The fifth annual MSTP Retreat had a new venue and some new faces this August 1st. The retreat organizing committee (Latey Bradford GSIII, Joshua Brown MSII, Carolyn Rosinsky MSII, Haiwen Chen GSII, and Kyle Wilson GSIV) selected the beautiful and historic Engineer’s Club in Mount Vernon for this year’s venue. With its ornately paneled walls, sunny atrium, and location just steps away from Mount Vernon Park, the Engineer’s Club was the perfect setting for the entire MSTP to reconnect and learn from each other and the invited speakers.

Following breakfast, the day began with MSTP Director Dr. Donnenberg welcoming our incoming students (see page 6). Next, our Associate Director, Dr. Keegan, announced some exciting new MSTP developments in the works: next year students will be able to take advantage of our neighboring institutions and undertake a Bioengineering PhD at University of Maryland, College Park, or complete their PhD work at NIH. Dr. Frayha, our liaison in the School of Medicine

Office of Student Affairs, reminded us that she is always available to serve as a resource as our students prepare to return to clinical years and work on their residency applications.

Next we welcomed Keynote Speaker Dr. Kelly Stone, Dr. Donnenberg’s first MD/PhD student! Dr. Stone gave us some excellent advice on developing a career as a physician-scientist (see Alumni Profile on page 5).

Two additional alumni spoke in the morning session. Dr. Eric Lancaster (class of 2003), now an Instructor in Neurology at the University of Pennsylvania, emphasized the importance of working with a good mentor throughout the different phases of the physician-scientist career path. Mentorship proved crucial for obtaining his K award, under which Dr. Lancaster is studying how autoantibodies can cause unusual and debilitating neuropathies. Recent alumna Dr. Cara Lang Morin (class of 2011), a Radiology resident at UMMS, spoke candidly about her choice to pursue Radiology, a non-traditional MD/PhD specialty. Echoing Dr. Lancaster, Dr. Morin emphasized the importance of finding good mentors, especially in a field that is not traditionally

Monica charpentier, GS iV

Dual Decreethe university of marylanD meDical scientist training program

Baltimore � Volume V � Issue 1 � Fall 2013

HISTORIC ENGINEER’S CLUB HOSTS FIFTH ANNUAL MSTP RETREAT

(continued on page 4)

MStp retreat 2013: University of Maryland MstP stUdents, facUlty, alUMni, and gUest sPeakers gathered in the atriUM of the engineer’s clUb in Mt. vernon for the fifth annUal retreat filled with Presentations, discUssions, and PrograM bonding.

The famous quote “Genius is 1% inspira-tion, 99% perspiration,” by Thomas Ed-ison, is frequently used to highlight the great importance of hard work in achiev-ing success. There is no question that the “99% perspiration” is required to success-fully transit through our program; mov-ing from the first year of medical school to graduate school, engaging in scientific discovery and publishing the discoveries, defending a thesis, returning to the clini-cal years of medical school, obtaining the MD and PhD degrees, and moving on to

internship and residency require great ef-fort. And it doesn’t stop there. Every day you must get up in the morning and go to work, leaving behind friends and loved ones, spending hours in the classroom, the library, and the laboratory, perform-ing experiments, most of which will fail. This is where the “1%” becomes important.

We all need a little inspiration to keep moving forward. But what is it, and where do we get it? Inspiration has many meanings including, as you learned in the early years, “the drawing of air into the lungs” and “the power to move the intellect or emotions,” the latter proba-bly the more appropriate definition in this context. Inspiration provides the passion and motivation to continue on in the face of adversity for the long haul. And as you know, this is the long haul.

Each of us can be inspired a number of different ways. We can be inspired by peo-ple, nature, art, music, literature, and, ap-propriately named, by inspirational say-ings. Since joining Michael Donnenberg and Jane Bacon in the leadership of the MSTP, I have been inspired by all of you and by the recent round of student appli-cants and new recruits. It is amazing to in-teract with such an accomplished group

of young people dedicated to the search for new knowledge and application of this to the improvement of human health.

One of the great attributes of our pro-gram is the strong camaraderie and collegiality amongst our students. This provides a critical support network that was clearly evident at our recent retreat. Several alumni of our program at various stages of their careers shared their inspirational stories with us. Our current students also have their own inspirational stories, still unfolding.

Over my career, I have had many sources of inspiration. Several of my favorites in-clude the advice from a professor at Hop-kins, “Don’t let anyone tell you what you can and can’t do,” and the quote, “If you think you can, you can; if you think you can’t, you’re right,” adapted by the suc-cessful businesswoman Mary Kay Ash.

What inspires you?

Will you share?

Please submit your sources of inspi-ration to the Dual Decre at dualde-cree@gmail.com or to Jane in the MSTP office. We will publish your sources of inspiration in the next issue!

Directors’ Decree: We all need a little inspiration.

aScah KeeGan, phDMStp aSSociate Director

Dual Decreethe university of marylanD meDical scientist training program

Baltimore � Volume V � Issue 1 � Fall 2013

eDitor-in-chief:Kristi Chakrabarti

Layout eDitor:Elise Ma

copy eDitor:Carolyn Rosinsky

photo eDitor:Alexander Tsai

contributinG eDitorS:Joshua Brown

Monica CharpentierPatrick Kerns

Jeffrey KleinbergerAparna KishorJesse Stokum

contact us: dualdecree@gmail.comThe views expressed herein are solely those of the authors and do not necessarily repre-sent the views of the University of Maryland School of Medicine or any affiliated institution.

