CD&Ds

In an effort to promote the Georgia life sciences sector, a coalition made up of counties and organizations is involved in the formation of a branding campaign for Georgia's Innovation Crescent.

The state has dubbed the Athens-to-Atlanta life science area Georgia's Innovation Crescent region and given it the tagline "Where Life Science Grows." Athens is home to the University of Georgia, Atlanta to Georgia Tech, Emory University, Georgia State University and other institutions.

This initiative, which is the Peach State's first regional branding campaign for the life sciences corridor, is geared toward providing workforce training for Georgia's burgeoning life sciences industry and shining a spotlight on the sector. Its management group is headed up by the Innovation Crescent Regional Partnership, which is comprised of 18 counties and organizations — and is a way to foster and draw in new business, as well as support existing business within the state.

The regional crescent effort focuses on a 13-county region which spreads from Cobb County east to Oglethorpe County and includes Atlanta and Fulton, DeKalb, Clayton, Gwinnett, Barrow, Jackson, Walton, Morgan, Oconee, Athens-Clarke and Madison counties.

"We think that by coming together it's going to make for a better marketing experience," Bill Davis, business development manager of healthcare & life sciences at the Gwinnett County Chamber of Commerce. "Let's say a company is looking for a place to start up a processing lab and Gwinnett is unavailable to help the company with its needs. Through the (initiative) I can say I can't help you in Gwinnett, but my colleague in Cobb County can."

Primary organizers of the effort consist of regional leaders from local chambers of commerce and economic development organizations across the metro area plus Georgia Bio (Atlanta) the Atlanta Regional Commission and the Georgia Department of Economic Development.

"The group has been meeting for sometime now to develop a marketing strategy to promote the sector," Cinda Herdon-King, a director for education programs at Georgia Bio, told Cardiovascular Devices & Drugs. "Unofficially we've been meeting for about a year but we just recently launched this branding campaign."

"The goal of the marketing campaign is twofold," said Ed Graham, project manager for the Innovation Crescent Regional Partnership, in a press release. "First, it serves to cluster the region's life science resources and more effectively promote the regions assets, marketing them to new businesses. And, second, it builds a brand position for Georgia's Innovation Crescent that recognizes the region as a hub of life science talent."

Most importantly, it gives the crescent a sort of unity — and puts respective counties all on one page when it comes to attracting business. In time, the crescent wants to rival the unity of Research Triangle, a large med-tech sector in the Piedmont region of North Carolina.

"Look everyone talks about the Research Triangle," Herdon-King told CD&D. "But no one can tell you about what counties make up the Research Triangle. Yet it's one of the most powerful life sciences sectors in the country. That's what we're aiming for here. We want to develop into a powerful force ... together."

North Carolina and Florida remain as two sterling examples of what can happen when the counties and communities have a strong lifesciences marketing strategy in place.

North Carolina has a state-funded Biotechnology Center that is a private nonprofit corporation that promotes biotech research, business, and education statewide. The center, which employs 69, operates on a $17.6 million annual budget, $13.1 million of which comes from the state.

Florida has a great deal of support as well, garnering $1 billion that is poured into subsides to attract academic research institutes as anchor employers of a biotech cluster created by Florida legislators.

"After we started researching this, we found out we have just as many life sciences companies as the Research Triangle," Davis said. "We just haven't been marketing our sector for 25 years like they have. We want companies who're thinking about coming to the South to think of the Innovation Crescent in the same way as they would the Research Triangle."

The Peach State may be close to becoming a life science sector powerhouse.

According to a recent Ernst & Young (New York) study, Georgia leaped to seventh place from 11th in the total number of life science companies in the country. The state's biotech industry also accounts for more than 15,000 jobs, a payroll close to $1 billion and product sales of $7 billion. To date, the more than 250 biotech businesses call Georgia home and the biotech industry alone has grown more than 140% throughout the last 10 years.

Among the leading life sciences companies in the crescent are Ciba Vision (Duluth); UCB (Alpharetta); Merial (Duluth); Solvay Pharmaceuticals (Marietta); Kimberly-Clark Health Care (Roswell); Immucor (Norcross); CryoLife (Kennesaw); Theragenics (Buford); OPTI Medical Systems (Roswell); and CardioMEMS (Atlanta).

"It's going to be a learning curve," Davis said. "Our first year is establishing the brand and when BIO [the huge annual conference of the Biotechnology Industry Organization] comes to Atlanta next year — hopefully we'll be able to hit the ground running."

'Stereoscopic' gaming offers view inside heart

In an NIH-funded study featured in the June Journal of Thoracic and Cardiovascular Surgery, cardiac surgeons from Children's Hospital Boston report good results with a technology borrowed from the gaming industry to perform beating heart surgery on babies: stereo glasses. Specifically, the system was developed for surgery to correct myocardial bridging (MB).

