New research by UAB researcher Robert Sorge, PhD and his team challenges the belief that males and females process pain in the same way.
The majority of existing research shows that men and women have different sensitivity to pain — women are more sensitive to pain overall — but the assumption has been that a common pain circuit exists in both sexes that is altered by circulating hormones like estrogen.
Sorge and colleagues found that this assumption may be false with males and females using different biological systems to process pain. The key sex difference appears to be in the immune system and under control of testosterone.
For years, researchers did not think the immune system had much to do with brain functions such as producing pain. But it is now known that the immune system does more than just fight off infection, and actually works in conjunction with the nervous system.
For example, many experiments have shown that one immune cell, called microglia, is critical for pain processing. When activated by injury, microglia sound the alarm by changing their shape and releasing chemicals. These chemicals communicate with nearby neurons in the spinal cord to turn up the volume knob of pain.
Sorge’s findings show that this process only occurs naturally in male mice. Interfering with the function of microglia blocks pain in male mice, but has no effect in female mice. A different type of immune cell, called T cells, appears to be responsible for releasing the same chemicals and sending the same signal in female mice. The study also found that females are able to use the male system in instances when the female system is not available or when high levels of testosterone are present.
“Realizing that females likely process pain differently than males will allow us to focus on creating alternate pain therapies for each sex,” Sorge said.
Molecular study points to possible therapy for autoimmune disease TTP
Thrombotic thrombocytopenic purpura (TTP) is a rare autoimmune disease that creates sudden pain in the abdomen or the head and is potentially fatal. The pain comes from a multitude of blockages of tiny blood vessels, formed after the patient’s own immune system somehow inhibits an enzyme that is vital to control clotting.
Treatment for TTP involves exchanging three to seven liters of plasma each day, at a cost of $10,000 a day, and may continue for several weeks or months.
Long Zheng, MD, PhD, director of the Division of Laboratory Medicine at the UAB Department of Pathology, wants to create a more effective treatment for these patients. This has led Zheng and colleagues to molecular-level studies of the antibody that inactivates a blood enzyme, called ADAMTS13. ADAMTS13 recognizes and cuts a blood adhesion protein called von Willebrand factor. The inhibition of ADAMTS13 activity by the antibody in TTP patients allows ultra-large von Willebrand factor to form disseminated microvascular clots.
The ability of ADAMTS13 to recognize von Willibrand factor is exquisitely sensitive, somewhat like a fan who goes to a football game with 50,000 people and recognizes his cousin out of all the faces in the crowd. Similarly, the ability of the autoimmune antibodies in a TTP patient to recognize and bind to the patient’s own ADAMTS13 enzyme is also sensitive.
Learning the molecular details of these two recognition abilities will help Zheng alter ADAMTS13 to produce a therapeutic enzyme that can elude recognition by the autoimmune antibodies, yet retain its activity to cleave von Willebrand factor. Such an engineered enzyme could be given to TTP patients in the hospital to speed recovery and slash the cost of treatment.
In a paper published in the Proceedings of the National Academy of Sciences, Zheng and colleagues report on those molecular details. The results reveal, for the first time, the mechanism of the inhibition of ADAMTS13 by autoantibodies and suggest an avenue for therapeutic intervention.
The researchers found that five small loops in the protein’s amino acid sequence are necessary for the autoantibodies to bind to ADAMTS13. Cutting or substituting several amino acids out of any single one of the five loops prevented binding; furthermore, those small deletions in any single one of the five small loops also left the enzyme unable to cut von Willebrand factor.
“This was surprising,” Zheng said. “It’s like a table with five legs. If you take one away, it should still stand, but somehow it collapsed. This suggests that you need the coordinated activity of all five.”
Thus, it appears that the autoimmune antibodies in TTP patients inhibit the enzyme by physically blocking the recognition site of ADAMTS13 for von Willebrand factor. More importantly, analysis of autoantibodies from 23 more TTP patients found that most use the same binding site, suggesting that a modified ADAMTS13 enzyme by protein engineering may be able to help a wide range of TTP patients.
