UAB MEDICINE PULMONARY SERVICES SPRING 2020
NEW PHYSICIANS
Chao He, MD, PhD
Assistant Professor
Dr. He received his medical degree from
Soochow University in China and his PhD in
free radical and radiation biology from the
University of Iowa. He joined the ABIM Pathway
in 2015 and completed his residency and clinical
fellowship in Pulmonary and Critical Care Medicine in June 2019.
He currently is a T32 postdoctoral research fellow working in Dr.
A. Brent Carter’s lab. Dr. He’s research is focused on defining the
role of alveolar macrophages in lung fibrosis. Previously he has
shown that macrophages undergo a different polarization process
during fibrosis development, and the process is regulated by
redox signaling. His current work investigates NOX4 and its role in
mediating lung macrophage polarization.
Daval Rhaval, MD
Assistant Professor
Dr. Rhaval’s clinical interests include critical
care, with special interest in ICU delirium, early
ambulation and sepsis management. He has had
robust exposure to various endobronchial and
pleural procedures, including indwelling pleural
catheter, percutaneous tracheotomy, bronchothermoplasty. Dr.
Rhaval is also interested in sleep medicine, ICU ultrasonography,
and hemodynamic management. His training in public health and
epidemiology gave him great insight in evidence-based medicine.
Dr. Raval also has experience as an independent hospitalist. He
has been involved in quality improvement and resource utilization
projects. His interest in resident and medical student education has
grown over his career, indicated by his teaching of medical students
and residents throughout his training.
Megan Kiedrowski, PhD
Assistant Professor
Dr. Kiedrowski is a microbiologist interested in
host-pathogen interactions during polymicrobial
infections. Her current work focuses on
interactions between the host airway epithelium,
bacterial pathogens, and viruses during cystic
fibrosis respiratory infections.
Previously, Dr. Kiedrowski worked as a postdoctoral fellow in
Jennifer Bomberger’s laboratory in the Department of Microbiology
and Molecular Genetics at the University of Pittsburgh. She
investigated polymicrobial infections in the CF lung and the impact
of the host environment on microbe-microbe interactions in
polymicrobial infections. She also worked as a postdoctoral fellow
in the laboratory of Jo Handelsman in the Department of Molecular,
Cellular and Developmental Biology at Yale University. There,
she conducted research on microbial communities and examined
microbe-microbe interactions in the gut environment and in biofilms.
Dr. Kiedrowski received her doctoral degree in microbiology from
the University of Iowa. She carried out her graduate research in
the laboratory of Alex Horswill, where she studied Staphylococcus
aureus biofilm formation and presented her work at many national
and international conferences.
RANKED NATIONALLY BY
U.S. News & World Report
To read these and past stories online, please visit
uabmedicine.org/referpulm.
RESEARCH POINTS TO POSSIBLE TARGET FOR
TREATING IPF
A. Brent Carter, MD, and colleagues report that the recruited
monocyte-derived macrophages, which have an increased
flux in the mevalonate metabolic pathway — without any
experimental injury — can induce lung fibrosis in a mouse
model. Their study, “Increased flux through the mevalonate
pathway mediates fibrotic repair without injury,” is published
in the Journal of Clinical Investigation.
“Here, we show a paradigm shift that indicates a critical and
essential role for monocyte-derived macrophage/fibroblast
crosstalk in the development and progression of fibrosis in
the absence of epithelial injury,” Dr. Carter says.
Research has shown that three hallmarks of the mechanism
that leads to lung fibrosis in the absence of injury in mice also
are found in bronchoalveolar (BAL) cells. The three hallmarks
are:
1. Activation of the small GTPase protein Rac1 and its
localization into the intermembrane space of mitochondria
in the BAL cells
2. Increased production of mitochondrial reactive oxygen
species by BAL cells in patients with IPF
3. Evidence of increased flux through the non-sterol arm of
the mevalonate pathway in the BAL cells that results in the
augmented activation of Rac1.
In macrophages, an increased flux through the non-sterol
arm of the mevalonate pathway increases the production of
geranylgeranyl diphosphate, or GGDP. This increased flux
is secondary to greater levels of acetyl-CoA from metabolic
reprogramming of the macrophages to β oxidation.
Using GGDP, an enzyme then adds geranylgeranyl (a
lipophilic membrane anchor) to Rac1, a Rho GTPase, and the
geranylgeranylated Rac1 translocates from the cytosol to
the intermembrane space of mitochondria. There, it induces
production of reactive oxygen species.
The reactive oxygen species cause a phenotypic shift of
the macrophage to a profibrotic state, acting through key
transcription factors. The profibrotic macrophages then
produce TGF-β1, which transforms fibroblasts into pathogenic
myofibroblasts.
“We propose that monocyte-derived macrophage/fibroblast
crosstalk can induce fibrosis without epithelial cell injury and
is the primary driver in mediating disease progression,” Dr.
