catalyst - cleveland clinic · head trauma because elevated s100b levels directly correlate with...

catalystPhilanthropy Sparks Innovation | fall 2013

Mappingthe Autistic Brain

Seeing Strokes Before They Happen

THE POWER OF

HOW NANOTECHNOLOGY WILL CHANGE MEDICINE

INSIDE: PYRAMID IDEAS ON FINANCIAL, ESTATE AND GIFT PLANNING

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visit clevelandclinic.org/giving to learn more

Furthering Medical Education

Students at Cleveland Clinic’s Lerner College of Medicine have a generous ally in KeyBank Foundation.

The KeyBank Minority Medical Student Scholarship Fund has provided more than $2 million since it was

established in 2005.

“Our goal for this scholarship is to ensure that financial constraints do not keep talented students from

pursuing a medical degree,” says Beth Mooney, KeyCorp Chairman and CEO. “We’re especially proud to

be supporting diverse candidates in their endeavors and helping them achieve their dreams. Diversity

strengthens us all.”

KeyBank Executive Vice President and KeyBank Foundation Chair Margot Copeland agrees.

“The growing needs of healthcare require the physicians of the future to be extraordinarily competent

and well trained,” she says. “The KeyBank Foundation Minority Medical Student Scholarship Fund

identifies the best students entering the profession and equips them for a life of service to all communities.”

InGrat itud e

Don Gerda/Cleveland Clinic

From left, Cleveland Clinic Lerner College of Medicine student Brittaney Wilson; Margot Copeland, KeyBank Executive Vice President and KeyBank Foundation Chair; student Vincent Cruz; and Beth Mooney, KeyCorp Chairman and CEO

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Catalyst | fall 2013

Cover: Michael Northrup

contents

Medicine Chest2 Getting to the heart

through the wrist

2 Football’s brain risks, beyond concussions

3 A brain map for autism

3 My Story: The long journey to heart repair

4 Cancer trials get an app

4 Watchful waiting for prostate cancer patients

Philanthropy at Work5 Story and Garschina

Chairs offer lasting legacy

6 1921 Society honors benefactors and physician

7 Lung transplant gets Jack Lally back in the race

8 Profile: Ryan Stevens out-swims Crohn’s disease

8 Panera’s campaigns for autism and cancer

Pyramid: Gift Planning9 Profile: Crile Award

winners Richard T. and Marjorie E. Garrett

10 CRTs: A trust-worthy gift

12 Meet your Gift Planning team

THE POWER OF THINKING SMALL13 Cover Story: Nanotechnology has huge potential to reshape medical therapy and imaging — at a scale as small as the basic building blocks of life.

Game Changer20 New technology would

allow doctors to see strokes before they happen.

Furthering Medical Education

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IT’S ALL IN THE WRISTPATIENTS WITH blocked arteries usually are treated with a surgical procedure in which a stent is inserted through the groin, requiring a hospital stay of at least a few days. However, an alternative procedure now offered by Howard Bush, MD, of Cleveland Clinic Florida’s Department of Cardiovascular Medicine, starts at the wrist.

“The hospital loves the treatment because it saves resources, frees up beds and saves money,” says Dr. Bush of the relatively new practice of inserting stents through the wrist. “Patients love it because it shortens the length of stay, and they can recover in their own beds.”

For nearly two years, Dr. Bush has been using this treatment method. Doctors in Europe and Canada have taken this approach since the 1990s, but Dr. Bush is among only 5 percent of U.S. doctors who do so.

He chooses the wrist because he believes that it minimizes the risk of bleeding. For some patients, including those using blood thinners, who are more likely to bleed, the wrist approach is especially helpful, Dr. Bush says.

Doctors who have perfected the groin technique may be hesitant to use the wrist technique on people who have had heart attacks. “But those are exactly the people who need it most,” Dr. Bush says. “I’m excited to train the next generation of cardiologists to use this approach.” — Heather Boerner

• C A R D I O L O GY

HARD HITS AND BRAIN RISK

• N E U R O L O GY

EVERY FOOTBALL SEASON, talk turns to the dangers of the sport’s hard hits — and the concussions that come with them. But a Cleveland Clinic/University of Rochester study of 67 college football players has found that brain changes can occur even when players haven’t had concussions.

This study found that the more hits to the head a player absorbs, even without concussions, the higher the levels of a brain protein known as S100B, commonly found in the bloodstream after a head injury. None of the players incurred a concussion during the season of the study, but four showed signs of an autoimmune response to S100B associated with brain disorders including epilepsy and dementia.

The study, sponsored by the National Institute of Neurological Disorders and Stroke, incorporated several methods of assessing brain injury, including CT scans, MRIs and the S100B blood test. Results were published March 6 in the online journal PLOS ONE.

Damir Janigro, PhD, Director of cerebrovascular research in Cleveland Clinic’s Lerner Research Institute, led the study in collaboration with Nicola Marchi, PhD, of Cleveland Clinic, and Jeffrey Bazarian, MD, MPH, of the Clinical and Translational Science Institute at the University of Rochester Medical Center.

Although S100B’s function is unknown, its presence helps detect mild traumatic brain injury when other signs are absent. Dr. Janigro’s team discovered that once the protein is in the bloodstream, it is treated as an invader by the autoimmune system. The body releases antibodies that seep into the brain and attack tissue, leading to long-term brain damage. The blood test offers an objective measure of whether a player has head trauma because elevated S100B levels directly correlate with the number and severity of head hits.

“Much attention is being paid to concussions among football players and the big hits that cause them, but this research shows that more common, ‘sub-concussive’ hits appear to cause damage too,” Dr. Janigro says. — Elaine DeRosa Lea

A study of 67 college

football players has found that brain changes

can occur even when players

haven’t had concussions.

medicine chest

2 catalyst | fall 2013

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3catalyst | fall 2013

THREE YEARS AGO, Sara Riahi, 26, left her Encino, Calif., home and flew more than 2,000 miles for lifesaving heart valve repair at Cleveland Clinic.

The flight took five hours, but her journey really began when she was 12 and diagnosed with mitral regurgitation. With this condition, a mitral valve does not close properly. Blood leaks into the upper heart chamber (atrium), rather than flowing into the rest of the body. This may lead to congestive heart failure.

“I was that kid in gym class who could never run a whole lap,” she says. “And when I would overexert, my heart would make a squeaking noise.”

For years, only she heard it, but one day, her mother heard it too while hugging her and promptly took her to a doctor.

That was when she first heard of Cleveland Clinic. “The doctor told my mom, ‘She may need surgery to fix it, and if it were my daughter, I would go to Cleveland Clinic.’ So, it was always in the back of my mind.”

With treatment, she was able to function for years. But then, at 24, she developed a blood clot in her eye and then shortness of breath, both attributable to her heart condition. About to be married and looking forward to a new life, she knew it was time to consider surgery.

“I wanted to have some quality of life and not feel like a 24-year-old trapped in an 80-year-old’s body,” she says.

After extensive research, including interviews with several surgeons, she chose A. Marc Gillinov, MD, who holds the Judith Dion Pyle Endowed Chair in Heart Valve Research and has performed more than 4,000 operations on patients with her condition.

