Podcasts about apol1

As our understanding of APOL1-Mediated Kidney Disease (AMKD) grows, so does the need for greater awareness. National APOL1-Mediated Kidney Disease (AMKD) Awareness Day is observed annually on the last Tuesday of April.  In this episode of Kidney Transplant Conversations, we share an inspiring story of resilience, advocacy, and hope. Sharron Rouse opens up about her personal journey with kidney disease — a journey that began with a diagnosis of lupus nephritis, only to later discover she was actually battling FSGS (focal segmental glomerulosclerosis), a condition sometimes linked to the APOL1 gene variant that is found in around 35% of people of African ancestry.  In a heartfelt conversation with host Rolf Taylor, Sharron discusses the shock of her diagnosis, the challenges of navigating unclear answers, and the life-changing gift of a kidney transplant from her sister. As the founder of Kindness for Kidneys International, Sharron is now a tireless advocate, raising awareness about the genetic factors influencing kidney health. She emphasizes the importance of early diagnosis, the critical role of research into APOL1-related kidney disease, and the urgent need for greater awareness in communities of African descent. Tune in to hear how Sharron's story offers hope to kidney warriors everywhere, highlights the life-saving potential of genetic testing, and makes a powerful case for early intervention. This episode is both inspiring and a call to action for greater education, early screening, and community empowerment. Kindness for Kidneys Website: https://www.kindnessforkidneys.org/ APOL1-Mediated Kidney Disease (AMKD) Awareness Day: https://www.kidneyfund.org/amkd-day-proclamation  Should I get tested for the APOL1 gene? https://www.kidney.org/kidney-topics/apol1-mediated-kidney-disease-amkd  (c) Project Advocacy 2025      

Welcome to this podcast where we dive into the intersection of cutting-edge science and practical healthcare, exploring the questions that shape patient outcomes and redefine how we approach complex diseases. Today we're continuing our conversation with Dr. Adriana Hung, this time with an emphasis on genetic testing in APOL1-mediated kidney disease (AMKD). Let us know what you thought of this week's episode on Twitter: @physicianswkly Want to share your medical expertise, research, or unique experience in medicine on the PW podcast? Email us at editorial@physweekly.com! Thanks for listening!

Jaime Albright Henighan shares her family's journey after two of her sons, Joshua and Jorden, were diagnosed with a rare genetic kidney disease called APOL1-mediated FSGS (Focal Segmental Glomerulosclerosis).   Jaime's story highlights the importance of early detection, education, and advocacy for families navigating this challenging condition. She discusses her partnership with Nephcure, a patient advocacy organization, and her mission to raise awareness about FSGS, especially among individuals of West African descent, who are at higher risk due to the APOL1 gene mutation.   Topics Covered: What is FSGS?: Understanding APOL1-mediated FSGS and its impact on kidney health. The Family's Journey: How high blood pressure led to Joshua's diagnosis, and the shock of discovering Jorden had the same condition. The Role of Genetics: Why individuals of West African descent are at greater risk and the importance of genetic awareness. Early Detection: How identifying symptoms early has helped Jaime's sons manage their health. Advocacy and Education: Jaime's work with Nephcure and her efforts to raise awareness globally, including in Ghana. Parenting Through Challenges: Jaime's emotional journey as a mother and her advice for other parents navigating rare diseases.   Key Moments: Jaime explains how her family discovered FSGS and the challenges they faced in obtaining a diagnosis. Insights into the genetic factors behind APOL1-mediated FSGS and its prevalence in specific populations. Advocacy efforts to educate families and healthcare providers about the disease.   Guest Bio: Jaime is a wife and mother of six. Her family resides in Alpharetta, GA. She is also a Forensic Interviewer and Podcast Producer at Tenderfoot TV. In 2021, her seemingly healthy 17 year old son, Joshua, was randomly diagnosed with high blood pressure. This led to additional testing and a diagnosis of Focal Segmental Glomerulosclerosis (FSGS), a rare genetic kidney disease. Later that year, her 25 year old son, Jorden, was also diagnosed with FSGS. This was shocking to the Albright Henighan family. How could they be at high risk of a disease that they had never heard of? They connected with Nephcure, a patient advocacy organization, for support and resources. They learned that 1 in 8 people of West African descent are at risk of APOL1 mediated FSGS due to a genetic mutation. Thanks to early detection, her sons are stable today but this is a rare outcome for FSGS patients due to a lack of education and barriers in the medical community. They decided to share their story across the United States and even in Ghana. Their goal is to educate and empower others. If caught early, there are medical interventions and clinical research trials that can save native kidneys and lives. There is hope for FSGS patients.   Resources Mentioned: Nephcure Kidney International: Advocacy and support for families affected by kidney diseases. Information on APOL1-mediated FSGS and genetic testing. Tips for recognizing early symptoms of kidney disease.   Connect with Us:  Stay tuned for the next new episode of “It Happened To Me”! In the meantime, you can listen to our previous episodes on Apple Podcasts, Spotify, streaming on the website, or any other podcast player by searching, “It Happened To Me”.    “It Happened To Me” is created and hosted by Cathy Gildenhorn and Beth Glassman. DNA Today's Kira Dineen is our executive producer and marketing lead. Amanda Andreoli is our associate producer. Ashlyn Enokian is our graphic designer.   See what else we are up to on Twitter, Instagram, Facebook, YouTube and our website, ItHappenedToMePod.com. Questions/inquiries can be sent to ItHappenedToMePod@gmail.com. 

