Story courtesy Saskatoon City Hospital Foundation
A seven-year commitment. That's what Dr. Michael Levin has given to Saskatoon City Hospital, the University of Saskatchewan and the community.
Dr. Michael Levin
After officially moving to the city in March, Dr. Levin and his wife, Audrey, are embracing Saskatoon. They chose a home in the Nutana neighbourhood. Audrey is working at the University of Saskatchewan. Their sons, university students in New Orleans, have visited and are interested in winter activities around the province.
Audrey Zucker-Levin, Danny Levin, Dr. Michael Levin, Samual Levin
While the commitment and role of the MS Clinical Research Chair in the province is new, Dr. Levin's dedication to neurological diseases isn't.
"I was always interested in neuroscience and always knew that I'd be a doctor in this field," says the Philadelphia-born Levin. "I knew, though, that I wanted to be involved in the research aspect, either as a full-time scientist or as a doctor. I've been in a lab in one form or another since my second year of college."
As a chemistry major at his undergraduate school, George Washington University, he got his first bench experience working in a psycho-neuro immunology lab. That inspired him to pursue medicine at Penn State Hershey, where he spent summers working with an endocrinologist.
Between the basic science and clinical years in medical school, Dr. Levin took a year sabbatical as a visiting graduate student at the prestigious Salk Institute in La Jolla. "I worked in neuroscience, looking at brain control of high blood pressure," he says. The experience further deepened his interest in the functioning of the brain.
That led Dr. Levin to his residencies in neurology. He trained at New York Hospital/Cornell Medical Center-Sloan Kettering Cancer Center, where he worked under two key figures, Dr. Fred Plum and Dr. Jerry Posner. "They helped define neurology in the U.S. and were top-notch mentors and thinkers as well as academicians."
While working in New York from 1988 to 1993, he had his first experience with MS. "I met MS patients through my residency. At that time, there were no proven drugs for MS. One was a lawyer who was going blind."
Dr. Levin decided to continue his post-doctoral studies at the National Institutes of Health in Bethesda, Maryland.
"On interview day, I spent a morning meeting different subspecialists in neurology. I met with the MS group, also known as the neuro-immunology branch, and found them to be a very dynamic, cutting-edge group," he says.
During his four years there, he found the perfect blend of research and clinical work. "Even though work was being done at the bench in the lab, you never lost sight of patients because they were always right down the hall."
This led to the opportunity at the University of Tennessee Semmes-Murphey Clinic in Memphis, where he served as Professor of Neurology and Anatomy/Neurobiology. "I got there in 1997. There hadn't been an MS doctor for five or 10 years. It was ideal for me to start a clinic and a basic MS lab."
He loved the fact the clinic was associated with a university and soon found his expertise in high-demand. "Once people hear there's an expert, everyone wants to see him. Because of demand, I was able to add and train two nurses and a nurse practitioner."
Two decades ago, the science behind MS and treatments for it were still very new, Levin says. "There were only four medications available, the platform meds – Avonex, Rebif, Beta-Seron, and Copaxone – all injectables. The next phase of that clinic happened when Tysabri came out, because it was a game-changer. It was an IV injection once a month and the efficacy exceeded existing therapies.
"There was a lot of energy and excitement; it was also the first time in my work where some of the MS patients met one another because we had two infusion chairs in the clinic. That helped create even more energy." Dr. Levin's career changed focus during his last decade in Memphis. "I became involved with the university's Veterans Affairs (VA) Medical Center. I was chief of neurology at the VA but still ran a subspecialty clinic in MS and kept my science research going."
After almost two decades in Memphis, it was time for a change. He began searching for a new position. "In early 2015 I got an email from a University of Saskatchewan recruiter. We struck up a conversation; he was very positive and thought the MS Clinical Research Chair was a really good opportunity; he was also very positive about [dean of the College of Medicine] Preston Smith.
"I interviewed with the recruiting team twice, with the search committee by Skype, and then they decided to bring me for a visit to Saskatoon."
Dr. Levin first visited Saskatoon in October 2015 "That's when I really got excited," he says, noting two reasons. "First, endowed chairs in neurology are uncommon; endowed chairs in MS are even less common. This was the opportunity of a lifetime. The other motivation was that this was a community-based chair; there was lots of enthusiasm to make this happen."
The relationship with the U of S was also decisive, he adds. "I wouldn't have come to a program without the university tie-in; you need the academic component and infrastructure. You need grad students, medical students, and post-doctoral fellows. A program without that just can't be long lasting."
