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00:13So, I've been at The Ohio State University for five years, and during that time, we've
00:19introduced over 30 new multidisciplinary precision neurology clinics, and some of these are unique.
00:28These clinics include, for example, a young onset dementia clinic.
00:34This is for people who develop cognitive symptoms before the age of 60, and the clinic is staffed
00:40by a dedicated neurocognitive neurologist, as well as a neuropsychologist, a genetic
00:46counselor, a speech therapist, and a social worker, all who are focused on that subgroup
00:52of patients to provide more holistic, what I call, unfragmented care.
00:57But another clinic is a chemotherapy-induced neuropathy clinic that we forge in collaboration
01:05with our cancer center.
01:07So, patients who develop neuropathy while being treated for cancer can be seen in this clinic.
01:13Once again, it's multidisciplinary with the neuromuscular neurologist, the pain specialist.
01:21And these clinics not only optimize clinical management, but they're wonderful for teaching
01:31our young neurologists and training, but they also serve as an itis for research.
01:37So, we are collecting samples from patients in each of these clinics, and they're very well
01:43characterized in terms of their deficits, confounding factors, making sure that competing diagnoses
01:52have been ruled out.
01:53And this helps fuel our bedside-to-bench-and-back approach to neurological research.
02:07So, how can Ohio State's experience with clinical trials be used to help improve healthcare in
02:18Saudi Arabia?
02:19Well, clinical trials are critical for moving the field forward and testing the newest ideas
02:25in terms of treatment and management of neurological diseases.
02:31Our Department of Neurology conducted over 350 clinical trials and studies itself last year.
02:38And we have a very elaborate, critical mass of clinical trial coordinators and managers.
02:44We have 41 principal investigators who are overseeing the clinical trials.
02:49These are physicians on our faculty.
02:51So, we've become quite experts in how to design and conduct experimental therapeutic research.
03:01We are very interested in partnering with colleagues in Saudi Arabia in order to demonstrate that
03:10a drug which is proven to be effective in patients in the United States is equally effective in a cohort
03:19of patients in the Middle East.
03:21Also, side effects may be different from one population to another.
03:27So, it is important to conduct clinical research on a global scale and make sure that the results are consistent.
03:42We call this progressive multiple sclerosis and the drugs that are so effective for younger people
03:48with that mass don't work very well when they transition into this progressive phase.
03:54So, we have discovered using preclinical models that as we age, cells in the brain called microglia change in a
04:05way that it supports chronic inflammation.
04:09And as a result, there's an unrelenting damage being perpetuated in the nervous system.
04:16We have also shown in human beings with multiple sclerosis is that there's a high correlation between markers of biological
04:24age and neurological deficits as well as lesion burden.
04:30So, putting this all together, we are finding new pathways of aging that can be targeted in progressive MS in
04:39order to ameliorate the disease.
04:40Some of these drugs are called senomorphic or senolytic agents that actually help clear out the older cells that are
04:49perpetuating this chronic inflammation.
04:52And one day, and hopefully in the near future, we hope to test these drugs in people with progressive MS.
04:59And perhaps we can have joint clinical trials between Ohio State University and medical institutions in Saudi Arabia.
05:11Ohio State has been a leader in human-mediated neurorepair research.
05:17How do you think recent advances in this area will be translated into treatments that could advance in healthcare systems
05:25like salt neuridius or neurology and neuro-regulation are in large fields?
05:32So, the question is about immune-driven neurorepair.
05:36One of the biggest challenges we face as neurologists is how to reverse damage once it's inflicted in the central
05:50nervous system, meaning the brain and the spinal cord, as well as the optic nerves.
05:55Once the damage is done following a stroke in patients with multiple sclerosis, in patients with neurodegenerative conditions such as
06:04Alzheimer's disease, we have no way to reverse that injury and to restore lost neurological functions.
06:11So, our research has actually identified a special type of immune cell that stimulates damaged nerve cells to survive and
06:23also triggers them to regrow nerve fibers that are broken in many of these diseases.
06:29So, this provides a lot of hope that we will actually be able to reverse neurological damage across multiple disease
06:38states.
06:38We first discovered this special immune cells in mice.
06:42Now, we have found this counterpart in humans.
06:44We have ways of taking bone marrow cells safely from human beings and stimulating those cells in a way that
06:52they turn into these healing immune cells and potentially re-infusing them into the same patient in order to attempt
07:01to cure their neurological ailments.
07:04So, we are moving towards bringing this new observation towards innovative trials and regeneration and we look forward to partnering
07:14with our colleagues in Saudi Arabia as we develop this project further.
07:34The new observation and erasure.