Welcome to this podcast where we dive into the intersection of cutting-edge science and practical healthcare, exploring the questions that shape patient outcomes and redefine how we approach complex diseases. Today we're talking about a topic that's critical for nephrologists and all healthcare professionals working with kidney disease, APOL1-mediated kidney disease, or AMKD.Let us know what you thought of this week's episode on Twitter: @physicianswkly Want to share your medical expertise, research, or unique experience in medicine on the PW podcast? Email us at editorial@physweekly.com! Thanks for listening!

On today's episode of The Big Podcast, NBA legends reunite as we welcome basketball legend and kidney health advocate, Alonzo Mourning, to the show. Between Shaq and ‘Zo's battles on the court, their contrasting lifestyles (wait until you hear about ‘Zo's diet vs. Shaq's!), and other stories from back in the day, these two legends have plenty to laugh about. But it's not all jokes—Alonzo shares his powerful journey with APOL1-mediated kidney disease (AMKD) and his mission with Power Forward (www.PowerForwardTogether.com) to educate others about this rapidly progressive kidney disease. Tune in for an inspiring conversation and some classic Shaq-and-'Zo banter you don't want to miss!This episode is sponsored by Vertex Pharmaceuticals Incorporated. Alonzo Mourning is a paid spokesperson for Vertex Pharmaceuticals.Don't miss out on all the action this week at DraftKings! Download the DraftKings app today! Sign-up using https://dkng.co/ogs or through my promo code BIGPODZipRecruiter. The smartest way to hire. Go to this exclusive web address to try ZipRecruiter for FREE: http://ZipRecruiter.com/BIGDownload the Gametime app today or http://Gametime.co for $20 off your first order with code BIGPODBuy Liquid Death With Free Shipping on Amazon or http://liquiddeath.com/BIGPODWant to bite Shaq's head off? Get some Shaq-A-Licious at your local Walmart!Subscribe to The Big Podcast YouTube Channel to watch more episodes!Follow us on all platforms: https://linktr.ee/bigpodcast00:00 Intro02:18 Zo saved Shaq in the Finals?06:18 In memory of Dikembe Mutombo12:15 DK segment14:00 DK ad15:10 VRTX ad16:20 Lack of rivalries in current NBA19:05 Today's Big Men23:12 Gametime ad24:25 Liquid Death ad25:40 Alonzo opens up on forced retirement37:00 How Zo takes care of his health53:00 Shaq vs Heat Culture56:44 Being teammates with Shaq59:12 What current players could've handled their era?01:01:10 Zo reviews Shaq's diet and lifestyle01:05:35 Shaqalicious segment01:10:17 Vince Carter dunk01:13:09 Bench meme01:16:07 EndingGAMBLING PROBLEM? CALL 1-800-GAMBLER, (800) 327-5050 or visit gamblinghelplinema.org (MA). Call 877-8-HOPENY/text HOPENY (467369) (NY).Please Gamble Responsibly. 888-789-7777/visit ccpg.org (CT), or visit www.mdgamblinghelp.org (MD).21+ and present in most states. (18+ DC/KY/NH/WY). Void in ONT/OR/NH. Eligibility restrictions apply. On behalf of Boot Hill Casino & Resort (KS).1 per new customer. Min. $5 deposit. Min. $5 bet. Max. $150 issued as non-withdrawable Bonus Bets if your bet wins. Bonus Bets expire in 7 days (168 hours). Stake removed from payout. Terms: dkng.co/dk-offer-terms. Ends 1/5/25 at 11:59 PM ET. Sponsored by DK.MB01RGAXHH8FSSS#nba #lakers #shaq #bigpod #basketball #bigshaq #bigpodcast #alonzomorning Hosted on Acast. See acast.com/privacy for more information.

