March 1, 2002

Coagulation grant may save thousands of lives

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Dr. Brian Donahue received the $756,000 NIH grant to study the coagulation system. (photo by Anne Rayner Pollo)

Coagulation grant may save thousands of lives

Dr. Brian Donahue, assistant professor of Anesthesiology, was recently awarded a five-year $756,000 National Institutes of Health K23 grant to study the coagulation system activation and how it impacts cardiac surgery.

Donahue, a participant in the Vanderbilt Physician-Scientist Development (VPSD) program, will work with his mentor on the project, Dr. Alfred L. George Jr., Grant W. Liddle Professor of Medicine, and director of Genetic Medicine. Dr. Jeff Balser, associate dean for Physician-Scientist Development, is the director of the VPSD program.

Complications as a result of surgery are always a concern to clinicians, and this is especially true of heart surgery. When complications such as excessive bleeding or clotting do occur, it is sometimes difficult to discern the exact reason for the complication.

Research on the factors that contribute to coagulation activation are justified on economic grounds as well, since cardiac surgery uses some 10 percent to 20 percent of the nation’s blood supply. Research that could lead to a reduction of the amount of blood required during cardiac cases could decrease the current drain on the supply.

K23 grants are patient-oriented career development awards given to physician-scientists early in their career. The K23 requires the recipient to have an established investigator as a mentor. George, who has extensive experience in molecular genetics, was a natural choice.

The VPSD program encourages junior faculty who are interested in a research idea and provides them with protected time away from their clinical duties, allowing them to pursue their research.

According to Donahue, were it not for the VPSD program, he may have likely never received his grant and might have joined other physician-scientists who become frustrated trying to balance research and clinical responsibilities.

“Look at me as a poster child for VPSD, as someone who was frustrated with being unable to pursue the research I wanted to do,” Donahue said. “Now the future is straight ahead for me. I see patients about 25 percent of my time, and I take call as frequently as my colleagues do. But now I have a vision, a plan, and an approach.”

Donahue, with George as his mentor, plans to use the grant to gain a better understanding of the intrinsic variability of the patient by understanding the role of specific gene polymorphisms and how they impact the activation of coagulation systems. He hypothesizes that a patient’s genetic makeup contributes to susceptibility to bleeding and clotting complications following surgery.

By studying the specific genotypes, he believes that it may be possible to ascertain which patients are at greater risk for complications.

During surgery, coagulation is activated. Some patients activate considerably, resulting in the consumption of coagulation factors and the potential for postoperative bleeding, while some patients activate very little. Currently, there is no clear understanding of all the mechanisms that contribute to the activation. However, it is becoming evident that intrinsic patient variability has some effect on the activation. The research is promising and may allow physicians to identify who may be predisposed to specific complications prior to surgery.

Donahue began his research in George’s lab, using a desk and a bench provided by George to carry out lab work. George feels Donahue’s perseverance and determination illustrate the potential of the VPSD program.

“Brian is a model for how Vanderbilt can be a nurturing environment for the young physician-scientist,” George said.

Donahue, who has begun collecting data on patients both at Vanderbilt and Duke University, is pleased with the grant and hopes that within the next five years, he will be able to convert it to an R01, an independent investigator grant. He sees the K23 as a stepping stone made possible by the VPSD program and the faculty members who recognized the need for it.

“Programs like this, that get young faculty bridged so that they can get a mentored award off the ground or obtain an R01, are extremely important in the development of the university,” Donahue said.

The VPSD program addressed an institution-wide need to provide young investigators with the support necessary to advance their research careers. Of the original VPSD class of eight investigators, five are already on the track to obtaining independent funding. The program not only benefits the individual investigators as they submit independent research grants and papers, but the university as well, as the research receives recognition throughout the medical field. The long-term benefits extend to the individual departments, the medical community as a whole, and ultimately to patients.

“VPSD has been critical to Brian’s success,” Balser said. “He is a shining example of what we can accomplish through the program.”