“I wanted the best facility and the best after-care too,” she says. “The other places I looked at didn’t have all the parts of the puzzle, but Cleveland Clinic did.”

Her surgery was a success. Today, at 29, Ms. Riahi is married, healthy and living the way she always wanted.

“Throughout my life, I’ve had to push myself through tasks that are second nature to other people, like running or even breathing,” she says. “I never knew what ‘normal’ felt like until I went to Cleveland Clinic.” — Elaine DeRosa Lea

• M Y S T O RY

BRUCE TRAPP, PHD, Chairman of Neurosciences at Cleveland Clinic’s Lerner Research Institute, is shining light on the autistic brain — literally.

Years ago, Dr. Trapp found a way to make astrocyte cells (the star-shaped cells that help synapses connect) glow fluorescently. This has allowed him to study how the brains of people with multiple sclerosis (MS) “drop” connections. Now, with the help of a $1.97 million grant from the National Institute of Mental Health, Dr. Trapp and his team will study how connections in the autistic brain differ from those of a normally functioning brain.

The researchers described dramatic changes in the synapses related to MS, and they suspect that such changes also occur in an autistic brain.

“In autism, the data suggests that the synaptic connections are altered,” Dr. Trapp says. “With this grant, we will be able to chart the wiring of the synapses.”

By lighting up the astrocytes, as they plan to do in their study, Dr. Trapp and colleagues will be able to map their appearance. For example, are they malformed and, if so, do they function incorrectly? Chiefly, they’ll be looking for whether the astrocytes have mutated and whether their appearance changes depending on where they are located in the brain. These are all important questions and come at a time when President Barack Obama has announced a new focus on brain mapping.

Dr. Trapp doesn’t believe that mapping astrocytes will be a silver bullet for curing autism. But he does believe that this research will help pave the way to a neurological treatment for the disorder.

“We hope to identify therapeutic targets, and that the data will be shared and will generate research in the future,” he says. — Heather Boerner

• N E U R O S C I E N C E A Long Journey for Lifesaving Care

MAPPING THE AUTISTIC BRAIN

$1.97millionThe amountof an NIMHgrant for studying theautisticbrain

A. Marc Gillinov, MD, with Sara Riahi

Opposite page from upper left: McMURRY/TMG; Sean Justice/Glow Images This page top left: Kati/Glow Images


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AN APP FOR TRIALSCLINICAL TRIALS ARE crucial to advancing cancer research, but fewer than 5 percent of adult cancer patients actually enroll, according to the National Cancer Institute.

Why do patients hesitate? Many may not know enough about clinical trials to consider them an option. “To them, ‘clinical trials’ sound mysterious and even scary,” says Brian Rini, MD, of the Taussig Cancer Institute. “Many patients don’t understand the potential benefits.”

To help, Dr. Rini and colleagues developed the Cleveland Clinic Cancer Clinical Trials app for the iPhone, iPad and Android devices (available for download in app stores). The app connects patients and doctors to open clinical trials. It allows users to search for trials by disease group, physician, hospital and location.

The app also includes a basic overview of clinical trials to help patients understand what they are and why they are important before they speak with their doctor about options. It also offers access to resources such as free treatment guides, support groups, financial services and Cleveland Clinic’s Cancer Answer Line. In fact, users can connect directly with cancer specialists through the answer line.

There’s no substitute for talking with your doctor about all treatment options, Dr. Rini says, but the app can be a helpful starting point.

“It’s an easy way to search trials, and we hope that patients, their families and doctors use the app together as a tool to find new treatment opportunities,” Dr. Rini says. — Chris Blose

TEST LETS YOU WATCH AND WAITOVERTREATMENT OF prostate cancer is one of the most significant issues in men’s health today, says Eric Klein, MD, Chair of Cleveland Clinic’s Glickman Urological & Kidney Institute.

“More than 90 percent of low-risk patients undergo immediate treatment, such as prostate removal or radiation, despite having less than a 3 percent chance of their disease progressing to become deadly,” says Dr. Klein, the Andrew C. Novick, MD, Distinguished Chair in Urology.

A new genetic test could change that. The Oncotype DX Prostate test, announced earlier this year, is designed to help doctors determine just how aggressive a patient’s cancer is — and whether surgery or radiation treatment is necessary. Dr. Klein and colleagues Cristina Magi-Galluzzi, MD, PhD, and Sarah Falzavano, MD, along with the test’s manufacturer, Genomic Health, led development studies of 700 Cleveland Clinic patients.

The test measures the expression of 17 genes in prostate cancer tissue, says Charis Eng, MD, PhD, Chair of Cleveland Clinic’s Genomic Medicine Institute. “If the results show aggressive cancer, you can get the treatment you need right away. If results show low-risk cancer, you can avoid unnecessary treatment and its side effects.” Instead, patients can choose “active surveillance,” a regimen of regular appointments, prostate-specific antigen tests (PSAs), biopsies and follow-up tests, says Dr. Eng, who holds the Sondra J. and Stephen R. Hardis Endowed Chair in Cancer Genomic Medicine.

Men who are interested in the test should speak with their doctors, Dr. Klein says. “The test must be ordered by a physician, who then will get a report and can meet with you to share the results, discuss the implications and help you decide on the best options.” — Chris Blose

PATIENT FASHIONNew patient gowns — designed by fashion icon Diane von Furstenberg — debuted at Cleveland Clinic this year. THE GOALS: More comfort, more modesty and easier access for exams and treatment.

• T E C H N O L O GY

• P R O S TAT E C A N C E R

4 From bottom left: Stephen Travarca/Cleveland Clinic; Chung Lee, McMURRY/TMG; Artpartner-images/Glow Images


5

philanthropy at work��

Two cases of exceptional care have inspired a family to endow two research chairs in Cleveland Clinic’s Digestive Disease Institute.

Ed and Joey Story of Comfort, Texas, established a chair in 2007, and in 2012, their daughter and son-in-law, Sara Story and Ken Garschina of New York City, did the same.

Joey Story was referred to Cleveland Clinic after complications following a J-pouch procedure in Houston that led to 21 additional procedures. (In a J-pouch procedure, the colon is removed and an internal pouch is created from the small intestine.) The couple was grateful for corrective surgery by Feza Remzi, MD, Department Chair of Colorectal Surgery.

As a result, the couple established the Ed and Joey Story Endowed Chair with Dr. Remzi as the first chair holder. The chair supports research “to keep what happened to me from happening to others,” Joey Story says.

As Department Chair of Colorectal Surgery, Dr. Remzi now holds the Rupert B. Turnbull, MD, Chair in Colorectal Surgery, established in 1994 by Betty M. Ambrose. Reflecting a team approach to patient care, Dr. Remzi chose another of Joey Story’s physicians, Bo Shen, MD, as the new holder of the couple’s endowed chair.

“Dr. Remzi saved my life, and Dr. Shen keeps me

running,” says Joey Story, who travels to Cleveland Clinic several times a year for her care.

Sara Story and Ken Garschina were so impressed by Joey Story’s care over the years that in 2012, when Mr. Garschina’s grandmother, Rosemary Ricciardi, was diagnosed with colon cancer, they took her to Cleveland Clinic rather than a hospital closer to their home. Dr. Remzi performed life-saving surgery, and Mrs. Ricciardi now is cancer-free and doing well.