We cover angina, COPD-asthma overlap, home oxygen, colon cancer screening, cancer survivorship, tobacco cessation, e-cigarettes, step counts for health,  new drugs, the RSV vaccine, addiction medicine, interstitial lung disease, APOL1-mediated kidney disease, testosterone therapy, antimicrobial resistance, office-based allergy testing and more! The Curbsiders review highlights, clinical pearls, and practice-changing updates from the American College of Physician Internal Medicine Meeting #IM2024!  No CME for this episode due to rapid turnaround, but claim CME for most episodes at  curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro ACP Pearls Outro Credits Producers: Matthew Watto MD, FACP; Paul Williams MD, FACP, Molly Heublein MD, Nora Taranto MD, Chris Chiu MD, Rahul Ganatra MD MPH, Beth Garbitelli MD Show Notes: Matthew Watto MD, FACP; Paul Williams MD, FACP, Molly Heublein MD, Nora Taranto MD, Chris Chiu MD, Rahul Ganatra MD MPH, Beth Garbitelli MD Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer:Matthew Watto MD FACP Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Sponsor: Beginly Health Visit https://beginlyhealth.com/curbsiders for the job matching platform for every Physician and Advanced Practice Clinician, from training to practice Sponsor: Freed You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month.

Join us for our first episode of 2024 as we welcome Dr. Alex Bick, Assistant Professor of Medicine in the Division of Genetic Medicine at Vanderbilt University. In this episode, we will explore the impact of clonal hematopoiesis on cancer and cardiovascular health, examine the integration of genomics in healthcare and preventative medicine, and discuss a recent finding from the Million Veterans Program of a modifier variant in APOL1 kidney disease.

Opportunities exist for clinical decision support (CDS) to help transplant nephrologists counsel living donors receiving APOL1 genetic test results. A new Kidney360 study provides insights from transplant nephrologists on how this CDS should be developed.

Everyone has the APOL1 gene but people with sub-Saharan African heritage may have variants of the gene that can cause kidney disease. Nephrologist Dr. Suneel Udani explains how new research is changing how certain kidney diseases are diagnosed and treated. This episode is sponsored by NANI – Nephrology Associates of Northern Illinois and Indiana. Learn more at nephdocs.com

Join Drs Matthew Sparks and Kirk Campbell as they dive into the murky waters of focal segmental glomerular sclerosis. How do you diagnose? How do you treat? Tune in to find out. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/991604). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Chronic Kidney Disease (CKD) https://emedicine.medscape.com/article/238798-overview Focal Segmental Glomerulosclerosis https://emedicine.medscape.com/article/245915-overview Membranoproliferative Glomerulonephritis https://emedicine.medscape.com/article/240056-overview Membranous Glomerulonephritis https://emedicine.medscape.com/article/239799-overview Collapsing Focal Segmental Glomerulosclerosis in Viral Infections https://pubmed.ncbi.nlm.nih.gov/35095882/ Novel Treatment Paradigms: Focal Segmental Glomerulosclerosis https://pubmed.ncbi.nlm.nih.gov/36644367/ Glomerular Diseases (GD) https://kdigo.org/guidelines/gd/ A Review of Podocyte Biology https://pubmed.ncbi.nlm.nih.gov/29852492/ APOL1 Nephropathy: From Genetics to Clinical Applications https://pubmed.ncbi.nlm.nih.gov/32616495/ A Study to Test BI 764198 in People With a Type of Kidney Disease Called Primary Focal Segmental Glomerulosclerosis https://classic.clinicaltrials.gov/ct2/show/NCT05213624 Efficacy and Safety of ACE Inhibitor and Angiotensin Receptor Blocker Therapies in Primary Focal Segmental Glomerulosclerosis Treatment: A Systematic Review and Meta-Analysis https://pubmed.ncbi.nlm.nih.gov/35518835/ Sodium-Glucose Transport Protein 2 (SGLT2) Inhibitors https://www.ncbi.nlm.nih.gov/books/NBK576405/ Calcineurin Inhibitors in the Treatment of Primary Focal Segmental Glomerulosclerosis: A Protocol of Systematic Review and Meta-Analysis of Randomized Controlled Trials https://pubmed.ncbi.nlm.nih.gov/33530282/ Effect of Dapagliflozin on Clinical Outcomes in Patients With Chronic Kidney Disease, With and Without Cardiovascular Disease https://pubmed.ncbi.nlm.nih.gov/33186054/ IgA Nephropathy https://emedicine.medscape.com/article/239927-overview Impact of Diabetes on the Effects of Sodium Glucose Co-Transporter-2 Inhibitors on Kidney Outcomes: Collaborative Meta-Analysis of Large Placebo-Controlled Trials https://pubmed.ncbi.nlm.nih.gov/36351458/ African Trypanosomiasis (Sleeping Sickness) https://emedicine.medscape.com/article/228613-overview Lupus Nephritis https://emedicine.medscape.com/article/330369-overview Inaxaplin for Proteinuric Kidney Disease in Persons With Two APOL1 Variants https://pubmed.ncbi.nlm.nih.gov/36920755/ Phase 2/3 Adaptive Study of VX-147 in Adults and Adolescents With APOL1-Mediated Proteinuric Kidney Disease https://classic.clinicaltrials.gov/ct2/show/NCT05312879 Antisense Oligonucleotides: An Emerging Area in Drug Discovery and Development https://pubmed.ncbi.nlm.nih.gov/32604776/ Janus Kinase-STAT Inhibition to Reduce APOL1 Associated Kidney Disease (JUSTICE) https://classic.clinicaltrials.gov/ct2/show/NCT05237388 APOL1 Long-Term Kidney Transplantation Outcomes Network (APOLLO) (APOLLO) https://classic.clinicaltrials.gov/ct2/show/NCT03615235 Nephrotic Syndrome Study Network (NEPTUNE) https://repository.niddk.nih.gov/studies/neptune/

