When It Comes to the Kidneys, This Center Leaves No Stone Unturned

Baldeep Singh, MD, with staff at Samaritan House

When It Comes to the Kidneys, This Center Leaves No Stone Unturned

When It Comes to the Kidneys, This Center Leaves No Stone Unturned

Half a million Americans go to the emergency room annually for kidney stone issues, and one in every 10 people in the United States will develop a kidney stone during his or her lifetime.

Kidney stones are exactly what they sound like — accumulations of minerals like calcium that crystallize into stone-like masses inside kidneys. Their formation isn’t necessarily painful, but passing them can be. If a stone gets lodged in a ureter, it can cause a clog that backs up urine in the kidneys. While stones aren’t life-threatening, complications can include kidney injury and increased risk of urinary infection.

Diagnosis and treatment of kidney stones is a two-part process. When patients come in with a painful kidney stone that won’t pass on its own, physicians identify and remove it. But removing it doesn’t address how to prevent future stones. Patients who’ve developed one stone have about a 50 percent risk for developing another within the next decade.

Prevention involves taking a detailed dietary and medical history, gathering urine and blood samples for analysis, then implementing appropriate strategies based on those findings. It’s a time-consuming and often piecemeal medical assessment that can take weeks, leaving the patient waiting to receive — and understand — the best treatment.

At the Stanford Kidney Stone Center, clinicians are working to provide the best treatment and prevention for kidney stones. In part, that’s because the center draws together experts from nephrology, urology, endocrinology, and nutrition.

Alan C. Pao, MD, assistant professor of nephrology, leads the center with Simon Conti, MD, clinical assistant professor of urology.

“Dr. Conti and I decided to divide the work so that the urologists focus on clinical-radiologic correlations and make surgical plans, and the nephrologists analyze the laboratory data and craft prevention strategies,” Pao says.

“It’s very efficient to discuss medical and surgical options for the same patient at the same time,” adds Pao, who is also joined at the center by nephrologists Robert Isom, MD, Pedram Fatehi, MD, and Fahmeedah Kamal, MD.

Pao says it’s not well understood why kidney stones form, but patients on high-meat and high-sodium diets or who don’t drink enough fluids are typically more at risk for stone recurrence. And appropriate treatments to prevent recurring kidney stones aren’t one size fits all. In fact, they depend on the diet, health, and stone type of each stone-former.

The secret to preventing stones, Pao says, is in a patient’s urine. Urine contents can reveal what minerals are in excess or in deficiency, and those mineral levels can help physicians determine how to help patients. That’s why a simple procedure like 24-hour urine collection is so vital — it provides a road map for improved treatment.

Half a million Americans go to the emergency room annually for kidney stone issues, and one in every 10 people in the United States will develop a kidney stone during his or her lifetime.

Kidney stones are exactly what they sound like — accumulations of minerals like calcium that crystallize into stone-like masses inside kidneys. Their formation isn’t necessarily painful, but passing them can be. If a stone gets lodged in a ureter, it can cause a clog that backs up urine in the kidneys. While stones aren’t life-threatening, complications can include kidney injury and increased risk of urinary infection.

Diagnosis and treatment of kidney stones is a two-part process. When patients come in with a painful kidney stone that won’t pass on its own, physicians identify and remove it. But removing it doesn’t address how to prevent future stones. Patients who’ve developed one stone have about a 50 percent risk for developing another within the next decade.

Prevention involves taking a detailed dietary and medical history, gathering urine and blood samples for analysis, then implementing appropriate strategies based on those findings. It’s a time-consuming and often piecemeal medical assessment that can take weeks, leaving the patient waiting to receive — and understand — the best treatment.

At the Stanford Kidney Stone Center, clinicians are working to provide the best treatment and prevention for kidney stones. In part, that’s because the center draws together experts from nephrology, urology, endocrinology, and nutrition.

Alan C. Pao, MD, assistant professor of nephrology, leads the center with Simon Conti, MD, clinical assistant professor of urology.

“Dr. Conti and I decided to divide the work so that the urologists focus on clinical-radiologic correlations and make surgical plans, and the nephrologists analyze the laboratory data and craft prevention strategies,” Pao says.

“It’s very efficient to discuss medical and surgical options for the same patient at the same time,” adds Pao, who is also joined at the center by nephrologists Robert Isom, MD, Pedram Fatehi, MD, and Fahmeedah Kamal, MD.

Pao says it’s not well understood why kidney stones form, but patients on high-meat and high-sodium diets or who don’t drink enough fluids are typically more at risk for stone recurrence. And appropriate treatments to prevent recurring kidney stones aren’t one size fits all. In fact, they depend on the diet, health, and stone type of each stone-former.

The secret to preventing stones, Pao says, is in a patient’s urine. Urine contents can reveal what minerals are in excess or in deficiency, and those mineral levels can help physicians determine how to help patients. That’s why a simple procedure like 24-hour urine collection is so vital — it provides a road map for improved treatment.

Along with John Leppert, MD, associate professor of urology, Pao is analyzing a national database of 120,000 kidney stone patients cared for in Veterans Affairs hospitals. They’re examining how frequently stone-formers are getting 24-hour urine collections, and whether subsequent analysis of the urine leads to changes in stone-prevention medications and decreases in stone risks.

Pao is also following the breadcrumbs of other kidney stone mysteries, like why patients with normal-looking 24-hour urine collections still develop recurrent stones. That occasional disconnect has also spurred him to work with another colleague, Joseph C. Liao, MD, associate professor of urology, on a new gadget that will allow patients to spot check their urine throughout the day and provide immediate feedback for how diet and medications are affecting their stone risk.

