Today is Saturday, Nov. 18, 2017

Department of

Surgery

NIH T32 Research Training: Host Response to Trauma

Traumatic injury is the leading cause of death in the United States in individuals under the age of 44 years. More than 100,000 deaths each year in the United States alone are attributed to trauma. With the advent of new technologies and strategies to resuscitate, stabilize, and transport trauma patients, individuals are now surviving insults that in years past would have been lethal. This sets the stage for an often prolonged series of complications that may subsequently lead to death for reasons other than the original traumatic injury. A greater understanding of the biological mechanisms of traumatic injury and its complications may lead to the development of new diagnostics, treatment modalities and patient care practices.

Our trauma training program is designed to directly investigate those mechanisms. Our program is unique in that it involves numerous clinicians and scientists from multiple departments that offer a tremendous breadth of expertise and perspective. Trainees devote 2-3 years to conduct research on a topic related to trauma, burns or perioperative injury. In addition, didactic training is provided in the responsible conduct of research and research ethics and additional topics as necessary. The training program is entering its 25th year and to date has trained over 44 individuals, many of which have gone on to successful academic careers.

Our program welcomes applicants from underrepresented minorities and those with disabilities.  For additional information please visit https://med.uc.edu/diversity and https://www.uc.edu/aess/disability.

Program Faculty

Charles Caldwell, PhDCharles C. Caldwell, PhD
Professor, Department of Surgery 

The goal of our lab is to manipulate the immune response to sepsis in a manner that reduces tissue injury and mortality.  A key aspect of the high mortality associated with sepsis is the inappropriate immune response to the systemic infection.  The process of inflammation is instrumental to an organism’s response to invading microorganisms or repair of damaged tissues.  This process is initiated by components of the innate immune system and is tempered by a number of regulatory mechanisms.  If this hyper-inflammatory process is prolonged and/or exaggerated, significant inflammatory tissue and organ damage may ensue.  In contrast, suppression of the immune response prior to complete pathogen eradication can lead to bacterial overgrowth and organ failure. Our lab has three interlocking research interests: 1) elucidation of underlying mechanisms that mediate inflammation during sepsis, 2) determination of the septic patients' immune status, and 3) intervention with molecular analogs to alter the immune response.  Specifically, during sepsis, we are currently investigating 1) the role of T cells and neutrophil-derived microparticles and 2) the use of flow cytometry to determine patient immune status in a time-constrained environment.

Michael J. Edwards, MD

Michael J. Edwards, MD
Professor & Chairman, Department of Surgery

Dr. Edwards is responsible for the professional development of all trainees in the department of surgery.

Michael D. Goodman, MD

Michael D. Goodman, MD
Assistant Professor, Department of Surgery

Our lab is focused on the physiologic response to traumatic brain injury. The primary theme of this line of research focuses on the effects of brain injury on coagulation and inflammation and examines the interaction of these two responses. A secondary theme of this work, done in collaboration with the United States Air Force, focuses on the response to hypobaric and hypoxic environments following traumatic brain injury and polytrauma. To this end, we have established murine and porcine models of traumatic brain injury, hemorrhagic shock, and tissue injury to further examine the physiologic responses to secondary insults following primary injuries.  Additional laboratory projects are examining the roles of platelets and platelet-derived microparticles after traumatic injuries, including hemorrhagic shock, traumatic brain injury, and burns.

Kenneth D. Greis, PhDKenneth Greis, PhD
Professor, Department of Cancer Biology 

For the past 20 years, my research has focused on technology development and the application of mass spectrometry to understand biochemical and biomedical systems. I have developed significant expertise in mass spectrometry technology development and project management while collaborating in a variety of research areas including: signal transduction, angiogenesis, metabolic regulation (obesity and diabetes), anti-infectives, musculoskeletal, inflammation, cardiovascular and cancer.  In addition to being a tenured Professor of Cancer Biology, I serve as the Director of Proteomics and Mass Spectrometry for the University of Cincinnati and Cincinnati Children’s Hospital Medical Center.  In this role, I act both as the core director and as a primary collaborator with many investigators on grant supported research that requires expertise in biological mass spectrometry and proteomics.  This includes all aspects of proteomics from 2D gel profiling to mapping protein modifications to quantitative mass spectrometry using label-free and isotope tagging (SILAC, iTRAQ) methods.  My independent research is focused on mechanistic understanding of biological systems by global and targeted phosphorylation profiling and quantitative mass spectrometry, and the development of novel mass spectrometry-based high throughput screening platforms (HTS-MS).  Finally, I also direct the UC Graduate Program in Cancer and Cell Biology, so I am fully engaged with training activities with an emphasis on ethics in research, mentoring and career development.

