Progress ReportReports of the Vice Chairmen

Research and Information Systems
Henry M. Spotnitz, MD

Henry M. Spotnitz, MD Vice Chairman Research & Information Systems

The key to a successful program in Translational Research is a creative dialogue between physicians and scientists of different talents and disciplines. Two divisions in the Department of Surgery encourage this exchange: Surgical Sciences under the direction of Ann Marie Schmidt, MD and The International Center for Health Outcomes and Innovative Research (INCHOIR) under Annetine Gelijns, PhD and Alan J. Moskowitz, MD. Both have impressive track records in innovation.

INCHOIR's NIH-supported REMATCH trial established the benefits of left ventricle assist devices for patients with end-stage heart disease and led to Medicare reimbursement for implantation. The Center is currently initiating a trial of third generation devices and has also received a $17 million SCCOR grant to study infection, coagulation, and the use of stem cells to regenerate the hearts of LVAD patients.

INCHOIR has also obtained a $7 million grant from the Agency for Healthcare Research and Quality (AHRQ) to focus on patient safety and methods of reducing medical errors. And as the lead institution in the Columbia-Stanford Consortium on Medical Innovation, INCHOIR explores the economic drivers of national healthcare policy, advocates training a new generation of physicians in the interdisciplinary aspects of research, and shares its studies of medical innovation with international healthcare agencies.

Surgical Sciences is cooperating with industry on the production of new pharmacologic agents involved in anticoagulation, novel treatments for Alzheimer's, vascular disease, colon and breast cancer, and arthritis, based on the RAGE protein (Receptor for Advanced Glycation Endproducts).

Our Division of Abdominal Organ Transplantation is investigating the role of RAGE in liver diseases. And in the coming year, investigators will study the role of RAGE and the polyol pathway in aging and cardiovascular disease.

Surgical Sciences researchers are also developing a variety of cancer vaccines, an anti-angiogenesis approach to solid childhood tumors, and new techniques of anticoagulation based on factor IX antagonists.

Our research portfolio extends from basic science to clinical trials of new treatments and surgical devices.

The Center for Innovative Cancer Management is engaged in groundbreaking research, testing tumor vaccines for metastatic kidney cancer and melanoma, and exploring ways to prevent tumor recurrences in colorectal cancer patients.

Columbia's transplant specialists are assessing immunosuppressant drugs designed to prevent kidney transplant rejection, cellular and immune therapies against Type I diabetes, and the results of islet cell transplantation.

A promising approach to pancreatic cancer now allows surgeons to perform resections in a substantial number of patients who were previously considered inoperable. This discovery has led to a multi-center clinical trial.

Other important studies include the CABG Patch Trial of the implantable defibrillator and assessments of the Evalve system for mitral valve repair, biventricular pacing of acute heart failure for patients after open-heart surgery, radiofrequency ablation for the treatment of arrhythmia, and robotic surgery.

Other trials focus on minimally invasive techniques refined or developed here at Columbia—Carotid Artery Angioplasty and Stenting, an alternative method of stroke prevention, a Thoracic Aortic Stent-graft for patients with thoracic aortic aneurysms, an Endobronchial Valve for Emphysema Palliation (the VENT trial), and the LAP BAND® for patients who are not considered morbidly obese.

In the area of General Surgery, researchers are exploring wound healing, cancer immunotherapy and the immunological aspects of minimal access surgery.

At present, the Department is conducting more than 60 sponsored clinical trials and many investigator initiated studies. To support this broad spectrum of research, we developed LabPlan®, a database that correlates funding for the entire medical school. Informatics specialists also created an Internet-accessible, HIPAA-compliant database for the management of surgical wounds, and a second database for the management of vascular surgery patients.

We hope to increase applications of medical informatics in the operating room, including use of heads-up displays, similar to fighter pilots' screens, to provide real time access to hemodynamic data, ultrasound images, angiograms, lab results, and clinical profiles. This project is a prime opportunity for collaboration with industry.

Surgeons of the future will perform more minimal access and robotic procedures and increasingly practice remote telemedicine. Columbia is positioned as a leader in these emerging fields.