Undoubtedly, precision medicine has trickled into kidney stone treatment, and Pao’s research ensures that patients receive their unique treatments for stone prevention.

Along with John Leppert, MD, associate professor of urology, Pao is analyzing a national database of 120,000 kidney stone patients cared for in Veterans Affairs hospitals. They’re examining how frequently stone-formers are getting 24-hour urine collections, and whether subsequent analysis of the urine leads to changes in stone-prevention medications and decreases in stone risks.

Pao is also following the breadcrumbs of other kidney stone mysteries, like why patients with normal-looking 24-hour urine collections still develop recurrent stones. That occasional disconnect has also spurred him to work with another colleague, Joseph C. Liao, MD, associate professor of urology, on a new gadget that will allow patients to spot check their urine throughout the day and provide immediate feedback for how diet and medications are affecting their stone risk.

Undoubtedly, precision medicine has trickled into kidney stone treatment, and Pao’s research ensures that patients receive their unique treatments for stone prevention.

Stanford Amyloid Center: From Start-up to Premier Status

Baldeep Singh, MD, with staff at Samaritan House

RONGLIH LIAO, PHD (left), reviews research data with lab instructor SEEMA DANGWAL, PHD.

Stanford Amyloid Center: From Start-up to Premier Status

RONGLIH LIAO, PHD (left), reviews research data with lab instructor SEEMA DANGWAL, PHD.

Stanford Amyloid Center: From Start-up to Premier Status

Although Kevin Anderson had committed no crime, he was facing a death sentence when he came to Stanford in 2007.

Anderson was dying from end-stage cardiac amyloidosis, an abnormal accumulation of proteins (amyloid fibrils) in his heart.

He had recently visited the Mayo Clinic in Minnesota to ask about a heart transplant, which at that time was the only viable treatment option for his disease. Because the amyloidosis was mostly in his heart and not in other parts of his body, Anderson qualified for a transplant.

Anderson, a urologist, lived near Sacramento, California. His proximity to Stanford brought him in contact with Ronald Witteles, MD, who at the time was a new faculty member, just starting the Stanford Amyloid Center.

Not long after Witteles met Anderson, the Stanford heart transplant team gave Anderson a second chance at life.

“Without the transplant, Dr. Anderson would not have survived that year. Now, more than a decade later, he remains alive and well, is back to work as a urologist, and he is thriving,” says Witteles, associate professor of cardiovascular medicine.

Antibodies and Light Chains
Anderson was afflicted with AL (primary) amyloidosis, which is related to a type of bone marrow cancer. Normally, plasma cells in the bone marrow produce antibodies. If a plasma cell becomes cancerous, it may produce extra pieces of antibodies called “light chains” (the L in AL amyloidosis). The light chains circulate in the bloodstream and can deposit in the heart and other major organs throughout the body, causing damage.

“A generation ago, a diagnosis of AL amyloidosis often was a death sentence, particularly when it involved the heart, but in the last 10 years treatments have improved by leaps and bounds so we can now give very effective treatments to many patients with the disease,” Witteles says.

Transthyretin (TTR) amyloidosis is the other main type of the disease. It is not related to cancer, and one of its two forms is inherited from those carrying a genetic mutation. The mutation is present in about 1 in 30 African Americans in this country; about 7 percent of the people with the mutation will develop the disease. Another form of TTR amyloidosis, which is not hereditary, first strikes people usually between ages 60 and 80 and causes mainly heart dysfunction. Up to a quarter of men in their 80s and 90s have significant deposits present in their hearts.

A Synergistic Approach
AL amyloidosis, the bone marrow type of the disease, is by definition a cancer, but it endangers other organs — including the heart, the kidneys, the liver, the gastrointestinal tract, and the nerves. Optimum patient care requires a true multidisciplinary approach in which amyloidosis specialists closely collaborate with experts in various medical specialties.

Witteles had that approach in mind when he first contacted Stanley Schrier, MD, professor of hematology, about an opportunity for a Stanford team to form a multidisciplinary group to battle this disease. Colleagues in other disciplines also expressed interest, including Richard Lafayette, MD, a professor of nephrology; Sally Arai, MD, an associate professor of blood and marrow transplantation; and Gerald Berry, MD, a professor of pathology. That first group of physicians wanted to learn everything they could about the disease, and they were willing to work collaboratively to contribute to the body of knowledge. That meant patients who would be coming from great distances could see all their specialists in one coordinated visit.

Although Kevin Anderson had committed no crime, he was facing a death sentence when he came to Stanford in 2007.

Anderson was dying from end-stage cardiac amyloidosis, an abnormal accumulation of proteins (amyloid fibrils) in his heart.

He had recently visited the Mayo Clinic in Minnesota to ask about a heart transplant, which at that time was the only viable treatment option for his disease. Because the amyloidosis was mostly in his heart and not in other parts of his body, Anderson qualified for a transplant.

Anderson, a urologist, lived near Sacramento, California. His proximity to Stanford brought him in contact with Ronald Witteles, MD, who at the time was a new faculty member, just starting the Stanford Amyloid Center.

Not long after Witteles met Anderson, the Stanford heart transplant team gave Anderson a second chance at life.

“Without the transplant, Dr. Anderson would not have survived that year. Now, more than a decade later, he remains alive and well, is back to work as a urologist, and he is thriving,” says Witteles, associate professor of cardiovascular medicine.

Antibodies and Light Chains
Anderson was afflicted with AL (primary) amyloidosis, which is related to a type of bone marrow cancer. Normally, plasma cells in the bone marrow produce antibodies. If a plasma cell becomes cancerous, it may produce extra pieces of antibodies called “light chains” (the L in AL amyloidosis). The light chains circulate in the bloodstream and can deposit in the heart and other major organs throughout the body, causing damage.

