171 Ashley Ave.
Charleston, SC 29425
843-792-1414
800-424-MUSC
|
 |
August 2005
This edition:
Letter from the Chair
 |
L. Lyndon Key, MD
Professor and Chairman
Department of Pediatrics |
Dear Faculty and Friends:
It is a pleasure to recognize the Division of Allergy and Pulmonary. Michael Bowman, MD, has been a force in
creating a clinical and research division at MUSC Children's Hospital. Dr. Bowman recruited Dr. Fred Schaffer
using a model of an MUSC/private office practice that was innovative and exciting. Dr. Susan Brooks worked with us part-time for a year as a
pulmonologist. Dr. Isabel Virella-Lowell joined the division with clinical expertise in pulmonary, especially cystic
fibrosis and with a strong funded research program. Recently, Dr. Michelle Montalbano has joined us for 10 months
as an allergist/pulmonologist and will be with the division for the next 10 months until she joins her husband who
will be relocating secondary to his military service.
Dr. Bowman is a man who enjoys seeing patients, managing their problems, day or night, and loves to impart his
knowledge. Dr. Virella-Lowell comes from a strong lineage of clinician researchers and teachers, her father and
mother are both on staff at MUSC. Dr. Virella-Lowell's expertise has allowed her to establish her own laboratory
efforts, dove-tailing in with those of the pulmonary research group headed by Dr. John Baatz (an internationally
recognized researcher in surfactant.
I am extremely proud of the many accomplishments of this group. Dr. Bowman is a leader at MUSC.
His division is being built with a superb underpinning of strong clinical care,
teaching and research. It is the paradigm for the "Triple Threat Division." I am sure that you will read with
delight about the development of our pulmonary division. We are very proud to have this marvelous group.
Sincerely,
L. Lyndon Key, MD
Chair, Department of Pediatrics
Feature Story: Division of Pediatric Pulmonary, Allergy and Asthma
 |
| Michael Bowman, PhD, MD |
Pediatric pulmonologists are rare in South Carolina so MUSC Children's Hospital is fortunate
to have a full-time staff of pediatric pulmonologists ready and willing to help children suffering from
respiratory infections and lung disorders.
The Division of Pediatric Pulmonology, Allergy and Asthma at MUSC is led by Michael Bowman, PhD, MD. Recruited in 2000
from a children's hospital in California, Dr. Bowman came to MUSC Children's Hospital to establish the division, conduct research and aid
in the training of pediatric residents and medical students.
"When I arrived at MUSC, children with lung diseases saw community allergists or adult pulmonologists or even went out
of town for care," says Dr. Bowman. "I came here with the goal of establishing a premier academic pediatric pulmonology
program, hoping for the addition of allergy and immunology at some point."
The pulmonology division is now responsible for the care of some 2,000 patients suffering from a variety of lung diseases
and allergies - asthma, apnea, bronchiolitis, bronchopulmonary dysplasia (BPD), cough, cystic fibrosis, respiratory failure
and tuberculosis, to name a few. They provide outpatient and inpatient care and offer consultation services to other divisions within the hospital.
Working with Dr. Bowman are two full-time physicians, two-part time physicians, a nurse practitioner and a division
secretary. The pulmonologists work closely with their adult counterparts to care for children with cystic fibrosis in
a unique program called Project Independence. "With the increased survival rate of cystic fibrosis, children with the
disease are living well into adulthood," says Dr. Bowman. "With Project Independence, we start encouraging our patients
at age 14 to be responsible for their own care. Parents have had years to learn how to care for their child; the child needs
to learn how to care for him or herself and understand the consequences of their actions or inactions when it comes to
managing their disease."
As part of caring for cystic fibrosis patients, an adult practitioner participates in diagnosing the case and talks with the parents
about the illness. The adult practitioner sees the child again at the start of high school and during the latter part of
their senior year. "By the time the child is ready for college, he or she has established a significant relationship with the
adult practitioner and should be ready to transition to that physician," says Dr. Bowman.
