P E N N’S Creating Knowledge, Providing Hope VOLUME 4 ISSUE 1 WINTER 2007 The Stem Cell Debate: Clarifying the Issues and New Breakthroughs The study of embryonic stem cells is politically charged, but is only a part of the medical discovery picture. Throughout the controversary, Penn has remained focused on adult stem cells to further treatment advances. Stem cells, first discovered by scientists in the early 1960s, have been used to treat leukemia and other blood cancers for decades. It was not until 1998, when developmental biologist and Penn Alumnus James Thomson and fellow researchers at the University of Wisconsin at Madison derived the first embryonic stem cell lines from frozen human embryos, that the highly contentious ethical and political debate surrounding the use of stem cells ignited. Embryonic stem cells are harvested from the inner cell mass of the early-stage embryo, or blastocyst, at about five days old in a process that destroys the embryo. Adult stem cells tend to give rise to cells more characteristic of their respective host tissue. So, an adult stem cell from the brain can become a neural cell, IN THIS ISSUE... Message from the Director Pg. 2 Patient Profile Pg. 2 AFCRI Update Pg. 3 Research Update Pg. 4 Faculty Highlights & Events Pg. 5 Spotlight: Patient Support Groups Pg. 6 but not a bone or liver cell. Current studies using adult stem cells are giving promise that they may in fact have more potential to be manipulated than previously thought. Xiaowei (George) Xu, M.D., Ph.D., Assistant Professor of Pathology and Laboratory Medicine at the University of Pennsylvania School of Medicine and fellow researchers have successfully isolated a new source of adult stem cells that appears to have the potential to differentiate into several cell types. “We are very excited about this new source of adult stem cells that has the potential for a variety of applications… Although we are just at the start of this research, our findings suggest that human hair follicles may provide an accessible, individualized source of stem cells,” says Xu. While it had been thought that adult stem cells are generally limited to differentiating into different cell types of their tissue of origin, discoveries like those of Xu suggest that adult stem cells do exhibit some level of plasticity and can be engineered to differentiate into a variety of cell types. There is no ethical debate surrounding the use of adult stem cells. If adult stem cells prove to be able to have more plasticity, this would enable researchers to overcome the obstacles surrounding the use of embryonic stem cells and allow them to move forward with their research at a higher rate of success and potentially discover treatments and cures for any number of diseases. Like the embryonic stem cell, adult stem cells could theoretically treat a wider range of diseases – without the obstacles created by the moral and political debate involving the definition and rights of a fetus. With limited federal funding for stem cell research, the United States, usually a leader in the field of biomedical research, has yet to establish itself within the field of stem cell research. Glen Gaulton, Ph.D as Executive Vice Dean and Chief Scientific Officer for the School of Medicine at the University of Pennsylvania School of Medicine says, “There isn’t any one single ‘Go to’ place for stem cells yet. Everybody is jogging. No one is running.” The University of Pennsylvania, being at the forefront of biomedical research, is thinking ahead and is in the final stages of establishing a center for research. The center will focus on the field of regenerative medicine, including gene therapy and other cell-based therapies, particularly stem cells. This will be a collaborative effort across the University bringing together a myriad of specialists across many disciplines. With such a unique institution in place, the University will be able to fuel world-class research in the stem cell field and launch new therapies in a number of specific diseases, cancer being the best example. A Message from the It has been a season of transition and growth at Penn’s Abramson Cancer Center. In the past few months, I was honored to be appointed as the Director of the Craig Thompson, M.D. Abramson Cancer Center after serving as the Deputy Director for seven years. In my career, I have been dedicated to finding new approaches to cancer research and patient care, and I am excited about the opportunities ahead in this field and my new role. PATIENT Tim Wilmott, The Power of Awareness and Prevention In response to this tragedy, his physician considered removing his pancreas to guarantee he would not get the same type of cancer. Instead of that very invasive procedure, Tim came to Penn’s Abramson Cancer Center where his family had received treatment and he knew the physicians to be “compassionate, kind, and an invaluable resource.” Penn’s Abramson Report will