“A generation ago, a diagnosis of AL amyloidosis often was a death sentence, particularly when it involved the heart, but in the last 10 years treatments have improved by leaps and bounds so we can now give very effective treatments to many patients with the disease,” Witteles says.

Transthyretin (TTR) amyloidosis is the other main type of the disease. It is not related to cancer, and one of its two forms is inherited from those carrying a genetic mutation. The mutation is present in about 1 in 30 African Americans in this country; about 7 percent of the people with the mutation will develop the disease. Another form of TTR amyloidosis, which is not hereditary, first strikes people usually between ages 60 and 80 and causes mainly heart dysfunction. Up to a quarter of men in their 80s and 90s have significant deposits present in their hearts.

A Synergistic Approach
AL amyloidosis, the bone marrow type of the disease, is by definition a cancer, but it endangers other organs — including the heart, the kidneys, the liver, the gastrointestinal tract, and the nerves. Optimum patient care requires a true multidisciplinary approach in which amyloidosis specialists closely collaborate with experts in various medical specialties.

Witteles had that approach in mind when he first contacted Stanley Schrier, MD, professor of hematology, about an opportunity for a Stanford team to form a multidisciplinary group to battle this disease. Colleagues in other disciplines also expressed interest, including Richard Lafayette, MD, a professor of nephrology; Sally Arai, MD, an associate professor of blood and marrow transplantation; and Gerald Berry, MD, a professor of pathology. That first group of physicians wanted to learn everything they could about the disease, and they were willing to work collaboratively to contribute to the body of knowledge. That meant patients who would be coming from great distances could see all their specialists in one coordinated visit.

From a Modest Start, the Center Quickly Grew
“It turned out that there were many more of these patients than anyone realized, and there was no other center for the disease within a thousand miles of here. Also, by luck of timing, the formation of our center occurred just as new treatments for AL amyloidosis were poised to take off and newer treatments for TTR amyloidosis were being studied and ultimately would be successful and on their way to approval,” Witteles says.

Elucidating the Basic Mechanisms of the Disease
Then came the recruitment in 2017 of Ronglih Liao, PhD, a professor of medicine whose expertise is in the basic science of amyloidosis.

“She and a very talented trainee, Kevin Alexander, MD, a fellow in advanced heart failure and transplant cardiology, moved their lab from Brigham and Women’s Hospital in Boston to Stanford to continue doing remarkable work in elucidating many of the basic mechanisms of the disease,” says Witteles.

The lab has been at the forefront of investigating questions like how amyloid deposits injure organs and why amyloidogenic immunoglobulin light chain proteins are so much more toxic than transthyretin.

The devotion of the Stanford Amyloid Center physicians and staff as well as the leadership in the Department of Medicine were factors that attracted Liao to Stanford.

“I was impressed with the recognition of the critical importance of basic and translational research. There is an understanding of how that research contributes to the continued success in providing top-quality patient care,” Liao says. “We are optimistic that at this center our scientific discoveries can rapidly be translated back to the clinic and we can use our patients to accelerate the discovery process, with each part helping the other. This will set up a feed-forward system that we hope will allow us to develop new therapies in record time.”

Enriching the Reputation
Prior to Liao’s arrival, Stanford was known for being on the cutting edge of some clinical treatments like transplants and newer chemotherapy approaches. Now, the basic science expertise is enriching its reputation.

Today, with about 125 new amyloidosis patients per year, several hundred others receiving regular care, and many enrolled in various clinical trials, the Stanford Amyloid Center is one of the largest such centers in the world. Witteles and Liao lead the center along with Michaela Liedtke, MD, an associate professor of hematology. The staff includes 14 faculty from three departments and five divisions in the Department of Medicine, a dedicated clinical trials coordinator, and two full-time nurse coordinators.

In August 2018 the FDA approved the first drug ever for treating TTR amyloidosis, and two more drugs are expected to receive approval in the coming year. All three of these drugs and many more that are on the way, including AG-10, which was first identified at Stanford, represent classic bench-to-bedside development: An initial understanding of the mechanism of the disease led to treatment approaches based entirely on that understanding.

What that all means is a leading role for the Stanford Amyloid Center in promising bright futures for patients like Kevin Anderson.

From a Modest Start, the Center Quickly Grew
“It turned out that there were many more of these patients than anyone realized, and there was no other center for the disease within a thousand miles of here. Also, by luck of timing, the formation of our center occurred just as new treatments for AL amyloidosis were poised to take off and newer treatments for TTR amyloidosis were being studied and ultimately would be successful and on their way to approval,” Witteles says.

Elucidating the Basic Mechanisms of the Disease
Then came the recruitment in 2017 of Ronglih Liao, PhD, a professor of medicine whose expertise is in the basic science of amyloidosis.

“She and a very talented trainee, Kevin Alexander, MD, a fellow in advanced heart failure and transplant cardiology, moved their lab from Brigham and Women’s Hospital in Boston to Stanford to continue doing remarkable work in elucidating many of the basic mechanisms of the disease,” says Witteles.

The lab has been at the forefront of investigating questions like how amyloid deposits injure organs and why amyloidogenic immunoglobulin light chain proteins are so much more toxic than transthyretin.

The devotion of the Stanford Amyloid Center physicians and staff as well as the leadership in the Department of Medicine were factors that attracted Liao to Stanford.

