2 -Dwight Hardy, Ph.D., Director of Clinical Microbiology general public. testing run on an automated In April, the team underinstrument, Roche Cobas 8800. took a second wave of test development for a serological blood “The Roche” is a state-of-the-art instrument that was already test to detect SARS-CoV-2 antibody, which would determine being used to test for other infectious diseases. Because of its whether someone has had COVID-19 in the past. The much ability to run batches of tests at a time, this proved to be a game anticipated test became available system-wide on June 1. changer. It meant previous send-outs could be brought in house While antibody tests will be useful in determining past infecand resulted within 24 hours. tions in the community, they raise many questions such as: Does Today, the lab performs over 1,000 PCR tests per day and the presence of antibody mean the patient is immune?

If so, how hopes to more than double that number. National shortages long does immunity last? of testing supplies have limited the lab’s ability to significantly These questions are among many that linger as many grapple increase volumes. with how to safely return to normalcy in the wake of the pandemHardy said despite ongoing hurdles his team has faced so far, ic.

All the while, the lab remains a critical source of support and and potentially more on the horizon, he’s extremely proud of the truth in these uncertain times.

Micro team for coming together to meet the challenges head on.

“Our team has risen to unprecedented challenges that were “All of us in the laboratory feel compassion for patients, unpredicted just a few months ago,” said Hardy. “We realize their families and their loved ones and want to do the best we that the challenges are not over, but we continue to do our part can as quickly as we can, to do our part in either the diagnosis day-by-day to provide the best diagnostic testing possible for our or management of this particular disease,” he said. “I think that’s patients and community.”

TESTING TIMELINE

March 12 ‒ First positive COVID-19 case confirmed in Rochester.

March 16 ‒ UR Medicine’s Clinical Microbiology Lab issues first patient test results. Due to manual nature of the test and limited testing resources, strict criteria is put in place for who can be tested.

April 3 ‒ Following FDA approval, UR Medicine Labs starts running automated testing on Roche 8800, which greatly increases test volume.

Mid-April ‒ Testing becomes available for some asymptomatic patients, including nursing home residents, those with respiratory symptoms, and those coming for elective procedures.

May 10 ‒ NY Governor mandates all nursing home staff must be tested twice weekly.

May 13 ‒ Strong Memorial Hospital requires universal testing for all patients that are admitted.

The Roche 8800 allowed the lab to drastically increase output of COVID-19 diagnostic results.

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June 1 ‒ UR Medicine begins coronavirus antibody testing for patients and clinical faculty and staff.

FROM THE CHAIR

H

Bruce Smoller, M. D.

Gaurav Gupta, M.D., Ph.D.

Ying Wang, M.D.

appy summer (finally)! It is not often that departments of pathology find themselves in the middle of the news and national debate, but it is also not often that we face a pandemic. So here we are! Our team has risen to the challenge and excelled. We have been able to develop many concurrently running platforms in order to offset some of the national shortages in testing reagents at all levels. Our turnaround times and the quality of our results have impressed our colleagues throughout the hospital. While there have been some glitches, we have managed to support our affiliated hospitals with adequate and timely testing, to this point. As the testing program requirements increase and the reagent shortages persist, additional challenges await our team, but I am certain that we will get through them with successes. It is important that I specifically commend the efforts of Drs. Dwight Hardy and Nicole Pecora in Microbiology, ably assisted at all steps by Debbie Jesien, chief supervisor. Melissa Allen, the Laboratory Director of Clinical Operations, has worked tirelessly for the last three months holding this operation together, while remaining cool under constant fire.

The department has also been ably represented by Dr. Pecora and me in a New York State Consortium of academic pathology departments as we meet weekly (via Zoom) to discuss issues, develop strategies, and most recently to publish our collective experiences. Dr. Pecora will be one of the main authors on the upcoming publication as we work together and very collegially with our academic counterparts in addressing the national crisis.

Many of you probably heard that due to the financial issues incurred by the medical center and the precipitous drop in laboratory work, we were required to furlough about 100 people, as well as implementing temporary (we hope) pay cuts for our faculty. I am glad to say that the workload has rebounded just as quickly and we are already bringing back many of these folks. In short, this has been an incredibly difficult period for our entire department, and the medical center as a whole. We have been asked to create an entire new testing enterprise and accommodate huge numbers of specimens within one section of the lab, while seeing tremendous losses of business elsewhere, all the while depriving our employees of their incomes to various degrees. Hopefully, the worst is over and we will revert to a “new normal” soon.

In other, happier news, the department re-location program continues, albeit at a somewhat attenuated pace. The second floor of the 2100 wing of the hospital is almost completely finished with its “face lift” and hopefully, residents will be moving over into that space before the new residents arrive. The blood bank and the automated clinical chemistry and hematology labs will be relocating to 1-2100 and G-2100 and open for business during the summer.

