Extending the Healthspan - Northwestern's new Potocsnak Longevity Institute aims to help people live healthier, longer. p. 14 - Northwestern ...
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SPRING 2022 Extending the Healthspan Northwestern’s new Potocsnak Longevity Institute aims to help people live healthier, longer. • p. 14 INSIDE UNLOCKING THE HUMAN NEW CHIEF OF ORGAN INNOVATIONS IN SPOTLIGHT ON DAVID PROTEOME • 18 TRANSPLANTATION • 22 CARDIAC CARE • 26 HOLTZMAN, ’85 MD • 38
FIRST GLANCE Northwestern Medicine Community Spotlight Learning from the Best In January, medical students learned how to perform cleft lip repair under the guidance of Arun Gosain, MD, division head of Plastic and Reconstructive Surgery at Ann & Robert H. Lurie Children’s Hospital of Chicago, and professor in the Division of Pediatric Surgery. Gosain and his colleagues lead the Cleft Lip and Palate Repair Program at Lurie Children’s. Photo by Jesse Arseneau Northwestern Medicine magazine Editorial Advisors: Eric G. Neilson, MD, ©2022 Northwestern University. Connect with NM online: is published quarterly for alumni vice president for Medical Affairs and Northwestern Medicine® is a federally fb.me/northwesternfeinberg Lewis Landsberg Dean; Alan Krensky, registered trademark of Northwestern and friends of Northwestern MD, vice dean for Development and Memorial HealthCare and is used by twitter.com/nufeinbergmed University Feinberg School of Alumni Relations; Nicole Mladic, Northwestern University. instagram.com/nufeinbergmed Medicine, Northwestern Memorial executive director of Communications; linkedin.com/school/northwestern- Material in Northwestern Medicine LINKEDIN-IN HealthCare, and the McGaw Babette Nyka, director of Alumni magazine may not be reproduced university-feinberg-school-of-medicine/ Relations Medical Center of Northwestern without prior consent and proper credit. Don’t miss NM web extras! University. Alumni Association: Edward S. Kim, Address all correspondence to: Catch up on the latest ’92 BS, ’96 MD (HPME), president Editor: Gina Bazer Northwestern University, Feinberg School Northwestern Medicine news Design: Taylor Design of Medicine, Office of Communications and check out more photos and Editorial Assistant: Katelyn May 420 E. Superior Street, Rubloff 12th Floor videos online at magazine.nm.org. Email us at medcommunications@ Contributing Writers: Emily Ayshford, Chicago, IL 60611 northwestern.edu Will Doss, Bridget M. Kuehn, Marla Paul, Win Reynolds, Melissa Rohman, Kim Waterman
NORTHWESTERN M EDICIN E MAGA ZIN E Spring 2022 CONTENTS Features 14 18 EXTENDING THE HEALTHSPAN UNLOCKING THE HUMAN PROTEOME Funded by a very generous gift from Chicago industrialist John Millions of molecular proteins are coursing through our body’s cells at all Potocsnak and family, Northwestern’s new Potocsnak Longevity times. To better understand them, Northwestern scientists are sequenc- Institute aims to help people age healthier. ing them the way the Human Genome Project sequenced genes and DNA. 22 26 TRANSPLANT TRANSFORMER THE RIGHT CARE AT THE RIGHT TIME Satish Nadig, MD, PhD, plans to usher in a new era of technology Whether it’s an acute cardiac episode or chronic unexplained in transplantation as director of Northwestern’s Comprehensive shortness of breath, Northwestern Medicine’s cardiac teams have Transplant Center. designed protocols for swift intervention. Departments LEADERSHIP PULSE ALUMNI PERSPECTIVE 02 Ahead of the Curve 03 On Campus 28 Trailblazers in Orthopaedics 41 The Healing Power Match Day, Research Briefs, and more 31 Alumni President’s Message of Storytelling 12 Media Spotlight 32 Progress Notes Jennifer Pien, ’01 MD 13 Faculty Awards & Honors 38 Alumni Profile ON THE COVER David Holtzman, ’85 MD Evaluations at the Human Longevity Laboratory — part of 40 Giving the new Potocsnak Longevity Investing in digital health and Institute — will include a blood test data science that measures DNA methylation and other biomarkers of aging- associated health conditions. The cover shows a 3D illustration of DNA methylation. Getty Images. MAGA ZIN E . N M .ORG 1
LEADERSHIP Ahead of the Curve clinicians, educators, and scholars, we intend led by Neil Kelleher, PhD, director of the to create the next generation of great phy- Chemistry of Life Processes Institute and a sician scientists, whose transformational professor of Medicine at Feinberg. As this leadership will chart the course. global team works to characterize all known While we cannot know what the prac- proteoforms while systematically discov- tice of medicine will look like in 30, 40, or 50 ering new ones, the potential and promise years — when our current trainees will be to impact human health and our study of deep into long careers — that is indeed the disease is enormous (page 18). very period we are shaping now. The ques- And Satish Nadig, MD, PhD, the new tions we pose, the plans we make today, will director of the Comprehensive Transplant collectively determine the time ahead. Center (CTC), arrived this past fall with bold This issue of Northwestern Medicine plans to usher in the era of modern immune magazine offers intriguing examples of such tolerance following transplantation. At visionary thinking and might inspire you to the helm of a stellar team already making consider what is possible when brilliant minds strides, his patient-centric approach to come together with significant purpose. innovation and technology may change the I Take, for instance, the new Potocsnak paradigm for transplants (page 22). N A REMARKABLE PLACE SUCH Longevity Institute, which signals an Finally, we share a quest for a future in AS OURS — A MEDICAL SCHOOL ” which there is equity in healthcare. A report DESIGNED FOR CONTINUOUS from a group of Black McGaw Medical learning, innovation, and discovery — looking Center alumni who have changed the face ahead is central to our mission. The students of the Department of Orthopaedic Surgery we train today will become future leaders; The questions we pose, — and medicine — over the past five the knowledge we uncover in the now can become treatments and cures for tomorrow. the plans we make today, decades is inspiring (page 28). We are forever grateful to the great We believe ideas sparked by collabora- tion have the power to generate electricity, will collectively determine minds in our midst. We aim to foster an en- vironment in which grand plans are encour- catalyze people, and drive meaningful change. the time ahead. aged and people are undaunted by even the To this end, at a recent research retreat, loftiest, most intimidating goals. Staying over 300 principal investigators gathered ahead of the curve demands the best of us. to establish priorities that will guide our enterprise for the next five years and beyond, ambitious new multidisciplinary approach positioning us to better meet the greatest to the science of aging. Led by Douglas With warm regards, challenges of the future. Vaughan, MD, chair of the Department of Our teaching faculty, likewise, con- Medicine, the institute aims to better un- Eric G. Neilson, MD tinuously innovate and study the impacts derstand complex biological changes and Vice President for Medical Affairs of novel education strategies on learning discover therapies and lifestyle interven- Lewis Landsberg Dean outcomes and downstream patient-care tions that can expand the healthspan for all quality. The field of medicine is undergoing people (page 14). tremendous change, and while our rigorous Another example of forward thinking curriculum has always produced outstanding comes from the Human Proteoform Project, 2 NORTHWESTERN M EDICIN E • S PRING 2022
