Dr. Maixner Appointed Vice Chair for Research

William Maixner, DDS, PhDWe are pleased to announce that William Maixner, DDS, PhD, has been appointed as the Vice Chair for Research at Duke Anesthesiology, effective July 1, 2017.

“It’s a great honor to assist the department and the university in promoting research and scholarship and to expand our presence on the national and international stage,” says Dr. Maixner. “I have been offered a unique opportunity to move our department forward and create a unique space for anesthesia research in the domain of translational medicine.”

Dr. Maixner’s appointment comes on the heels of David S. Warner, MD, a Distinguished Professor of Anesthesiology, retiring from the position of Vice Chair for Research which he has held since 2001, positively impacting the careers and research directions of Duke Anesthesiology trainees and faculty for the past 16 years. “The department has made a remarkable team effort to grow our academic mission and position itself for a brilliant future in advancing patient care. It’s been a tremendous honor and a joy to be a part of it,” says Dr. Warner. “I want to express gratitude to the entire department for their contributions, all of which have been essential.”

Dr. Maixner was recently named the Joannes H. Karis, MD, Professor of Anesthesiology, and is the director of Duke Anesthesiology’s Center for Translational Pain Medicine and Duke Innovative Pain Therapies (a first-of-its-kind, multispecialty pain practice at Brier Creek). In his new role as Vice Chair for Research, Dr. Maixner will develop an interdisciplinary strategy for the department and continue to lead efforts to grow, promote, and support research and scholarship of programs in pain medicine/mechanisms, cognitive decline after surgery, transfusion medicine, organ preservation and resuscitation, perioperative genomics, obstetrics, simulation and safety, and hyperbaric medicine. He will also develop a multidisciplinary research vision, strategically leading and identifying novel investigative opportunities, while ensuring that junior faculty members establish formal career development plans with aggressive, but realistic, timelines and milestones in a pathway to research independence.

“Dr. Warner has made a significant mark within this department, university and the national level; I have some big shoes to fill. He has set a standard for me to look towards and to strive to achieve,” says Dr. Maixner. “I look forward to working with Dr. Warner during this transition, and it’s my hope and goal that we’ll be working arm-in-arm as we move forward on developing initiatives and research activities. He’s passing the baton, but we’re part of the same relay.”

“We are now in a position to harness the many resources that have been created to develop a mature and programmatic strategy that will provide focused collaborations, training, and innovation, yet still support a critically important inclusive culture,” adds Dr. Warner. “There is no better person than Dr. Maixner to take our mission to the next level. He has already proven his capability to achieve this vision.”

Please join us in extending congratulations to Dr. Maixner and thanking Dr. Warner for his many years of outstanding service to all of us.

Chris KeithDr. Maixner Appointed Vice Chair for Research
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2017 Resident Graduation Wrap-Up!

Saturday, June 17 marked a memorable evening for Duke Anesthesiology’s “Resident Class of 2017” as they graduated from this nationally-acclaimed program and gathered with their families to celebrate at Hope Valley Country Club in Durham.

Chairman Joseph Mathew delivered opening remarks about the impact anesthesiologists have on patient care before he, the director (Dr. Annemarie Thompson) and assistant directors (Drs. Brian Colin and Ankeet Udani) of the residency program gave each of the 13 graduates their diplomas. The Outstanding Graduate Award was presented to Dr. Jenna Falcinelli, the co-chief resident of the graduating class. And, Drs. Annie Castro, Theresa Crowgey and Taylor Herbert were all winners of Dr. Richard Moon’s trainee quiz awards.

Several awards were also presented to faculty throughout the evening. Dr. Brian Ginsberg received the Robert Sladen Teacher of the Year Award; Dr. Kerri Wahl received the Mentor Award and Dr. Abigail Melnick received the Residency Program Contribution Award.

Additionally, the department recognized resident leadership positions by presenting them with certificates:

  • Chief Resident Leadership: Drs. Jenna Falcinelli and Chris Wahal
  • Academic Chief Resident Leadership: Drs. Taylor Herbert and Kendall Smith
  • Teaching Scholar Leadership: Drs. Stephanie Jones and Alex Reskallah

Congratulations to all of the graduates and award winners!

Resident Graduates Post-Residency Plans
Jason Bluth Private practice in Hawaii
Jenna Falcinelli Pediatric Anesthesiology Fellowship at Duke University
Taylor Herbert Critical Care Medicine Fellowship at Duke University
Alina Hulsey Adult Cardiothoracic Anesthesiology Fellowship at Duke University
Shawn Jia Critical Care Medicine Fellowship at University of California, San Francisco
Stephanie Jones Pediatric Anesthesiology Fellowship at Duke University
Allison Overmon Adult Cardiothoracic Anesthesiology Fellowship at Duke University
Alexander Reskallah Critical Care Medicine Fellowship at Duke University
Brian Rogers Adult Cardiothoracic Anesthesiology Fellowship at Duke University, then a Critical Care Medicine Fellowship at Johns Hopkins University
Brandon Seifert Private practice in Buffalo, New York
Kendall Smith Critical Care Medicine Fellowship at Duke University
Dennis Thapa Pain Medicine Fellowship at Massachusetts General
Chris Wahal Regional Anesthesiology and Acute Pain Medicine Fellowship at Duke University

Chris Keith2017 Resident Graduation Wrap-Up!
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Dr. Jordt Named Co-Chair of Terrorism & Inhalation Disasters Section

Sven-Eric Jordt, PhDThe American Thoracic Society (ATS) elected Duke Anesthesiology’s Sven-Eric Jordt, PhD, as the co-chair of its Section on Terrorism and Inhalation Disasters (TID) on May 23 at the society’s annual meeting.

