Meet Alfred Atanda Jr.

Alfred Atanda Jr.
Credit: Cynthia Brodoway, Nemours/Alfred I. duPont
Hospital for Children
Alfred Atanda Jr.
Fields: Pediatric orthopedic surgery, sports medicine
Works at: Nemours/Alfred I. duPont Hospital for Children
Blogs: as Philly.com’s Sports Doc at http://bit.ly/sportsdoc Exit icon
Family fact: Youngest of seven children
Musical skills: Piano and trumpet
Kitchen talent: Baking chocolate desserts for his pediatrician wife and their two young children

As a kid, Alfred Atanda loved science, sports and tinkering. He dreamed of being a construction worker or an engineer. Today, he works on one of the most complex construction projects of all: the human body.

As a pediatric orthopedic surgeon, Atanda focuses on sports medicine and injuries to children. He has a special passion for young baseball pitchers who have torn the ulnar collateral ligament (UCL) in the elbow of their throwing arm.

This sort of injury is most often caused by overuse. Many small tears accumulate over a long period, resulting in pain and slower, less accurate pitches. Decades ago, this sort of damage occurred almost exclusively in elite athletes. Now, Atanda sees it in children as young as 12 years old. He aims not only to study and treat these injuries, but also to find ways to prevent them.

His Findings

Atanda was first introduced to research on UCL injuries while working alongside team physicians for the Phillies, the professional baseball team in Philadelphia. The physicians wanted to determine whether ultrasound imaging could detect early warning signs—slight anatomical changes in the ligament—before the damage became severe enough to warrant an operation known as Tommy John surgery.

The research focused on Phillies pitchers who had no pain or other symptoms of injury. The multi-year project showed that the UCL in the throwing elbows of these players got progressively thicker and weaker compared to the same ligament in the players’ nonthrowing elbows. The scientists concluded that these physical changes are caused by prolonged exposure to professional-level pitching.

Alfred Atanda Jr. with Joe Piergrossi
Atanda examines the elbow of a young patient. Courtesy: Cynthia Brodoway, Nemours/Alfred I. duPont Hospital for Children

Atanda wondered whether ultrasound imaging could also detect early signs of UCL damage in young pitchers—those in Little League through high school. There has been a dramatic rise in the number of young pitchers who are experiencing the same injuries and undergoing the same surgery as the pros.

Atanda secured funding for this project from an Institutional Development Award (IDeA). The IDeA program builds research capacities in states like Delaware, where Atanda works, that historically have received low levels of funding from the National Institutes of Health.

Atanda’s project began about a year ago, and has examined 55 young athletes so far.

“We found similar results to what we found with the Phillies,” Atanda says, indicating that the UCL in the throwing elbows of young athletes was noticeably thicker than the UCL in the nonthrowing elbows. And the damage seems progressive, he says: “We saw that these ligaments got thicker as the pitchers got older and had more pitching experience.”

The immediate goal of this project, which he hopes to continue for another 3 years, is prophylaxis. “We’re trying to prevent any kind of overuse elbow injuries and the need for Tommy John surgeries later on,” Atanda says. He also hopes to establish quantitative correlations between pitching behavior and anatomical changes.

Atanda also has longer-term aspirations. “My goal is to change the culture in sports for young athletes in general,” he says. “I want to show there are downsides to pitching so much.”

In addition to championing pitch count limits Exit icon recommended by the American Sports Medicine Institute, Atanda advises a focus away from excess competition and toward getting exercise, enjoying social inter­action, building self-confidence and having fun.

Atanda’s research is funded by the National Institutes of Health through grant P20GM103464

Content adapted from the NIGMS Findings magazine article Game Changer

Molecules Known to Damage Cells May Also Have Healing Power

Free radicals in an ying-yang symbol
Biology in balance: Molecules called free radicals—like the peroxide molecules illustrated here—have a reputation for being dangerous. Now, they’ve revealed healing powers. In worms, at least. Credit: Stock image

When our health is concerned, some molecules are widely labeled “good,” while others are considered “bad.” Often, the truth is more complicated.

Consider free radical molecules. These highly reactive, oxygen-containing molecules are well known for damaging DNA, proteins and other molecules in our bodies. They are suspected of contributing to premature aging and cancer. But now, new research shows they might also have healing powers Exit icon.

Using the oft-studied laboratory roundworm known as C. elegans, a research group led by Andrew Chisholm Exit icon at the University of California, San Diego, made a surprising discovery. Free radicals, specifically those made in cell structures called mitochondria, appear necessary for skin wounds to heal. In fact, higher (but not dangerously high) levels of the molecules can actually speed wound closure.

If further research shows the same holds true in humans, the work could point to new ways to treat hard-to-heal wounds, like diabetic foot ulcers.

This work was funded in part by NIH under grants R01GM054657 and P40OD010440.

Improving the Odds of Surviving Sepsis

Acupuncture
A form of acupuncture—or a drug that mimics its effect—may one day lead to an anti-inflammatory therapy for people with sepsis. Credit: Stock image.

