Art is Medicine: A Two-Way Flow of Talent Between Brazil and Miami | InventUM

An article for Sylvester Comprehensive Cancer Center / UHealth

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BY ROCHELLE BRODER-SINGER

Art is Medicine: A Two-Way Flow of Talent Between Brazil and Miami

Sylvester’s third annual “Art is Medicine” installation opens Nov. 25 and will feature a new collection that highlights nature photography from the Everglades to Brazil, “The Bridge to Bahia.”

Patients, caregivers and other visitors to the Miami main campus of Sylvester Comprehensive Cancer Center, a part of the University of Miami Miller School of Medicine and UHealth—University of Miami Health System, will have an opportunity to enjoy images from the Everglades to the beaches in Brazil in this new exhibit. It will be located on the first floor of the Sylvester main building at the medical campus in Miami. There, the atrium will feature new pieces for patients and visitors to view and will highlight the intersectionality of art, scientific research and people.

Art is Medicine

Titled “Bridge to Bahia,” the new “Art is Medicine” installation includes a QR code that links to faculty profiles highlighting Sylvester’s bidirectional scientific collaborations across cultures, customs, education and patient care. The installation also includes South Florida photography, which showcases other winners of Sylvester’s Patient, Faculty, Staff and Community Arts Challenge.

“One of our great advantages is the diversity of our community here in South Florida,” said Stephen D. Nimer, M.D., Sylvester’s director and professor of medicine, biochemistry and molecular biology, the Oscar de La Renta Endowed Chair in Cancer Research and executive dean for research at the Miller School. “Beautiful photography embracing the landscapes in Brazil warms the hearts of everyone at Sylvester, whether one is from Brazil or not. The exhibit also allows us to share the creativity of our community, as well as showcase a few of our faculty and trainees from Brazil. We hope this enables them and all our colleagues to feel honored and enjoy this exhibit. We thank Dar Riser and our patients, students, staff, and faculty who contributed art to this exhibition.”

Desert Horse-Grant, Sylvester’s chief transformation officer, created the arts challenge and curated the exhibition.

“In collaboration with Dr. Nimer, our goal is to create a respite of peace and a place of hope,” said Horse-Grant. “We intentionally selected art that represents places many would want to travel to. We hope that, even momentarily, we can transport patients and caregivers to a place of peace and wonderment when they walk through the exhibit.”

Research has shown that images of nature can reduce stress, elevate a person’s mood, enhance problem-solving skills, restore mental energy and more.

“Art has the power to ground us, offering patients with cancer a sanctuary of calm through scenes of nature. Viewing images of tranquil landscapes or vibrant gardens has been shown to provide a whole range of momentary physical and mental health benefits, including reducing anxiety and stress, lowering one’s heart rate and increasing one’s focus or attention,” said Lara Traeger, Ph.D., clinical psychologist at Sylvester and associate professor of psychology at the University of Miami. “These benefits can help to ease the mind amid the challenges of treatment.”

In bringing together nature photos from the northeastern Brazilian state of Bahia with images from South Florida and beyond, the “Art is Medicine” installation parallels Sylvester’s broad connections to diverse communities. With more than half of Miami-Dade County’s population born outside the U.S., the region is diverse in culture, customs and heritage. Sylvester’s faculty and clinicians are equally diverse, and many faculty do research, outreach and educational work in other countries.

“Our faculty really represent our community, and they maintain their connections when they come to us from other nations,” Horse-Grant said. “Our support for diversity contributes to health status and well-being for all because our patients represent so many different genetic populations.”

The exhibit reflects Sylvester’s commitment to fostering collaboration across borders, with physician-scientists engaged in research and training that impact both local and global patients.

From Resident to Medical Leader

Miami’s position as the gateway to the Americas has helped bring patients and researchers from around the region to Sylvester. Many researchers first connect with Sylvester through the William J. Harrington Medical Training Programs. These University of Miami Health System and University of Miami Miller School of Medicine programs offer opportunities for Latin American and Caribbean medical graduates to complete a variety of postgraduate medical education.

