I last reported to Missouri Medicine on the state of the Saint Louis University (SLU) School of Medicine in 2011. Since that time, with the support of a productive faculty and staff, we’ve been able to grow and evolve our clinical practice, recruit strong new academic and research leaders and build on the quality of student life on campus.
What many would regard as the most significant advance at SLU is one of the most recent. On September 1, 2015, following two years of confidential negotiations, a three-way transaction was completed that allowed SLU to reacquire SLU Hospital from the Tenet Corporation and immediately transfer the hospital to the ownership of the St. Louis portion of the Sisters of St. Mary system (SSMSTL). In return for this transfer, SLU received two positions on the board of directors of SSMSTL and received a minority equity stake in the corporation.
The national publication Becker’s Hospital Review rated it as the most interesting healthcare transaction in the nation in 2015. This transaction put SLUH, which now is known as SSM Health -Saint Louis University Hospital, at the tertiary-quaternary apex of an eight-hospital regional network that also contains many SSMSTL outpatient centers.
The early returns from this new partnership are positive. SSM is bringing its mission-driven and quality-driven hospital management style to SLUH. SLUH sits adjacent to the Cardinal Glennon Children’s Medical Center, which also is an SSM hospital. This provides the SLU campus with a unified hospital vision and partner for the first time in decades. Over the next five years, SSMSTL is committed to invest in new building and renovation projects including a new mainframe adult hospital and a new outpatient ambulatory care center on the Grand Boulevard campus. Over the past three years, SLU has managed to acquire the land and properties north of the current hospital location all the way to Chouteau Avenue. This provides an excellent area in which to develop what will be the new Grand Avenue medical center. Although our clinical practice, SLUCare, remains contractually independent of SSMSTL, it is rapidly becoming deeply integrated into the SSMSTL regional network. We’re optimistic that our patients, students, faculty and community will be the ultimate beneficiaries of this exciting new partnership.
Over these past several years many new academic leaders have been recruited to SLU’s School of Medicine. One of them is Dr. Tom Burris who came to SLU from Scripps Florida in 2013 to lead our department of pharmacology and physiology. Since his arrival at SLU, Dr. Burris has received multiple new NIH R01 grant awards in his primary area of investigation, which is nuclear receptor biology. Dr. Burris has recruited several outstanding people to join him at SLU. He and his team are pursuing nuclear receptor science in cancer, neurodegenerative disease, autism, and a variety of other disorders.
Dr. Dan Hoft, a productive SLU faculty member who is nationally respected for his work on tuberculosis and other infectious diseases, stepped in upon the retirement of Dr. Bob Belshe and now leads SLU’s Infectious Diseases group and the Vaccine Trial and Evaluation Unit (VTEU) where he works closely with Dr. Sharon Frey. About two years ago the VTEU was renewed by the NIH as one of nine vaccine development units in the nation and more recently was designated as one of only two of the VTEUs that will serve to develop the “_omics” components (proteomics, genomics, metabolomics, etc.) of vaccine trial and development work for the other VTEUs. Dr. Hoft also received a recent multimillion dollar award from the Gates Foundation to pursue his development of a vaccine for multi-drug resistant tuberculosis.
When Dr. Rick Lee, a noted cardiovascular surgeon, joined SLU from Northwestern three years ago, we merged the division of cardiology, which was in internal medicine, with cardiovascular surgery, a division within the department of surgery. This created a new fiscally independent operational unit known as the Center for Comprehensive Cardiovascular Care (“C-4”). C-4 is seeing much higher volumes of patients than before the merger and is providing state of the art inter ventional and surgical approaches to patients with atrial fibrillation, valvular heart disease and many other cardiac conditions.
The departments of neurology and psychiatry, which had been a single joint department for nearly 10 years at SLU, once again are independent. These disciplines are independent at virtually all other American medical schools. They merged at SLU at a time when such mergers seemed like a new and innovative way to move ahead. Over the years, most other schools who tried this approach eventually returned to independent departments. Dr. Henry Nasrallah, who we recruited from the University of Cincinnati three years ago, initially led the joint department and then facilitated the return to separate departmental status. He now chairs the department of psychiatry. The department of neurology has interim leadership through Dr. Sean Goretzke, head of the division of pediatric neurology. This new alignment occurred only months ago and is off to a solid start.
