Renewing the Field

Renewing the Field

Nurturing the Next Generation of Infectious Disease Physician-Scientists

Renewing the Field

Nurturing the Next Generation of Infectious Disease Physician-Scientists

The COVID-19 pandemic highlighted the importance of having a robust workforce of skilled infectious disease physicians and researchers. They played a vital role in vaccine development, understanding the virus’s behavior, diagnosing and treating patients, and studying its transmission.

To cultivate a vibrant field that continues to flourish and attract the sharpest and brightest minds, the division of infectious diseases and geographic medicine prioritizes mentoring and nurturing the next generation of infectious disease physician-scientists. When another pandemic happens, these emerging new scientists will be the ones on the front lines tasked with safeguarding the public’s health.

Many of the Infectious Diseases Fellows gain clinical experience, connecting with patients and helping them live healthier lives before transitioning to become postdoctoral trainees in laboratory collaborations where they don their creative hats and delve into the depths of exploration. A comprehensive understanding of both clinical and research aspects prepares the trainees for leadership roles as physician-scientists.

Mentors provide both the space and guidance for trainees to engage creatively with the work and pursue innovative and novel solutions to pressing health problems, while also actively assisting them in securing National Institutes of Health grants and other sources of funding.

These grants serve as a crucial milestone, enabling trainees to establish their research programs and replenish the infectious disease field with new and exciting findings.

This year, four trainees stand out, having received top scores for their grant proposals on the first try, an “exceedingly rare” achievement, according to John Scroggs, senior administrative division director. In their own words, the four profiles that follow reflect the trainees’ exceptional abilities and the quality of mentorship they receive, as well as examples of how they recharge, renew, and stave off burnout in a rigorous and competitive industry.

“They are going to be the next generation of the best of the best,” Scroggs says.

Arjun Rustagi, MD, PhD

Instructor of Medicine, Division of Infectious Diseases and Geographic Medicine, Postdoctoral Research Fellow, Blish Lab

Arya Khosravi, MD, PhD

Postdoctoral Research Fellow, Bollyky Lab

Karen B. Jacobson, MD, MPH

Instructor of Medicine, Division of Infectious Diseases and Geographic Medicine, The Stephen Bechtel Endowed Fellow in Pediatric Translational Medicine, Postdoctoral Medical Fellow, The Jagannathan Lab

Joelle I. Rosser, MD

Instructor of Medicine, Division of Infectious Diseases and Geographic Medicine, Faculty Fellow, Center for Innovation and Global Health, Postdoctoral Research Fellow, Luby Lab

Arjun Rustagi, MD, PhD

Instructor of Medicine, Division of Infectious Diseases and Geographic Medicine, Postdoctoral Research Fellow, Blish Lab

Arya Khosravi, MD, PhD

Postdoctoral Research Fellow, Bollyky Lab

Karen B. Jacobson, MD, MPH

Instructor of Medicine, Division of Infectious Diseases and Geographic Medicine, The Stephen Bechtel Endowed Fellow in Pediatric Translational Medicine, Postdoctoral Medical Fellow, The Jagannathan Lab

Joelle I. Rosser, MD

Instructor of Medicine, Division of Infectious Diseases and Geographic Medicine, Faculty Fellow, Center for Innovation and Global Health, Postdoctoral Research Fellow, Luby Lab

Arjun Rustagi, MD, PhD

Research focus: Reproducing SARS-CoV-2 infection of the human lung in the lab, in order to understand the types of lung inflammation caused by viruses and how to stop them.

How the research advances the field: Identified several pathways that allow SARS-CoV-2’s entry into cells, and determined unexpected cellular targets in the human lung, including macrophages. These findings present new therapeutic targets to reduce SARS-CoV-2 infection and lung inflammation.

Published: 37 publications

Funding: Mentored Career Development Award (K08) from the National Institute of Allergy and Infectious Diseases: $772,000 over four years

Arjun Rustagi, MD, PhD, and Catherine Blish, MD, PhD

Arjun Rustagi, MD, PhD, and Catherine Blish, MD, PhD

Arjun Rustagi, MD, PhD

Research focus: Reproducing SARS-CoV-2 infection of the human lung in the lab, in order to understand the types of lung inflammation caused by viruses and how to stop them.

How the research advances the field: Identified several pathways that allow SARS-CoV-2’s entry into cells, and determined unexpected cellular targets in the human lung, including macrophages. These findings present new therapeutic targets to reduce SARS-CoV-2 infection and lung inflammation.

Published: 37 publications

Funding: Mentored Career Development Award (K08) from the National Institute of Allergy and Infectious Diseases: $772,000 over four years

Arjun is the quintessential triple threat: a clinician scientist who excels in research, teaching, and clinical care. He is a generous collaborator and teacher, working with several other laboratories on complex infection models and training many individuals on virology and immunology. He is clearly a leader and ready to run his own group.

— Catherine Blish, MD, PhD, George E. and Lucy Becker Professor of Medicine

The power of mentorship: Having Catherine as a mentor has been essential. She connected me to collaborators and provided opportunities for me to build research infrastructure at Stanford. When the university shut down during the pandemic, she helped me logistically continue my biobank and BSL3 work.

What the future holds: Looking for a permanent job as a physician-scientist, ideally in the Bay Area, where my partner is also a physician-scientist.

Takeaways from the pandemic: The COVID-19 pandemic has shown us that science in a vacuum or shared only among scientists misses an opportunity to inform the public and help nonscientists think about complex biomedical concepts. I am inspired by programs like Radiolab that mix scientific concepts with audio and visual arts. To help the public better understand my work, I teamed up with art students who helped me translate my main scientific project (studying lung inflammation that happens in response to infection) into artistic concepts.

Preference: Clinical or research? In college, I initially could not decide. Then, the summer before senior year I joined a program working with students in Arusha, Tanzania, to teach basic HIV biology. As I spent time with people living with HIV in the community, I felt that with HIV and infectious disease, I could blend my interests in clinical medicine and basic science and have a fulfilling career. I then worked in a biomedical lab for a couple of years while I applied to MD/PhD programs.

Preventing physician burnout: This is really hard. Our lab has regular social events and retreats, usually overnight at a house in Sonoma or along the coast north of San Francisco. These retreats provide an annual opportunity to take stock. I also benefit from talking and interacting in person with other postdocs and fellows in the lab about the intersection of science, medicine, family, and maintaining balance.

Unwinding with the family: Bike rides through Golden Gate Park with my daughters or playing ultimate Frisbee in the park or on the beach; car camping and trying new restaurants.

Hobbies: Listening to music and podcasts; playing the piano and saxophone; gardening; tending to orchids and my aquarium.