Sylvester’s Denise Pereira, M.D., is among the hundreds of physicians from Latin America who have completed their residencies through the Harrington program. She is the director of clinical operations for Sylvester’s Adult Stem Cell Transplantation Program and associate professor of medicine in the Division of Transplantation and Cellular Therapy at the Miller School. A native of Brazil, she went to medical school in Rio de Janeiro and then completed her internal medicine residency at Jackson Memorial Hospital/UHealth. She stayed a fourth year as chief medical resident, learning more about the teaching and administrative side of medicine.

Dr. Denise Pereira came to Miami from Brazil via the William J. Harrington Medical Training Programs.

“The University of Miami has a tradition of being a hub for training Latin American physicians,” Dr. Pereira said.

After completing a fellowship at the Mayo Clinic in Minnesota, Dr. Pereira returned to Brazil, eventually becoming chief of oncology at one of the nation’s national cancer institutes, Instituto Nacional de Câncer – INCA. But she and her husband, who is also a physician, wanted to return to the U.S., where she felt she’d have more opportunities to grow in the field of stem cell transplant. That brought her to Sylvester in 2003.

“The University of Miami held a lot of promise,” she said. “Besides that, [my husband and I] also felt Miami was an international city. We felt very welcome, and it didn’t feel so different from home for us.”

At Sylvester, Dr. Pereira has been able to realize her ambitions to expand the use and availability of stem cell therapy for patients, as well as to participate in clinical research.

“I have gotten to build something, to make something better and to provide care to people,” she said. “We have developed certain abilities that allow us to serve our community as it is, including transplanting people without a perfect match because minorities have difficulty finding donors. This is a way to give more people access to treatment.”

The large and diverse population served by Sylvester’s stem cell transplant program, combined with its state-of-the-art facilities, also brought opportunities to engage with emerging cellular therapies. Sylvester’s reputation in stem cell transplantation attracts clinicians and researchers from Brazil to observe and train, Dr. Pereira explained.

Not long ago, Daniel Tabak, M.D., the Brazilian physician whose letter of reference helped Dr. Pereira get into the Harrington Medical Training Program, came to see Sylvester’s cellular transplant team at work. It wasn’t Dr. Tabak’s first time at UM. The stem cell transplant physician had also trained in the Harrington program, from 1981 to 1984, and then returned to Brazil. He eventually became director of one of that nation’s first stem cell transplant sites.

Expanding Opportunities in Brazil

Brazilian-born Gilberto Lopes, M.D., associate director and medical director for international affairs at Sylvester and professor and chief of the Division of Medical Oncology at the Miller School, also came to Sylvester through his post-graduate training. After completing his internal medicine residency, as well as a hematology and oncology fellowship, at UM/Jackson Memorial Hospital, the Porto Alegre native returned to Brazil. There, he served in positions including chief medical and scientific officer for the Oncoclinicas Group, one of the largest oncology providers in the world.

In 2016, Sylvester leadership invited Dr. Lopes to return to help create a global oncology program and lead thoracic oncology.

“Sylvester was the natural place for me to come back to in the United States,” he said.

Dr. Gilberto Lopes trained in Miami, returned to his home in Porto Alegre and then returned to Sylvester to create a global oncology program.

Although he returned to Sylvester, “I continue to have a number of initiatives in my country,” Dr. Lopes said. “For example, I mentor colleagues who have leading roles in public and private institutions in Brazil. I also speak, organize and chair several lectures a year with Brazilian institutions, including public hospitals.”

This year, he has given remote lectures on lung cancer updates to Hospital Sírio-Libanês in Brasilia and Hospital Israelita Albert Einstein in São Paulo, with more planned in Porto Alegre. On Nov. 9, he gave a lecture at the Brazilian Society of Clinical Oncology on using social media for education, mentoring and professional development for oncologists in that nation. Dr. Lopes also participates remotely in tumor boards with Brazilian colleagues.