MB occurs when the heart is malformed, with a bridge of muscle fibers overlying a section of a coronary artery, usually the left anterior descending (LAD) artery. When the heart beats, the artery is squeezed and normal blood flow is disrupted during both the pumping and relaxed cycles. This can produce signs and symptoms similar to coronary artery disease primarily the result of the entrapment/constriction of this artery. MB has been linked to a variety of conditions, including heart rhythm abnormalities, heart attacks and even sudden cardiac death.

The researchers, led by Pedro del Nido, MD, and Nikolay Vasilyev, MD, of the department of cardiac surgery at Children's, had been testing a 3-D ultrasound imaging system, but these images, even displayed in real time, provided little true indication of depth, and in animal tests, surgeons trying to navigate surgical tools inside the heart became disoriented when guided by these images. Del Nido, chief of cardiac surgery at Children's, says that he needed more than 3-D vision.

Watching the flat picture on the computer screen was like watching a baseball game on TV, he said. "It's good enough to follow what's happening in the game, but you could never grab a ball in mid-flight." And he and collaborators developed a stereoscopic vision system.

Research partner Robert Howe, PhD, of Harvard University (Cambridge, Massachusetts), borrowed a solution from video games, splitting computer images in two and cocking them at slightly different angles. When wearing gamers' flickering glasses, users can see ultrasound images of the beating heart as a hologram. "You definitely have depth perception," says Vasilyev. "You feel like you're inside the heart chamber."

Vasilyev tested the glasses to operate on pigs with atrial septal defects, closing the defects using a catheter and carrying a tiny patch, threaded into the heart through a vein, then fastening the patch around the hole with tiny anchors. In all, he placed 64 anchors: 32 using standard 3-D ultrasound guidance, 32 using the stereoscopic display.

Using the stereoscopic system, Vasilyev placed the anchors 44% faster than with the standard display (9.7 vs. 17.2 seconds). The tip of the anchoring device also navigated more accurately deviation from the ideal path averaged 3.8 mm, compared to 6.1 mm, a 38% improvement.

The accuracy of anchor placement didn't differ significantly between the two sets of tests, Vasilyev said, acknowledging his experience with procedure and the availability of tactile information to help guide the final step of driving in the anchors. However, the speed of the anchor placement improved significantly. The researchers believe that the ability to precisely navigate tools inside the beating heart will minimize risk to neighboring heart structures.

Clinical trials of beating-heart surgery with the patching system could begin in children with atrial septal defectss this year, Vasilyev said.

The real-time stereoscopic visualization system was designed to handle and render 30MB of data every second. The renderer was implemented on a GeForce FX 7800, developed by nVidia (Santa Clara, California).

Better diagnostic classification for MB

In other research focused on myocardial bridging (MB), researchers at Cedars-Sinai Medical Center (Los Angeles), the University of Texas Medical Branch (Galveston) and RWTH Aachen University (Aachen, Germany) report the development of a new classification system that may help guide decision-making for this procedure.

Ernst Schwarz, MD, PhD, a cardiologist at Cedars-Sinai's Heart Institute, is the first author of an article describing the system, in the June 25 online edition of Cardiology. Though MB, as noted above, has been linked to various serious cardiovascular conditions, it often is harmless and no treatment is required. "There has been no universally accepted protocol to determine whether a patient with myocardial bridging requires therapy, or which option is best in each case," the researchers said.

The study was designed to better understand the usefulness of various diagnostic tests to help doctors select the best treatment for MB patients.

The study included 157 patients who had MB and no evidence of other heart disease or coronary artery disease, considered the largest group of MB patients and, with a five-year follow-up, the longest observation period described in the medical literature. Another 100 patients without MB, artery disease or other heart disease made up a control group.

The researchers reviewed the patients' histories for symptoms of typical angina (chest pain during stress with relief at rest); atypical angina (non-exertional chest pain); non-specific symptoms, such as palpitations and fatigue; or no symptoms. They evaluated results from non-invasive tests, such as EKGs, exercise stress tests or nuclear SPECT scans, angiograms and invasive tests measuring different hemodynamic parameters using microtransducers within the arteries of the heart.

They found that clinical symptoms, EKGs and non-invasive stress tests are not specific for diagnosing MB, but that in MB patients, clinical symptoms correlated with results from qualitative coronary angiography (QCA) and blood flow studies such as intracoronary Doppler and intravascular ultrasound.

"In our classification system, we incorporated clinical symptoms and results of both non-invasive and invasive diagnostic tests. Qualitative coronary angiography and intracoronary Doppler hemodynamics were able to assess the functional significance of myocardial bridging," Schwarz said.

The researchers placed the MB patients into three categories: 58 in class A, having clinical symptoms but no objective signs of ischemia; 62 in class B, having clinical symptoms and objective signs of ischemia by non-invasive stress tests; 37 in class C, having clinical symptoms and objective altered intracoronary hemodynamics, based on angiography and intracoronary Doppler, with or without signs of ischemia by non-invasive stress tests.

Based on initial observations and five-year follow-up, the cardiologists propose a new diagnostic work-up and therapeutic strategy:

• Type A: No further diagnostic work or therapy needed. Nitrates should be avoided.; in rare cases, beta-blockers might be considered temporarily to relieve symptoms.