Arya Khosravi, MD, PhD

Research focus: Host-microbial interactions. Specifically, I am studying how some bacteria partner with a virus to establish an ecological niche and cause chronic infections, which are very difficult to treat and are a major cause of suffering and even death.

How the research advances the field: Provides insight into the pathophysiology of chronic infections, allowing for the development of more effective diagnostic and therapeutic interventions.

Published: Three publications (1 article, 2 reviews) while at Stanford; 10 other publications previously

Funding: Cystic Fibrosis Foundation, Doris Duke Charitable Foundation

Paul Bollyky, MD, PhD (left), and Arya Khosravi, MD, PhD

Paul Bollyky, MD, PhD (left), and Arya Khosravi, MD, PhD

Arya Khosravi, MD, PhD

Research focus: Host-microbial interactions. Specifically, I am studying how some bacteria partner with a virus to establish an ecological niche and cause chronic infections, which are very difficult to treat and are a major cause of suffering and even death.

How the research advances the field: Provides insight into the pathophysiology of chronic infections, allowing for the development of more effective diagnostic and therapeutic interventions.

Published: Three publications (1 article, 2 reviews) while at Stanford; 10 other publications previously

Funding: Cystic Fibrosis Foundation, Doris Duke Charitable Foundation

Arya is meticulous, rigorous, and committed to excellence in both the clinic and the lab. He is an outstanding physician-scientist.

— Paul Bollyky, MD, PhD, associate professor of infectious diseases and of microbiology and immunology

Why a career as a physician-scientist? In undergrad, I got a job washing glassware in a lab focused on bacteria that cause infections. The principal investigator and lab members included me in discussions and explained to me what they were studying and why, as well as the methods by which they pursued their studies. I attended clinical rounds and got to see how the same bacteria we were studying in the lab were causing disease in patients. I was hooked. This was exciting, precise work that allowed me to be creative and work alongside passionate and incredibly intelligent individuals while at the same time offering the possibility of providing a significant impact on patient outcomes.

When I eventually started my own project, the lab members helped me understand the difference between statistically significant and meaningful data as well as taught me to be my own harshest critic. They also instilled the value that the purpose of science is to advance knowledge and our understanding of life.

Preference: Clinical or research? Research. It provides me more opportunities to be creative and explore ideas. I very much appreciate patient care and feel my time spent on service is more productive and possibly more meaningful than time in the lab. However, there is a lot of repetition. We often see similar cases and have near-identical discussions with the primary teams calling daily for consultations. In contrast, the questions I am trying to answer in the lab can change drastically from week to week. It’s rewarding to watch a project or idea evolve over time.

What do you love about the job? Allows me to be curious and connect dots. It’s fun when immunology intersects with microbiology, metabolism, ecology, and even philosophy.

Preventing burnout: When I am not in the lab, I am sleeping or watching TV shows to unwind. When I can make time, I enjoy reading and woodworking.

Karen B. Jacobson, MD, MPH

Research focus: Global Health, SARS-CoV-2, Malaria: Studies the natural history, epidemiology, and long-term effects of COVID-19. Most recently, studying the effects of SARS-CoV-2 infection in pregnancy on infant growth and development in Uganda.

How the research advances the field: By leveraging a cohort of pregnant women enrolled in malaria clinical trials in eastern Uganda, my colleagues and I were able to retrospectively document the spread of SARS-CoV-2 during the first pandemic waves when it was spreading undetected due to a lack of available testing. After the first Omicron wave in early 2022, nearly 100% of the cohort had been exposed. The data also hinted that there may be an association between COVID-19 in pregnancy and shorter height in infancy, which has not previously been reported. Further research with larger sample sizes is needed to confirm this finding. Next, further research to examine the mechanisms by which COVID-19 in pregnancy, with and without malaria infection, can adversely affect fetal and infant development, and how vaccination can potentially mitigate these effects.

Funding: K23, National Institute of Allergy and Infectious Diseases, $192,000 per year for 5 years (pending); Burroughs Wellcome Fund/ASTMH Postdoctoral Fellowship in Tropical Infectious Diseases; NIH T32; Stephen Bechtel Endowed Fellowship in Pediatric Translational Medicine; Thrasher Early Career Award recipient.

Prasanna Jagannathan, MD, and Karen B. Jacobson, MD

Paul Bollyky, MD, PhD (left), and Arya Khosravi, MD, PhD

Paul Bollyky, MD, PhD (left), and Arya Khosravi, MD, PhD

Karen B. Jacobson, MD, MPH

Research focus: Global Health, SARS-CoV-2, Malaria: Studies the natural history, epidemiology, and long-term effects of COVID-19. Most recently, studying the effects of SARS-CoV-2 infection in pregnancy on infant growth and development in Uganda.

How the research advances the field: By leveraging a cohort of pregnant women enrolled in malaria clinical trials in eastern Uganda, my colleagues and I were able to retrospectively document the spread of SARS-CoV-2 during the first pandemic waves when it was spreading undetected due to a lack of available testing. After the first Omicron wave in early 2022, nearly 100% of the cohort had been exposed. The data also hinted that there may be an association between COVID-19 in pregnancy and shorter height in infancy, which has not previously been reported. Further research with larger sample sizes is needed to confirm this finding. Next, further research to examine the mechanisms by which COVID-19 in pregnancy, with and without malaria infection, can adversely affect fetal and infant development, and how vaccination can potentially mitigate these effects.

Funding: K23, National Institute of Allergy and Infectious Diseases, $192,000 per year for 5 years (pending); Burroughs Wellcome Fund/ASTMH Postdoctoral Fellowship in Tropical Infectious Diseases; NIH T32; Stephen Bechtel Endowed Fellowship in Pediatric Translational Medicine; Thrasher Early Career Award recipient.

Karen is a rising superstar in global maternal and child health. She is well on her way to an outstanding career as a translational scientist in infectious diseases.

— Prasanna Jagannathan, MD, assistant professor of medicine and of microbiology and immunology

The power of mentorship: I have been very lucky to have Dr. Jagannathan as my primary research mentor. He is supportive, enthusiastic, and always available to his trainees, and has cultivated a collaborative yet rigorous lab atmosphere. I feel lucky to have worked with him and learned from his example.

What the future holds: In fall 2023, I joined the Vaccine Study Center within the division of research at Kaiser Permanente Northern California, based in Oakland, as a research faculty member.

Preference: Clinical or research? Both! I prefer to spend most of my time on research because I like to think about the bigger picture, but I think it’s essential to maintain some patient contact and have those personal connections in order to keep a grounded perspective and remember why the bigger picture is so important.

