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Bone Marrow Brothers

They were brothers. Best friends. Bonded for life. They enjoyed skiing, hunting and riding motorcycles – things teenage boys do. But, in October 2012, life took a very dramatic turn for Tyler and Tanner Snow, when Tyler came home from college with a bad stomachache.

“It was hard because nobody knew what was wrong with him,” remembers 18-year-old Tanner. “It was a difficult and scary time.”

Tyler’s stomachache lingered for a week. When he started vomiting blood, his parents rushed him to the emergency room in Kearney, Neb. Doctors ran a number of tests and referred Tyler to Mojtaba Akhtari, MD, an oncologist/hematologist at The Nebraska Medical Center.

“When I first met Tyler, I thought his illness could be a diagnostic challenge,” says Dr. Akhtari. “He was very young, pale and chronically ill. I was worried about him.”

After running more tests, Dr. Akhtari was able to diagnose Tyler with paroxysmal nocturnal hemoglobinuria (PNH) and aplastic anemia.

“PNH is a very rare blood disorder in which red blood cells are destroyed by the immune system and it could be associated with an empty-looking bone marrow,” explains Dr. Akhtari. “Aplastic anemia is when the bone marrow gets wiped out by the immune system and blood numbers drop. Patients need frequent transfusions and could die due to infection or bleeding.”

Given the seriousness of the situation, Dr. Akhtari began consulting with other doctors around the country. They came to the conclusion that Tyler would need a bone marrow transplant, or he may not live to see his 30th birthday.

“It didn’t matter what it took to get well,” says 20-year-old Tyler. “I didn’t have very long. Everything kept going downhill and I needed a life saver.”

bm_brothers_1Tyler’s brother, Tanner, was one of several family members tested to see if they would be a match.

Doctors began looking for a bone marrow donor. Immediate family members were tested first, but none proved to be a match.

“Our family is very close, so I was bummed when I found out I couldn’t help my brother,” admits Tanner. “I wanted to make things better.”

Determined to make a difference, Tanner looked to his fellow high school students for help. “Each year, the senior class does a blood drive. So, we decided to host a bone marrow drive too,” smiles Tanner. “It was great. We live in a small town, so people made meals and volunteered. Word got around. More than 100 people signed up on the bone marrow donor registry.”

Unfortunately, none of the donors in the brothers’ hometown of Litchfield, Neb., were a match. But, in May 2013, doctors found an anonymous donor.

“All I know is it’s a young male who lives outside the United States,” says Tyler. “I wrote my donor a letter and hope to be able to meet him one day.”

bm_brothers_2Tyler, the day after his transplant, flanked by brother Tanner (left) and a cousin.

Once the donor was located, things started moving quickly for Tyler. He had chemotherapy for six days prior to the transplant, in order to kill off the bone marrow that was already in his body. Finally, on June 12, the bone marrow transplant took place.

“The cool part was that I could see the clumps of cells going into my body,” remembers Tyler. “I immediately felt better. No more fatigue, no more headaches.”

Four months after the transplant, the Snow brothers were met with another surprise – this time on Tanner’s end.

“I got a phone call saying I was a bone marrow match for someone!” recalls Tanner. “All I know is that it’s a woman in her 40′s who has leukemia. It’s really exciting knowing I can help someone.”

While the transplant has yet to be scheduled, Tanner and Tyler are seizing the moment and encouraging everyone to sign up on the bone marrow registry.

“It’s so easy. Just go to bethematch.org and they’ll send you a free kit,” explained Tyler. “You could save a life.”

For now, the Snow brothers plan to live life to the fullest – knowing exactly what they’re grateful for this Christmas.

“We are so thankful for Tyler’s donor; but especially the doctors and nurses at The Nebraska Medical Center. They saved my brother’s life,” says Tanner. “This entire experience has brought our family closer together. You never know what will happen the next day.”

bm_brothers_3The Snow family (from left to right: Rod, Jenelle, Tanner and Tyler) have much to be grateful for this holiday after Tyler received a successful bone marrow transplant and Tanner is a match for someone he doesn’t know.