Erich Gulbins, MD, PhDErich Gulbins, MD, PhD
Chair, Department of Molecular Biology, University of Duisburg-Essen
Professor, Department of Surgery, University of Cincinnati

My laboratory studies the role of the acid sphingomyelinase/ceramide system in biomedicine. Currently, my lab is investigating the function of the acid sphingomyelinase/ceramide/acid ceramidase/sphingosine system in bacterial infections, tumor biology and cellular stress responses. In particular, we investigate the role of the acid sphingomyelinase, ceramide, acid ceramidase and sphingosine in pulmonary and systemic infections with Pseudomonas aeruginosa, Staphylococcus aureus and Mycobacteria (BCG). Mechanistic insights are applied to cystic fibrosis, ventilation-associated pneumonia and bacterial sepsis. Novel strategies to prevent these illnesses or treatments options are actively developed. Many cellular signalling events that are activated in response to bacterial pathogens are also involved in the response of the microenvironment to a malignant tumor. The group therefore studies the role of the acid sphingomyelinase/ceramide/acid ceramidase system in cells of the microenvironment of malignant tumors for their growth and treatment response. Finally, we are interested in understanding the role of sphingolipids in cellular stress responses. We study the signalling events initiated in mammalian cells by various forms of stress and applies these basic studies to the regulation of cell death.

Dennis J. Hanseman, PhDDennis J. Hanseman, PhD
Statistician, Department of Surgery

I serve as a biostatistician in the department of surgery at the University of Cincinnati.  My primary responsibilities are to provide methodological consulting and data analysis to faculty, residents and research fellows conducting clinical trials, observational clinical research, and bench research projects. My activities include: providing assistance with statistical power analyses and sample size determination; assisting with research design; carrying out complex statistical analyses, data interpretation; and publishing of results. I also designed and teach a short course each year in basic statistical methods delivered to research residents and critical care fellows.

David A. Hildeman, PhDDavid A. Hildeman, MD
Professor, Department of Pediatrics, Immunology, CCHMC

Our lab studies the molecular mechanisms underlying T cell homeostasis in health and disease. Using gene-deficient mouse models, we have made seminal observations on the role of the proapoptotic molecule Bim in the control of the apoptotic “crash” of T cell responses. Further, our lab has shown the critical role of a common-gamma-chain cytokine/STAT5/Bcl-2 network acting to antagonize Bim and promote CD8+ effector and memory T cell survival. Current work in the lab focuses on (i) manipulation of autoimmune responses using small molecule Bcl-2 family member antagonists; (ii) epigenetic and transcriptional regulation of Bim in effector and memory CD8+ T cells; (iii) identification of molecular mechanisms controlling the accrual of CD4+ FoxP3+ regulatory T cells (and immunosuppressive function) in aging mice and humans; (iv) mechanisms that regulate T cell homeostasis and function during sepsis. The long-term goal of the lab is to uncover novel therapeutic targets that can be used to promote T cell survival in some instances (e.g. vaccines, sepsis) and enhance T cell apoptosis in other instances (e.g. autoimmunity, lymphoid neoplasia).  

Alex B. Lentsch, PhDAlex B. Lentsch, PhD
Professor, Department of Surgery

Our laboratory studies molecular and cellular mechanisms of local and systemic inflammation induced by organ ischemia/reperfusion. Our work in this regard has evolved over the past 20 years, during which we have made several seminal contributions towards our understanding of the induction, propagation, and resolution of the acute inflammatory response to hepatic ischemia/reperfusion.  We are currently investigating the divergent roles of CXC chemokines in regulating the recovery and regeneration of damaged liver parenchyma after ischemic insult.  Most recently we have found that hepatocytes release exosomes that have proliferative effects during the process of tissue repair.  Moreover, the release of these exosomes is regulated by the CXC chemokine receptors, CXCR1 and CXCR2, in a manner completely independent from their known function as chemoattractant receptors.  I have also been intimately involved in other trauma-related research labs related to this training program in order to help provide our trainees the best research experience possible.