Fall 20132 the Dual Decree Fall 20132 the Dual Decree

dates & remindersoctober 7, 2013 @ 12 pm Translational Medicine Topics [HSFII Rm 341]

october 10, 2013 @ 12:15 pm Molecules to Medicine [Student Center 2nd Floor]

october 12, 2013 Baltimore Running Festival october 16, 2013 @ 5 pm Clinical Case Studies [HSFII Rm 341]

october 24, 2013 @ 5 pm Physician Scientist Seminar with [HSFII Rm 341] Pedro Jose, MD, Ph.D november 5, 2013 @ 5 pm Physician Scientist Seminar with [HSFII Rm 341] Alan Shuldiner, MD

november 7, 2013 @ 3 pm MSTP White Coat Ceremony Reception [MSTP Office]

In the chapter “An Impatient War” of Siddhartha Mukherjee’s book The Emperor of All Maladies,

the author explores Mary Lasker’s post-WWII crusade against cancer. Her model for the organization of research was the Manhattan Project: a targeted “SWAT team” of scientists toiling away toward the annihilation of cancer. Her philosophy was in direct contrast with that of Vannevar Bush, whose recommendations were adopted by a current major US funding agency, the NSF. He recommended broad exploration of the basic sciences, a bottom-up approach, with little emphasis on the targeted development of new technologies. Lasker versus Bush is one argument that will never go away.

To me, clear objectives are great. I gravitate toward engineering-flavored labs that problem-solve, not basic science labs with an explorer’s attitude. I’m also aware that if everyone were a Laskerite like me, we’d all still be treating migraines with trepanning and learning about the wonders of phlogiston in the pulmonary section of Functional Systems. Many important ideas like the Fourier transform and concepts of cell signaling have arisen from bottom-up

research. Later, through targeted top-down research, these concepts have transformed into usable applications such as cell phones and the “magic bullet” drug Imatinib. The progression from bottom-up to top-down and back again highlights that the Bush and the Lasker approaches are both important for scientific discovery. However, evident by the more than 100-year gap between Fourier’s discovery and the first cell phone, it’s very rare to find them both running strongly in the same lab. Dr. Karl Deisseroth, a professor at Stanford University, is a great example of how targeted development of technologies can feed right back into the

production of novel basic principles. He is essentially producing novel tools to ask novel questions.

This year at the MSTP’s annual Max Lecture on April 22, Dr. Deisseroth, an MD/PhD from Stanford, presented a new technique his team only recently announced: the CLARITY (Clear Lipid-exchanged Acrylamide-hybridized Rigid Imaging/Immunostaining/In situ hybridization-compatible Tissue-hYdrogel) method. Via electrophoresis, his method “clears” the brain of its opaque constituents, which mostly turn out to be the lipids composing the cell plasma membrane. After rendering the brain clear, immunohistochemistry can then be applied to label and visualize proteins in their native 3D spatial location. While the technique’s possible applications are innumerable, CLARITY appears to be a powerful tool for the notoriously difficult problem of fiber tracking in the brain. The CLARITY process is relatively simple to implement, only requiring a power supply, some platinum wire, a water pump, some toxic chemicals, and an electrophoresis chamber. Happily for us burgeoning neuroscientists, the Deisseroth group has embraced an “open source” mentality. Their paper is free, and there is extensive supporting information, a parts list, and a dedicated forum for Q & A. Earlier that day, during a lunch with students, Dr. Deisseroth explained the development of CLARITY—how the right expertise was needed, how he hired a dedicated chemical engineer, and how he created a small independent team to toil away at CLARITY in secrecy. He even lightheartedly compared it to the Manhattan project.

Cementing the Lasker v. Bush connection, Dr. Deisseroth then spoke about his basic science research. His team is using optogenetics, another novel method that he created, to pry into the neuronal circuits surrounding reward and learning. This research is unique because they can monitor and control neural circuitry in freely moving animals, testing previously untestable hypotheses with their techniques.

Dr. Deisseroth would have been friends of both Mary Lasker and Vannevar Bush. Mrs. Lasker would have appreciated his top-down, problem-based approach to research. Vannevar Bush would have admired his passion for exploration. Personally, I hope to emulate his group’s flexibility in my own work. I feel that while a good scientist values both approaches, a great scientist is able to employ both and meld them together.

3mdphd.umaryland.edu

Role Model for Invention and Exploration Speaks at Max LectureJeSSe StoKuM, GS i

Fall 2013 3mdphd.umaryland.eduFall 2013

Max Lecture 2013: dr. karl deissertoh gives the 2013 Max lectUre (right). dean reece and the Max faMily with dr. deisseroth (left).

KarL DeiSSeroth, MD, phD

RETREAT

research-heavy. Dr. Morin’s talk demonstrated how an independent and determined attitude is essential to designing your individual career path.