On Campus Celebrating Match Day 2022 T orn envelopes littered the floor once again, as fourth- year students resumed the decades-long tradition of cele- brating their residency matches in person. “We’ve had this pent-up excitement over the last few years, and the fact that we get to be together in one space to share this moment is magical,” said Ketan Jain-Poster, who matched in oto- laryngology at Kaiser Permanente Oakland Medical Center. On Match Day, an annual tradition held on the third Friday of March, all fourth-year medical students across the country learn — at the exact same time — where they will train as residents for the next three to seven years. This year, Feinberg students and their families attended the Match Day celebration at the Louis A. Simpson and Kimberly K. Querrey Biomedical Research Center on Northwestern’s Chicago campus. Match Day continued on the next page → WRIT TEN BY Will Doss MAGA ZIN E . N M .ORG 3
PULSE On Campus “We’ve had this pent-up excitement over the last few years, and the fact that we get to be together in one space to share this moment is magical.” KETAN JAIN-POSTER Residency matches are made by the challenges you’ve faced and the National Resident Matching solutions you’ve provided have Program (NRMP), which uses made you an inspiration,” Green an algorithm to pair graduating said. “You are an exceptional class.” medical students with available Match Day is the beginning training positions at U.S. teach- of the end of medical school for ing hospitals. The model takes students at Feinberg, many of into account the top choices whom will leave Chicago for train- of both the students and the ing across the country. Zenaida residency programs. Enchill, a fourth-year student This year’s graduating class who matched in orthopaedic faced enormous adversity due surgery at the Harvard Combined to the COVID-19 pandemic, Orthopaedic Residency Program, said the events conjured up mem- ories of Founders’ Day four years ago, where first-year students were welcomed to campus. “I remember the white coat ceremony, just down the street, and now we’re here,” Enchill said. “I am very grateful for my mentors and support system, and I’m incredibly excited.” Other students will stay at Northwestern, including Christopher Yang, a fourth- year student who matched into Dermatology at the McGaw Medical Center of Northwestern according to Marianne Green, University. Yang said the backing MD, the Raymond H. Curry, MD, he received from the Northwestern Professor of Medical Education community was influential in his and vice dean for Education, who decision to remain in Chicago. spoke to students and their fam- “Northwestern has been ilies before the envelope opening. fantastic, the mentors here are “You’ve had a unique incredible, and I could not have medical school experience, and done it without them,” Yang said. 4 NORTHWESTERN M EDICIN E • S PRING 2022
On Campus 33 students were inducted into the Feinberg chapter of the Alpha Omega Alpha medical honor society. Honoring Achievement I n a ceremony on March 15, the Alpha and apply it to my learning as a resident and to Omega Alpha (AOA) medical honor society serving my patients during practice.” welcomed 43 new members into the New housestaff inductees were announced Feinberg chapter on the basis of outstanding by Linda Suleiman, MD, ’17 GME, assistant dean scholastic achievement and significant contri- of Medical Education, director of diversity butions to medicine. and inclusion for the McGaw Medical Center Prior to the induction ceremony, Elizabeth of Northwestern University, and an assistant McNally, MD, PhD, the Elizabeth J. Ward professor of Orthopaedic Surgery. Professor of Genetic Medicine, delivered the “It is an immense honor to be inducted Walter G. Barr, MD, Lecture, speaking about into AOA,” said Katherine McGee, chief resident the promising future of cardiac risk prediction in medicine and AOA inductee. “I owe so much using genetic variation. to my mentors, education, and training at Following the lecture, guests attended Northwestern, which has prepared me for this Elizabeth McNally, MD, PhD, the Elizabeth J. Ward the induction ceremony, where Shilajit Kundu, continued work, and joining the AOA commu- Professor of Genetic Medicine, delivered the Walter G. Barr, MD, Lecture, speaking about the promising future MD, ’07 GME, chief of Urologic Oncology in the nity at Northwestern is an exciting new chapter.” of cardiac risk prediction using genetic variation. Department of Urology, welcomed inductees. Marianne Green, MD, the Raymond H. “We recognize our students, housestaff, Curry, MD, Professor of Medical Education and and faculty, who not only provide superb care vice dean for Education, welcomed alumni and to patients, but have gone above and beyond faculty inductees into the medical honor society. to distinguish themselves to be worthy of AOA “I would like to thank my family for their induction,” said Kundu, who serves as AOA unrelenting support of my endeavors, and councilor for Feinberg. everyone at Feinberg who has encouraged, Susan Goldsmith, MD, ’08 GME, associate supported, and challenged me to better myself, dean for student affairs and associate professor both professionally and personally,” said of Obstetrics and Gynecology in the Division of Khalilah Gates, MD, assistant dean of Medical General Obstetrics and Gynecology, welcomed Education, associate professor of Medicine in Faculty AOA inductees (L-R): Crystal Clark, MD, MSc, the 33 new medical student members into AOA. the Division of Pulmonary and Critical Care, and associate professor of Psychiatry and Behavioral Sciences and of Obstetrics and Gynecology; Daniela “My time at Feinberg has been defined by an AOA inductee. Ladner, MD, MPH, professor of Surgery in the Division of continuously striving for improvement,” said Meron Teklu and Michael Wang, fourth-year Organ Transplantation and of Medical Social Sciences; June McKoy, MD, JD, MBA, ’01 GME, professor of Matias Pollevick, a fourth-year student pursu- medical students and AOA inductees, received Medicine in the Division of General Internal Medicine and Geriatrics; and Khalilah Gates, MD, assistant ing a residency in internal medicine who was the Alpha Omega Alpha Scholarship, an award dean of Medical Education and associate professor of inducted into AOA. “I hope to take this spirit funded by donors to Northwestern University. Medicine in the Division of Pulmonary and Critical Care. WRIT TEN BY Will Doss MAGA ZIN E . N M .ORG 5