A leading cause of death in U.S. intensive care units is sepsis, an overwhelming immune response to infection that triggers body-wide inflammation and can cause organ failure.

Sepsis is challenging to diagnose and treat. Many of its early signs, such as fever and difficulty breathing, are similar to those of other conditions. When doctors do not detect sepsis until a more advanced stage, they are often unable to stop its progression or prevent its complications.

“Sepsis is a complex problem,” says Sarah Dunsmore of the National Institutes of Health (NIH). “We need more research at all levels—from the molecular to the patient—to improve sepsis diagnosis and treatment and to enhance the quality of life for sepsis survivors.”

NIH-funded scientists use a variety of tools, including blood tests and acupuncture, in their quest to detect sepsis early, treat it quickly and reduce its later effects.

Read more about sepsis research in this Inside Life Science article.

The “Virtuous Cycle” of Technology and Science

A scientist looking through a  microscope. Credit: Stock image.
Whether it’s a microscope, computer program or lab technique, technology is at the heart of biomedical research. Credit: Stock image.

Whether it’s a microscope, computer program or lab technique, technology is at the heart of biomedical research. Its central role is particularly clear from this month’s posts.

Some show how different tools led to basic discoveries with important health applications. For instance, a supercomputer unlocked the secrets of a drug-making enzyme, a software tool identified disease-causing variations among family members and high-powered microscopy revealed a mechanism allowing microtubules—and a cancer drug that targets them—to work.

Another theme featured in several posts is novel uses for established technologies. The scientists behind the cool image put a new spin on a long-standing imaging technology to gain surprising insights into how some brain cells dispose of old parts. Similarly, the finding related to sepsis demonstrates yet another application of a standard lab technique called polymerase chain reaction: assessing the immune state of people with this serious medical condition.

“We need tools to answer questions,” says NIGMS’ Doug Sheeley, who oversees biomedical technology research resource grants. “When we find the answers, we ask new questions that then require new or improved tools. It’s a virtuous cycle that keeps science moving forward.”

Dormant Viruses Reactivate, Signaling Effect of Lingering Sepsis

Doctors with a patient
A new study finds that people with lingering sepsis may have suppressed immune systems. Credit: Stock image.

Each year, more than 200,000 people in the United States die from sepsis, a condition caused by an overwhelming immune response that can quickly lead to organ failure. While many people with sepsis survive this immediate threat, they may die days or even months later from secondary infections.

A research team that included Richard Hotchkiss, Jonathan Green and Gregory Storch of Washington University School of Medicine in St. Louis suspected that when sepsis lasts for more than a few days, it compromises the immune system. To test this hypothesis, the scientists compared viral activity in sepsis patients, other critically ill patients and healthy individuals. They looked for viruses like Epstein-Barr and herpes-simplex that are often dormant and innocuous in healthy people but can reactivate and cause problems in those with suppressed immune systems.

Of the three study groups, sepsis patients had much higher levels of these viruses, suggesting that their immune responses may be hindered. Immune suppression could make it difficult to defend against the reactivated viruses as well as new infections like pneumonia. The team now plans to test whether immune-boosting drugs can prevent deaths in people with lingering sepsis.

Learn More:
Washington University in St. Louis News Release Exit icon
NIGMS Sepsis Fact Sheet

Good Vibrations

A knot-like structure in a section of RNA from a flavivirus
Findings in mice may lead to a drug-free, noninvasive way to treat chronic wounds in people with type 2 diabetes. Credit: Stock image.

For people living with type 2 diabetes, wounds often heal slowly, sometimes even becoming chronic. Now, scientists have shown that low-intensity vibrations can speed up the healing process in a strain of diabetic mice commonly used to study delayed wound healing. The research team, led by Timothy Koh exit icon of the University of Illinois at Chicago, found that exposing the mice to barely perceptible vibrations five times a week for just 30 minutes promoted wound healing by increasing the formation of new blood vessels and of granulation tissue, a type of tissue critical in the early stages of healing. If researchers can show that the vibration technique also works in humans, this approach could one day offer a drug-free, non-invasive therapy for chronic wounds in people with diabetes.

This work also was funded by NIH’s National Institute of Dental and Craniofacial Research.

Learn more:
University of Illinois at Chicago News Release exit icon

Study Comparing Sepsis Treatment Methods Shows Equivalent Survival Rates

Doctors and a patient in a hospital
A 5-year, randomized clinical trial helped resolve a long-standing debate about how best to manage sepsis patients.

For years, doctors have debated the best ways to identify, predict and treat sepsis. The condition, which is usually triggered by infection, is marked by body-wide inflammation and can lead to a dangerous drop in blood pressure known as septic shock. Sepsis affects more than 800,000 people each year and kills about 20 to 30 percent of them. It’s the most expensive condition treated in U.S. hospitals, costing more than $20 billion a year.

Now, a nationwide, 5-year clinical trial that set out to compare three different treatment approaches has shown that survival of patients with septic shock was the same regardless of whether they received treatment based on structured, standardized medical plans (protocols) or the usual high-level standard of care. If patients were diagnosed shortly after the onset of sepsis and treated promptly with fluids and antibiotics, they did equally well whether they received treatment based on either of two specific protocols—one less invasive than the other—or got the usual, high-level care provided by the academic hospitals where the study was conducted.