Amy T. Makley, MDAmy T. Makley, MD
Assistant Professor, Department of Surgery

Our research focuses on understanding the roles of sphingosine-1-phosphate (S1P) and its receptor, S1P receptor 1 (S1PR1) in endothelial barrier function after massive transfusion for hemorrhage.  We have identified a loss of endothelial barrier function as a contributor to acute lung injury resulting from hemorrhage and resuscitation and preliminary evidence from our laboratory shows that the transfusion of aged pRBCs causes endothelial cell dysfunction in association with alterations in the S1P / S1PR1 signaling pathway.  The goals of our research are to determine the mechanisms by which the S1P / S1PR1 system regulates endothelial cell function and integrity, and elucidate the manner in which this system is altered by exposure to pRBCs following transfusion for hemorrhagic shock. To achieve our goals, we have established models of polytrauma and hemorrhagic shock in small and large animals as well as in vitro models to study endothelial cell barrier function.

Timothy A. Pritts, MD, PhDTimothy A. Pritts, MD, PhD
Professor of Surgery

Our laboratory studies the impact of different resuscitation strategies for hemorrhagic shock. We have found that the ideal resuscitation fluid is a one to one ratio of packed red blood cells to fresh frozen plasma.  This work has influenced resuscitation strategies for massive transfusion at our trauma center and in the United States military. Some of our most recent efforts have examined the red blood cell storage lesion in packed red blood cells.  This lesion is a series of biochemical and physical changes in erythrocytes that leads to degradation of the quality of the red blood cell unit and harm to the recipient.  Our goal is to maximize the quality of erythrocytes transfused during resuscitation.  Additional work has focused on the special needs of the injured warfighter.  Through our partnership with the US military, we have worked together to advance our understanding of how to provide optimal care in austere and challenging environments, especially in the far-forward critical care transport setting.  Aspects of this work include the effect of aged, as compared to fresh, blood components as well as hypotensive resuscitative strategies on the host response to hemorrhagic shock.

Hector R. Wong, MD

Hector R. Wong, MD
Professor, Department of Pediatrics, Critical Care Medicine, CCHMC

Our laboratory is engaged in translational and basic science approaches to sepsis. The translational component consists of a multi-institutional database of children with sepsis and septic shock. The database consists of whole blood-derived RNA, DNA, and serum, and is richly annotated with extensive clinical data. This database has been in existence over a decade and has been leveraged for the derivation of gene expression-based subclasses of children with septic shock having clinically relevant phenotypes, the discovery of stratification biomarkers, and the discovery of novel therapeutic targets. These data are frequently brought back to the laboratory for formal hypothesis testing using both adult and immature models of sepsis. Recently, this work expanded to the related area of intestinal ischemia/reperfusion injury, which was the focus of research for one of the surgical residents in the Wong laboratory (Daly).  The interplay between these translational and basic science efforts provides a rich environment for current and prospective T32 trainees.

Basilia Zingarelli, MD, PhDBasilia Zingarelli, MD, PhD
Professor, Department of Pediatrics, Critical Care Medicine, CCHMC

Our laboratory is focused on the investigation of the pathophysiologic mechanisms of sepsis, trauma and hemorrhagic shock, which are leading causes of morbidity and mortality in intensive care units. Ongoing projects are primarily funded by two R01 grants from the National Institutes of Health. Dr. Zingarelli has identified putative anti-inflammatory nuclear receptors, the peroxisome proliferator activated receptors (PPARγ, PPARα and PPARδ ), and liver X receptors (LXRs), which regulate gene transcription of several cytotoxic modulators and may be important defense factors. Recent research efforts also focus on understanding the role of aging on the clinical course of infections, severe hemorrhage and trauma. The Zingarelli laboratory is also investigating the role of the PPARγ co-activator-1α (PGC-1α) and the AMP activated kinase (AMPK) in a variety of metabolic processes with particular interest on the molecular mechanisms of autophagy, a process that allows the cell to dispose dysfunctional organelles, and mitochondrial biogenesis, a process that allows the cell to restore energy homeostasis. The laboratory employs a multidisciplinary approach combining in vivo and in vitro experimental models in genetically modified rodents and cell lines. These models are also utilized as a translational research platform to screen novel pharmacological compounds that can modulate the molecular mechanisms of organ function. The goal is to identify specific therapeutic interventions for pediatric, adult and elderly patients.

