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Doernbecher Scientist Earns Coveted Javits Award

The National Institutes of Health hand-selects just a few investigators nationwide whose leading-edge research merits a full seven years of grant funding.

Stephen A. Back, M.D., Ph.D.,an internationally recognized expert in pediatric neurology at Doernbecher Children's Hospital, Oregon Health & Science University, recently was awarded a prestigious $2,346,313 Javits Neuroscience Investigator Award from the National Institute on Disease and Stroke (NINDS) for his pioneering work in the cellular and  molecular cause(s) of brain injury in premature infants. NINDS is a branch of the National Institutes of Health.

"I am thrilled the NINDS continues to recognize the potential of the unique research models we have developed – some of which are not used anywhere else in the world. With the help of this long-term grant, we hope to devise therapies that cannot only reverse brain damage in infants but slow cognitive decline in aging adults as well," said Back, associate professor of pediatrics and neurology, Doernbecher Children's Hospital, OHSU School of Medicine.

Back's research looks at the mechanisms responsible for causing white matter brain injury in developing infants. White matter brain injury is the underlying basis for cerebral palsy, or CP, a condition  in which permanent brain damage causes movement disorders, including inability to walk without an assistive device, inability to use one's arms and legs and weak torso muscles; as well as, intellectual challenges, including thinking, reasoning, remembering, imagining or learning words.

Premature birth is the leading cause of cerebral palsy, explains Back, and in the United States, a child who will develop CP is born every 30 minutes. In addition, he says, children are 10 times more likely to have CP than cancer.

"Dr. Back's groundbreaking work is increasing our knowledge of what causes cerebral palsy and other important neurological diseases," said Stacy Nicholson, M.D., Doernbecher Physician-in Chief and Credit Unions for Kids Professor and Chair of Pediatrics, OHSU School of Medicine. "His work should lead to real breakthroughs for patients struggling with these debilitating disorders. OHSU and Doernbecher are fortunate to have a scientist of his caliber."

"The Javits Investigator Award for Dr. Back is a recognition of his seminal contributions to the field of developmental brain injury. His proposed work includes the use of a novel pre-clinical animal model to test new translational strategies that will have the potential for restoration of normal myelination and neurological function in children with white matter lesions," said Dan Tagle, Ph.D., program director for Neurogenetics, NINDS, NIH.

Back and colleagues hope their research will benefit three large groups of children at risk for CP. Infants that survive after premature birth, full-term babies later discovered to have brain injury that occurred during pregnancy; and infants born with heart disease. These infants commonly develop injury to one major part of the brain, called the white matter, which contains the nerve fibers that control brain functions such as walking, speaking and thinking. White matter injury occurs when blood flow to the developing brain falls below normal or when maternal infection occurs during pregnancy. Critically ill premature babies are especially at risk to develop white matter injury from either cause.

White matter injury occurs during brain development when nerve fibers in the white matter are actively being wrapped in myelin, the insulation that allows nerve fibers to rapidly transmit signals in the brain. Dr. Back and his team have shown that during human brain development, there is a critical time period when the cells (oligos or oligodendrocyte progenitors) required to make myelin are easily killed by low blood flow to the brain. The loss of these oligo-cells results in failure to make the myelin required for normal brain function.

Progress in preventing this brain injury has been slow, Back says, because of the lack of animal models to test therapies for the complex forms of brain injury that occur in human survivors of premature birth. Recently, Back's team developed the first animal model that reproduces the major forms of brain damage that occur in premature infants. This model has substantially altered the way leaders in this field believe damage occurs to the developing white matter of the brain.

"We previously believed that the developing brain fails to make normal myelin, because the oligo-cells that make the myelin were completely killed. Hence, it was thought that the children with CP sustain permanent abnormalities in movement and intellect," Back explained. "However, our recent studies suggest that this view may not be correct.

Back and Lawrence Sherman, Ph.D., an associate scientist in the OHSU Oregon National Primate Research Center, have discovered that after adult white matter damage, numerous oligo-cells survive, but fail to mature to make myelin. This appears related to a molecule called hyaluronic acid (HA) that builds up in the damaged white matter and prevents the normal production of myelin.

