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JACKSONVILLE, Fla. — September 7, 2012.  More than a cancer-causing gene is needed to trigger pancreatic cancer, a study led by Mayo Clinic has found. A second factor creates a "perfect storm" that allows tumors to form, the researchers say. The study, published in the Sept. 10 issue of Cancer Cell, overturns the current belief that a mutation in the KRAS oncogene is enough to initiate pancreatic cancer and unrestrained cell growth. MULTIMEDIA ALERT: Video resources, including an interview with Dr. Crawford, are available for journalists at the Mayo Clinic News Network. The findings uncover critical clues on how pancreatic cancer develops and why few patients benefit from current therapies. The findings also provide ideas about how to improve treatment and prevention of pancreatic cancer. The research team, led by Howard C. Crawford, Ph.D., a cancer biologist at Mayo Clinic's campus in Florida, and Jens Siveke, M.D., at Technical University in Munich, Germany, found that for pancreatic cancer to form, mutated KRAS must recruit a second player: the epidermal growth factor receptor, or EGFR.A third genetic participant known as Trp53 makes pancreatic tumors very difficult to treat, the study showed. The scientists also found that EGFR was required in pancreatic cancer initiated by pancreatic inflammation known as pancreatitis. "We believe the perfect storm needed to trigger pancreatic cancer include KRAS mutations and inflammation in the organ, which then work synergistically to turn on EGFR," says Dr. Crawford. "The bottom line is, without EGFR, tumors don't form — and that was never known before this study," he says. "We also think that inflammation in the pancreas has a big impact on turning on EGFR." The researchers discovered that when they blocked EGFR activity, the mice studied were protected against developing chronic pancreatitis and pancreatic cancer. They further found that in mice that had lost expression of the TP53 tumor suppressor — a situation that mirrors up to 60 percent of human pancreatic cancer cases — tumors escape the dependency on EGFR for initiation and continued growth of pancreatic cancer, Dr. Crawford says. Pancreatic cancer is a highly lethal disease; no drug has been able to target the mutant KRAS protein. The study suggests some patients, such as those with chronic pancreatitis, may be good candidates for treatment with EGFR inhibitors to fight or prevent pancreatic cancer, Dr. Crawford says.

JACKSONVILLE, Fla. — September 5, 2012.  Motivated by their commitment to better the Jacksonville community and improve the lives of its citizens, J. Wayne and Delores Barr Weaver have given $7 million to the new Multidisciplinary Simulation Center at Mayo Clinic in Florida. The center will be named "Mayo Clinic J. Wayne and Delores Barr Weaver Simulation Center" and is expected to open early 2013. This gift, in addition to several prior gifts the Weavers have given to various Jacksonville health-related organizations, demonstrates the family's commitment to improving access, quality of health care and collaboration in our community. The Weavers, Jacksonville community leaders and former owners of the Jacksonville Jaguars, say their gift is meant to promote high-quality patient care, education and research and that the benefits of Mayo's Simulation Center should be shared with the entire community. "Wayne and I believe that simulation training will have a tremendous impact on improving the overall quality of health care in Jacksonville," Delores Weaver says. "It's a tremendous resource that physicians and other health care professionals can use to improve their skills and share best practices. We're excited to be a part of Mayo Clinic's simulation center and we look forward to seeing various organizations and the community sharing this resource and benefiting from Mayo Clinic's expertise." Simulation training is becoming more prevalent in medical education and is deemed to be very effective. Recent advancements in technology, the advent of robotic surgery, and innovations in the delivery of education are fostering the evolution of simulation in medicine. Simulation encompasses a variety of approaches from allowing surgeons to practice fundamentals and master new techniques, to hospitalist physicians and nursing staff undergoing team training, to other healthcare staff providing patient assessments using standardized patients. Mayo's new simulation center will offer these experiences in a medical theatre environment, where learners can practice all the scenarios with experienced faculty in a space that replicates real life. "The age of simulation training is here, and studies show its enormous potential for improving the quality and safety of patient care, as well as its utility for innovation," says William Rupp, M.D., chief executive officer of Mayo Clinic in Florida. "We are excited to pursue this new addition for our patients and the community. We are especially grateful for the support of the Weavers and other benefactors whose philanthropy made this center a reality."

JACKSONVILLE, Fla. — September 4, 2012.  Mayo Clinic and the University of North Florida are honoring National Breast Cancer Awareness Month in October by hosting ...