The ability to work with patients and continue lab work was an added attraction. All of his work will be done at Saskatoon City Hospital – his office is on the eighth floor, the MS Clinic is on seventh and his lab in the Cameco MS Neuroscience Research Center is on the fifth floor.
This is crucial to the philosophy of his chosen vocation. "We're physician- scientists; we see patients but also do the science. In the States, competitive funding has seen more people like me becoming one or the other; it's hard to be both. Here it seems like physician-scientists are encouraged."
Dr. Levin will work in the lab, will have graduate and medical students, fellows and residents rotating through, and will also see patients one day a week. "I am so glad to see patients here. That 80-20 mix is good. I've always maintained that it's MS patients who are going to help us the most with discovering the breakthrough.
"This is 'from benchside to bedside' observations – taking studies of patients in clinic and work in the lab and applying it back to patients."
Levin has high praise for the team at the clinic, including physicians Dr. Katherine Knox, and Dr. Ilia Poliakov, director of the MS Clinic since late 2016. While the clinic also employs a nurse, a nurse educator, and a clinical research coordinator, the funding for the chair means more positions -- including an additional nurse and a nurse practitioner.
Being in the lab with Dr. Val Verge, other investigators and staff is also important, Dr. Levin says. "I want to collaborate with other researchers. The center's open space design is ideal. The lab group and MS Clinic team means this position is starting strong; there's a tremendous amount of infrastructure which I hope to help organize as chair."
With this in place, he can quickly get to the task at hand – MS research. "I'm interested in several things. The first will deal with how we all make antibodies that protect us from things like viruses and bacteria. MS patients are unique -- not only are they making these antibodies, they're also making antibodies to parts of their brains.
"We found that a certain kind of antibody gets into the brain and begins to stick to neurons and also to a protein called A1. Not only do MS patients make antibodies to A1, but, if you take those antibodies from a patient and put them in a mouse, the mouse becomes sicker and gets spastic. That may help us understand part of the mechanism of MS, how patients get spastic, and how we can not only treat the disease but also treat the spasticity.
"The second thing I'd like to study is mutations. Every human has two kinds in their DNA – mutations that we're born with and mutations that we acquire in a lifetime. Much of the research to now has been on inherited mutations. I'm more interested in the acquired mutations. We can study this simply by taking blood samples from patients – we know what the human genome looks like, we know what the DNA sequence looks like, and we know what the inherited mutations are in MS patients. So we can see if MS patients are acquiring mutations from the environment and if that plays a role in the triggering of MS."
He also wants to study Apolipoprotein A1 (APO A1). "This is an older study I want to resurrect. It's part of cholesterol metabolism, which plays a role in the immune system and its regulation."
Clinically, Dr. Levin wants to study how patients access the MS clinic at Saskatoon City Hospital, determining first where they are in the province.
"Next, I'd like to know where the doctors caring for MS patients are located. Then, we can examine how we provide care for patients – are they willing to drive three hours or do they want something local; or a hybrid of say, annual visits, with local follow-ups?"
As chair, he says, "first and foremost, the expectation is that we develop a reputation for research and research excellence. I want to put Saskatoon and Saskatchewan on the MS map nationally and internationally. I'm pretty confident we can do that.
"Second, I want to try to get all the pieces of success stories we have here at Saskatoon City Hospital and the University and other organizations to work together and communicate better. I want to meet with them regularly, make sure they're talking to and collaborating with each other, applying for more grants, and growing the research we do here. At the same time, I want to ensure we're supporting the clinical enterprise because the two go hand in hand.
"This is not a short-term thing. It's a seven-year vision and my mission, at the end of the seven years, is that we'll be a top-notch center in Canada. I believe the tools are here to do that."
"Having the chair here increases capacity and opportunities to do more MS research. It is the leadership Saskatchewan needs to tackle how we can better help people with MS. I am really excited to have a growing team of people passionate about making a difference,." Says Dr. Katherine Knox, College of Medicine.
"We are delighted to have Dr. Michael Levin join our research group. His excellent research program that bridges the bench and the patient, coupled with his extensive expertise as an MS neurologist and highly collaborative nature, will bring a new dimension and insight to our fight against MS," says Dr. Val Verge, Director Cameco MS Neuroscience Research Center.
"The understanding and management of MS has been growing at an exponential pace. However, there is still a lot to learn. Translational research, will be instrumental in any future advances. With a clinical research chair, we can start tying together the experience and ingenuity of the MS research center and clinical physicians. This will hopefully result in new treatment options for patients, and eventually greater understanding of relapsing as well as progressive multiple sclerosis," says Dr. Ilia Poliakov, Director of the MS Clinic, Saskatoon City Hospital.