Featuring articles on inaxaplin in persons with two APOL1 variants, expectant management or early ibuprofen for patent ductus arteriosus, closed-loop control in children with diabetes, BCMA-specific CAR T cells in refractory myeloma; a review article on translation defects in neurodegenerative diseases; a case report of a woman with refractory hemolytic anemia; and Perspective articles on Medicare Part D coverage of antiobesity medications, on the erosion of judicial deference to the FDA, and on pregnancy and residency.

CME credits: 0.25 Valid until: 30-12-2023 Claim your CME credit at https://reachmd.com/programs/cme/talking-rare-epidemiology-and-pathogenesis-of-apol1-mediated-kidney-disease/14781/ End-stage kidney disease (ESKD) is at least 3x higher among African Americans compared to Americans of European descent. Carriers of APOL1 variants with chronic kidney disease (CKD) are associated with more rapid disease progression and an increased risk of kidney failure. Join Drs. Martin Pollak and Susanne Nicholas as they discuss the epidemiology and possible mechanisms of APOL1 kidney disease, as well as recent clinical evidence for therapies in development that can potentially prevent rapid disease progression.

CME credits: 1.25 Valid until: 21-12-2023 Claim your CME credit at https://reachmd.com/programs/cme/interpreting-genetic-testing-results-for-amkd-how-do-we-assess-disease-causing-variants/14534/ This program discusses the need to increase awareness about APOL1-Mediated Kidney Disease (AMKD), the clinical impact of genotyping for early diagnosis, disease management, and the need for new small-molecule drug treatments. There is currently a lack of awareness among key decision-makers and in the Black community regarding the health disparities and the importance of genotyping in AMKD. Increasing awareness among nephrologists, hospitalists, geneticists, and patient communities on the impact of early genotyping for APOL1 in Black patients have the potential to improve outcomes and reduce health disparities. Moreover, increasing awareness among nephrologists and patient networks may improve clinical trial participation among underrepresented communities, which can directly impact the development of new AMKD treatments.

CME credits: 1.25 Valid until: 21-12-2023 Claim your CME credit at https://reachmd.com/programs/cme/amkd-pathophysiology-what-we-currently-know/14532/ This program discusses the need to increase awareness about APOL1-Mediated Kidney Disease (AMKD), the clinical impact of genotyping for early diagnosis, disease management, and the need for new small-molecule drug treatments. There is currently a lack of awareness among key decision-makers and in the Black community regarding the health disparities and the importance of genotyping in AMKD. Increasing awareness among nephrologists, hospitalists, geneticists, and patient communities on the impact of early genotyping for APOL1 in Black patients have the potential to improve outcomes and reduce health disparities. Moreover, increasing awareness among nephrologists and patient networks may improve clinical trial participation among underrepresented communities, which can directly impact the development of new AMKD treatments.

CME credits: 1.25 Valid until: 21-12-2023 Claim your CME credit at https://reachmd.com/programs/cme/the-genetics-of-apol1-how-does-it-cause-disease/14533/ This program discusses the need to increase awareness about APOL1-Mediated Kidney Disease (AMKD), the clinical impact of genotyping for early diagnosis, disease management, and the need for new small-molecule drug treatments. There is currently a lack of awareness among key decision-makers and in the Black community regarding the health disparities and the importance of genotyping in AMKD. Increasing awareness among nephrologists, hospitalists, geneticists, and patient communities on the impact of early genotyping for APOL1 in Black patients have the potential to improve outcomes and reduce health disparities. Moreover, increasing awareness among nephrologists and patient networks may improve clinical trial participation among underrepresented communities, which can directly impact the development of new AMKD treatments.