“I have also collaborated with the City Cancer Challenge NGO, helping to improve cancer care in Porto Alegre,” he added.

In addition, he is working on several research projects with Brazilian colleagues, including the evaluation of an immunotherapy implementation project at the National Cancer Institute in Rio de Janeiro. Dr. Lopes, who maintains his medical oncology license in Brazil, co-founded a biotech that started its first clinical trial at University of Campinas in Brazil’s Sao Paulo state this year. The trial is exploring a point-of-contact detection test for Human papillomavirus (HPV), a virus that can cause cancers.

Dr. Lopes and two Sylvester colleagues – Alvaro Alencar, M.D., a Brazilian native who is chief medical officer and an associate professor of clinical medicine in the Division of Hematology at the Miller School, and Joseph Rosenblatt, M.D., professor of medicine in the Division of Hematology and holder of the William J. Harrington Chair in Hematology at the Miller School, were also involved in creating a path for ongoing collaboration between Sylvester and Barretos Cancer Hospital in Sao Paulo state. Barretos is one of Brazil’s most advanced public hospital cancer centers and, like Sylvester, is also a teaching and research institute. The two organizations signed a memorandum of understanding for collaborative research in 2018, which has led to several meetings and lectures, as well as to Sylvester hosting oncologists and trainees.

Dr. Lopes has helped make a variety of connections between Sylvester researchers and their Brazilian counterparts. For example, he worked with Alberto Caban-Martinez, D.O., Ph.D., M.P.H., C.P.H., a member of Sylvester and assistant professor in the Department of Public Health Sciences at the Miller School, to help Brazil-born Miller School student Nicole Dias de Souza launch the Beatriz Project In 2019. The project brought two exchange students from Hospital de Amor in Barretos for a clinical rotation at Sylvester while two students from the Miller School worked at Hospital de Amor.

Dr. Lopes notes that, in addition to research, tumor boards and lectures in Brazil, much of the interchange between Sylvester and Brazilian health care practitioners occurs via training.

“At Sylvester, we usually receive more than 10 Brazilian medical students, residents and fellows every year,” he explained. “They come to get a more comprehensive experience in cancer care, research and education.”

Unique Research Partnerships

Sylvester’s connections with Brazil have opened doors for unique research opportunities. For example, Wael El-Rifai, M.D., Ph.D., Sylvester researcher, professor of biochemistry and molecular biology and John and Judy Schulte Senior Chair in Cancer Research at the Miller School, is preparing to start a research collaboration with Brazil’s Molecular Oncology Research Center at Barretos Cancer Hospital. This collaboration is another result of the memorandum of understanding Sylvester signed with Barretos.

Dr. El-Rifai is researching micro-RNA screening for early detection of gastric cancer and response to chemotherapy in diagnosed gastric cancers. He and Zeng Chen, M.D., Ph.D., a research assistant professor in the Division of Surgical Oncology at the Miller School, have validated the predictive data for the screening model with populations in China and Chile, but need to validate the data with a larger cohort.

Dr. Wael El-Rifai is developing a research collaboration with Brazil’s Molecular Oncology Research Center.

Brazil has a high prevalence of gastric cancer and has endoscopy samples going back 20 years for patients with and without gastric cancer. Most of Brazil’s population is also not of typical European ancestry, which will add further genetic diversity to the data set. Dr. Lopes connected Dr. El-Rifai with Barretos Cancer Center, and the research collaboration is set to begin soon.

“Miami is diverse, so the diversity at the university among the faculty allows you to have a larger network,” Dr. El Rifai said. “Often, research collaborations come through word of mouth, someone who knows someone. That’s how this came about.”

While the process for multisite collaboration can come naturally, pooling strengths between researchers, there is scientific rigor and specificity for Sylvester’s team science efforts.