Current Trainees

Nick C. Levinsky, MDNick C. Levinsky, MD

Dr. Levinsky is currently involved in basic science and clinical research.  The basic science research is focused on the role of olfactomedin-4 in systemic inflammation.  Olfactomedin-4 is a protein present in neutrophil granules, among other tissues, which has been implicated in cancers and various inflammatory syndromes.  Initial outside work demonstrated that olfactomedin-4 identifies a subset of neutrophils, a novel concept as neutrophils were previously thought to represent a homogenous population. Prior work in the laboratory has demonstrated that pediatric septic shock patients who do poorly have a larger population of olfactomedin-4 positive neutrophils as well as higher serum levels of olfactomedin-4.  This is suggestive of a possible pathogenic subset of neutrophils.  Building on this, Dr. Levinsky is using a murine model of intestinal ischemia/reperfusion injury to investigate the role of olfactomedin-4 positive neutrophils in the response to IR injury.  To parallel the basic science research and prior clinical work in pediatric patients, Dr. Levinsky will be initiating a clinical research program to evaluate olfactomedin-4 positive neutrophil populations in severely injured adult trauma patients. 

Hannah V. Lewis, MD

Hannah V. Lewis, MD

Dr. Lewis is involved in both basic and clinical research. The basic research program is focused on the role of AMPK in ischemia reperfusion injury of the small intestine and novel therapeutic agents to ameliorate injury. AMPK is known to be a key regulatory agent in the mitochondria. During ischemia reperfusion injury or times of stress, it is known to regulate cellular metabolism and reduce excess levels of reactive oxygen species that are detrimental to cells. An anti-apoptotic peptide, Humanin, produced endogenously, has been synthesized and can be administered exogenously and has been discovered to ameliorate myocardial ischemia-reperfusion injury and thus further investigation into small intestine ischemia is desired. Dr. Lewis is using genetically modified animals to investigate the role of AMPK in an ischemia reperfusion model and testing various dosages of Humanin to assess the optimal response. The clinical research project is focused on measuring levels of Humanin in blood of both septic/traumatic pediatric and septic/traumatic adult patients to see if there is a correlation between higher levels of Humanin and recovery from injury.

Amanda M. Pugh, MD

Amanda M. Pugh, MD

Dr. Pugh is involved in both basic science and clinical research.  The basic science research focuses on the host immune response to sepsis and trauma.  Due to increasing antibiotic resistance and susceptibility to Pseudomonas aeruginosa (PA) infections in burn and septic patients, she is investigating the role of sphingosine in the innate antimicrobial defense against PA in burn-injured and septic murine models.  Dr. Pugh is also involved in analyzing the role of hypothermia in sepsis and the mechanism linking hypothermia and T cell dysfunction, which increases susceptibility to infection. The clinical research is focused on a specific patient population in the surgical intensive care unit described as having persistent inflammation, immune suppression, and catabolism syndrome (PICS).  The PICS patient continues to acquire nosocomial infections without clinical progress despite appropriate antibiotics and treatment.  Dr. Pugh is involved in the study and collection of data that will define the characteristics of this patient population and identify who is at risk.  The aim is to provide preventative care to patients at risk for PICS.

 

Application Process

Appointments begin on July 1 of each year. Interested applicants should submit a current CV and three letters of recommendation, no later than November 1 of the prior year, and send to the T32 program administrator below.

Elizabeth (Betsy) Rodarte Boiman, Administrator
Division of Research, Department of Surgery
University of Cincinnati
231 Albert Sabin Way, ML 0558
Cincinnati, OH 45267-0558
Elizabeth.Boiman@uc.edu
513-558-8674

Surgical researchers in the UC Department of Surgery.
More Information:
Alex B. Lentsch, PhD
Program Director
Department of Surgery
University of Cincinnati College of Medicine
231 Albert Sabin Way
Cincinnati, OH 45267-0558
513-558-8674

Alex.Lentsch@uc.edu