When Ralph Sacco, M.D., M.S., was a medical student he watched his grandfather struggle with the consequences of a stroke: paralysis, confinement to a wheelchair, and the subduing of the formerly jovial and fun-loving Atlantic City restaurateur’s personality.

“He had further strokes, and I saw what it was like for him to try and recover and for my family to cope with his disabilities,” says Sacco.
Appointed in April as chairman of the Department of Neurology at the Miller School of Medicine, Sacco was studying at Boston University (BU) with Phillip A. Wolf, M.D., of the landmark Framingham Heart Study when his grandfather became ill, both factors that motivated Sacco toward his specialty.

The Miller Professor of Neurology, Epidemiology and Human Genetics, Sacco keeps a photo portrait of his mentor in his campus office. He hopes to replicate that special relationship with students and other physicians in his new leadership role.

“The importance of a mentor relationship to somebody in training in medicine is critical,” says Sacco.

Sacco’s grandfather founded a famous restaurant in Atlantic City, and his father went on to establish a chain of restaurants in southern New Jersey. He is the first doctor in his family, having earned a medical degree from BU’s School of Medicine and a master’s degree in epidemiology from the Columbia University School of Public Heath. He is famous for establishing the Northern Manhattan Stroke Study when he was an assistant professor of neurology and epidemiology at Columbia University, College of Physicians and Surgeons and Mailman School of Public Health. He rose up the ranks to tenured professor of neurology and epidemiology at Columbia, associate chairman for clinical research and training, and head of the Stroke and Critical Care Division at New York Presbyterian Hospital.

The 17-year-old stroke study research will be shared between Columbia, where the participants are enrolled, and Miami, where some data, blood, and carotid imaging will be analyzed. This new collaborative arrangement is in keeping with the National Institutes of Health’s efforts to encourage sharing and broader use of datasets.

A second effort is the Northern Manhattan Family Study of 1,500 participants from 100 Dominican families in New York and the Dominican Republic. All the subjects have had carotid and cardiac imaging as well as blood and DNA samples, and the data was brought to UM.

“We are beginning genetic analysis,” says Sacco, who hopes to work with Miller School geneticists Margaret A. Pericak-Vance, Ph.D., and Jeffery M. Vance, M.D., Ph.D., of the Miami Institute for Human Genomics on this project. His family study coordinator, Edison Sabala, M.P.H., has also been recruited to UM to help establish a clinical research core within the department.

With everything he has learned about stroke, Sacco believes he could have helped prevent his grandfather’s experience. He says stroke risk factors are partly explained by modifiable conditions, or lifestyle controls, while the remaining ones are genetic.

“Looking back there are certain lifestyle factors he could have changed to prevent a stroke,” Sacco says. “He was clearly overweight, did not exercise, and did not have the best diet. He also probably drank a little more than the protective amount of alcohol. My own research now has shown that mild to moderate drinking will reduce your risk of stroke.”

Sacco has appeared with Dr. Sanjay Gupta on CNN and other programs to talk about stroke symptoms and prevention. “The public doesn’t understand stroke warning signs,” he says of the onset of sudden sensations like loss of vision in one eye, numbness or tingling on one side of the body, and weakness or difficulties speaking or walking. “There are 750,000 strokes in the U.S. every year,” he says, and of patients who endure a non-bleeding stroke, only 5 percent get the blood clot-busting drug tPA in time.

He would like to establish programs in Miami like the New York project Stroke Warning Information for Faster Treatment (SWIFT), developed with a colleague at Columbia, which increased public awareness of stroke symptoms.

Heart, brain, spinal cord, and genetic researchers are discovering more and more commonalities in their work, and Sacco says that the Miller School is the perfect place for these problem-solvers to work together. “To do high-quality research, you have to work as a multidisciplinary team,” says Sacco.

He hopes to work with Neil -Schneiderman, Ph.D., professor of psychology, on the new Hispanic Health Study, funded by the National Heart, Lung and Blood Institute. UM was selected as one of the four centers for the Hispanic cohort study and will enroll 4,000 South Floridians to monitor vascular risk factors for heart disease and stroke.

The Miami Project to Cure Paralysis is another place where Sacco seeks partnerships, and he has been discussing this proposition with Barth A. Green, M.D., president and founder of The Miami Project and professor and chairman of the Department of Neurological Surgery, and W. Dalton Dietrich, Ph.D., scientific director of The Miami Project.

“Some of the things being investigated with spinal cord injury also have a role with stroke,” Sacco says, describing hypothermia treatments and neuro-protective drugs as examples. “There are parallels of research where we can salvage, save, and recover from spinal cord injury, just like we can work to salvage, save, and recover from other brain injuries including stroke and trauma.”

Two members of his faculty have lab space in The Miami Project, which is trying to translate animal model discoveries to human treatments.

Sacco has recruited Tatjana Rundek, M.D., Ph.D., from Columbia, an expert in carotid imaging. She will transfer to UM a grant on genes as they relate to early carotid disease, which will be another opportunity for connections with the Vances. Stroke is not just a silent killer, it is also a sneaky one, whose hints of disease to come are slowly being discovered by research into sub-clinical carotid and brain disease, predictors of vascular disease.

“In these cases there are no symptoms to the brain we can detect clinically, but through imaging we can see that early changes in the brain can be measured and could be predictors of future disease,” Sacco notes.

Sacco says it is an exciting time for his work, and UM is the right place. “I sense that things are really aligned, and there are incredible growth opportunities at the medical school. With the effective leadership of Dean Goldschmidt and President Shalala we will be well poised to confront the health problems of an aging, multiethnic population.”