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Neurocritical Care Researchers and the Road to Career Development Awards

By Currents Editor posted 01-03-2019 14:35

Lauren_Koffman_Headshot.jpgBy Lauren Koffman

This is the first installment in a Currents series that will feature neurocritical researchers who have been awarded career development awards, or K awards. Each person was asked to describe their research background, experience with the application process and a bit about their research project.

Jonathan Elmer, MD, is at the University of Pittsburgh Medical Center and says that writing the first draft of the grant was a learning experience but fun. Dusting the application off a year later to revise and respond to the pink sheet was painful. The novelty had worn off and the novel science already felt a bit like old news. He started dabbling with clinical research as a resident with a grant from the Emergency Medicine Foundation.

“I wasn’t good at it and didn’t like it. As a fellow, I completed a master’s degree in clinical research and discovered that research was a lot more fun when done right. I transitioned from my fellowship program onto an institutional K12 from NHLBI, which was really instrumental in allowing me the time to develop both my science and me to a point where both were ready for an independent K.”

His grant explores quantitative EEG after cardiac arrest. “We’re working to develop new analytical tools capable of transforming this complex, longitudinal data into clinically actionable knowledge. In Aim 1, we’re trying to identify non-invasive qEEG signatures of secondary brain injury, validated against invasive multimodality monitoring as our gold standard. In Aim 2, we’re developing multidimensional trajectory models of qEEG over time and testing whether these models shorten the time to an accurate prognosis when added to conventional methods.”

Christopher Anderson, MD, practices at Massachusetts General Hospital and recently pursued a K-R transition. “The K23 application process was straightforward but requires attention to detail, particularly as it pertains to the interaction between your research plan and your career development plan. A first-rate mentor is a key component, and the more developed their track record in academic mentorship, the better. K awards are really about the PI-mentor team, and I think one mistake people make is paying too much attention to their research strategy rather than the other critical components of the application.”

He completed a formal research fellowship at Massachusetts General Hospital and the Broad Institute between residency and a critical care fellowship. “A dedicated post-doctoral fellowship was critical to my funding success. Following my critical care fellowship, I received an AAN CRTF, followed by my K23 and some institutional awards. During my K23, I also obtained a master’s degree in translational investigation from Harvard Medical School and performed a second post-doctoral research fellowship at Biogen Inc. I received my first R01 in the fourth year of my K23. I am also a PI of an AHA Strategically Focused Research Network in Atrial Fibrillation, studying the utility of polygenic risk scores in clinical practice for stratification of atrial fibrillation risk in cryptogenic stroke.”

His research program is based on the population genetics of ischemic and hemorrhagic stroke. His AAN award studied genetic variants involved in the pathways serving mitochondrial bioenergetics and their associations with small vessel ischemic stroke and non-lobar intracerebral hemorrhage. “My K23 built on my track record in pathway-based genome wide analyses, focusing on genetic influences on lipid levels and their role in intracerebral hemorrhage risk and recurrence. In my R01, I am studying whole genome sequencing data to perform fine-mapping of genome wide association study signals, with gene-editing of leading signals to identify cellular phenotypes.”

Raj Dhar, MD, from Washington University School of Medicine says he did not apply in his first few years as neurocritical care faculty until was able to obtain permanent U.S. residency (after training in Canada) but was able to obtain AHA grant in the interim (as well as foundation award) to start a research career.

“Persistence pays off. I had prior K23 application on a different project and with a different mentor that was not funded and started work in a new area with a new mentor, which led to an institutional KL2 grant for two years.” He obtained preliminary data prior to successful submission of K23 grant about two years ago but describes it as a long journey. Resubmission was required as the first application did not reach a fundable score, but was he able to respond to critiques including more relevant training and improving the focus on mechanisms (genetics) rather than clinical (prediction). He had no formal research training prior to or during fellowship, but the KL2 grant included significant research training including a focus on genomics (which was related to his research project), ultimately leading to Master of Science in clinical investigation degree at Washington University in St. Louis.

The overall goal of his project is to identify genetic markers that explain variability in rate of cerebral edema formation after ischemic stroke. The primary aim is to create and validate an imaging endophenotype that captures the dynamic change in edema formation over the first few days after stroke. “We are integrating automated image analysis (using machine learning on thousands of serial head CTs) to measure rate of edema formation with genomic data on this same large cohort of stroke patients to identify which genetic variants explain the heterogeneity in cerebral edema. This will both aid in the early prediction of malignant cerebral edema as well as identify potential targets for drug development to prevent or minimize edema formation."

#NCSRoundup #December2018 #LaurenKoffman 

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