Why a career as a physician-scientist? I knew I wanted to be an infectious disease physician and researcher before going to medical school. The medicine part has always interested me, but I’ve also been intrigued by the societal impact of infections. Pathogens have shaped the course of human history and seem to lay bare so much of our social and political rifts, with infections like HIV, Ebola, and of course COVID-19 more recently. The advances we’ve seen just in the last century — antibiotics, vaccines, a SARS-CoV-2 vaccine developed in less than a year — are astounding. I think it’s such an interesting and important field!

Avoiding burnout: I recently had the opportunity to attend the Gordon Malaria Conference in Spain. Connecting with colleagues from around the world and being able to travel a bit for fun was definitely rejuvenating.

Relaxing after a hard day’s work: Spending time with family and friends and watching TV on my couch.

Joelle I. Rosser, MD

Research focus: Impact of climate change on infectious diseases: evaluating interventions to ameliorate the risks of climate change and foster resiliency and sustainability, employing a combination of field studies and modeling to conduct research. The focus is on populations that are highly vulnerable to climate change in the Asia-Pacific.

How the research advances the field: Climate change poses the greatest threat to human health globally. However, the study of climate change and health — predicting and mitigating the impacts on human health — is still in its infancy. My research focuses on developing new approaches to rigorously studying climate change and health, using a mechanism-based framework and a solution-oriented mindset.

Funding: K23 Career Development Award ($996,0000)

Joelle I. Rosser, MD

Joelle I. Rosser, MD

Joelle I. Rosser, MD

Research focus: Impact of climate change on infectious diseases: evaluating interventions to ameliorate the risks of climate change and foster resiliency and sustainability, employing a combination of field studies and modeling to conduct research. The focus is on populations that are highly vulnerable to climate change in the Asia-Pacific.

How the research advances the field: Climate change poses the greatest threat to human health globally. However, the study of climate change and health — predicting and mitigating the impacts on human health — is still in its infancy. My research focuses on developing new approaches to rigorously studying climate change and health, using a mechanism-based framework and a solution-oriented mindset.

Funding: K23 Career Development Award ($996,0000)

Joelle combines a capacity to identify, interpret, and critically consider key scientific findings in the literature with a commitment to use the scientific process to improve the lives of low-income marginalized communities globally.

Stephen Luby, professor of medicine, infectious disease; associate dean for global health research

What the future holds: Continuing my academic research in climate change and infectious diseases with hopes of getting a faculty position somewhere.

Preference: Clinical or research? This is a very difficult question. I love both. They are fundamentally different but also completely complementary. I love interacting with patients, learning about their lives, and working to make their lives better in a very tangible and gratifying way. But I also love the exploration and creativity that research affords. With research, every day feels like a new adventure, a new opportunity. But what makes the research feel worthwhile is also imagining how it might benefit people and the planet in some way later down the road.

Why a career as a physician-scientist? I wanted to be a primatologist. But while studying wildlife conservation, my deepening appreciation for the interdependency between the environment and human health drove me to become a physician-scientist working at this intersection. I also suppose one could argue that by studying medicine, I still did become a primatologist of sorts, just not studying the kind of primate that typically swings from trees.

For the love of science: I love that I get to work with brilliant, caring people with all sorts of different skills and backgrounds. My work is inherently interdisciplinary, and I love learning from and sharing with people across a whole range of expertise.

Active relaxation: Biking, hiking, pack rafting, Latin dancing, windsurfing, challenging my husband to a fierce game of backgammon, and trying to find the best cheese, scones, and hole-in-the-wall music venues.

SCCR’s Quality and Compliance Team Shows Resilience Amid Pandemic Pivots

Mary Varkey, clinical research coordinator, with a RECOVER participant
Mary Varkey, clinical research coordinator, with a RECOVER participant.

SCCR’s Quality and Compliance Team Shows Resilience Amid Pandemic Pivots

Mary Varkey, clinical research coordinator, with a RECOVER participant
Mary Varkey, clinical research coordinator, with a RECOVER participant.

SCCR’s Quality and Compliance Team Shows Resilience Amid Pandemic Pivots

When COVID-19 hit in 2020, it dramatically disrupted ongoing clinical research, as well as quality and compliance monitoring.

The Quality and Compliance team at the Stanford Center for Clinical Research (SCCR) faced the challenges head-on, pivoting and pivoting again as the situation on the ground shifted. By the time the brunt of the pandemic ended, the Department of Medicine had a larger clinical research portfolio than ever — from $125.7 million in sponsored research in 2019 to $164 million in 2022, and quality and compliance monitoring had entered a new era.

Essential Trials Go Virtual

When COVID hit, the university paused nonessential research, a category that included observational clinical trials unrelated to COVID.

The majority of studies that SCCR participates in are interventional, however, and remained active. At the same time, many new studies that were focused on understanding and treating COVID launched across the department. The SCCR Quality and Compliance team quickly learned how to operate in the new virtual paradigm.

Study monitoring that had been done on-site went remote. Teams moved to use electronic consent forms that participants could sign remotely or on encrypted iPads with plastic covers that could be cleaned after each use. If paper consent forms had to be used, staff took photos of the signature pages for study records. They then quarantined the paper forms for 10 days in sealed bags before removing and filing. Checklists became an essential tool to ensure that study conduct remained as methodical and precise in the new, shifting paradigm as it was prior to COVID.

Restarting Research and Refreshing Protocols

When it was time to resume paused studies, study teams received refreshers on the study protocol, consenting processes, and data entry.

Some studies resumed before pandemic restrictions had entirely lifted. One such study was the Project Baseline study — a large, multiyear observational study that aims to map human health. The project was paused for seven months and then resumed with virtual operations.

The study team worked with the research sponsor to build systems to conduct virtual study visits and temporarily waive on-site assessments. They often met with participants over video to help them through study processes that would typically be done face-to-face.

Kelly Olszewski, clinical research coordinator, explains the RECOVER study process.

In February 2021, as vaccines became available, Project Baseline was able to resume some onsite visits for assessments such as specimen collection, vital signs, and EKGs.

The study team’s resilience in the face of multiple hurdles kept the research project alive against the odds. “Retention for this seminal, longitudinal Team Science study remains high (88%) as we approach the end of the study,” says Sumana Shashidhar, SCCR’s associate director of clinical research operations. (Read about Shashidhar’s work with a Johnson & Johnson vaccine study in this Stanford Daily Q&A.)

Yasmin Jazayeri, clinical research coordinator, gathers data for the RECOVER study

When COVID-19 hit in 2020, it dramatically disrupted ongoing clinical research, as well as quality and compliance monitoring.

