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Melanie Cole, MS (Host): Welcome to UF Health MedEd Cast with UF Health Shands Hospital. I'm Melanie Cole. And today, we're highlighting how the UF Department of Neurosurgery ranks number two in NIH funding and how the Department of Neurology and Neuroscience ranked three. Joining me in this panel is Dr. Michael Jaffe, he's the Chair in the Department of Neurology at the University of Florida College of Medicine; and Dr. Brian Hoh, he's the Chair of the Lillian S. Wells Department of Neurosurgery at the University of Florida College of Medicine and he's the Chief of the Medical Staff for UF Health Shands Hospital.

Doctors, thank you so much for joining us today. What an exciting show we have today. And Dr. Hoh, I'd like to start with you. Can you provide a bit of an overview of the research focus areas within the UF Department of Neurosurgery that have contributed to its high ranking in NIH funding?

Dr. Brian Hoh: Yeah, thanks, Melanie. You know, the Blue Ridge Biomedical Research Rankings for NIH funding are something that really puts into picture the robust research portfolio of the Department of Neurosurgery at the University of Florida. Among all neurosurgery departments across the country, our department of Neurosurgery ranked number two in total NIH funding. And really, that is the result of many years, decades of work by our faculty and our investigators. But a lot of that work really centers around two areas. One is stroke and one is brain tumor treatment. In terms of stroke, that NIH funding represents a multi-center randomized phase III clinical trial that I lead as principal investigator called CAPTIVA, which is a study to look at the best antithrombotic treatment for patients with symptomatic intracranial atherosclerotic disease in the hopes of reducing the risk of recurrent stroke.

 My laboratory also does preclinical research to find a better treatment and understand the basic biology and pathophysiology of brain aneurysms and the result of ruptured brain aneurysms, subarachnoid hemorrhage and attempt to prevent delayed cerebral ischemia and improve neurological outcomes after subarachnoid hemorrhage. And a number of NIH-funded projects in Neurosurgery also are centered around improving treatments for brain tumors, in particular, malignant primary brain tumors, which have a horrible prognosis, and really need better treatments. Patients with malignant primary brain tumors are looking at a median survival of about 12 to 14 months. And in some cases, and in the worst types of brain tumors, even shorter than that. And so, a number of our faculty in our Department of Neurosurgery have created novel therapies in the laboratory consisting of immunotherapy, RNA nanoparticles or CAR T-cell therapy, which in preclinical models have significantly improved outcomes and improved mortality from these malignant primary brain tumors. And now, in a very exciting way, these therapies are being tested in NIH-funded, in DOD-funded clinical trials in human patients. And so, really bringing translation from the laboratory to the bedside.

Melanie Cole, MS: What an exciting time, Dr. Hoh, in your field. And thank you for telling us, because it's really important to know how these go from bench to bedside. And we'll talk a little bit more about that later. Dr. Jaffe, give us a bit of an overview of the research focus areas within the UF Department of Neurology that have contributed to its high ranking in NIH funding.

Dr. Michael Jaffee: You really hit it on the head when you talked about the exciting time it is. And in the area of the clinical neurosciences, as Brian was starting to discuss, we now really entered an era where there are treatments and understandings that were never available before. And we're actually seeing a lot more of these developments unfold thanks to a lot of the efforts in neurological research and the clinical neurosciences. So, within Neurology, we have a wide variety of research, everything from preclinical researchers with labs who are investigating the mechanisms of disease and trying to understand how disease begin and how they progress. This might include the effects of certain genetic changes. So, one exciting development over the past year was identifying a new genetic change contributing to Parkinson's that hadn't been previously understood. We have a lot of researchers who are focusing on treatments using various technologies, and that might be with the use of state-of-the-art neuromodulation. It might be with new generation medications and even certain types of interventions.

And one exciting initiative that Brian and his team has partnered with us on is a study that involves 12 different sites across the country of a clinical trial of people who've suffered from a subarachnoid hemorrhage with pain control using a form of a pain block as a means of sparing them from narcotics. And so, just a whole 'nother innovative way of trying to manage the complications of these very seriously injured patients. An area of opportunity for us has been really utilizing the emerging science and technologies of AI, of artificial intelligence. And we have a number of initiatives where we are sort of collaborating with a number of AI scientists and we are trying to understand certain patterns and being able to make predictions that we weren't able to make before and even repurpose some medications for the use in neurological diseases that may not have been understood before.

