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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.
07:34Relation and neurogeneration.
07:36Relation and neurogeneration, which also is combined with studies on the
07:41impact of aging on the nervous system. A second major area of focus is neurogenetics and gene
07:47therapy, and the third major area is neuroimmunology, studying interactions between the immune system
07:54and the nervous system. We have strategically recruited both senior investigators who are
08:00broad leaders in each of those fields, as well as promising young junior investigators. Some of
08:07these investigators are physician scientists, some are scientists, but they act synergistically and
08:13have overlapping skill sets and features. For the young investigators, it's very important to provide
08:19them with protected time and resources so that they can really launch their laboratory programs,
08:25as well as strong mentorship from both our senior investigators, as well as organized advisory
08:32committees, composed of thoughtful scientists from across the College of Medicine. In addition,
08:40we've been very thoughtful about integrating our scientists into our clinical operation, so scientists
08:47who are studying the reticular neurologic disease, for example in mice or in cells, interact frequently
08:55with clinicians who are treating human beings with those diseases. So there's an open dialogue,
09:01whereas observations that are made in the clinic that could be used to pose questions at the bench,
09:07and scientists become better aware of what are the most informed questions they can pose in their
09:13research that are likely to lead to therapeutic advances. We also have introduced
09:20thematically focused symposium on different neurological topics, where we bring together our scientists and
09:27clinicians at the Ohio State University with colleagues from throughout the world on a particular area of focus,
09:35such as neurogenetics or neurology, and we get our learners involved as well. So it's about communication,
09:42communication, dialogue, and providing an environment where the clinical and research faculty can intermingle,
09:51and really drive innovative science. Also, informants provide a proper infrastructure. So we have built a
10:01first-grade viral repository and brain bank. We are collecting samples such as blood, blood cells, cerebral spinal cord,
10:10neurobiopsy, and brain tissue that can be used by our researchers that 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,
10:34uh, emphasizing innovation and creativity and enabling people and patients to claim need to succeed.
10:54So the question is about the infrastructure that we've built at Ohio State that may be used as
11:01um, um, um, a source to inform the development of a similar infrastructure at King Faisal and other, uh,
11:09sites within Saudi Arabia. Well, building a biorepository in Green Bank was critical. So we have been routinely
11:18collecting blood, cerebral spinal fluid, neurobiopsy, skin biopsy, post-mortem, and autopsy,
11:27reed and spinal cord tissue from patients that we see across our departments, both in the outpatient
11:34and the patient site. So we've established satellite labs wherever we see patients for the immediate
11:41collection and storage of samples. We have a blanket, uh, institutional review board protocol that allows
11:49us to collect those samples in an ethical and safe manner. We have e-consent. We have a dedicated
11:57freezer farm and a full-time biorepository manager. And importantly, we are integrating a biorepository
12:04with a sophisticated budidense that has high quality accurate demographic diagnostic data as well as
12:12clinical, radiological, and neurophysiological outcome measures. This provides a tremendous
12:17resource for translational neuroscience research where investigators who have a question now have
12:23samples they could use at their disposal and could be secure that these samples were obtained from an
12:30individual who's been correctly diagnosed. And they can correlate, for example, if they're measuring a
12:35particular biomarker with an array of different measures of otanical disability as well as other measures,
12:43paraclinical measures of safer nervous system damage, whether they be radiological, neurophysiological,
12:52or some other type of measure that need by which we evaluate patients.
12:59So that's very important. Also as part of the infrastructure,
13:03the physical structure is making sure that junior faculty have a proper mentorship, not only in
13:11terms of senior faculty in our department, but also by establishing the advisory committees that meet
13:19regularly and get updates from junior faculty about that progress. You get done advice about
13:25applications and research papers. In addition to that, we provide biostatistical and biorepository
13:33mathematics consultations at work for all our junior faculty, and we make sure that they have the
13:39equipment 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.
14:13These clinics include, for example, a young onset dementia clinic. This is for people who develop
14:20cognitive symptoms before the age of 60, and the clinic is staffed by a dedicated neurocognitive
14:26neurologist, as well as a neuropsychologist, a genetic counselor, speech therapist, and a social worker,
14:33all who are focused on that subgroup of patients, provide moralistic, what I call unfragmented care.
14:42But another clinic is a chemotherapy and use neuropathy clinic that we forged in collaboration with our
14:50cancer center. So patients who develop neuropathy while being treated for cancer can be seen in this clinic.
14:57Once again, it's multidisciplinary with the neuromuscular neurologists, the pain specialists,
15:05and these clinics not only optimize clinical management, but they are wonderful for teaching our
15:16young neurologists and training. They also serve as a nurse for research. So we are collecting samples from
15:24patients in each of these clinics, and they're very well characterized in terms of their deficits,
15:31but found the factors, making sure they can be diagnoses that they move out. And this helps fuel our
15:42data science advantage in that approach to neurologic research.
15:48Hindsight is key.
16:04So how can states experience with clinical trials be used to help improve healthcare in Saudi Arabia?
16:15Well, clinical trials are critical for moving the field forward and testing the newest ideas in terms of
16:22treatment and management of neurological diseases. Our department and neurologic conducted over 350 clinical
16:32trials and studies itself last year. And we have a very elaborate, critical mass of clinical trial
16:39coordinators and managers. We have 41 principal investigators who are focusing in clinical trials.
16:45These are positions on our faculty, so we become quite experts in how to design and conduct experimental therapeutic
16:55research. We are very interested in partnering with colleagues in Saudi Arabia in order to demonstrate that a
17:07drug which is proven to be effective in patients in the United States is equally
17:13affected in a couple of patients in the Middle East. Also, side effects may be different from one population to
17:22the
17:23other. So it is important to conduct clinical research on a scale and make sure that the results are consistent.
17:46So last thoughts. Um, this is my first time visiting Saudi Arabia and I have been extremely impressed. Um, our
17:56hosts see people in general, pretty big hospitable and visiting team based off hospital. It is so clear that that
18:06group of
18:07neurologists have acquired a lot of neurologists have acquired a high degree of expertise and are on a steep positive
18:13trajectory to find a building of confidence in terms of translation and research. Um, so we're very excited about
18:21World2Future Alliances and working together as partners in research and in clinical experience.
18:28World2Future Alliances and working together as partners at the Ohio State University and our colleagues at Keith Basel and other
18:38institutions in Saudi Arabia.
18:44World2Future Alliances and working together as partners.
18:45World2Future Alliances and working together as partners.
18:45World2Future Alliances and working together as partners.
18:45World2Future Alliances and working together as partners.
18:46World2Future Alliances and working together as partners.
18:46World2Future Alliances and working together as partners.
18:46World2Future Alliances and working together as partners.
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