JACKSONVILLE, Fla. — August 29, 2012.  Removing the entire pancreas in patients with cancer or precancerous cysts in part of the organ does not result in unmanageable diabetes — as many physicians previously believed, research at Mayo Clinic in Florida has found. The study, published online Sunday in the journal HPB Surgery, evaluates how well patients who had their entire pancreas removed could control their resulting diabetes. The pancreas produces insulin to remove sugar from the blood, so when the organ is gone, insulin must be replaced, usually through an external pump or with injections. The researchers examined control of insulin over several years in 14 patients whose entire pancreas was removed. They compared their findings with 100 people with type 1 diabetes, and must use insulin replacement. They found both groups had little difficulty controlling their blood sugar, and no complications resulted. The findings should reassure physicians and surgeons that removing the entire pancreas is reasonably safe and effective, says senior investigator Michael B. Wallace, M.D., chair of the Division of Gastroenterology & Hepatology at Mayo Clinic in Florida. "What has confounded surgery for pancreatic cancers and precancerous cysts for a long time is the notion that if the entire organ is removed, patients will have great difficulty in controlling the resulting diabetes," Dr. Wallace says. "Most surgeons try to leave as much of the pancreas as possible". "What we have shown here is that, due to wonderful recent improvements in insulin therapy, patients without a pancreas can control their blood sugar as effectively as type 1 diabetes patients can," he says. Although this study was small, Dr. Wallace says the findings are mirrored in the experiences of patients treated at Mayo Clinic in Florida with total pancreas removal. Even though the approach of preserving as much of the pancreas as possible benefits most patients, leaving part of the pancreas in some patients may put them at risk of developing hard-to-detect cancer in the remaining organ, he says.

Jacksonville, Fla. — August 24, 2012.  As another storms brews in the Atlantic, residents of coastal communities are starting to prepare for a potential severe weather emergency. But hurricane shutters, flashlights and batteries are not the only things to consider. Food safety is critical to maintaining wellbeing during a natural disaster, and finding creative ways to feed a family can become an issue if refrigeration and electricity are unavailable. MULTIMEDIA ALERT: Video and audio clips of Ron Stone, Nutrition Services at Mayo Clinic, are available for journalists to download on the Mayo Clinic News Network. "Whether it's a hurricane or another natural disaster, it's critical to understand basic food and water safety, particularly if power outages or flooding occur. Having a plan in place will ensure proper nutrition, energy, and long-term wellness," says Sherry Mahoney, director of Nutrition and Food Services at Mayo Clinic in Florida. She advises creating a meal plan in advance, "since most people aren't thinking about recipes (during a disaster), and refrigeration and cooking may become a problem." But eating out of a can doesn't have to be boring, says Ron Stone, Assistant Director of Nutrition. "There are many options to mix and match from your pantry, and with advanced planning and a little creativity, you can provide healthy and delicious meals for your family," he says." Under their direction, Mayo Clinic dietetic interns recently created sample three-day meal plans (PDF) to feed a family of four. The recipes do not require the use of power or refrigeration, but are still "colorful, exciting and nutritious," Mahoney says. The recipe list (PDF) includes "Coconut Oatmeal Energy Bars," "Stir It Up Vanilla Pudding Parfait," "Reggie's Chopped Barbecue Chicken Salad on Flatbread" or "Chocoholic Peanut Butter Pie." Here are tips from Stone for prepping your pantry and planning an emergency menu: Know the safe temperature zones of perishable food. When the power goes out, keep the refrigerator and freezer doors closed as much as possible to maintain the cold. The refrigerator, if unopened, will keep food cold for about four hours. A full freezer will maintain its temperature for around 48 hours (24 hours if it is half full) if the door remains closed. Stock up on condiments, particularly those that are vinegar-based, which have a long shelf life and are versatile, such as ketchup, mustard, soy sauce and BBQ sauce. Consider travel-sized containers for convenience. Keep canned protein on hand (chicken, salmon, beans and peanut butter). Don't forgo the milk: Keep boxes of powdered milk or shelf-stable cartons on hand for cereal or deserts. Dried fruits, nuts and spices can add a boost of flavor to otherwise bland dishes. Don't forget a manual can opener.