Truhlsens honored as outstanding philanthropists

November 18, 2013

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Stanley M. Truhlsen, M.D., and Dorothy Truhlsen cut the ribbon at the Stanley M. Truhlsen Eye Institute earlier this year.

Last week, the Association of Fundraising Professionals Nebraska Chapter honored Stanley M. Truhlsen, M.D., and his wife Dorothy as Outstanding Philanthropists for the state of Nebraska.

The Truhlsens were honored Nov. 12 — National Philanthropy Day — for their generous commitment to improving access to the arts and their work in health care, including the creation of the Stanley M. Truhlsen Eye Institute at UNMC.

“Stan and Dottie Truhlsen are true givers to the Omaha community and the state of Nebraska,” said their nominator Carol Russell. “They are philanthropists, humanitarians and civic leaders, as well as being two of the nicest, most genuine people you could ever meet.”

At UNMC, their philanthropy has funded:

The Stanley M. Truhlsen Eye Institute. The Truhlsen Eye Research Laboratories at the Durham Research Center. The Dr. Stanley M. and Dorothy Truhlsen Campus Events Center in the Michael F. Sorrell Center for Health Science Education.

Elsewhere, their philanthropy has funded:

The Stanley M. and Dorothy Truhlsen Lecture Hall at the Durham Museum. The Joslyn Museum Stanley M. and Dorothy Truhlsen Discovery Sculpture Garden. Many purchases and projects at the Joslyn Art Museum. A contribution toward construction of the Holland Performing Arts Center. Renovations to the sanctuary at Countryside Community Church and a gymnasium addition. Gifts to Prevent Blindness Nebraska, Goodwill Industries and many more organizations.

Dr. Truhlsen, emeritus professor and former chairman of UNMC’s Department of Ophthalmology, is national recognized in the field of ophthalmology. A 1944 graduate of UNMC, he has served as president of the American Academy of Ophthalmology and president of the American Ophthalmological Society.

 

UNMC researchers work to improve outcomes of lymphoma patients

by Lisa Spellman, UNMC public relations

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Kai Fu, M.D., Ph.D. 

Researchers at UNMC have discovered that patients with diffuse large B-cell lymphoma don’t respond well to the standard drug therapy used to treat this type of cancer if they have high levels of a gene called STAT3.

The findings are published in the November issue of the Journal of Clinical Oncology, the medical journal of the American Society for Clinical Oncology.

“These results are significant in that it gives oncologists a better understanding of the best way to personalize medical treatment for these patients and offer them hope for more positive outcomes,” said Kai Fu, M.D., associate professor in the department of pathology and microbiology.

STAT3, or signal transducer and activator of the transcription 3 gene, is part of a family known as the STAT genes that provide instructions for making proteins that are part of essential signaling pathways related to cell proliferation and survival within cells.

When these genes are activated, they move into the nucleus of the cell and bind to specific areas of DNA in regulatory regions near genes. The STAT proteins then regulate whether these genes are turned on or off.

Patients with this type of lymphoma are treated with a combination of immunotherapy using rituximab with a chemotherapy regimen that includes cyclophosphamide, doxorubicin, vincristine and prednisone, commonly referred to as R-CHOP.

“Using this combination of drug therapy usually has very good results but not in those patients with this specific type of lymphoma,” Dr. Fu said. “We wanted to find out why so we could figure out a way to change those outcomes.”

Dr. Fu and his team, along with UNMC investigators Julie Vose, M.D., James Armitage, M.D., John Chan, M.D., Dennis Weisenburger, M.D., and Timothy Greiner, M.D., initiated the study in 2005 with collaborators from 11 institutions around the world.

They began looking at the gene and found patients with high levels of the gene responded poorly to standard chemotherapy compared to those with lower levels.

The next step in the research is to use a specific STAT3 inhibitor to see if it helps the R-CHOP chemotherapy regimen work more efficiently and improve patient survival rates by identifying patients who are at higher risk, he said.

“We are very fortunate to be given the opportunity to be involved with many early phase clinical trials for the treatment of lymphoma including a new STAT3 inhibitor, which is based on this research,” Dr. Vose said.

International student enrollment rises across NU system

by John Keenan, UNMC public relations 

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International students at a UNMC orientation event in 2012. 