PULSE On Campus Feinberg Among Top Medical Schools F einberg School of Medicine was ranked 17th among OVERALL RANKING research-oriented institutions by the latest U.S. News & World Report, immediately after a three-way 17 15 tie for 14th. This is the 15th year in a row Feinberg has placed in the top 20 of research-oriented medical schools. “Feinberg continues to be recognized as a member of an elite group of world-class institutions, which is a in the nation for years in a row that testament to the dedication and drive of our faculty, staff, research-oriented Feinberg has been students, and trainees,” said Eric G. Neilson, MD, vice medical schools in the top 20 president for Medical Affairs and Lewis Landsberg Dean. “I am proud of the medical school’s leading-edge scientific SPECIALTY PROGRAM RANKINGS discovery, innovative medical education, and commitment to transforming the future of medicine. I have no doubt that our outstanding reputation will continue to grow in the future.” This year, seven of Feinberg’s specialty programs were 6 16 4 15 also recognized among the best in the nation. Obstetrics and gynecology ranked 6th, surgery was ranked 13th, pedi- in the nation for in the nation in the nation in the nation obstetrics and for radiology for physical for psychiatry atrics ranked 14th, internal medicine and psychiatry each gynecology therapy ranked 15th, radiology rose one spot to rank at 16th, and anesthesiology was ranked 17th. Physical therapy, assessed 13 14 15 17 every four years by U.S. News, ranked 4th in the nation in 2020. In the U.S. News rankings of public health programs, Feinberg’s public health program was ranked 24th, the second-highest ranking for a U.S. public health program in the nation in the nation in the nation for in the nation for that is part of a medical school. for surgery for pediatrics internal medicine anesthesiology 6 NORTHWESTERN M EDICIN E • S PRING 2022
On Campus INVESTIGATING PRECISION NUTRITION N orthwestern, the University of Chicago, Illinois Institute of Technology, University of Illinois Chicago, and Rush University are part of a $170 million National Institutes of Health (NIH) program that is the first comprehensive study to investigate precision nutrition. The goal of “Nutrition for Precision New Technology in Medical Education Health” (NPH), powered by the All of Us Research Program, will be to develop algorithms to predict individual F einberg is bringing the latest tech- students the knowledge and skills to opti- responses to food and dietary routines. nology into the classroom with its new mize their utilization of those technologies, The Illinois Precision Nutrition curriculum enhancements. The Augusta ultimately for the benefit of the patients Research Consortium — one of six Webster, MD, Office of Medical Education has they treat,” Vaidyanathan said. centers around the country — is com- begun instruction in Digital Health and Data Anatomy education is, too, getting posed of Northwestern and its partners. Science, a curriculum being co-developed a boost of new technology. Feinberg is Their grant will be $13,321,184 awarded by David Liebovitz, MD, associate vice chair partnering with Case Western Reserve for clinical informatics in the Department of University School of Medicine to integrate over five years, pending availability Medicine and co-director of the Center for its HoloAnatomy software. The software of funds. Medical Education in Data Science and Digital uses Microsoft’s HoloLens 2 mixed reality Precision nutrition, also known Health, and Mahesh Vaidyanathan, MD, MBA, headsets, which allow students to visu- as personalized nutrition, will move assistant professor of Anesthesiology. alize every part of the body as a virtual, away from one-size-fits-all diet recom- Students will meet several core compe- three-dimensional hologram. Feinberg’s mendations and create a customized tencies and learning outcomes while learning new anatomy curriculum is currently being diet plan for individuals based on about the health data ecosystem; the health introduced to first-year and second-year individual differences, such as genetics IT regulatory environment; data science medical students in their Phase 1 Module and metabolism. methods and research; digital health decision and to first-year PA students. support; bias, ethics and health equity; and “We use this technology not as a “We will learn more precisely how the sociotechnical context for digital health replacement for dissection but to augment to match dietary recommendations to and data science. and enhance the learning of anatomy in the needs of an individual,” said Linda “No matter what specialty students a more efficient and effective way,” said Van Horn, PhD, professor of Preventive choose to practice or where they end up prac- Patricia Garcia, MD, MPH, associate dean Medicine in the Division of Nutrition and ticing medicine, they will have to utilize digital for curriculum and a professor of Obstetrics one of the senior principal investigators. healthcare and data science every day of their and Gynecology in the Division of Maternal careers. This curriculum is designed to give Fetal Medicine and of Medical Education. 2022 NEMMERS PRIZE RECIPIENT ANNOUNCED J eremy Nathans, MD, PhD, an investigator The award, which carries a $200,000 Jeremy Nathans, at the Howard Hughes Medical Institute stipend, is given to a physician-scientist whose MD, PhD and the Samuel Theobald Professor body of research exhibits outstanding achieve- of the Wilmer Eye Institute at Johns Hopkins ment in their discipline as demonstrated by Medicine, known for his landmark discoveries works of lasting significance. A jury of distin- in the molecular mechanisms of visual system guished scientists from around the country development, function, and disease, is the recip- made the final selection. Nathans will deliver a ient of the 2022 Mechthild Esser Nemmers Prize public lecture and participate in other scholarly in Medical Science at Northwestern University. activities at Feinberg in the coming year. WRIT TEN BY Melissa Rohman and Marla Paul MAGA ZIN E . N M .ORG 7
PULSE More details on these studies at magazine.nm.org RESEARCH BRIEFS DISE ASE DISCOVE RI ES INVESTIGATING Idiopathic dilated cardiomyop- “dilates,” and becomes weaker, and many athy (DCM) was found to have patients will ultimately require a heart trans- PREVALENCE RISK a familial etiology in 30 percent plant. In the case of DCM, the cause of the OF FAMILIAL HEART of individuals diagnosed with heart muscle’s dysfunction is often unknown, FAILURE DCM, and the overall risk for a family member though recently investigators have learned of developing DCM was nearly 20 percent that many cases are common in families, sug- by the age of 80, according to a family-based, gesting a genetic cause. cross-sectional study published in JAMA. Furthermore, Black patients, who have “This study is incredibly important a higher risk of heart failure hospitalization because our goal at the outset was to create a and death, have historically been underrepre- large, diverse cohort of patients with DCM and sented in clinical trials exploring heart failure, their families to understand the risk of devel- underscoring the importance of including oping heart failure simply by being related to more diverse patient cohorts in studies, someone who has DCM,” said