In gratitude, the couple established the Story Garschina Endowed Chair in Colorectal Surgery. Luca Stocchi, MD, head of research in the Department of Colorectal Surgery, is the first chair holder.

“Dr. Stocchi is a great researcher, surgeon and academic,” Dr. Remzi says. “And he’s a great human being.”

Sara Story says that she and her husband were “inspired by our family and for our family” to create their endowed chair at Cleveland Clinic. “It’s in honor of our parents, our grandparents and our children.”

Dr. Remzi is grateful for philanthropic support of the Digestive Disease Institute and future patient care. Noting that Mrs. Ambrose, supporter of the Turnbull Chair, has since passed away, he says, “The people who endow a chair are mortal. But their legacy for patients, residents and all mankind is immortal.”

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FAMILY INSPIRATION, LASTING LEGACY

Sara Story says that she and her husband were “inspired by our family and for our family” to create their endowed chair at Cleveland Clinic.

All stories by Elaine DeRosa Lea

From left, Ed and Joey Story, Rosemary Ricciardi, Ken Garschina and Sara Story

Stephen Travarca/Cleveland Clinic

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Courtesy of Cleveland Clinic

L E R N E R H U M A N I TA R I A N AWA R DAnother highlight of the 1921 Society dinner was the presentation of the Alfred and Norma Lerner

Humanitarian Award to Richard A. Rudick, MD, Director of Cleveland Clinic’s Mellen Center for

Multiple Sclerosis Treatment and Research. The award, established in 2002 as Cleveland Clinic’s

most prestigious physician honor, recognizes a physician who exemplifies the highest values of the

medical profession and demonstrates expertise, wise mentorship and a personal commitment to

Cleveland Clinic.

Dr. Rudick also is Vice Chairman of Cleveland Clinic’s Neurological Institute, a professor at

Cleveland Clinic Lerner College of Medicine, and holder of the Hazel Prior Hostetler Endowed Chair.

1921 SOCIETY HONORS BENEFACTORS AND PHYSICIAN

in bringing care to West Palm Beach, Fla. She was recognized with the first Sydell Miller Award at the 2011 Cleveland Clinic Florida Ball.

Helen and Ronald J. Ross, MD, FACRDr. Ross is the Emeritus Director of Radiology at Hillcrest Hospital, having served as Director from 1990 to 2000. In the late 1990s, he played a crucial role in the

Meridia Health System merger with Cleveland Clinic. Dr. Ross is a member of both the Board of Directors for Cleveland Clinic and Cleveland Clinic Community Hospitals. He is also Chair of the Hillcrest Hospital Board of Trustees. He is a member of the Medallion Society, served on the Trustee Development Committee for 12 years, and was an Executive Vice Chair of the Today’s Innovations, Tomorrow’s

Five esteemed benefactorsreceived the highest lifetime honor that Cleveland Clinic bestows upon supporters and volunteers at the 1921 Society dinner in October 2012. The honorees were given white coats signifying their new status as Distinguished Fellows during the special event. The 1921 Society Chair is Norma Lerner.

Conferred by Cleveland Clinic’s Board of Trustees, the fellowship is awarded to select individuals making extraordinary contributions of service and resources to Cleveland Clinic. The honorees were:

Sydell L. MillerIn recognition of her longtime dedication to Cleveland Clinic’s cardiovascular programs, the Sydell and Arnold Miller Family Pavilion was named in her family’s honor. The building is home to the Sydell and Arnold Miller Family Heart & Vascular Institute. Along with her daughters, Stacie Halpern and Lauren Spilman, Mrs. Miller has made gifts to many areas at Cleveland Clinic in Ohio and Florida. She was an Honorary Chair of the Today’s Innovations, Tomorrow’s Healthcare fundraising campaign and is a member of the Medallion Society. She serves on Cleveland Clinic’s Board of Trustees and is a member of the Pyramid Legacy Society and the Miller Family Heart & Vascular Institute Leadership Council. In addition, she is a member of Cleveland Clinic Florida’s West Palm Beach Leadership Council and was instrumental

Healthcare campaign. Grateful for the care that their grandson Edward Jack received, Dr. and Mrs. Ross established the first endowed chair at Cleveland Clinic Children’s, the Ronald and Helen Ross Chair in Pediatric and Congenital Heart Surgery. They also are members of the Pyramid Legacy Society. Over the years, the Ross family has supported the Cosgrove Innovation Fund, Cleveland Clinic Florida, the

From left, Larry Ruvo; Sydell L. Miller; Richard A. Rudick, MD; Helen and Ronald J. Ross, MD, FACR; Delos M. Cosgrove, MD


7catalyst | fall 2013Courtesy of Jack Lally

Only when Jack Lally neared the point of no return did he finally agree to lung transplant surgery.

Before that, his years-long battle with emphysema had led him to Marie Budev, DO, MPH, FCCP, Medical Director of Cleveland Clinic’s lung transplant program. “But I wasn’t ready to consider surgery then,” he says. Still pondering alternative approaches, he continued traveling every six months from his horse farm in Lexington, Ky., to see Dr. Budev at Cleveland Clinic.

“I was getting worse all the time,” he says. “[Dr. Budev] would say, ‘His lips are blue, but he’s telling me he’s fine, and he’s talking about going to Costa Rica for a stem cell transplant.’”

Their friendly but serious banter continued for years. “Finally, she said to me, ‘We don’t have any other options.’”

Family echoed Dr. Budev’s message. “My daughter, Dana, and my wife, Louise, were just hounding me,” he says. “The only way to stop them was to agree to the surgery. I didn’t have any choice.”

On Easter Sunday 2010, Mr. Lally was at Cleveland Clinic, being prepared for single-lung transplantation. “I had reconciled myself

to doing this and was ready to go,” he says. But at 3 a.m., the nurse received word that the lungs the team received were not usable. “That was a big letdown.”

Within three weeks, he returned, and this time, the donor lungs were usable. A successful operation was performed by Gosta Pettersson, MD, PhD, Vice Chair of Thoracic and Cardiovascular Surgery, who holds the Peter and Elizabeth C. Tower and Family Endowed Chair in Cardiothoracic Research.

Today, Mr. Lally is feeling good and happy to be back to his business of raising thoroughbreds. In friendship and gratitude to Dr. Budev, he named one of his sleekest, most promising racehorses Dame Marie (see photo in table of contents). The filly is winning races and recently came close to one track’s record, missing it by only three-fifths of a second.

But Mr. Lally knows he’s the really big winner. And to show his thankfulness and help other patients, he and his family have made a significant planned gift supporting Cleveland Clinic’s lung transplantation program.

“Before I had surgery, I was on oxygen 24 hours a day,” he says. “That was no life at all. I owe my life to Cleveland Clinic.”

Jack Lally��

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BACK IN THE RACEJack Lally with one of his racehorses

Sydell and Arnold Miller Family Heart & Vascular Institute, the Glickman Urological & Kidney Institute, the Edward Jack Ross Appreciation Fund and Hillcrest Hospital.