International student enrollment at the University of Nebraska has reached another record high this fall, continuing NU’s momentum in attracting talent from around the world.

International student enrollment this fall is 3,638, a 4.7 percent increase over last year, according to the university. The students represent more than 130 different countries, with the most common countries of origin being China, India and South Korea. An increasing number of students also are coming to NU from Brazil and Oman. The university has established a goal to double international enrollment to about 6,000 by 2020.

At UNMC, there are 266 international students representing 27 countries. These numbers do not include researchers, house officers, observers and other members of the UNMC community, which bring the total number of international participants at UNMC to nearly 700.

“UNMC differs from the other NU campuses in recruiting efforts, because we have a largely graduate population whose numbers are constricted by lab space,” said Sara Pirtle of the international health and medical education department. “Some of the College of Public Health programs, however, do not have these limitations, and their enrollment numbers have been booming, thanks to the enthusiastic recruitment efforts of (former dean) Ayman El Mohandes and COPH faculty.”

Owing to the efforts of its Global Health Student and Faculty Advisory Committee, UNMC has made great strides in offering services and activities to orient new international students to life in Omaha and the UNMC community, Pirtle said.

“Our international population contributes a richness and vibrancy to the fabric of our daily lives at UNMC and in society,” Pirtle said. “They make a priceless and profound contribution to the work place and community.”

NU President James B. Milliken and Gov. Dave Heineman hosted welcome events for new international students at the four campuses to celebrate Nebraska’s continued progress in attracting global talent.

“I’m very pleased that a growing number of talented students from around the world are choosing to study at the University of Nebraska,” Milliken said. “International students add a great deal of diversity and richness to our campuses and communities. Their presence is a tremendous benefit to our U.S.-born students, who are more prepared to succeed in today’s global economy after living and working with students of different backgrounds.”

From colds to deadly lung diseases, one protein plays key role

by Dan Meyers, University of Colorado, and Tom O’Connor, UNMC public relations

sisson 

Joe Sisson, M.D. 

Joe Sisson, M.D., a UNMC clinician-scientist, was part of an international team of researchers that has zeroed in on a protein that plays a key role in many lung-related ailments, from seasonal coughing and hacking to more serious diseases such as MRSA infections and cystic fibrosis.

The finding, which was reported in the current issue of the journal Nature, advances knowledge about this range of illnesses and may point the way to eventually being able to prevent infections such as MRSA. The researchers on the study hailed from several states, as well as Mexico and England.

The key protein is called MUC5B. It’s one of two sugar-rich proteins, with similar molecular structure, that are found in the mucus that normally and helpfully coats airway surfaces in the nose and lung. The other is MUC5AC.

“We knew these two proteins are associated with diseases in which the body produces too much mucus, such as cystic fibrosis, asthma, pulmonary fibrosis and COPD,” said Chris Evans, Ph.D., an associate professor in the University of Colorado School of Medicine and the lead author on the study. “We also knew that many patients with asthma or COPD have as much as 95 percent less MUC5B in their lungs than healthy individuals, so we wanted to see if one of these is the bad player in chronic lung diseases.”

The researchers compared mice that lacked one or the other of the proteins. The animals without MUC5B got sick. Those that lacked MUC5AC were fine.

Dr. Sisson, the Larson Professor of Medicine and chief of the UNMC pulmonary, critical care, sleep and allergy section, has been involved in the study over the past two years.

A pulmonologist and NIH-funded cilia investigator, Dr. Sisson’s role was to determine the importance of ciliary motility in mice lacking MUC5B. Cilia are motorized finger-like projections of the cells that line the windpipe and bronchial tubes of the lungs. When cilia beat they create an escalator-like motion producing waves that lift mucus up and out of the lung. This function is called mucociliary clearance and is critical for normal lung health.

“We established that MUC5B is a really important component of the lung’s mucociliary clearance system,” Dr. Sisson said. “If you don’t have MUC5B, airway clearance fails even though airway cilia motility appears to be normal.”