Jane Wilcox, MD, according to Wilcox. The study findings ’10, ’11 GME, associate professor of Medicine in emphasize that heart failure screening should the Division of Cardiology and a co-author of be of the same rigor and consistency as is the study. screening for other genetic illnesses, espe- In dilated cardiomyopathy, one of the cially among Black individuals, Wilcox said. leading causes of heart failure in the U.S., one This study was supported by National Heart, Lung, and Blood Institute R01HL128857 and a supplement from the or both of the heart’s ventricles stretches, National Human Genome Research Institute. CLI N ICAL B RE AK TH ROUG HS Patients May Benefit From Atrial Shunt A Northwestern Medicine-led Sanjiv Shah, MD, the Neil J. Stone, MD, Professor study published in The Lancet of Medicine in the Division of Cardiology and suggests that some patients with lead author of the study. Shah is also director the most common form of heart of research at the Bluhm Cardiovascular failure may benefit from a novel, minimally Institute and director of the Northwestern invasive cardiac implant device called an atrial Medicine HFpEF Program. “The normal re- shunt. The study also offers new insight into sponse to exercise is relaxation of the blood the role exercise plays in understanding, diag- vessels in the lungs. Patients with HFpEF who nosing, and treating this type of heart failure. are able to relax the blood vessels in their lungs Heart failure with preserved ejection frac- appear to do well with the device, whereas tion (HFpEF), also called diastolic heart failure, those whose blood vessels can’t relax appear affects 3 million Americans. Despite being the to do worse when an atrial shunt is implanted.” most common type of heart failure in the U.S., “What we saw in this study suggests effective treatments remain elusive, leading to that future clinical trials should specifically people with this type of heart failure — that is high morbidity and mortality. investigate the subgroup of patients with 2 million people who could benefit from this “While the overall trial was neutral, in our HFpEF whose pulmonary blood vessels respond innovative therapy. This simple, one-time proce- subgroup analyses we found that what happens normally to exercise,” Shah said. “If future trials dure could significantly improve quality of life.” in the heart and lungs during exercise is of prime validate what we found, the potential is enor- importance in this type of heart failure,” said mous. This subgroup comprises two-thirds of Funding for the study was provided by Corvia Medical. 8 NORTHWESTERN M EDICIN E • S PRING 2022 WRIT TEN BY Melissa Rohman
Research Briefs CLI N ICAL B RE AK TH ROUG HS Neural Stem Cell Therapy May Improve Metastatic Cancer Survival Neural stem cells (NSCs) therapies, have long stalled progress engineered by Northwestern to improve patient outcomes. Medicine investigators used The overexpression of HER2 CLI N ICAL B RE AK TH ROUG HS in combination with the is observed in about 30 percent of HER2 inhibitor drug tucatinib improved patients with breast cancer and is survival in mice with HER2- known to be associated NEW TREATMENT positive breast cancer brain with advanced disease FOR METASTATIC metastases, according to findings published in Proceedings of the National OF PATIENTS WITH 50% and decreased overall sur- vival. Additionally, about 50 percent of patients HORMONE-SENSITIVE PROSTATE CANCER Academy of Sciences. OVEREXPRESSED with overexpressed HER2- The study, led by Maciej HER2-POSITIVE positive breast cancer will A new drug, administered in Lesniak, MD, chair and BREAST CANCER develop central nervous the Michael J. Marchese WILL DEVELOP system metastases and combination with standard Professor of Neurosurgery, CENTRAL are given an average androgen-deprivation therapy NERVOUS SYSTEM survival rate of 11 to 18 (ADT) and docetaxel chemo- demonstrates the thera- METASTASES. peutic utility of engineered months after diagnosis. therapy, increased survival in patients with NSCs for drug delivery to While chemotherapy metastatic hormone-sensitive prostate cancer, brain tumors and may lead to the devel- drugs have improved outcomes for according to a trial published in The New opment of novel and more efficient thera- patients with primary breast cancer England Journal of Medicine. peutic options against HER2-positive and patients with systemic metas- This represents a new strategy for man- breast cancer brain metastases. tases, more effective targeted ther- aging metastatic hormone-sensitive prostate Brain metastases are one of the apies for patients with breast cancer main causes of mortality for patients metastases in the central nervous cancer (mHSPC), according to Maha Hussain, with breast cancer. A lack of clinical trials system are desperately needed. MD, the Genevieve E. Teuton Professor of coupled with the presence of the blood Lesniak is a member of the Medicine in the Division of Hematology and brain-barrier, which significantly de- Robert H. Lurie Comprehensive Cancer Oncology, a co-author of the study and study creases the efficacy of existing targeted Center of Northwestern University. steering committee member. Hussain is also deputy director of the Lurie Cancer Center. This work was supported by National Institutes of Health grants R35CA197725, R01NS093903, 1R01NS115955-01, R33NS101150, R01NS106379 and R37CA258426. In the current double-blind, phase 3, multi-site trial, investigators enrolled patients with mHSPC, randomizing them to receive either darolutamide with standard ADT and docetaxel chemotherapy or a placebo with standard ADT and docetaxel chemotherapy. During the three-year trial period, patients receiving darolutamide were 32.5 percent less likely to die compared to patients receiving the placebo. In addition, patients receiving darolutamide experienced signifi- cantly delayed time to developing castration- resistant prostate cancer — the terminal state of the disease — and pain progression, helping reduce negative quality-of-life impacts. “This is a very important and practice- changing finding, but there is more to be Representative immunostainings of brain sections harvested from mice treated with LM008 achieved,” Hussain said. anti-HER2 neural stem cells (NSCs). The amount of anti-HER2 antibodies released by NSCs (green) was measured with antihuman IgGs (yellow). Presence of HER2 antibodies binding to the membrane This study was supported by Bayer and Orion Pharma. of HER2-positive BT474-Br cells (red). Nuclear staining is shown in blue. WRIT TEN BY Will Doss MAGA ZIN E . N M .ORG 9