And so, the other aspect of that is that we are developing new technologies. So, we actually have a protocol with the population down in the villages. And we're actually working with a number of collaborators to develop a device that lets us better evaluate brain function during sleep and to see how that relates to brain health or the progression of cognitive decline. And so, if you think about the kind of the broad spectrum of research that we have, it really sort of covers a lot of different things. Even a newer protocol that we got this year, it's a federal grant in which we were asked to partner with the state of Florida, using research funds to develop a policy for those with acquired brain injury throughout the state of Florida. And so, developing policy is not a typical thing, but it's an innovative partnership that we have with state government, recognizing, I think, the advances that we have and as we kind of work together as we navigate now these newer generation treatments and the implications that we have for our patients in a collaborative way.

Melanie Cole, MS: Thank you for telling us about that. So, Dr. Hoh, back to you for a second as you're telling us about key research projects or initiatives that have received this significant NIH funding within the department. What impact do you anticipate these projects will have on the field of Neurosurgery? As Dr. Jaffe was just speaking about, helping to develop policy and actually working with, as he described, residents of the villages, that sort of thing, tell us how you anticipate the projects will have on the field of Neurosurgery, not just within the department or at the University of Florida College of Medicine, but around the country.

Dr. Brian Hoh: I'll speak to two of the areas of focus. The CAPTIVA trial, which I mentioned earlier, is a multi-center randomized clinical trial conducted across the United States. And soon, we'll be adding sites in Canada to study three different antithrombotic medications: clopidogrel, otherwise known as Plavix; ticagrelor, otherwise known as Brilinta; and rivaroxaban, otherwise known as Xarelto, in comparing these drugs for preventing recurrent stroke in patients with narrowing of the arteries in the brain, something that we call intracranial atherosclerotic disease. And we'll be enrolling 1,683 patients.

At the conclusion of this trial, we expect to find an answer as to which is the best treatment for patients with this condition. And so, once that trial is concluded, it will make a major impact on this field and in those patients with this disease, because it will give us the answer as to what is the best treatment for these patients.

Now, in terms of brain tumor treatment, as I mentioned earlier, this is a very serious and grave disease. Again, patients with malignant primary brain tumors are looking at a prognosis of 12 to 14 months to live and then certain more severe types of this disease, even shorter. And so, we are already seeing exciting results showing promising longer survivals, better outcomes in patients with these novel immunotherapy treatments, RNA nanoparticles and CAR T-cell therapies. And we are really hoping and expect that at least one or more of these therapies will result in much better prognoses, longer term outcomes and longer survivals for these patients. And this will make a huge impact for these patients with this grave and severe illness.

Melanie Cole, MS: Dr. Jaffe, same question to you. As you're telling us about the research projects that you've discussed a little bit here today, what impact do you anticipate that these will have on the field of Neurology, both within the department and around the country?

Dr. Michael Jaffee: Well, I think we're seeing this new generation of treatments available that only came about because of research like this. And the more we know, the more we uncover new questions that sort of help us take us to that next level. And so, I think we are seeing the fruit of this research evolve to the point where we can make direct benefits on the patients.

And one of the benefits of the University of Florida that's been able to succeed, I think, with these research successes that we're talking about is the environment that's there. And we are very fortunate to have a number of centers and institutes in which we bring together our preclinical scientists and our clinicians who can collaborate, they can inform, we can understand from each other what is the most relevant questions we can answer. And by those collaborations, as these discoveries get made, we can more rapidly apply those findings to the clinical care of patients. And as we care for more patients, we can clarify the questions that we need our researchers to better answer for us. And so, in a way, I like to summarize that process as learning as we treat and as our treatments get better and better.

And so, part of that is I talked about a system of collaborations, and we're talking today about our NIH-funded research, but that is also in the context of a larger research portfolio that includes funding from a number of foundations. And we partner with a variety of industries in a number of clinical trials. And in fact, when we're kind of looking at this using the knowledge that's been gained, we in the Department of Neurology have 70 total trials going on with 580 patients currently enrolled in a variety of diseases as we're exploring some of these new treatments where we can see better and better effects.