The afternoon sessions featured the research of Tuo Peter Li (GSIII) and Christy Perry (GSII). Peter discussed his work in Dr. Tom Blanpied’s lab: determining whether AMPA receptors at the post-synaptic density are maintained in location by binding to scaffolding proteins, steric hindrance, or both. Christy taught us about her research in Dr. Alan Shuldiner’s lab: utilizing pharmacometabolomics to find causes for heterogeneous patient responses to aspirin administration. The presentations were a great way to learn more about the research our fellow MSTP students are doing, and to give early-phase students an idea of some of the research topics and techniques that could be available to them.

After the student presentations, retreat attendees divided for breakout sessions in which students received advice from the Directors, faculty, and students further along in the MSTP. Topics discussed included preclinical years of medical school, transitioning into graduate school, transitioning into the clinical years, applying to residency, and crucial graduate school choices like mentor selection, qualifying exams, and writing F30 grants. The breakout sessions provided an informal way for students to share their tips and experiences.

The retreat ended with a social hour of cocktails, hors d’oeuvres, and informal conversation. Finally, the sun came out and attendees were able to enjoy the First Thursday Concert taking place outside the Engineer’s Club in Mount Vernon. The 2013 MSTP Retreat was a successful day for the MSTP students to welcome the incoming students, bond with each other, network with the invited speakers, and enjoy spending the day with the entire MSTP.

MEDICS on ETHICS

Mr. SH was a 34-year-old man who came to the Emergency Department (ED) of a local hospital because his left side had grown progressively weaker over the last seven or eight days. I was a Sub-Intern with the Medicine team and I was on call that day, so my senior resident and I received the admission. I met Mr. SH in the ED—he was a young, clean-cut African-American man. Although he did not hide anything, he struck me as reserved, intensely private, self-possessed, and strong-willed. He was pleasant, respectful, and almost business-like in his demeanor.

When I examined Mr. SH, he had almost no movement and

no strength in his left arm and leg. Importantly, he had atypical posturing of his arm and leg: the arm was flexed and internally rotated while the left leg was extended with a bit of a foot drop; he circumducted his left leg (swung it in a circle) in order to walk. I also noticed that his left cheek was flattened – a sign of facial weakness. Note that the weakness in the face and in the body were on the same side. He also had a small scar on his left scalp.

Mr. SH’s medical and social history influenced my and my team’s understanding of his case – as for all patients, context often influences understanding, and should. We knew from previous records and from the information Mr. SH gave to me that he had come from a group home; he had a history of non-injection cocaine use, but had been sober for many years; he had spent time in prison. These factors alone did not direct us immediately toward a diagnosis, although they did offer some clues. The alarm bells went off, however, when we reviewed his discharge summary (same hospital) from four months prior. His brain imaging from the previous admission and his lab work identified a toxoplasma lesion in the left frontal lobe; he was found to be HIV positive with a CD4 count in the 20s. His toxoplasma lesion was removed by excisional brain biopsy. Viral drug susceptibility testing was performed at that time and he was discharged to a rehab facility with instructions and information on how to follow up with a dedicated HIV clinic.

At the rehab facility, Mr. SH did very well; he regained complete use of his right side. Although he continued on his toxoplasma treatment and his prophylactic medications against opportunistic infections and seizures, he never followed up with an HIV clinic. As he slipped through the cracks in the healthcare system, so did the results of his viral testing. His virus was sensitive to essentially every single antiviral drug in our anti-HIV arsenal.

Talking With Families: Lessons on Confidentiality and Terminal Illness

JoShua LieberMan, MS iV

(continued on page 8)

Fall 20134 the Dual Decree

(continued from page 1)

5mdphd.umaryland.eduFall 2013

At the 2013 MSTP Retreat, students had the privilege of hearing from Maryland MD/PhD alumnus Dr. Kelly Stone. Dr. Stone first started on the path toward becoming a physician-scientist during his undergraduate days at Johns Hopkins, where he caught the research bug working in pediatric endocrinology labs with none other than now-Maryland faculty member Dr. Curt Civin. In the MD/PhD program at Maryland, Dr. Stone switched gears and completed his PhD in now-MSTP Director Dr. Donnenberg’s lab. During his PhD years, Dr. Stone had the opportunity to present his research at a Gordon Conference, which he highly recommends graduate students attend. Dr. Stone advised early MSTP students that the key to success in graduate school is finding a good mentor, rather than focusing solely on the specifics of the research topics. A good mentor will provide invaluable training in the conduct of research as well as crucial skills such as grant writing and data presentation, he explained.

Dr. Stone went on to complete a Pediatrics residency at Children’s National Medical Center in DC, and then a Fellowship in Immunology at Boston Children’s. He recommends seeking out residency programs that will be provide excellent clinical training, particularly high-volume, resident-centered programs. Dr. Stone feels that selection of the Fellowship program is a pivotal career choice because the research you do during Fellowship serves as the basis for your career and is critical in obtaining your first faculty position. After Fellowship, Dr. Stone took a position at Children’s National Medical Center, where he received a K12 grant and then additional funding from the National Institute of Allergy and Infectious Diseases (NIAID). He had been training NIH fellows, and then used this connection to move to NIAID, where he is now the Director of the Allergy and Immunology Clinical Fellowship Program. Dr. Stone loves working at NIH because it gives him the opportunity to take care of and study patients with extremely rare diseases in a way that is only possible at NIH. One of the fascinating diseases he has had the opportunity to study is PLAID (PLCG2-associated antibody deficiency and immune dysregulation).