The Quality and Compliance team at the Stanford Center for Clinical Research (SCCR) faced the challenges head-on, pivoting and pivoting again as the situation on the ground shifted. By the time the brunt of the pandemic ended, the Department of Medicine had a larger clinical research portfolio than ever — from $125.7 million in sponsored research in 2019 to $164 million in 2022, and quality and compliance monitoring had entered a new era.

Essential Trials Go Virtual

When COVID hit, the university paused nonessential research, a category that included observational clinical trials unrelated to COVID.

The majority of studies that SCCR participates in are interventional, however, and remained active. At the same time, many new studies that were focused on understanding and treating COVID launched across the department. The SCCR Quality and Compliance team quickly learned how to operate in the new virtual paradigm.

Study monitoring that had been done on-site went remote. Teams moved to use electronic consent forms that participants could sign remotely or on encrypted iPads with plastic covers that could be cleaned after each use. If paper consent forms had to be used, staff took photos of the signature pages for study records. They then quarantined the paper forms for 10 days in sealed bags before removing and filing. Checklists became an essential tool to ensure that study conduct remained as methodical and precise in the new, shifting paradigm as it was prior to COVID.

Kelly Olszewski, clinical research coordinator, explains the RECOVER study process.

Restarting Research and Refreshing Protocols

When it was time to resume paused studies, study teams received refreshers on the study protocol, consenting processes, and data entry.

Some studies resumed before pandemic restrictions had entirely lifted. One such study was the Project Baseline study — a large, multiyear observational study that aims to map human health. The project was paused for seven months and then resumed with virtual operations.

The study team worked with the research sponsor to build systems to conduct virtual study visits and temporarily waive on-site assessments. They often met with participants over video to help them through study processes that would typically be done face-to-face.

In February 2021, as vaccines became available, Project Baseline was able to resume some onsite visits for assessments such as specimen collection, vital signs, and EKGs.

The study team’s resilience in the face of multiple hurdles kept the research project alive against the odds. “Retention for this seminal, longitudinal Team Science study remains high (88%) as we approach the end of the study,” says Sumana Shashidhar, SCCR’s associate director of clinical research operations. (Read about Shashidhar’s work with a Johnson & Johnson vaccine study in this Stanford Daily Q&A.)

We learned a lot during the pandemic about how we can simplify research conduct and maintain high scientific rigor, quality, and compliance. 

— Ken Mahaffey, MD, SCCR director and department vice chair of research

Yasmin Jazayeri, clinical research coordinator, gathers data for the RECOVER study.

COVID-19 Leaves an Electronic Legacy…

As pandemic restrictions lift, some of the quality and compliance processes created in response to the COVID lockdown have become standard practice. For example, it’s increasingly common to gather participant consent forms electronically and to keep trial documentation in electronic trial master files instead of binders.

“We learned a lot during the pandemic about how we can simplify research conduct and maintain high scientific rigor, quality, and compliance,” says SCCR director and department vice chair of research Ken Mahaffey, MD. “I am incredibly proud of the work that the SCCR Quality and Compliance team has done.”

…and a Clinical Research Legacy

As teams across the department launched COVID-19 studies, SCCR’s regulatory team partnered with investigators to swiftly submit Investigational New Drug (IND) applications to the FDA.

“We launched nearly 20 COVID-19 projects seemingly overnight,” says Toni Nunes, SCCR’s director of operations and strategy.

In 2020, for example, SCCR participated in the Ensemble trial of the Janssen COVID-19 vaccine, enrolling 205 participants in two months. SCCR also operationalized the RECOVER study at Stanford, a National Institutes of Health–funded initiative to study the long-term effects of COVID.

Though COVID threw a logistical curveball at researchers and quality and compliance monitors alike, the pandemic ultimately contributed to growth in clinical research across the department, bringing in organizations and faculty members who had never done research before and now were doing research on COVID and beyond.

A prime example is Stanford Health Care Tri-Valley Hospital (SHC Tri-Valley). In 2020, SHC Tri-Valley hospitalists participated in a trial of treatments for people hospitalized with COVID, with support from SCCR. A series of COVID studies based at SHC Tri-Valley followed, including TRACK COVID, a public health surveillance study. In 2022, SHC Tri-Valley became a site for the Medtronic Ellipsys Vascular Access System Post Market Surveillance Study. The trial evaluates the safety and effectiveness of the Ellipsys Vascular Access System, a device used to create vascular access for hemodialysis — and has nothing to do with COVID.

We learned a lot during the pandemic about how we can simplify research conduct and maintain high scientific rigor, quality, and compliance. 

— Ken Mahaffey, MD, SCCR director and department vice chair of research

 

COVID-19 Leaves an Electronic Legacy…

As pandemic restrictions lift, some of the quality and compliance processes created in response to the COVID lockdown have become standard practice. For example, it’s increasingly common to gather participant consent forms electronically and to keep trial documentation in electronic trial master files instead of binders.

“We learned a lot during the pandemic about how we can simplify research conduct and maintain high scientific rigor, quality, and compliance,” says SCCR director and department vice chair of research Ken Mahaffey, MD. “I am incredibly proud of the work that the SCCR Quality and Compliance team has done.”

…and a Clinical Research Legacy

As teams across the department launched COVID-19 studies, SCCR’s regulatory team partnered with investigators to swiftly submit Investigational New Drug (IND) applications to the FDA.

“We launched nearly 20 COVID-19 projects seemingly overnight,” says Toni Nunes, SCCR’s director of operations and strategy.

In 2020, for example, SCCR participated in the Ensemble trial of the Janssen COVID-19 vaccine, enrolling 205 participants in two months. SCCR also operationalized the RECOVER study at Stanford, a National Institutes of Health–funded initiative to study the long-term effects of COVID.

Though COVID threw a logistical curveball at researchers and quality and compliance monitors alike, the pandemic ultimately contributed to growth in clinical research across the department, bringing in organizations and faculty members who had never done research before and now were doing research on COVID and beyond.

A prime example is Stanford Health Care Tri-Valley Hospital (SHC Tri-Valley). In 2020, SHC Tri-Valley hospitalists participated in a trial of treatments for people hospitalized with COVID, with support from SCCR. A series of COVID studies based at SHC Tri-Valley followed, including TRACK COVID, a public health surveillance study. In 2022, SHC Tri-Valley became a site for the Medtronic Ellipsys Vascular Access System Post Market Surveillance Study. The trial evaluates the safety and effectiveness of the Ellipsys Vascular Access System, a device used to create vascular access for hemodialysis — and has nothing to do with COVID.