Discussion for the research collaboration led to an invitation for Dr. El-Rifai to be a keynote speaker at the IX International Symposium on Translational Oncology, held at Barretos Cancer Center Sept. 13–14. He shared an overview of the state of gastric cancer and the need to develop predictive biomarkers for early detection, as well as the importance of screening for H. Pylori infection, the major risk factor for gastric cancer. Dr. El-Rifai is excited to share his research with a new audience at the Brazilian symposium.

“Sharing information is part of who we are as scientists,” he said. “Sharing with the scientific community the state-of-the-art in the field allows us to potentially help more patients. If there’s an opportunity to establish a collaboration, we can potentially help more patients.”

Dr. Estelamari Rodriguez Honored as GRACE Patient Educator of the Year - InventUM

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An article for InventUM | Sylvester Comprehensive Cancer Center

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BY ROCHELLE BRODER-SINGER

Spanish-language content for lung cancer patients helps break down barriers to care.

As a physician and a Latina, Estelamari Rodriguez, M.D., M.P.H., has seen firsthand the ways that language barriers often prevent Spanish-speaking patients from receiving optimal care.

Dr. Rodriguez, a bilingual thoracic oncologist at Sylvester Comprehensive Cancer Center, part of UHealth—University of Miami Health System, is breaking down those barriers by creating Spanish-language educational content about lung cancer for patients and caregivers.

Since 2020, Dr. Rodriguez has created Spanish-language video content and seminars for Cancer GRACE (Global Resource for Advancing Cancer Education), a nonprofit patient advocacy organization that offers expert-mediated information on cancer management to empower patients, caregivers and health care professionals to collaborate in cancer care.

She’s covered a wide range of lung cancer topics, including advances in targeted therapies and the newest research on biomarker testing, immunotherapy and emerging therapies. Her goal is to provide information that will help Spanish-speaking lung cancer patients communicate their concerns to health care providers and make better treatment decisions for themselves.

Educate and Empower Cancer Patients

For her work, GRACE honored Dr. Rodriguez with its Patient Educator of the Year award at its annual gathering on May 31 in Chicago.

“It is a great honor to receive this award from the GRACE patient advocacy group,” Dr. Rodriguez said. “Educated patients are the best self-advocates.”

GRACE has presented the Patient Educator of the Year award annually since 2018. It recognizes an oncologist who has gone above and beyond in educating and empowering patients with cancer.

“We chose Dr. Rodriguez because she exemplifies our mission of providing accurate and reliable cancer education to patients and their advocates,” said GRACE Program Manager Maria Christian. “She tries to participate in our recorded video libraries and live events as often as possible. And if she’s unable to work it into her schedule, then she will personally record a presentation on her own time and send it to GRACE for publication.”

A Driving Force in Lung Cancer Treatment

Dr. Rodriguez is a triple board-certified hematologist and oncologist who helped establish the multidisciplinary lung cancer care approach at Sylvester, South Florida’s only National Cancer Institute-designated center. The multidisciplinary approach incorporates clinicians from outside of oncology, creating a team that works with patients from initial screening through diagnosis, treatment and support.

Dr. Rodriguez is also a driving force behind Sylvester’s lung cancer screening program and has a particular interest in treating malignant mesothelioma. Stationed at the Sylvester at Aventura office, she treats patients from both Miami-Dade and Broward counties.

Throughout her career, Dr. Rodriguez has advocated for health equity. She is an active member of the ECOG/ACRIN Cancer Research Group Health Equity Committee and a American Society of Clinical Oncology’s Virtual Diversity Mentoring Program mentor for minority medical students and fellows. Her research has included studying methods to reduce disparities in mesothelioma outcomes related to social determinants of health, such as age, gender, race and income.

The Unique Perspective of a Latina Oncologist

Dr. Rodriguez uses her unique perspective as a Latina physician – only 2.4% of physicians in the U.S. are Latina – to improve outcomes and care for all of her patients.

“I have witnessed in my own family from Puerto Rico and in my medical training how our Spanish-speaking patients and caregivers are sometimes left out of the physician-patient conversation,” she said. “Many patients in our Latinx community are receiving suboptimal care because of lack of access and education about treatment options, risks and benefits and alternative treatments.”

