Dimitri Krainc and Andrew Parsa had only heard of each other before they came to Northwestern Medicine. Now they share a vision as new leaders for the academic and clinical missions in neurology and neurosurgery.
With global acclaim, both men had other options before them, but came to Northwestern because the medical school and hospital share their drive to provide the best possible care. They emphasize that they really do come to work thinking about every patient―from people with common to rare disorders―whose only hope rests on novel thinkers who advocate for them and find treatments.
Dimitri Krainc, MD, PhD, is the new chair of the Ken and Ruth Davee Department of Neurology and Aaron Montgomery Ward Professor. Andrew Parsa, MD, PhD, chairs the Department of Neurological Surgery and is the Michael J. Marchese Professor. However, they think beyond Northwestern’s walls to improve care for patients throughout the world.
They are well aware that exemplary professionals made their departments among the top in the nation, well before they arrived at Northwestern. Both men say they want to give their people optimal conditions and support to move forward in research, student/resident education and patient care. Increasing collaboration between disease specialists and surgeons to find new therapies is one of the key initiatives they started at the Feinberg School of Medicine.
“We will expand our portfolio for research and patient care,” Dr. Krainc insists. “We will also focus on incurable diseases that have proven especially challenging from the standpoint of drug development. We owe this to our patients and their families.”
An International Outlook
It would seem that Krainc was at the top of his game after 21 years at Harvard Medical School, where he achieved international prominence in the field of neurodegenerative diseases. A native of Slovenia, he completed his research and clinical training, including residency and fellowship, at Massachusetts General and Brigham and Women’s hospitals. As a Harvard faculty member, he continued as a practicing neurologist at Massachusetts General, where he was named a 2013 Research Scholar and given five years of unrestricted funding to pursue projects that may lead to unexpected discoveries.
He loved Boston and the smart people there who pushed him to his full potential as a physician-scientist; however, Northwestern presented an option to lead one of the nation’s top neurology departments and collaborate with experts throughout the University. (Even before he officially started at Northwestern, Dr. Krainc began partnering with faculty from the Robert R. McCormick School of Engineering and Applied Science and Richard Silverman, PhD, from the Weinberg College of Arts and Sciences, who developed the chemical marketed as the drug Lyrica.) Since traditional drug development in neurology has stalled, Krainc says the opportunity to work with experts in nanotechnology, medicinal chemistry, and biomedical engineering was extremely important to him in order to use novel technologies to discover therapies for devastating diseases such as Parkinson’s, Huntington’s, ALS, and Alzheimer’s.
“Northwestern Medicine is one of the few places in the country that has an upward trajectory in these challenging times for healthcare,” Krainc says. “That was very appealing to me. It is a combination of visionary leadership and a good business model, along with recent changes that enable the seamless integration of clinical care with biomedical research.”
Dr. Krainc maintains strong European connections, supported by his global research partnerships and multi-lingual background. As part of education programs at Harvard Medical International, he participated in the development of medical education curricula and faculty training programs around the world.
He says the experience taught him to “listen first to understand their approach and their culture, then try to help”―a credo he operates by to this day. “As a father of two wonderful teenage daughters, Talia and Maya, I have learned once again that listening is preferred to unsolicited advice,” he adds.
Hit the Ground Running
In his laboratory, Krainc investigates neurodegenerative diseases and is distressed by pharmaceutical companies downsizing or eliminating neuroscience programs because they are difficult business models. Meanwhile, the number of people with Alzheimer’s disease, the most common form of dementia, is expected to dramatically increase in the next decade, creating a major problem to care for these patients.
“You have some pharmaceutical companies bailing out, but patients are not bailing out. They want treatments now more than ever,” he says. “As part of an academic medical center, I feel that we should step up and take the lead, increasing our efforts to find cures for these terrible diseases. We should also advocate for more collaborations between academic centers, NIH and industry to mobilize all available resources.”
As part of this vision, Krainc will establish a Center for Rare Neurological Diseases, bringing together scientists and physicians to find targeted therapies by exploring links between rare and common disorders. He and others have observed that children who suffer from rare genetic disorders exhibit brain tissue pathologies resembling those found in common neurodegenerative diseases. Studying these similarities is essential for drug development. If investigations are successful, efforts could lead to treatments for rare conditions like neuronopathic Gaucher’s disease, an often fatal children’s disorder caused by an enzyme deficiency, and common diseases such as Parkinson’s, in which the loss of dopamine cells in the brain affects the adult nervous system.
