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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.
07:21We look forward to it and we look forward to mid to alta panoricanal.
07:26We are be looking forward to hearing from people come to us and see you morning speaking about the term
07:34from brain damage and depression.
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07:51immunology, study interactions between the immune system and the nervous system.
07:55We have strategically recruited both senior investigators who are broad leaders in each
08:01of those fields, as well as promising young junior investigators.
08:06Some of these investigators are physician scientists, some are scientists, but they
08:11act synergistically and have overlapping skill sets and features.
08:15For the young investigators, it's very important to provide them with protected time and resources
08:22so that they can really launch their laboratory programs, as well as strong mentorship from
08:27both our senior investigators, as well as organized advisory committees composed of thoughtful
08:35scientists from across the College of Medicine.
08:39In addition, we've been very thoughtful about integrating our scientists into our clinical
08:45collaboration.
08:46So scientists who are studying a particular neurologic disease, for example, in mice or in cells,
08:54interact frequently with clinicians who are treating human beings with those diseases.
08:59So there's an open dialogue, whereas observations that are made in the clinic that could be used
09:05to pose questions at the bench.
09:07And scientists become better aware of what are the most informed questions they can pose in
09:12their research that are likely to lead to therapeutic advances.
09:17We also have introduced the radically focused symposium on different neurological topics, where we bring together
09:26our scientists and clinicians at The Ohio State University with colleagues from throughout the world on a particular
09:33area of focus, such as neurogenetics or neurogenology, and we get our learners involved as well.
09:41So it's about communication, dialogue, and providing an environment for clinical and research faculty to intermingle and really
09:51be a dry, innovative science, also inform this, provide a proper infrastructure.
09:59So we have built a first-grade biorepository in Green Bay.
10:04We are collecting samples such as blood, blood cells, cerebral spinal fluid, nerve biopsy, post-mortem brain tissue,
10:13that could be used by our researchers that ask questions regarding biomarkers and needs that are
10:21acute targets, and making sure that those biospecimens are linked with the sophisticated data based
10:28with high-quality demographic and clinical data.
10:31So it's about integrating our clinical and research missions, emphasizing innovation and creativity,
10:38and enabling people and patients 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
11:03go along 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.
11:15So we have been routinely collecting blood, cerebral spinal fluid, nerve biopsy, skin biopsy, post-mortem, and autopsy
11:27green spinal fluid from 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 of samples.
11:43We have a blanket institutional review board protocol that allows us to collect those samples in an ethical and safe
11:52manner.
11:52We have e-consent, we have a dedicated freezer farm, and a full-time biorepository manager, and importantly,
12:01we are integrating a biorepository with a sophisticated data that has high-quality and accurate demographic diagnostic data,
12:11as well as clinical, radiological, and neurophysiological outcome measures.
12:16This provides a tremendous resource for translation on neuroscience research, where investigators who have a question now have samples they
12:24could use at their disposal
12:25and could be secure that these samples were obtained from an individual who's been correctly diagnosed,
12:32and they could correlate, for example, if they're measuring a particular biomarker, with an array of different measures of otanical
12:39disability,
12:40as well as other measures, paracinical measures of safer nervous system damage, whether they be radiological, neurophysiological,
12:51or some other type of measure that need biorepository patients.
12:59So that's very important.
13:01Also, as part of the infrastructure, the physical infrastructure, is making sure that junior faculty have proper mentorship,
13:10not only in terms of senior faculty in our department, but also by establishing the advisory committees that meet regularly
13:20and get updates from junior faculty about that progress and get them advice about applications and research papers.
13:28In addition to that, we provide biostatistical and bioinformatics consultations for all our junior faculty,
13:37and we make sure that they have the 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,
14:03we've introduced over 30 new multidisciplinary precision neurology clinics, and some of these are unique.
14:13These clinics include, for example, a young onset dementia clinic.
14:18This is for people who develop cognitive symptoms before the age of 60,
14:23and the clinic is staffed by a dedicated neurocognitive neurologist, as well as a neuropsychologist,
14:29a genetic counselor, speech therapist, and a social worker, all who are focused on that subgroup of patients,
14:37provide moralistic, what I call unfragmented care.
14:42But another clinic is a chemotherapy-based neuropathy clinic that we forged in collaboration with our cancer center.
14:51So patients who develop neuropathy while being treated for cancer can be seen in this clinic.
14:57Once again, once again, it's multidisciplinary with the neuromuscular neurologists, the pain specialists,
15:04and these clinics not only optimize clinical management, but they are wonderful for teaching our young neurologists and training.
15:19They also serve as a neuropathy, but they also serve as a neuropathy research.
15:22So we are collecting samples from patients to each of these clinics,
15:26and they're very well characterized in terms of their deficits,
15:32but counting factors, making sure the competing diagnoses have been ruled out.
15:37And this helps fuel our scientific bench and back approach to neurological research.
15:48Hind state is key.
16:04So how can states experience with clinical trials be used to help deprove health care in Saudi Arabia?
16:15Well, clinical trials are critical for moving the field forward and testing the newest ideas in terms of treatment and
16:24management of neurological diseases.
16:27Our department conducted over 350 clinical trials and studies itself last year.
16:34And we have a very elaborate critical mass of clinical trial coordinators and managers.
16:41We have 41 principal investigators who are focusing on clinical trials.
16:45These are positions on our faculty, so we've become quite experts in how to design and conduct experimental therapeutic research.
16:57We are very interested in partnering with colleagues in Saudi Arabia in order to demonstrate that a drug which is
17:09proven to be effective in patients in the United States
17:12is equally affected in a couple of patients in the Middle East.
17:18Also, side effects may be different from one population to the other.
17:23So it is important to conduct clinical research on a scale and make sure that the results are consistent.
17:46So last thoughts.
17:49This is my first time visiting Saudi Arabia, and I have been extremely impressed.
17:54Our hosts see people in general, incredibly hospitable, and visiting teeth based on a hospital.
18:03It is so clear that that group of neurologists have acquired a high degree of expertise and are on a
18:12steep positive trajectory
18:14to try to build the confidence in terms of translation and research.
18:18So we are very excited about World2FutureAlliances and working together as partners in research
18:26and in clinical experience.
18:29And it is so quickly beneficial to both us at The Ohio State University and our colleagues at Keith Basel
18:37and other institutions in Saudi Arabia.
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