Camille and Larry RuvoThe Las Vegas couple is dedicated to ensuring that residents of Nevada and surrounding communities have access to the highest-quality neurological care. When Mr. Ruvo’s father, Lou Ruvo, first showed signs of Alzheimer’s disease, the couple had to travel to California to consult with a specialist. After his father’s death in 1994, Mr. Ruvo hosted a dinner in his memory at which friends gave money toward Alzheimer’s research. With these contributions, Mr. Ruvo created Keep Memory Alive to promote research, treatment and caregiver support. In 2009, Cleveland Clinic joined with Mr. Ruvo to establish the Cleveland Clinic Lou Ruvo Center for Brain Health in a building designed by world-renowned architect Frank Gehry. The Lou Ruvo Center for Brain Health offers leading-edge neurological care, access to clinical trials, and resources for caregivers. Mr. Ruvo is a member of Cleveland Clinic’s Board of Trustees and the Chairman of Keep Memory Alive. Mrs. Ruvo serves as Vice Chairman of Keep Memory Alive’s Executive Board. Together, the couple recently established the Camille and Larry Ruvo Endowed Chair in Brain Health.




Courtesy of Ryan Stevens; Courtesy of Tim Turner/Panera Bread/Covelli Enterprises

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Partner for Autism, Breast Cancer

Panera Bread/Covelli Enterprises and Cleveland Clinic have partnered to boost donated funds for breast cancer and autism.

Through the “Go Pink with Panera Bread” and “Pieces of Hope for Autism” fundraising campaigns, Panera Bread/Covelli Enterprises has contributed close to $220,000 to Cleveland Clinic in the past two years.

“Panera Bread helps Cleveland Clinic because we feel strongly about giving back to the community,” says Cara Sutch, Regional Marketing Director. “Our partnership allows us to do that by helping children and women in need.”

In 2011 and 2012, all 45 Northeast Ohio Panera bakery-cafes participated in Panera Bread/Covelli Enterprises’ Go Pink with Panera Bread campaign. A portion of the proceeds from each sale of a Pink Ribbon Bagel — featuring cherry chips, dried cherries and dried cranberries — went toward cancer survivorship programs at Cleveland Clinic’s Taussig Cancer Institute.

This year and in 2012, Panera Bread/Covelli Enterprises hosted the Pieces of Hope for Autism fund raiser, selling a specialty shortbread puzzle-piece cookie. A portion of the proceeds from each cookie sold was donated to Cleveland Clinic Children’s Center for Autism.

“One in 88 children is affected by autism,” Ms. Sutch says. “We heard that statistic and asked, ‘How can Panera Bread get involved?’”

Panera Bread and Cleveland Clinic are exploring ways to provide funding to other areas of the hospital.

The third annual “Go Pink with Panera Bread” fundraising campaign will run through October. To learn more, please visit www.paneracovelli.com/gopinkcle.

SWEET CAMPAIGNS

OUTSWIMMING CROHN’S DISEASE

On Christmas morning 2008, Ryan Stevens became ill with what he thought was a nasty stomach virus. A 36-year-old lifelong swimmer, he considered himself healthy. But days later, still battling “the worst stomach flu” he’d ever had, he reluctantly heeded the advice of his wife, Samantha, and went to a doctor.

“Turns out, Christmas morning was when my Crohn’s disease woke up,” he says.

Over the next few years, Mr. Stevens tried nearly every Crohn’s medication available. “None of them helped,” he says. Finally, in 2011, he was admitted to Cleveland Clinic after losing 65 pounds, and becoming lethargic and weak from devastating bouts of diarrhea. A colonoscopy helped determine that Crohn’s was “running rampant” in his body and he needed ileostomy surgery to remove his colon.

The surgery restored his health. Within a week, he regained 11 pounds. Eventually, he was healthy enough to have another operation to reverse the ileostomy and return him to normal body function.

“For two years prior to ileostomy, I was living on my couch,” he says. “Since my surgery and the reversal, I have been doing very well. I now wish to give back and help raise money for Cleveland Clinic’s Digestive Disease Institute so that they can continue to help others with inflamatory bowel disease.”

Mr. Stevens set a goal of swimming 24 miles across Lake Erie in July to raise funds for Cleveland Clinic. However, because of adverse weather predicted for his original date, July 27, he set out the night before and swam a full six miles in frigid water before hypothermia and bad weather, creating 8-foot rolling waves, ended his attempt.

“I’ll be back next year,” he says. “I have to complete this swim now. It’s hard to explain, but the lake is in me now, just like Crohn’s. I won’t be satisfied until I make it across.”

For now, Mr. Stevens is happy to have helped raise awareness of and funds for Crohn’s and colitis research at Cleveland Clinic. Through his personal fundraising page on Cleveland Clinic’s website, he has raised more than $3,000 for the Digestive Disease Institute. In addition, media reports about his efforts helped raise another $1,200.

To learn more about Mr. Stevens, visit giving.ccf.org/goto/RyanStevens. To create your own Cleveland Clinic Personal Fundraising page, visit giving.ccf.org/personalfundraising or call 216.448.0667.



PYRAMIDIDEAS ON FINANCIAL, ESTATE AND GIFT PLANNING FOR FRIENDS OF CLEVELAND CLINIC

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Ken Baehr/Cleveland Clinic

Inside This Section

ACHIEVE YOUR GIVING GOALS CHARITABLE REMAINDER TRUST

Want to give a life-income gift that accomplishes your charitable goals, supports yourself and your family, and bolsters research at Cleveland Clinic? Consider a charitable remainder trust (CRT).

Richard T. and Marjorie E. Garrett, the 2013 George W. Crile Sr. Award recipients, are advancing multiple sclerosis (MS) research through

planned gifts to Cleveland Clinic.The couple, of Rocky River, Ohio, and Naples,

Fla., were honored at Cleveland Clinic’s Partners in Philanthropy event in June. They established a charitable remainder annuity trust to support the work of Bruce Trapp, PhD, Chairman of Cleveland Clinic’s Department of Neurosciences.

For many years, MS cast a shadow over the lives of Mr. Garrett and his first wife, Marilyn, who struggled with the debilitating disease until she passed away in 1991. The Garretts say that they hope their annuity trust will help others facing MS by furthering research into its cause and leading to new treatments.

Although MS is not inherited, the chances of having it can increase from 1 in 1,000 for the general population to 15 in 1,000 for those with a parent who has the disease, Dr. Trapp says. There currently is no test to determine the likelihood of contracting it.

With MS, the immune system attacks the protective sheath covering the nerves, interfering with communication between the brain and the

Garretts Receive 2013 Crile Award

rest of the body. Eventually, nerves may deteriorate, and some people lose the ability to walk or talk. Although the disease can occur at any age, it most often is diagnosed in people between the ages of 20 and 40, and it affects more women than men.

In recent years, researchers have developed drugs to slow the progression of MS, greatly improving the quality of life for most patients, Dr. Trapp says. “Unfortunately, we are not able to stop the disease. Generous gifts like the Garretts’ support basic science and translational research investigating the causes of MS and therapeutic intervention. Our ultimate goal is to find a cure.”

Mr. Garrett, who is retired from the engineering company he owned, Garrett and Associates Inc., and Mrs. Garrett also have made gifts to other areas of Cleveland Clinic. Mrs. Garrett’s first husband, Robert O. Fricke, who passed away from complications of lung cancer in 1988, also was a patient at Cleveland Clinic.