Important research activities around the world have led to the increased survival rate for cystic fibrosis patients. Dr. Bowman and his
colleagues are busy themselves with CF-related research activities. "My colleague, Dr. Isabel Virella-Lowell, devotes 75
percent of her time to research, primarily CF and airway inflammation," say Dr. Bowman. "She has a new project studying
vitamin D metabolism in patients with CF, and I'm involved in developing new antibiotics and other treatments for the disease."
Additionally, the division is very active in the teaching program for both residents and medical students. "All of our faculty members
teach residents who are caring for our patients on the inpatient service and those students who choose to take our
electives in pediatric pulmonology or in allergy/immunology," says Dr. Bowman. "We give lectures to residents about once
a month and have just started a month-long pulmonary elective for fourth year students."
With specialized care for children suffering from respiratory diseases, allergies and asthma now available at MUSC, the
patient population has grown. "When I first came, we had 43 pediatric and 45 adult patients with cystic fibrosis and no
clinic or in-house pulmonary patients except for those with CF," says Dr. Bowman. "Now we have about 75 of each age group
of CF, and we have a state program to identify children with CF by newborn screening. Our inpatient and outpatient services
have grown in numbers and complexity. Our clinical and basic science research programs are blossoming. And we've done a lot
of teaching in the community as well as here at MUSC Children's Hospital. In the near future, we want to add more faculty and staff
so we can help more children in need of our specialty."
Establishing a division from the ground up is no easy task, but Dr. Bowman's efforts, and those of his staff, seem to be working.
Message from the Medical Staff
 |
Frederick W. Tecklenburg, MD
Associate Professor
Coordinator of Pediatric Transport Team |
The impact of respiratory symptoms and diseases cannot be overstated. Asthma is the most common reason for school absence, cystic fibrosis
is the most common genetic pulmonary illness and respiratory distress or insufficiency is the most frequent reason for emergency admission
to pediatric intensive care units. In fact, much of the care at MUSC Children's Hospital revolves around pulmonary care.
MUSC Children's Hospital has developed a pediatric respiratory care department to complement the excellent clinical leadership of our
division of pediatric pulmonary, allergy and asthma. The respiratory care department is comprised of 35 respiratory therapists who have
special expertise and experience in caring for the respiratory care of children. The seasoned personnel in this department average
15.5 years experience in respiratory therapy with an average of more than eight years at MUSC Children's Hospital.
They provide outpatient and inpatient care with serial respiratory monitoring, aerosol treatments, chest physiotherapy and ventilator management.
The respiratory therapists have also participated in important clinical and bench trials of new therapies such as surfactant, nitric oxide
and heliox that have revolutionized the respiratory care of some of our sickest patients. For many years, MUSC Children's Hospital has invested
in state of the art respiratory care equipment including high frequency oscillators, the most modern ventilators and monitoring devices.
Our children's hospital through the combined efforts of the division of pediatric pulmonary, allergy and asthma, the pediatric respiratory care
department and investigators in the Charles P. Darby Children's Research Institute will continue our extensive focus on the innovative treatments of respiratory
diseases in children.
Update from the Administrator
 |
John Sanders, MHA
Administrator
MUSC Children's Hospital |
Medically Fragile Children's Program Set to Open
Several years ago, I attended a conference in Seattle where I was lucky enough to hear a presentation by Pat
Votava and her colleagues on the Medically Fragile Children's Program in Columbia, South Carolina.
I was impressed with the commitment between the hospital and state agencies to provide an efficient operation with excellent
outcomes for children. We are now very excited to have Pat join the MUSC team to manage our new program.
Like Columbia's program we have had great cooperation with the Department of Social Services and Health and Human Services in
replicating the program here in Charleston. We expect to see similar outcomes in chronically ill children -- fewer emergency
department visits and inpatient admissions and focused care to help these children reach their fullest potential. The staff,
including medical director, Kara Blevens, MD, is very excited about the start of this unique service.
The Medically Fragile Children's Program
will be an example for other facilities and states on how comprehensive care can be
successfully provided to a complex medical population with excellent outcomes. MUSC Children's Hospital continues to strive
to provide excellent care for children. After all, we are all about kids!