• Type B: Initiate beta-blockers or calcium channel blockers. If symptoms are not relieved, quantitative coronary angioplasty or invasive blood-flow studies should be performed, after which stenting may be considered if there is objective evidence of reduced blood flow to the heart muscle.

• Type C: Initiate beta-blockers or calcium channel blockers. If symptoms are refractory, consider stenting of the bridged segment.

"One of the our most important recommendations is that Type C patients — those with hemodynamic changes — always be treated, regardless of results of non-invasive stress testing," Schwarz said.

Study raises estimates of 'silent' strokes

About 10% of apparently healthy middle-aged participants with no symptoms of stroke had experienced "silent strokes," researchers report in Stroke, a journal of the American Heart Association (Dallas). Silent cerebral infarction (SCI), or silent stroke, is a brain injury likely caused by a blood clot interrupting blood flow in the brain. It's a risk factor for future strokes and a sign of progressive brain damage that may result in long-term dementia.

"The findings reinforce the need for early detection and treatment of cardiovascular risk factors in mid-life," said Sudha Seshadri, MD, co-author of the study and associate professor of neurology at Boston University School of Medicine. "This is especially true since SCIs have been associated with an increased risk of incident stroke and cognitive impairment."

Researchers evaluated MRI scans from about 2,000 people, average age 62, who are part of the Framingham Offspring Study (children of participants in the original Framingham Heart Study). The offspring have undergone clinical examinations every four to eight years.

Among patients who displayed no symptoms of stroke, 10.7% had SCIs on routine brain MRI, researchers said. Previous estimates of SCIs ranged from 5.8% to 17.7% depending on age, ethnicity and other issues. Of those in the study with SCIs, 84% had a single lesion.

The study is the first to correlate the total score of the Framingham Stroke Risk Profile to prevalence of SCI. The risk profile estimates the 10-year probability of having a stroke. The factors in the profile are age, systolic blood pressure, antihypertensive therapy, diabetes mellitus, cigarette smoking, cardiovascular disease, left ventricular hypertrophy and atrial fibrillation (AF).

All the components of the Framingham Stroke Risk Profile were associated with an increased prevalence of SCI, for the first time showing a significant correlation between AF and silent cerebral infarction. "In our data, AF increased the risk of prevalent SCI more than two-fold," Seshadri said. Hypertension and systolic blood pressure were also associated with an increased prevalence of SCI.

Risk factors for stroke also are risk factors for AF. Hypertension and other factors that make it more likely individuals will experience AF also predispose those people to clinical stroke and probably to SCI. AF, therefore, may be a simultaneous outcome rather than a cause of SCI, researchers said.

The observational data could not indicate if screening for and appropriately treating AF would reduce the population burden of silent stroke, researchers said.

The study also found that high systolic blood pressure, hypertension and elevated levels of blood homocysteine, a sulfur-containing amino acid found in the blood, were other risk factors commonly associated with stroke that also raised participants' chances of having SCI. Hypertension consistently has been implicated as a risk factor of SCI. Neither age nor gender significantly changed the effect of any of the risk factors on SCI.

"The significant relationship between hypertension, elevated serum homocysteine, carotid artery disease and prevalent SCI underscores the importance of current guidelines for the early diagnosis and prevention of hypertension and atherosclerosis and their risk factors," Seshadri said.

Scans are heart disease predictor in elderly

Measuring calcium deposits in the heart's arteries can help predict overall death risk in American adults, even when they are elderly, according to a study in the July issue of the Journal of the American College of Cardiology.

Matthew Budoff, MD, a study author and researcher at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed), said previous studies had found measuring coronary arterial calcium with computed tomography (CT) heart scans could predict overall death risks in most American adults. He said the latest study is the first extensive examination of coronary arterial scans of the elderly.

"This study indicates calcium scans can be the best predictor currently available to detect who is likely to suffer a heart attack and who is not," said Budoff. "Previous studies found coronary arterial calcium scans were effective tools for determining the overall death risk in young adults, diabetics, smokers and those suffering from renal failure. This study indicates coronary arterial scans are effective in measuring overall death risk in the elderly."

A calcium scan looks for calcification — hardening of the arteries caused by high blood fats and calcium deposits — in the arteries leading to and from the heart. These calcifications can block blood vessels and cause heart attacks, strokes or other health issues.

Researchers studied 35,383 adults, aged 40 to 80, in Torrance, California, and Nashville, Tennessee, for an average of 5.8 years after having a coronary artery calcium scan. Among these research volunteers, 3,570 were age 70 or older. In total, 838 deaths were recorded, 320 in women and 518 in men. The study found the overall death risk was higher among those with higher coronary arterial calcium scores.

"This study provides additional validation of coronary calcium studies," said Budoff. "Coronary arterial calcium scans can be very useful tools in assessing a patient's overall death risk. With this information, physicians can advise patients on diet, medications, exercise and other lifestyle changes that will help them avoid the risk of heart attack, strokes and other health problems."

LA BioMed is an independent institute academically affiliated with the David Geffen School of Medicine at UCLA.