Specifically, Krainc is studying brain pathology in children afflicted with rare genetic forms of diseases involving lysosomes, the “recycling centers” that rid cells of toxins and debris. When lysosomes weaken due to enzyme deficiency, nerve cells are unable to recycle correctly and brain function diminishes. A substantial portion of his research focuses on pinpointing methods to reactivate the enzyme, which could result in the first targeted therapy for these disorders, both in children and adults.
“This approach is different because we are focusing on the molecular targets that have already been validated in patients with rare and common disorders,” he explains. “Using specific drugs, we are trying to activate these targets and measure molecular activity to see what works. This strategy will hopefully lead to less expensive clinical trials because we will quickly determine which drugs are effective.”
Collaborating with teams of fellow neurologists and neurosurgeons, Krainc, with assistance from Parsa, has already enhanced care and laid the groundwork to improve treatment for stroke patients.
Physicians from seven Chicago-area hospitals recently formed the Chicago Stroke Trials Consortium, with Northwestern Medicine as the regional coordinating center under the supervision of Shyam Prabhakaran, MD, associate professor of neurology. Supported by a $2 million NIH grant, the consortium facilitates participation in national clinical trials for stroke prevention, treatment and recovery and fosters home-grown trials. In one initiative, PI Andrew Naidech, MD, MSPH, associate professor and medical director of the ICU, and his team proposes a clinical trial this spring for the drug desmopressin to control acute intracranial hemorrhage, an extremely debilitating stroke caused by a blood vessel rupture in the skull. No FDA-approved therapy exists to treat it.
At Northwestern, Krainc is a mentor on several fronts, including grantsmanship strategies, and back-to-basics education and patient care.
A scientist with diversified public and private funding, he encourages faculty to develop projects that also appeal to private investors.
“Many people are interested in contributing to research, but they are looking for innovative strategies. Philanthropists are very sophisticated and they do not appreciate approaches that have not worked in the past. They want novel solutions for patients at all levels, from basic science to clinical care,” he says.
For some, technology defines progress, but Krainc is exasperated by too much technology that does not always enhance patient care. He wants to refocus students on adept examination and diagnostic skills, and strong doctor-patient bonds.
“Students and residents tend to rely too much on technology and have less and less time to talk with patients!” he says. “I want to promote fundamental knowledge that brings doctors back to the patient’s bedside.”
Dr. Parsa’s management style is highly personal: he prefers face-to-face meetings rather than emails, and constantly acknowledges the good efforts of colleagues and staff. He prides himself on knowing the names of everyone he works with—from the security guards in his office building to the entire OR staff. He gives his cell phone number to patients so they can reach him if conventional channels fail. He’s at Northwestern Memorial Hospital (NMH) seven days a week and even takes his daughters Julia and Micheline, 9, and son, Ismail, 7, on rounds to meet his patients and staff because he believes everyone benefits.
Prior to joining Northwestern, Parsa was professor and vice chair in the department of neurological surgery at the University of California, San Francisco (UCSF).
“Coming here was an outstanding opportunity to grow a department that was already clinically excellent. When I looked at metrics such as patient volumes, growth capacity, research infrastructure and administrative support, there really was no place like Northwestern,” he says.
When it comes to top U.S. training programs and busy medical centers, Parsa has seen plenty. He earned his bachelor’s degree at Yale College in molecular biophysics and biochemistry. He returned to his birthplace, Brooklyn, for his medical degree and doctorate in immunology and cell biology from SUNY Downstate Medical Center, working at Kings County Hospital Center, one of the nation’s largest county hospitals.
During his residency at Columbia University, he met his wife, Charlotte Shum, MD, who was appointed associate professor of orthopaedic surgery at Feinberg last fall. She was a hand and upper extremity specialist for more than a decade at Permanente Medical Group in Oakland, Calif.
Building on his ideas from UCSF and empowering Feinberg specialists to move forward, Parsa is intensifying collaboration between surgeons and neurologists to enhance care.
For instance, he supported expansion of the Telestroke program to remote Chicago-area hospitals outside the NMH network. (The network includes Chicago and Lake Forest hospitals and a free-standing emergency room in Grayslake.) Telestroke rapidly connects these institutions with NMH neurologists and neurosurgeons via the Internet for time-critical stroke assessment and treatment guidance, which are essential to prevent patients from becoming disabled. If needed, patients can be transferred to an NMH hospital. Richard Bernstein, MD, PhD, professor of neurology and director of the Stroke and Telestroke program, implemented the program last fall at Norwegian American Hospital on Chicago’s West Side and at Northwest Community Hospital in suburban Arlington Heights this spring. Other locations are being considered.