And so when we kind of look at this whole cycle of research, we are at the end of the day, everyone, whether it's the preclinical researcher or the clinician, is really caring and trying to make about the improvement in the quality of life of people who have these significant diseases. And so, we are looking at really improving the quality of life in these people. If we can't completely treat it, we're going to improve their quality of life.

Melanie Cole, MS: This question is for both of you. And Dr. Hoh, I'd like you to go first. How does the UF Department of Neurosurgery and then, Dr. Jaffe, the UF Department of Neurology foster this collaborative research environment to maximize the impact of these NIH-funded projects? We saw, before the pandemic, more research was conducted in silos, but now there's so much interdisciplinary and inter-institutional research going on. It's fascinating to me how this all happens now and how it all comes together. Dr. Hoh, why don't you start?

Dr. Brian Hoh: Well, really, it comes down to the goal, and the goal is to take better care of our patients. And that's the goal that all of us, clinicians, scientists, and clinician scientists have. We really want to find a better treatment to take better care of our patients. And we really have the advantage of the opportunity of working at a major university like the University of Florida, where we have excellence in many different fields and many different departments. And we can draw on that expertise of all the faculty throughout the university to really maximize our efforts and use synergy to approach these diseases, really with the goal in mind of finding the best possible treatment for these patients.

And so, the University of Florida creates that atmosphere and the environment to promote collaboration. And really, I think that this was going on long before the COVID pandemic. But, ultimately, now after decades of work, we're starting to see the results and see the translation from the laboratory to the bedside of the work of many of the faculty, the clinicians, and the scientists in the Department of Neurosurgery, as well as Neurology and Neuroscience. And so, it really feeds on itself. As we as clinicians see patients with these severe and horrible diseases, it drives us to try to find a better approach, and that passion really drives us to work in collaboration with our scientist colleagues, and collaborators throughout the university to really try to find, in a manner of discovery and collaboration, what we hope for is a better outcome for our patients.

Melanie Cole, MS: Dr. Jaffe?

Dr. Michael Jaffee: I couldn't agree with Brian more that I think that's something that is unique and special about the environment of the University of Florida, that there is almost an expectation of the collaboration. And so, you will see that we have a lot of academic events in which we have individuals from many different departments or disciplines coming together, sharing ideas. And through those dialogues, new collaborations and new ideas form. And I think that just speaks to the structure of the University of Florida. I like to make the joke sometimes that, if you look at a lot of our research papers, they have a lot of names on them because we do work in teams, but those teams create synergy. And certainly, I think we're seeing the fruit of that. And it turns out that Neurosurgery and Neurology share a hospital, our UF Neuromedicine Hospital. And I like to just point out geographic landmarks in Gainesville and that there is a bridge that leads right to that hospital. And it's called the DNA Bridge because it's shaped like the double helix of a DNA. And so, I oftentimes like to make this point by saying that collaboration is in our DNA when we talk about the neurosciences at the University of Florida.

Melanie Cole, MS: I love that. And Dr. Jaffe, sticking with you for a minute, interdisciplinary collaboration. As we're talking about these strategies, one of the most interesting things to me, and certainly one of the most impressive, based on both of your rankings, is successfully competing for this NIH funding among so many institutions around the country in such a highly competitive research landscape. What strategies do you use in the Department of Neurology? And, Dr. Hoh, you can jump in with Neurosurgery as well. How are you competing like that? I mean, that's hard.

Dr. Michael Jaffee: Well, I think it is. So, one thing we have the benefit from is experience. When we talked about this collaborative environment, it means our scientists help each other kind of review the grants and make sure that it reads well and explains the innovative concepts that we want to get across and that it addresses any potential holes that a reviewer might find as we can explain our ideas and show our data. And it turns out, I think what we're seeing is that we naturally are a multidisciplinary and interdisciplinary. And that approach seems to be valued by NIH. And I think the reason why it's valued is because they are seeing the significant progress that can be made when you create such collaborations and put people together who are using the best of their knowledge and creating that synergy.