Dr. Stone recommended that MSTP students not overlook the opportunities for training at NIH. Fellowships at NIAID can take 3-5 years, and provide excellent training in clinical research, and all of the patients that fellows see at NIH are on research protocols. According to Dr. Stone, the combination of team-oriented research, access to unusual patient populations, and the latest technology make NIH “an amazing place” to conduct research.

Kelly stone, mD, phDclass of 1998

Monica charpentier, GS iV

MStp retreat 2013: kyle wilson, gs iv and aaron hess, Ms iv network and Mingle at the haPPy hoUr following the retreat (left). UPPer level gradUate stUdents give advice on grant writing and Picking a Mentor in the afternoon breakoUt seassions (right). sara stockMan, gs i and Jesse stokUM, gs i talk to the keynote sPeaker, dr. kelly stone, dUring lUnch (oPPosite).

AlumniProfile

Introducing...Sai was born in Guntur, India, but he has spent most of his life in Baltimore and the surrounding areas. He comes from a family that is rooted in science; his father works in a diagnostic lab and his uncle is a gastroenterologist. Sai’s un-dergrad studies were at the University of Maryland, Baltimore County (UMBC). He was a member of the Meyer-hoff Scholarship Program, as were some of the other current and previous students in the University of Maryland MSTP. He also had the opportunity to work with Dr. Michael Summers, a Howard Hughes Medical Institute investigator, for three years. During that time, he studied HIV-1 structure and packaging with ITC and NMR.

Sai matriculated at the University of Maryland School of Medicine in 2012. After beginning his medical training, he realized that he had an instinctive desire to dig deeper in the topics he studied. Sai felt a need to cultivate his critical thinking and technical skills through PhD training. He applied and was accepted to the MSTP as an internal applicant. Sai is hopeful that the MSTP will allow him to attain his goal of becoming an academic physician.

Sai is much more than just a student and researcher, as he has a range of interesting hobbies. He is a talented singer, taking part in an a capella group at UMBC where he was a bass, beat-box, and partial lead singer. He also sings Carnatic music, which is a type of Indian Classical music, and plays the violin. Along with music, Sai also enjoys playing sports such as tennis and soccer and experiencing beautiful scenic views. We are excited that Sai has chosen to join us in the University of Maryland MTSP, and we are sure that he will have a productive training experience that will help him achieve his career goals.

the Dual Decree � Fall 2013 � mdphd.umaryland.edu6

Jeffrey KLeinberGer, GS i

FOUR new members of the MSTP this year at the University of Maryland. Three are incoming first year medical students, and one is a second year medical student internal admission. They were kind enough to share some of their backgrounds and interests with us.

Michael has taken an interesting route to reach the University of Maryland MSTP. He grew up in Long Island, but decided to travel to Los Angeles at age 17 to pursue a career as a jazz guitarist. He soon realized that he really wanted to study medicine, and he en-rolled in the Baccalaureate/MD program at the Uni-versity of Southern California. During his senior year, Michael spent a semester in the lab of Dr. Matthew Dean where he studied genetics. He continued to work on bioinformatics in the Dean lab, and he found that he really loved the curiosity and excitement of research, as well as medicine, and wanted to study both together. Mi-chael decided that a dual MD/PhD degree would be the best route for his interests.

After his experience in the Dean lab, Michael knew that he wanted to study ge-nomics further, but he also had other, more personal, research interests. In 2003, he suffered a spinal fracture while playing basketball, and he has gone through multi-ple unsuccessful spinal operations to repair the injury. As a result, he is afflicted with chronic back pain that makes activities as simple as sitting in a chair extremely pain-ful. This personal difficulty has driven Michael to learn more about the scientific un-derpinnings of pain. When Michael learned of the exciting genomics and pain re-search going on at the University of Maryland, he couldn’t help but matriculate here.

Even though Michael has picked up interests in research and genomics, he hasn’t dropped his other hobbies. He is still an avid guitarist, and he enjoys studying jazz music. Recently, “old, dark, and/or eclectic films” have piqued his interest in cine-matography. Finally, being from New York, Michael is a big fan of the New York Yankees. We can overlook the fact that he’s a Yankees fan because we know that Mi-chael is an excellent addition to our program who will be very successful in the future.

Nathan’s hometown is Huntsville, AL, which is not the type of place that comes to mind when you think of Alabama. The city is very high-tech, with NASA’s Marshall Space Flight Center, US Army Redstone Arsenal post (a military base that focuses on missiles and missile defense), and a burgeoning biotechnolo-gy industry. Nathan proudly described the honor Huntsville received in 2011, being named the fourth “Geekiest City” in the US by Forbes Magazine, along with being honored as the ninth “Smartest City” in the world in 2009. There is no doubt that growing up in such a technologically-inclined location had a lasting effect on Nathan.