be one of many ways that I will keep you and all of the Abramson Cancer Center friends appraised of Penn’s progress in cancer care. One relatively new area of medical discovery is stem cell research. While the debate continues around kitchen tables and the halls of Congress, at the University of Pennsylvania we are thinking ahead and focused on adult stem cell research to further treatment advances. Scientists are already making breakthroughs in this area of cancer research and Penn is in the final stages of creating a research center that will focus on the field of regenerative medicine and gene therapy, particularly stem cells. Other articles in this edition of Penn’s Abramson Report describe the comfort patients and survivors offer to each other through forums such as monthly support groups. The power of this ‘connectedness’ is demonstrated by the story of Tom Yohe, a six-year Head and Neck Cancer survivor. We also illustrate the importance of aggressive screening with our profile of Tim Wilmott, whose family has been devastated by Gastrointestinal Cancers. I am grateful for the support shown to me in my first few months as Director by friends, faculty, and staff. I look forward to a long relationship with the Abramson Cancer Center’s many friends who, like you, support our efforts through their philanthropy – your generosity makes our innovations in cancer research and patient care possible. 2 Craig B. Thompson, M.D. Tim Wilmott is a Wharton graduate who has become a successful businessman with a loving wife and young daughter. On the surface, he appears to have everything. But Tim lives with the knowledge that he may have a genetic predisposition to developing gastrointestinal cancer – a type of cancer that is usually diagnosed from symptoms once it has already progressed past effective treatment. Tim and his family have been devastated by this type of cancer. His father was diagnosed with esophageal cancer in 1998. Then, his mother passed away from pancreatic cancer in 2000. And three years ago, his younger brother John, passed away at the age of 44 from pancreatic cancer. Other extended family members on his mother’s side also passed away from the same disease. Tim consulted with Michael Kochman, M.D., a leader in the field of pancreatic imaging whose work is advancing new surgical treatment options. Tim and his brother, Matt, decided to participate in the Abramson Cancer Center’s High-Risk GI Cancer Screening and Evaluation Program. He first had genetic testing with Anil Rustgi, M.D., and now, each year, Tim travels from his home in Las Vegas to come to Penn and undergo an endoscopic ultrasound with Dr. Kochman as part of an aggressive screening program. Tim’s motivation for taking part in the program is larger than his own personal welfare. He is committed to supporting Dr. Kochman’s research to advance early detection methods. Tim believes this effort will increase survival rates among future GI cancer patients and in the long-term, his daughter, nieces and nephews can be saved from having the same fear of watching loved ones pass away from this form of cancer. “Tribbles” Protein Implicated in both Common and Aggressive Leukemia For those of you who remember Tribbles as the furry little creatures who took over the starship Enterprise in the original Star Trek series, you might think the following is pure science fiction. However, here at the Abramson Cancer Center of the University of Pennsylvania, Warren Pear, M.D., Ph.D., and his laboratory team, have identified a new oncogene which they have affectionately named Tribbles. Dr. Pear, Associate Professor of Pathology and Laboratory Medicine, has linked for the first time this new protein, Tribbles (Trib-2), to acute myelogenous leukemia (AML). This discovery is very good news for people who suffer with AML. AML is a malignancy that arises in white blood cells and develops when there is a defect in immature immune cells in the bone marrow. AML is the most common type of leukemia in adults, with an estimated 10,100 new cases reported each year. This is a new protein to human cancer and has a specific and overwhelming effect when expressed in hematopoietic stem cells, the cell type that gives rise to all elements of the blood. Dr. Pear, a senior investigator at the Abramson Family Cancer Research Institute along with, first author and postdoctoral fellow Karen Keeshan, Ph.D., and colleagues found Tribbles by chance when looking for the molecular partners of another protein called Notch. Specifically, the Tribbles protein degrades other proteins in the blood which act as tumor suppressors. Once these tumor suppressors or “guardians” have been destroyed, the pathway is open for this type of leukemia to develop. The surprise in the discovery was that all the mice engineered to express Tribbles (Trib-2) in hematopoietic stem cells developed AML. Dr. Pear and his colleagues knew from fruit fly studies that Tribbles