Transplant Allows Teen to Enjoy Birthday Cake for the First Time in Years

For the first eleven years of his life, Tyson Smith did everything a normal kid would do. He went to school, played with friends and had birthday parties. His normal life changed when complications arose after a bout of H1N1 influenza. His parents took him to the doctor in their small home town of Sharon Springs, Kansas. Tyson couldn’t eat; he was weak; he was losing weight.

“By the time we took him to the children’s hospital in Denver, I had to carry him. He couldn’t walk,” remembers Tyson’s father Justin Smith. “In less than a year, he lost half his body weight. Forty-two pounds.”

Over the next several years, there were numerous surgeries and hospital stays for Tyson.

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Tyson Smith and his parents Wendy and Justin enjoy birthday cake together for the first time in six years. His 17th birthday party was held at the Ronald McDonald House Sept. 11, 2013.

“Every holiday, every birthday we spent in the hospital,” Smith says.

His mother quit her job to care for him. His father would make the three hour drive from Denver to Sharon Springs to continue working to support the family. Neighbors and co-workers pitched in. But Tyson’s health was still failing. He could no longer eat and received all his nutrition through a feeding tube.

“I lived for months in the hospital, ICU stays,” Tyson says. “Many times, I had to say my goodbyes to my family. I heard doctors say I wasn’t going to make it; that they could make me comfortable, but that there wasn’t really anything they could do.”

His condition worsened to the point that physicians in Denver said Tyson might be a candidate for an intestinal transplant.

“They first suggested contacting Pittsburgh, which we did,” Smith says. “But we ran into someone in Denver who had been through the same thing. She said, ‘Go to Omaha. That’s what we did. And we’re from Pittsburgh.’”

It’s a decision the Smiths are very glad they made.

“The care has been awesome,” Tyson’s mom Wendy Smith says. “He got his second chance. He’s going to make it.”

Tyson’s transplant team has every reason to be optimistic. One month and three days after having his intestine, liver and pancreas transplanted, Tyson was out of the hospital.

“He’s made an excellent recovery,” says David F. Mercer, MD, PhD, Tyson’s transplant surgeon. “He should be able to do what he wants, what activities he wants to; travel, be whatever he wants when he grows up.”

Tyson had just gotten used to eating again after so many years on feeding tubes. The idea of a birthday party with actual cake was a lot for him to process.

“It’s going to be very emotional. I haven’t done anything like that in over five years. It’s a huge milestone in my life. It’s my 17th birthday, but it’s like the first day of my life. It represents a new beginning.”

 

Dr. Wang’s research offers hope for family with history of cancer

by Vicky Cerino, UNMC public relations

 

wang 

San Ming Wang. M.D. 

It’s not very often that those affected by breast cancer come face-to-face with researchers trying to find a cure for the disease.

Brandi Preston, 22, was one of five women who met in late summer with UNMC breast cancer researcher San Ming Wang, M.D.

Dr. Wang had just spoken about the latest in breast cancer research to the local members of Bright Pink, a support group chapter for those affected by familial breast cancer — those who carry a gene that can be passed down.

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Ben, Bailey and Brandi Preston (Photo courtesy Preston family) 

It was an emotional experience for Dr. Wang.

“I use DNA material from patients to study, but that was the first time I had direct contact with patients,” Dr. Wang said. “I learned from them all how psychologically stressful it is to have a breast cancer gene — like carrying a time bomb.

“I feel more pressure when I think about the patient,” he said. “It’s not so simple anymore to think of my research work as just science.”

Preston said meeting Dr. Wang was fascinating.

“He is doing so much amazing research,” Preston said. “It gives me a lot of hope for the future.”

Preston is facing a decision of whether or not to have a double mastectomy.

Preston’s mother carried the BRCA1 gene, as did her grandmother, great-grandmother and great- great grandmother. (Both her great-grandmother and great-great grandmother had breast and ovarian cancer.)

Preston’s mother was diagnosed with breast cancer on Thanksgiving of 2000. Before she passed away in 2005 at the age of 40, she asked Brandi to be tested for the BRCA gene when she turned 19.

The test came back positive. Preston’s brother also is positive for the BRCA I gene.

The gene requires extra vigilance. Every six months Preston has a breast exam, a yearly breast MRI, ovarian screening and a pap smear.

