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Researcher Spotlight:

Getting to Know David Fogelman, PhD

As an Assistant Professor in the Department of Gastrointestinal Medical Oncology, David Fogelman has developed an interest in understanding how a patient’s body composition changes in disease and in response to treatment.  Working with computer tools and patients’ CAT scans, he is able to segregate muscle from visceral, intramuscular and subcutaneous adipose.  “Using CT imaging, we can measure fat from the shoulders to the pelvis, and estimate the adipose tissue in a patient,” he explains.  “We also use a tool, the ‘Slice-O-Matic,’ that allows us to quantify a patient’s muscle mass.  “The greater the muscle mass, the better the experience they typically have with chemotherapy.  Conversely, heavyset patients with low muscle mass tend to have the poorest outcomes.”

“I think that cachexia today is what nausea was to patients in the 1970s.”  As treatments for nausea have improved over the years, Dr. Fogelman explains that patients have an easier time tolerating chemotherapy and benefit more from it.  Drawing an analogy to cachexia, he is now studying whether countering muscle and fat loss with diet, exercise and medication may likewise improve patient longevity and quality of life.   

Dr. Fogelman also studies the role of chemotherapy in improving overall survival for patients with metastatic disease, and treats both pancreatic and colorectal cancer patients. “We are looking for ways to improve outcomes and encounter less relapse,” he explains.  “Pancreatic cancer patients lose weight in a way that colorectal patients do not. This may be due to both mechanical and biochemical reasons, such as inflammation.  Such patients often demonstrate early satiety, by feeling full faster.  Inflammation does affect colon cancer patients, albeit to a lesser degree.”

Approximately 70% of pancreatic patients already have metastatic disease, but 10-15% have potentially resectable disease.  Most patients in the latter group will receive chemotherapy and radiation.  “We are working to see if these patients can tolerate a diet and exercise regimen in preparation for surgery.  This therapeutic approach, along with chemotherapy, may improve patient outcomes with surgery and ultimately, survival rates.”  A similar study for metastatic patients will be forthcoming.

A native New Yorker and die-hard Mets fan, Dr. Fogelman has studied pancreatic cancer since his fellowship.  After graduation, he joined a clinical practice at Montefiore Hospital, where he continued to enroll patients in research studies.  Dr. James Abbruzzese, former head of G.I. Medical Oncology at MD Anderson, recruited Dr. Fogelman to the hospital in 2007.  Prior to working at MD Anderson, he completed his internal medicine residency at Montefiore, and his hematology/oncology fellowship at Columbia University.  He is Board Certified in hematology, medical oncology and internal medicine.  He earned his BS in Biology from Cornell University and his MD from Albert Einstein College of Medicine.

In the future, through collaborative research with Dr. Basen-Engquist and others, he hopes to see diet, exercise and pharmacology as the go-to combination to minimize cancer and maximize quality of life.  “I have chosen to work directly with and for patients, in clinic and in my research, and no matter our challenges, I want to make a noteworthy difference in my lifetime.”  

 

Getting to Know Rosemarie Schmandt, PhD

In Rosemarie “Rosie” Schmandt’s research lab, mice run in circles up to four miles a day for fun. The goal of her research is to understand how diet and exercise can reduce the incidence and recurrence of gynecologic tumors.

Current research suggests that regular exercise can significantly reduce cancer recurrence, increase overall survival and improve quality of life. However, few studies have examined the link between regular exercise and gynecologic cancer outcomes.

“Using mouse models of ovarian cancer, we have shown that a high fat diet and obesity accelerates tumor growth and spread.  We have also shown that by giving mice regular access to an exercise wheel, ovarian tumor growth and metastasis is significantly slower than that seen in obese or sedentary animals. This results in longer survival times for our exercising mice,” Dr. Schmandt explains.

Dr. Schmandt and her team are hopeful that their findings in mice can be translated to people. They are working with Dr. Basen-Engquist and Dr. Karen Lu to translate the findings to women.  

Dr. Schmandt is Associate Professor in the Department of Gynecologic Oncology and Reproductive Medicine in the Division of Surgery at M.D. Anderson, where she has worked since 1999. She received her B.S. in Biochemistry from Laurentian University and her M.S. and Ph.D. in Clinical Biochemistry from the University of Toronto. Rosie’s interest in cancer research began with her sister’s diagnosis of ovarian cancer more than 30 years ago. She also lost both parents to cancer while in graduate school.