was linked to cell growth and cellfate determination and is closely related to the Tribbles gene in mammals. The Pear lab worked with colleagues in Holland to test more than 200 patients with AML. All of these patients expressed a higher lever of Trib-2 in their blood. For the first time, this linked Trib-2 to the human cancer, AML. These results were recently published in the periodical, Cancer Cell. The next steps for the Pear laboratory will be to identify the process whereby Tribbles actually degrades the “good proteins” in the blood. It will be like “going fishing” with Tribbles to see which tumor suppressors it destroys and how it destroys it them. Then Dr. Pear and his team can begin to find different mechanisms to block its function. Penn: Partner in Initiatives to Prevent Lung Cancer As part of an international effort launched to potentially revolutionize the prevention and management of lung cancer, Penn’s Abramson Cancer Center has joined 11 leading research institutions to create a database for scientists. The goal of this global collaboration is to deepen the understanding of lung cancer at its earliest, most treatable stages. To date, understanding how precancerous conditions become cancerous has been difficult because no single institution was able to gather data from enough patients or to follow patients for a sufficient period of time to provide clinically relevant answers. Now, principal investigators from these 11 centers, including Penn’s Abramson Cancer Center, will contribute patient information to this registry to answer critical questions and focus on the goal to develop a diagnostic test to screen for changes and investigate genetic biomarkers that may lead to or predict lung cancer. Daniel Sterman, M.D., Director of Interventional Pulmonology, and Anil Vachani, M.D., both from the Division of Pulmonary, Allergy, and Critical Care at the University of Pennsylvania School of Medicine, will head the registry at the Abramson Cancer Center. Dr. Vachani said “The information on high-risk individuals screened at the Abramson Cancer Center will play a critical partnership role in achieving the registry’s goals.” He added, “With the knowledge we gain through this registry, we’ll be able to intervene with high-risk patients before they develop clinically evident lung cancer.” 3 Cancer Stem Cells: Discovering New Therapies Stem cells – especially cancer stem cells – are seen as a potentially revolutionary source of information about how organ tissues develop and as a potential source of treatment. Two important characteristics distinguish stem cells from other types of cells. First, they are unspecialized and renew themselves through cell division. Second, under certain physiologic or experimental conditions, they can be induced to become cells with special functions such as the beating cells of the heart muscle or the insulin-producing cells of the pancreas. Serving as a sort of repair system for the body, stem cells can theoretically divide without limit and replenish other cells in the body. When a stem cell divides, each new cell has the potential to either remain a stem cell or become another type of cell with a more specialized function, such as a muscle cell, a red blood cell, or a brain cell. Dr. Stephen Emerson, the Francis C. Wood Professor of Medicine, chief of the Division of Hematology-Oncology, and Associate Director of the clinical research for Penn’s Abramson Cancer Center, calls stem-cell biology the “Rosetta Stone” of modern health and disease treatment. “Discovering the language of stem cells, and the secrets of its translation, will make clear 4 pathway may one day lead to new treatments for such blood diseases as leukemia, as well as a better understanding of how HSCs work in the context of bone-marrow and peripheralstem-cell transplantation. much that has been previously undecipherable.” Although there are still many unknowns in the field of cancer stem cell research, there have already been a number of potentially ground-breaking discoveries made by Penn scientists. Although there are still many unknowns in the field of cancer stem cell research, there have already been a number of potentially ground-breaking discoveries made by Penn scientists. “We want to figure out how this process is normally regulated in the body, so that we can learn to control it for therapeutic purposes,” explains Emerson. “We might want to shift the balance so that we can grow more stem cells, for those who need them. Conversely, for patients in whom this process has gone awry, such as acute leukemia, we might block the regulatory gene to shift the balance of self-renewal versus differentiation so that all the immature, leukemic cells differentiate and die.” NF-Ya protein Dr. Emerson and his team of researchers recently discovered a protein called NF-Ya that activates several genes known to regulate the development of hematopoietic stem cells (HSC), or blood