CME credits: 1.25 Valid until: 21-12-2023 Claim your CME credit at https://reachmd.com/programs/cme/current-treatment-options-for-amkd-and-critical-updates-on-clinical-trials-what-tools-do-we-have/14537/ This program discusses the need to increase awareness about APOL1-Mediated Kidney Disease (AMKD), the clinical impact of genotyping for early diagnosis, disease management, and the need for new small-molecule drug treatments. There is currently a lack of awareness among key decision-makers and in the Black community regarding the health disparities and the importance of genotyping in AMKD. Increasing awareness among nephrologists, hospitalists, geneticists, and patient communities on the impact of early genotyping for APOL1 in Black patients have the potential to improve outcomes and reduce health disparities. Moreover, increasing awareness among nephrologists and patient networks may improve clinical trial participation among underrepresented communities, which can directly impact the development of new AMKD treatments.

CME credits: 1.25 Valid until: 21-12-2023 Claim your CME credit at https://reachmd.com/programs/cme/communicating-genetic-testing-results-to-amkd-patients-the-impact-of-early-diagnosis/14535/ This program discusses the need to increase awareness about APOL1-Mediated Kidney Disease (AMKD), the clinical impact of genotyping for early diagnosis, disease management, and the need for new small-molecule drug treatments. There is currently a lack of awareness among key decision-makers and in the Black community regarding the health disparities and the importance of genotyping in AMKD. Increasing awareness among nephrologists, hospitalists, geneticists, and patient communities on the impact of early genotyping for APOL1 in Black patients have the potential to improve outcomes and reduce health disparities. Moreover, increasing awareness among nephrologists and patient networks may improve clinical trial participation among underrepresented communities, which can directly impact the development of new AMKD treatments.

CME credits: 1.25 Valid until: 21-12-2023 Claim your CME credit at https://reachmd.com/programs/cme/underrepresented-communities-in-rare-or-kidney-disease-clinical-trials-why-is-this-important/14536/ This program discusses the need to increase awareness about APOL1-Mediated Kidney Disease (AMKD), the clinical impact of genotyping for early diagnosis, disease management, and the need for new small-molecule drug treatments. There is currently a lack of awareness among key decision-makers and in the Black community regarding the health disparities and the importance of genotyping in AMKD. Increasing awareness among nephrologists, hospitalists, geneticists, and patient communities on the impact of early genotyping for APOL1 in Black patients have the potential to improve outcomes and reduce health disparities. Moreover, increasing awareness among nephrologists and patient networks may improve clinical trial participation among underrepresented communities, which can directly impact the development of new AMKD treatments.

CME credits: 1.25 Valid until: 21-12-2023 Claim your CME credit at https://reachmd.com/programs/cme/amkd-disease-burden-and-management-strategies-the-need-for-small-molecule-treatments/14538/ This program discusses the need to increase awareness about APOL1-Mediated Kidney Disease (AMKD), the clinical impact of genotyping for early diagnosis, disease management, and the need for new small-molecule drug treatments. There is currently a lack of awareness among key decision-makers and in the Black community regarding the health disparities and the importance of genotyping in AMKD. Increasing awareness among nephrologists, hospitalists, geneticists, and patient communities on the impact of early genotyping for APOL1 in Black patients have the potential to improve outcomes and reduce health disparities. Moreover, increasing awareness among nephrologists and patient networks may improve clinical trial participation among underrepresented communities, which can directly impact the development of new AMKD treatments.

APOL1-c is a kidney disorder associated with certain APOL1 genetic mutations, often found in people of Western and Central African descent. The disease can lead to kidney cell injury, cell death and damage to the glomeruli, which filters blood in the kidney. This leads to abnormal amounts of protein in the urine and decreased kidney function.   Dr. Reshma Kewalramani, CEO of Vertex Pharmaceuticals discusses the company's research into the underlying cause of APOL1-mediated kidney disease.

NBA great Alonzo Mourning returned home feeling ill after winning the gold medal from the Sydney Olympics. Surprisingly, he was diagnosed shortly after with kidney disease. His type of kidney disease is linked to genetic variants of the APOL1 gene carried by 13% of people with African ancestry. Ogo Egbuna leads clinical development researching APOL1-mediated kidney disease at Vertex, where they're investigating a small molecule therapy to target its underlying cause... Like this podcast? Please help us by supporting the Naked Scientists