“I love my job. I get to work with a great group of people, scientists and clinicians alike. It’s fun and rewarding to see how molecular biology can be used to answer important clinical questions, and lead to improved treatments for cancer patients.” 

 

Getting to Know Lorenzo Cohen, PhD

“In a perfect world, all cancer patients would have integrative medicine consults to improve their outcomes and be given all the necessary supports. Today, research proves that stress reduction and other complementary medicine modalities make an undeniable difference in our patients’ long-term quality of life.”

The goal may be ambitious, but the trend in cancer care and treatment is leaning in this direction, claims Dr. Lorenzo Cohen, PhD.

Director of MD Anderson’s Integrative Medicine Program since 2002, Dr. Cohen wears many hats – he holds the Richard E. Haynes Distinguished Professorship in Clinical Cancer Prevention in the Departments of General Oncology and Behavioral Science at MD Anderson; Adjunct Professor, Behavioral Sciences, University of Texas School of Public Health and Distinguished Clinical Professor, Fudan University Cancer Hospital, Shanghai, China.  At his core, he is trained as a research psychologist who studies the impact of stress on cancer and the body’s immune system.  Today, Dr. Cohen and his team conduct large-scale NIH-funded clinical trials that examine the biobehavioral effects of integrative medicine practices aimed at reducing the negative aspects of cancer treatment and improving quality of life and clinical outcomes, including studies of meditation, yoga, tai chi/qigong, stress management, emotional writing, neurofeedback and acupuncture. The Integrative Medicine Program has three areas of focus:  education, research and patient care.

“We have a very comprehensive approach for helping patients get away from the concept of finding the magic pill, herb or supplement to cure their cancers,” he explains.  “We provide treatments and interventions for patients for which there is an evidence-base for improving quality of life and/or clinical outcomes, with an emphasis on lifestyle factors such as diet, exercise and stress management.  Research shows that each of these behaviors independently affects us at the genetic level.”

In the last four years, the Integrative Medicine team has collaborated with the Energy Balance team and many other departments at MD Anderson in what they call the ‘Comprehensive Lifestyle Study.’ This landmark study is a randomized clinical trial examining the effects of intensive training in nutrition, physical activity, stress management and social support in women with stage III breast cancer undergoing radiotherapy.  

The study was made possible through major philanthropic and foundation funding generated by Dr. Cohen and the late Dr. David Servan-Schrieber, author of the best-selling book, Anticancer:  A New Way of Life.  “David’s poignant personal story that he documented at the end of his life in Not the Last Goodbye emphasized the need for stress reduction and ‘finding calm,’ among all the other lifestyle modalities,” recalls Lorenzo.  “So we created a multi-faceted approach that includes dietary guidelines, exercise, mind-body practices of yoga and meditation, and providing extensive support for the participants.  These women, who are here five days a week, but ultimately, out on their own, have all the tools and methods to quiet their minds, fuel their bodies and feel empowered in all they do.  There are no randomized trials combining all these individual components, but the epidemiological data overwhelmingly supports their synergistic effect.  Exercise, stress reduction, social support and a healthy diet – combined – are the best long-term prescription, not only for living an anti-cancer life, but for preventing diabetes, heart disease and other chronic inflammatory conditions.  This is just one study, which can be replicated in other centers.  We are anxious to see this happen.”

Dr. Cohen, who completed fellowship training at the Toronto Hospital and the University of Pittsburgh Cancer Institute, was born in Rome, Italy, and spent his childhood in New Haven, Connecticut and Toronto, Ontario, Canada.  He earned his BA in Psychology from Reed College in Portland, Oregon, and his MS and PhD in Medical Psychology from the Uniformed Services University of the Health Sciences, in Bethesda, Maryland.

While studying the impact of stress on the body, Dr. Cohen was drawn to the practice of yoga that he knew about since childhood.  He was greatly influenced by his Italian grandmother, Vanda Scaravelli, a renowned yoga master.  In his early twenties, he lived with her in Italy for a year, and learned much about mind-body practices, taking daily yoga lessons and watching her write a book on yoga “that she was typing while standing at her piano.”  The experience gave him insight into how lifestyle changes can help people strengthen their defenses against cancer – getting it, or having a recurrence.  “And today, my kids eat vegetables at breakfast, we try and have a daily 10-minute family meditation before school and we are very strict about getting enough sleep, so I guess it’s being passed from generation to generation.”  