producing stem cells, in bone marrow. His laboratory wants to find a way to control the directives that NF-Ya issues to its stem cell subjects, forcing them either to self-renew or to differentiate into daughter cells. Knowing the details of this Stephen Emerson, M.D., Ph.D., and his colleagues are making advances in the field of cancer stem cell research NEW ABRAMSON CANCER CENTER FACULTY The Abramson Cancer Center is pleased to welcome the following individuals to Penn as new faculty members, who each bring a wealth of experience and genuine enthusiasm to their cancer research and patient care. Carol Kaplan, M.D., has joined the Penn faculty as an Assistant Professor of Clinical Medicine, after completing a hematology/oncology fellowship at Penn. As a fellow, she focused on breast cancer clinical trials, including development of a trial using Avastin and Abraxane™ to treat metastatic breast cancer patients. While an undergraduate at Duke University, Dr. Kaplan was a Howard Hughes fellow in hematology and held research positions at the National Institute of Environmental Health Sciences. She then received her medical degree from Washington University in St. Louis. Alison Loren, M.D., MSCE, has been appointed to the Bone Marrow and Stem Cell Transplant program at Penn as an Assistant Professor. Dr. Loren received her bachelor’s degree cum laude from Harvard University and medical degree from Washington University in St. Louis. She also has a master’s degree in clinical epidemiology from Penn where she completed an internship and residency in internal medicine, and a fellowship in hematology/oncology as well as clinical epidemiology and biostatistics. In addition to her clinical practice, Dr. Loren is actively researching bone marrow transplantation techniques to improve outcomes. Jason G. Newman, M.D., has brought his specialty with Head and Neck Cancer, and his expertise in minimally invasive and endoscopic cranial base surgery, to Penn as an Assistant Professor of Otorhinolaryngology. Dr. Newman received his M.D. from Jefferson Medical College and completed his surgical residency at New York Presbyterian Hospital of Columbia, Cornell University, and Memorial Sloan Kettering Cancer Center. After practicing in the Washington, D.C. area, Dr. Newman decided to return to the Philadelphia area and joined PENN Medicine. Ben Z. Stanger, M.D., Ph.D., has joined Penn as an Assistant Professor of Medicine in the Gastrointestinal (GI) Division and Assistant Investigator in the Abramson Family Cancer Research Institute. His research will focus on understanding how stem cells are regulated during normal development and how programs utilized by stem cells are involved in the development and progression of GI cancers. He received his M.D. and Ph.D. from Harvard Medical School, and completed residency training in Internal Medicine at University of California, San Francisco. Before coming to Penn, Dr. Stanger was on the faculty at Harvard. Dr. Stanger said of his decision to come to Penn: “I was drawn by the opportunities for collaborative interdisciplinary studies.” Penn’s Abramson Cancer Center will benefit greatly from the wide range of experience and expertise of each of these new members, and is proud to welcome them to the ranks of our prestigious faculty. March PENN Medicine Week March 5-7, 2007 Palm Beach, Florida The Abramson Cancer Center will host lectures on different educational topics including prevention, new therapies, and survivorship at this annual event at the Colony on March 7. April Men’s Event at the Palm April 2007 Penn’s Abramson Cancer Center teams with the National Cancer Prevention Fund and the Philadelphia Palm Restaurant to sponsor a Men’s Event including dinner, cocktails, prizes, and informal sessions to educate local businessmen about prostate and testicular cancers. Kids Swim for the Cure Saturday, April 14, 2007 – 9:00 a.m. to 4:00 p.m. Westtown School, Westtown, PA Kids Swim for The Cure is being organized by Philadelphia area kids of all ages to raise funds for skin cancer research. Support their heartwarming efforts by sponsoring a swimmer. All proceeds benefit skin cancer research at Penn’s Abramson Cancer Center. For more information, visit www.swimforthecure.org. May Kelly Rooney Foundation Golf Tournament May 14, 2007 – 12:00 to 8:00p.m. Cedarbrook Country Club, Blue Bell, PA This inaugural golf tournament and dinner will benefit breast cancer genetics research at the Abramson Cancer Center. Celebrating Innovations: Abramson Cancer Center Research Report and Annual Reception Wednesday, May 16, 2007 – 4:00 p.m. to 7:00 p.m. Houston Hall, 3417 Spruce Street, Philadelphia, PA Join the Abramson Cancer Center as we celebrate our accomplishments and honor our dedicated faculty and staff and generous friends. Tickets are $500 per person and sponsorships are available. Conferences Educational conferences for patients of the Abramson Cancer Center, as