A PUBLICATION FOR ALUMNI & FRIENDS OF UMDNJ-ROBERT WOOD JOHNSON MEDICAL SCHOOL

SPRING 2008

A PUBLICATION FOR ALUMNI & FRIENDS OF UMDNJ-ROBERT WOOD JOHNSON MEDICAL SCHOOL

RobertWood Johnson � MEDICINE 19

UMDNJ-Robert Wood

Johnson Medica l

School passed important mile-

stones in the past year. This

special section highlights these

events and celebrates the people

whose achievements define

the history of the medical

school and create the founda-

tion for its future.

MilestonesRWJMSMilestonesRWJMSat

COURTESY

OFAbioC

or

6RobertWood Johnson � MEDICINE 21

SixYears Later— and the

Dust Hasn’tSettledAfter the attack on and resulting

collapse of the World Trade

Center, every component within its two

towers was pulverized — large amounts of

alkaline, massive amounts of paper, fibers

from windows, trace elements of asbestos,

and other toxic materials ground to pow-

der. Everything that had gone into those

proud edifices, every commonplace object

from pencils to computers, was reduced to

mountains of an environmentally haz-

ardous dust, the impact of which contin-

ues to threaten the health of those exposed

to it.

B Y R I T A M . R O O N E Y

P H O T O S B Y J O H N E M E R S O N

“We learned a lot,

though probably not as much

as we would have learned with

the luxury of time,” says Paul J. Lioy, PhD,

professor of environmental and

occupational medicine and member

of the Environmental and Occupational

Health Sciences Institute (EOHSI),

(right), with Jeffrey D. Laskin, PhD,

professor of environmental

and occupational medicine and

member of EOHSI..

22 Robert WoodJohnson � MEDICINE

I n the early days that followed 9/11, when virtually allthat remained was the dust, UMDNJ-Robert WoodJohnson Medical School researchers and clinicians

were among the first to react to the needs of survivors andresponders, and to assess the extent of environmental con-tamination. Since then, RWJMS teams have led efforts inthe identification of compounds that potentially could beused in terrorism attacks, and they are developing drugs tocounteract both chemical and biological threats. The dusthas yet to settle on the energies that propelled these single-minded trailblazers who worked swiftly to protect anuncertain future. Possibly, it never will.

First on the Scene

Years from now, when 9/11 historians look back tothe aftermath of the event, they may refer to Paul J.Lioy, PhD, professor of environmental and occupa-

tional medicine, as the father of human exposure science.For the past 30 years, Dr. Lioy, a member of theEnvironmental and Occupational Health Sciences Institute(EOHSI), a joint project of RWJMS and Rutgers, The StateUniversity of New Jersey, has worked to eliminate environ-mental hazards.

“It has given me a different sense of purpose,” he says.“Being at Ground Zero so soon afterward, and being theresince, has done that.”

Immediately after 9/11, Dr. Lioy and members of aUMDNJ E-Team, consisting of members of EOHSI and theUMDNJ-School of Public Health, were invited by the PortAuthority of New York and New Jersey to review the effectsof contamination. The National Institutes of Health (NIH)had asked him to get samples of the dust, and he did so, call-ing on colleagues across the country to assist him in analyz-ing the samples. Little did they know at the time that the samples would turn out to be enormously helpful in dealingwith what became known as the World Trade Center cough.His efforts, in collaboration with researchers at other institu-tions, established the scientific basis that explained theimpact of the contaminants on those exposed.

The U.S. Environmental Protection Agency (EPA) want-ed to know where the largest concentrations of dust were.The Lioy team determined that high concentrations con-tinued for 12 hours after the collapse, covering most oflower Manhattan and parts of Brooklyn. Further, Dr. Lioyand Panos Georgopoulos, PhD, professor of environmentaland occupational medicine and a member of EOHSI, led anEPA-sponsored effort to map the World Trade Centerplume for 31 days following 9/11. That information wasused in epidemiological studies determining whether specif-

ic individuals had been exposed and for how long.Dr. Lioy explains that the mixture with which they were

dealing was a complex one, with a significant amount ofvarious gases that had not been sampled, making irrefutableconclusions difficult.