Driving Medical Progress

Susan S. Jacobs, MS, RN

Susan S. Jacobs, MS, RN

Driving Medical Progress

Susan Jacobs’ 25-Year Journey in Clinical Research Leadership

Susan S. Jacobs, MS, RN

Susan S. Jacobs, MS, RN

Driving Medical Progress

Susan Jacobs’ 25-Year Journey in Clinical Research Leadership

When Susan Jacobs, RN, MS, nurse coordinator and research nurse manager, started in the division of pulmonary, allergy, and critical care medicine (PACCM), there was no clinical trial program. “Part of the purpose of my position was to start it,” she says. And over the past 25 years, under her dedicated and driven direction, the clinical research program has grown immensely, from one or two treatment trials for patients with chronic lung diseases to roughly 30 different research projects and protocols overseen by about 15 principal investigators.

“Susan is one of the most competent, diligent, hardworking, and dependable colleagues I’ve ever had,” says Rishi Raj, MD, clinical professor of medicine at Stanford.

The clinical trials that Jacobs coordinates now span a wide variety of treatments and diseases. Some of the pulmonary diseases that the program provides treatment options for are common, like asthma, and some are rarer, like pulmonary fibrosis, lymphangioleiomyomatosis (LAM), post-lung transplantation rejection, and chronic lung infections like non-tuberculous mycobacteria.

The types of trials vary widely: Some are treatment trials for an investigational drug for a particular lung disease. Others are observational studies that utilize registries, where patients are monitored over time, and data such as bloodwork and pulmonary function are collected to try to better understand a disease. 

For example, “we might try to identify some biomarkers that could predict how a disease will progress,” Jacobs says.

One theme that ties all the clinical trials together: Jacobs’ “power and initiative,” as well as her expansive knowledge of clinical trial management, says Stephen Ruoss, MD, professor of pulmonary and critical care medicine. 

“She was the architect of some annual meetings of clinicians and faculty between our institution and others,” he says. “She’s got great organizational initiative and focus.”

When Susan Jacobs, RN, MS, nurse coordinator and research nurse manager, started in the division of pulmonary, allergy, and critical care medicine (PACCM), there was no clinical trial program. “Part of the purpose of my position was to start it,” she says. And over the past 25 years, under her dedicated and driven direction, the clinical research program has grown immensely, from one or two treatment trials for patients with chronic lung diseases to roughly 30 different research projects and protocols overseen by about 15 principal investigators.

“Susan is one of the most competent, diligent, hardworking, and dependable colleagues I’ve ever had,” says Rishi Raj, MD, clinical professor of medicine at Stanford. The clinical trials that Jacobs coordinates now span a wide variety of treatments and diseases. Some of the pulmonary diseases that the program provides treatment options for are common, like asthma, and some are rarer, like pulmonary fibrosis, lymphangioleiomyomatosis (LAM), post-lung transplantation rejection, and chronic lung infections like non-tuberculous mycobacteria.

The types of trials vary widely: Some are treatment trials for an investigational drug for a particular lung disease. Others are observational studies that utilize registries, where patients are monitored over time, and data such as bloodwork and pulmonary function are collected to try to better understand a disease. 

For example, “we might try to identify some biomarkers that could predict how a disease will progress,” Jacobs says.

One theme that ties all the clinical trials together: Jacobs’ “power and initiative,” as well as her expansive knowledge of clinical trial management, says Stephen Ruoss, MD, professor of pulmonary and critical care medicine. 

“She was the architect of some annual meetings of clinicians and faculty between our institution and others,” he says. “She’s got great organizational initiative and focus.”

She’s deeply engaged equally in patient care and in support of the research initiatives we have. Her resilience and endurance really set her apart.

— Stephen Ruoss, MD, professor of pulmonary and critical care medicine

Juggling the coordination of multiple studies in different phases is not without its challenges. Jacobs shares that keeping track of many moving parts is one of her most difficult and critical tasks. “Susan possesses an extensive knowledge of clinical trial protocols, having worked on a diverse range of studies across different therapeutic areas,” says Hope Woodworth, the PACCM finance and grants management specialist. “This expertise enables her to execute study procedures with meticulous precision while adhering to rigorous ethical standards and regulatory guidelines.”

Jacobs’ expertise has been indispensable as the number of trials has grown significantly the past few years. “We’ve had immense growth in the number of principal investigators in our division, the number of trials that are being offered,” says Jacobs. “That’s good — we want to support the fact that we need better treatments. For example, in pulmonary fibrosis, over the past 20 years, despite numerous trials, we only have two drugs that are FDA approved. So with that challenge, we have to keep going.”

That dedication to her patients shines through everything Jacobs does. “The patients love her,” says Ruoss. “They see her as the linchpin of the program. She’s been a committed, enduring support for our patients.” To that end, Jacobs initiated and organized several patient support groups, for LAM and interstitial lung disease. “Many patients are incredibly hard-hit by these diseases, and the support that the groups provide is critical for them,” says Ruoss.

In all that Jacobs does, her dedication to her patients shines. “She’s known by patients as a kind of fairy godmother for these chronic diseases,” he says. Caring for patients feeds right back into supporting research, as far as Jacobs sees it. “Our patients see clinical trials as a great opportunity, especially those who have exhausted all their treatment options,” she says. “Our study participants are incredibly dedicated and committed, and we are so thankful for their participation. We couldn’t complete these trials and get these drugs to market without them.”

Another role Jacobs plays is to help support junior investigators, faculty who are just starting their research careers and writing their own protocols. With her decades of experience, she is able to help guide young researchers along the way as they learn to navigate the ins and outs of clinical trials. “Her strong leadership qualities inspire confidence, foster camaraderie, and contribute to a positive work environment,” says Woodworth.

“She’s always there,” says Ruoss. “She’s deeply engaged equally in patient care and in support of the research initiatives we have. Her resilience and endurance really set her apart.” Raj says, “She is the glue that holds the clinical research in the pulmonary division together.”

She’s deeply engaged equally in patient care and in support of the research initiatives we have. Her resilience and endurance really set her apart.

— Stephen Ruoss, MD, professor of pulmonary and critical care medicine

Juggling the coordination of multiple studies in different phases is not without its challenges. Jacobs shares that keeping track of many moving parts is one of her most difficult and critical tasks. “Susan possesses an extensive knowledge of clinical trial protocols, having worked on a diverse range of studies across different therapeutic areas,” says Hope Woodworth, the PACCM finance and grants management specialist. “This expertise enables her to execute study procedures with meticulous precision while adhering to rigorous ethical standards and regulatory guidelines.”

Jacobs’ expertise has been indispensable as the number of trials has grown significantly the past few years. “We’ve had immense growth in the number of principal investigators in our division, the number of trials that are being offered,” says Jacobs. “That’s good — we want to support the fact that we need better treatments. For example, in pulmonary fibrosis, over the past 20 years, despite numerous trials, we only have two drugs that are FDA approved. So with that challenge, we have to keep going.”

