Melanie Cole, MS (Host): Welcome to UF Health Med EdCast with UF Health Shands Hospital. I'm Melanie Cole. And today, we're highlighting how according to the 2025 Blue Ridge rankings for NIH funding, the UF Departments of Neurosurgery and Neurology neuroscience research ranks number two nationally in NIH funding.

Joining me in this panel is Dr. Brian Hoh. He's the James and Brigitte Marino Family Professor and Chair of the Lillian S. Wells Department of Neurosurgery at the University of Florida. And Dr. Hoh is also the Chief of the Medical Staff at UF Health Shands Hospital. And Dr. Michael Jaffee, he's the Chair in the Department of Neurology, Director of Brain Injury Rehabilitation and Neuroresilience Center, and a Bob Paul Family Professor of Neurology.

Doctors, thank you so much for joining us today. And Dr. Hoh, to start, I'd like you to give us the big picture, what does it mean for the University of Florida neuro research to rank number two nationally in NIH funding? From your perspective as clinician scientist, why is this milestone more than just a number?

Dr Brian Hoh: Yeah. Thanks, Melanie. And thank you for that question. I think that the real importance of this is that our faculty, our trainees and our students and the Department of Neurosurgery at the University of Florida are conducting science and doing research that is impactful and will translate into real novel changes and therapies that will improve the lives of patients now and in the future. And this is one way of measuring the impact of that. But we really have this vision and this mission to do more for our patients and to improve their health and their lives.

Melanie Cole, MS: Well, I think that's so important. And so then, along those lines, Dr. Jaffee, as we think about the role of NIH funding, why it's such a critical driver of innovation in neurology and neurosurgery, how does strong NIH support translate into attracting top-tier talent, fostering collaboration, and advancing research?

Dr. Michael Jaffe: So, having the opportunity to have competitive grants for NIH does make for an attractive research environment. You hit on something that I believe is a key element and an ingredient for the success that we've had, and that being collaboration and that our investigators collaborate with many different departments and even across colleges here at the University of Florida, oftentimes producing these innovative interdisciplinary proposals that I think catch the eye of NIH because they realize the synergy that a place like the University of Florida can provide. And so, when you have that kind of an environment with the natural collaborations and support, it really makes itself conducive to team science and a way to be attractive to the scientists.

But even more important than being attracted to the scientists, I think that Dr. Hoh might agree that having this kind of environment really makes us an exciting place for patients because what it does is it shows that we're on the cutting-edge. And we can oftentimes provide hope as we are pushing the forefront of treatments and knowledge about these diseases.

Melanie Cole, MS: Dr. Hoh, let's shift into the work coming out of the UF Department of Neurosurgery. What are some of the most exciting or impactful research areas right now that you're all looking into? Discuss a little bit about the research being conducted at your department.

Dr Brian Hoh: Thanks, Melanie. A few areas where we have exceptionally strong interdisciplinary research where we're making impacts on patients include research into novel therapies for brain cancer. Our group in the University of Florida Department of Neurosurgery has been developing novel immunotherapy approaches to treat malignant brain cancer, a disease that has a very serious and dismal prognosis. And with this research, they're offering hope for these patients using the power and the strength of each individual patient's immune system and harnessing that power to fight against these horrible brain cancers.

Another area where our department is conducting significant researches in the area of stroke. As you and many people know, stroke is a significant leading cause of death and the number one cause of disability in the United States. And so, a group that I'm a part of a team for is conducting research into preventing stroke from intracranial atherosclerotic disease or narrowing of the blood vessels of the brain caused by atherosclerosis. This is a condition that has a very high rate of stroke and death in patients. And so, we have been conducting a major national stroke trial, studying three different treatments to prevent stroke from intracranial atherosclerotic disease.

Melanie Cole, MS: That's so exciting, the work that you're doing. It's a really exciting time in your field. And along those lines then, Dr. Hoh, when you're taking us from bench to bedside, how is innovation, imaging, AI surgical techniques changing that neurosurgical landscape at UF because that's such an exciting prospect.