For his undergrad training, Nathan attended University of Alabama. Almost im-mediately, he began working in the lab of Guy and Kim Caldwell. The Caldwell lab is affectionately known as the “Worm Shack” because their studies focus on the nematode roundworm model organism C. elegans. Nathan continued this research on disorders of endoplasmic reticulum stress in the Worm Shack for his three years of undergrad, and continued working there while he obtained his MS degree. He decided that he would like to learn more about the clinical aspect of his stud-ies, and the best way to pursue that knowledge was with a dual MD/PhD degree.

On a personal note, Nathan got married just before making the move to Balti-more. He and his wife, Lindsay, have been together for 8 years. She is planning on applying to nursing programs in the area. Since they are both University of Al-abama alumni, they are obliged to be huge Alabama Crimson Tide football fans, and it’s common to hear Nathan proudly sound the team slogan, “Roll Tide.” Nathan also enjoys studying history and playing sports like soccer and ten-nis. We are excited to have Nathan bring some southern flare to our team at the UMD MSTP and are sure he will have a fruitful training experience with us.

MICHAEL KESSLER , MS IGenetics, pain research,

and all that jazz

SAI DIVAKARUNI, MS IIMD to MD/PhD: Singing a slightly different tune

NATHAN ROBERTS, MS IBackground of “geeks,”

worms, and Crimson Tide

Sai was born in Guntur, India, but he has spent most of his life in Baltimore and the surrounding areas. He comes from a family that is rooted in science; his father works in a diagnostic lab and his uncle is a gastroenterologist. Sai’s un-dergrad studies were at the University of Maryland, Baltimore County (UMBC). He was a member of the Meyer-hoff Scholarship Program, as were some of the other current and previous students in the University of Maryland MSTP. He also had the opportunity to work with Dr. Michael Summers, a Howard Hughes Medical Institute investigator, for three years. During that time, he studied HIV-1 structure and packaging with ITC and NMR.

Sai matriculated at the University of Maryland School of Medicine in 2012. After beginning his medical training, he realized that he had an instinctive desire to dig deeper in the topics he studied. Sai felt a need to cultivate his critical thinking and technical skills through PhD training. He applied and was accepted to the MSTP as an internal applicant. Sai is hopeful that the MSTP will allow him to attain his goal of becoming an academic physician.

Sai is much more than just a student and researcher, as he has a range of interesting hobbies. He is a talented singer, taking part in an a capella group at UMBC where he was a bass, beat-box, and partial lead singer. He also sings Carnatic music, which is a type of Indian Classical music, and plays the violin. Along with music, Sai also enjoys playing sports such as tennis and soccer and experiencing beautiful scenic views. We are excited that Sai has chosen to join us in the University of Maryland MTSP, and we are sure that he will have a productive training experience that will help him achieve his career goals.

the Dual Decree � Fall 2013 � mdphd.umaryland.edu 7

Raisa originally grew up on “The Nature Isle,” which is the nickname for the Commonwealth of Dominica in the Eastern Caribbean. She lived there until she came to Baltimore to attend Mor-gan State University. The change that Raisa expe-rienced when she came to Baltimore was daunting, but she was able to connect with a lot of other international students and profes-sors. Morgan State’s supportive atmosphere gave Raisa the opportunity to learn a great deal about American history, especially the roles of minorities throughout history and in current American society. It was during her time there that Raisa discovered her interest in biomedical research. She finds the mechanisms behind the physiology and pathophysiology of the human body to be very intriguing.

In addition to education and research, music is a very important part of Raisa’s life. When she was growing up, she sang in her church choir. Later, while she was at the NIH, she sang in an a capella group called “Nerds in Harmony.” Raisa doesn’t just make music with her voice, as she is also able to play the steelpan. In addition to making music, Raisa performs a traditional dance from Dominica called bélé.

Raisa is passionate about traveling, discovering exciting new places, and being exposed to different cultures. She and friends often travel to large cities during the season of Carnival to participate in the celebration. Growing up, she joined a cos-tume band each year during Carnival. In addition to her appreciation for the amaz-ing costumes, she also loves the Calypso and Soca music of the season. She finds that the high energy of the festival makes it especially enjoyable. Raisa’s rich cultur-al background and interests are a welcome addition to our MD/PhD program.

Michael has taken an interesting route to reach the University of Maryland MSTP. He grew up in Long Island, but decided to travel to Los Angeles at age 17 to pursue a career as a jazz guitarist. He soon realized that he really wanted to study medicine, and he en-rolled in the Baccalaureate/MD program at the Uni-versity of Southern California. During his senior year, Michael spent a semester in the lab of Dr. Matthew Dean where he studied genetics. He continued to work on bioinformatics in the Dean lab, and he found that he really loved the curiosity and excitement of research, as well as medicine, and wanted to study both together. Mi-chael decided that a dual MD/PhD degree would be the best route for his interests.

After his experience in the Dean lab, Michael knew that he wanted to study ge-nomics further, but he also had other, more personal, research interests. In 2003, he suffered a spinal fracture while playing basketball, and he has gone through multi-ple unsuccessful spinal operations to repair the injury. As a result, he is afflicted with chronic back pain that makes activities as simple as sitting in a chair extremely pain-ful. This personal difficulty has driven Michael to learn more about the scientific un-derpinnings of pain. When Michael learned of the exciting genomics and pain re-search going on at the University of Maryland, he couldn’t help but matriculate here.