JACKSONVILLE, Fla. — July 31, 2012.  A potentially powerful new approach to treating two lethal metastatic cancers — triple negative breast cancer and clear cell renal cell carcinoma, the most common form of kidney cancer — has been discovered by researchers at Mayo Clinic in Florida. In the online issue of Molecular Cancer Therapeutics, they report that two drugs, romidepsin and decitabine, work cooperatively to activate a potent tumor suppressor gene that is silenced in these cancers. Once the gene, secreted frizzled related protein one or sFRP1, went to work after the drugs were used, the laboratory tumor cells stopped growing and died. Both drugs are approved by the Food and Drug Administration to treat blood cancer and are being tested individually in numerous solid cancers in which sFRP1 is disabled. This study was the first to test the use of both in these metastatic cancers linked to sFRP1, and the results are very encouraging, says senior investigator John Copland, Ph.D., a Mayo Clinic molecular biologist. "We now have the basis for a clinical trial aimed at providing effective therapy for two drug-resistant cancers and perhaps many more tumor types in the future," Dr. Copland says. In addition to breast and kidney cancer, sFRP1 is disabled in colon, ovarian, lung, liver and other tumor types. Dr. Copland and his colleagues earlier discovered that sFRP1 was silenced in certain cancers. This new work demonstrates that its expression can be restored by romidepsin, which is a histone deacetylase inhibitor, and decitabine, a methyltranferase inhibitor. Both are epigenetic drugs, modifying genes in a way that affects whether they are turned on or off. "Individually, each drug did not induce any form of cell death but, together, they killed all of the different cell lines of kidney and triple negative breast cancer that we tested in the laboratory," says lead investigator Simon Cooper, Ph.D., a Mayo Clinic molecular biologist who specializes in renal cancer. The two cancers affect up to 80,000 Americans each year and therapies to treat both, especially when they are advanced, have been very limited, says co-author Edith Perez, M.D., deputy director of Mayo Clinic Cancer Center. "But now, not only do we have a very promising lead on future therapy, but if this combination treatment works as we hope it does, we will have a biomarker to be able to test which patients might benefit the most," she says. "In other words, a biopsy test could identify patients whose tumors had lost sFRP1 function." The approach to finding this potential new treatment strategy is novel, adds oncologist Michael Menefee, M.D., who is also a study co-author.

VIDEO ALERT: Audio and video resources available on Mayo Clinic's YouTube Channel. Jacksonville, Fla. — July 18, 2012.  As sports training season gets underway, Florida parents, particularly those of youth athletes, should be aware of a new law that goes into effect on Sunday pertaining to concussions and the ability of student athletes to return to play if they suffer a head injury. With the adoption of HB 291, Florida's youth athlete concussion bill, which goes into effect on Sunday, July 1, Florida joins more than 30 states that have adopted concussion guidelines for youth sports. The bill, which was introduced by Rep. Ron "Doc" Renuart, R- Ponte Vedra, mandates that any athlete suspected of sustaining a concussion or head injury be immediately removed from practice or competition until the athlete receives written medical clearance to return from an appropriate health care practitioner. "There are over 300,000 head injuries reported annually in high school athletics and over 90 percent are concussions, so it's important that coaches, parents and sports officials be aware of the pervasiveness of concussions, the signs and symptoms, and the fact that returning to play too soon after sustaining an injury could have detrimental effects," says Mayo Clinic family and sports medicine physician Jennifer Roth Maynard, M.D., who is also chair of the Northeast Florida Regional Sports Concussion Task Force. After a concussion, if an athlete continues to play or returns to play too early, there is a significant risk of experiencing another concussion, Dr. Maynard says. "Repeat concussions may take longer to resolve and come with a risk of permanent neurological damage or, rarely, death." Children, adolescents and female athletes appear to be at a higher risk for concussions, and may also take longer to recover. With the new law, there is no same-day return to play. Rather, the ruling specifies a graduated return to exercise protocol (light aerobic activity, moderate aerobic activity, sport specific drills, full contact practice) that must be supervised and approved by a responsible adult or athletic trainer before a physician will give the final clearance to safely return to sport. "Since each person may present concussion differently, the diagnosis of a concussion, assessment of its severity and knowing when an athlete can return to physical activity, competition, work or school is not always clear. Mayo Clinic advocates for having a computerized baseline concussion assessment for each athlete to assist in identifying and quantifying changes in brain function should a concussion occur," says Dr. Maynard. Baseline computerized neurocognitive testing is used to help establish the normal brain function of an athlete with respect to memory, reaction time, speed and concentration. When compared to a post-injury test, this is a helpful tool for a physician to determine when the brain has returned to normal and it is safe for an athlete to begin a return to play protocol. This non-invasive test is set up in "video-game" type format and takes about 15-20 minutes to complete. Mayo Clinic's campus in Florida began providing baseline assessments earlier this year and is offering screening opportunities at a flat rate of $20 per athlete, regardless of insurance coverage.

