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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.
07:34My favourite question was the Aunt Florence관.
07:35The association and neurogeneration.
07:37The same meeting
07:39with studies on the impact of aging on the nervous system.
07:44A second major area of focus is neurodegenerative and gene therapy.
07:48And the third major area is neuroimmunology,
07:52studying interactions between the immune system and the nervous system.
07:55We have strategically recruited both senior investigators
07:59who are broad leaders in each of those fields,
08:02as well as promising young junior investigators.
08:06Some of these investigators are physician scientists,
08:09some are scientists, but they act synergistically
08:12and have overlapping skill sets and features.
08:16For the young investigators, it's very important to provide them
08:20with protected time and resources
08:22so that they can really launch their laboratory programs,
08:25as well as strong mentorship from both our senior investigators
08:30as well as organized advisory committees
08:33composed of thoughtful scientists from across the College of Medicine.
08:39In addition, we've been very thoughtful about integrating our scientists
08:43into our clinical operation.
08:46So scientists who are studying a particular neurologic disease,
08:51for example, in mice or in cells,
08:53interact frequently with clinicians
08:56who are treating human beings with those diseases.
08:59So there's an open dialogue,
09:01whereas observations that are made in the clinic
09:04that could be used to pose questions at the bench,
09:07and scientists become better aware of what are the most informed questions
09:11they can pose in their research
09:13that are likely to lead to therapeutic advances.
09:17We also have introduced,
09:20thematically focused symposiums on different neurological topics,
09:24where we bring together our scientists and clinicians
09:27at The Ohio State University
09:29with colleagues from throughout the world
09:32on a particular area of focus,
09:35such as neurogenetics or neuroendology,
09:38and we get our learners involved as well.
09:41So it's about communication,
09:43dialogue, and providing an environment
09:45where the clinical and research faculty
09:49can intermingle and really thrive innovative science.
09:55Also, inform this, provide a proper infrastructure.
09:59So we have built a first free biorepository in Green Bay.
10:04We are collecting samples such as blood,
10:07blood cells, cerebral spinal cord,
10:10nerve biopsy, post-mortem brain tissue
10:13that can be used by our researchers
10:17and ask questions regarding biomarkers
10:20and needs that are puny targets
10:23and making sure that those biospecimens
10:25are linked with a sophisticated data
10:28with high-quality demographic and clinical data.
10:31So it's about integrating our clinical
10:33and research missions,
10:36emphasizing innovation and creativity
10:38and enabling people and patients to claim need to succeed.
10:54So the question is about the infrastructure
10:56that we built at Ohio State that may be used as a source
11:02to inform the development of a similar infrastructure
11:06at King Faisal and other sites within Saudi Arabia.
11:11Well, building a biorepository in Green Bay was critical.
11:16So we have been routinely collecting blood,
11:20cerebral spinal fluid, nerve biopsy, skin biopsy,
11:25post-mortem, and autopsy brain and spinal cord tissue
11:29from patients that we see across our departments,
11:33both in the outpatient and in the patient setting.
11:36So we've established satellite labs wherever we see patients
11:40for the immediate collection and storage of samples.
11:43We have a blanket institutional review board protocol
11:48that allows us to collect those samples
11:50in an ethical and safe manner.
11:53We have e-consent.
11:55We have a dedicated freezer farm
11:58and a full-time biorepository manager.
12:00And importantly, we are integrating a biorepository
12:04with a sophisticated database that has high quality,
12:07accurate demographic diagnostic data,
12:11as well as clinical, radiological,
12:14and neurophysiological outcome measures.
12:16This provides a tremendous resource for
12:18translational neuroscience research,
12:20where investigators who have a question now have samples
12:24that they could use at their disposal,
12:25and could be secure that the samples were obtained
12:29from an individual who's been correctly diagnosed.
12:32And they can correlate, for example,
12:34if they're measuring a particular biomarker
12:36with an array of different measures
12:39of clinical disability, as well as other measures,
12:43paraphernal measures of safer nervous system damage,
12:46whether they be radiological, neurophysiological,
12:51or some other type of measure that need
12:56by which we evaluate patients in the clinical.
