First Week of Immersion
This first week of my summer immersion at Weill Cornell has been interesting to say the least. In the first few days here, I had met with Dr. Susan Gauthier and her staff to get a background on what her clinical practice is like and what kinds of research projects are currently being done. Dr. Gauthier specializes in multiple sclerosis, or MS, and looks into ways of monitoring progression in patients using MRI and PET scans with radioligands such as [11C]PK-11195 and more recently [18F]DPA. At our first meeting, members of her staff went over current projects, proposals, and grants and their current statuses.
When discussing potential immersion projects, we came to an agreement that I would work on a pharmacokinetic model for a radioligand contrast's uptake into brains with multiple sclerosis lesions under Dr. Yeona Kang. While a model exists for healthy patients with intact blood-brain barriers for general uptake, the model in mind will be for investigating how much of the uptake seen in PET scans is due to clusters of microglia in the lesions to which the radioligand binds to and how much uptake is due to the blood brain barrier's disruption around the lesions for the development of a more accurate disease-specific kinetic model. Since meeting with both Dr. Gauthier and Dr. Kang about the project, I have been looking through the literature in preparation of analyzing the data to hopefully draw some conclusions for the project.
Aside from the research project, I have shadowed Dr. Gauthier as she met with her patients. I observed many of the simpler methods to monitor disease progression, including timing a walk, checking balance, testing spatial control and physical strength of limbs, and checking sensory pathways by use of a modified tuning fork of all things.
Meeting with the patients gave me an eye-opening experience as I was able to see first-hand how important research into clinical diseases is, especially ones as long and life-altering as MS. I had seen how beneficial advancements in treatments for the disease have been; of the patients that had come through, many showed very few signs of disease progression to the point that they had to state that they had been diagnosed with MS or I had to see their MRIs in order for me to know because of how early the disease was diagnosed and how effective the medications were at maintaining their quality of life. However, I also saw many of the limitations of the treatments. For most of the treatments, because the immune system is suppressed (by various methods and to various degrees), there was risk of longer illnesses with colds and flus extending weeks, but also of the patients contracting Progressive Multifocal Leukoencephalopathy (PML) caused by the normally suppressed John Cunningham (JC) virus. Most every patient had expressed concern about PML because of how fast acting and lethal the infection is; it is a case where the side effect would be worse than the disease. The patients have to face a tradeoff between paralysis by MS or potential development of and death by PML. AS a result, patients have frequent monitoring for antibody development as an indication of infection development and MRIs for progression.
I am also seeing how it is that patients react to a new drug on the market. Within the past few months, the FDA approved ocrelizumab for treating MS, and the fact that the drug was so new led to mixed reactions. Some patients were excited at the prospect of having a new treatment to avoid some of the worse tradeoff treatments currently available, while others were more hesitant because the drug was new and because a story came out of a patient on the drug developing PML.
One last thing that I took note of was the potential financial cost for these people. Being diagnosed with MS meant that the patients would need an MRI to be done at least annually but would also need to be on medication for most of or the rest of their lives. There was a patient whose insurance was ending and they were worried about getting a new policy that would continue to pay for treatment. For them, being able to afford to continue moving was a very real and very terrifying reality.
When discussing potential immersion projects, we came to an agreement that I would work on a pharmacokinetic model for a radioligand contrast's uptake into brains with multiple sclerosis lesions under Dr. Yeona Kang. While a model exists for healthy patients with intact blood-brain barriers for general uptake, the model in mind will be for investigating how much of the uptake seen in PET scans is due to clusters of microglia in the lesions to which the radioligand binds to and how much uptake is due to the blood brain barrier's disruption around the lesions for the development of a more accurate disease-specific kinetic model. Since meeting with both Dr. Gauthier and Dr. Kang about the project, I have been looking through the literature in preparation of analyzing the data to hopefully draw some conclusions for the project.
Aside from the research project, I have shadowed Dr. Gauthier as she met with her patients. I observed many of the simpler methods to monitor disease progression, including timing a walk, checking balance, testing spatial control and physical strength of limbs, and checking sensory pathways by use of a modified tuning fork of all things.
Meeting with the patients gave me an eye-opening experience as I was able to see first-hand how important research into clinical diseases is, especially ones as long and life-altering as MS. I had seen how beneficial advancements in treatments for the disease have been; of the patients that had come through, many showed very few signs of disease progression to the point that they had to state that they had been diagnosed with MS or I had to see their MRIs in order for me to know because of how early the disease was diagnosed and how effective the medications were at maintaining their quality of life. However, I also saw many of the limitations of the treatments. For most of the treatments, because the immune system is suppressed (by various methods and to various degrees), there was risk of longer illnesses with colds and flus extending weeks, but also of the patients contracting Progressive Multifocal Leukoencephalopathy (PML) caused by the normally suppressed John Cunningham (JC) virus. Most every patient had expressed concern about PML because of how fast acting and lethal the infection is; it is a case where the side effect would be worse than the disease. The patients have to face a tradeoff between paralysis by MS or potential development of and death by PML. AS a result, patients have frequent monitoring for antibody development as an indication of infection development and MRIs for progression.
I am also seeing how it is that patients react to a new drug on the market. Within the past few months, the FDA approved ocrelizumab for treating MS, and the fact that the drug was so new led to mixed reactions. Some patients were excited at the prospect of having a new treatment to avoid some of the worse tradeoff treatments currently available, while others were more hesitant because the drug was new and because a story came out of a patient on the drug developing PML.
One last thing that I took note of was the potential financial cost for these people. Being diagnosed with MS meant that the patients would need an MRI to be done at least annually but would also need to be on medication for most of or the rest of their lives. There was a patient whose insurance was ending and they were worried about getting a new policy that would continue to pay for treatment. For them, being able to afford to continue moving was a very real and very terrifying reality.
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