James R. Andrews, MD Inducted into AOSSM Hall of Fame
In July, James R. Andrews, MD was inducted into the American Orthopaedic Society for Sports Medicine (AOSSM) Hall of Fame.
Andrews is one of the founding members of Andrews Sports Medicine and Orthopaedic Center in Birmingham. He is also founder and chairman of the American Sports Medicine Institute, which is a non-profit enterprise. In addition, he is a founding partner of the Andrews Institute and the Andrews Research and Education Institute in Gulf Breeze, Florida.
Andrews is internationally known for his skills as an orthopaedic surgeon. In addition, he has made numerous presentations around the world, and has authored hundreds of scientific articles and books.
He graduated from the LSU School of Medicine in 1967 and completed his orthopaedic residency at Tulane Medical School in 1972. He had surgical fellowships at the University of Virginia School of Medicine and at the University of Lyon in France.
Andrews is a past President of AOSSM, and has served on the Board of Directors of the Arthroscopy Association of North America and the International Knee Society.
He is Clinical Professor of Orthopaedic Surgery at the UAB Medical School, the University of Virginia School of Medicine, University of South Carolina Medical School, Adjunct Professor in the Department of Orthopaedic Surgery at the University of South Alabama, and Clinical Professor of Orthopaedics at Tulane University School of Medicine.
Currently, Andrews serves as Medical Director for Auburn University Intercollegiate Athletics and Team Orthopaedic Surgeon and Senior Orthopaedic Consultant at the University of Alabama.
In professional sports, Andrews is Senior Consultant for the Washington Redskins and Medical Director for the Tampa Bay Rays. He is also the Medical Director of the Ladies Professional Golf Association.
Trinity Medical Center Welcomes Endocrinologist
Sheela Lohiya, MD has joined the medical staff at Trinity Medical Center. Lohiya is board certified in Internal Medicine and specializes in Endocrinology, Diabetes and Metabolism and has joined the practice of Trinity Endocrinology.
Lohiya received her medical degree from Kempegowda Institute of Medical Sciences in India. She completed her residency with Baptist Health System and her fellowship at UAB.
Blue Cross and Blue Shield of Alabama Initiative to Expand Access to Primary Care
Blue Cross and Blue Shield of Alabama announces an initiative to expand access to primary care physicians and further improve the quality of healthcare for Alabamians.
Recent studies show there is a shortage of primary care physicians, and thousands of Alabamians lack access to primary care doctors.
To help meet this need, Blue Cross is investing in the future of our Primary Care Physician Network by providing $3million in scholarships, over a three-year period, to the Alabama College of Osteopathic Medicine in Dothan, Alabama.
“Evidence shows that access to primary healthcare results in improved health outcomes and lower healthcare spending, including preventable emergency room visits and hospital care,” said Terry Kellogg, President and CEO of Blue Cross and Blue Shield of Alabama.
“Alabama faces serious problems with chronic conditions,” Governor Robert Bentley said. “In order to have a healthier Alabama, we need more primary care physicians in rural areas. With this partnership I hope we can encourage some of these students to practice in those rural areas.”
CMRC Center for Wound Healing Recognized for Excellence
Healogics, the nation’s largest provider of advanced wound care services, has recognized the Cullman Regional Medical Center (CMRC) Center for Wound Healing with the Center of Distinction Award. The CMRC Center for Wound Healing achieved outstanding clinical outcomes for 12 consecutive months, including patient satisfaction higher than 92 percent and a minimum wound healing rate of at least 91 percent within 30 median days to heal. Of the 506 centers eligible for the Center of Distinction award, only 172 achieved the honor.
The CRMC Center for Wound Healing is a member of the Healogics Network of more than 635 Centers, which provides access to benchmarking data and experience treating more than two million chronic wounds. CRMC Center for Wound Healing offers specialized wound care to patients suffering from diabetic ulcers, pressure ulcers, infections and other chronic wounds. Advanced treatments include hyperbaric oxygen therapy, negative pressure wound therapy, bio-engineered skin substitutes, biological and biosynthetic dressings and growth factor therapies.