“We learned a lot,” he says, “though probably not as muchas we would have learned with the luxury of time.”

More recently, Dr. Lioy and Dr. Georgopoulos have beenworking with the U.S. Department of Veterans Affairs in devel-oping a plan to triage emergency patients following chemicalexposure. A mathematical model and a series of protocols arebeing designed for various situations, among them an instancein which a chemically exposed patient becomes a source ofexposure to health care workers.

In another experiment, for the U.S. Department ofHomeland Security, Dr. Lioy’s team participated in the sim-ulated dispersal of gas at two Manhattan locations,Madison Square Garden and Rockefeller Center. Severalexposure simulations, with people assuming the roles of vic-tims — those trapped and those getting away — andresponders, helped chart the actual time and aerial exposureduring an attack drill. The hope is that these kinds of exper-iments can be translated into a prescription for action in theevent of a real attack.

Dr. Lioy contends that there is a need to develop exposure-science measurement tools and strategies for event pre-paredness, and his laboratory is working with various gov-ernment agencies to establish such guidelines.

“In the aftermath of an event like 9/11, you soon realizethat excessive analysis can lead to paralysis,” he says. “Youhave to make quick judgments because there are so manyvariables.”

He adds, however, that the events of 9/11 need to be placedwithin the appropriate context for the future, so that theworld will not have to relearn the hard lessons of that day.

Anthrax Confrontation

One month after the fall of the towers, a telephonecall from Parvaiz Malik, MD, chair, Department ofSurgery at Robert Wood Johnson University

Hospital, Hamilton (RWJUHH), to the hospital’s chief ofpathology, Janusz J. Godyn, MD, professor of pathology andlaboratory medicine, sounded the alarm signaling a possibleterrorism plot using anthrax. The physician had treated anon-healing lesion in a female employee of a local PostalService facility, and called Dr. Godyn to rule out cutaneousanthrax. The tissue was sent to the Centers for DiseaseControl and Prevention (CDC), and a positive result forBacillus anthracis antigen was publicly announced shortly

thereafter. A few days later, it was announced that two addi-tional postal employees at that facility were suffering fromsymptoms of anthrax infection.It was later determined that while no specific anthrax-

contaminated letter had been identified in New Jersey, such let-ters mailed to Manhattan and the District of Columbia hadpassed through the processing and sorting facility in Hamilton.

“Of course, we had to work fast, and we couldn’t affordany margin for error made by hasty decision-making,” Dr.Godyn says. “One of the first questions we had was whetheror not we should include nasal swab cultures to determineanthrax exposure.” He reports that no official recommendations for such cul-

tures had been made by the CDC or the New Jersey

RobertWood Johnson � MEDICINE 23

.The bottom line, as far as Janusz J. Godyn, MD, professor of

pathology and laboratory medicine

and chief of pathology at Robert

Wood Johnson University Hospital,

Hamilton, and his colleagues were

concerned, was that the community

looked to its hospital to take

responsible action, and they weren’t

about to fall short of those

expectations..

24 Robert WoodJohnson � MEDICINE

Department of Health and Senior Services, although theswabs had been offered to federal employees in the HartSenate Office Building in Washington, D.C., during an ear-lier threat.

“At the time, no one had clear-cut answers regarding theeffectiveness of nasal swabbing,” Dr. Godyn says. “But wewere dealing with a highly emotional and potentially haz-ardous issue, and we didn’t want to take chances.”

The bottom line, as far as Dr. Godyn and his colleagues atRWJUHH were concerned, was that the community lookedto its hospital to take responsible action, and they weren’tabout to fall short of those expectations. Protocols for per-forming and examining nasal swab cultures, according toexisting guidelines, were approved during a phone conversa-tion between Dr. Godyn and a CDC microbiologist in chargeof anthrax contamination. The cultures were initiated with-out delay, and received additional commendation by a CDCteam visiting the hospital during the crisis. More than 1,300cultures were performed on postal employees and othersduring the first few days alone. Help in administering thecultures later came from other local hospitals and RobertWood Johnson University Hospital, New Brunswick.