PULSE Research Briefs SCI E NTI F IC ADVANCES SCI E NTI F IC ADVANCES STUDY FINDS DOPAMINE Investigators Identify New SIGNALING PROMOTES COMPULSIVE BEHAVIOR Connections Between Circadian Northwestern investigators have Rhythm and Muscle Repair discovered that dopamine signaling Northwestern Medicine investi- regeneration and muscle repair has re- in the brain’s dorsomedial striatum gators have discovered a novel mained limited. promotes the development of mechanism that connects In the current study, Peek’s team compulsive behaviors in animal models, accord- circadian rhythm-controlled investigated the role of adult muscle stem ing to findings published in Current Biology. Talia cellular metabolism and regeneration with cell’s circadian clock in controlling muscle Lerner, PhD, assistant professor of Neuroscience, muscle repair after injury, according to regeneration and tissue repair after acute was senior author of the study. recent findings published in the journal ischemic injury in mice. They zeroed in on Corticostriatal circuits are neural circuits Genes and Development. Clara Peek, PhD, the protein Bmal1 — a circadian clock connecting the brain’s cerebral cortex to the assistant professor of Biochemistry and regulator protein expressed in virtually all Molecular Genetics, was senior author of the cells in the body — and aimed to identify striatum, a cluster of neurons within the basal study. Peek is also an assistant professor of its exact role within muscle stem cells and ganglia that are responsible for controlling Medicine in the Division of Endocrinology, greater muscle repair. movement and reward-seeking behaviors. Prior Metabolism and Molecular Medicine and a Peek and her team found that muscle research suggested these circuits control the member of the Lurie Cancer Center. repair after injury was greater when mice expression of compulsive behaviors commonly Disruptions in circadian rhythm — the were active or awake compared to when observed in obsessive-compulsive disorder body’s internal 24-hour clock that regulates they were inactive or resting. Additionally, (OCD) and substance misuse disorders. rest and wakeful- the loss of Bmal1 within the muscle stem While corticostriatal circuits were thought PEEK’S TEAM ness — have been cells led to impaired muscle regeneration. to be involved, the precise mechanisms that AIMED TO associated with Using metabolomic profiling to study IDENTIFY the pathogenesis approximately 10,000 activated muscle cause compulsive of different met- stem cells in vivo and cultured myoblast behaviors to emerge THE PROTEIN abolic disorders, cells, or premature muscle cells, the investi- have remained unclear. BMAL1’S EXACT including dia- gators demonstrated that the loss of Bmal1 Lerner and colleagues ROLE WITHIN betes and obesity. reduced the amount of activated muscle hypothesized that MUSCLE STEM However, research stem cells on the third day after injury. dopamine activity, CELLS AND regarding its which regulates the GREATER association This work was supported by the National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases grant R01DK123358, National Cancer plasticity of corticostriatal circuits, played a MUSCLE REPAIR. with tissue Institute grant R35CA197532 and National Institute on Aging grant P01AG049665. crucial role in this process. For the current study, the investigators studied dopamine activity in two regions of the brain’s striatum, the dorsomedial striatum and the dorsolateral striatum, which are involved in different types of reward learning: the dorsome- dial striatum is involved with goal-oriented learn- ing behaviors, while the dorsolateral stratum is involved with habitual behaviors. Although it was previously thought that habit played a role in compulsion, to their surprise, the team found that dopamine signaling activity was actually upregulated in the mice’s dorsomedial striatum, where it predicted the development of compulsive reward-seeking behavior. The study was supported by the National Institutes of Health K99/R00 Award R00MH109569, a NARSAD Young Investigator Award from the Brain & Behavior Research Foundation, and National Institutes of Health Diversity Supplement R00MH109569-04S1. 10 NORTHWESTERN M EDICIN E • S PRING 2022 WRIT TEN BY Melissa Rohman
Research Briefs DISE ASE DISCOVE RI ES GENETIC VARIANT OF HIGH-RISK CHILDHOOD LEUKEMIA REVEALED A genetic variant changing just one base pair of nucleotides greatly increases risk of a high- risk subtype of childhood acute lymphoblastic leukemia (ALL), according to a Northwestern Medicine study published in Nature Genetics. Tracing this oncogenic pathway provides ALL oncogenes through a cascade of interac- Childhood acute lymphoblastic leukemia a template for future studies of other types of tions,” said Yue, who is also an associate pro- is the most common leukemia among children. cancers as well, according to Feng Yue, PhD, fessor of Biochemistry and Molecular Genetics, Genetic contributions to childhood ALL have been the Duane and Susan Burnham Professor of and of Pathology, as well as director of the previously identified, but the mutations that lead Molecular Medicine and co-senior author of Center for Cancer Genomics at the Lurie Cancer to subtypes — such as the more-lethal “Ph-like” the study. Center. “If we can manipulate this pathway, we ALL — have remained mostly uncharacterized. “In this study, we discovered how an inher- could potentially prevent the development of This study was supported in part by National Institutes of Health grants ited gene variation regulates multiple known this cancer.” 1R35GM124820, R01HG009906, U01CA200060 and R24DK106766. CLI N ICAL B RE AK TH ROUG HS Locoregional Treating a tumor in the breast “It appears the positive effects of tumor when distant metastases have removal were not greater than the negative Therapy Does Not already occurred does not quality of life generated by the presence of the improve outcomes in women breast tumor,” Khan said. “This is probably related with stage IV breast cancer, according to to the bodily injury caused by surgery or radiation, Improve Breast a new study published in the Journal of Clinical Oncology. which can have some long-lasting effects.” While the results are disappointing, they Cancer Survival Retrospective studies of treatment outcomes had suggested there was a contain an important lesson about retrospective studies. Critical for understanding health and benefit to treating the breast tumor, instead generating hypotheses, retrospective trials do of only treating the metastases, which has suffer from many types of bias — in this case, long been standard practice, according selection bias, according to Khan. to Seema Khan, MD, the Bluhm Family “Someone in better overall condition may Professor of Cancer Research, interim have been offered surgery for the breast tumor, co-vice chair of research in the Department while only the distant tumor was treated for of Surgery and lead author of the study. someone in worse condition,” Khan said. “This is “It’s possible that some subset of pa- one of the cases where the retrospective studies tients will derive a benefit from treatment were helpful, but the discussion can only be of the breast tumor, but we were unable to settled with a randomized trial.” identify such a subset in our trial, so this remains hypothetical,” said Khan, who is This study was conducted by the ECOG-ACRIN Cancer Research Group and supported by the National Cancer Institute of the National Institutes of Health also a professor of Surgery in the Division of under the following award numbers: U10CA180821, U10CA180863, Canadian Cancer Society #704970, U10CA180820, U10CA180868, U10CA180822, Breast Surgery and a member of the Lurie U10CA180888, U10CA180794, UG1CA189830, UG1CA189859, UG1CA189953, UG1CA232760, UG1CA233180, UG1CA233193, UG1CA233234, UG1CA233277, Cancer Center. UG1CA233320, UG1CA233329 and UG1CA233341. WRIT TEN BY Will Doss MAGA ZIN E . N M .ORG 11