Dr Brian Hoh: Yes, definitely. And that is one of the reasons why I chose neurosurgery, neuroscience as a field is because, among all the medical disciplines, neurosurgery, neurology, neuroscience is one of the most rapidly changing, innovative fields in medicine. And novel imaging, novel diagnostic methods, and novel therapies continue to come in a fast and rapid pace.

And so, in the UF Department of Neurosurgery, we've made it our vision and our mission to contribute to that in a significant way. Some of the immunotherapy treatments that have been developed by our faculty in the laboratory in preclinical experiments are now actually being delivered to human patients with malignant brain cancer, first-in-human clinical trials, really an example of bench-to-bedside treatment. There are many other areas that the UF Department of Neurosurgery is translating research to bedside treatments for patients, including in the realm of movement disorders with novel, innovative devices and brain stimulation techniques, focused ultrasound, the treatment of vascular diseases with novel endovascular devices and procedures, and then the treatment of brain tumors with laser interstitial thermal therapy, as well as a clinical trial using focused ultrasound. So, it's a very exciting time. And I'm excited to be a part of this field where there's rapid innovation and change.

Melanie Cole, MS: Well, thank you for sharing that with us. And Dr. Jaffee, turning to neurology. Tell us about some of the major research priorities you have right now across the UF Department of Neurology and really how neurologists at UF are bridging that bench research with real-world clinical application.

Dr. Michael Jaffe: So, one of the things I'm most proud of about the research portfolio in the Department of Neurology is its utter variety, its depth and breadth, and that we have initiatives that are focused on common conditions to even some of the most rare conditions. And so, as an example, we have an exciting protocol that's using non-invasive stimulation to help enhance walking and cognition in older people as we age, looking at the linkages between the decreased walking ability along with cognition as a common challenge of aging, all the way to some of the most rare conditions. We actually have an initiative looking at using technology to stimulate the brain to treat spinal cerebellar ataxia, which is a genetic form of progressive ability to lose balance and the ability to walk, which is a rare genetic condition.

And when you also look at this, we go across the entire spectrum of settings of what we have from acute into an ICU setting to a chronic outpatient setting. And so, for example, in the acute ICU setting, we have a protocol using innovative nerve blocks to help with pain control and people that have had a subarachnoid hemorrhage. And then, looking at even more of the outpatient kinds of clinics, we have a variety of initiatives or people, say, with Parkinson's disease or being treated on the outpatient basis, that helps open up the door to understanding both pathologies and treatments. We have a newer initiative that's kind of using functional MRI to map out the neuronal networks that might be contributing to anxiety that people with Parkinson's may have and how that may look differently when they're on a medicine versus when they're off of a medicine.

We have everything from testing and developing high tech innovative devices to even a grant where we were developing policy for the state of Florida to help those with acquired brain injuries. And so, when I look at the entire portfolio, I just like to think of it as being deep and wide.

Melanie Cole, MS: That is so interesting. So then, Dr. Hoh, I'd like you to speak a little bit about the interdisciplinary collaboration, and especially between neurology and neurosurgery as you two work so well together in advancing these efforts as far as the importance of these types of research that both departments are doing and the impact on the health of patients, as you have seen.

Dr Brian Hoh: So, in every example that Dr. Jaffee and I spoke about in terms of research initiatives and programs out of our true departments, these are all active interdisciplinary collaborations between neurology, neurosurgery, neuroscience, and many other departments.

So, just to name a few examples, Dr. Jaffee alluded to a clinical trial investigating ways to prevent and reduce headache after subarachnoid hemorrhage. That is a multi-PI clinical trial called BLOCK-SAH, and the principal investigators, come from the Department of Neurology, Department of Neurosurgery, and the Department of Anesthesiology. And so, that is just one example, multi-PI, multidisciplinary, multi-departmental collaboration in a large, national multicenter, randomized clinical trial.

Another example is in research in movement disorders, which has been a longstanding, fruitful and productive collaboration between the Departments of Neurology and the Departments of Neurosurgery and the Departments of Biomedical Engineering, understanding and mapping brain pathways, neuroanatomy, brain connections, and then developing novel brain stimulation techniques to treat neurodegenerative disorders.