The School of Medicine’s funded research portfolio is growing, with especially notable contributions in structural biology. Dr. Enrico Di Cera, who joined SLU as chair of biochemistry nearly five years ago, published recently his group’s excellent work showing for the first time the molecular structure of prothrombin (See Figure 1). In 2016, Dr. Duane Grandgenett, a long-time SLU professor who first described the critical enzyme integrase over 30 years ago, published in Nature with colleagues from the University of Minnesota and Cornell, the first demonstration of the molecular structure of the intasome of the retrovirus known as Rous sarcoma virus (RSV). This structure is critical to understanding HIV integration into human cell DNA (Figure 2), and will help guide the development of new anti-HIV drugs.
Figure 1.
X-ray crystal structure of the vitamin K-dependent coagulation factor prothrombin showing the spatial arrangement of the Gla domain (Gla), two kringles (K1, K2), protease domain with the A chain (Ac) and catalytic B chain (Bc) and three linkers connecting the Gla domain to kringle-1 (Lnk1), the two kringles (Lnk2) and kringle-2 to the A chain (Lnk3). The structure was validated by single molecule FRET (smFRET) measurements using probes (spheres) introduced in various domains. X-ray crystallography and smFRET equipment are state-of-the-art resources in the Department of Biochemistry and Molecular Biology.
Figure 2.
Integration of HIV-1 DNA into cell DNA. A. The HIV-1 integrase (blue oval) inserts the viral DNA into human cell DNA producing a permanent copy of the viral DNA in the genome. The integrated HIV-1 DNA subsequently produces more virus particles to infect other human cells. B. Integrase inhibitors (red triangles) prevent the integration of the viral DNA and thus stops virus replication. There are three FDA approved integrase inhibitors which are used in combination with different inhibitors that block other viral proteins thus preventing HIV-1 replication. Combinational drug therapies help prevent drug resistance.
Drs. Burris and Di Cera working together with SLU’s department of chemistry have put together a program that has allowed SLU to purchase a 700 MHz nuclear magnetic resonance (NMR) instrument that will be housed on SLU’s main campus. Together with our powerful x-ray diffraction capabilities and single molecule analytic techniques in Dr. Di Cera’s lab, this new NMR will allow SLU to have a state of the art Structural Biology Program. The NMR is expected to be fully operational within a year.
Because our ultimate goal as a medical school is to teach and develop great physicians, I save for the last the work being done in these areas. In 2015, Dr. Angela Sharkey, associate dean for faculty affairs and development, created the School of Medicine’s first Academy of Educators. The Academy is designed to honor the school’s very best educators – those who have received other school-wide or departmental teaching awards, not once or twice, but repeatedly during their careers. We expect this honor to be reserved for no more than one to two inductees per year. One of the five inaugural inductees to the Academy was Dr. Stuart Slavin. Dr. Slavin, who is our associate dean for curriculum, has been working to improve student well being and the organization of the SLU curriculum over the past several years. These improvements focus on the pre-clinical years and include a true pass-fail approach, shortening and moving the Anatomy course later in the first year curriculum, developing substantial time for student electives in the first and second year and beginning the phase three clinical year in April of the second year. These structural changes have been well received, but are only part of the story. By providing more personal attention to students and working on student formation (Figure 3), Dr. Slavin and his colleagues strive to develop great physicians who have the resiliency to cope with the high stress existence of a medical student and physician. The results of Dr. Slavin’s work have been widely cited and show that the frequency of anxiety and depression among SLU medical students has declined dramatically. In addition, the new national AAMC survey of second-year student satisfaction and attitudes, published for the first time in February, 2016, shows that SLU students have significantly more positive feelings about their time in school, their approach to patients and their future careers than the national averages derived from a composite of all other schools. We are heartened to see these new results, and are encouraging Dr. Slavin and his colleagues to continue this outstanding work.
Figure 3.
Stuart Slavin, MD, with six SLU medical students on the SLU medical campus.
I’m delighted to be able to report these activities at SLU and will watch eagerly to see how the school and medical campus evolve over the years ahead. I will not, however, do that as the dean of the school. A few months ago I approached President Fred Pestello and indicated that I believed it was the right time to begin the process of searching for my successor. I am proud to have served as the dean at SLU for eight full years as this article goes to press. God willing, I will continue to serve until my successor is appointed through a national search process that now is underway. It has been a great pleasure to work with the outstanding faculty and staff of this medical school and especially our wonderful students during my eight years here at SLU. I know that our faculty leaders and my successor will lead the SLU School of Medicine to great levels of achievement in the years ahead.
Biography
Philip O. Alderson, MD, MSMA member 2009, is Dean, School of Medicine and Vice President, Medical Affairs, at Saint Louis University.
Contact: palderso@slu.edu