“I was impressed with the recognition of the critical importance of basic and translational research. There is an understanding of how that research contributes to the continued success in providing top-quality patient care,” Liao says. “We are optimistic that at this center our scientific discoveries can rapidly be translated back to the clinic and we can use our patients to accelerate the discovery process, with each part helping the other. This will set up a feed-forward system that we hope will allow us to develop new therapies in record time.”

Enriching the Reputation
Prior to Liao’s arrival, Stanford was known for being on the cutting edge of some clinical treatments like transplants and newer chemotherapy approaches. Now, the basic science expertise is enriching its reputation.

Today, with about 125 new amyloidosis patients per year, several hundred others receiving regular care, and many enrolled in various clinical trials, the Stanford Amyloid Center is one of the largest such centers in the world. Witteles and Liao lead the center along with Michaela Liedtke, MD, an associate professor of hematology. The staff includes 14 faculty from three departments and five divisions in the Department of Medicine, a dedicated clinical trials coordinator, and two full-time nurse coordinators.

In August 2018 the FDA approved the first drug ever for treating TTR amyloidosis, and two more drugs are expected to receive approval in the coming year. All three of these drugs and many more that are on the way, including AG-10, which was first identified at Stanford, represent classic bench-to-bedside development: An initial understanding of the mechanism of the disease led to treatment approaches based entirely on that understanding.

What that all means is a leading role for the Stanford Amyloid Center in promising bright futures for patients like Kevin Anderson.

A Breakthrough Drug Facilitates Safer Bone Marrow Transplants

Baldeep Singh, MD, with staff at Samaritan House

A Breakthrough Drug Facilitates Safer Bone Marrow Transplants

A Breakthrough Drug Facilitates Safer Bone Marrow Transplants

Within the walls of the Center for Clinical Sciences Research, scientists are hard at work developing life-saving treatments for patients with blood and bone marrow cancers.

Since 1987, Stanford has performed more than 7,000 adult bone marrow transplants, long considered the gold standard for treating people with these cancers. However, a potentially serious complication of bone marrow transplantation is graft versus host disease (GVHD).

GVHD is caused when immune cells from a donor start attacking the normal tissues of a recipient. This can lead to painful, debilitating problems in organs from the skin and mouth to the liver and lungs, including itchy rashes, nausea and vomiting, muscle weakness, and breathing difficulty.

For those needing a bone marrow transplant, the ideal option is to find a donor within the patient’s family, but the odds for a match of antigens between family members are at best only one in four. The next best option is a transplant of cells from an unrelated donor, known as a hematopoietic cell transplant. However, the risk for GVHD increases with unrelated donors.

Corticosteroids were the conventional treatment for GVHD, but the long-term use of steroids has many side effects, and GVHD frequently re-emerges when steroids are stopped.

Researchers had been working for years to find a more reliable treatment than steroids, and they found it in ibrutinib, the first drug approved by the U.S. Food and Drug Administration (FDA) for the treatment of GVHD.

A team led by David Miklos, MD, PhD, associate professor of blood and marrow transplantation, contributed greatly to the development of ibrutinib.

“We’d been looking for a long time for targeted effective therapies to get patients with chronic GVHD off steroids. But other drugs, even those that showed early promise, all ended up failing to show benefit in randomized clinical trials,” Miklos says.

Miklos discovered that B lymphocytes — one type of immune cell — are critical to the development of chronic GVHD. Blocking B cell activity, he hypothesized, could prevent or treat the disease. Ibrutinib — a drug first developed to treat B cell cancers and already approved for multiple cancer types — was able to potently deplete B cells from a hematopoietic cell transplant donor.

Within the walls of the Center for Clinical Sciences Research, scientists are hard at work developing life-saving treatments for patients with blood and bone marrow cancers.

Since 1987, Stanford has performed more than 7,000 adult bone marrow transplants, long considered the gold standard for treating people with these cancers. However, a potentially serious complication of bone marrow transplantation is graft versus host disease (GVHD).

GVHD is caused when immune cells from a donor start attacking the normal tissues of a recipient. This can lead to painful, debilitating problems in organs from the skin and mouth to the liver and lungs, including itchy rashes, nausea and vomiting, muscle weakness, and breathing difficulty.

For those needing a bone marrow transplant, the ideal option is to find a donor within the patient’s family, but the odds for a match of antigens between family members are at best only one in four. The next best option is a transplant of cells from an unrelated donor, known as a hematopoietic cell transplant. However, the risk for GVHD increases with unrelated donors.

Corticosteroids were the conventional treatment for GVHD, but the long-term use of steroids has many side effects, and GVHD frequently re-emerges when steroids are stopped.

Researchers had been working for years to find a more reliable treatment than steroids, and they found it in ibrutinib, the first drug approved by the U.S. Food and Drug Administration (FDA) for the treatment of GVHD.

A team led by David Miklos, MD, PhD, associate professor of blood and marrow transplantation, contributed greatly to the development of ibrutinib.

“We’d been looking for a long time for targeted effective therapies to get patients with chronic GVHD off steroids. But other drugs, even those that showed early promise, all ended up failing to show benefit in randomized clinical trials,” Miklos says.

Miklos discovered that B lymphocytes — one type of immune cell — are critical to the development of chronic GVHD. Blocking B cell activity, he hypothesized, could prevent or treat the disease. Ibrutinib — a drug first developed to treat B cell cancers and already approved for multiple cancer types — was able to potently deplete B cells from a hematopoietic cell transplant donor. Miklos approached Pharmacyclics, the Sunnyvale-based company that makes ibrutinib, about launching a clinical trial of the drug for GVHD; the company agreed.