PULSE On Campus Read more about Northwestern faculty’s insights in the media at news.feinberg.northwestern.edu/media-coverage MEDIA SPOTLIGHT Rare Virus Lineages Were Older Americans Are the Ignored Predominant in Nigeria in 2021. Victims of the Opioid Epidemic They Were Hardly Noticed. In adults ages 55 and older, opioid overdose deaths Eta, a SARS-CoV-2 variant that circulated in rose tenfold between 1999 and 2019, surging from Nigeria in early 2021, may have warranted 0.9 deaths per 100,000 people to 10.7, according to designation as a “variant of concern” had a new study published in JAMA Network Open that its growth potential been recognized earlier, analyzed two decades of data. Maryann Mason, according to investigators at Feinberg and PhD, associate professor of Emergency Medicine, the University of Ibadan in Nigeria. Judd was lead author of the study. Hultquist, PhD, the associate director of the In the near-decade she’s been involved Center for Pathogen Genomics and Microbial in opioid overdose research, Mason says she’s Evolution, said worldwide tracking of “almost never” seen older adults’ drug use variants was uneven. “Less than 1 percent of addressed in the media or in academic studies. sequences are from the continent of Africa, This lack of attention, plus a culture rife with and less than 3 percent are coming from ageism, can conceal the threat opioids pose to South America,” he told The NewYork Times. older people, according to Mason. “We have “Eta was able to outcompete the Alpha variant this idea in our mind of what older people are in the region before the arrival of Delta.” like — what grandma and grandpa are like — and they’re not people who use recreational drugs,” Mason told Time. “I think that keeps a lot of people from looking into this area.” Revamped ‘Cancer Moonshot’ Could Prevent Deaths and Improve Quality of Life for Survivors Most Vaccine-Hesitant Health Care Workers Change Their Minds, President Joe Biden’s ambitious “Cancer Study Shows Moonshot” relaunch has a goal of reducing the Most health care workers at a large U.S. hos- Her team surveyed nearly 4,200 healthcare cancer mortality rate by at least 50 percent pital who initially refused COVID-19 vaccines workers at Northwestern Medicine when COVID- over the next 25 years for a disease that is eventually went and got their shots, new 19 vaccines became available last winter. At that expected to kill 609,360 people in the U.S. research reveals. time, three-quarters said they intended to take in 2022 alone. Experts worry that cancers “It shows there is opportunity to change the shots. By spring, a second survey found that associated with obesity, such as uterine and people's decisions about not getting vaccinated,” 95 percent had been vaccinated, including 90 pancreatic cancer, could rise. said lead study author Charlesnika Evans, PhD, percent of those who had been unsure. Of those Maha Hussain, MBChB, a medical MPH, professor of Preventive Medicine in the who initially said they didn't plan to get vacci- oncologist and deputy director of the Robert Division of Epidemiology. nated, nearly 60 percent had done so by spring. H. Lurie Comprehensive Cancer Center of Northwestern University, said a continued focus on prevention and screening was critical to meeting the rest of the goals in Biden’s plan. The Coronavirus Invades Cells in the Penis and Testicles of Monkeys, “The best thing is to not get cancer, and Researchers Discover that’s what we need to invest in, so definitely prevention,” she said. “And if you get cancer, Studies have reported about 10 to 20 “The signal that jumped out at us was the we want to make it something that can be percent of men with the coronavirus have symp- complete spread through the male genital tract,” treated, so early detection. The next step toms linked to male genital tract dysfunction. said Thomas Hope, PhD, professor of Cell and would be making cancer a chronic disease as Men infected with the virus are three to six times Developmental Biology. “We had no idea we opposed to an acute, deadly disease.” as likely as others to develop erectile dysfunction. would find it there.” 12 NORTHWESTERN M EDICIN E • S PRING 2022 PHOTOG R APHY COU RTESY OF Getty Images
On Campus FACULTY AWARDS & HONORS 1 2 3 4 5 6 7 Peng Ji, MD, PhD, Catherine Woolley, elected to serve on John Rogers, PhD, Each year, Clarivate David Cella, PhD, associate professor PhD, professor of the Consortium of the Louis Simpson Analytics releases chair of the of Pathology, has Neurology in the Universities for Global and Kimberly a list of highly cited Department of been awarded the Ken & Ruth Davee Health Board of Querrey Professor of investigators who Medical Social 2022 Ramzi S. Cotran Department of Directors. 6 Materials Science have “demonstrated Sciences and Young Investigator Neurology, have been and Engineering, significant and broad the Ralph Seal Award from the United selected 2021 fellows Stephen Miller, PhD, Biomedical influence, reflected Paffenbarger States and Canadian of the American the Judy Gugenheim Engineering and pro- in the publication of Professor of Medical Academy of Pathology, Association for the Research Professor fessor of Neurological multiple papers fre- Social Sciences, an award that recog- Advancement of of Microbiology- Surgery, has been quently cited by their Neurology, Pediatrics, nizes investigative Science. Immunology, awarded the 2022 peers during the last Preventive Medicine, work that has contri- Dermatology and James Prize in Science decade.” Below is a and Psychiatry and buted significantly to Robert Kushner, MD, of Medicine in and Technology list of the Feinberg in- Behavioral Sciences, the diagnosis and un- ’80, ’82 GME, the Division of Integration by the vestigators who made in Social Sciences; derstanding of human professor of Medicine Gastroenterology and Council of the National the list in 2021 and Donald Lloyd- disease. 1 in the Division of Hepatology, has been Academy of Sciences. the category in which Jones, MD, chair of Endocrinology, was named an American they were identified: the Department of Ritu Nayar, MD, honored by the Clinical Association of Bonnie Spring, PhD, Preventive Medicine professor of Pathology Research Forum with Immunologists 2022 director of the Center Brian Mustanski, and the Eileen M. Foell and of Medical a 2022 Top 10 Clinical Distinguished Fellow. for Behavior and PhD, director of the Professor of Preventive Education, was named Research Achievement 7 Health and chief of Institute for Sexual Medicine, Medicine, vice president of the Award and with the Behavioral Medicine and Gender Minority and Pediatrics, in Executive Committee prestigious Herbert Rola Kaakeh, PharmD, in the Department of Health and Wellbeing Clinical Medicine; for the American Pardes Clinical adjunct instructor in Preventive Medicine, and professor of Navdeep Chandel, Board of Pathology. Research Excellence the Department of has been selected Medical Social PhD, the David W. 2 Award. 