07:36The evaluation of neuralgia regeneration, which is also combined with studies on the impact of aging on the nervous system,
07:44the second major area focuses neuroent injection therapy, and the
07:49third major area is neuroimmunology, studying interactions between the immune system and the
07:54nervous system. We have strategically recruited both senior investigators who are broad leaders
08:01in each of those fields, as well as promising young junior investigators. Some of these investigators
08:08are physician scientists, some are scientists, but they act synergistically and have overlapping
08:14skill sets and features. For the young investigators, it's very important to provide them with protected
08:20time and resources so that they can really launch their laboratory programs, as well as strong
08:26mentorship from both our senior investigators, as well as organized advisory committees composed of
08:35thoughtful scientists from across the College of Medicine. In addition, we've been very thoughtful
08:41about integrating our scientists into our clinical operation. So scientists who are studying
08:48a particular neurologic disease, for example, in mice or in cells, interact frequently with clinicians
08:56who are treating human beings with those diseases. So there's an open dialogue, whereas observations
09:03that are made in the clinic that could be used to pose questions at the bench, and scientists become
09:08better aware of what are the most important questions they can pose in their research that are likely
09:14to lead to therapeutic advances. We also have introduced a thematically focused symposium on different
09:23neurological topics, where we bring together our scientists and clinicians at the Ohio State University,
09:29working with colleagues from throughout the world on a particular area of focus, such as
09:35neurogenetics or neurology, and we get our learners involved as well. So it's about communication dialogue and
09:44providing an environment for clinical and research faculty to intermingle and really drive innovative science. Also,
09:56inform this to provide a proper infrastructure. So we have built a first free viral repository in Green Bay. We
10:05are
10:05collecting samples such as blood, blood cells, cerebral spinal fluid, nerve biopsy, post-mortem brain tissue that could be used
10:15by our
10:17researchers and ask questions regarding biomarkers and needs that are
10:22targets, and making sure that those biospecimens are linked with the sophisticated data based with high quality
10:29demographic and clinical data. So it's about integrating our clinical and research missions,
10:36emphasizing innovation and creativity, and giving people the patients to claim they need to succeed.
10:54So the question is about the infrastructure that we've built at Ohio State that may be used as a source
11:02to inform the development of a similar infrastructure at King Faisal and other sites within Saudi Arabia.
11:11Well, building a biorepository in Green Bay was critical. So we have been routinely collecting blood,
11:20cerebral spinal fluid, nerve biopsy, skin biopsy, post-mortem, and autopsy brain and spinal or tissue
11:29from patients that we see across our departments, both in the outpatient and in the patient setting.
11:36So we've established satellite labs wherever we see patients for the immediate collection and storage
11:43of samples. We have a blanket institutional review board protocol that allows us to collect those samples
11:50in an ethical and safe manner. We have e-consent. We have a dedicated freezer farm and a full-time
11:58biorepository manager. And importantly, we are integrating biorepository with a sophisticated
12:05database that has high quality accurate demographic diagnostic data as well as clinical, radiological,
12:14and neurophysiological outcome measures. This provides a tremendous resource for translational
12:19neuroscience research where investigators who have a question now have samples they could use at their
12:25disposal and could be secure that these samples were obtained from an individual who's been
12:31correctly diagnosed. And they can correlate, for example, if they're measuring a particular biomarker
12:36with an array of different measures of otanical disability as well as other measures,
12:43paraclainical measures of central nervous system damage, whether they be radiological, neurophysiological,
12:52or some other type of measure that need biorepository diureate patients. So that's very important.
13:01Also, as part of the infrastructure, the physical infrastructure is making sure that junior faculty
13:08have a proper mentorship, not only in terms of senior faculty in our department, but also by establishing
13:17advisory committees that meet regularly and get updates from junior faculty about that progress.
13:24We get done advice about applications and research papers. In addition to that, we provide
13:31biostatistical and bioinformatics consultations of our junior faculty, and we make sure that they have
13:39the equipment and startup funds they need to launch a new research program.
13:58So, I've been at the Ohio State University for five years, and during that time, we've introduced over 30 new
14:07multidisciplinary precision neurology clinics, and some of these are unique. These clinics include,
14:15for example, a young onset dementia clinic. This is for people who develop cognitive symptoms before
14:21the age of 60, and the clinic is staffed by a dedicated neurocognitive neurologist, as well as a
14:28neuropsychologist, a genetic counselor, a speech therapist, and a social worker. All who are focused
14:34on that subgroup of patients provide moralistic, what I call, unfragmented care. But another clinic
14:44is a chemotherapy-advised neuropathy clinic that we forged in collaboration with our cancer center. So,
14:51patients who develop neuropathy while being treated for cancer can be seen in this clinic. Once again,
14:58it's multidisciplinary with the neuromuscular neurologist, the pain specialist, and these clinics not only
15:10optimize clinical management, but they are wonderful for teaching our young neurologists and training.
15:19They also serve as a nurse for research. So, we are collecting samples from patients at each of these
15:25clinics. And they're very well characterized in terms of their deficits, but counting factors,
15:34making sure that competing diagnoses that they move down. And this helps fuel our
15:40our scientific bench in that approach to neurological research.
15:48Mind state is key.
16:04So, how can states experience with clinical trials, uh, be used to help, uh, improve healthcare in Saudi
16:14labia? Well, clinical trials are critical for moving the field forward and testing the newest ideas in terms of
16:22treatment, uh, and management of neurological diseases. Um, our department of neurology conducted over
16:30350 clinical trials and studies itself last year. And we have a very elaborate, uh, critical mass of clinical
16:38clinical trial coordinators. So we've become quite expert in how to design and conduct experimental therapeutic
16:55research. Um, we are very interested in partnering with colleagues in Saudi Arabia in order to demonstrate
17:06that a drug which is proven to be effective in patients in the United States is equally
17:14affected in a couple of patients in the Middle East. Also, side effects may be different, uh,
17:21from one population to the other. So it is important to conduct clinical research on a scale and make sure
17:30that the results are consistent.
17:47So last thoughts, um, this is my first time visiting Saudi Arabia and I have been extremely impressed, um, our
17:56hosts and people in
17:57in general have been predicated hospitable and visiting teeth based on hospital. It is so clear that that group of
18:07neurologists
18:07have acquired a high degree of expertise and are on a steep positive trajectory to predibility departments in terms
18:16of translation and research. Um, so we're very excited about work to future alliances and working together
18:24as partners in research in a clinical experience that you're sick with me beneficial to both
18:33us at the Ohio State University and our colleagues at Keith Basel and other institutions in Saudi Arabia.
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