JACKSONVILLE, Fla. — July 12, 2012.  Mayo Clinic's campus in Florida has received an "A" rating for excellence in patient safety from The Leapfrog Group, ...

Note: Funding information at the end of the news release has been updated. JACKSONVILLE, Fla. — July 10, 2012.  Cellular change thought to happen only in late-stage cancers to help tumors spread also occurs in early-stage lung cancer as a way to bypass growth controls, say researchers at Mayo Clinic in Florida. The finding, reported in the July 11 issue of Science Translational Medicine, represents a new understanding of the extent of transformation that lung cancer — and likely many other tumor types — undergo early in disease development, the scientists say. They add that the discovery also points to a potential strategy to halt this process, known as epithelial-mesenchymal transition, or EMT. "Our study points to EMT as a key step in lung cancer progression during the earliest stages of cancer development," says lead investigator and cancer biologist Derek Radisky, Ph.D. "Normal cells recognize when they are dividing too rapidly, and turn on programs that block inappropriate cell division. Here we found that early-stage lung cancer cells switch on EMT in order to bypass these controls," he says. The discovery could offer a new way to prevent progression to late-stage lung cancer, possibly by inhibiting a particular molecule from functioning, Dr. Radisky says. Because EMT is a well-recognized late-stage transition that occurs in all sorts of solid tumors, the researchers say they believe that the same early-stage use of EMT they found in lung cancer is likely occurring in other cancers. EMT is a biological process used in embryonic development to allow body development, which requires the ability of cells and tissues to morph from one type to another, and develop in an orchestrated fashion. Late-stage cancer uses EMT to change tumor cells into a form that can migrate through blood. "The gaps in our knowledge of lung cancer have not allowed us to develop more effective targeted therapies," Dr. Radisky says. "This study offers us great new clues for a new approach to treating lung and possibly other cancers as early as possible."

JACKSONVILLE, Fla. — June 20, 2012.  A molecule widely believed to fight many forms of cancer actually helps deadly thyroid tumors grow, and cancer therapies now being tested in humans might boost the activity of this newly revealed bad guy, researchers at Mayo Clinic in Florida say. Their findings are published online this month in the Journal of Cell Science. The study found that in anaplastic thyroid cancer, the Forkhead transcription factor, FOXO3a, is not the helpful tumor suppressor everyone thought it was, but, instead, is a lethal promoter of tumor growth. When FOXO3a was silenced in laboratory models of human anaplastic thyroid cancer, the cells grew slowly, but when it was added, they grew much faster. "This result is exactly the opposite of what we expected," says senior author John A. Copland, Ph.D., a Mayo cancer biologist. "We were more than surprised. We were concerned." FOXO3a is known as a suppressor of tumor growth because it responds to all forms of cell stress, including that produced in cancer, by turning on genes inside the nucleus that trigger the cell's death. Cancer, in turn, is known to shut down FOXO3a by sending it out of the nucleus and into the cell's cytoplasm, where it is degraded. The molecule that ships FOXO3a out of the nucleus is Akt, which tries to keep cancer cells alive. The research team used an Akt blocker — similar to the ones now being used in human cancer clinical trials — expecting to increase nuclear FOXO3a and suppress cancer growth in anaplastic thyroid cancer. They were trying to find a treatment for one of the deadliest known cancers, which accounts for just 2 percent of thyroid cancer cases in the U.S. but is responsible for about 40 percent of thyroid cancer deaths. "The issue we are grappling with is that there are no effective treatments for this cancer. These tumors are so aggressive because there are so many genetic abnormalities," says study co-author Robert Smallridge, M.D., a Mayo endocrinologist who treats thyroid cancer patients. "We are studying what drives this cancer and how it can be treated." The study showed that FOXO3a remained in the nucleus, with the use of an Akt inhibitor, and that instead of helping to kill cancer cells, FOXO3a was accelerating their growth. This raises concern about the use of Akt inhibitors since one of the mechanisms is to cause FOXO3a to remain active in the nucleus. "We discovered a biological switch that turns FOXO3a from a good guy into a bad actor, but we don't know what that is yet, or in which cancers that might happen," says lead researcher Laura Marlow, a Mayo biologist. "Cancer researchers, including those testing Akt inhibitors, should know that FOXO3a has pro-cancer activity as well as anti-cancer properties," Dr. Copland says. "Concern should be raised that an Akt inhibitor will enhance retention of FOXO3a in the nucleus, causing FOXO3a to remain active.

