Duke Health Scholars

Chronic kidney disease takes a dreadful toll. Some 13 percent of adult Americans live with the condition. Despite that high prevalence, multitudes of mysteries persist about how chronic kidney disease progresses and how to stop or slow it.

Julia Scialla, MD, MHS, is eager to help change that with studies exploring the physiology of chronic kidney disease complications.

Last year in Christopher Holley’s lab, an uninstalled exhaust hood still wrapped in plastic suggested that the young investigator was just getting going.

Don’t be deceived. Holley arrived a lab-bench veteran when he joined Duke’s cardiology division faculty in 2015. But the physician-scientist is launching something very new: wide-reaching molecular studies into a new field of RNA biology with vast potential.

In clinic, cardiologist Sudarshan Rajagopal, MD, PhD, has no means to cure most patients with pulmonary hypertension, not the narrowing of blood vessels in their lungs, not damage done to their hearts.

The physician-scientist can prescribe medicines that extend the lives of many patients, but the precious gains can come with unwelcome costs.

“All these drugs help open blood vessels in the lungs and help treat heart failure. But they can have horrible side effects,” Rajagopal says, including nausea, diarrhea, weight loss and other side effects.

But help may come from complex pharmacology studies that Rajagopal first encountered at Duke in the laboratory of Nobel Prize winner Robert Lefkowitz, MD.

These are heady days for immunotherapy researchers, the scientists making progress unleashing the human immune system against lethal cancers.

Interventions once envisioned in laboratories are now treatments saving the lives of some patients struck by melanoma, kidney cancer, and lung cancer. Promise is rising for treatments against malignancies arising elsewhere as well.

With his new insights into how cancer cells use biochemical signaling to suppress our immune system, Brent Hanks, MD, PhD, is part of this translational momentum.

It was the chance to try to help people, even at their sickest, that drew Dr. Steven Crowley to medicine 25 years ago.

Today the nephrologist still sees patients at the Durham VA Medical Center, but he spends much more time decoding how immune system cells contribute to hypertension and organ damage in his laboratory.

Still, the mission endures.

“The most important aspect of our work is to show solidarity with our patients. That is something we can always do, regardless of the stage of their illness,” says Crowley, whose research may lay groundwork for needed improved treatments.

Dorothy Sipkins, MD, PhD, is a hematologist-oncologist who studies cancer. But to understand the cleverness of her work, it’s helpful to think of her as an ecologist—a cell ecologist.

Sipkins identifies very specific biological habitats and interactions that allow malignant cells to move, proliferate and survive chemical attacks, traits that too often produce fatal disease.

“I love thinking about what is on the outside of the cell. What the cell is seeing. What the cell is interacting with, the 3-D environment it interacts with,” says Sipkins.

It is no small matter that terminally ill African-Americans patients enroll in hospice less often than white patients. Lower participation contributes to health disparities between the races.

African-American patients are less likely than white patients to have their pain adequately diagnosed and treated, for one. They less often obtain medicine to treat pain and are less satisfied with communication and overall care from health providers.

When geriatrician Kimberly Johnson, MD, MHS, first observed these differences as a resident in the 1990s, she understood immediately that physicians needed to address them. So she did.

The photograph of blue, pink and neon-green globes that Christina Barkauskas, MD, keeps on her desk inside the Nanaline Duke Research Building looks like a string of glowing holiday lights. That is, until she decodes it.

Produced with a confocal microscope, the image is evidence of new insight into how some lung tissue repairs itself. It captures type 2 epithelial cells within alveoli functioning like stem or progenitor cells by giving rise to type 1 epithelial cells, which contribute to tissue repair.  

For Dr. Barkauskas, this is not knowledge for knowledge’s sake. It’s data needed to better serve  patients with often-lethal idiopathic pulmonary fibrosis.

To better understand blood cancers, Sandeep Davé, MD, MBA, MS, hunts down variation in the DNA sequences important to those cancers. One international project he launched is deploying comparative genetics to better classify the more than 100 blood cancers.

But the research never stops there.

As a young researcher, Svati Shah expected that genomic studies would reveal vital insights into the roots of disease. When they did not, the cardiologist widened her net to compare many more molecular components at once. The result is a growing understanding of the cellular profile of disease more specific than tales told by static DNA. 

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