Ralph Sacco, M.D., M.S., was a medical student he
watched his grandfather struggle with the consequences
stroke: paralysis, confinement to a wheelchair, and
of the formerly jovial and fun-loving Atlantic City
“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.,
landmark Framingham Heart Study when his grandfather
became ill, both factors that motivated Sacco toward
The Miller Professor of Neurology, Epidemiology
and Human Genetics, Sacco keeps a photo portrait of his
in his campus office. He hopes to replicate that special
with students and other physicians in his new leadership
“The importance of a mentor relationship
to somebody in training in medicine is critical,” says
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
where some data, blood, and carotid imaging will be
analyzed. This new collaborative arrangement is in
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
New York and the Dominican Republic. All the subjects
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
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
the protective amount of alcohol. My own research now
has shown that mild to moderate drinking will reduce
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
(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
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
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
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
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
to human treatments.
Sacco has recruited Tatjana Rundek, M.D.,
Ph.D., from Columbia, an expert in carotid imaging. She
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
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