According to the study’s leaders, the trial “helps resolve a long-standing clinical debate about how best to manage sepsis patients, particularly during the critical first few hours of treatment,” and shows that “there is not a mandated need for more invasive care in all patients.”

Learn more:
NIGMS News Release
University of Pittsburg News Release Exit icon
New England Journal of Medicine Article Exit icon
Sepsis Fact Sheet

Protein Triggers Inflammatory Responses in Hemorrhage and Sepsis

Doctors helping a patient. Credit: U.S. Navy.
Inflammation is part of the body’s natural response to trauma, but when it becomes widespread, it can lead to sepsis. Credit: U.S. Navy.

Inflammation is part of the body’s natural response to trauma, playing a vital role in wound healing and prevention of infection. However, when inflammation becomes widespread, or systemic, it can lead to sepsis, a condition that can damage organs and cause death. Scientists led by Ping Wang Exit icon of the Feinstein Institute for Medical Research have found a way to potentially target harmful systemic inflammation. They identified a protein–cold-inducible RNA-binding protein (CIRP)–that triggers inflammatory responses during hemorrhagic shock and sepsis. Wang then hypothesized that blocking CIRP activity might mitigate the body’s overall inflammatory response and improve patient survival. In a preclinical study using mice, an antibody against CIRP decreased mortality after hemorrhage and sepsis. The molecule could lead to the development of an anti-CIRP drug.

This work also was funded by the NIH Office of the Director and NIH’s National Heart, Lung, and Blood Institute.

Learn more:

Feinstein Institute for Medical Research News Release Exit icon
Fact Sheets on Sepsis and Trauma
The Body’s Response to Traumatic Injury Video

Meet Brad Duerstock

Brad Duerstock
Brad Duerstock
Fields: Neuroscience, assistive technology design
Works at: Purdue University, West Lafayette, IN
Hobbies: Gadgetry, architectural design
Bizarre collectible: Ecuadorian shrunken head (not a real one—it’s a replica made from goatskin)
Credit: Andrew Hancock, Purdue University

At the age of 18, Brad Duerstock had a devastating accident. A star member of his high school swim team, Duerstock hit his head during practice in a way that broke his neck and paralyzed all of his limbs. Today, he studies spinal cord injuries much like his own, investigating how the damage occurs and how it could possibly be repaired.

Duerstock has worked to make science accessible to people with disabilities, whether they use wheelchairs, as he does, or have visual or other impairments. For example, he has redesigned laboratory space to make it easier for people with disabilities to navigate and perform tasks.

“I like knowing that what I do can ultimately impact others,” Duerstock says.

Duerstock’s Findings

Much of Duerstock’s research deals with what occurs immediately following a nerve injury. In a spinal cord injury, nerve tissue becomes severed or dies. The immune response and bleeding in the injured area can cause extra damage to nerves in the spinal cord. Duerstock and his team have found that a molecule called acrolein is produced in spinal cord injuries and that it kills the nerves it encounters as it spreads around the injury site. They have been investigating a compound called polyethylene glycol (PEG), a polymer that could seal ruptured nerve cell membranes, possibly protecting nerve tissue from further damage immediately following a spinal cord injury.

Duerstock also founded and leads the Institute for Accessible Science (IAS) Exit icon, a community of scientists, students, parents and teachers whose goal is to promote better accommodations for people with disabilities who are studying or working in the sciences. The IAS looks into how to redesign lab spaces and equipment to increase accessibility for people with disabilities, particularly those with limited mobility or vision.

Although Duerstock originally wanted to be a doctor, he believes his true calling is in research. “The sense of discovery and the impact on others are big motivations for me,” says Duerstock. “Being a researcher, you might have a broader impact on society than you would as a practicing physician.”

Content adapted from the NIGMS Findings magazine article Opening Up the Lab.

Protein May Help Reduce Intestinal Injury

HB-EGF protein. Credit: National Center for Microscopy and Imaging Research.
HB-EGF has the potential to protect the intestines (magnified here) from different types of injury. Credit: National Center for Microscopy and Imaging Research.

Gail Besner of Nationwide Children’s Hospital and her research team recently found out how the HB-EGF growth factor protein could potentially aid the development of treatments for a number of conditions. Using model systems in two separate studies, the scientists discovered that HB-EGF could protect the intestines from injury by stimulating cell growth and movement and by decreasing substances formed upon intestinal injury that worsen the damage. They also showed that administration of mesenchymal stem cells could further shield the intestines from injury. Future treatments involving a combination of HB-EGF and stem cells could, for example, help cancer patients sustain fewer intestinal injuries resulting from radiation therapy.

This work also was funded by NIH’s National Institute of Diabetes and Digestive and Kidney Diseases.

Speaker icon Listen to Gail Besner talk about this and related research in her lab. Read transcript.

Learn more:

Nationwide Children’s Hospital News Release Exit icon