“Knowledge is power,” she said. “Now that I know I have this gene, I can do something about it. I can monitor.

“After each breast exam I say, ‘Whew, no cancer, I’m good for another six months.’ But why wait until I develop it? That’s why I’m thinking of having the double mastectomy.”

 

Dr. Vose to be president of American Society of Clinical Oncology

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Julie Vose, M.D. 

UNMC’s Julie Vose, M.D., has been elected president of the American Society of Clinical Oncology (ASCO) for a one-year term beginning in June 2015.

Dr. Vose will take office as president-elect during the ASCO annual meeting in Chicago in June 2014.

“ASCO is a very diverse and multifaceted organization with so much to offer its membership,” Dr. Vose said. “I am excited to serve the ASCO membership as president and to make a difference for oncology professionals and our patients.”

Dr. Vose cited the recent enhancements in the society’s educational offerings, quality improvement, and broadened advocacy as areas where her experience and training can add to the current ASCO activities, including CancerLinQ(TM), ASCO’s groundbreaking health information technology initiative to achieve higher quality, higher value cancer care with better outcomes for patients

Ken Cowan, M.D., Ph.D., director of the Fred & Pamela Buffett Cancer Center, called the election a great honor for Dr. Vose and UNMC.

“She is an internationally recognized leader in clinical trials in lymphoma,” he said. “As the leader of the largest organization of clinical oncologists, she will be able to have a major impact on the future directions of clinical research and clinical care in cancer.”

Dr. Vose’s election and involvement in ASCO and other national oncology organizations are a credit to UNMC as well as Dr. Vose, said James Armitage, M.D., the Joe Shapiro Professor of Internal Medicine in the UNMC Division of Oncology/Hematology.

“I’m incredibly proud of Julie and what she’s accomplished,” Dr. Armitage said. “This is the most visible and one of the most important oncology positions in the world. It reflects her excellence in clinical medicine and research.”

Dr. Vose is the Neumann M. and Mildred E. Harris Professorial Chair and chief of the oncology/hematology division in the UNMC Department of Internal Medicine, as well as the associate director of clinical research and co-chair of the lymphoma program at the Fred & Pamela Buffett Cancer Center. Since joining ASCO in 1991, she has served on the board of directors, as chair of the Cancer Education Committee and is the current chair-elect of the Integrated Media and Technology Committee, among other activities.

ASCO’s board of directors is comprised of oncology leaders who are elected to positions reflecting various specialties within the oncology field.

 

Med Center Physicians Leading the Way in New Cardiology Specialty

Several decades ago someone like Taylor Harms wouldn’t be a second year medical student. Someone like Taylor Harms may very well have died as a child. Advances in medicine and surgery over the years mean people like him, born with congenital heart disease are growing up to be adults.

Harms has a perspective most of his medical school classmates won’t – the perspective of a patient. And not just any patient – one who’s had open heart surgery twice.

“I first learned about my condition when I was eight years old,” Harms says. “I went to the doctor with high blood pressure and it turned out I had a narrowed aorta.”

He had surgery to repair his aorta, the body’s main blood vessel when he was eight. Harms also had a bicuspid aortic valve – a condition where one of the heart’s valves develops only two leaflets instead of three. The stress on his heart also meant that its main pumping chamber was much larger than it should have been. By July, even though Harms was feeling fine, his blood pressure was going up. His condition had worsened.

“Blood was leaking back through that valve,” explained Shane Tsai, MD, cardiologist and congenital heart disease specialist. “Instead of being ejected into the body, the blood is falling back into the heart’s main pumping chamber.”

Harms would again need open heart surgery to remove the narrowed section of his aorta and to replace his aortic valve with a mechanical valve.

“We would prefer to get someone early in the stage of their disease,” says Kim Duncan, MD, cardiovascular surgeon at The Nebraska Medical Center. “We can do a procedure and preserve cardiac function for a much longer period of time.”

Dr. Duncan performed surgery on Harms in mid-July. He replaced the aortic valve with a mechanical valve they hope will last for decades. Dr. Duncan also replaced a portion of Harms’ aorta with a synthetic blood vessel.