Dr. Rodriguez also noted that caregivers and family members often play an integral role as members of the treatment team for Hispanic patients. She makes an extra effort to speak to them, as well as to patients, in her videos and seminars.

GRACE’s Christian praised Dr. Rodriguez’s understanding of how to communicate to overwhelmed caregivers and patients by being factual, professional and personable. Christian also underscored the importance of Dr. Rodriguez’s Spanish-language material, which, she noted, reaches “a vulnerable population that too often find a lack of materials when searching for information.”

Post-Pause Speech Patterns Help Detect Mild Cognitive Impairment

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An article for InventUM | University of Miami Miller School of Medicine

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BY ROCHELLE BRODER-SINGER

In individuals with mild cognitive impairment, speech behavior following pauses is different than in healthy individuals. Machine learning algorithms can use this behavior to screen for cognitive impairment. University of Miami Miller School of Medicine researchers have published the first research showing how post-pause speech in certain tasks can play an important role in identifying mild cognitive impairment.

“Speech is an easy-to-collect behavior, and computer analysis of specific speech tasks offers a minimally invasive way to help identify those with mild cognitive impairment (MCI),” said Michael Kleiman, Ph.D., research assistant professor of neurology at Miller School, member of the University of Miami Comprehensive Center for Brain Health and the article’s first author. “These findings suggest that tracking how people talk in specific tasks could become a simple way to spot early signs of Alzheimer’s or other cognitive problems.”

Around 80% of patients who have MCI are not diagnosed until after they’ve progressed to clinical dementia.

“Early detection of cognitive impairment offers patients the possibility of opportunities for early intervention with medication, participation in clinical trials and advanced care planning, but most patients in the U.S. are not diagnosed until the moderate stage,” explained the article’s senior author, James Galvin, M.D., M.P.H., Alexandria and Bernard Schoninger Endowed Chair in Memory Disorders and professor of neurology, psychiatry and behavioral sciences at the Miller School. “While there are many reasons for this later diagnosis, one important reason is the lack of sensitive tools for early detection. Further research is needed, but the use of speech patterns analyzed with artificial intelligence potentially provides a novel path forward.”

Dr. James Galvin, the study’s senior author, is hopeful speech pattern analysis will open up avenues for early detection of cognitive decline.

The article was published in the Journal of Alzheimer’s Disease online and will be published in the journal’s print edition.

How Mild Cognitive Impairment Affects Speech

Some of the earliest impacts of MCI often occur in the brain regions associated with language and speech production. Prior research has shown speech changes in people with mild cognitive impairment may include slower speech, use of words with fewer syllables and changes in pauses. The research by Dr. Kleiman and Dr. Galvin found that the words immediately following a pause (post-pause speech) are affected, too.

Pauses are a normal part of human speech. They can be unfilled (extended silences between words) or filled with utterances such as “uh,” “um” and “er.” Filled pauses are generally considered “searching” pauses and signal longer cognitive delays than unfilled pauses. During searching pauses, the speaker may be searching for the correct answer to a question or the correct thing to say, searching for something new to describe or searching for their next words. Dr. Kleiman and Dr. Galvin found that, in certain circumstances, individuals with MCI have meaningfully different behavior after filled pauses

Dr. Michael Kleiman is using AI to analyze speech patterns and predict cognitive impairment.

“People with mild cognitive impairment show subtle changes in their speech, such as using simpler words after pauses and taking longer to resume speaking, especially during demanding tasks like storytelling,” Dr. Kleiman noted.

These differences are significant enough that algorithms can use them to identify which individuals are likely to have MCI and which are likely healthy.

Analyzing Speech with AI and Machine Learning

The study by Dr. Kleiman and Dr. Galvin included 53 total participants, each older than 60. The 14 participants with MCI and 39 healthy controls are part of the Healthy Brain Initiative, a longitudinal study of brain health and cognition at the Comprehensive Center for Brain Health.