JACKSONVILLE, Fla. — June 6, 2012.  Using a new and powerful approach to understand the origins of neurodegenerative disorders such as Alzheimer's disease, researchers at Mayo Clinic in Florida are building the case that these diseases are primarily caused by genes that are too active or not active enough, rather than by harmful gene mutations. VIDEO ALERT: Video resources of Nilufer Ertekin-Taner, M.D., Ph.D., discussing the study are available here. In the June 7 online issue of PLoS Genetics, they report that several hundred genes within almost 800 brain samples of patients with Alzheimer's disease or other disorders had altered expression levels that did not result from neurodegeneration. Many of those variants were likely the cause. "We now understand that disease likely develops from gene variants that have modest effects on gene expression, and which are also found in healthy people. But some of the variants — elevating expression of some genes, reducing levels of others — combine to produce a perfect storm that leads to dysfunction," says lead investigator Nilufer Ertekin-Taner, M.D., Ph.D., a Mayo Clinic neurologist and neuroscientist. "If we can identify the genes linked to a disease that are too active or too dormant, we might be able to define new drug targets and therapies," she says. "That could be the case for both neurodegenerative disease as well as disease in general." Dr. Ertekin-Taner says no other lab has performed the extent of brain gene expression study conducted at Mayo Clinic's Florida campus. "The novelty, and the usefulness, of our study is the sheer number of brain samples that we looked at and the way in which we analyzed them. These results demonstrate the significant contribution of genetic factors that alter brain gene expression and increase risk of disease," she says. This form of data analysis measures gene expression levels by quantifying the amount of RNA produced in tissue and scans the genome of patients to identify genetic variants that associate with these levels. Mayo researchers measured the level of 24,526 transcripts (messenger RNA) for 18,401 genes using cerebellar autopsy tissue from 197 Alzheimer's disease patients and from 177 patients with other forms of neurodegeneration. The researchers then validated the results by examining the temporal cortex from 202 Alzheimer's disease patients and from 197 with other pathologies. The difference between these samples is that while the temporal cortex is affected by Alzheimer's disease, the cerebellum is relatively spared. From these analyses, the researchers identified more than 2,000 markers of altered expression in both groups of patients that were common between the cerebellum and temporal cortex. Some of these markers also influenced risk of human diseases, suggesting their contribution to development of neurodegenerative and other diseases regardless of their location in the brain. They identified novel expression "hits" for genetic risk markers of diseases that included progressive supranuclear palsy, Parkinson's disease, and Paget's disease, and confirmed other known associations for lupus, ulcerative colitis, and type 1 diabetes. "Altered expression of brain genes can be linked to a number of diseases that affect the entire body," Dr. Ertekin-Taner says.

JACKSONVILLE, Fla. — May 24, 2012.   The Jacksonville campus of Mayo Clinic will invest about $97 million in two new major construction projects scheduled to begin this summer. The projects include the addition of two floors and 90 beds to its hospital, and the construction of an off-site primary care center that will be built near the intersection of Interstate 295 East Beltway (formerly 9A) and Gate Parkway. The expansion projects will add about 400 new jobs at Mayo and 250 construction jobs, says William Rupp, M.D., chief executive officer of Mayo Clinic in Florida. Mayo Clinic currently has about 4,900 employees and generates $1.6 billion annually to the northeast Florida economy. "Our hospital has been operating at or near capacity almost since it first opened four years ago," Dr. Rupp says. "The additional beds and other improvements to the hospital will help us continue to offer the highest quality of care and meet the needs of our patients." This marks the first expansion of the Mayo Clinic hospital since it opened in April 2008. Currently, the hospital has 214 beds. After the $80 million expansion, the hospital will have 304 private rooms and eight floors. The two-story, 40,000-square-foot primary care center will be designed to support 20 physicians and providers and offer X-ray, mammography, ultrasound and laboratory services. The high-performance and environmentally friendly building design will allow Mayo to seek LEED (Leadership in Energy and Environmental Design) certification when construction is completed.