"The oligo-cells are blocked at a critical period in their cell development before they are able to make myelin. The fact that these cells appear normal and are present in large numbers in the regions of brain damage raises the possibility that we might develop therapies that allow these oligo-cells to mature and make the myelin needed to restore greater function to the damaged brain," Back said.

Back is the second OHSU researcher to receive this highly coveted award. In 2002 Edward Neuwelt, M.D.,professor of neurosurgery and neurology, OHSU School of Medicine, Portland Veterans Affairs Medical Center, and director of the OHSU Blood Brain Barrier Program, received a Javits Award for his contributions to the understanding of the blood-brain barrier and his progress toward innovative strategies for treating central nervous system tumors.

"Dr. Back's multidisciplinary laboratory collaborates with leading scientists in academic institutions around the world. This cross-fertilization among scientific leaders is an NIH priority intended to accelerate the pace of translational research. We are delighted his work has been singled out by this very senior assembly of distinguished neurologists and neuroscientists," said Mark Richardson, M.D., M.B.A.,dean, OHSU School of Medicine.



Congress established the Javits Neuroscience Investigator Award in 1983 in honor of Sen. Jacob Javits, who for several years battled amyotrophic lateral sclerosis (ALS), a degenerative neurological disorder also known as Lou Gehrig's disease. Sen. Javits was a staunch advocate for research into a wide variety of brain and nervous system disorders.

The Javits Neuroscience Investigator Award is given to scientists who have demonstrated exceptional scientific excellence and productivity in one of the areas of neurological research supported by NINDS. Approximately 505 awards have been made to date.

Researchers cannot apply for this award. Submissions are hand-selected by the NINDS Council. Awardees must have a proposal of the highest scientific merit and be judged highly likely to continue to do cutting-edge research for the next seven years.



Oregon Health & Science University is the state's only health and research university, and Oregon's only academic health center. OHSU is Portland's largest employer and the fourth largest in Oregon (excluding government), with more than 12,000 employees. OHSU's size contributes to its ability to provide many services and community support activities not found anywhere else in the state. It serves 189,000 patients annually, and is a conduit for learning for more than 3,400 students and trainees. OHSU is the source of more than 200 community outreach programs that bring health and education services to every county in the state.

As a leader in research, OHSU earned $294 million in research funding in fiscal year 2006. OHSU serves as a catalyst for the region's bioscience industry and is an incubator of discovery, averaging one new breakthrough or innovation every three days, with more than 3,500 research projects currently under way. OHSU disclosed 116 inventions in 2006 alone, and OHSU research resulted in 28 new spinoff companies since 2000, most of which are based in Oregon.

Doernbecher Children's Hospital, a division of Oregon Health & Science University, is a world-class academic health center that each year cares for more than 56,000 patients from across the United States. In the most patient- and family-centered environment, children receive outstanding cancer treatment, specialized neurology care, highly sophisticated heart surgery, and care in many other pediatric specialties. In addition to several locations in the Portland metropolitan area, Doernbecher's pediatric experts travel throughout Oregon and southwest Washington providing pediatric specialty care at 13 outreach clinics.



Stephen Back, M.D., Ph.D., has studied in the labs of several international leaders in basic and clinical neuroscience, including Dr. Floyd Bloom, former chairman of neuropharmacology at The Salk Institute and one of the first to use modern molecular techniques in brain-specific genes; Dr. Howard Fields, at the University of California, San Francisco, a leader in the neurobiology of pain pathways in the brain; and Dr. Joseph Volpe, the recognized founder of neonatal neurology, professor of neurology at Harvard Medical School and the former neurologist-in-chief at Children's Hospital Boston.

Back joined the Doernbecher faculty in 1999 and has established an internationally recognized laboratory in the study of perinatal brain injury. He is the Director of the Doernbecher Pediatric Neuroscience Research Program.  The focus of Back's research is in cerebral palsy related to cerebral white matter injury in premature infants.

Throughout his career Back has sustained a record of independent NIH funding. He currently is a principal investigator or co-investigator on five National Institutes of Health grants and four foundation grants, including funding from the March of Dimes and the American Stroke Association. He is the recipient of several prestigious awards, including the Young Investigator Award of the Child Neurology Society, a Bugher Award from the American Heart Association and now the Javits Award.


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