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Breakthrough Medicine

Fighting cancer. Curing tremors. Developing drugs. Stemming addictions. Transplanting hands. Treating aneurysms. It’s all in a day’s work for these pioneering Minnesota doctors and researchers.

Breakthrough Medicine

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Jon Grant

Psychiatry professor // University of Minnesota

On a wall in psychiatrist Jon Grant’s office at the University of Minnesota’s Riverside Hospital hang two framed scans of human brains. One shows a healthy brain, full of overlapping nerve cells that resemble a thick tangle of spaghetti. The other contains far fewer strands.

Standing on an oriental rug a few steps from a bookshelf lined with titles like Poker and Stop Me Because I Can’t Stop Myself, Grant explains that the image with missing strands is the brain of a shoplifting addict. “The part of the brain that should be telling other parts of the brain, ‘Stop this,’ doesn’t have enough roadways to make that communication robust,” he says. Imaging studies now show similar patterns in the brains of people with all sorts of addictions—alcohol, drugs, sex, gambling—as well as obsessive-compulsive disorders.

Jon GrantBy examining structural differences between addicted and healthy brains, Grant hopes to zero in on better treatments. In a 2006 study, for example, he and colleagues concluded that a drug called nalmefene had a positive effect in treating gambling addictions by targeting specific brain chemicals to dampen cravings. He has also found that an amino acid called n-acetyl cysteine, which is available over the counter, may aid gamblers seeking to quit. The hope is that research on gambling addiction will eventually inform treatments for other addictions.

As scientists learn more about the genetics, brain regions, and neurotransmitters involved in addiction, Grant is also determined to figure out what it is that makes the brain of one addict different from another. “We tend to treat addictions as we have for the last 30 years,” he says. “Our goal is really to come up with healthier and more effective treatments. We’re getting very important pieces of this puzzle.”


 

Judy Boughey

Breast-cancer surgeon // Mayo Clinic

Judy BougheyWhen Judy Boughey meets her patients, they already know they have breast cancer. Once at the Mayo’s Breast Clinic, Boughey brings each woman into a quiet exam room. She motions the woman and her husband or partner to take a seat on the couch, and with a kind face and a soothing British accent, she leans forward, puts her hand on the patient’s knee, looks directly into her eyes, and says something like, “You’ve been through a lot. How are you doing?” There is always a box of tissues in the room. “It’s rare that I finish a meeting and we’re not hugging,” she says.

Developing trust is essential to Boughey. Over the course of each initial consultation, she is likely to present women with some surprising new ideas about how their treatment might progress—suggesting, for example, that they undergo chemotherapy before surgery instead of afterwards, a re-ordering that has led to rapid developments in how doctors understand the disease. To some patients, she also recommends joining the clinical trial she has just launched, which aims to drastically improve outcomes by personalizing care with the help of new genetic tools.

The BEAUTY Project (officially, the Breast Cancer Genome Guided Therapy Study) aims to enroll 200 high-risk breast-cancer patients. After taking a biopsy from a patient’s tumor, the doctors will inject her cancer cells into mice “avatars,” and allow the tumors to grow in the mice. By comparing gene sequencing in the tumor with the gene sequencing in the patient’s healthy cells, Boughey and colleagues hope to pinpoint molecular pathways that will explain why some patients respond better to some treatments than others do. Those results could then lead to new types of drugs that zero in on the cause of each patient’s disease. Research on 18 women is already underway.
“Breast cancer is not all one disease, and I believe there’s no one drug that’s perfect. If there was, we probably would’ve found it by now,” Boughey says. “In the future, we’ll say: ‘Your tumor genome over-expresses this particular pathway, so this is the best way to treat you.’”
 

David TubmanDavid Tubman

Neuroradiologist // Abbott Northwestern Hospital

If your ruptured aneurysm (a ballooned blood vessel in the brain) was treated in 1990, you had a 10-percent chance of ever returning to work. Today, David Tubman says, patients go home the next day, and roughly 90 percent of those treated go back to work immediately. Rapid advances in technology explain the improvement in results, says Tubman, who has treated some 1,200 aneurysms and 300 strokes and has been doing it longer than anyone else in the Midwest. Among other cutting-edge procedures, he regularly implants platinum coils in aneurysms by pushing tiny catheters through arteries, beginning in the groin and ending in the brain. The coils fill the aneurysm and cut it off from blood flow, reducing pressure and preventing rupture. Still, it’s a tricky, risky procedure. “The devices are good, but they’re very hard to use,” he says. “You’re not just throwing them in there. A mistake is a death, or worse.”
 

Brian Carlsen

Plastic Surgeon // Mayo Clinic

Brian Carlsen clicks the “play” icon on his Mac, eager to show a video of the man he recently flew to France to meet. On screen, the 22-year-old Frenchman zips his vest. He shaves his face with a razor. Then, he butters a baguette. All mundane tasks except for one exceptional detail: the hands he uses are not the ones he was born with. A year ago, the young man received a double hand transplant at a hospital in Lyon, France, making him one of roughly 50 people around the world to experience such a miracle.

Brian CarlsenThe Mayo Clinic officially launched its own hand-transplant program nearly two years ago, geared toward people who have lost both hands, often in farming or industrial accidents. But before Mayo surgeons initiate their first surgery, they want to find a patient who is physically and psychologically primed. Conditions must be right for the best possible outcome. Sometime in the near future, Carlsen expects, he and his team will perform Minnesota’s first hand transplant. “We have several promising patients,” Carlsen says. “But it’s complicated. This has to work.”

The surgery likely will last about eight hours, as surgeons attach blood vessels, nerves, skin, and more than 20 tendons in each hand. So far, Carlsen says, 95 percent of hand transplants have stuck, and many patients have been able to return to work. New hands never quite work like the originals, but recipients often report a satisfying sense of feeling.

The biggest challenge remains convincing the body not to reject a foreign set of appendages. Patients must take immune-suppressing drugs, which come with major risks. As some researchers search for drugs that are less toxic than existing solutions, Carlsen is focused on a more sci-fi solution: tissue engineering. He describes a process where all the cells are removed from part of a donated hand, turning it into a three-dimensional matrix. Recipient-generated stem cells would then be allowed to repopulate the structure, eliminating the need for chronic drugs. “That is Space Age, right?” he says. “That is the future.”
 


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