The University of Louisville Alumni Magazine: for alumni, faculty, staff, students and anyone that is a UofL Cardinal fan.
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A C R O S S C A M P U S On the front lines: Polypharmacy The School of Medicine's Department of Geriatrics is gaining nationwide recognition for raising awareness of a syndrome called polypharmacy. Defi ned as the use of more than fi ve medications simultaneously, polypharmacy becomes a problem when mul- tiple medications cause adverse reactions and side effects, or otherwise compromise a patient's health. It most frequently affects the elderly, who often are prescribed multiple medica- tions, causing confusion, agitation, eating and sleeping disorders, and increased inci- dence of injury due to falls or other accidents. The situation worsens when a patient's medical condition is neither adequately nor appropriately coordinated among caregiv- ers, physicians and pharmacists. Demetra Antimisiaris, MD, director of geriatric pharmacotherapy, said UofL has one of only 13 departments of geriatrics in the nation and is positioned to take the lead in polypharmacy research, education and outreach. "We collaborate closely with our neurology and psychiatry departments, as well as our Kent School of Social Work," Antimisiaris said. "All of these departments work and live on the front lines of polypharmacy-induced harm." "Another reason we are fortunate to have this critical mass of experts concerned with polypharmacy is that Kentucky ranks in the top three states with the high- est number of prescriptions per capita, along with West Virginia and Tennessee," Antimisiaris said. "So polypharmacy has become a regional problem, most recently made worse by the emergence of teens and younger people using prescription drugs purposefully as drugs of abuse." As a result, she explained, the initiative has unexpect- edly grown beyond geriatric polypharmacy. The team from UofL Geriatrics is receiving many requests to share their expertise and training. Workshops and other programs have been presented to the Kentucky Substance Abuse Conference, Eastern Kentucky's Substance Abuse Coalition and Northern Kentucky University's Substance Abuse School. In addition, they have provided continuing medical education and expert testimo- ny to the Kentucky legislature, and conferences in Utah, Florida and Nevada. Special consultation and training have also been requested by Morehouse University Medical School in Atlanta. A geriatric pharmacotherapy fellow has been hired to help keep up with the grow- ing demand for education, research and public outreach. A website and other materials are being prepared to fulfi ll requests for information from non-medical or lay groups. "Polypharmacy is a silent epidemic and signifi cant public health threat," Antimisia- ris said. "It requires an interdisciplinary solution — starting with patients, caregivers and the public — which will force the health care system to more responsibly address the problem. Public outreach is an important part of making an impact." Help on the way for dry mouth? UofL researchers are one step closer to helping the mil- lions of people who lose salivary gland function due to disease or treatment of disease. Douglas Darling, PhD, a UofL professor of oral health and rehabilitation, and his team have identi- fi ed a protein-sorting mechanism used by the salivary glands. This important National Institutes of Health – supported study, chronicled online in a recent issue of the Journal of Dental Research, could form the basis for advanced therapies in patients whose salivary glands no longer function due to radiation therapy, prescription drugs or Sjogran's Syndrome, an immune system disor- der commonly defi ned by dry eyes and dry mouth. The salivary glands are essential for lubrication, defense and beginning digestion in the mouth. The largest of these — the parotid — secretes important proteins into the saliva. With seven possible pathways in the body, the parotid must sort proteins destined for saliva into the correct path. Transport along these mul- tiple pathways requires sorting proteins into vesicles, or hollow membrane sacs, that carry their "cargo" to the proper destination. Previously, scientists believed cargo proteins moved into the forming vesicles by attaching to sorting recep- tor proteins. However, Darling and his team discovered a new approach that suggests a salivary-sorting receptor protein may not even exist. Instead, the salivary cargo protein, or Parotid Secretory Protein (PSP), selectively and directly binds to a rare lipid, a type of fat molecule called PtdIns(3,4) P2, only present in certain cell membranes — and only on one side of the membrane. "These data imply that phosphatidylinositol-phos- phate liquids like PtdIns(3,4)P2 may have multiple func- tions on the inner surface of organelles," Darling said. The next step for Darling and his team is to identify the molecular components used for fl ipping PtdIns(3,4) P2, and develop approaches to test ways to manipulate this potential protein-sorting mechanism. FALL UOFL MAGAZINE|41 SCHOOL OF DENTISTR Y SCHOOL OF MEDICINE