Dr. Brian Hoh: Melanie, I'll add to that, and I'll say that really the NIH rankings number two for Neurosurgery, number three for Neurology and Neuroscience really are a reflection of the outstanding faculty and researchers that we have at the University of Florida. That's what it really comes down to. We have the best clinicians and the best researchers in the departments of Neurosurgery and the departments of Neurology and Neuroscience right here at the University of Florida. They are asking all the important, significant questions and they're coming up with the best possible potential therapies and treatments for these diseases. And I think that the NIH rankings really reflect that. And I certainly feel lucky and fortunate to be working at this university and working in this environment with these truly outstanding faculty, clinicians, scientists, and clinician scientists.

Melanie Cole, MS: I'd love to give you each a chance for a final thought here. Dr. Jaffe, Populations Upholding Policy, innovative collaboration with industry, clinical trials with industry partners, I'd like you to speak about some of the department's goals and aspirations in terms of future funding and advancing Neurology research to secure unmet needs. Tell us a little bit about what you hope to see happen, what will be happening, just kind of summarize the department for us.

Dr. Michael Jaffee: I think all of us share the goals of really not just curing neurological disease, I mentioned before enhancing quality of life, but even understanding the things that might lead to disease and being able to prevent it in the first place. And so, that gets into concepts of brain health and that gets an understanding kind of root causes and being able to move on from not only curing disease, but optimizing function and optimizing quality.

And so, I think that a lot of us went into the neurosciences, be it Neurology or Neurosurgery, because we were fascinated with the workings of the brain and how it works. For me, it's still the final frontier of terms of understanding the physiology and function in the body. We are still learning more and more as we do this research, which then allows us to come up with newer ways of addressing and treating some of these disorders and optimizing function.

So, I am looking to expand upon our networks of collaboration and where we can actually see not just the great impact that we're having on individual patients, but trying to find the day when we can see significant impacts on the populations as a whole of people who have any type of neurological dysfunction.

Melanie Cole, MS: Dr. Hoh, last word to you. Looking ahead, what are some of the department's goals and aspirations for securing more funding, advancing research? Tell us what you see or hope to see happening in the next 10 years or so.

Dr. Brian Hoh: So, our Department of Neurosurgery has a strategic plan. And we identified three strategic goals. This is the vision of our department. And so, those three goals are, from a clinical standpoint, we want UF neurosurgery to be the premier destination for patients with neurosurgical diseases. From a research standpoint, our vision is we want to change the standard of care for neurosurgical diseases and conditions through our research. And from an education standpoint, our vision is to attract and train and educate the best students and trainees from across the country.

And if you think about those three goals, they're all tied together in what we call a virtuous cycle. In other words, patients from all over the country and all over the world will come here to UF because we will have the best research and the best treatment. We will change the standard of care through our research and we will provide novel therapies and treatments that are not available anywhere else. For example, these patients with malignant primary brain tumors, they will come to UF because we will offer them novel immunotherapies, RNA nanoparticle therapy, CAR T-cell therapy that they can't get anywhere else. And the best students and trainees from all over the country will come to UF because they want to take part in that research. They want to contribute to that and learn how to become the next generation of scientists and clinician scientists.

And so, what I see in the next 10 years is that we'll follow that vision, and we'll change the standard of care for the treatment of stroke and for malignant primary brain tumors. And because of that, patients from all over the country and all over the world will come for those treatments, and we'll attract the best students and trainees from all over the country because they'll want to be part of that team, investigating and finding and discovering the best treatments that will change the standard of care.

Melanie Cole, MS: Very well said, both of you. Thank you so much for joining us and telling us about all the exciting research that you're doing in both of your departments. To learn more about this and other healthcare topics at UF Health Shands Hospital, please visit innovation.ufhealth.org. And to listen to more podcasts from our experts, you can always visit ufhealth.org/medmatters. That concludes today's episode of UF Health Med EdCast with UF Health Shands Hospital. Please always remember to subscribe, rate, and review UF Health Med EdCast on Apple Podcasts, Spotify, iHeart, and Pandora. I'm Melanie Cole. Thanks so much for joining us today.