Not a bad legacy, indeed.

Getting to Know Lorna Haughton McNeill, PhD, MPH 

As Associate Professor in Health Disparities Research in the Division of Cancer Prevention and Population Sciences at M.D. Anderson since 2006, Dr. Lorna McNeill studies the risk factors which make underserved and racial/ethnic minority populations more susceptible to cancer.  “These populations have the highest obesity rates, which is an important cancer determinant,” she explains.  “Additionally, there are other social and contextual issues that come into play.  My primary focus is reducing cancer risk related to obesity/physical inactivity by identifying, improving and addressing these social and contextual factors in order to increase physical activity – for the long haul.”

“My research focuses on three areas.  The first is focusing on minorities and other underserved populations via intervention research; essentially trying to promote behavior change to reduce cancer risk.   Through behaviorally-focused research, we discover what is meaningful and relevant to increase participation in activities and choices that can make positive differences in health outcomes, actions they can stick with.”  

“I also focus on neighborhoods and the environment – the social and physical factors that have an impact on physical activity and behavior.  Individuals must be personally motivated to make healthy changes in their behaviors, and internally believe they can do it, but support in their social and neighborhood environments must also be there.  Minority neighborhoods often lack the sidewalks for walking and the parks for playing that other non-minority or more affluent neighborhoods take for granted.  This directly impacts their ability to be physically active.  Policy implications, like zoning, speed bumps on streets and neighborhood safety – may all inhibit people from being active outdoors, if they feel they’re in an uncontrolled or uncontrollable environment.”

“Thirdly, I conduct dissemination and implementation research (D&I) -- taking strategy and evidence on what works to get folks physically active and putting this into real world situations, to determine if it still is effective. Does this or that approach work, and if not, how do we modify it so it does?  NIH is making this an important part of their strategic framework, and I am currently focused on D&I research in the context of obesity prevention and weight loss interventions in low-income safety net clinics.”  

Originally from New York and the daughter of Jamaican immigrants, Dr. McNeill is the first child in her family to be born in the U.S.  She earned a BA in African American Studies and Industrial Relations at the University of North Carolina at Chapel Hill, and followed this with an MPH in Health Behavior and Health Education, also at UNC.  She earned her PhD at the St. Louis University School of Public Health, and did her post doc fellowship at Harvard School of Public Health, where her then-mentor made her aware of a new position opening at M.D. Anderson.  She is currently the first of two faculty members in her department, and “welcomes the opportunity to collaborate with others who also do work in energy balance.”

“There is so much exciting work being done at M.D Anderson, and it is truly a thrill to do something that has real meaning.  We each bring our own expertise and insight, and together, anything is possible,” she proclaims.

Getting to Know Craig Logsdon, PhD

Craig Logsdon, Ph.D., and his research colleague, Zobeida Cruz-Monserrate, Ph.D., credit a large population of obese mice for providing insight into preventive, therapeutic and diagnostic options for minimizing the risk of pancreatic cancer. “By studying the relationship between a high-fat diet and cancer in mice with mutant KRAS, we are making headway into learning how both genes and the environment are key in the development of this lethal cancer,” explains Craig, a Professor in the Department of Cancer Biology at M.D. Anderson for the last 10 years.

“KRAS is a molecule that acts like a switch to turn on cellular activity.  When KRAS is “on” it is like hitting the gas in your car- everything gets revved up.  Everyone has KRAS genes, and as we age most people develop some KRAS genes that are mutated.  The mutated version of KRAS is associated with cancer because the mutation affects how long it stays “on” after being activated.  Mutated KRAS stays on much longer than the normal KRAS,” continues Craig.  “Only mutated KRAS genes drive the development of cancer, but they don’t do it on their own.  They must initially be stimulated to a fairly high degree.  However, once KRAS activity is strong enough, then it is able to generate its own stimulants by causing inflammation.  Inflammation of any kind is a great stimulant of KRAS activity, so obesity, smoking and other inflammatory-inducing activities are risky if mutant KRAS is present.  The mutant KRAS in our bodies needs a ‘kick’ to turn bad, and anything that causes inflammation, can give that kick.”