Children's Research Institute News Brief
 |
Bernard L. Maria, MD, MBA
Executive Director
Darby Children's Research Inst. |
|
 |
Inderjit Singh, PhD
Scientific Director
Darby Children's Research Inst. |
|
 |
John Baatz, PhD
Associate Professor
Department of Pediatric Pulmonary Biology |
|
The research goals of the pediatric pulmonary biology program focus on the molecular and cellular events required for
normal perinatal pulmonary adaptation, as well as finding treatment or cure of pediatric lung diseases. This
program is built around the strengths and ongoing interactions of MUSC faculty representing clinicians
and basic scientists in pediatric pulmonology and several other departments on campus. This foundation will foster growth
in pediatric pulmonary biology research, and will also promote further cooperative efforts with other investigators in the
Charles P. Darby Children's Research Institute.
The program includes a group of established senior and junior investigators currently at MUSC that form a strong alliance that
will address underlying mechanisms and treatments of pediatric pulmonary diseases. This program will also place emphasis on development of research projects that
address lung diseases indigenous to South Carolina and to southeastern coastal regions. The strengths of the investigators
in this program will fuel interactive and translational research projects pertaining to pediatric pulmonary biology at MUSC
and with other medical institutions.
Four areas of focus are:
- developmental pulmonary biology
- cystic fibrosis
- lung injury and inflammation
- lung toxicology.
Collectively, these four areas of research represent the basis for the most common lung disorders in children. The translational
approach to research will allow program researchers to not only develop a strong basic science focus, but also develop a stronger
clinical research program with our collaborators in the clinical sciences. Each of these areas has exceptional corresponding
clinical programs such as those highlighted in this issue of Kids Connection. Programs and facilities available include neonatology,
pediatric pulmonology, pediatric hematology/oncology, as well as the cystic fibrosis center, the neonatology intensive care units and
the pediatric intensive care units. Therefore, development of clinical trials for treatments or pharmaceuticals
developed from the basic research of this program will be readily feasible.
One specific project will focus on determining the structural/function relationships of pulmonary surfactant proteins. The long term
goals of this research include delineation of the underlying mechanisms for normal surfactant protein function and development of
surfactant based therapies for treatment of respiratory distress syndrome, genetic surfactant protein deficiencies and both viral and
bacterial lung infections. An increasing amount of evidence indicates that exposure of pregnant mothers to second hand and/or direct
cigarette smoke may impact neonatal lung development and surfactant protein secretion or function. We are in the preliminary stages of
designing experiments and protocols to obtain preliminary data for a grant proposal submission that would address these issues. The
objectives of this project would be: 1) to determine the effects of second hand smoke byproducts on surfactant protein function,
2) to assess the effects of cigarette smoke exposure of mothers on surfactant protein secretion in neonates using a mouse model,
3) to define the effects of second hand smoke exposure on key components of the innate immune system of the adolescent mouse lung,
4) to determine effects of second hand smoke on oxidative state of surfactant proteins adolescent mice, and 5) to establish the pattern
of surfactant protein secretion in (human) neonates of mothers exposed to direct or second hand cigarette smoke.
Another project area focus is on gene therapy for correction of the CF defect, antibacterial proteins of the lung and underlying mechanisms
of bacterial infection of the lung in CF. Cystic Fibrosis (CF) is the most common autosomal recessive disease in North America, with an
incidence rate of ~1/3000 Caucasian live births in the US and 1/20 heterozygous carries for the genetic defect. CF results from mutations
in a chloride channel, the Cystic Fibrosis Transmembrane conductance Regulator (CFTR) and re-institution of the correct gene into CF cells
has been shown to correct the anion transport defect. Current therapeutic approaches to CF are symptomatic in application, as well as
timely and invasive. Primary aberrations within the airways of CF patients include deficiency of cAMP-activated chloride conductance,
sodium hyperabsorption, and a marked propensity for infection with Pseudomonas aeruginosa resulting in purulent inflammation and an
imbalance of protease activity over antiprotease activity. Inflammation may actually precede infection. These effects ultimately result
in partial or complete obstruction of the airway lumen, cytotoxicity, and destruction of the extracellular matrix. The exact mechanisms
underlying the propensity to inflammatory airways disease are unknown, but may relate to an alteration in the glycosylation pattern of
surface glycoproteins, increased binding of Pseudomonas aeruginosa, and an exaggerated pro-inflammatory cytokine response that might
relate to the presence of a cell stress response.