well as their families and friends, are held on a regular basis throughout the year. March 16 April 13 May 18 Gastrointestinal Cancers Head and Neck Cancers Melanoma For more information on any of these events, please call 215-573-4028, or visit www.penncancer.org. 5 Patient and Family Support Groups Support groups provide patients and their loved ones a forum where they can share experiences, gain insights, and learn ways of coping with the uncertainty and changes that occur during the cancer experience. Beyond this opportunity for patients and survivors to share their experiences and concerns, support group participants also find that the sessions allow them to share information that they have found to be useful. This exchange of information is enhanced at Penn’s Abramson Cancer Center where social workers and other counselors work together to create programming for several monthly support groups, including: Head and Neck Cancer, Breast Cancer, Prostate Cancer, and Leukemia and Lymphoma. The Abramson Cancer Center is also starting a Young Adult Cancer Support Group in 2007. It will encourage patients and survivors from 18 to 30 years old to talk about topics of special interest, such as dating and careers. When there is a common theme of discussion in a group meeting, the staff may bring in a speaker on that topic. Past speakers have primarily been Penn faculty who are nationally renowned researchers, physicians, nurse practitioners, and physical and occu- pational therapists. The groups allow time for members to ask questions on topics from treatment issues to post treatment concerns and quality of life issues. According to Tom Yohe, a member of the Head and Neck Cancer Group, “the combination of getting expert input, advice, and ideas from these professionals and other patients has proven invaluable to me and the other members of my group.” Further, if patients bring up an individual problem that requires further attention, then they are guided to the specialist at Penn who can best help them. Staff members involved with the support groups have been inspired and energized, and the response from the group members has been overwhelming. Members in each group have been impacted, but maybe none as much as the Head and Neck Support Group which is the longest running group at the Abramson Cancer Center. These patients face unique physical challenges, but they also have the most positive views about their treatment and care at Penn. Some topics addressed include: speech and swallowing problems, oral care concerns, nutritional problems, neck and shoulder dysfunction, cancer and depression, caregiver concerns, issues of cancer survivorship, and advances within different fields of treatment modalities. Head and Neck Support Group Success Stories Ernst Schneck has been a regular volunteer at the Abramson Cancer Center since 2001. He distributes patient education material and participates in the One-on-One Contact program. In this role and in the Head and Neck Cancer Support Group, he talks with newly diagnosed head and neck cancer patients and offers them hope as a six year survivor. Micki Namoli, a head and neck cancer survivor who helped start this support group, has become a national facilitator on the topic and was a speaker at a national support group conference this past year. The Abramson Cancer Center Support Group has meant a lot to Micki and Ben, her husband of 40 years – both of whom have only missed two meetings in six years. Members of the Head and Neck Support Group at their January monthly meeting (Continued on Page 7) 6 (Continued from Page 6) Patient Support Group: Patient Spotlight – Tom Yohe Tom Yohe is a cancer survivor. In addition to the support of his wife, Jeanne Marie, one of the reasons he credits for making a miraculous recovery after being diagnosed six years ago with a non-operable stage 4 tumor is the Head and Neck Cancer Support group at the Abramson Cancer Center. The support group “inspired him during the long treatment periods.” Tom continues to regularly attend meetings to “make suggestions, listen and simply ‘be there’ for others who are now at the beginning of the most frightening ordeal of their lives” and he adds, “I continue to get occasional nuggets of helpful hints for myself as well.” He is an original member of the Head and Neck Cancer Support Group which had its first meeting in October of 2000. Tom learned of the group from Susan Brodish, a former staff member who was the first coordinator for the group, when he was in the hospital for his initial round of chemotherapy and radiation. He was hospitalized for the first week due to the 24 hour drip required for the chemo regimen he was undergoing, and as Tom tells the story, “it took some argument to be able to go as my Tom and his wife, Jeanne Marie "Jeamer" Yohe chemo had to be changed in the middle of the meeting. They were not going to let me off the floor but I was insistent