NBA great Alonzo Mourning returned home from the Sydney Olympics after winning the gold medal feeling ill. He surprisingly was diagnosed shortly after with kidney disease. Scientists have discovered his type of kidney disease is linked to having genetic variants of the APOL1 gene – ones that 13% of people with African ancestry carry. Dr. Ogo Egbuna leads clinical development for the team researching APOL1-mediated kidney disease at Vertex where they're investigating a small molecule therapy to target its underlying cause.Produced by Bloomberg Media Studios and Vertex Pharmaceuticals.  Featured guests:Alonzo Mourning is a retired NBA player, the Vice President, Player Programs for the Miami Heat, an advocate for kidney disease research, and a beneficiary of a kidney transplant.David Friedman is an Associate Professor of Medicine, Harvard Medical School and a Principal Investigator and Nephrologist at Beth Israel Deaconess Medical Center. He's researched and consulted for Vertex Pharmaceuticals.Janice Lea  is a Professor of Medicine and Clinical Director of Nephrology at Emory University School of Medicine.Ogo Egbuna is Vice President, Clinical Development at Vertex Pharmaceuticals Read more about Vertex's approach to targeting kidney disease.Produced by Bloomberg Media Studios and Vertex Pharmaceuticals.  

Tiffany Jones-Smith is a people connector. With over 20 years of experience in nonprofit and private business, she has a reputation for opening the lines of communication between clients, organizations and businesses. She leverages influence and experience to form strategic alliances. Jones-Smith is the host of the popular 930 AM radio show and VLOG On the Record with Tiffany. She holds a Public Leadership Credential fromHarvard Business School Online along with a BA in Journalism and Foreign Service from Baylor University and a certificate in Italian studies from L'Universita per Stranieri in Perugia, Italy. Tiffany attended high school at MaryMount International School in Rome, Italy. Tiffany is a journalist, businesswoman, and healthcare advocate. “The United States has a broken healthcare system. The current system compensates providers for taking care of people who are sick. We need a healthcare system that compensates providers for making patients better. My goal is to fix the broken system.” She strives to close the gap in healthcare disparities by addressing obesity, diabetes, hypertension and social determinants of health. She believes we have a broken healthcare system. An ideal system would reward providers based on improved health outcomes for patients. With 140 million Americans below the poverty line, addressing healthcare outcomes is her focus. Jones-Smith is a writer and advocate. She draws from her professional and personal experiences when writing. She has been published in national, state and local publications. Her recent work is a research paper authored with 18 colleagues as a member of the APOL1 in Chronic Kidney Disease (CKD) Delphi Consensus, a group of investigators dedicated to the study of APOL1, the first CKD genetic link to descendants of West Sub-Saharan Africa.  Delphi consensus and systematic review on diagnosis, education and care of patients with APOL1-associated nephropathy will be published in 2020. Jones-Smith was recently appointed by Governor Greg Abbott to the Texas Chronic Kidney Disease Task Force. She also belongs to the We Work for Health Texas Coalition, Honor the Gift Campaign, SAAACAM, San Antonio Business Journal Leadership Trust, American Association of Kidney Patients, and the San Antonio Hispanic Chamber of Commerce. Jones-Smith serves as the President and Chief Executive Officer of Dynamic Life Press. She is also the CEO of the Texas Kidney Foundation.See omnystudio.com/listener for privacy information.

Tiffany Jones-Smith is a people connector. With over 20 years of experience in nonprofit and private business, she has a reputation for opening the lines of communication between clients, organizations and businesses. She leverages influence and experience to form strategic alliances. Jones-Smith is the host of the popular 930 AM radio show and VLOG On the Record with Tiffany. She holds a Public Leadership Credential from Harvard Business School Online along with a BA in Journalism and Foreign Service from Baylor University and a certificate in Italian studies from L'Universita per Stranieri in Perugia, Italy. Tiffany attended high school at MaryMount International School in Rome, Italy. Tiffany is a journalist, businesswoman, and healthcare advocate. “The United States has a broken healthcare system. The current system compensates providers for taking care of people who are sick. We need a healthcare system that compensates providers for making patients better. My goal is to fix the broken system.” She strives to close the gap in healthcare disparities by addressing obesity, diabetes, hypertension and social determinants of health. She believes we have a broken healthcare system. An ideal system would reward providers based on improved health outcomes for patients. With 140 million Americans below the poverty line, addressing healthcare outcomes is her focus. Jones-Smith is a writer and advocate. She draws from her professional and personal experiences when writing. She has been published in national, state and local publications. Her recent work is a research paper authored with 18 colleagues as a member of the APOL1 in Chronic Kidney Disease (CKD) Delphi Consensus, a group of investigators dedicated to the study of APOL1, the first CKD genetic link to descendants of West Sub-Saharan Africa.  Delphi consensus and systematic review on diagnosis, education and care of patients with APOL1-associated nephropathy will be published in 2020. Jones-Smith was recently appointed by Governor Greg Abbott to the Texas Chronic Kidney Disease Task Force. She also belongs to the We Work for Health Texas Coalition, Honor the Gift Campaign, SAAACAM, San Antonio Business Journal Leadership Trust, American Association of Kidney Patients, and the San Antonio Hispanic Chamber of Commerce. Jones-Smith serves as the President and Chief Executive Officer of Dynamic Life Press. She is also the CEO of the Texas Kidney Foundation. See omnystudio.com/listener for privacy information.