“We are humbled and proud to be the 2013 recipients of the George W. Crile Sr. Award,” the Garretts say. “We are certain that we are two of many other Clevelanders who cherish and respect the medical expertise of Cleveland Clinic. How fortunate to have this world-class facility in our city.” — Elaine DeRosa Lea

From left, Richard T. and Marjorie E. Garrett with her son and daughter-in-law, Wade and Laura Fricke, at the Partners in Philanthrophy celebration

09-12 Pyramid Insert.indd 9 10/3/13 2:28 PM


A TRUST-WORTHY GIFTAFTER CAREFULLY WEIGHING all their options, Richard and Marjorie Garrett of Rocky

River, Ohio, made a plan: Contribute to research at Cleveland Clinic by establishing a

charitable remainder trust (CRT), a life-income gift that would help accomplish their charitable

goals while supporting them and their family.

Life-income gifts can support an individual’s favorite charity, such as Cleveland Clinic,

while allowing for significant tax savings and annual income based on the value of the gift.

Like the Garretts, you, too, may find that a CRT is the perfect way to achieve your philanthropic

objectives.

How Does a CRT Work?A CRT is established by transferring asset(s) into a charitable trust, which then will generate income to one or more named beneficiary(ies) for life, or for a set term of years (not to exceed 20 years). A trust established with Cleveland Clinic pays an annual income of no less than 5 percent and no more than 8 percent. At the conclusion of the trust term, the remaining balance passes to Cleveland Clinic. The benefits to you, your family and Cleveland Clinic can be significant.

Two Types of CRTsThe difference between the two types of CRTs is the manner in which income paid to the beneficiary(ies) is calculated.

A Charitable Remainder Annuity Trust (CRAT) will make fixed payments to the income beneficiary for the term of the trust. For example, a $100,000 trust with a 5 percent payout will provide an income of $5,000 every year for the trust term.

In contrast, a 5 percent Charitable Remainder Unitrust (CRUT) of $100,000 would provide $5,000 the first year, and then future payments would be based on 5 percent of the trust’s balance as revalued annually. A CRUT is a hedge

against fluctuations in the economy. Payments to the income beneficiary will increase when the market value rises. To preserve the principal gift, payments decrease if the market value drops.

Choosing an Asset to Fund the CRTA CRT can be funded in a number of ways, the most common being cash. A key benefit of funding a trust with an appreciated asset such as stock or real estate is that no capital gains are recognized upon a transfer of appreciated assets to the trust, or upon a sale by the trustee within the trust. Part of the beneficiary’s income may be taxed at low capital-gains tax rates under the four-tier tax reporting system, and will be spread out over the trust term.

Example:After speaking with his adviser, Andrew Jones, 68, decides he would like to support Cleveland Clinic with a charitable remainder unitrust. His gift of $400,000 to establish a CRUT generates a charitable deduction of $196,988, which may save him $78,007 in federal income tax in his 39.6 percent tax bracket ($196,988 x 39.6%). To his advantage, Mr. Jones funded this CRUT with 5,000 shares of appreciated

Life-income gifts can support an individual’s favorite charity, such as Cleveland Clinic, while allowing for significant tax savings and annual income based on the value of the gift.



stock that he purchased many years earlier at $10 per share. This will allow him to avoid immediate payment of capital-gains tax of $83,300 ($350,000 gain x 23.8%) that he would owe if he instead liquidated the stock and funded the trust with cash. The decreased amount of capital-gains tax still due will be spread out over the term of the trust. In addition, the trust was established with a 5 percent annual payout, which means that Mr. Jones will receive income of $20,000 (5 percent of $400,000) in the first year. This income could increase in subsequent years.

Charitable DeductionEstablishing a CRT allows you to benefit from a charitable deduction in the same year in which it is created. The federal charitable income-tax deduction is based on the present value of the remaining balance that ultimately will pass to Cleveland Clinic. Together, several factors determine the remainder interest, including the value of the assets transferred into the trust, the age(s) of the income beneficiary(ies), the term of the trust, the payout rate and the type of trust selected.

Additional BenefitsA CRUT offers added benefits and also allows you to incorporate special provisions to provide for a variety of needs. For example:

• You can make additional gifts to a CRUT, which will increase the annual income and generate an additional charitable deduction.

• You can limit the initial annual income it pays out. If you still are working, this can be a terrific retirement planning tool since it allows the trust to grow faster, eventually producing even more income once you retire.

• You can add a life insurance component for family security. If you are concerned that establishing a charitable remainder trust will reduce the inheritance going to family members, you could consider using distributions from the trust to make premium payments on a life insurance policy. When the policy terminates, it will be paid directly to family members free of estate and income tax.

Good charitable planning can provide opportunities to enhance financial security for you, your family and Cleveland Clinic. A charitable remainder trust is the type of gift that can help you accomplish all of these goals.

Benefits to Mr. Jones Benefits to Cleveland Clinic

Immediate Benefits

$196,988Federal income tax deduction

$83,300Immediate capital-gains tax avoided

(remainder spread over the term of the CRT)

Immediate Benefits

Will help buildCleveland Clinic’s future

Annual Benefits

$20,000First year payment

(payment amounts vary in future years)

Future Benefits

May reduce estate taxes and cost

Future Benefits

Projected remainder to Cleveland Clinic$473,722

This example assumes a 39.6% tax bracket and 23.8% capital-gains tax (20% capital gains and 3.8% surtax)

Charitable Remainder Unitrust—5% Payout

*The examples in this newsletter are not based on actual benefactors but represent realistic illustrations of various gift planning opportunities. If you would like to know how these opportunities might apply to your situation, please contact Cleveland Clinic or your financial adviser.

Andrew Jones $400,000$50,000 Basis


We would be glad to work with you and your advisers to arrange a gift plan that best suits your objectives. To discuss your charitable goals in confidence with one of our gift planning professionals, please call 216.444.1245 or 800.223.2273, ext. 41245, and ask for Gift Planning, or send an email to [email protected].

Meet Our Team Cleveland Clinic is grateful for all gifts.

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Clin

ic

PYRAMID

Pyramid Legacy Society

You can plan for your future while supporting Cleveland Clinic through a charitable gift. If you have included Cleveland Clinic in your estate plans, please let us know! We would love to welcome you as a member of our Pyramid Legacy Society.

To learn more, request a copy of our complimentary Pyramid Legacy Society brochure.

If you wish to discuss, in confidence, a plan that best suits your family and charitable needs, please call Cleveland Clinic’s gift planning professionals at 216.444.1245. You also may send an email request to [email protected], or visit us online at clevelandclinic.org/giving.

We look forward to assisting you.