that this was very important. It turns out that Susan was an experienced chemo nurse, and we worked it out with the staff for her to change the bag.” At the first meeting, Tom was the only attendee who was an inpatient and actively undergoing treatment. As a result, he arrived wearing his hospital gown and in a wheelchair accompanied by a chemo drip. Right in the middle of the meeting, everyone stopped talking while Susan changed the bag. According to Tom, “no one batted an eye and then we continued with our discussion.” When asked why he insisted on going and why he still continues to attend the meetings after four years of being out of treatment, Tom says “I knew that I could not survive the coming ordeal without the help of other people, especially people who had been cancer patients like me -who could understand what it was I was going through from the patient side. I knew my survival chances were not great given what the physicians had shared with me, and I felt I needed every tool at my disposal.” Tom continues, “I was convinced then, and even more convinced now, that a key element to surviving the disease, the treatment, and the aftermath is the support of people around you and people who have been through what I was going through and willing to listen and share. Medical science alone can only do so much, the remainder is still largely a mystery but it seems to me that ‘connectedness’ describes it as well as we can right now.” Resources All support group meetings are located in Philadelphia on the Penn campus. If you'd like to attend a meeting or would like more information about any of our support groups, please call 1-800-789-PENN or go to www.penncancer.com. 7 Annual Giving PA R T N E R S I N H O P E Donors in each category receive all gifts and honors awarded to those in previous categories. Friends $10 - $499 Special appreciation gift, newsletter, various invitations. Circle of Hope $500- $999 Recognition in online and printed materials, including the Abramson Cancer Center’s Annual Report. Patient Care Society $1,000 - $2,499 An opportunity to provide a personal narrative on how cancer touched your life. Faculty Society $2,500- $4,999 Participation in Abramson Cancer Center’s annual seminar, including personal interaction with leading cancer researchers and clinicians. Benefactor $5,000 - $9,999 A PENN Medicine magazine subscription, Abramson Cancer Center bookmark and/or special gift. More than 500 former patients, friends, colleagues, and family members came together on November 20th to honor John H. Glick, M.D. for his more than 20 years of service as Director of Penn’s Abramson Cancer Center. In his remarks, Dr. Glick said “Tonight in this room we have many of our top donors and friends standing shoulder-toshoulder with some of the best medical minds in the nation. If all of us work together in the forthcoming campaign for PENN Medicine, we will move the Abramson Cancer Center, PENN Medicine, and the city of Philadelphia to our rightful place as the best in the nation and, most importantly, achieve the goal and the dream of curing cancer in our lifetime.” Visible in the Philadelphia sky were six pillars of light on December 6th to celebrate the establishment of the Roberts Proton Therapy Center. The beams of light outlined the space where the world’s first fully integrated proton therapy facility will be built. The Roberts Proton Therapy Center is named in honor of Ralph J. and Suzanne Roberts and Brian and Aileen Roberts, who generously pledged $15 million to help create this facility that will treat up to 3,000 patients a year. "Philadelphia and The University of Pennsylvania have always been special to our family," said Ralph J. Roberts. "Suzanne and I are delighted to have the opportunity to give back to these two communities that have meant so much to us, with a gift that gives life through groundbreaking cancer research and treatment. Proton therapy as a treatment for cancer will undoubtedly touch thousands of lives, both adults and children, and we are fortunate to be a part of that process." Director’s Society $10,000 - $99,999 Membership in the Abramson Cancer Center’s Director’s special services program, complimentary tickets to annual reception, and invitations to special events. To make a gift to the Abramson Cancer Center, please contact the Development Office at 215-898-0578. F O R I N F O R M AT I O N O R A P P O I N T M E N T S We hope you never need us. But if you do, please know that we are here for you with a “patients first” attitude and a compassionate environment to offer hope and comfort to those who need it most. Call 1-800-789-PENN or visit our website at www.penncancer.org For the latest information about cancer — visit our awardwinning Internet resource, OncoLink, at www.oncolink.org Development Office 3535 Market Street, Suite 750 Philadelphia, PA 19104-3309 (215) 898-0578
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