Building a career as an independent researcher in academic medicine requires innovative thinking and creativity; training and good mentorship; and taking advantage of key opportunities. Michael Satlin, MD, a recent KL2 scholar of the Weill Cornell Clinical and Translational Science Center (CTSC), has achieved the next step on his path with his recent award of a K23 Research Career Development grant from the National Institutes of Health (NIH).
The CTSC KL2 Scholar Program, administered by the Clinical and Translational Education Program (CTEP), fosters the next generation of translational researchers by providing salary, education and training, and other support to promising early-career investigators, protecting their time so that they may concentrate on developing the skills, experience, and networks necessary for eventual independence. Upon completion of the program, KL2 Scholars are expected to submit a grant proposal for funding, such as the NIH K23.
Dr. Satlin’s five-year K23 award will support his study of carbapenem-resistant Enterobacteriaceae (CRE), a multidrug-resistant gut bacteria considered an important pathogen in immunocompromised cancer patients and other vulnerable groups. Infection with CRE is extremely difficult to treat and may increase the risk for death in infected individuals.
Dr. Satlin, an Instructor of Medicine at Weill Cornell Medical College, became interested in multidrug-resistant, gram-negative bacteria during his fellowship in the study of infectious diseases. “As I became an attending (physician) and began caring almost exclusively for immunocompromised patients,” he recalled, “I found these patients were also getting infected by these drug-resistant bacteria. Because of their weak immune systems, these patients need immediate treatment with effective antibiotics as soon as they develop signs of infection, such as fever.”
Health professionals, however, must pay close attention to the risk of bacteria developing resistance to existing antibiotic treatments and the risks of potential toxicity with newer treatments in patients. Both concerns necessitate judicious use of antibiotics. “CRE are resistant to the recommended initial antibiotic treatments, and it takes two to three days to know that a patient is infected with CRE,” he explained. “By this time, patients are often too sick to recover from their infection, even if ‘effective’ treatments are started.”
In his K23 project, Dr. Satlin will investigate whether there is a way to screen for vulnerable patients at high risk for CRE infection, a breakthrough that would help guide treatment decisions to maximize the effectiveness of available antibiotics. “The goal of my research is to rapidly identify patients who are at high risk of CRE infection,” he said, “So that these patients can be given one of the few antibiotics that is still active against CRE immediately after the onset of infection.
“The first step is to identify patients who are colonized with infections,” he explained. “Current techniques for detection take too long, so can we use emerging gene technologies to improve detection? Finally, by comparing the bacteria, can we determine if vulnerable patients are being made ill by the same bacteria as the ones that colonized them? If not, how are patients acquiring these bacteria?”
Collaboration is an important aspect of Dr. Satlin’s research: CRE infection is relatively uncommon, and having access to data from only a single center has been a limitation of previous studies. In order to gather a meaningful number of patients, working with other groups, such as at the Memorial Sloan-Kettering Cancer Center, to solve challenging logistics of multicenter studies would be essential. With the K23 award, he hopes to continue to develop his skills in building and nurturing multicenter networks and interdisciplinary teams for conducting this research. “By working with people with different skill sets, you can accomplish more. My background is in clinical research, but I’m being mentored by molecular epidemiologists.”
Under the K23, Dr. Satlin will be mentored by Thomas Walsh, MD (Weill Cornell Medical College, NYC), and Barry Kreiswirth, PhD (The Public Health Research Institute, NJ). He will benefit from access to Dr. Walsh’s extensive expertise and experience in conducting clinical and translational infectious diseases research in immunocompromised patients and Dr. Kreiswirth’s expertise in molecular diagnostics and molecular characterization of multidrug-resistant bacteria.
With Dr. Walsh, Dr. Satlin is a member of the Transplantation-Oncology Infectious Diseases Program. Dr. Satlin observed, “Although we essentially started four or five years ago, we’ve rapidly developed into a true clinical program with exciting laboratory and clinical research.” He credits the leadership and lab work of Dr. Walsh and the collaboration with his program colleagues Rosemary Soave, MD; Samantha Jacobs, MD; and Catherine Small, MD, with improving care for immunocompromised patients.
As NIH career development grants such as the K23 and K08 programs become increasingly competitive, programs like the CTSC KL2 Award give early-career investigators like Dr. Satlin the protected time and opportunities to research, publish, and gain experience and mentorship. Dr. Satlin noted that the training he received through the CTSC helped put him in a position to successfully achieve his goal. For example, the opportunity to participate in the Weill Cornell CTSC Grant Writing Honors Program, which pairs a select few CTSC grant recipients with a grant writer in order to produce a high-quality NIH application, helped Dr. Satlin prepare to be competitive for the K23.
For the future of CRE treatment, Dr. Satlin noted the potential of his research to improve the targeting of patients for therapy. “Some new drugs in the pipeline may be effective. Even if drugs were approved, we still need to figure out who should get the therapy. This is an observational study, and the next step would be a multicenter clinical trial: would screening and early treatment improve patient outcomes?”
The CTEP is accepting applications for upcoming TL1 training and other educational opportunities in Clinical and Translational Investigation. Applications are due January 21, 2015. For more information, visit here.