That dedication to her patients shines through everything Jacobs does. “The patients love her,” says Ruoss. “They see her as the linchpin of the program. She’s been a committed, enduring support for our patients.” To that end, Jacobs initiated and organized several patient support groups, for LAM and interstitial lung disease. “Many patients are incredibly hard-hit by these diseases, and the support that the groups provide is critical for them,” says Ruoss.

In all that Jacobs does, her dedication to her patients shines. “She’s known by patients as a kind of fairy godmother for these chronic diseases,” he says. Caring for patients feeds right back into supporting research, as far as Jacobs sees it. “Our patients see clinical trials as a great opportunity, especially those who have exhausted all their treatment options,” she says. “Our study participants are incredibly dedicated and committed, and we are so thankful for their participation. We couldn’t complete these trials and get these drugs to market without them.”

Another role Jacobs plays is to help support junior investigators, faculty who are just starting their research careers and writing their own protocols. With her decades of experience, she is able to help guide young researchers along the way as they learn to navigate the ins and outs of clinical trials. “Her strong leadership qualities inspire confidence, foster camaraderie, and contribute to a positive work environment,” says Woodworth.

“She’s always there,” says Ruoss. “She’s deeply engaged equally in patient care and in support of the research initiatives we have. Her resilience and endurance really set her apart.” Raj says, “She is the glue that holds the clinical research in the pulmonary division together.”

Teaching Tolerance to the Immune System

Everett Meyer, MD, PhD

Everett Meyer, MD, PhD

Teaching Tolerance to the Immune System

A Q&A with Everett Meyer

Everett Meyer, MD, PhD

Everett Meyer, MD, PhD

Teaching Tolerance to the Immune System

A Q&A with Everett Meyer

A healthy immune system is in a constant state of vigilance, patrolling the human body for invading pathogens and mounting a quick response against dangerous bacteria or viruses. But what happens when that immune response is unwanted? After a sick patient receives a lifesaving transplant, the immune system can attack the new organ, triggering transplant rejection. In people with autoimmune conditions like rheumatoid arthritis and lupus nephritis, the immune system attacks healthy cells, causing disease. In both cases, clinicians want to block the immune response — but without shutting off the entire immune system.

Researchers and clinicians in the bone and marrow transplantation and cellular therapy division are developing and testing new methods of cellular immune tolerance — techniques to reprogram the immune system to be more tolerant of healthy cells and transplanted organs. This kind of renewal of the healthy immune system offers hope for patients who have long had few options. Physician-scientist Everett Meyer, MD, PhD, who has been studying cellular immune tolerance for more than a decade, recently answered some questions about how these breakthroughs are impacting Stanford Medicine patients.

Doctors have been trying to prevent organ rejection and to treat autoimmune disease for a long time. What’s changed in recent years?

In the past decade, we’ve had an incredible amount of advancement in our basic understanding of the immune system. Scientists have developed extremely powerful new techniques that let us see at a very deep level how individual immune cells function. At the same time, we also have new ways to reprogram those immune cells using genetic tools. The success of cancer immunotherapy, which reprograms immune cells to attack cancer cells, has paved the way for us. Now, we’re expanding those same approaches used to prevent organ rejection and treat autoimmune disease in completely new ways.

How are clinicians at Stanford Medicine applying these breakthroughs to organ transplants?

Right now, by really pushing the frontiers of how we prevent organ rejection. We can reengineer immune cells and transplant them into patients at the same time they receive a new organ. This has the potential to allow patients to completely stop taking standard immunosuppression drugs that shut down the immune system. We have a large California Institute of Regenerative Medicine grant to study whether patients can be weaned completely off immunosuppressants if they receive a bone marrow transplant and cell cultured immune cells at the same time as a kidney transplant.

The success of cancer immunotherapy, which reprograms immune cells to attack cancer cells, has paved the way for us.

How are clinicians at Stanford Medicine applying these breakthroughs to organ transplants?

Right now, by really pushing the frontiers of how we prevent organ rejection. We can reengineer immune cells and transplant them into patients at the same time they receive a new organ. This has the potential to allow patients to completely stop taking standard immunosuppression drugs that shut down the immune system. We have a large California Institute of Regenerative Medicine grant to study whether patients can be weaned completely off immunosuppressants if they receive a bone marrow transplant and cell cultured immune cells at the same time as a kidney transplant.

What does this mean for patients in terms of their quality of life?

For most of history, patients who received organ transplants had to take immunosuppressant pills for the rest of their life. This leads to a lot of long-term side effects — not only are you more prone to getting sick, but you can get secondary cancers, diabetes, and hypertension. In some cases, the immunosuppression can actually end up damaging the new organ that you’re trying to protect. What’s more, even when immunosuppression is effective, the organ is often rejected after 15 or 20 years. Patients who get transplants when they’re young usually plan to get another one or two organs over their life span.

With the new cell therapies we’re testing, patients can get one organ transplant that lasts for life, and they won’t have to take immunosuppressants forever. This means far fewer long-term side effects, as well as not having the burden of daily pills.

Are you also expanding these therapies for autoimmune disease?

Yes, some of the same approaches that are being used to treat B cell cancers can be repurposed to treat autoimmune diseases, because in both cases, you have faulty B cells. Right now, we’re planning a trial that will test these therapies in lupus nephritis and multiple sclerosis. We’re also involved in a large, national trial that’s planning to treat multiple sclerosis with bone marrow transplants, and we are working with a company developing cell therapy for rheumatoid arthritis. In all these cases, we’re using molecular tools to reeducate the immune system to stop responding to things that it shouldn’t be responding to. For our patients, having access to these trials, which offer a completely new paradigm of treating autoimmune disease, is incredibly valuable.

Why is Stanford such an ideal place to be studying this?

Stanford has taken an innovative stand in terms of bringing together all the different players in cellular immune tolerance into one program. We are among the leading centers in the world when it comes to studying human immunology, and we have a rich history of being innovators in transplantation. In addition, we have this entrepreneurial culture and collaborative environment that fosters the development of these kinds of completely new approaches to medicine. All these things come together to make Stanford uniquely positioned to really advance the field of cellular immune tolerance.

Revealing Microbial Triggers of Autoimmune Disease

William Robinson, MD, PhD

William Robinson, MD, PhD

Revealing Microbial Triggers of Autoimmune Disease

William Robinson, MD, PhD

William Robinson, MD, PhD

Revealing Microbial Triggers of Autoimmune Disease

For decades, scientists have suspected that many autoimmune diseases, including multiple sclerosis (MS) and rheumatoid arthritis (RA), might be triggered by infections. Now, Department of Medicine researchers have shown exactly how this happens for two common autoimmune diseases — MS and RA. William Robinson, MD, PhD, the James W. Raitt, MD, Professor and chief of immunology and rheumatology, and colleagues discovered how infection with the Epstein-Barr virus, a common herpes virus, can trigger MS, as well as how bacteria normally found in the mouth can breach into the bloodstream to cause RA flare-ups in people with gum disease.