While some CFTR gene therapy may eventually serve to prevent the development of CF lung disease in infants, it will not have an effect in
ameliorating the lung disease already present in older patients. Investigators in the Program are focusing on developing and evaluating
potential gene therapies that would be more useful in patients with established lung disease, as well as examining other strategies aimed
at enhancing gene transfer to the airway. In an effort to enhance gene expression in the lung, recombinant AAV (rAAV) vectors expressing
alpha 1-antitrypsin or IL-10 will be constructed utilizing different promoters and/or capsid serotypes. These studies will enable researchers
to determine the optimal vector dose for vector studies, that which gives the highest levels of expression with the lowest number of adverse effects.
A more recent project area involves marine biomedicine in relation to lung health. Marine mammals of this area, such as bottlenose dolphins,
may be more vulnerable to contaminants and biotoxins due to constant exposure and bioaccumulation of these compounds through aspiration of
contaminated seawater or inhaled toxic particulates. While dolphins share similar respiratory structure with humans, dolphins have increased
air exchange during respiration and increased flow rate in comparison. Therefore, increased exposures of dolphin lungs to pathogens implicate
the dolphin as a sentinel for human lung health in threatened coastal environments. In an effort to assess dolphin health, immunity, and
response to stress and environmental insult we aim to identify variations in expression of immunoglobin proteins and cytokines in the dolphin
lung in site-specific environments so that humoral and cellular immune responses to marine bio-contaminants can be defined. Identification of
antibacterial proteins in dolphin airway surface fluid may lead to unique treatments of bacterial infections in the human lung. Since children
are often intrigued by the dolphin, it is a goal that this research is shared directly with the pediatric patients in the hospital setting.
Mental Health Resource News Brief
Back to School - Tips to Help Children Adjust
Back to school time is exciting but often means changes for children and families. Smooth transitions between home
and school are important to help children adapt to new situations. Transitions can be good opportunities for children to learn, but can cause anxiety.
Tips for parents:
- Be enthusiastic about the upcoming change. Your child will sense your enthusiasm and confidence and will tend to feel the same way.
- Prepare in advance. Note how your child reacts to separation or new settings. Visit the new setting with your child and possibly arrange to introduce your child to the new teacher.
- Re-establish daily routines that add to continuity and predictability. Begin an earlier bedtime several weeks before.
- Make extra time for talking with your child, especially on the first few days of school. Always say good-bye to your child, but do not prolong the good-bye as this will only make the separation harder. Supportive statements like, "it's hard to say good-bye" are appropriate.
- At the end of the day, put aside other concerns and focus on being a parent.
Our monthly Promoting Happy and Healthy Youth group provides peer group supervision and discussion for topics such as child adjustment issues.
This format provides an ideal way to disseminate mental health and developmental information customized to the needs/questions of participants.
Moderators are Drs. Eve Spratt and Michelle Macias, and co-moderators Drs. Angela LaRosa and Roxane Scott. Any interested pediatric health care
provider is welcome to attend. A bonus is that breakfast and CME's are provided!
For more information e-mail spratte@musc.edu or
macaism@musc.edu.
A special thanks to the following individuals for their efforts in putting together Kids Connection each month.
Managing Editors: Bernard L. Maria, MD, MBA and Jessica Munday (Trio Solutions Inc.)
Publisher: Jennifer Cherock (Trio Solutions Inc.)
Web design: Brian Dadin (Trio Solutions Inc.)
Contributing Writers: Lyndon Key, MD; Bernard Maria, MD; Inderjit Singh, PhD; Fred Tecklenburg, MD;
Michelle Macias, MD; Eve Spratt, MD and John Baatz, PhD
|
|
Print Version