TID brings together ATS members with interests in mechanisms and treatment approaches for chemically-induced inhalation injuries and their health effects, epidemiology of inhalation injuries, identification and control of inhalation threats associated with terrorism, industrial accidents, infectious diseases and environmental disasters, preparedness and first responder networks. Dr. Jordt will support the section’s mission by coordinating section proposals, official society publications and outreach efforts.

An ATS report calling for an increase in research efforts to develop new therapeutics for chemical inhalation injury was published in the June 1, 2017 issue of the Annals of the American Thoracic Society, titled “An Official American Thoracic Society Workshop Report: Chemical Inhalational Disasters. Biology of Lung Injury, Development of Novel Therapeutics, and Medical Preparedness.”

Dr. Jordt is an associate professor of anesthesiology, faculty of Duke Anesthesiology’s Center for Translational Pain Medicine, and the director of the Chemical Sensing, Pain and Inflammation Research Laboratory which focuses on the mechanisms that enable humans and animals to sense touch, pain and irritation.

Chris KeithDr. Jordt Named Co-Chair of Terrorism & Inhalation Disasters Section
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Dr. Swaminathan Elected Vice President of ASE

Madhav Swaminathan, MD, FASE, FAHAOn June 4, Duke Anesthesiology’s Madhav Swaminathan, MD, MMCi, became the first anesthesiologist to be appointed as vice president of the American Society of Echocardiography (ASE) in the organization’s 42-year history.

“It is humbling to be accepted by the society into a key leadership role that will eventually lead to the presidency of the largest and most influential voice in echocardiography in the world,” says Dr. Swaminathan. “It represents recognition of years of hard work by many giants in the field who have made it possible for an anesthesiologist to be in this position.”

In his new role as vice president on ASE’s Board of Directors, Dr. Swaminathan says he hopes to continue some of the work that they have been doing in the society – expanding its global presence in echocardiography and reaching out to non-traditional users of cardiovascular ultrasound, such as critical care medicine practitioners, through educational initiatives. He believes these efforts will continue to foster innovation in echocardiography and explore novel ways in which diagnostic cardiovascular ultrasound can add value to population health.

According to Dr. Swaminathan, Duke Anesthesiology has been a leader in the field of perioperative echocardiography since its inception. “My appointment to the leadership of the ASE is unprecedented and reflects years of hard work by leaders in our specialty,” adds Dr. Swaminathan. “Many in our institution, including Drs. Joseph Mathew, Jonathan Mark, and Mark Newman of Duke Anesthesiology, and Joseph Kisslo and Pamela Douglas of Duke Medicine, both past ASE presidents, have been instrumental in this effort.”

Dr. Swaminathan has assumed roles on several ASE committees, most recently as chairman of the Membership Committee and chairman of the Council on Perioperative Echocardiography. He has also served on the Industry Relations Committee, Education Committee, and as co-chairman and chairman of the Perioperative Echocardiography track for ASE’s Scientific Sessions from 2011-2015. Notably, he was the first anesthesiologist selected to deliver the prestigious Feigenbaum Lecture at ASE’s Scientific Sessions in 2015.

Dr. Swaminathan is a professor of anesthesiology, the clinical director of the Cardiothoracic Anesthesiology Division, and co-director of Perioperative Optimization. His research focuses on elucidating mechanisms of, and risk factors for, perioperative acute kidney injury in patients undergoing heart surgery with emphasis on the role of early recovery of kidney function. He is also involved in research exploring the role of transesophageal echocardiography in outcomes after cardiac surgery.

Chris KeithDr. Swaminathan Elected Vice President of ASE
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Cancer-Pain Discovery at Duke Makes Headlines

Ru-Rong Ji, PhDOnce hailed as a breakthrough in cancer treatment, immunotherapies are now raising concerns as doctors note new side effects like severe allergic reactions, acute-onset diabetes and heart damage.

These drugs, which work by unleashing the immune system to fight cancer, are only effective in about a fifth of cases, prompting many patients to wonder if they are worth the risk.

But a new study from Duke University researchers, featured in Duke TODAY and The San Diego Union-Tribune, suggests there may be a quick and easy way to predict which cancer patients are likely to benefit from immunotherapy treatments.