� FROM LEFT: RICH HILBRICH; ANNE CORRETTE; BRITTANY NEAL, ESQ.; NANCY MCCANN; DONESHA PEAK, JD; KATHERINE COLLIN, ESQ.; NELSON J. WITTENMYER JR., ESQ., PHILANTHROPY INSTITUTE VICE CHAIR

Building the Foundation for Tomorrow’s Healthcare

Pyramid Legacy Society

2 0 1 3 P A R T N E R S

Ronald W. Bradley, Trustee James E. Bradley Trust

Tom Goodman, CLU, ChFC, PartnerCedar Brook Financial Partners

John W. Pinter, CLU, ChFCJPS Financial LLC

Andrew E. Randall,

Managing Director, MBA

New York Private Bank and

Trust

Jeffrey Wasserman, Director of Specialty Life, Exec. V.P.Oswald Companies

Allied Partners in

Philanthropy (APP) is

a society established by

Cleveland Clinic to thank

and recognize allied

professionals (attorneys,

accountants, bankers,

brokers, financial planners,

etc.) who have helped

facilitate a charitable gift

to Cleveland Clinic. If

you have assisted your

client(s) with a gift to

Cleveland Clinic, please

contact Nancy McCann at

216.445.8980 or send

an email to

[email protected].

ALLIED

PARTNERS IN

PHILANTHROPY

COMPLIMENTARY BOOKLET

1 2 catalyst | fall 2013


THE POWER OF THINKING

Nanotechnology has huge potential to reshape medical therapy and imaging — at a scale as small as the basic building blocks of life.

A WOMAN WORRIED that she might have breast cancer. A man paralyzed by a traumatic injury to the spinal cord, with little hope of regaining mobility. A person who beat cancer years ago but now fears it has recurred and may be spreading.

What if every one of these people could be helped by technology that’s more than 100,000 times thinner than a sheet of paper?

SMALL

By Chris Blose

Science Photo Library/Glow Images 13catalyst | fall 2013

13-19 Feat-Nanotech.indd 13 10/1/13 3:44 PM

14 catalyst | fall 2013 Water drops, RunPhoto/Getty Images; Russell Lee/Cleveland Clinic

Such is the promise of nanotechnology. This emerging field uses particles invisible not only to the naked eye, but also to most microscopes.

Although the scale is small — one to 100 nanometers, with each nanometer being a billionth of a meter — the promise is enormous. The federal budget for nanotechnology is around $1.7 billion annually (see “A Brief History of Nano” on page 19). Nanotechnology research and materials can be applied to everything from energy production and defense technology to data storage, anti-aging creams and coatings that make everyday products water- and wear-resistant.

But because of its scale, nanotechnology’s greatest promise may be in medicine.

For example, a glucose molecule is just 1 nanometer in diameter. Hemoglobin, which carries oxygen in the blood, is only about 5 nanometers in diameter. Human chromosomes are each about 100 nanometers in diameter.

With nanoparticles, work begins at the same size as the basic building blocks of life.

“Nanotechnology is a tool that can transform medicine,” says Vinod Labhasetwar, PhD, a researcher in Cleveland Clinic’s Lerner Research Institute, where he works in the Department of Biomedical Engineering developing applications for spinal cord injury, stroke and cancer, among others. “It could make treatments more effective, less toxic and more precise.”

OUR GOAL

IS TO BLOCK THAT

CASCADE

AND LET

THE BODY

HEAL ITSELF.

—Vinod Labhasetwar, PhDVinod Labhasetwar, PhD


15catalyst | fall 2013Science Photo Library/Glow Images; Laguna Design/Getty Images

THE PROPERTIES OF PARTICLES Being tiny is not the only thing that sets nanotechnology apart from other fields. The real advantages come from how nanoparticles behave.

“There are three things we talk about when defining nanotechnology,” says Geoff Holdridge, an analyst and contract staff director for the National Nanotechnology Coordination Office, which supports the U.S. government’s National Nanotechnology Initiative (NNI). “One is the size scale of 1–100 nanometers. Second is the unique properties that arise from working with structures at nanoscale. And third is that we’re in control of those structures and properties.”

Look at it this way, Dr. Labhasetwar suggests: “Sand is made from rock, but their characteristics are different. The same thing happens when you make certain materials at nanoscale. The physical, biological and chemical properties change.”

Take the property of water solubility, for example. Dr. Labhasetwar points out that any number of promising drug compounds never make it to clinical trials because they can’t be dissolved in water. Rather, they dissolve only in materials that are toxic to the body or are not stable under biological conditions. Nanomaterials can address these issues.

For instance, if you use nanoparticles with certain compounds, they become water-soluble, allowing the body to tolerate them safely longer — or making them stable in the body so their biological effects can be explored.

“You prolong the drug effect, and that is very critical for certain chronic disease conditions, including cancer therapy and regenerative diseases such as spinal cord injury,” Dr. Labhasetwar says.

In addition, nanoparticles can change the “biodistribution” of drugs, meaning that doctors can target key organs without healthy tissue being killed, a drawback of many current treatments. He points to the example of DOXIL®

(doxorubicin), an intravenous cancer treatment based on lipid nanoparticles that would be toxic to the heart were it not for nanotechnology.

He could cite examples from his own work on spinal cord injury too.

HELPING THE BODY HEAL ITSELFWhen the spinal cord is damaged, it triggers a cascade of reactions that progressively harm the spinal cord and bodily functions and eliminate mobility — reactions that seem irreversible today.

“Our goal is to block that cascade and let the body heal itself,” Dr. Labhasetwar says. “The body has a built-in mechanism to repair tissue, but it may not function if you cannot provide a healthy environment in which the body can respond.”

He and his colleagues work with special enzymes that can inhibit the damage caused by a spinal cord injury. The trouble is that these enzymes degrade within eight to 10 minutes of entering the body. They never even make it to the target tissue around the spinal cord.

BEING TINY IS NOT THE ONLY

THING THAT SETS

NANOTECHNOLOGY

APART FROM

OTHER FIELDS. THE

REAL ADVANTAGES

COME FROM HOW

NANOPARTICLES

BEHAVE.


16 catalyst | fall 2013 Tom Merce/Cleveland Clinic

WE SHOULD

BE USING

IMAGING TO GUIDE TREATMENT.

THE IDEA IS

THAT YOU CAN

HAVE AN IMAGE

THAT WILL TELL

YOU WHETHER

SOMETHING IS

CANCER, AND

THEN YOU CAN

FLIP THE SWITCH

OR TURN ON

THE LIGHT AND

DESTROY THE

TUMOR.

Enter nanotechnology. By incorporating these enzymes into nanoparticles in lab studies, Dr. Labhasetwar and colleagues have made a formulation that hits its target, then stays there long enough to help the body heal.

“We show that this particular formulation can release the enzyme in active form for 90 days,” he says. Not only that, but the particles are small enough to enter cells and release the healing enzymes over time. Because of these unique properties, treatment with nanoparticles eventually may help spinal cord injury patients regain mobility.

Lab studies have shown this method’s effectiveness. Next are safety studies and, if all goes well, clinical trials. Dr. Labhasetwar is seeking funding for safety studies, a major step

on the way to human trials. He is hoping that because there are no products of this kind for spinal cord injury, FDA approval may come more quickly than for other kinds of treatments. The process also may be attractive to commercial companies because it has additional potential uses, including treatments for traumatic brain injuries that affect everyone from soldiers and athletes to survivors of car crashes.

“If we are lucky enough, we might be able to get through in the next four to five years and put a product on the market,” he says.