“Pancreatic cancer is KRAS-dependent, and mutant, oncogenic KRAS isn’t always ‘on.’  But we now know that mice on a high-fat diet do get cancer, and that there is a direct correlation between obesity and cancer, which we have been studying in-depth.”

What is it about a high-fat diet that causes cancer?  “A high-fat diet provides the stimulus needed to fully activate the oncogenic KRAS, which initiates inflammation in the pancreas at least in part by increasing the levels of COX2.  We now have models of mice with mutated KRAS expression directed to their pancreas.  Our studies show the mechanism by which a high fat diet induces cancer in these mice appears to involve activation of oncogenic KRAS, and the up-regulation of COX2, which promotes pancreatic inflammation.  Importantly, COX 2 inhibitors prevent this process, which is an exciting finding regarding prevention. This may explain why daily aspirin has been found to be preventative in some studies, as it inhibits COX2.”

Born and raised in Oregon, Craig came to cancer research in mid-career, after studying pancreatic physiology at UC San Francisco and the University of Michigan, where he was a professor.  “I worked with rodents for many years, and one day discovered that the process I was investigating was totally different in people.  At that point, I decided to change directions and study people.  My goal is to see if I might make a difference with the scientific knowledge I have while I’m still alive to see it happen,” he admits.  Since assuming his endowed chair at MD Anderson, “we have learned a lot about mechanisms that increase risk for pancreatic cancer – even in children.” His current focus remains on pancreatic cancer and he is collaborating with Zobeida for studies on how to prevent this disease.

“It’s a slow process, but we are making progress and beginning to translate what we know to help patients in the clinical setting.  We love to collaborate, and hope that by doing so, we’ll make a real difference and save more lives – sooner vs. later.” 

Getting to Know Carrie Daniel-MacDougall, PhD, MPH

As a nutritional epidemiologist and Director of M.D. Anderson’s Nutrition Research Group and CORE, Carrie Daniel-MacDougall, PhD, MPH, specializes in “population medicine,” researching variations among large free-living groups of individuals to study disease risk and discover new ways to improve outcomes in overall health.  More specifically, she is focused on the role diet plays in cancer development and prevention, and the modifiable scientific mechanisms behind these relationships.  “I have traditionally been interested in everything ‘up-stream’ of cancer, but I came to M.D. Anderson to shift some of my research toward also helping individuals who already have cancer.”

“Diet, energy balance and inflammation are common themes behind obesity and related chronic conditions – like – diabetes – that impact both cancer risk and survival,” she explains.  She and her colleagues utilize ‘dietary assessment methodology,’ as well as novel biomarkers to identify new risk factors for both obesity and cancer.  Some of the most informative findings have come from large, healthy U.S. populations followed long-term (10+years) for cancer outcomes, as well as from understudied international and minority populations with unique diet and lifestyle traits.

“Through studying diet, obesity and inflammation in the etiology of cancers of the kidney and digestive system, I have been drawn to a new field of research on the microbiome.  I believe it offers an exciting tool as we look for new ways to target disease risk via diet,” she adds.  “By sequencing the geonomes of bacteria living within the body, we are learning more about all the direct and systemic processes that these ‘bugs’ are involved in.”  Using the framework of large epidemiologic studies of cancer risk, and linking into her colleagues’ expertise in molecular epidemiology, genomics and metabolomics, she hopes to integrate the microbiome, as another important ally in understanding and preventing cancer.

In one of her current collaborative studies, she is working with the endoscopy clinic to track the seemingly ‘normal’ patients who develop pre-cancerous colorectal polyps.  “As part of a larger study, headed by my Chair, we are looking at screening patients’ habitual or long-term diet, lifestyle and medical histories and collaborating with a lab at Baylor to sequence their gut microbiomes.”  This is just the first step, as Carrie and her colleagues want to continue to design new studies, share experiences and find new mutually-beneficial collaborations.  “I love working with our inspiring clinicians, and look forward to continuing to learn about their approach to patients and how to better tailor research to support their efforts.”