Even though Michael has picked up interests in research and genomics, he hasn’t dropped his other hobbies. He is still an avid guitarist, and he enjoys studying jazz music. Recently, “old, dark, and/or eclectic films” have piqued his interest in cine-matography. Finally, being from New York, Michael is a big fan of the New York Yankees. We can overlook the fact that he’s a Yankees fan because we know that Mi-chael is an excellent addition to our program who will be very successful in the future.

MICHAEL KESSLER , MS IGenetics, pain research,

and all that jazz

SAI DIVAKARUNI, MS IIMD to MD/PhD: Singing a slightly different tune

RAISA JONES, MS I A multitalented musician

from Morgan State

8 the Dual Decree Fall 2013

Our initial differential diagnosis included things like a stroke – both HIV infection and cocaine use are bad vascular risk factors – as well as a recurrence of toxoplasmosis despite treatment. A single such lesion would have to be in the internal capsule to hit ipsilateral face and body. Also, a stroke would have an acute onset. Therefore, we performed an MRI which, along with some laboratory testing, confirmed a diagnosis of PML: Progressive Multifocal Leukoencephalopathy. So here was Mr. SH, presenting with an AIDS-defining illness for the second time in four months and a CD4 count of 7. The median survival of HIV patients after being diagnosed with PML is two years.

Mr. SH spoke with his grandfather, and in turn asked me to speak to his grandfather. Mr. SH also told me he wanted his grandfather to know as little as possible – nothing about prognosis, nothing about HIV. I suggested to Mr. SH that he tell his family he had a rare and degenerative brain disease. I thought I was ready to talk to Mr. SH’s family and to give them the minimal information I was allowed to share. I thought I could keep things under wraps. I was wrong.

Families care about their loved ones, even the estranged prodigal son who has absconded to Baltimore. Mr. SH’s grandfather was no exception. He had lots of question and I did my best to answer them vaguely. I made no mention of HIV, but I did mention PML and in response to the very direct question of “could this be fatal,” I responded in the affirmative.

The next time I saw Mr. SH he said, “Dr. Lieberman, you outed me!” I was horrified by what I had done. Anyone with an internet connection or a library card can figure out pretty quickly that PML implies HIV, or at best, cancer and immunosuppressive treatment. I told Mr. SH exactly what I had said; that I hadn’t mentioned one whiff of HIV. He accepted my apology, but it didn’t matter; his sister had already called him crying and now the whole family knew he was HIV positive.

We never did discover how Mr. SH contracted HIV. As he so eloquently put it during the initial interview, “what does it matter how I got it; I have it and that’s that.” He was right, but any mention of HIV immediately begs

questions of sexual/gender identity – a touchy area for many patients, especially in the African-American community. A Pediatric Grand Rounds on HIV in February 2013 noted that gay African-American males in Baltimore had an HIV infection rate of about 50%, more than four or five times their Latino and White counterparts, despite similar

or lower rates of risk behavior. This sentiment was echoed by a physician at the Institute of Human Virology with whom I worked during my Internal Medicine rotation. I still don’t know Mr. SH’s sexual history, but certainly being identified as HIV-positive would raise potentially uncomfortable

questions for him and his family.

My story illustrates several key pitfalls in medical communication. The first, and most important, is: be impeccable with your word. As a [student] physician, you will have tremendous power to impact patients with what you say and do. Patients and their families will for years carry around tremendous hurt from a few harsh, hasty, or careless words from one of their caregivers. Similarly, the right words shared with a patient will serve as a great balm

for their soul. Some days you will find the right words; some days you won’t.

Confidentiality is the second lesson, and just as important as mindful speech. Families can only know what the [adult or adolescent] patient consents to share. As I experienced for the first time with Mr. SH’s family, it is incredibly difficult to deny information

to a concerned family member. Be ready to say, “I’m sorry, but for more information you’ll have to speak with the patient. I’ve told you exactly what they have allowed me to say.” Be ready to have this feel unfulfilling and empty. Be ready to make mistakes and to potentially “out” a patient, launching them into a complex and uncomfortable exploration of social or gender politics. Be ready to forgive yourself for your mistakes. No mistake will feel small, and that’s good; don’t forget the mistakes you make, either.

Mr. SH was discharged to a rehab facility and started on a three-drug cocktail for Highly Active Anti-Retroviral Therapy (HAART) while in hospital – a rare move, done partly because we all felt he had been failed in his care and because his outcome was likely so poor. The next month I was relieved to learn that he had started at a local HIV clinic. I thought I saw him walking on the street the other day; alas, the person I saw walked smoothly with intact, symmetric arm and leg movements.

“ “‘Dr. Lieberman, you outed me!’ I was horrified by what I

had done.”

“ As a [student] physician, you will have tremendous power to impact

patients with what you say and do.”

(continued from page 4)

MEDICS on ETHICS

This past summer, I spent over two months in the Philippines, living with family, learning about the culture, and expanding my experience as a future physician.