We will be welcoming a few new faculty members in July. Dr. Ying Wang will be joining the GU Pathology section from St. Louis, having completed prior training in Boston and Columbia, Missouri. Dr. Gaurav Gupta will join the transfusion medicine team and is currently finishing up his training at Yale after a stint at the NIH and at Tufts.

There is much more to share and I always aim to keep everyone informed.

For the first time in years, things have been rather tough in the department, but we all look forward to better times ahead.

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MEET THE RESIDENTS We are happy to welcome seven new residents this summer as we fondly bid farewell to those moving on. Read more about them here.

XIAOQIN (LUCY) LIU Hometown: Taiyuan, Shanxi, China Medical school: Shanxi Medical University Plan B for a career: Medical researcher Hobbies or Interests: Swimming, cooking, playing tennis, and traveling Family: Husband, Feng (Felix) and son, David, 18. We moved to Pittsburgh from China about 10 years ago and are excited to embrace the lovely Rochester community.

Fun fact about me: My favorite month of a year is September. I love beautiful fall scene adorned by colorful leaves and pleasant weather that is awesome for outdoor activities. It is also my birthday and wedding month.

HARSIMRAN KAUR Hometown: Punjab, India Medical school: Baba Farid University of Health Sciences Plan B for a career: Dentist Hobbies or interests: Cooking, reading spiritual books Family: Me and my husband, Simranjit Singh Fun fact about me: I was called Rapunzel in my medical school.

LEAH MILITELLO Hometown: Buffalo, NY Medical school: University at Buffalo School of Medicine Plan B for a career: I practiced as an accountant before I started studying medicine, and I would definitely do that again.

Hobbies: Arts and crafts, stand up paddling, reading (especially fantasy and sci-fi) Family: Me and my boyfriend, Jerry Fun fact about me: I have the most adorable pet rats!

BAHADIR YILDIZ Hometown: Trabzon, Turkey Medical school: Saglik Bilimleri University, Gulhane Faculty of Medicine, Turkey What was your Plan B for a career: Software engineer Hobbies or interests: Chess, CrossFit, traveling, swimming Family: Married happily to Betul who is also my co-resident Fun fact about me: I use Linux as my main operating system.

DINGANI NKOSI Hometown: Lilongwe (Malawi) Medical school: University of Malawi, College of Medicine Plan B for a career: Civil engineering Hobbies or interests: Hiking, playing soccer, sightseeing, watching sports Family: Me and my wife Fun fact about me: My kitchen is like a lab. I love tasting new foods and trying to be good at cooking.

HATICE BETUL ZENGIN Hometown: Ankara, Turkey Medical school: Istanbul University Cerrahpasa Medical Faculty Plan B for a career: Being a conductor was my childhood dream.

Hobbies or Interests: Playing the flute, Traveling, Salsa, Jogging.

Family: Bahadir, husband and co-resident Fun fact about me: I was in the military with my husband.

WILRAMA (WILA) LIMA Hometown: Fortaleza, Ceara, Brazil Medical school: University of Fortaleza Plan B for a career: Try "plan A" until I succeed.

Hobbies or interests: Body Pump classes, movies Family: Mine is everything to me - Husband, Stefano, daughter, Ivy, and my doggo, Finn!

Fun fact about me: I'm a dentist as well.

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MEET THE RESIDENTS WHERE THEY’RE HEADED RESIDENTS Cynthia Reyes Barron – Dermatopathology fellowship, URMC Phoenix Bell – GI fellowship, Brigham & Women’s Hospital Alexandra Danakas – Cytopathology fellowship, URMC Mushal Noor – Hematopathology fellowship, University of Pennsylvania Roula Katerji – GI fellowship, URMC INCOMING FELLOWSHIPS Anne Wilkerson – Forensic Pathology Nivedita Suresh – Genitourinary Pathology

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FELLOWSHIPS Caroline Bsirini – Cytopathology fellowship, Emory University Hani Katerji – Breast/Gyn fellowship, URMC Hasan Khatib – Breast/Gyn pathologist, Catholic Health System in Buffalo Andy Ngo – Instructor, Transfusion Medicine, URMC FELLOWSHIPS FOR 2021 Pediatric Pathology Transfusion Medicine Hematopathology

RESEARCH NEWS FROM IDEA TO ACTION Among the many changes wrought by the coronavirus Excellence, whose network has turned its attention to the pandemic, one stands out to me as a scientist more than COVID-19 pandemic with the same incredible speed any. Never before in my lifetime, maybe in the history demonstrated by our clinical microbiologists. The group of biomedicine, has science been asked to translate so will study the durability of immunity after viral infection quickly from bench to bedside, from idea to action. The to inform our understanding of how long recovered incredible need to understand more about our “invisible patients or future vaccine recipients may retain immunity enemy” has sparked many kinds of research activity to the virus, among other key questions. around the world, and our department is no exception.