IMAGES AND TREATMENTS, ALL IN ONESomeday in the near future, a woman may be able to have an MRI to identify possible breast

Vijay Krishna, PhD, and Stephen Grobmyer, MD

—Stephen Grobmyer, MD



Nano Numbers

1 nanometer: 1 billionth of a meter

$1.7 billion: The proposed budget for federal funding in nanotechnology for fiscal year 2014

$254 billion: The estimated size of the global market for nanotechnology as of 2009

$1 trillion: The estimated global market for nanotechnology by 2015

40-plus: The number of countries with nanotechnology activity

100-plus: The number of clinical trials underway using different nano-formulations

40-plus: The number of nano-based products already on the medical market

1 million times larger: The size of an ant compared with a nanometer

cancer and then have that cancer eradicated almost immediately.

This all-in-one approach is a dream of surgeon Stephen Grobmyer, MD, Director of Breast Services at Cleveland Clinic. Imaging technology has improved so much in recent years that it would be a shame not to pair it with treatment in real time.

“We should be using imaging to guide treatment,” Dr. Grobmyer says. “The idea is that you can have an image that will tell you whether something is cancer, and then you can flip the switch or turn on the light and destroy the tumor.”

The second part of this scenario is easier said than done, but it may become a reality thanks to collaboration between Dr. Grobmyer and biomedical researcher Vijay Krishna, PhD, of the Department of Biomedical Engineering. The two began their work together about eight years ago at the University of Florida and have since brought their program to Cleveland Clinic.

Their work takes full advantage of the unique properties of nanotechnology. In their case, they work with molecules known as polyhydroxy fullerenes (PHF), which are among the smallest of the small at 1.3 nanometers in size. In pure form, the fullerenes have been used in wear-resistant coatings for bowling balls and tennis racquets. However, fullerenes on their own could be toxic to humans because they are not water-soluble.

The solution: Make fullerenes water-soluble by modifying their structure. With this approach, PHF can be used in products including anti-aging creams and health drinks. Not only is it water-soluble, but it also has health benefits of its own because it is an antioxidant. Antioxidants help the body fight the cell damage that leads to disease.

But what most excites Dr. Grobmyer and Dr. Krishna is PHF’s potential for transforming cancer treatment because of its heat and sound-related qualities.

First, the heat: Dr. Krishna discovered that PHF generates heat with the use of low-intensity lasers (like those found in CD or DVD writers). This could prove useful in cancer treatments

that generate heat in tumors to destroy them. Current treatments are effective but are invasive, painful and have side effects because they require surgery or toxic chemotherapy.

PHF may change that. “We could inject [PHF] in the tumor and then shine the laser from outside the body, because we can use a near-infrared laser to penetrate the tissue a few centimeters deep,” Dr. Krishna says. “We can restrict the treatment to the tumor only. The healthy tissue is not damaged in any way.”

In lab studies using this technique, tumors decreased in size by half within just two hours. Dr. Krishna says the photothermal properties do much of the work, but the sound matters too — even if researchers are not entirely sure why. Shining a light on PHF generates acoustic shock waves, which help break up the tumor tissue.

Combine heat and sound, and PHF could become a powerhouse. And because it works with so many light frequencies, it could reach forms of cancer located deep in the body. Dr. Grobmyer and Dr. Krishna have collaborated with colleagues at MD Anderson Cancer Center in Houston on the use of radio frequency waves, which can penetrate deeply without causing damage to the body.

The possible benefits don’t stop there, though. To Dr. Grobmyer, imaging is a key factor. Because of its cage-like structure, PHF can carry other elements, including an agent used for MRIs.

“PHF has been developed independently as an MRI contrast agent, and it’s a very, very good one,” Dr. Grobmyer says. This means clinicians could use it to guide treatment precisely — and confirm in real time whether that treatment is working.

DIFFERENT NEEDS, DIFFERENT BACKGROUNDSAaron Fleischman, PhD, has been working on the science of miniaturization his whole career. Maciej Zborowski, PhD, studies ways of separating different cells in the body, both for research and for therapeutic treatments.

Put the two together, and you have the kind of multidisciplinary partnership common to


18 catalyst | fall 2013 Tom Merce/Cleveland Clinic

the field of nanotechnology. Just as the beauty of nanoparticles lies in their different behavior, the promise of nanotechnology comes in large part from the wide variety of backgrounds it encompasses. Engineers work hand in hand with medical researchers. Material manufacturers join forces with physicians.

In their case, Dr. Zborowski and Dr. Fleischman, both of the Lerner Research Institute’s Department of Biomedical Engineering, are working to better detect metastasis, the deadly spread of cancer. Together they have developed a technology that separates circulating tumor cells from healthy blood cells.

Identifying these circulating tumor cells is a good way to gauge metastasis. However, in the past, the search has been largely futile. Other techniques proved impractical when it came to finding these needles in extremely large haystacks.

Enter iron oxide nanoparticles and their magnetic properties. These particles bind so well to cells that they allow Cleveland Clinic’s biomedical engineering team to sort millions of healthy cells from the blood and examine what’s left with precision and speed.

“In normal, healthy donors, we can identify nearly all the cells in the blood,” Dr. Zborowski says. “But in metastatic patients, we see many unusual cells. It is these cells that interest us.” And thanks to nanotechnology, he and his colleagues can follow up on that interest.

Analyzing these rare cells would not be possible without collaboration, though. Dr. Zborowski provides the cell-sorting expertise, and Dr. Fleischman furnishes the know-how in fluid dynamics and mechanical systems. The system Dr. Fleischman uses helps make it possible for the various cells to remain separated for analysis.

Maciej Zborowski, PhD, and Aaron Fleischman, PhD

I FIRMLY BELIEVE

THAT WE ARE

WORKING

ON THE

TECHNOLOGY

OF TOMORROW

AND MAKING

IT HAPPEN

RIGHT NOW.

—Aaron Fleischman, PhD


19catalyst | fall 2013Science Photo Library/Glow Images

Although he never used the phrase “nanotechnology,” Nobel Prize–winning scientist Richard Feynman may have kicked off the nano revolution back in 1959. During his talk, “There’s Plenty of Room at the Bottom,” Feynman spoke of the promise of smaller and smaller devices and predicted that technology eventually could be the size of atoms.

Fast forward to 1999, and employees at IBM — long at the forefront of nanotechnology — used atoms to spell out the company’s name. Publicity stunt, perhaps, but it captured attention and imagination.

Government involvement and funding fell into place in 2000, when then-President Bill Clinton introduced the National Nanotechnology Initiative (NNI). This umbrella organization coordinates the highly varied research and applications work performed by the many participating government agencies. In addition, it helps boost business participation, a key component in a world where private funding can bridge the gap between research and development.

The U.S. government has provided nearly $18 billion in nanotechnology research funding since the NNI’s founding, and the field still is growing. In addition to medicine, nanotechnology is used in electronics, energy production, cosmetics, optoelectronics, magnetics, materials applications and much more.

“The initial investment launched a large number of fundamental science projects — from applied science to medicine to structural materials to electronics,” says National Nanotechnology Initiative Coordination Office Director Robert Pohanka, PhD. “And after approximately a decade of investment, a number of products are emerging. A recent report sponsored by the National Institutes of Health says that there are approximately 250 medical products either in clinical testing or actually on the market.”