The researchers showed that a molecule called PD-L1, which is blocked by the popular immunotherapy drug, nivolumab, acts not only on immune cells but also on the nerve cells that signal pain. That insight could lead to a simple test that measures subtle differences in pain sensitivity to gauge whether or not the body is responding to treatment.

The findings, published May 22 in the journal, Nature Neuroscience, underscore the surreptitious nature of cancer, which uses a variety of tricks to evade detection by the body’s natural defense mechanisms.

“Cancer cells are smart. We already knew that they produced PD-L1 to suppress the immune system,” said senior study author Ru-Rong Ji, Ph.D., professor of anesthesiology and neurobiology at Duke University School of Medicine. “But there’s another defense system at play as well, and that is pain. We showed that this well-known molecule can mask pain, so that cancers can grow without setting off any alarms before metastasis.”

In its early stages, when cancer cells are just starting to grow and multiply in a given tissue or organ, the disease is not usually painful. But as the cancer becomes more aggressive and spreads throughout the body, these cells secrete thousands of pain-inducing chemicals, which either trigger pain-sensing nerve fibers or, in the case of molecules like nerve growth factor, generate entirely new ones. The pain can become so unbearable that some cancer patients die from opioid overdoses.

Ji has been studying pain for over twenty years. Recently, his group noticed that mouse models of melanoma didn’t show the typical signs of pain that he observed in mice with other kinds of cancer, which would flinch or lick their hind paws whenever they were in discomfort.

Ji also knew that melanoma cells could produce a molecule called PD-L1, which latched onto a receptor called PD-1 on the surface of white blood cells, effectively putting the brakes on the immune response. Ji wondered whether there was a connection. So his team treated mice with nivolumab, a drug that prevents PD-L1 from binding to PD-1. Then they poked the animals’ hind paws with a calibrated filament and measured how much force it took for them to withdraw their hind paws. They found that the mice responded to much lower forces than before treatment, indicating they had become more sensitive to pain. In addition, they also found that nivolumab caused spontaneous pain in mice with melanoma, which made them tend to their affected hindpaws like never before.

Next, the researchers performed the opposite experiment. They injected PD-L1 — the pain-masking factor in this equation — into the hind paws or spinal cord of mouse models of three different kinds of pain — inflammatory, neuropathic and bone cancer pain. In every case, the injections of PD-L1 had an analgesic effect, deadening the mice’s sensitivity to pain.

“The effect was surprisingly fast,” said Ji. “We saw a reduction of pain in under half an hour.”

To figure out the mechanism behind this quick response, Ji’s team examined the sensory neurons of the dorsal root ganglion (DRG), a collection of nerves and neurons near the top of the spinal cord. They isolated these cells from mouse DRGs as well as human DRGs from donors and cultured them in a dish, with or without PD-L1, and then recorded their electrical activity. The researchers found that PD-L1 impaired the ability of sodium channels to fire neurons (action potentials) in response to pain.

Ji believes the finding could potentially lead to new treatments for pain, as well as new ways to predict the efficacy of already existing treatments based on PD-1 and PD-L1. “The response to cancer drugs can take a long time, weeks to months,” he said. “The response to pain happens in minutes to hours.”

Sensory neurons from human dorsal root ganglia, a collection of nerves and neurons near the top of the spinal cord, show red for PD-1, a binding site for immunotherapies against cancer. The blue stain shows cell nuclei. Photo credit: Ru-Rong Ji Lab, Duke Anesthesiology

Sensory neurons from human dorsal root ganglia, a collection of nerves and neurons near the top of the spinal cord, show red for PD-1, a binding site for immunotherapies against cancer. The blue stain shows cell nuclei. Photo credit: Ru-Rong Ji Lab, Duke Anesthesiology

In the future, Ji would like to explore whether the mechanism uncovered in this study also applies to other immunotherapy treatments. He is also interested in working with clinicians to measure changes in patients’ pain sensitivity after treatment, a first step toward developing a diagnostic test.

The study was a collaboration between Duke University and two Chinese universities, Fudan University and Nantong University. Professor Yu-Qiu Zhang from Fudan University, the co-senior author of the paper, is a well-known expert in cancer pain. The lead author, Dr. Gang Chen, was an Assistant Professor at Duke  and is now a Professor at Nantong.

The research was supported by the National Institutes of Health (NS87988, DE17794, and DE22743), the National Science Fund of China (31420103903), and the National Research Foundation of Korea (2013R1A6A3A04065858)

CITATION:  “PD-L1 inhibits acute and chronic pain by suppressing nociceptive neuron activity via PD-1,” Gang Chen, Yong Ho Kim, Hui Li, Hao Luo, Da-Lu Liu, Zhi-Jun Zhang, Mark Lay, Wonseok Chang, Yu-Qiu Zhang, and Ru-Rong Ji. Nature Neuroscience, May 22, 2017. DOI: doi:10.1038/nn.4571

Source: Duke University Office of News and Communications (Durham, N.C. – Tuesday, May 23, 2017)

Chris KeithCancer-Pain Discovery at Duke Makes Headlines
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