“We’re finally starting to gain insights into what actually causes these very prevalent autoimmune diseases,” says Robinson, who led the work. “In the near future, this may fundamentally change how we treat or prevent these diseases.”

In the new studies, Robinson’s team used a technology that they developed at Stanford over the last decade. It allows them to sequence the antibody repertoire of human B cells — the immune cells that produce antibodies. The gene sequences tell them exactly what antibodies each B cell is making.

“In the old days, someone’s entire thesis project might have been sequencing the antibodies of a few B cells, and it would take years,” says Robinson. “With this approach that is now available commercially, we can now sequence thousands of B cells at once. This is an incredibly powerful tool.”

In healthy individuals, the antibodies made by B cells recognize only viruses and bacteria that are harmful to the body; in those with autoimmune disease, however, antibodies attack the body’s own healthy tissues. In MS, for instance, the immune system attacks the protective coverings of nerve fibers, causing numbness, muscle weakness, and fatigue. However, the exact antibodies and immune response that mediate MS were not known.

Robinson’s group isolated thousands of B cells from the spinal fluid of patients with MS and sequenced the antibody repertoires of those B cells to discover what antibodies they produced. Then, the researchers tested those antibodies to see whether they reacted with viruses or healthy human tissue. Their experiments revealed one antibody that recognized both Epstein-Barr virus and a protein, called myelin, made in the brain and spinal cord.

“This means when the immune system attacks Epstein-Barr virus, in some people it also ends up attacking molecules in the central nervous system,” says Robinson.

His group went on to show that approximately a quarter of all patients with MS have detectable levels of these Epstein-Barr antibodies that cross-react with myelin. The findings, published in 2022 in the journal Nature, suggest that in the future, a vaccine against Epstein-Barr virus could help prevent MS, and a drug that blocks the cross-reactive viral antibodies has the potential to treat the disease.

With this approach that is now available commercially, we can now sequence thousands of B cells at once.

Using the same B-cell sequencing technology, Robinson and his colleagues studied the immune cells of people with RA, a chronic disease that causes joint inflammation and pain in approximately 0.5% of the population. When Robinson’s team sequenced B cells from patients with active flares of RA, they discovered antibodies that bind mouth bacteria and cross-react with joint tissues.

Through a series of experiments, the researchers showed that in people with periodontitis, or gum disease, bacteria from the mouth breach into the bloodstream and cause an immune response. In some people, the oral bacteria activate an autoimmune response that causes RA flares. The results were published in February in Science Translational Medicine.

“Right now, to treat RA, we give patients very broad-acting drugs that block whole pathways of the immune system,” says Robinson. “But if a subset of RA arises from breakdown of the gums, letting bacteria into the bloodstream, what if we focus more on oral health?”

Robinson says that these two major findings are likely just the tip of the iceberg on how viruses and bacteria can induce or mediate chronic autoimmune disease. More work is needed to make these connections and to understand why viruses and bacteria trigger long-term autoimmune disease in only some people.

“Stanford is one of the best places in the world to be working on this kind of translational immunology,” Robinson adds. “It’s an incredibly collaborative environment, and we have experts studying all aspects of rheumatologic diseases, along with clinical investigators running trials to translate these types of findings to patients.”

Click image above to expand

For decades, scientists have suspected that many autoimmune diseases, including multiple sclerosis (MS) and rheumatoid arthritis (RA), might be triggered by infections. Now, Department of Medicine researchers have shown exactly how this happens for two common autoimmune diseases — MS and RA. William Robinson, MD, PhD, the James W. Raitt, MD, Professor and chief of immunology and rheumatology, and colleagues discovered how infection with the Epstein-Barr virus, a common herpes virus, can trigger MS, as well as how bacteria normally found in the mouth can breach into the bloodstream to cause RA flare-ups in people with gum disease.

“We’re finally starting to gain insights into what actually causes these very prevalent autoimmune diseases,” says Robinson, who led the work. “In the near future, this may fundamentally change how we treat or prevent these diseases.”

In the new studies, Robinson’s team used a technology that they developed at Stanford over the last decade. It allows them to sequence the antibody repertoire of human B cells — the immune cells that produce antibodies. The gene sequences tell them exactly what antibodies each B cell is making.

“In the old days, someone’s entire thesis project might have been sequencing the antibodies of a few B cells, and it would take years,” says Robinson. “With this approach that is now available commercially, we can now sequence thousands of B cells at once. This is an incredibly powerful tool.”

In healthy individuals, the antibodies made by B cells recognize only viruses and bacteria that are harmful to the body; in those with autoimmune disease, however, antibodies attack the body’s own healthy tissues. In MS, for instance, the immune system attacks the protective coverings of nerve fibers, causing numbness, muscle weakness, and fatigue. However, the exact antibodies and immune response that mediate MS were not known.

Robinson’s group isolated thousands of B cells from the spinal fluid of patients with MS and sequenced the antibody repertoires of those B cells to discover what antibodies they produced. Then, the researchers tested those antibodies to see whether they reacted with viruses or healthy human tissue. Their experiments revealed one antibody that recognized both Epstein-Barr virus and a protein, called myelin, made in the brain and spinal cord.

“This means when the immune system attacks Epstein-Barr virus, in some people it also ends up attacking molecules in the central nervous system,” says Robinson.

His group went on to show that approximately a quarter of all patients with MS have detectable levels of these Epstein-Barr antibodies that cross-react with myelin. The findings, published in 2022 in the journal Nature, suggest that in the future, a vaccine against Epstein-Barr virus could help prevent MS, and a drug that blocks the cross-reactive viral antibodies has the potential to treat the disease.

Click image above to expand

With this approach that is now available commercially, we can now sequence thousands of B cells at once.

Using the same B-cell sequencing technology, Robinson and his colleagues studied the immune cells of people with RA, a chronic disease that causes joint inflammation and pain in approximately 0.5% of the population. When Robinson’s team sequenced B cells from patients with active flares of RA, they discovered antibodies that bind mouth bacteria and cross-react with joint tissues.

Through a series of experiments, the researchers showed that in people with periodontitis, or gum disease, bacteria from the mouth breach into the bloodstream and cause an immune response. In some people, the oral bacteria activate an autoimmune response that causes RA flares. The results were published in February in Science Translational Medicine.

