Jun Yan, M.D., Ph.D., Director, Division of Immunology in the Department of Surgery and professor of surgery and microbiology and immunology at the University of Louisville, led a team of researchers in the discovery of an important biomarker that predicts a crisis in COVID-19 patients that could lead to death.
Yan, an immunologist, along with UofL Professor of Anesthesiology Jiapeng Huang, M.D., Ph.D., and M.D./Ph.D. student Samantha Morrissey, Ph.D., conducted a patient study to better understand the most severe cases of COVID-19.
Approximately 20 percent of COVID-19 patients experience severe disease, including pneumonia and acute respiratory distress syndrome (ARDS). In some of these patients, the rapid influx of immune cells to the lungs to fight the infection leads to complications in the lung and blood coagulation disorders, resulting in heart attack, pulmonary embolism, stroke or deep vein thrombosis.
To better understand these serious complications, Yan’s team evaluated levels of various immune cells in blood samples of COVID-19 patients and compared those levels with those of healthy individuals. They discovered that one type of immune cells, low-density inflammatory neutrophils, became highly elevated in some patients whose condition became very severe. This elevation signaled a point of clinical crisis and increased likelihood of death within a few days.
Neutrophils are one type of immune cells that serve as the first line of defense in the body. When an individual acquires an infection, neutrophils rush to the site to clear the pathogen causing the infection. However, if their presence is persistent or there is a very high volume of cells at the site of infection, in this case the lungs, they can cause unwanted adverse effects. In the case of patients with severe COVID-19, a blood clotting disorder known as coagulopathy occurred, that can manifest as pulmonary embolism, heart attack or stroke.
The study, published online as a preprint, details shifting levels of these neutrophils and other immune cells through repeated blood samples from study participants, correlated with improvement or worsening of the patients’ condition. If clinicians could detect a rise in these cells, they may be able to provide therapy to prevent the potential life-threatening conditions associated with them.
“Based on this study, we believe that the low-density inflammatory band neutrophil population contributes to COVID-19-associated coagulopathy (CAC) and could be used as a clinical marker to monitor disease status and progression,” Yan said. “Identifying patients who are trending toward a cellular crisis and then implementing early, appropriate treatment could improve mortality rates for severe COVID-19 patients.”
To provide additional clinical options for physicians in addressing these crises, Yan is now working with other researchers at UofL to test potential therapies.
The Department of Surgery welcomed two new faculty members Sept. 1. Sandra L. Kavalukas, M.D. joins the section of Colorectal Surgery and Stewart R. Carter, MD joins the Division of Pediatric Surgery.
Dr. Kavalukas attended medical school at Pennsylvania State University, completed her residency in General Surgery at Vanderbilt University Medical Center and a fellowship in Colorectal Surgery at the Cleveland Clinic in Florida. She also trained as a Physician Assistant prior to attending medical school. Dr. Kavalukas' expertise includes inflammatory bowel disease, colorectal cancer, diverticulitis, laparoscopic and robotic surgery and anorectal disorders.
Dr. Carter attended medical school at University of Louisville School of Medicine, completed his residency in General Surgery at Loyola University of Chicago and fellowships in Pediatric Surgery and Pediatric Endosurgery at University of Alabama Birmingham/Children's of Alabama and Pediatric Surgical Critical Care at Northwestern University/Lurie Children's Hospital Chicago. His expertise includes minimally invasive surgery, single incision laparoscopy, surgical critical care and pediatric trauma, and his research interests include non-invasive monitoring in critically ill infants and children, pulmonary inflammation in the surgical patient, neonatal Extracorporeal Membrane Oxygenation, surgical education with a focus on pediatric and neonatal laparoscopy.
Dr. Brian Harbrecht, Professor of Surgery in the Department of Surgery at UofL and Director of Trauma Surgery at UofL Hospital, and Dr. Raymond Orthober, Assistant Professor of Emergency Medicine and Medical Director of Louisville Metro EMS, will lead UofL's participation in a Department of Defense (DOD)-funded clinical trial aimed at improving survival among people who have difficulty breathing after a trauma.
UofL will join nearly two dozen emergency medical service agencies across the country in the prehospital Airway Control Trial (PACT), which is an $8.8 million, four-year study, beginning at the end of 2019 that will test different strategies to help patients breathe at the scene of a trauma to see if one works better than another at increasing survival.
This is an “exception from informed consent” trial, which means that since the trial requires performing a potentially life-saving procedure in traumatically injured patients who are too injured to give consent to the trial, they will be automatically enrolled if they fit the criteria. Once patients are stable, they and/or their families will be notified that they were enrolled, and they can opt out of continued participation at that point. Learn more at
Dr. J. David Richardson
was selected for the UofL Distinguished Faculty Award in the category of Distinguished Service. Dr. Richardson has enjoyed a distinguished career as a surgeon and educator in the Department of Surgery at University of Louisville School of Medicine for more than 40 years and served as Vice Chairman of the Department for more than two decades. Dr. Richardson will receive his award at the UofL Celebration of Faculty and Staff Excellence, which has been delayed because of the COVID-19 pandemic.
Cynthia D. Downard, MD, MMSc, FACS, was named division chief of the Division of Pediatric Surgery in July. Dr. Downard is a professor of Surgery, the Hirikati S. Nagaraj, MD Chair of Pediatric Surgery, Program Director of the Pediatric Surgery Fellowship and Surgeon-in-Chief, Norton Children’s Hospital.
She is also a fellow of the American Academy of Pediatrics and fellow of the American College of Surgeons. A graduate of Vanderbilt University School of Medicine, Dr. Downard completed her general surgery residency at Oregon Health & Science University and a fellowship in Surgical Critical Care at Children’s Hospital Boston, where she also was a Clinical Research Fellow in Surgery. She has a Masters in Medical Science in Translational Research from Harvard Medical School, Boston, MA. Dr. Downard also completed a Fellowship in Pediatric Surgery at Emory University – Children’s Healthcare of Atlanta. Dr. Cynthia Downard began practicing Pediatric Surgery in 2007.
The University of Louisville, Department of Surgery, has a long and proud tradition
of excellence. From its inception in 1837, when the University of Louisville served
as the premier medical training ground for the western frontier of the United States,
the Department of Surgery has been at the forefront of surgical education, patient
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The Department of Surgery at the University of Louisville School of Medicine is committed to diversity, equity, inclusion, and anti-racism.