We’d been looking for a long time for therapies to get patients with chronic GVHD off steroids

Miklos and his colleagues presented favorable results of that trial at an annual meeting of the American Society of Hematology. On the heels of that research, the FDA fast-tracked its approval process, and in August 2017 the FDA approved ibrutinib for the treatment of patients with chronic GVHD who have failed at least one systemic treatment.

More recent insights come from senior scientist Bita Sahaf, PhD, who has worked in the Miklos lab since 2007. Sahaf presented the mechanism for ibrutinibchronic GVHD during a top abstracts session at the combined annual meetings of the Center for International Blood & Marrow Transplant Research and the American Society for Blood and Marrow Transplantation in early 2018.

“Our research is focused on B and T cells, two important components of the immune system. The overall research goal is the characterization of adaptive B and T cell immune responses that cure cancer while avoiding GVHD,” Miklos explains.

Now, Miklos and his colleagues are working on a randomized placebo-controlled trial of 185 patients to see if ibrutinib is effective in patients with earlier stages of GVHD. They expect to have results by the end of 2019.

“Perhaps most exciting, the Stanford Bone Marrow Transplant program has initiated its own clinical trial to see if ibrutinib immediately following transplant can prevent chronic GVHD from developing months later,” Miklos says.

We’d been looking for a long time for therapies to get patients with chronic GVHD off steroids

Miklos approached Pharmacyclics, the Sunnyvale-based company that makes ibrutinib, about launching a clinical trial of the drug for GVHD; the company agreed.

Miklos and his colleagues presented favorable results of that trial at an annual meeting of the American Society of Hematology. On the heels of that research, the FDA fast-tracked its approval process, and in August 2017 the FDA approved ibrutinib for the treatment of patients with chronic GVHD who have failed at least one systemic treatment.

More recent insights come from senior scientist Bita Sahaf, PhD, who has worked in the Miklos lab since 2007. Sahaf presented the mechanism for ibrutinibchronic GVHD during a top abstracts session at the combined annual meetings of the Center for International Blood & Marrow Transplant Research and the American Society for Blood and Marrow Transplantation in early 2018.

“Our research is focused on B and T cells, two important components of the immune system. The overall research goal is the characterization of adaptive B and T cell immune responses that cure cancer while avoiding GVHD,” Miklos explains.

Now, Miklos and his colleagues are working on a randomized placebo-controlled trial of 185 patients to see if ibrutinib is effective in patients with earlier stages of GVHD. They expect to have results by the end of 2019.

“Perhaps most exciting, the Stanford Bone Marrow Transplant program has initiated its own clinical trial to see if ibrutinib immediately following transplant can prevent chronic GVHD from developing months later,” Miklos says.

Integrating Medicine with Basic Science

Baldeep Singh, MD, with staff at Samaritan House

Integrating Medicine with Basic Science

Integrating Medicine with Basic Science

Justin Annes, MD, PhD, assistant professor of endocrinology, gerontology and metabolism, and ChEM-H faculty fellow, feels that he owes a great deal of credit for his unique research program to the ChEM-H Institute, which stands for Chemistry, Engineering & Medicine for Human Health. “What they do,” he says, “is take a physician scientist like me and enable me to bring chemistry into the laboratory in a really significant way.” Envisioned by Chaitan Khosla, PhD, professor of chemistry, ChEM-H is co-directed with Carolyn Bertozzi, PhD, professor of chemistry, “both outstanding scientists and wonderful leaders,” Annes says.

He continues: “ChEM-H has allowed me to unleash chemistry in an informed and supported way. One important person for me has been Mark Smith, PhD, director of the ChEM-H Medicinal Chemistry Knowledge Center, who is an engaged partner in our drug-development programs. Another is Justin Du Bois, PhD, associate professor of chemistry, who has generously provided the chemists in my group an environment and culture of chemistry. We recently developed a first-generation ‘smart drug’ that applies the principles of chemistry to selectively target a regenerative medicine to insulin-producing β-cells. We hope someday this medicine will be used to reverse diabetes.”

Annes has also developed an interdisciplinary research effort that integrates engineering, chemistry, and biology. “My collaboration with Amin Arbabian, PhD, an electrical engineer, and Richard Zare, PhD, a chemist, aims to develop a new nanoparticle-based drug-delivery microdevice to reverse life-threatening hypoglycemia in diabetic patients. This is a uniquely Stanford project as it reaches across scientific disciplines that normally don’t interact. My role as leader of the Stanford Diabetes Research Center enrichment program, which fosters cross-disciplinary work, was instrumental in developing this collaboration.”

Justin Annes, MD, PhD, assistant professor of endocrinology, gerontology and metabolism, and ChEM-H faculty fellow, feels that he owes a great deal of credit for his unique research program to the ChEM-H Institute, which stands for Chemistry, Engineering & Medicine for Human Health. “What they do,” he says, “is take a physician scientist like me and enable me to bring chemistry into the laboratory in a really significant way.” Envisioned by Chaitan Khosla, PhD, professor of chemistry, ChEM-H is co-directed with Carolyn Bertozzi, PhD, professor of chemistry, “both outstanding scientists and wonderful leaders,” Annes says.

He continues: “ChEM-H has allowed me to unleash chemistry in an informed and supported way. One important person for me has been Mark Smith, PhD, director of the ChEM-H Medicinal Chemistry Knowledge Center, who is an engaged partner in our drug-development programs. Another is Justin Du Bois, PhD, associate professor of chemistry, who has generously provided the chemists in my group an environment and culture of chemistry. We recently developed a first-generation ‘smart drug’ that applies the principles of chemistry to selectively target a regenerative medicine to insulin-producing β-cells. We hope someday this medicine will be used to reverse diabetes.”