Carter says. “These observations suggest that targeting the
mevalonate pathway may abrogate the role of macrophages
in dysregulated fibrotic repair.”
ABOUT OUR SERVICES
UAB Medicine recently launched a new webpage for medical professionals devoted to many of our key service areas, including the
Division of Pulmonary, Allergy, and Critical Care Medicine. Located at uabmedicine.org/referpulm, the page features details about
conditions we treat and many important therapies and clinical programs offered by the Division, such as:
• Asthma and COPD Clinic
• Critical care medicine, including extracorporeal membrane
oxygenation (ECMO)
• Sleep/Wake Disorders Center
FEATURE STORIES
DRS. IYER AND DRANSFIELD STUDY END-OF-
LIFE SPENDING AND HEALTH CARE UTILIZATION
AMONG OLDER ADULTS WITH COPD
In the American Journal of Medicine, UAB Medicine pulmonary
physicians Anand Iyer, MD, and Mark Dransfield, MD, recently
published their findings related to spending and care utilization
among older patients with COPD.
As end-of-life spending and health care utilization in older
adults with COPD have not been previously described, Drs. Iyer,
Dransfield, and collaborators examined data from Medicare
beneficiaries age 65 and up who had COPD and died between
2013 and 2014. End-of-life measures were retrospectively
reviewed for two years prior to death. Hospital referral regions,
or HRRs, were categorized into quintiles of age-sex-raceadjusted
overall spending during the last two years of life. The
research examined geographic and spending quintile variation
in spending and health care utilization across the continuum.
The investigators analyzed data from 146,240 decedents with
COPD from 306 HRRs. Age-sex-race-adjusted overall spending
per decedent during the last two years of life varied significantly
nationwide, from roughly $48,000 to $79,000. Inpatient care
accounted for 40.2% of spending. Overall, approximately 82% of
decedents were admitted to the hospital for nearly two weeks,
with 55% of those in an intensive care unit for about five days.
Compared to HRRs in the lowest spending quintile, HRRs in the
highest spending quintile had hospital lengths of stay that were
1.5-fold longer. Skilled nursing facilities accounted for 11.6%
of spending (approximately $7,000 per decedent) and were
used by nearly 40% of decedents for nearly 20 days. Hospice
accounted for 10.3% of spending (about $6,307 per decedent)
and was used by approximately 47% of decedents for roughly
40 days. There was significant geographic variation in hospice
use nationwide.
After completing its analysis, the research team discovered that
end-of-life spending and health care utilization in older adults
with COPD varied substantially nationwide. Decedents with
COPD frequently used acute and post-acute care near the end
of life. Hospice use was higher than expected, with significant
geographic disparities.
• Pulmonary fibrosis and interstitial lung disease
• Primary Ciliary Dyskinesia and Bronchiectasis Clinic
• Cystic fibrosis
• Interventional pulmonology
To read these and past stories online, please visit uabmedicine.org/referpulm.
UAB EMPLOYEE WELLNESS HOSTS SECOND
ANNUAL ‘LOVE YOUR LUNGS’ EXPO
On Dec. 5, 2019, the UAB Division of Pulmonary, Allergy, and
Critical Care Medicine collaborated with the UAB Lung Health
Center and UAB Employee Wellness to host the second annual
“Love Your Lungs” Health Expo. UAB employees, students
and members of the community were invited to learn about
healthy lung resources, win prizes, discuss lung health with
UAB Medicine faculty, take part in educational contests, and, of
course, snap a selfie with 17-foot inflatable lungs.
Participating organizations provided resources and
opportunities to help employees live well — from a dynamic
schedule of wellness programs and initiatives to on-campus
tools, classes, and screenings that make it easy to make healthy
choices in the workplace.
“The whole reason we’re doing this event is to remind
employees about how important it is to take care of your lungs
by living tobacco-free and by paying attention to the risk
factors for lung cancer,” says Anna Threadcraft, previous UAB
Employee Wellness director and the event’s coordinator.
Love Your Lungs also was designed to communicate with the
local community, alerting residents about important lung health
information they may have not known.
“Lung cancer is the number one cause of death in Alabama, and
80% of those who have lung cancer are either current or former
smokers,” says Monica Baskin, PhD, professor of Preventive
Medicine and associate director for Community Outreach and
Engagement at the O’Neal Comprehensive Cancer Center at
UAB.
This event also served to remind UAB Medicine physicians
to encourage their patients to quit smoking, emphasizing the
impact that a simple suggestion can have coming from a health
care provider.
“One of the most effective interventions you can do is to advise
your patients to quit smoking,” says John I. Kennedy Jr., MD,
senior advisor and director of Wellness at UAB.
Healthy lung resources are available online at uab.edu/
loveyourlungs.