As a result of the confirmation of anthrax exposure, allpostal workers from the Hamilton postal site were offeredup to a 30-day supply of ciprofloxacin, an antibiotic usedto treat or prevent bacterial infections including anthrax.Ciprofloxacin works by killing the bacteria.

When the crisis ended, it was determined that resultsfrom nasal swab examinations did not provide additionalclinical information. The process did demonstrate conclu-sively that the test does not detect infection in an examinedpopulation, and therefore probably isn’t useful in future sit-uations. As Dr. Godyn points out, it is the existence ofexposure, not a laboratory result, that justifies treatment.However, the uncompromising decision of the hospital toimplement nasal swabs provided the community with need-ed reassurance during a period of fear and uncertainty. Nonew cases of anthrax contamination were reported follow-ing the hospital’s intervention and precautionary adminis-tration of ciprofloxacin.

In the Research Laboratory

A$19.2 million NIH grant brings to mind severalstrong terms. Sizable is one. Imperative is another.Both words apply to the five-year award granted to

RWJMS, Rutgers University, and the Health SciencesProgram at Lehigh University, for the creation of a Center ofExcellence to develop medical countermeasures againstchemical threats. Led by Jeffrey D. Laskin, PhD, professor of

environmental and occupational medicine and a member ofEOHSI, the CounterACT (Against Chemical Threats)Research Center is developing drugs as potential new thera-pies to be used in the event of a chemical attack. Dr. Laskinis joined by Donald Gerecke, PhD, professor of pharmacol-ogy and toxicology, Ernest Mario School of Pharmacy,Rutgers University, as co-director.

Dr. Laskin reports that the group’s first target is poison-ing by sulfur mustard, a powerful chemical warfare vesi-cant, or blistering agent, used in World War I and duringthe more recent Iran-Iraq war. He points out that the gov-ernment believes it is more likely that a future attack willresult from a chemical threat than from any other, becausechemicals provide easier access than nuclear or biologicalmaterials.

“We’re optimizing lead compounds to determine whichmolecules are medically active against sulfur mustard,” hesays. “We already have come up with some test drugs thatcan be used. Further testing is needed to assure effective-ness, and once we get beyond that stage, we have plans tobring the drugs to the Federal Drug Administration (FDA)for approval.”

Whereas drug development generally is a slow process thatbecomes even more painstaking due to the protracted periodduring which approval is secured, the government’s ProjectBio-Shield has given CounterACT and similar projects highpriority, and the FDA will actively participate in the approvalprocess. Because any of the drugs formulated will be used fordefense only, and not for the general market, certain regula-tory steps can be eliminated.

A primary advantage at the center is that the team has notonly the ability to identify compounds that can be used, butalso the pharmaceutical resources and talent to develop thedrugs themselves. Undoubtedly, such resources underline theconsiderable grant that provides for a comprehensive pro-gram from drug discovery through drug testing. Projects alsoare under way to detect mechanisms of action within sulfurmustard, and targets for therapeutic intervention if thechemical attacks eyes, skin, and lungs, which it has thepotential to do.

“Ultimately, we will be targeting additional chemicalthreats,” Dr. Laskin says. “Sulfur mustard is an importantone because of its availability to a potential enemy, andbecause, although it has been studied for more than 80years, no effective countermeasures have been found. Inaddition to the value of finding a therapeutic agent againsta chemical attack, an effective anti–sulfur mustard drugwould be valuable in the event of industrial accidents andother instances.”

RobertWood Johnson � MEDICINE 25

He adds that some of the chemical poisons on the team’sagenda include nerve gas, chlorine gas, and metabol-ic/cellular poisons such as cyanide. In addition to drugdevelopment activities, the center is directing a training andeducation program to health care providers at RWJMS, theUMDNJ-School of Public Health, Rutgers University, andthe Health Sciences Program at Lehigh University.