Annes has also developed an interdisciplinary research effort that integrates engineering, chemistry, and biology. “My collaboration with Amin Arbabian, PhD, an electrical engineer, and Richard Zare, PhD, a chemist, aims to develop a new nanoparticle-based drug-delivery microdevice to reverse life-threatening hypoglycemia in diabetic patients. This is a uniquely Stanford project as it reaches across scientific disciplines that normally don’t interact. My role as leader of the Stanford Diabetes Research Center enrichment program, which fosters cross-disciplinary work, was instrumental in developing this collaboration.”

This is one of the great joys of being in an academic institution: discovery and mentorship all in one moment.

Annes’ research and clinical interests, which are in diabetes and hereditary endocrine disorders, have led him to work with patients who have two neuroendocrine tumor-related conditions, pheochromocytoma and paragangliomas. While at Brigham & Women’s Hospital, says Annes, “I became the pheochromocytoma and paraganglioma guy, and when I came to Stanford I continued to see these patients, extending my practice to neuroendocrine tumors in general. I got to know Pamela Kunz, MD, assistant professor of oncology, a leader in neuroendocrine tumors on the oncology side. Over the years we’ve brought our clinics together, and now we have an endocrine cancer clinical program.”

When not seeing patients, Annes can be found in his lab where, he says, “our driving principle is to harness the power of chemistry to deliver new insights into biologic function and to develop a regenerative therapeutic for diabetes and improved chemotherapeutics for our neuroendocrine tumor patients.”

His lab spans the spectrum of preclinical drug development. His biologists, chemists, and biochemists work with animal models to understand pathophysiology and identify the molecular basis of disease, in-vitro systems to identify lead compounds for therapeutic targets, and test tubes where they build drugs from individual components. And then they take those drugs back into cell systems and animal models to demonstrate their activities.

Asked to describe a good day, Annes returns to the lab: “One of my favorite days is when I go into the lab, and a couple of my graduate students are trying to stay calm despite being exuberant about a new experimental result. I get to sit down and see what the science is, what they’ve discovered, how fulfilled, motivated, and off-the-wall happy they are by the new discovery.”

“This is one of the great joys of being in an academic institution: discovery and mentorship all in one moment.”

This is one of the great joys of being in an academic institution: discovery and mentorship all in one moment.

Annes’ research and clinical interests, which are in diabetes and hereditary endocrine disorders, have led him to work with patients who have two neuroendocrine tumor-related conditions, pheochromocytoma and paragangliomas. While at Brigham & Women’s Hospital, says Annes, “I became the pheochromocytoma and paraganglioma guy, and when I came to Stanford I continued to see these patients, extending my practice to neuroendocrine tumors in general. I got to know Pamela Kunz, MD, assistant professor of oncology, a leader in neuroendocrine tumors on the oncology side. Over the years we’ve brought our clinics together, and now we have an endocrine cancer clinical program.”

When not seeing patients, Annes can be found in his lab where, he says, “our driving principle is to harness the power of chemistry to deliver new insights into biologic function and to develop a regenerative therapeutic for diabetes and improved chemotherapeutics for our neuroendocrine tumor patients.”

His lab spans the spectrum of preclinical drug development. His biologists, chemists, and biochemists work with animal models to understand pathophysiology and identify the molecular basis of disease, in-vitro systems to identify lead compounds for therapeutic targets, and test tubes where they build drugs from individual components. And then they take those drugs back into cell systems and animal models to demonstrate their activities.

Asked to describe a good day, Annes returns to the lab: “One of my favorite days is when I go into the lab, and a couple of my graduate students are trying to stay calm despite being exuberant about a new experimental result. I get to sit down and see what the science is, what they’ve discovered, how fulfilled, motivated, and off-the-wall happy they are by the new discovery.”

“This is one of the great joys of being in an academic institution: discovery and mentorship all in one moment.”

Tamara Dunn in Focus

Baldeep Singh, MD, with staff at Samaritan House

Tamara Dunn in Focus

Tamara Dunn in Focus

A steady hum of energy and activity seems to constantly surround Tamara Dunn, MD, clinical assistant professor of hematology. Perhaps it’s the time of day — it’s early evening, a notoriously hectic time, and she’s toggling between the end of her work day, her children’s after-school commitments, patients’ schedules, and her dog’s veterinary appointment. But, after an hour of conversation, it becomes clear that this is a more permanent state — a reflection of the passion and attention she brings to each sphere of her busy life.

Dunn was one of those kids who “always knew” she wanted to be a physician. She was raised in Kansas City and her father’s job as a dentist gave her an insider’s glimpse into the medical field.

“My dad had a lot of friends who were physicians. In fact, his best friend was my pediatrician,” she explains. “I was very fortunate to be surrounded by this group of black professionals who inspired me. It was completely the norm. ” The early exposure planted the seeds for what would become one of her causes: building — and fostering — inclusive communities in medicine.

After a post-college break spent living in France and New York, performing “off-off-Broadway,” singing – and recording a demo – with a band, and toying with a career as a financial trader, Dunn found her way back to her childhood love — medicine.

She received her MD from SUNY Downstate Medical Center and came to Stanford for her residency, where she’s remained ever since, treating patients at Veterans Affairs, working alongside residents and fellows on the diversity council, and playing a role in the establishment of the Adolescent and Young Adult Cancer Program. In the process, she’s emerged as a champion for diversity and inclusion — at Stanford, at the American Society of Hematology, and beyond. Dunn shared more about performing, medicine, and her diversity work in a recent interview.