5 Preventive Medicine, by Feinberg’s Women Sciences, Psychiatry Cugell, MD, Professor has been awarded the Faculty Organization and Behavioral of Medicine and Linda Teplin, PhD, Lucas Pinto, MD, MS, Above and Beyond as this year’s winner of Sciences and in the Biochemistry and of the Owen L. Coon PhD, assistant pro- Pharmacy Champion the fifth annual Paula Weinberg College of Molecular Genetics, in Professor of Psychiatry fessor of Neuroscience, award from GoodRx, H. Stern Award for Arts and Sciences, Molecular Biology and and Behavioral was selected as a recognizing her Outstanding Women in Social Sciences; Genetics and Biology Sciences and of Sloan Research Fellow advocacy, spirit, and in Science and Chad Mirkin, PhD, and Biochemistry; Medicine in the in neuroscience, a leadership. Medicine. professor of Medicine Philip Greenland, Division of Infectious two-year $75,000 in the Division of MD, the Harry W. Diseases, is the recip- fellowship that is one Derek Wainwright, Jane Winter, MD, Hematology and Dingman Professor ient of the American of the most compet- PhD, assistant pro- professor of Medicine Oncology and in the of Cardiology and of Psychology-Law itive and prestigious fessor of Neurological in the Division of Weinberg College of Preventive Medicine, in Society Award awards available for Surgery, Microbiology- Hematology and Arts and Science, in Cross-Field; Samuel for Distinguished young researchers. Immunology, Neuro- Oncology and a highly Cross-Field; Clyde Weinberg, MD, PhD, in Contributions to science, and of Medi- regarded lymphoma Yancy, MD, MSc, Cross-Field; and Sanjiv Psychology and Law. Lisa Hirschhorn, cine in the Division of expert, will serve vice dean for Diversity Shah, MD, the Neil J. 3 MD, MPH, pro- Gastroenterology and as president of the and Inclusion and Stone, MD, Professor fessor of Medical Hepatology, has been American Society chief of Cardiology of Medicine in the Paula H. Stern, PhD, Social Sciences named a NextGen of Hematology for in the Department Division of Cardiology, ( 4) professor emer- and of Psychiatry Star by the American a year-long term of Medicine, in in Clinical Medicine. itus in the Division of and Behavioral Association for through December Cross-Field; Pharmacology, and Sciences, has been Cancer Research. 2022. MAGA ZIN E . N M .ORG 13
EXTENDING THE HEALTHSPAN Northwestern’s new Potocsnak Longevity Institute aims to help people age healthier. Written by Emily Ayshford and Marla Paul 14 NORTHWESTERN M EDICIN E • S PRING 2022
T he notion of a person’s biological or Funded by a very generous gift from functional age being very different than the number of times they’ve orbited The Chicago industrialist John Potocsnak and family, the institute aims to extend what Vaughan terms the sun is nothing new. But the idea that one Potocsnak the human “healthspan.” might be able to find out what actually comprises aging itself has always seemed like science Longevity Through centers and laboratories, scientists and clinicians will address the period of life when fiction. Until now. The futuristic-sounding Human Longevity Institute people are at the greatest risk for aging-related comorbidities — arthritis, dementia, heart disease, Laboratory at Northwestern — part of the new The Institute is made up of diabetes, aging-related cancer, hypertension, Potocsnak Longevity Institute — is on a fast track interdisclipinary centers that work frailty — in an effort to help people live not just to open later this year. to lengthen the human healthspan. longer, but in a healthier and more highly func- There, a person will find themselves under- tioning way. going comprehensive evaluations that examine Aging research has accelerated significantly hearing ability, balance, grip strength, gait speed, in recent years as the Baby Boomer generation pulmonary function, heart rate variability, and grows older. Recently, Feinberg has identified cognitive function. A machine learning algorithm aging as a key research theme, and research will analyze their electrocardiogram. Center funding to the medical school from the National A blood test will measure their DNA for Population Institute of Aging has risen to more than methylation and other important Science & $40 million since 2016. biomarkers of aging-associated Aging “The idea of actually doing health conditions, such as something about aging has levels of inflammation and gone from magical thinking Center for Potocsnak coagulation. to theoretical thinking to an Nanoscience & Center for The result: the revela- actual, pragmatic possibility,” Aging Aging & HIV tion of one’s actual biological Vaughan says. age. But the laboratory will do more than merely measure ROOTS IN HIV biological age: It will provide RESEARCH opportunities for patients to enroll in The Potocsnak family has supported longitudinal clinical studies to track the Feinberg for decades through a close Human Center for velocity of aging and in interventional relationship with Frank Palella, MD, Longevity Basic & investigative programs to determine if the Potocsnak Family – C.S.C. Professor Laboratory Translational the rate of aging can be slowed or even of Medicine in the Division of Infec- Biology reversed. tious Diseases. “We now have the tools to Palella has long studied HIV and measure biological age in everyone,” serves as the director of the Potocsnak says Douglas Vaughan, MD, director of the Center for Aging & HIV within the Potocsnak new institute and chair and Irving S. Cutter Longevity Institute, for which he serves as asso- Professor of Medicine. “And we will most ciate director. When effective combination-an- certainly have the ability to change the time on tiretroviral therapies to treat HIV were intro- your clock face — shift it back a bit, or at least HELPING PEOPLE LIVE LONGER, duced in the late 1990s, physicians found that slow it down. With the new Potocsnak Longevity HEALTHIER LIVES people living with HIV could live much longer Institute, we will create a multidimensional The Human Longevity Laboratory is just one lives than they previously had. program unlike any others that currently exist. part of the ambitious multi-center institute, But there was a catch — those living with We will be able to cultivate and build a contem- whose goal is to foster new biomedical dis- HIV still died 10 to 15 years earlier than people porary dataset to better understand the trajec- coveries and build on Northwestern’s ongoing without HIV as a result of the premature onset tory of aging while including people from all research in the rapidly advancing field of aging, of aging-related health conditions that occurred communities.” also called geroscience. due to having chronically elevated levels of ► MAGA ZIN E . N M .ORG 15
