Medical Student Research Fellowship for Summer 2009
Mentor: Heidi Jacobe
Department: Dermatology
Room number: JA5.120
Mail Code: 9069
Phone number: 214-648-2985
E-mail: heidi.jacobe@utsouthwestern.edu
Project title: Project 1: Clinicopathologic correlation in morphea
Project 2: Defining subcutaneous findings in morphea via MRI and ultrasound.
Human subjects IRB approved project number (where applicable): 032007-021
Animal subjects IRB approved project number (where applicable): NA
Project Type: Patient-based research
Project 1 Summary: Morphea is a form of scleroderma isolated to the skin. It is characterized by sclerosis of the papillary and reticular dermis with varied degrees of inflammation and edema depending on the stage of disease. Although incompletely understood, these changes are at least in part due to the down regulation of the expression and protein levels of matrix metalloproteinases/collagenase I and upregulation of TGF beta. UVA-1 phototherapy has demonstrated efficacy in the treatment of morphea in numerous small trials, but the mechanism by which this effect is mediated is poorly described. In this study, the student will assess the effect of UVA1 phototherapy on skin thickness and fibrosis scores using H and E stained histological sections of skin pre and post therapy with UVA-1 as well as the level of MMP/collagenase I and TGF beta protein in the same tissue sections, using previously published protocols for ELISA. These changes will be correlated with clinical improvement scores.
Student Role for Project 1: The student will be responsible for the measurement of skin thickness, determination of TGF beta and MMP1 levels using ELISA, and the evaluation of this data under the supervision of myself and out consulting dermatopathologist Dr. Joseph Susa.
Project 2 Summary: Recent observations by our group and others indicate that morphea may have superficial lesions that are easily evaluated visually and by palpation and deep lesions that are clinically in apparent until advanced, producing functional impairment. The utility of imaging modalities (20 mHz ultrasound, MRI) to detect early deep lesions is unknown. This pilot study seeks to begin to address this deficiency by correlating clinical findings (including modified Rodnan Skin Score, Morphea Skin Score), pathological findings, and imaging (U/S, MRI) results in our cohort. Further, baseline assessments will be compared with post treatment images and compared with clinical assessments of improvement.
Student Role for Project 2: The student will be responsible for reviewing findings of morphea on ultrasound/MRI published to date, reviewing and cataloging findings on MRI/US in our cohort to date (including reviewing films with PI and radiologist). Correlation of these results with clinical scores/evaluation (including assisting PI with study patient evaluation).
Project 3 title: Use of computerized imaging to create lesion distribution maps in morphea
Human subjects IRB approved project number (where applicable): 032007-021
Animal subjects IRB approved project number (where applicable): NA
Project Type Patient-based
Brief Description of Project:
Morphea is currently classified into 5 subtypes based on the clinical appearance of the lesions. To date, there have been no consistent correlations between disease subtypes, autoantibody profiles or HLA type. Recent studies using computerized mapping of skin lesions demonstrate that these current subtypes are inaccurate. This project entails optimization of software to map cutaneous morpheous lesions, creating distribution frequencies for the lesions and thereby a more accurate subcategorization of the disease. These findings will then be correlated with existing autoantibody and HLA data.
Student role for project: The student will be directly responsible for working with software designers to create imaging mapping system application of software to existing lesion maps and analysis of the results. In addition the student, along with the mentor, will correlate these results with existing antibody and HLA data.
Previous Research Activities or Publications with Medical Students:
Doris Duke Foundation Clinical Research Fellows
Doris Duke fellow 2007-2008
Rachael Cayce
A retrospective review of the epidemiologic and autoimmune characteristics of
morphea patients.
Poster Presentation SID, Kyoto, Japan, May 2008
Leitenberger J, Cayce R, Haley RW, Adams-Huet B, Bergstresser PR Jacobe H. Morphea
subtypes are distinct autoimmune syndromes: A review of 242 adult and pediatric
cases. Arch Dermatol (in press) 2008.
Doris Duke fellow 2006-2007
Justin Leitenberger (UT Houston)
A retrospective review of the epidemiologic and autoimmune characteristics of
morphea patients.
Poster Presentation SID, Los Angeles, CA, 2007.
Leitenberger J, Cayce R, Haley RW, Adams-Huet B, Bergstresser PR Jacobe H. Morphea
subtypes are distinct autoimmune syndromes: A review of 242 adult and pediatric
cases. Arch Dermatol (in press) 2008.
Third and Fourth Year Dermatology Elective
Noori Kim, fall 2008 - Protein microarray signatures in morphea. Abstract accepted ICD, Praque, Czech, May 2009.
Shadi Kourosh, summer 2008 - Carpel tunnel syndrome as a presenting sign of scleroderma. Manuscript in preparation, Archives Internal Medicine.
Second Year Summer Research Fellowship
Siewee Lee, 2008
Mona Sadgephour, 2008 (Yale University School of Medicine)
Aimee (Heewon) Kwak, 2008
Julie Nguyen, 2007 - Jacobe HT, Nguyen J, Cayce R. UVA1 phototherapy is effective
in darker skin: A review of 101 patients of Fitzpatrick skin types I-V. Br J
Dermatol 159(3):691-696, 2008
Angela Brimhall
Summer 2004
Metaanalysis of biologics for psoriasis
Manuscript submitted for publication, British J of Dermatol. Brimhall A, King
L, Licciardone J, Jacobe H, Menter A: Safety and efficacy of alefacept, efalizumab,
etanercept and infliximab in treating moderate to severe plaque psoriasis: A
meta-analysis of randomized controlled trials. Br J Dermatol 159(2):24-85, 2008.
Angela Escobar
Summer 2004
A comparison of medium high dose UVA, phototherapy for the treatment of morphea.
Manuscript in preparation.