How did you first become interested in medicine?
I always wanted to be a physician, but I took a very unconventional path. When I arrived at Stanford as an undergraduate I was taking all the  premed courses — I began as a human biology major — but I changed my major after my sophomore year to French.

I had already performed quite a bit in high school, but I really cultivated my abilities during this time. I was in an a cappella group that performed world music focusing on the African-American diaspora, I was involved in Stanford’s theatrical society and was performing in shows every year, and I was in a funk band that performed at campus parties. My mother died when I was 15, and I realized how quickly life could change. Since then I’ve had a “carpe diem” attitude and have never taken anything for granted — I believe in following your passion and that anything is possible.

After graduation, I went to performing arts school at the American Musical and Dramatic Academy in New York City, and did some more theater work — performing off-off-Broadway and auditioning. Then, I took a 180 degree turn into finance. I got licensed and was working on the trading floor on the sales side. I was offered a position in the trader training program but had already enrolled in the post-bac pre-med program at Hunter College.

A steady hum of energy and activity seems to constantly surround Tamara Dunn, MD, clinical assistant professor of hematology. Perhaps it’s the time of day — it’s early evening, a notoriously hectic time, and she’s toggling between the end of her work day, her children’s after-school commitments, patients’ schedules, and her dog’s veterinary appointment. But, after an hour of conversation, it becomes clear that this is a more permanent state — a reflection of the passion and attention she brings to each sphere of her busy life.

Dunn was one of those kids who “always knew” she wanted to be a physician. She was raised in Kansas City and her father’s job as a dentist gave her an insider’s glimpse into the medical field.

“My dad had a lot of friends who were physicians. In fact, his best friend was my pediatrician,” she explains. “I was very fortunate to be surrounded by this group of black professionals who inspired me. It was completely the norm. ” The early exposure planted the seeds for what would become one of her causes: building — and fostering — inclusive communities in medicine.

After a post-college break spent living in France and New York, performing “off-off-Broadway,” singing – and recording a demo – with a band, and toying with a career as a financial trader, Dunn found her way back to her childhood love — medicine.

She received her MD from SUNY Downstate Medical Center and came to Stanford for her residency, where she’s remained ever since, treating patients at Veterans Affairs, working alongside residents and fellows on the diversity council, and playing a role in the establishment of the Adolescent and Young Adult Cancer Program. In the process, she’s emerged as a champion for diversity and inclusion — at Stanford, at the American Society of Hematology, and beyond. Dunn shared more about performing, medicine, and her diversity work in a recent interview.

How did you first become interested in medicine?
I always wanted to be a physician, but I took a very unconventional path. When I arrived at Stanford as an undergraduate I was taking all the  premed courses — I began as a human biology major — but I changed my major after my sophomore year to French. I had already performed quite a bit in high school, but I really cultivated my abilities during this time. I was in an a cappella group that performed world music focusing on the African-American diaspora, I was involved in Stanford’s theatrical society and was performing in shows every year, and I was in a funk band that performed at campus parties. My mother died when I was 15, and I realized how quickly life could change. Since then I’ve had a “carpe diem” attitude and have never taken anything for granted — I believe in following your passion and that anything is possible.

After graduation, I went to performing arts school at the American Musical and Dramatic Academy in New York City, and did some more theater work — performing off-off-Broadway and auditioning. Then, I took a 180 degree turn into finance. I got licensed and was working on the trading floor on the sales side. I was offered a position in the trader training program but had already enrolled in the post-bac pre-med program at Hunter College.

What drew you to hematology, your current specialty?
It was always an interest of mine. I was just excited to look at blood smears — I thought the cells looked so beautiful on the slide. And all the diseases intrigued me, especially leukemia. I fell in love with how intense the field was and how deep of a relationship you form with your patients and their families. So, I went right into a hematology sub-specialty training program at Stanford, and I loved it.

What does an average work day look like for you?  
One thing I love about my job is that every day is unique. Some days I’m focused on my clinic patients, some days I’m performing inpatient consults at the VA or Stanford Hospital, some days are fellowship heavy. I also work on research for our Adolescent and Young Adult (AYA) Cancer Program. I recently did a study where we gave all the AYA patients receiving therapy Fitbits and an iPad to encourage physical activity because we believe it can improve cancer-related fatigue and quality of life. We also gave our patients a quality of life assessment tool, and using the technology did in fact improve their score.

Does your artistic background ever come into play when you’re practicing medicine?
Not quite yet, although I’m hoping when things calm down and life is a bit less crazy I’ll be able to perform more. Music is so powerful, especially for patients. I will tell you this: I always sing to every patient in my clinic when it’s their birthday – they get a big happy birthday song from me, and many have come to expect it. I was also able to sing at the Survivor’s Day celebration at the VA. That was really special. When I was a resident and fellow I used to sing on the units.

You’ve become a voice for diversity and inclusion – which is a pressing issue in all of higher education – in the Department of Medicine. How are you bringing communities together?
I’ve been working alongside Wendy Caceres, MD, clinical assistant professor of primary care and population health, for the past couple of years as a faculty advisor on the diversity council, which is composed mostly of residents and fellows. Having a community is one thing — we know we should improve our diversity — but I think making the people who are currently here feel comfortable is where the inclusion piece comes in. Once the community is formed and people are feeling acclimated, strong, and important, that’s when you start to attract more underrepresented minorities.

I’ve hosted informal get-togethers at my home where we share dinner and discussion, and that is a valuable space. We have a few initiatives in the pipeline: We’re trying to incorporate diversity into the weekly medicine grand rounds by encouraging a more diverse speaker roster. We also have taken a larger role in the recruitment process. We’re doing more distance travel meetings and making sure that we’re bringing diverse faculty to the table. I am also a member of the Graduate Medical Education’s Diversity and Inclusion Committee where we are trying to promote diversity on a broader level.