Dr. Tsai says patients like Harms will become more common as medical advances continue.

“As medicine and surgery has gotten better, we have more survivors,” he says. “A few decades ago, 90% of these babies may not have survived into adulthood. We now expect that 85% of children born with these heart problems will survive into adulthood.”

But just because they live to be adults does not mean they are free from heart trouble. Dr. Tsai says that’s where the medical center’s program shows its importance.

“For the first time in the U.S. there are more adults than children living with congenital heart disease. There are over one million adults with these problems,” he says. “Unfortunately there are not a lot of specialized heart centers dealing with congenital heart disease.”

There are also few physicians who specialize in pediatric and adult congenital heart disease. Because of UNMC Physicians’ collaboration with Children’s Hospital and Medical Center, Dr. Tsai says med center physicians are uniquely positioned to care for these patients throughout their lives. Drs. Tsai and Duncan see pediatric patients at Children’s and adult patients at The Nebraska Medical Center.

“We see them when they’re babies and through adulthood,” he says. “We have different interventions and surgeries we can perform and we work together as a group to decide what is best for each patient.”

Taylor Harms is recovering quickly and just started his second year of medical school at UNMC. He’s already learned a lot about what it’s like to be a patient. He has a little bit of time to decide what specialty he’ll follow as an MD.

“I’m thinking maybe cancer,” Harms says. “I think cardiology may be a little too close.”

 

Eyeing new discoveries in Shanghai

by Tom O’Connor, UNMC public relations

 

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Shan Fan, M.D., and Carol Toris, Ph.D., of UNMC, with Tao Guo, M.D., associate professor of ophthalmology, Tenth People’s Hospital, Shanghai. 

SHANGHAI – Quan Dong Nguyen, M.D., is pumped.

The new chairman of ophthalmology and visual sciences, part of the UNMC delegation in China, is excited about the research that UNMC is doing with Tongji University and Tenth People’s Hospital in Shanghai.

The work, led by Carol Toris, Ph.D., professor of ophthalmology and visual sciences, is aimed at improving our understanding of glaucoma, the leading cause of irreversible blindness in the United States and worldwide. More than 60 million people in the world are living with glaucoma. It’s estimated that more than 80 million people will develop glaucoma by 2020.

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From left, UNMC’s Quan Dong Nguyen, M.D., UNMC’s Carol Toris, Ph.D., Fang Wang, M.D., chair of the department of ophthalmology at Tenth People’s Hospital, and UNMC’s Shan Fan, M.D.

“It’s all about aqueous humor dynamics,” Dr. Nguyen said. Glaucoma can occur when the optic nerve is damaged, and frequently this is associated with high intraocular pressure.

That’s where aqueous humor dynamics come into play. To maintain intraocular pressure at a steady level requires a fine balance between the production, circulation and drainage of ocular aqueous humor.

Dr. Toris is one of the leading experts in the world on aqueous humor dynamics — Google the term and Dr. Toris’ name is the first to appear.

Working with Tongji University and Tenth People’s Hospital researchers led by Tao Guo, M.D., Dr. Toris, along with Shan Fan, M.D., assistant professor of ophthalmology and visual sciences and also with UNMC’s delegation to Shanghai, measure fluid flow in the eyes of volunteers.

They have studied healthy Caucasian adults, an ethnic group that is prone to a certain type of glaucoma. Now in collaboration with Tenth People’s Hospital they are studying healthy Chinese adults, an ethnic group that is prone to a different kind of glaucoma.

The team will compare data to identify differences that may help explain why people may get a particular kind of glaucoma. These findings should help determine the best treatments for the particular type of glaucoma.

“With a population of 1.35 billion, China is a fertile environment for finding research subjects,” Dr. Nguyen said.

“It’s a great collaboration,” Dr. Nguyen proclaimed. “To have all these patients done on Chinese soil is indicative of how well the project is going.”

In the next two years, Dr. Nguyen said that the Truhlsen Eye Institute at UNMC, and Tongji University and Tenth People’s Hospital hope to combine forces on several other projects, expanding to other areas of significant concerns for visual loss such as age-related macular degeneration, diabetic retinopathy, and uveitis and ocular inflammation.

 

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