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Walking with Heart

Nestor (l) with Azzolino.

Nick Azzolino first developed leg swelling, red patches and other symptoms while trying to shake a persistent virus in 1993. Initially the 54-year-old husband and father feared a recurrence of the thyroid cancer he had overcome years before — but a local hospital failed to yield a clear diagnosis. In 1995, breathing problems began. He recalls, “while touring a school with my college-bound daughter, I got so out of breath I couldn’t walk up a hill.”

In 2004 Azzolino came to BIDMC for testing and was referred to the Advanced Heart Failure Clinic, where he learned his symptoms were due to viral cardiomyopathy, a form of heart failure most likely brought on by the virus a decade earlier.

Azzolino is one of five million Americans affected by heart failure each year. Finding new treatments for such patients is one of the goals of the American Heart Association (AHA) and the Boston Heart Walk, an annual AHA event sponsored by BIDMC and other local institutions to raise awareness and funds.

All staff at BIDMC are invited once again this year to join the Heart Walk on Sept. 17 or pledge support for those who are walking. The more
than $2 million BIDMC cardiology researchers received from the AHA in 2004-2005 has helped bring new knowledge from the laboratory directly to BIDMC patients like Azzolino.

“The one-on-one relationship we develop with each patient is what makes BIDMC’s Advanced Heart Failure Clinic so effective,” says Monique Nestor, NP, one of Azzolino’s nurse practitioners.

In addition to the newest diagnostic and therapeutic techniques, the clinic emphasizes patient education, support groups and telephone follow-up.

Although Azzolino’s hospitalizations decreased, his heart’s ability to pump blood has declined. Recently his BIDMC cardiologist, Lana Tsao, MD, decided that a transplant was necessary.

Through a collaborative program with New England Medical Center, Azzolino is now on the heart transplant list.

Azzolino recalls: “I was surprised when Dr. Tsao told me I needed a new heart, but I trust her completely. The doctors and nurses at BIDMC watch over me like I’m their own father.”

— Peggy Egan

The 2005 Boston Heart Walk
Sat., Sept. 17
Charles River Esplanade
Captains, walkers and donors needed. Contact Nancy Safar, cardiology, (63)2-7393, nsafar@bidmc.harvard.edu, or visit http://heartwalk.kintera.org/bostonma

BIDMC Pathology Pioneer
Leaves Nothing to Chance

Dvorak at work.

No less an authority than “the father of medicine,” Louis Pasteur, is credited with having said, “chance favors the prepared mind.”

The quote is a favorite of BIDMC’s Harold Dvorak, MD, who retired in July after 26 years as chief of BIDMC’s department of pathology. He now turns his energies to co-directing (with Deputy Director William Aird, MD) BIDMC’s Center for Vascular Biology Research (CVBR).

“Hal’s outstanding department leadership over the past two-and-a-half decades has helped put BIDMC at the forefront of medical research,” says BIDMC President and CEO Paul Levy, “and his lab’s landmark discoveries have made, and continue to make, a huge impact on care for patients with cancer and other diseases.”

In 1983, Dvorak’s laboratory made the groundbreaking discovery of a protein now called VEGF (vascular endothelial growth factor), a breakthrough that proved to be a critical piece in the puzzle of how angiogenesis — the abnormal growth of blood vessels — enables cancerous tumors to grow.

The VEGF discovery, which helped bring about an important new direction in cancer research, was recently honored by the Institut de France. The Institut awarded its prestigious scientific honor, the Grand Prix Lefoulon-Delalande Institut de France, to Dvorak and fellow angiogenesis researchers Judah Folkman, MD, of Children’s Hospital Boston, and Napoleone Ferrara, MD, of the biotechnology company Genentech.

“There was an ‘aha’ moment when we realized that this was the molecule we had been searching for,” says Dvorak, describing VEGF’s discovery by investigators in his laboratory led by Donald Senger, PhD. “But it took years of hard work and effort to get to that ‘aha’ moment. It wasn’t pure chance. Don and the rest of us were prepared.”

BIDMC President and CEO Paul Levy delivers opening remarks at a celebration held at the Isabella Stewart Gardner Museum to honor Dvorak. Pictured (l to r): Levy; Judy Jensen, department of pathology; Dvorak; and his wife, Ann Dvorak, MD, department of pathology.

Dvorak was among the first to call attention to the similarities between cancer and wound healing and to describe cancer as a “wound that doesn’t heal.” He recognized that just as a wound causes leaky blood vessels, clotting and angiogenesis to begin the healing process, tumors “turn on” this same mechanism to enable blood vessels to grow. And, as he and his colleagues discovered, among both wounds and tumors it is VEGF that initiates this process.
“However,” he notes, “tumors differ from wounds in a very important respect. Once a wound has healed, VEGF production abruptly stops. But with tumors, VEGF production continues, keeping the ‘healing mechanism’ in the ‘on’ position, causing cancerous tumors to grow and spread.”

Dvorak’s career is now taking an interesting turn at the 18-month-old CVBR. The center represents a novel approach in research by uniting more than 40 researchers from various disciplines and departments — including medicine, pathology, surgery and radiology — to study the role of blood vessels in both health and disease.

“Scientific knowledge has expanded enormously since I began my career,” Dvorak notes. “As one looks to the future, scientists will have to work collaboratively to achieve the best results, as well as to be awarded funding. The CVBR is a prime example of collaboration that, we hope, will yield scientific insights that might otherwise have gone undiscovered.”

— Bonnie Prescott