“Right now, to treat RA, we give patients very broad-acting drugs that block whole pathways of the immune system,” says Robinson. “But if a subset of RA arises from breakdown of the gums, letting bacteria into the bloodstream, what if we focus more on oral health?”

Robinson says that these two major findings are likely just the tip of the iceberg on how viruses and bacteria can induce or mediate chronic autoimmune disease. More work is needed to make these connections and to understand why viruses and bacteria trigger long-term autoimmune disease in only some people.

“Stanford is one of the best places in the world to be working on this kind of translational immunology,” Robinson adds. “It’s an incredibly collaborative environment, and we have experts studying all aspects of rheumatologic diseases, along with clinical investigators running trials to translate these types of findings to patients.”

On the Hunt for Knowledge

From left: Cailin Collins, MD, Peter Greenberg, MD, and Gabe Mannis, MD

From left: Cailin Collins, MD, Peter Greenberg, MD, and Gabe Mannis, MD

On the Hunt for Knowledge

Two Hematologists, Two Challenging Diseases, Two Careers Dedicated to the Pursuit of Answers

Peter Greenberg, MD, and Gabriel Mannis, MD, are on the hunt to understand two different but related hematologic diseases. Greenberg, an emeritus professor of hematology, has seen a revolution in knowledge of myelodysplastic syndromes (MDS) over his long career. Mannis, an assistant professor of hematology, is a decade into his research on acute myeloid leukemia (AML). For both Greenberg and Mannis, advancements in technology and precision medicine have transformed their fields of study and offered patients longer, better lives.

From left: Cailin Collins, MD, Peter Greenberg, MD, and Gabe Mannis, MD

From left: Cailin Collins, MD, Peter Greenberg, MD, and Gabe Mannis, MD

On the Hunt for Knowledge

Two Hematologists, Two Challenging Diseases, Two Careers Dedicated to the Pursuit of Answers

Peter Greenberg, MD, and Gabriel Mannis, MD, are on the hunt to understand two different but related hematologic diseases. Greenberg, an emeritus professor of hematology, has seen a revolution in knowledge of myelodysplastic syndromes (MDS) over his long career. Mannis, an assistant professor of hematology, is a decade into his research on acute myeloid leukemia (AML). For both Greenberg and Mannis, advancements in technology and precision medicine have transformed their fields of study and offered patients longer, better lives.

Peter Greenberg, MD

Professor Emeritus of Hematology

Director, Stanford Myelodysplastic Syndrome (MDS) Center

Chair of the National Comprehensive Cancer Network Practice Guidelines Panel for MDS

click to play the audio

A Fellowship Investigation Becomes a Lifelong Inquiry

Peter Greenberg’s role in the sea change in MDS research started during his hematology and oncology fellowship at Stanford, which he completed in 1971. “My chief of hematology said, ‘Greenberg, we have a set of patients that are interesting to evaluate. What can you tell us about that? How can you study it?’”

In fact, Greenberg was positioned to tell a lot about MDS, an illness in which blood cells fail to develop normally in the bone marrow. Patients with MDS often experience fatigue, anemia, frequent infections, and easy bleeding, among other symptoms.

“At the time, I was studying the growth of bone marrow cells within tissue culture, and a new system had just become available to evaluate the normal and abnormal growth of bone marrow cells,” Greenberg says. He contrasted MDS, AML, and normal tissue samples. “It turned out that there were marked differences that became quite informative as to trying to understand the nature of the disease.”

He went on to become an internationally recognized leader in the classification and treatment of MDS, with at least 200 papers on the disease. His publications closely parallel medicine’s developing understanding of MDS, from broad questions of what is its biological nature and best treatments to how to determine an MDS patient’s risk of developing acute leukemia and differentiated treatment based on risk level. More recent papers reflect the role that genetic mutations play in disease progression and the significance of particular mutations on prognosis and treatments.

Every answer that you have leads to other questions. The important thing now is that there’s new technology that permits us to ask these questions more effectively.

Question, Answer, Question

“Every answer that you have leads to other questions,” says Greenberg. “The important thing now is that there’s new technology that permits us to ask these questions more effectively.”

One of the biggest questions Greenberg has helped answer is why MDS remains relatively stable in some patients and becomes very aggressive in others. Advancements in technology such as next-generation sequencing — which rapidly analyzes DNA and RNA samples — have helped provide answers.

“Each cancer has its own heterogeneous group of what we call driver mutations that have major implications for responsivity to certain drugs or aggressivity of disease,” Greenberg says. “Understanding that, hopefully, will help us know what specific drugs should be used for different subtypes of MDS.”

Gabriel Mannis, MD

Assistant Professor of Hematology

Medical Director, Stanford Inpatient Leukemia Service

click to play the audio

A Lethal Disease and a Chance to Make an Impact

“AML is probably one of the most aggressive and lethal hematologic malignancies, and unfortunately, most of my patients will die from their disease,” says Gabriel Mannis.

Patients with AML have immature, abnormal cells called myeloid blasts that crowd out healthy blood cells. In addition to the anemia, infection, and bleeding problems common to MDS, patients with AML are at risk of organ failure and rapidly life-threatening complications.

When Mannis started researching AML in 2013, during his hematology and medical oncology fellowship at UC San Francisco, there were few options available for patients. “I would go to conferences and every trial would be a negative trial,” Mannis says. “There had only been one drug approved for AML since the 1970s, and that drug had been taken off the market.”

He saw an opportunity to make an impact. Once he started seeing patients, his drive to find answers grew even deeper.

When I’m looking at opening different trials, the strategy is ‘How can I best serve the patients that I’m taking care of?’

Patient-Driven Research

“Every patient I see, I think, is there a clinical trial that would be good for this patient?” he says. “Down the road, if this first treatment doesn’t work, what can we then have as a backup for this patient?”

Today, Mannis has opened nearly a dozen clinical trials, most focused on finding better AML treatments. He also sees patients, teaches residents and fellows at the bedside, and teaches part of the hematology course for medical students.

It’s a demanding schedule, but given the fact that most AML patients don’t meet the criteria for the only AML cure — a bone marrow transplant — there’s much to do.

“It’s very difficult, and only a select few are healthy enough to move forward with transplant,” Mannis says. “A transplant is fraught with all sorts of risks and challenges. If we can find the right drugs to eliminate every last leukemia cell without a transplant, that’s really my goal.”

Toward More Elegant Treatments

In the interim, treatment options are improving. “There have been 10 or 11 drug approvals from the FDA, just since 2017,” Mannis says.

Patients are living longer and with better quality of life. With developments in precision medicine, the treatments are increasingly tailored to a patient’s particular disease biology and health status.

“We are able to get more effective treatments with less toxicity,” he says. “We are able to be much more elegant.”