12:59So that's very important.
13:01Also, as part of the infrastructure,
13:03the physical infrastructure,
13:05is making sure that junior faculty
13:08have proper mentorship,
13:10not only in terms of senior faculty in our department,
13:14but also by establishing advisory committees
13:19that meet regularly and get updates from junior faculty
13:23about that progress.
13:24We give them advice about applications and research papers.
13:28In addition to that, we provide
13:31biostatistical and bioinformatics consultations
13:34at work for all our junior faculty,
13:37and we make sure that they have the equipment
13:40and startup funds they need to launch a new research program.
13:57So, I've been at the Ohio State University for five years,
14:02and during that time, we've introduced over 30 new
14:07multidisciplinary precision neurology clinics,
14:10and some of these are unique.
14:13These clinics include, for example,
14:16a young onset dementia clinic.
14:18This is for people who develop cognitive symptoms
14:21before the age of 60,
14:23and the clinic is staffed by a dedicated
14:26neurocognitive neurologist,
14:28as well as a neuropsychologist,
14:30a genetic counselor, speech therapist,
14:32and a social worker.
14:34All who are focused on that subgroup of patients
14:37provide more holistic, what I call,
14:40unfragmented care.
14:42But another clinic is a chemotherapy
14:45at least neuropathy clinic that we forged in collaboration
14:49with our cancer center.
14:51So patients who develop neuropathy
14:53while being treated for cancer can be seen in this clinic.
14:57Once again, it's multidisciplinary
14:59with the neuromuscular neurologists,
15:03the pain specialists.
15:05And these clinics not only optimize clinical management,
15:12but they are wonderful for teaching our young neurologists
15:18and training.
15:19They also serve as a neuropsychologist in research.
15:22So we are collecting samples from patients
15:25to each of these clinics.
15:26And they're very well characterized
15:28in terms of their deficits,
15:32the counting factors,
15:34making sure the complete diagnosis
15:36that they're ruled out.
15:37And this helps fuel our,
15:41they decide to bench in that approach
15:44to neurological research.
16:04So how can states experience clinical trials
16:09be used to help deprove healthcare in Saudi Arabia?
16:15Well, clinical trials are critical
16:17for moving the field forward
16:19and testing the newest ideas
16:21in terms of treatment
16:23and management of neurological diseases.
16:27Our department of neurology conducted
16:30over 350 clinical trials
16:32and studies itself last year.
16:34And we have a very elaborate,
16:36critical mass of clinical trial coordinators
16:40and managers.
16:41We have 41 principal investigators
16:43who are focusing the clinical trials.
16:45These are positions on our faculty.
16:48So we've become quite experts
16:50in how to design and conduct
16:53experimental therapeutic research.
16:56We are very interested in partnering with colleagues
17:02in Saudi Arabia in order to demonstrate
17:06that a drug which is proven to be effective
17:10in patients in the United States
17:12is equally affected in a couple of patients
17:16in the Middle East.
17:17Also, side effects may be different
17:20from one population to the other.
17:23So it is important to conduct clinical research
17:27on a scale
17:28and make sure that the results are consistent.
17:46So last thoughts.
17:48This is my first time visiting Saudi Arabia
17:52and I have been extremely impressed.
17:55Our hosts see people in general
17:57probably being hospitable
17:59and visiting teeth based off hospital.
18:03It is so clear
18:04that that group of neurologists
18:07have acquired a high degree of expertise
18:11and are on a steep positive trajectory
18:14to find a good confidence
18:15in terms of translation and research.
18:19So we're very excited about
18:21what we'll do future alliances
18:22and working together as partners
18:25in research and in clinical experts.
18:29that you're sick with me beneficial
18:31to both us at the Ohio State University
18:35and our colleagues at Keith Basel
18:37and other institutions in Saudi Arabia.
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