You were recently named an American Society of Hematology (ASH) ambassador. What will this new job entail?
The ASH ambassador program is in its inaugural year, and Stanford was chosen to be one of 16 participating institutions. The ambassadors serve as liaisons between the society and trainees. The goal of the program is to recruit and retain diverse trainees into hematology.

Underrepresented minorities are even more underrepresented in subspecialties like hematology, and representation decreases from med school, to residency, to fellowship, to faculty positions. So, ASH has established a minority recruitment initiative, and the ambassador program is a function of this. One of our primary goals is getting the word out about the awards ASH has to offer — for example, their minority medical student awards programs. These awards not only provide funding for students, but more importantly, they provide mentorship.

What do you consider to be some of the biggest challenges and the biggest successes in your diversity work?
It’s often hard to talk about diversity-related issues, because we know we have a lot of work to do. We all have biases, which are a natural thing, but defensiveness does not allow us to make progress. Research shows that we are all better when our environments and communities are more diverse — we’re better doctors, better people, and better researchers.

I’m proud to be an underrepresented minority in a leadership position,  because I know that impacts people who are applying. This year the hematology division has more female fellows than male fellows, and it’s wonderful to see young women achieving so much. The men are outstanding as well; it’s just that since I can remember the men have outnumbered the women disproportionately. It’s been an honor to work alongside Wendy Caceres, who has worked tirelessly to build a more diverse and inclusive community. I’m also heartened that diversity and inclusion have come to the forefront of discussion at Stanford, and that Stanford is showing that these issues are important.

What drew you to hematology, your current specialty?
It was always an interest of mine. I was just excited to look at blood smears — I thought the cells looked so beautiful on the slide. And all the diseases intrigued me, especially leukemia. I fell in love with how intense the field was and how deep of a relationship you form with your patients and their families. So, I went right into a hematology sub-specialty training program at Stanford, and I loved it.

What does an average work day look like for you?  
One thing I love about my job is that every day is unique. Some days I’m focused on my clinic patients, some days I’m performing inpatient consults at the VA or Stanford Hospital, some days are fellowship heavy. I also work on research for our Adolescent and Young Adult (AYA) Cancer Program. I recently did a study where we gave all the AYA patients receiving therapy Fitbits and an iPad to encourage physical activity because we believe it can improve cancer-related fatigue and quality of life. We also gave our patients a quality of life assessment tool, and using the technology did in fact improve their score.

Does your artistic background ever come into play when you’re practicing medicine?
Not quite yet, although I’m hoping when things calm down and life is a bit less crazy I’ll be able to perform more. Music is so powerful, especially for patients. I will tell you this: I always sing to every patient in my clinic when it’s their birthday – they get a big happy birthday song from me, and many have come to expect it. I was also able to sing at the Survivor’s Day celebration at the VA. That was really special. When I was a resident and fellow I used to sing on the units.

You’ve become a voice for diversity and inclusion – which is a pressing issue in all of higher education – in the Department of Medicine. How are you bringing communities together?
I’ve been working alongside Wendy Caceres, MD, clinical assistant professor of primary care and population health, for the past couple of years as a faculty advisor on the diversity council, which is composed mostly of residents and fellows. Having a community is one thing — we know we should improve our diversity — but I think making the people who are currently here feel comfortable is where the inclusion piece comes in. Once the community is formed and people are feeling acclimated, strong, and important, that’s when you start to attract more underrepresented minorities.

I’ve hosted informal get-togethers at my home where we share dinner and discussion, and that is a valuable space. We have a few initiatives in the pipeline: We’re trying to incorporate diversity into the weekly medicine grand rounds by encouraging a more diverse speaker roster. We also have taken a larger role in the recruitment process. We’re doing more distance travel meetings and making sure that we’re bringing diverse faculty to the table. I am also a member of the Graduate Medical Education’s Diversity and Inclusion Committee where we are trying to promote diversity on a broader level.

You were recently named an American Society of Hematology (ASH) ambassador. What will this new job entail?
The ASH ambassador program is in its inaugural year, and Stanford was chosen to be one of 16 participating institutions. The ambassadors serve as liaisons between the society and trainees. The goal of the program is to recruit and retain diverse trainees into hematology.

Underrepresented minorities are even more underrepresented in subspecialties like hematology, and representation decreases from med school, to residency, to fellowship, to faculty positions. So, ASH has established a minority recruitment initiative, and the ambassador program is a function of this. One of our primary goals is getting the word out about the awards ASH has to offer — for example, their minority medical student awards programs. These awards not only provide funding for students, but more importantly, they provide mentorship.

What do you consider to be some of the biggest challenges and the biggest successes in your diversity work?
It’s often hard to talk about diversity-related issues, because we know we have a lot of work to do. We all have biases, which are a natural thing, but defensiveness does not allow us to make progress. Research shows that we are all better when our environments and communities are more diverse — we’re better doctors, better people, and better researchers.

I’m proud to be an underrepresented minority in a leadership position,  because I know that impacts people who are applying. This year the hematology division has more female fellows than male fellows, and it’s wonderful to see young women achieving so much. The men are outstanding as well; it’s just that since I can remember the men have outnumbered the women disproportionately. It’s been an honor to work alongside Wendy Caceres, who has worked tirelessly to build a more diverse and inclusive community. I’m also heartened that diversity and inclusion have come to the forefront of discussion at Stanford, and that Stanford is showing that these issues are important.