First, the researchers administered four speech-focused tasks to participants:

• An immediate narrative-recall task, during which a story was read and visually presented to participants. They were asked to recall the story immediately.

• A delayed-recall task, asking participants to recall the narrative 15 to 20 minutes later, after they had been distracted with other speech tasks.

• A picture-description task, giving participants 90 seconds to describe an image.

• A free-response task, in which participants were asked to describe their typical morning routines.

Responses were recorded. Leading and trailing silence and background noise such as room tone and other voices were removed. Those audio files were processed into text transcripts using the OpenAI Whisper Large-v2 model, then manually corrected as needed by trained research staff. Finally, the transcripts were parsed using a script that incorporated a variety of speech analyses. The speech of healthy controls and those with MCI was compared.

The researchers controlled for age in their analysis, using it as a covariate in all comparisons between participants with and without MCI. There were no differences in performance between groups based on gender, years of education, race, ethnicity, vulnerability or resilience.

Pauses and Post-pause Speech

Several characteristics distinguished the speech of individuals with MCI from the healthy controls. The two most significant differences were found following filled pauses:

• Those with MCI had longer latencies during the delayed narrative recall task.

• Those with MCI used more high-frequency language during the free-response task.

Individuals with MCI demonstrated a number of other differences, including:

• Significantly more filled pauses, especially using “uh”

• Longer latencies between any type of pause and their next word

• Lower total word count in every speech task

• Less use of adverbs after unfilled pauses in the free-response task

• Use of less-complex syntax to describe the picture

“The most important takeaway is that you can analyze speech with a bunch of different tasks, and each tells you something different,” Dr. Kleiman said. “They all give us a small piece of the puzzle. Only by combining them all together may we be able to identify mild cognitive impairment.”

Screening for Mild Cognitive Impairment

The predictive model developed in this study does a good job of distinguishing between individuals with and without mild cognitive impairment. The two most effective screening measures – looking for increased use of more-common words after pauses during less-demanding tasks and post-filler latency in highly demanding tasks – accurately predict MCI with area-under-the-curve (AUC) accuracy of 79.1%.

This particular study is a stepping stone. The ultimate goal is to build a speech-based detection algorithm that can identify mild cognitive impairment, maybe even pre-Alzheimer’s disease.
Dr. Michael Kleiman

The analysis developed by Dr. Kleiman and Dr. Galvin has a very low rate of false positives, correctly identifying individuals who do not have mild cognitive impairment with a specificity of 94.6%. However, the model has a sensitivity of just 43.6%, meaning it missed more than half of cases with impairment present. This makes the model useful for screening purposes. It’s good at ruling out nonimpaired individuals but  it is less reliable for diagnosing impairment.

“Post-pause metrics of latency and use of common language would be an excellent addition to any machine-learning model that utilizes speech behavior and seeks to identify healthy individuals,” Dr. Kleiman said.

Expanding the Model to Address Limitations

The study is ongoing, and these early results had a number of limits the researchers are addressing, including:

• A small sample size

• Far more healthy controls than individuals with MCI

• Primarily non-Hispanic, white participants

• Exclusively English-speaking participants

• A lack of biomarker data

• Examination of only three pause fillers (“uh,” “um” and “er”)

Dr. Kleiman is adding participants’ biomarker data into the model and is recruiting more participants with mild cognitive impairment, as well as more racially and ethnically diverse individuals, including those who primarily speak Spanish. He has a grant specifically focused on collecting speech data from underserved populations, such as those who speak with accents or use dialects such as African American Vernacular English. He currently has nearly 300 participants, compared to 53 in this study.

“Our lab is really trying to make our cohort as diverse as possible. We’re aiming for no more than 50% of our cohort to be non-Hispanic white,” Dr. Kleiman said. “The thing about machine learning models is that you need them to be representative, because if they don’t represent everyone, they’re not able to be accurate for everyone.”

If non-Hispanic white people are overrepresented in the data, he explained, screening will be less accurate for individuals in other populations.