While FSGS was once thought to be a single disease entity, it is now understood to be a pattern of injury caused by diverse mechanisms, but classifying FSGS accurately can be challenging. In this episode, we provide an overview of these classifications and risk factors that can help stratify disease progression risk and assist with determining management approaches. To help understand how we can most effectively and accurately classify FSGS, we are joined by Professor An De Vriese, who is head of the Division of Nephrology and Infectious Disease at the AZ Sint-Jan hospital in Bruges, Belgium. By completing this activity you can qualify for 0.25 CME credits. To claim your credits, you must listen to the podcast and successfully pass the post-module assessment at nephrology.knowledgeintopractice.com, where you can find all past episodes of the podcast as well as other free CME resources. References: 1. De Vriese AS et al. Differentiating primary, genetic, and secondary FSGS in adults: A clinicopathologic approach. J Am Soc Nephrol 2018;29(3):759-774. 2. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int 2021;100(4S):S1–S276. 3. Jacobs-Cachá C et al. Challenges in primary focal segmental glomerulosclerosis diagnosis: from the diagnostic algorithm to novel biomarkers. Clin Kidney J 2020;14(2):482-491. 4. Friedman DJ & Pollak MR. APOL1 nephropathy: From genetics to clinical applications. CJASN, 2021;16(2):294-303. 5. Zee J et al. APOL1 genotype-associated morphologic changes among patients with focal segmental glomerulosclerosis. Pediatric Nephrology. 2021;36(9):2747-2757. 6. Shabaka A et al. Focal segmental glomerulosclerosis: State-of-the-art and clinical perspective. Nephron 2020;144(9):413-427. Disclosures: Prof. An De Vriese has no disclosures to announce. Liberum IME staff, ACHL staff and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose. The Academy for Continued Healthcare Learning (ACHL) requires that the faculty participating in an accredited continuing education activity disclose all affiliations or other financial relationships (1) with the manufacturers of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) with any commercial supporters of the activity. All conflicts of interest have been mitigated prior to this activity. Funding: This independent educational activity is supported by an educational grant from Travere Therapeutics. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Travere Therapeutics has had no influence on the content of this education.

Dr. Jean-Tristan Brandenburg discusses the findings from his study "Apolipoprotein L1 High-Risk Genotypes and Albuminuria in Sub-Saharan African Populations," on behalf of his colleagues.

Tiffany Jones-Smith is a people connector. With over 20 years of experience in nonprofit and private business, she has a reputation for opening the lines of communication between clients, organizations and businesses. She leverages influence and experience to form strategic alliances. Jones-Smith is the host of the popular 930 AM radio show and VLOG On the Record with Tiffany. She holds a Public Leadership Credential from Harvard Business School Online along with a BA in Journalism and Foreign Service from Baylor University and a certificate in Italian studies from L'Universita per Stranieri in Perugia, Italy. Tiffany attended high school at MaryMount International School in Rome, Italy. Tiffany is a journalist, businesswoman, and healthcare advocate. “The United States has a broken healthcare system. The current system compensates providers for taking care of people who are sick. We need a healthcare system that compensates providers for making patients better. My goal is to fix the broken system.” She strives to close the gap in healthcare disparities by addressing obesity, diabetes, hypertension and social determinants of health. She believes we have a broken healthcare system. An ideal system would reward providers based on improved health outcomes for patients. With 140 million Americans below the poverty line, addressing healthcare outcomes is her focus. Jones-Smith is a writer and advocate. She draws from her professional and personal experiences when writing. She has been published in national, state and local publications. Her recent work is a research paper authored with 18 colleagues as a member of the APOL1 in Chronic Kidney Disease (CKD) Delphi Consensus, a group of investigators dedicated to the study of APOL1, the first CKD genetic link to descendants of West Sub-Saharan Africa.  Delphi consensus and systematic review on diagnosis, education and care of patients with APOL1-associated nephropathy will be published in 2020. Jones-Smith was recently appointed by Governor Greg Abbott to the Texas Chronic Kidney Disease Task Force. She also belongs to the We Work for Health Texas Coalition, Honor the Gift Campaign, SAAACAM, San Antonio Business Journal Leadership Trust, American Association of Kidney Patients, and the San Antonio Hispanic Chamber of Commerce. Jones-Smith serves as the President and Chief Executive Officer of Dynamic Life Press. She is also the CEO of the Texas Kidney Foundation. See omnystudio.com/listener for privacy information.