The Philippines was a great experience and a huge culture shock. There are a wide variety of regions in the Philippines. Some of them are poor areas with no electricity or running water and buildings self-made from cinder blocks and wooden roofs. Then there are areas that rival the best living conditions here in America. In the capital city of Manila, you can walk from the Mall of Asia to the next alley where there are families cooking on a makeshift stove on the side of the street.

While in the Philippines, I shadowed at the Emergency Department of Angeles University Hospital. It was a small hospital, but it contained a medical school along with an undergraduate institution. I also volunteered at St. Martin’s Orphanage. Rev. Fr. Florentino S. Concepcion, also known as Father Boyet, founded the orphanage. Working at St. Martin’s was one of my favorite experiences. It is located in a rural area and it houses about 120 children in cottages that were built by Father Boyet and his volunteers. They grow their own food and have their own running water. Every Sunday, Father Boyet holds a church service and afterwards we prepared food for the children. Even without volunteers, the children have specific jobs and responsibilities, such as delivering and distributing the food to the various cottages. The orphanage is very self-sustainable.

The children ranged from twelve years old to adults over twenty. Sometimes it was very difficult to speak with them because they barely knew English and I knew little Tagalog, the Filipino language. Many of them had difficult backgrounds, involving parents who were too poor to take care of them, addicted to drugs, in jail, or who had just abandoned them. It was very enlightening to be able to talk with the children and see the struggles they had overcome. Despite their different backgrounds, all of the children seemed very happy. They always told me how they appreciate Father Boyet taking them in and how much freedom they have at St. Martin’s. Luckily, now the children are receiving an education provided by St. Martin’s all the way up to college. I was able to get to know the children there very well. I am hoping to do medical missions to St. Martin’s in the future to help the orphanage that taught me so much.

JoShua brown, MS ii

Volunteering in the Phillippines 9mdphd.umaryland.eduFall 2013

taGaLoG with the KiDS: JoshUa brown sUrroUnded by the children of st. Martin’s orPhan-age bUilt in noveMber of 2002 in bUstos, located in the Province of bUlacan in the PhilliPines.

Existing institutEs

- National Cancer Institute (NCI)- National Institute on Aging (NIA)- National Institute on Alcohol Abuse and Alcoholism (NIAAA)- National Institute on Deafness and Other Communication Disorders (NIDCD)- National Institute of Dental and Craniofacial Research (NIDCR)- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)- National Institute on Drug Abuse (NIDA)- National Institute of Environmental Health Sciences (NIEHS/NIH)- National Institute of Mental Health (NIMH)

More NIH Institutes to Take Part in MD/PhD F30 Grant ProgramJeffrey KLeinberGer, GS i

nEw institutEs

- National Heart, Lung, and Blood Institute (NHLBI)- National Human Genome Research Institute (NHGRI)- National Institute of Allergy and Infectious Diseases (NIAID)- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

MD/PhD trainees have a specific NIH grant dedicated only to them, known as a F30. Recently, this grant has undergone important changes to include more participating institutions.

It seems so long ago that the Molecules to Medicine (M2M) course became a feature of our program. The fall of 2009 has probably receded into a distant memory, but it was a time of immense evolution for the MD/PhD program, of which the initiation of M2M was but one of many changes (see Winter 2009/2010 Dual Decree for the full story). Before M2M began, the problem confronting students and faculty was the paucity of opportunities for our newest MD/PhD students to hone their scientific critical reading skills. They were then at a disadvantage when entering graduate school since their PhD-only counterparts had completed a rigorous curriculum of paper reviews in the GPILS core course (from which MD/PhD students are exempt). There had been some attempts to address this issue.

With the writing of the MSTP grant, however, it became clear that we needed to develop a more integrated program both in terms of curriculum as well as student cohesion. So new course was developed. The goal of the course was to have students work together to delve into literature about a significant scientific discovery or technology. Their exploration and presentations would be guided by faculty mentors. M2M has

undergone minor changes every year. In its first incarnation in 2009, faculty mentor for a given topic would present the associated papers. This format was not very popular, and the course was redesigned to be more of a student-run journal club. However, as students became more involved, the structure of each session became more variable and issues of grading became more pronounced. Now heading into its fifth year, the most recently revised M2M curriculum was discussed at the 2013 MSTP retreat by Associate Director, Dr. Keegan.

In general, the essence of M2M has not changed. It remains a curated journal club with extensive group involvement. In the spirit of our MSTP, students were asked which topics and mentors they wanted to see involved in the course, and the final curriculum was developed to respect those choices. With the new framework, each subject will be covered in three sessions. The first session is a faculty introduction and the subsequent two are student paper presentations. The four major scientific areas that will be the focus of this year’s M2M are MHC restriction, fluorescent proteins, G-protein coupled receptors, and the cochlea. The topics are designed to correlate with the clinical information being taught in medical school. If the

structure works, it will be continued for the 2014 academic year with four new topics and the cycle will be repeated. Evaluations of students’ performance will be based on what the faculty and students think of a given student presenter, and what the student presenter thinks of the group participation.