A native of Tucson, Carrie was interested in the impact diet plays in health from a young age, thanks to her mother, who became a real ‘health nut’ when Carrie was growing up in the 1980s.  “Around my age (30s), my mother lost her sister to late stage breast cancer and her mother – my grandmother – to cardiovascular disease.”  Carrie earned her BS in Molecular and Cellular Biology from the University of Arizona, and was planning to become a premed student, when she was exposed to epidemiology.  “I loved the field, and decided that was the direction my life should take,” she recalls.  She subsequently earned her MPH and Ph.D in Nutritional Epidemiology from Emory University, “a wonderful, interdisciplinary program.”  She did part of her pre-doctoral research at the American Cancer Society and went on to a post-doctoral research fellowship at the NCI.  In the summer of 2012, she moved from Washington, D.C., to Houston, with her husband and pet Dalmatian to join M.D. Anderson, where they soon welcomed their first child.  She is excited about building a core of colleagues to study diet and cancer in new ways.  “Fortunately, the concept of diet and nutrition is totally accessible – our goal is to find the most meaningful and safe ways to apply what we know on a public health level.”

Getting to Know Joya Chandra, PhD

A cell biologist and long-time leukemia researcher, Joya Chandra Ph.D.’s mantra is simple, yet profound:  “Our diet is a modifiable and incredibly powerful tool for augmenting cancer treatments and controlling and reducing risk in cancer survivorship.  And a nutritionally-sound diet is accessible to us all.”

Since joining M.D. Anderson’s Children’s Cancer Hospital in 2002, Dr. Chandra and her team of researchers have studied the impact of oxidative stress (OS) in both treating and preventing cancer.  “We try to increase OS to enable chemotherapy to selectively kill cancer cells, which already have a higher level of OS,” she explains.  “Conversely, we want to block or decrease OS in cancer cells to keep them from growing, on the prevention side.”

Changing OS “at the organismal level,” is feasible through diet and nutrition.  By studying nutrition and measuring OS in pediatric leukemia patients, Dr. Chandra wants to understand how micronutrients and certain OS-increasing diets may enable chemotherapies to work more effectively. To help parents and families determine what foods are most beneficial for their children, Dr. Chandra and her team launched the “ON to Life Program,” an instructional program developed for The Children’s Cancer Hospital that teaches healthy lifestyle techniques, provides resources for tolerating treatments and offers a virtual cookbook of customizable, easy to make recipes that promote optimal nutrition, weight loss and healthy eating habits for pediatric cancer patients, survivors and their families.

“We know that patients on steroids often gain weight, and obesity places them at higher risk for other cancers and cardiovascular problems down the road,” explains Dr. Chandra.  “By guiding families through the ON to Life Program and supporting them with dieticians and actual real-world tested healthy recipes, we can instill healthy eating habits as a lifestyle, early-on.”  The on-line cookbook, “At the Table,” can sort foods that may help minimize certain symptoms, while also fulfilling FDA requirements for diets, and sound nutrition.  
Additionally, her team is collaborating with experts who have designed video games for kids to learn about “energy balance,” the need to eat healthfully, exercise regularly and gain strength in a comprehensive, coordinated way. A new game specifically designed for pediatric cancer survivors is in the works.  “We are using our cookbook, video games and personalized diet and exercise plans to help children seen at the pediatric clinic, and we routinely include parents in these initiatives,” shares Dr. Chandra.  “The electronic cookbook has been welcomed as a useful resource by families of our patients. It’s all openly available on our website, and can be viewed on tablets, iPads and smartphones,” she adds.  “Ultimately, we would like to deliver our message, change diets and measure the impact it has in/on cancer patients.”

Dr. Chandra is well-suited to the multi-disciplinary role she plays as a researcher and educator.    She grew up in New Orleans and is a graduate of Louisiana State University and the University of Texas School of Biomedical Sciences, where she received her Ph.D. in cancer biology and immunology.  She studied toxicology at the Karolinska Institute in Stockholm, Sweden, and did her second post doc at the Mayo Clinic.  “I was first introduced to research on late effects of cancer therapy in pediatric patients in the M.D. Anderson summer program for college students.  After graduating from LSU with a degree in microbiology, I worked as a lab tech at Baylor, prior to joining the University of Texas Health Science Center at Houston Graduate School of Biomedical Sciences.  I realized how much I enjoyed research, and I’ve never looked back.”  