Moreover, several lung biologists and immunologists First and foremost, our Clinical Microbiology team among our Pathology PhD program researchers were deserves the highest praise for bringing not one but recently awarded grant funding to study COVID-19 two new testing modalities from validation to go-live related questions. These include Dr. Steve Georas, in under three months. Under normal circumstances, whose proposal entitled, “Novel role of protein kinase such a pace of development would be inconceivable but D in airway inflammation and antiviral immunity” extraordinary needs call us to extraordinary action. As was funded by the National Institute of Allergy and highlighted elsewhere in this newsletter, the Clinical Infectious Diseases. Dr. David Dean has recently Microbiology laboratory, directed by Dr. received multiple awards to study gene Dwight Hardy, through a team led by transfer as a method for treatment of Associate Director Dr. Nicole Pecora, disease, including R01 funding from put in a Herculean effort to validate the National Heart, Lung and Blood both PCR testing for current SARSInstitute for his project entitled, “A CoV2 infection and antibody testing multimodal delivery and treatment to assess whether healthy people have approach for Acute Lung Injury.” And previously been infected by the virus. Dr. Dr. Tom Mariani received pilot funding Pecora’s team for creating both laboratory from the Clinical and Translational developed tests included postdoctoral Sciences Institute to study, “Airway fellows in Clinical Microbiology, Andrew biomarkers for prediction of acute Cameron, Ph.D. and Jessica Bohrhunter, respiratory infection.”

Ph.D., as well as Dr. Hardy and a group All of this work inspires optimism of medical technologists. for the ability of scientific discipline Beyond development of our clinical to uncover key features of the natural Helene McMurray, Ph.D. testing, URMC physicians and scientists world and lead us to new understanding are involved in research to study every facet of SARSof, and ultimately diagnosis and treatment of, diseases CoV2 and COVID-19 disease. In fact, the University has such as COVID-19. I am further heartened by the rejust christened a new Center for Coronavirus Research, opening of our broader scientific research enterprise in the whose web site contains the most up-to-date information Department and throughout the University of Rochester, about ongoing COVID-19 studies at URMC. Central to which began on May 18 and is proceeding through these efforts is Dr. David Topham, a noted immunologist a staged process to protect the most vulnerable while focusing on respiratory pathogens and member of making clinical trials and basic scientific research once our Ph.D. program faculty. Dr. Topham is working in again available for the betterment of our world. I hope to collaboration with Drs. Anne Falsey and Angela Branche be able to continue to share good news about our research under the auspices of the New York Influenza Center of endeavors as we move forward.

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Department of Pathology and Laboratory Medicine University of Rochester Medical Center 601 Elmwood Avenue, Box 626 Rochester, NY 14642

FOCUS ON FACULTY: PHILIP KATZMAN, M.D. It was a very personal experience that drew Philip Katzman to medicine. As a boy, he suffered from severe asthma that sent him from doctor to doctor with no relief. He later participated in a study by a group of allergists who would develop one of the first inhaled steroids for asthma.

By the time he entered college, his asthma was under control. Now years later, Katzman credits that experience with pointing him toward a career in pediatrics.

“I could see myself helping people, especially kids,” he said.

Today he’s paying it forward as the director of Pediatric Pathology at URMC and New York State’s only ACGME pediatric pathology fellowship, in addition to participating in research specializing in lung health.

While at University of Vermont for medical school, he was fortunate to have a mentor (a pulmonologist) who encouraged him to do a year-out fellowship in pathology. This kept Katzman onsite to do cancer research and led him to cross paths with several pathology residents who became great role models for him.

In 1992 he came to Rochester for a pediatric residency but in 1995 he switched into pathology residency. “I had been living with friends in the small town of Burlington, Vermont,” he recalls.

“Going to Rochester was like a breath of fresh air because it was

a larger place.” After residency he returned to New England for a pediatric pathology fellowship at Boston Children’s Hospital. While in Boston he met his wife, Joanne.

Shortly after they were married, they moved to Rochester where Katzman was offered a pathology faculty position with a special assignment teaching a postnatal pathology rotation for residents.

His work has since become subspecialized in pediatric pathology, and Katzman co-teaches hands-on labs in placental pathology and congenital heart disease.

This year he was honored to be named to the Test Development and Advisory Committee for Pedi Path by the American Board of Pathology (ABP). He is also chairman of the meeting committee for the Society for Pediatric Pathology’s biannual meeting that will be hosted in Rochester for the first time in 2021.

While these new responsibilities take up most of his non-clinical work time these days, Katzman’s long-range research has included fruitful collaborations with OB/GYN faculty including Richard K. Miller (placental pathology) and Pediatrics faculty including Gloria Pryhuber, whose research lab sponsors the LungMAP project that’s currently gearing up to look into lung tissue of coronavirus patients.

Outside of work, he enjoys spending time outdoors for gardening, family hikes and bike rides with his wife and sons, Leo (16) and Seth (14). They live in Brighton.

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