Dr. Laskin says the center is one of onlyfour such programs in the country, and one ofonly three involved in sulfur mustard studies.

“I believe that we are in an ideal position totake on a program of this magnitude,” he says.“To begin, we have the infrastructure on site,with university-wide programs in preparednessactivities that align with ours. We have avail-able collaboration from the pharmacologydepartment at RWJMS, and the pharmaceuti-cal and pharmacology and toxicology depart-ments at Rutgers. Thanks to our location inNew Jersey, where we are surrounded by lead-ing pharmaceutical companies, we have thesupport of major firms willing to help in thiscritical endeavor.”

A National Landmark Project

First there was the highly competitive $5 million EPA grant establishing theonly National Center of Excellence for

Environmental Bioinformatics and Predictive Toxicology.Then came the more recent $1.4 million award from theDefense Threat Reduction Agency of the Department ofDefense (DOD) to develop and apply advanced computa-tional tools to predict and characterize potential chemicaland biological warfare agents. Both projects are headed byWilliam J. Welsh, PhD, Norman Edelman Professor inBioinformatics and Computer-Aided Molecular Design, pro-fessor of pharmacology, and director, UMDNJ InformaticsInstitute. Both underline the substance and seriousness of homeland security activities undertaken by RWJMSresearchers.

“We’re profiling chemicals and nerve agents in much thesame way airlines do profiling of passengers,” Dr. Welshsays. “We’re using computational tools to hopefully iden-tify possible threats to our national security.”

He explains that his laboratory’s computational toolscan rapidly screen massive databases in which a large col-lection of chemicals can be characterized according to theirstructure and properties. The same battery of computa-

In theClinic

I ris Udasin, MD, associateprofessor of environmen-tal and occupational med-

icine and a member of EOHSI,is someone whose work

reflects a compassion that hasbecome intrinsic to her missionas physician. As the New Jerseyprincipal investigator of theWorld Trade Center MedicalMonitoring and TreatmentProgram, Dr. Udasin runs anRWJMS clinic that continues totreat 40 to 50 respondersmonthly. Funded at $1.3 mil-lion by the National Institute ofOccupational Safety and Healthof the CDC, the clinic servesworkers who were on thescene during and following thedevastation of the towers.Among them, many of whomwere volunteers, are construc-tion and communication work-ers, building tradespeople, fire-

fighters, and law enforcementand health care personnel.Dr. Udasin, who testified

before Congress in September,outlining the condition ofWorld Trade Center responders,reports that, six years after thetragedy, more than 60 percentof her clinic’s patients continueto suffer serious conditions. “One 39-year-old previously

healthy man came to the clinicwith severe shortness of breathand a chronic cough,” she says.“His original diagnosis waspneumonia. After receiving sev-eral courses of antibiotics thatresulted in no relief of hissymptoms, a biopsy of hislungs was performed, whichproved to be consistent withsarcoidosis. Today, he takesthree prescriptions for his ill-ness, and unfortunately, he stillis disabled and cannot returnto his work as a police officer.”She suggests it is painful to

think of the hundreds like himwhose lives have been shat-tered by their response to duty.Asked about the frustrationsand rewards of her work, shesays she often becomes dis-couraged by the lack of aware-ness among people who don’tappear to understand the con-tributions of 9/11 responders.“These are heroic people,”

she says. “They weren’t therebecause they were New Yorkersor because they came fromNew Jersey. They were there fortheir country.” As for rewards,she says she feels justlyrewarded every time she cantell a patient his or her illnessis treatable.“I can’t always say that to a

patient,” she says. “But when Ican, well, those are very spe-cial times for me.”

“When I can tell a patient his or her illness is

treatable, those are very special times for me,”

says Iris Udasin, MD, associate professor of

environmental and occupational medicine and a

member of EOHSI ..

MM