University Times

Cardiologists study device to treat atrial fibrillation

UPMC Health System cardiologists have begun a two-year study of the Medtronic Jewel AF arrhythmia management device (AMD), designed to detect and treat, without drugs, a variety of heart rhythm disturbances including atrial fibrillation.

Atrial fibrillation is a heart rhythm problem that causes rapid and irregular beating of the heart. An estimated 2 million Americans have atrial fibrillation and about 15 percent of strokes are attributable to the disorder.

The AMD detects and distinguishes various atrial rhythms by analyzing rhythm patterns, much as a physician reviews patterns shown by an electrocardiogram.

The device, slightly larger than a pacemaker, is implanted under the skin just below the collarbone. Wires from the AMD are threaded through veins leading back to the heart's right atrium and right ventricle. The procedure requires a local anesthetic and takes about two hours. Hospitalization is usually for one or two days.

"This is a one-of-a-kind device. It is designed not only to prevent the onset of atrial fibrillation but also to treat it rapidly with a high success rate," said David Schwartzman, principal investigator in the study, Pitt assistant professor of medicine and director of the Atrial Fibrillation Consultation and Advanced Therapies Center at UPMC Presbyterian.

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Researchers develop strategy to use dendritic cells to treat, prevent tumors

Like a coach who reviews game tapes and learns the opponent's weaknesses, then chooses the best plays and utilizes the most talented players, Pitt researchers have studied the immune response to tumor cells and mapped out a simple yet effective strategy to rally the immune system to recognize and destroy established tumors and prevent future ones.

In a study published as a "Cutting Edge" article in the April 1 Journal of Immunology, Pitt researchers briefly exposed dendritic cells to melanoma or lung carcinoma cells to create a cancer vaccine that prevented tumor development in healthy mice and reduced tumors in 80 percent of mice with established tumors, significantly prolonging their survival.

"Not only is this approach simple, but also it appears to be relatively effective, which suggests that this model could be adapted for use in the clinical setting to treat patients," said Louis D. Falo, assistant professor and vice chairperson of dermatology and a member of the University of Pittsburgh Cancer Institute.

"Using tumor cells taken from patients, we may be able to create a vaccine specific for each individual," Falo said. "So instead of relying on a generic vaccine, we could tailor a vaccine to attack unique features of each patient's tumor." Previous approaches to tumor vaccination have required researchers to identify and isolate antigens from cancer cells and then develop ways to introduce them to a patient to stimulate an immune response. Because identifying and obtaining tumor antigens is so difficult, most cancer vaccine efforts have used the few antigens that already have been identified.

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Image Engine Project expands medical records system

Medical records have entered the electronic world through the UPMC Health System's Image Engine Project, a multimedia electronic medical record system that combines clinical images with text stored in UPMC's Medical Archival Record System.

Funded by the U.S. National Library of Medicine, the project began in 1994 and is based at Pitt's Clinical Multimedia Laboratory (CML) in the Center for Biomedical Informatics. Henry Lowe, associate professor of medicine and CML director, directs the project.

Most, if not all, existing computer medical records systems store only text, Lowe said. But increasingly, clinical images have become important parts of patients' medical records.

The Image Engine system allows clinicians to download a series of thumbnail images on the screen, which help physicians select which full-size images to retrieve for viewing. Currently, the system can acquire, compress, store, retrieve, display and manipulate many kinds of clinical images, including radiographs, CT scans, MRI scans, nuclear medicine studies, gastrointestinal endoscopy images, EKGs and microscopic pathology.

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Cystic Fibrosis Research Center set up

The Cystic Fibrosis Foundation has awarded Pitt a three-year, $1.2 million grant to establish a center for CF research.

"This funding will allow us to offer $40,000 grants to young researchers or those new to the cystic fibrosis field at Pitt to start pilot projects," said Ray Frizzell, center director and chairperson of the University's cell biology and physiology department. "These grants also will enable us to attract new investigators to the CF field and to employ imaginative and creative approaches in addressing both fundamental and applied questions regarding cystic fibrosis." Cystic Fibrosis Foundation funds also will be used to train pre- and post-doctoral fellows and support core facilities at Pitt that enable researchers to conduct clinical trials, cell and tissue imaging, molecular biology, drug development and human airway cell research.

Cystic fibrosis afflicts more than 30,000 Americans.

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Gene therapy study to grow blood vessels in the heart

Cardiologists at UPMC Health System have begun a clinical trial of a gene therapy treatment to stimulate growth of new blood vessels to increase the supply of blood to the heart. These newly formed vessels will provide an alternate route for blood to bypass clogged and blocked arteries.

The process is called angiogenic gene therapy and selectively delivers human fibroblast growth factor genes into patients' hearts.

"This represents a fundamentally new and different way of treating coronary artery disease. The treatment may eventually help angina patients who have exhausted other means of heart revascularization such as angioplasty and bypass surgery," said principal investigator Joon Sup Lee, a Pitt assistant professor of medicine.

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Localized arthritis gene therapy heals distant joints

Pitt researchers have made the unprecedented and unexpected finding that localized gene therapy for arthritis produces healing effects on distant joints affected with the disease.

Results of the research, conducted on rabbits, were published in the April 15 issue of the Proceedings of the National Academy of Sciences. Researchers called their findings a major advance in bringing arthritis gene therapy into widespread clinical use.

"This offers the first evidence that arthritis gene therapy can produce widespread, or systemic, results. Our hope is that it would be possible to inject one arthritic joint in a patient with a therapeutic gene and find that arthritic joints elsewhere in the body respond," said the study's lead author Steve Ghivizzani, a post-doctoral fellow in molecular genetics and biochemistry.

Rheumatoid arthritis causes painful inflammation and erosion of joints and affects 2.1 million Americans.

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Gamma knife successful for facial pain

Stereotactic radiosurgery, which uses intensely focused gamma radiation, can successfully treat pain associated with trigeminal neuralgia (TGN), according to a study by neurological surgeons at UPMC Health System.

TGN is a severe, sharp or electric shock-like pain in the face, lasting seconds to minutes. Laughing, chewing, brushing the teeth, talking or even touching the face can trigger the pain. Patients typically are treated with medication or microvascular decompression, a surgical treatment pioneered by Peter Jannetta, former chairperson of neurological surgery here.

The gamma knife, in contrast, performs precise, computer-driven bloodless brain surgery. It destroys brain tumors and vascular malformations in the brain that were once considered inoperable. Gamma knife surgery is safer than many other procedures because patients need not undergo risky open-skull procedures, and adults do not require general anesthesia. Gamma surgery also causes few side effects. Patients usually leave the hospital within 24 hours.