Today, Dr. Chandra is a highly-published principal investigator, teacher and mentor to pre and postdoctoral fellows.  She has won numerous awards for her work on apoptosis and OS.  She is open to collaborating on using OS as a biomarker for diet-related behavioral change, and ideally, including her cookbook as part of a clinical trial.

“I am interested in the power of food to make a positive impact in the lives of our patients.  We want to take the knowledge out of the lab and apply it directly to those we counsel and treat as soon as we can.”

Getting to Know Ann Klopp, MD, PhD

Ann Klopp has always been a “research person,” who also enjoys face-to-face patient care.  Today, she conducts translational research, lab studies which are designed with a goal of improving clinical treatments.

A radiation oncologist, Dr. Klopp and her team study how obesity influences stem cells in abdominal/visceral fat, tracking how these cells migrate into tumors, form supporting stroma and drive cancerous tumor growth in heavier patients.  She has focused both her research and clinical work on women’s health, in particular, endometrial, ovarian and cervical cancer.  “Today, we’re much closer to learning how obesity impacts the development and recurrence of gynecologic cancer,” she explains.

Dr. Klopp isolates visceral adipose stem cells from the omentum, and compares these cells to stem cells from other tissue sources to see how these cells can promote endometrial and ovarian cancer.  “We’ve discovered that visceral adipose-derived stem cells (ASC) promote the growth of endometrial cancer,” she explains.  “We are able to see differences in stem cells from mice which are fed a high-fat diet, vs. a low-fat diet, and we are investigating how ASC drive tumor growth in obesity.  We are isolating stem cells from both obese and thin patients to learn more about how obesity alters stem cells in patients.”

Dr. Klopp and her team use unique software for measuring the volume of visceral adipose in ovarian cancer patients.  The technology is able to distinguish fat tissues from fluid, soft tissue, gas and bone in order to develop a highly accurate measure of visceral adipose.  “In the short-term, we hope to determine whether obesity impacts outcome in endometrial and ovarian cancer, and in the long-term, we hope to understand exactly how this happens,” she explains. Research-wise, Dr. Klopp is interested in collaborating with others who are studying the prognostic effects of visceral adiposity and mechanisms by which obesity promotes cancer progression.  Clinically, Dr. Klopp is also interested in the management of advanced endometrial cancers and the use of advanced radiation techniques to minimize toxicity.

Dr. Klopp, a graduate of the University of Michigan and the Medical College of Wisconsin, earned her MD and PhD in Microbiology and Molecular Biology.  In addition to her research and clinical work, she serves as a moderator for The Center for Energy Balance Journal Club and enjoys mentoring trainees in both clinical and translational research. A native of Milwaukee, she is married with three young children, and enjoys swimming, traveling and reading in her spare time.  Dr. Klopp arrived in Houston eight years ago to do her residency, and “never left.”  “I feel fortunate that the work I do in research and clinical oncology is both intriguing and gratifying,” she claims.  Which is lucky for us all, indeed.   

Omental adipose tissue-derived stromal cells promote vascularization and growth of endometrial tumors.
Klopp AH, Zhang Y, Solley T, Amaya-Manzanares F, Marini F, Andreeff M, Debeb B, Woodward W, Schmandt R, Broaddus R, Lu K, Kolonin MG.
Clin Cancer Res. 2012 Feb 1;18(3):771-82.

Concise review: Dissecting a discrepancy in the literature: do mesenchymal stem cells support or suppress tumor growth?
Klopp AH, Gupta A, Spaeth E, Andreeff M, Marini F 3rd.
Stem Cells. 2011 Jan;29(1):11-9. doi: 10.1002/stem.559. Review.

Mesenchymal stem cells promote mammosphere formation and decrease E-cadherin in normal and malignant breast cells.
Klopp AH, Lacerda L, Gupta A, Debeb BG, Solley T, Li L, Spaeth E, Xu W, Zhang X, Lewis MT, Reuben JM, Krishnamurthy S, Ferrari M, Gaspar R, Buchholz TA, Cristofanilli M, Marini F, Andreeff M, Woodward WA.


© 2014 The University of Texas MD Anderson Cancer Center