Early Diagnosis of Cognitive Impairment

The article only covers a small portion of the data the researchers have collected. They continue to build a more diverse corpus of data to improve the algorithm and expand its use to other languages.

“This particular study is a stepping stone,” Dr. Kleiman said. “The ultimate goal is to build a speech-based detection algorithm that can identify mild cognitive impairment, maybe even pre-Alzheimer’s disease, using a two-to-10-minute speech test or interview.”

This research was funded by grants from the National Institute on Aging, the Alzheimer’s Association, the Evelyn F. McKnight Brain Research Foundation and the Harry T. Mangurian Jr. Foundation.

Scratching for an Explanation for Psoriatic Itchy Scalp

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Turning an academic research paper into a physician-accessible article for InventUM | University of Miami Miller School of Medicine

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BY ROCHELLE BRODER-SINGER

Scratching for an Explanation for Psoriatic Itchy Scalp

Psoriatic scalp itch may have a larger neural component than previously thought, with neuroimmune mediators — rather than the histamine system — controlling the severity of this type of itch, according to a study led by Miller School of Medicine researchers.

As many as 70% of people with psoriasis report itchy scalps, and treatment is challenging due to the location of scalp lesions and an incomplete understanding of exactly what causes and affects this type of itch. This study was the first of its kind to examine mediators involved in itchy psoriatic scalp and provides some novel insights into how the mechanisms of psoriatic scalp itch are different from psoriatic itch in other locations.

“This study demonstrated that histamine is not a mediator in psoriatic scalp itch, and the use of antihistamines, a common treatment, will not help patients,” said Gil Yosipovitch, M.D., professor, Stiefel Chair of Medical Dermatology, and director of the Miami Itch Center at the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery. “Inhibitors that block neural channels may better treat this type of itch, and our research indicated specific types of inhibitors to work on in order to help these patients.”

Dr. Yosipovitch was senior author of the study “Neuroimmune Mediators of Pruritus in Hispanic Scalp Psoriatic Itch,” published recently in Acta Dermato-Venereologica and funded by a research grant from LEO Pharma, a dermatological pharmaceutical company. The study’s first author, Leigh A. Nattkemper, Ph.D., is a research assistant professor in the department. Co-authors Zoe M. Lipman, M.D., and Giuseppe Ingrasci, M.D., were Miller School students who are now in their internships. Co-author Enrique Loayza, M.D., was one of Dr. Yosipovitch’s fellows and currently works in the dermatology department at Hospital Luis Vernaza in Guayaquil, Ecuador, where the patient research was conducted.

Mediating a Complex Interplay of Itch’s Causes

The researchers examined scalp biopsies from Hispanic patients with psoriasis who were not receiving treatment or who had stopped treatment prior to the biopsy. The patients were asked to rate the intensity of their scalp itch, which was found not to correlate with the visual severity of their scalp psoriasis.

The group of patients who reported severe scalp itch and the group that reported no scalp itch or mild to moderate itch showed several differences in neuropeptide, transient receptor potential and immune system expression, although they showed no difference in histamine expression.

“Our results indicate that the severity of itching in scalp psoriasis involves both neurogenic and immunogenic inflammation, but itch severity is not mediated by a histaminergic pathway,” Dr. Yosipovitch said, noting that these findings are consistent with prior data on most other types of chronic itch.

The scalp skin of patients with severe itch showed significantly greater expression of protease-activated receptor 2 (PAR2), substance P, the transient receptor potential ion channels TRPV3 and TRPM8 (a cold receptor), and immune-cell activating interleukin-23 (IL-23) cells. The itchier the patient said their scalp was, the higher the expression. All of these are known to make skin more prone to itch and/or to amplify itching sensations.

However, another substance known to increase itchiness — histamine — did not appear to play a role in the level of psoriatic scalp itch in these patients. There was no significant difference in histamine+ cells between the two groups of patients with psoriasis, and no correlation between histamine+ cell levels and itch severity.