James Grotting, MD Named President of American Society for Aesthetic Plastic Surgery
James C. Grotting, MD was elected President of the American Society for Aesthetic Plastic Surgery at the group’s annual meeting in May.
Grotting, who is in private practice in Birmingham, serves as a clinical professor of plastic surgery at UAB and as an adjunct clinical professor at the University of Wisconsin-Madison. He is also a director and oral examiner for the American Board of Plastic Surgery. He is the author or editor of five plastic surgery textbooks, and is a past president of the Southeastern Society of Plastic Surgeons.
Grotting’s tenure as President will revolve around expanding aesthetic fellowships for plastic surgery residents, improving aesthetic education for members, improving relationships with the national plastic surgery community and continuing to emphasize the importance of patient safety.
Manderson Cancer Center Earns National Accreditation with Commendation
The Lewis and Faye Manderson Cancer Center at DCH Regional Medical Center has been awarded its third three-year accreditation with commendation from the Commission on Cancer (CoC) of the American College of Surgeons. This is the highest level of approval granted by the organization.
To earn voluntary CoC accreditation, the Manderson Cancer Center had to exceed on 34 CoC quality care standards, be evaluated on-site every three years and maintain levels of excellence in the delivery of comprehensive care.
The Manderson Cancer Center also is affiliated with MD Anderson Cancer Network®, a program of MD Anderson Cancer Center. CoC approval is one of the prerequisites for certified membership in the network. The certified member program is a best-practices program that seeks to improve cancer care by providing evidence-based guidelines to local hospitals.
Sudduth Joins Birmingham Orthopedics Sports and Spine at Trinity
William Douglas Sudduth, MD, a board certified orthopaedic specialist, has joined Birmingham Orthopedics Sports and Spine on the Trinity Medical Center campus.
Sudduth received his medical degree and completed his residency with UAB.
New Subspecialty for Female Pelvic Disorders
Holly Richter, MD, Robert Varner, Jr, MD, and Robert Holley, MD from the UAB Department of Obstetrics and Gynecology, and Tracey Wilson, MD, of the UAB Department of Urology, have received certification in a new subspecialty, Female Pelvic Medicine and Reconstructive Surgery (FPMRS).
“The new specialty brings multiple disciplines under one umbrella, further blurring territorial lines that could negatively impact patient care,” says Wilson. “With this certification urologists, who undergo extensive training in bladder physiology, have the expertise to care for female patients with the most complex pelvic floor dysfunctions.”
FPMRS was accredited in 2011 by the American Board of Medical Specialties. FPMRS is now supported by jointly accredited fellowship programs at UAB and 42 other institutions and is jointly boarded by the American Board of Obstetrics and Gynecology and the American Board of Urology. Board exams were first offered in 2013.
Samford’s Nursing School Receives Grant to Prepare Veterans as Nurses
Samford University’s Ida V. Moffett School of Nursing has received a $1,047,385 grant from the U.S. Department of Health and Human Services to launch a program designed to help veterans seeking a Bachelor of Science in Nursing.
“Many veterans have significant healthcare training and experience that make them qualified to care for patients in the military,” said Stephanie Wynn, associate professor in the School of Nursing. “However, after leaving the military, without a degree, they are not allowed to care for civilians in the same capacity. Our program will help these veterans transition into the civilian workforce while also giving credit for the hands-on medical experience they already have.”
Samford’s program will offer a curriculum tailored to each veteran. After review of a portfolio, students may opt for a traditional or an accelerated BSN track. Veterans with prior healthcare experience may receive credit for some courses and take refresher courses as needed.
“In Alabama, nursing has been identified as one of the top 13 occupations classified as high-demand based on growth rate and wage criteria,” Wynn said. “The number of job openings throughout the state is expected to continue to grow, so the timing is perfect for a program like this.” Alabama has an estimated 398,343 veterans and the 6th largest Army National Guard in the US.
The School of Nursing seeks to graduate 30 BSN prepared veterans over the course of the three year grant. The first class of students will begin in summer 2016 and applications will be accepted starting in January.
Earlier this year, masters programs in Samford’s School of Nursing were ranked among the top in the country for veterans by U.S. News & World Report.