Thus, the MSTP works to foster the scientific mind in medical school. But then, as part of students’ progress through the program, they run into the opposite problem: how can the clinician be kept alive in graduate school? To address this question, the longitudinal requirement was accompanied by the Clinical Case Studies (CCS) course in 2010. Once a month, a case study is presented by clinical faculty in partnership with a GS2/GS3 student. The presentation covers diagnostic, therapeutic, and ethical issues for discussion by the group as a whole. The course has been extremely popular and often exceeds the one-hour scheduled time slot. This year, presentations will be in various areas of internal medicine. A new feature for 2013 is the partnership of MS4s with the GS2 presenters for an additional level of guidance and perspective. This will mark the first time the current MS4s have been involved in any of the MSTP courses.

Keeping one Foot on Each Side: Updates to MSTP Coursesaparna KiShor, MS iii

10 the Dual Decree Fall 2013

Elevating endogenous serotonin (5HT) with traditional antidepressants, like SSRIs, selectively potentiates ex-citatory synapses formed by the temporoammonic pathway with CA1 pyramidal cells (the TA-CA1 pathway) in the hippocampus, a major brain area affected by depression. This potentiation is realized via activation of 1B-type 5HT receptors (5-HT1BRs), and is expressed post-synaptically by AMPA-type glutamate receptors and their phos-phorylation by CaMKII. Using field electrophysiology, an extracellular recording technique in which a synaptic response is observed serially, we demonstrated that long-term potentiation (LTP- the neurobiological substrate for learning at the cellular level) and 5HT-induced potentiation occlude each other at TA-CA1, because of shared ex-pression mechanisms. (a) TA-CA1 is activated with high-frequency stimulation (HFS) to induce LTP, after which the 5HT1BR agonist anpirtoline has no effect. (b) After stable potentiation, the stimulator is turned back down to a baseline-sized response, to demonstrate that the block of drug-induced potentiation in (a) is not a function of absolute strength. (c) Drug-induced potentiation is elicited, blocking subsequent HFS-induced potentiation. (d) Potentiation was not observed at the nearby Schaffer Collateral pathway with application of the 5HT1BR agonist anpirtoline, nor was LTP affected by anpirtoline application. Thus, this drug-induced potentiation is selective for specific inputs even to the same population of target neurons. In this paper, we show that this 5HT-induced potenti-ation is quantitatively and qualitatively altered in a rat model of depression, restored by chronic antidepressants, and required for the ability of chronic antidepressants to reverse stress-induced anhedonia. Changes in 5HT-mediated potentiation, and its recovery by antidepressants, implicate excitatory synapses as a locus of plasticity in depression.

froM the bench of MarK KVarta, GS iii

11mdphd.umaryland.edu

featured figure

Fall 2013

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Affix Mailing Label & Postage

Doctoral Dissertations

congrats!

Nicolas DorseyPh.D. Molecular Microbiology

& ImmunologyThe role of STAT6 modulation of natu-ral and inducible Tregs during allergic lung inflammation.

Jessica ShiuPh.D. Molecular Microbiology

& ImmunologyThe role of IRAK-M in limiting helico-bacter-associated gastic immunopathol-ogy.

Julie CraigPh.D. Molecular Medicine

The LDL receptor-related protein (LRP1) regualtes the PDGF singaling pathway by binding the protein phos-phatase SHP-2 and modulating SHP-2 mediated PDGF signaling events

Dorsey NJ, Chapoval SP, Smith EP, Skupsky J, Scott DW, Keegan AD. STAT6 controls the number of regulatory T cells in vivo thereby regulating allergic lung inflammation. Journal of Immunology 2013 Aug 15;191(4):1517-28.

Kvarta MD, Harris-Warrick RM, and Johnson BR. Neuromodulator-Evoked Synaptic Metaplasticity Within a Central Pattern Generator Network. Journal of Neurophysiology Nov 2012 108:2846-2856. PMC3545119

Shiu J, Czinn S, Kobayashi KS, Sun Y, Blanchard T.IRAK-M expression limits dendritic cell activation and proinflammatory cytokine production in response to Helicobacter pylori. [In press – PLoS One]

Shiu J, Harberts E, Gaspari AA, Nickoloff BJ. Skin: Immunological Defense Mechanisms. (April 2013) Skin: Immunological Defence Mechanisms. In: eLS. John Wiley & Sons Ltd: Chichester. http://www.els.net

Shiu J, Blanchard T. Dendritic Cell Function in the Host Response to H. pylori in the Gastric Mucosa. Pathogens & Disease. 2013 Feb. 67(1): 46-53.

Wilson, K.A., Haskal, Z.J. (2013), Durable plug and Onyx occlusion of a refractory bile leak. Journal of Vascular and Interventional Radiology, (in press)

publications12 the Dual Decree Fall 2013

Teresa Lee, MS IV

Molly Hritzo, MS II - First PlaceSai Divakaruni, MS II - First Place

Andrew Wescott, MS II - Second PlaceCarolyn Rosinsky, MS II - Third Place

Mark Kvarta, GS III

alpha omega alpha honor meDical society

meDical stuDent research Day

gpils phD scholar awarD

gpils phD thesis project awarD

Aparna Kishor, MS IV