inflammation and chronically overstimulated immune systems. “That means HIV became a good model in which to explore determinants and interven- tions for aging processes,” Palella says. “There is a cross-pollination here between studying what improves and extends the healthspan Center for Applied and lifespan of people with HIV and the aging general population.” Health Research on Aging Discussions with the Potocsnak family on expanding HIV research led to broader discus- sions on aging research, and the idea for the S institute was born. ince 2019, Feinberg’s Center The team is also working to serve “We are grateful for the opportunity to for Applied Health Research low-income areas of Chicago to deliver on Aging (CAHRA) has brought messaging about the need for COVID support the vision put forth by Northwestern’s together investigators who focus on vaccinations. “Vaccination rates among leaders, scientists, and physicians to help aging issues to conduct research into middle age and older adults in these people live their longest, healthiest lives pos- the cognitive, psychosocial, community, areas has really lagged behind, and we’re sible,” Potocsnak shares. “The promise of the and health system factors that affect a trying to address that disparity,” says amazing work being done by Doug, Frank, and person’s ability to manage their health. Michael Wolf, PhD, ’02 MPH, director of many others holds the potential to profoundly the center, and associate vice chair for impact quality of life for millions. My wife Laura, To say they have had a busy two years is research in the Department of Medicine. myself, and my family are proud to support this an understatement. “We have had a very productive launch, especially in terms CAHRA is also home to Northwestern’s important work as we strive to make the world of research funding,” says Julia Yoshino Claude D. Pepper Older American’s a better place than when we got here.” Benavente, MPH, associate director of Independence Center, part of a national the center. network of National Institutes of Health FROM PROTEINS TO NANODEVICES centers contributing to aging research. The institute builds on decades of aging During the To date, the Pepper Center has supported research at Feinberg. A few years ago, Vaughan COVID-19 pan- 10 early career investigators with funding discovered that a distinct community of Old demic, CAHRA for pilot projects and/or protected time. investigators have Order Amish in Indiana have a genetic variant Now, the center looks forward to working been conducting that protects them against multiple aspects with the Potocsnak Longevity Institute. novel research into of biological aging. Amish people with this the experiences “Aging research across the university mutation have significantly less diabetes and a MICHAEL WOLF, of older adults has always been strong but somewhat younger vascular age than those who don’t have PhD, ’02 MPH with complex care fragmented, and we look forward to the mutation. director of the needs — whether supporting this long-needed institute It turns out these individuals have very Center for Applied they were expe- in bringing together faculty for mean- low levels of PAI-1 (plasminogen activator inhib- Health Research riencing isolation ingful collaborations and helping junior on Aging itor), a protein that comprises part of a “molec- and loneliness, investigators advance their career path ular fingerprint” related to aging or senescence how their access to healthcare was af- in aging research,” Wolf says. fected, if their lifestyle and self-care be- (deterioration) of cells. haviors changed, and ultimately whether Northwestern has contributed to the COVID-19 has widened inequities in development of an experimental drug with a health outcomes. Japanese company that blocks PAI-1 that is now 16 NORTHWESTERN M EDICIN E • S PRING 2022
being tested in clinical trials, showing that it is clearly possible to lower PAI-1 levels in adults without gene editing. One of these trials is in high-risk patients over age 50 with COVID-19 “The ultimate goal is to push here at Northwestern. This drug and others back the onset of age-related will likely be included in clinical trials per- formed in the Human Longevity Laboratory. diseases and give people the opportunity Northwestern investigators are also at the forefront of studying what are known as to live healthier, longer.” SuperAgers — adults over age 80 who have the FRANK PALELLA, MD memory capacity of individuals who are at least Potocsnak Family – C.S.C. Professor of Medicine in the Division of Infectious Diseases three decades younger. The institute plans to collaborate closely with the Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, the home for this research. biochemical and genetic markers — to “We are going to be reaching out to our fellow The institute will also build on current demystify the aging process in large popula- Chicagoans to get as much ethnic, socioeco- research by convening investigators into tions of humans at all ages. nomic, and educational diversity as we can. All several centers. In the Center for Population The Center for Nanoscience & Aging of these factors impact aging, and we want our Science & Aging, scientists will utilize and will leverage Northwestern’s strengths to work to reflect the diversity of our community.” refine existing tools — including well-defined develop nanotechnological devices, novel Those who visit the Human Longevity diagnostic measures, and innovative anti- Laboratory will become part of a large dataset aging therapies and drug-delivery platforms. that will help investigators track aging pro- “It might be wearable devices that track cesses and clinical events and to discover physiological measures, or drug delivery essential factors with which they can intervene. systems that can impact different sites in Patients will also have the opportunity to par- the body,” Vaughan says. “It will bring chem- ticipate in clinical research trials. istry, nanoscience, nanotechnology, and engineering all to the table.” A ‘BREATHTAKING OPPORTUNITY’ Work is already underway at the institute, “We will be able to EDUCATING STUDENTS AND THE with hopes to open the Human Longevity cultivate and build a PUBLIC Laboratory as soon as possible. contemporary dataset The institute will also train and educate “This is a breathtaking opportunity to future clinicians and scientists in aging bring together not just HIV and infectious to better understand research disciplines through its Geroscience disease experts, but experts across disciplines the trajectory of aging Academy, which will develop curriculum to identify and predict aging-related conditions while including people and educational materials as well as host lec- so we can design interventions that can delay, from all communities.” tures and community engagement activities. treat, and even reverse them,” Palella says. “To In fact, community engagement will be have this under one roof is unprecedented.” DOUGLAS VAUGHAN, MD, a huge priority as the institute gets off the The ultimate goal is to push back the director of the new institute ground, especially for patient-focused initia- onset of aging-related diseases and give people and chair of Medicine tives like the Human Longevity Laboratory. the opportunity to live healthier, longer. “We want this institute to be relevant to “Our aspirations are big, but so are our every community in Chicago,” Vaughan says. abilities,” Palella says. MAGA ZIN E . N M .ORG 17
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