And then, finally, treatments for malignant brain cancer bridge many departments including neurosurgery, neurology, radiology. Melanie, you mentioned AI. AI is a very active and integral part of the brain cancer research, as well as immunotherapy, immunology, and the basic neurosciences. So, none of this research could be done without active and collaborative relationships between multiple departments and, in many cases, multiple colleges.

Melanie Cole, MS: Yes. Those are such important points and I'd love to give you each a chance for final thoughts here. So, Dr. Jaffee, what does it mean for patients to be treated at a center with this depth of NIH-supported research? And looking ahead, what areas of neuroscience research are you most excited about over the next five or 10 years or so?

Dr. Michael Jaffe: It is an exciting time and sort of the build on this whole idea of one of the things that we provide is this interactive collaboration, what some people would refer to as team science. And so, we have the opportunity to bring together these teams who then together can push the technology that can open up more understanding, open up the next generation of questions, and we've seen that. We have some investigators who've been working together for years, and then they're bringing in the experts from the newer technology.

So, to kind of build upon an example that Dr. Hoh gave is that whenever we talk about some of the research that involves deep brain stimulation, it definitely is a collaboration between all the disciplines that he said, neurosurgery, neurology, and engineering. And what we have seen over time now is, even with that, they are now using AI to sort of talk about how to improve the programming of the stimulator to give even more precision care to the individuals. And so, we are looking at newer generations of technology to improve the treatments that we have. And we're also looking at newer generations of technology to better understand what we have.

And so, one of the newest pieces of equipment that we've had for the past couple of years, it is called a magnetoencephalogram that is used for advanced brain mapping. And having that opportunity for advanced brain mapping helps us, one, understand the pathophysiology of disease, but two directly translate into helping people because, as Dr. Hoh was talking about the importance of brain cancer, for example, that kind of brain mapping technology from the magnetoencephalogram can be used to help plan brain cancer forms of surgeries. And we are using it to better plan and collaborate with neurosurgery for epilepsy surgeries to having a very precise surgical intervention to improve the lives of people.

And so, overall, what we're heading for is the precision that we can gain through understanding the disease, through personalizing the medicine, understanding the genetics or the things that are unique to that individual so that we can tailor that treatment with this higher technology to be specific to what that individual needs with the idea that being no two individuals might get exactly the same thing, that the treatments themselves are using this technology to really hone in on the exact precision intervention needed for that individual.

And so, that is kind of what we are continuing to evolve towards as we continue to do our best to improve the qualities of life for people with neurological diseases through a variety of interventions, which would include technology, which would include surgery, which would include medications, which would include a variety of other therapies, which might include non-invasive stimulation. So as we are trying to push the envelope on all of these, both treatments and technologies and diagnostics to allow us to better help people and improve quality of life.

Melanie Cole, MS: What a fascinating discussion and field that you're both in. Thank you so much, Dr. Jaffee. And Dr. Hoh, last word to you. How will sustained NIH funding continue to shape the future of neurologic and neurosurgical care? And what would you like clinicians listening to take away about the importance of engaging with research regardless of their practice setting?

Dr Brian Hoh: I think the takeaway message, Melanie, is that support from the federal government through NIH funding and other federal agencies is so critical and so important to sustaining the vital research that we and many other academic medical centers across the country are performing. But what I'd like to express to clinicians and to others listening is that the research that we are conducting here at the University of Florida and the Department of Neurosurgery as well as neurology is research that is having direct translational impact on patients. And we're not talking about something way off in the future, but actually today. Direct translation from novel therapies that our faculty have developed in the laboratory that are being used now to treat patients today and having a real impact. And so, the sustained momentum that we're hoping to continue with our scientific discovery is to really work on finding ways that we can make direct impacts on improving the lives and the health of patients today and in the future.

Melanie Cole, MS: Very well said. Thank you both so much for joining us today and sharing your incredible expertise as clinicians, scientists, and practicing physicians. Thank you so much. And 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 go to ufhealth.org/medmatters.

That concludes today's episode of UF Health Med EdCast with UF Health Shands Hospital. I'm Melanie Cole.