In another neurology-neurosurgery initiative, Dr. Parsa is working to increase use of stereotactic electroencephalography (EEG) procedures to pinpoint causes and locations of brain seizures. Stereotactic EEG is a potentially less-invasive and more precise method than traditional approaches to assess patients with epilepsy.
Sweating the Small Stuff
Since 2002, Parsa’s laboratory has focused on understanding how the immune system can be used to fight brain cancer. He is study chair for the largest randomized brain tumor vaccine trial ever funded by the National Cancer Institute. Coordinators plan to enroll more than 200 patients with recurrent glioblastoma that can be surgically removed. A vaccine made from the patient’s tumor is administered to induce an immune response that kills remaining tumor cells and extends survival.
The Phase II data supporting clinical trial was recently published in the journal Neuro-Oncology. Parsa plans to meet with the FDA in early 2014 to discuss the ongoing trials and submission requirements for drug approval.
“It has been 10 years since I started this, and my goal has always been to take it as far as I could,” explains the co-leader of the Translational Research in Solid Tumors Program (TRIST) at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. “Moving something from the experimental phase to a standard of care is a complicated process that requires multiple teams of devoted scientists and clinicians. We are doing everything we can to facilitate approval of this drug, which has shown promising results to date.”
His outlook that no patient should be forgotten drives him to seek better treatments for rare types of brain tumors, particularly understudied skull base tumors. Usually benign, these tumors located behind the eyes, nose and ears press on nerves and blood vessels, destroying body functions. Accessing and surgically resecting them can be challenging. Parsa is pursuing an adaptive hybrid approach combining radiation with resection to minimize disease and maximize tumor control.
“I see many patients from all over the world with skull base tumors, and I think there is a great opportunity to develop a better understanding about the different pathophysiologies, the best treatments, and the best management paradigms. It is important not to treat all tumors with one approach of only radiation or only aggressive surgical resection; the complications of the latter can be devastating,” he says.
In spring 2014, Parsa will be a lead PI in a multi-center trial for adaptive hybrid surgery using software that helps surgeons determine how much tumor they have removed and identify optimal radiation targets for what remains.
An Imperfect Leader
Parsa has one candid message to his trainees and neurosurgical colleagues: “I have made plenty of mistakes.”
He believes one of the most important things a chair can do is to share his or her errors so others don’t repeat them.
Among his prime lessons: Don’t take on too much, too soon before infrastructure is set up. “Otherwise, what happens is that you do everything in an average way but not as well as you would like to. With so many great things going on at Northwestern, it is tempting to take on too much.”
His frank communication style earned him many teaching awards at UCSF. He was twice awarded the Harold Rosegay Resident Teaching Award in the department of neurological surgery. In 2010, he was named Mentor of the Year for the medical school. He continues to take pride in mentoring, and speaks weekly with former residents and students.
However, he is not dogmatic about what his trainees should do in neurosurgery. As someone who performs about 300 surgeries annually while conducting research and clinical trials, he does not try to mold students and residents in his image. He seeks to understand what motivates them about neurosurgery and steers them to that interest.
“My philosophy for my residents is basically this: Tell me where you want to be in 10 years and we’ll get you there in a way that makes us very proud of what you do.”
Staying on Top
Drs. Krainc and Parsa are quick to say that neurological diseases cannot be solved unless neurologists and neurosurgeons work well together. And the chairs are resolute about maintaining Northwestern Medicine’s position among the nation’s top neurology and neurosurgery programs.
“If I have one clear message, it is that I am very patient-oriented and that’s what gets me up every morning,” Krainc says. “I want the best delivery of care, I want top-notch research. We should have a sense of innovation and collaboration. If we do all of these things, we have fulfilled our promise to the people we care for.”
As an in-demand surgeon who leads a high-powered department, a father of three young children, and a scientist, Parsa continues full-speed ahead with an unwavering focus.
“I don’t see much separation between my work and my family. My work is one continuous stream of people I care about,” he says. “I have been going this way since I was a resident in 1996. I don’t know any other way to do it than to be fully involved on both sides.”