At Cleveland Clinic, the Department of Biomedical Engineering has numerous nanomedicine projects in the works, says Department Chair D. Geoffrey Vince, PhD, who holds the Virginia Lois Kennedy Endowed Chair in Biomedical Engineering and Applied Therapeutics.

“The promise of nanomedicine is to get within the cells of the human body to affect specific areas without harming normal cells,” Dr. Vince says. “We already have seen remarkable results from nanomedical research targeting breast and brain tumors, spinal nerve repair and trauma from battlefield head wounds. Once we bring some of these promising nanomedical constructs to the point of commercial development, we can make a real and substantial difference to each patient our clinical colleagues treat.”

A B R I E F H I S T O R Y O F

N A N O“You only want the cells tagged with magnetic

particles to be pulled out by the magnetic process,” Dr. Fleischman says. “You don’t want mud.”

The team has published results on safety, but, like many other researchers in this promising but young field, they need funding to take it to the next stage of trials. Once again, the variety of potential applications may improve their odds of finding support. For example, they also are working with researchers at Case Western Reserve University on a magnetic process for malaria diagnosis. And they have published research on a screening test for biowarfare agents using Department of Defense funding.

“The days of researchers imagining what doctors want have been replaced to a great degree by people of different backgrounds working together on readily identified, unmet needs,” Dr. Fleischman says.

FUTURE TOOLSInterestingly, Dr. Fleischman and Dr. Zborowski take a similar approach to that of Dr. Grobmyer and Dr. Krishna by combining diagnostic and therapeutic tools. They believe their magnetic cell-sorting technique could lead to a tool that determines whether cancer chemotherapy is working.

There is overlap elsewhere too. In addition to his spinal cord injury work, Dr. Labhasetwar is involved in a number of nanotechnology projects for cancer treatment. Imaging is an important part of this work.

“If you use magnetic nanoparticles to deliver the drugs, you also can see where the particles are and how long they are lasting in the target tissue,” Dr. Labhasetwar notes.

Combining diagnosis and therapy into what are called “theranostic” agents for patients is bound to be appealing in an era in which efficiency and effectiveness are prized. Above all, though, it demonstrates the power and potential of nanotechnology to heal.

“I firmly believe that we are working on the technology of tomorrow and making it happen right now,” Dr. Fleischman says. “The direction of research that we are working on here is completely defined by improving a patient’s outcome. We want to give a clinician a method that will make a patient better more reliably, more quickly and less expensively.” �

“nanotechnology,” Nobel

A B R I E F H I S T O R Y O F

A N O



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Illustration: Glenn Pierce, McMURRY/TMG; Dr. Vince, courtesy of Cleveland Clinic

EACH YEAR, as many as 100,000 people in the United States are at risk of debilitating or lethal strokes or mini-strokes caused by narrowing or blockage of their carotid arteries. Yet, we currently have no reliable, noninvasive way of determining whether a patient with one of these conditions is likely to have a stroke.

The best technology in use today is carotid duplex ultrasound, which reveals the degree of blood vessel narrowing and the size and location of plaque causing a blockage — both key causes of stroke. But it cannot help predict a patient’s risk of stroke. This makes treatment challenging.

My lab is working to resolve this problem by using the least invasive means — external ultrasound — to determine the nature of the plaque.

We believe that the composition of plaque, whether of a fibrous material or cholesterol-based, indicates the risk of stroke. Our hypothesis is that cholesterol blockages are more dangerous than fibrous ones because they can burst. It’s also important to know the plaque’s composition because surgery to remove a blockage carries the risk of stroke, the very problem we are trying to prevent. If external ultrasound could determine the type of blockage, then the surgeon could

SEEING STROKES BEFORE THEY HAPPEN

see potential for this technology as a diagnostic tool that can guide therapy. It eventually may become part of a patient’s annual checkup. If the physician detects buildup in a patient’s arteries and determines that it is cholesterol, the physician would monitor that patient closely and tailor therapy accordingly.

Philanthropic funding can help further our development of this technology, which may avert strokes caused by unnecessary treatment as well as those arising from treatable blockages. Although the technology may be complex, the idea is simple: The more we know, the more lives we can save.

D. Geoffrey Vince, PhD, is Chairman of Biomedical Engineering in Cleveland Clinic’s Lerner Research Institute and holds the Virginia Lois Kennedy Chair in Biomedical Engineering and Applied Therapeutics.

decide whether an operation is necessary.

With all of this in mind, we are developing external ultrasound imaging that can detect certain frequencies arising from blockages and transmit them to a computer. Current technology produces only grayscale images, which are less reliable for predicting stroke than color images would be. To understand the difference, compare a black-and-white printout with a high-resolution color photo.

Our device, the size of a cellphone, scans the artery from outside the patient’s body. It sends images that the computer uses to produce a kind of map with colors indicating whether the plaque is fibrous or the more dangerous type, cholesterol.

We now are exploring the possibility of creating a database that will teach a computer to recognize plaque composition. We

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Our hypothesis is that cholesterol blockages are more dangerous than fibrous ones because they can burst.

By D. Geoffrey Vince, PhD

20-c3 Game Changer-Innov.indd 20 10/3/13 2:31 PM

Electrical stimulation can treat many disorders caused by dysfunctional cell “firing” — how cells

communicate via electrical and chemical signals. Such stimulation helps with Parkinson’s disease,

childhood dystonia, epilepsy, tremor, hearing and vision loss, and heart disease, and it’s being considered as

a treatment for spinal cord injury, headache, depression and Alzheimer’s.

Still, these therapies have limits. Metal-tipped electrodes are unsafe to use with magnetic resonance

imaging (MRI), and can’t always precisely target tissues.

A team of Cleveland Clinic researchers led by John Gale, PhD, of the Lerner Research Institute, is working

with colleagues at Massachusetts General Hospital on a potential solution: microscopic magnetic coils the

size of pepper flakes.

Electrode-free, these microcoils can overcome safety concerns and be precisely targeted. They are small

enough for many applications, Dr. Gale says.

Philanthropic support would help advance this research into human clinical trials, which Dr. Gale

anticipates within three years.

visit clevelandclinic.org/giving to learn more

Innovati on

Cellular structure: ArtBox/Glow Images; Microcoil courtesy of Cleveland Clinic

Electric, magnetic medicine

20-c3 Game Changer-Innov.indd 3 10/1/13 3:47 PM

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clevelandclinic.org/giving

Cleveland Clinic Catalyst is published by the Philanthropy Institute for friends and benefactors of Cleveland Clinic.

Cleveland Clinic, founded in 1921, integrates clinical and hospital care with research and education in a private, nonprofit group practice. Cleveland Clinic depends on the generosity of individuals, families, corporations and foundations to ensure its continued excellence in patient care, medical research and education.

Cleveland Clinic realizes that individuals would like to learn more about its particular programs, services or developments. At the same time, we fully respect the privacy of our patients. If you do not wish to receive any materials containing this information, please call us at 216.448.0226, fax us at 216.448.0678 or write to us at: The Philanthropy Institute, Cleveland Clinic, 3050 Science Park Drive, AC/322, Beachwood OH 44122.

catalystVolume 11 | Issue 2 Fall 2013

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