The "Understanding Genetic Kidney Diseases: Insights into APOL1" topic was originally presented during National Minority Quality Forum's weekly webinar series. Listen now for a closer look at addressing existing disparities. Panelists: Ogo Egbuna, MD, MSC, FASN Vice President, Clinical Development Vertex Kristen Hood, MSN, RN Executive Director, Research Engagement NephCure Brandon Garrett, JD Chief Operating Officer & Chief of Staff National Minority Quality Forum (Moderator)

Tiffany Jones-Smith is a people connector. With over 20 years of experience in nonprofit and private business, she has a reputation for opening the lines of communication between clients, organizations and businesses. She leverages influence and experience to form strategic alliances. Jones-Smith is the host of the popular 930 AM radio show and VLOG On the Record with Tiffany. She holds a Public Leadership Credential from Harvard Business School Online along with a BA in Journalism and Foreign Service from Baylor University and a certificate in Italian studies from L'Universita per Stranieri in Perugia, Italy. Tiffany attended high school at MaryMount International School in Rome, Italy. Tiffany is a journalist, businesswoman, and healthcare advocate. “The United States has a broken healthcare system. The current system compensates providers for taking care of people who are sick. We need a healthcare system that compensates providers for making patients better. My goal is to fix the broken system.” She strives to close the gap in healthcare disparities by addressing obesity, diabetes, hypertension and social determinants of health. She believes we have a broken healthcare system. An ideal system would reward providers based on improved health outcomes for patients. With 140 million Americans below the poverty line, addressing healthcare outcomes is her focus. Jones-Smith is a writer and advocate. She draws from her professional and personal experiences when writing. She has been published in national, state and local publications. Her recent work is a research paper authored with 18 colleagues as a member of the APOL1 in Chronic Kidney Disease (CKD) Delphi Consensus, a group of investigators dedicated to the study of APOL1, the first CKD genetic link to descendants of West Sub-Saharan Africa.  Delphi consensus and systematic review on diagnosis, education and care of patients with APOL1-associated nephropathy will be published in 2020. Jones-Smith was recently appointed by Governor Greg Abbott to the Texas Chronic Kidney Disease Task Force. She also belongs to the We Work for Health Texas Coalition, Honor the Gift Campaign, SAAACAM, San Antonio Business Journal Leadership Trust, American Association of Kidney Patients, and the San Antonio Hispanic Chamber of Commerce. Jones-Smith serves as the President and Chief Executive Officer of Dynamic Life Press. She is also the CEO of the Texas Kidney Foundation. See omnystudio.com/listener for privacy information.

Tiffany Jones-Smith is a people connector. With over 20 years of experience in nonprofit and private business, she has a reputation for opening the lines of communication between clients, organizations and businesses. She leverages influence and experience to form strategic alliances. Jones-Smith is the host of the popular 930 AM radio show and VLOG On the Record with Tiffany. She holds a Public Leadership Credential from Harvard Business School Online along with a BA in Journalism and Foreign Service from Baylor University and a certificate in Italian studies from L'Universita per Stranieri in Perugia, Italy. Tiffany attended high school at MaryMount International School in Rome, Italy. Tiffany is a journalist, businesswoman, and healthcare advocate. “The United States has a broken healthcare system. The current system compensates providers for taking care of people who are sick. We need a healthcare system that compensates providers for making patients better. My goal is to fix the broken system.” She strives to close the gap in healthcare disparities by addressing obesity, diabetes, hypertension and social determinants of health. She believes we have a broken healthcare system. An ideal system would reward providers based on improved health outcomes for patients. With 140 million Americans below the poverty line, addressing healthcare outcomes is her focus. Jones-Smith is a writer and advocate. She draws from her professional and personal experiences when writing. She has been published in national, state and local publications. Her recent work is a research paper authored with 18 colleagues as a member of the APOL1 in Chronic Kidney Disease (CKD) Delphi Consensus, a group of investigators dedicated to the study of APOL1, the first CKD genetic link to descendants of West Sub-Saharan Africa.  Delphi consensus and systematic review on diagnosis, education and care of patients with APOL1-associated nephropathy will be published in 2020. Jones-Smith was recently appointed by Governor Greg Abbott to the Texas Chronic Kidney Disease Task Force. She also belongs to the We Work for Health Texas Coalition, Honor the Gift Campaign, SAAACAM, San Antonio Business Journal Leadership Trust, American Association of Kidney Patients, and the San Antonio Hispanic Chamber of Commerce. Jones-Smith serves as the President and Chief Executive Officer of Dynamic Life Press. She is also the CEO of the Texas Kidney Foundation. See omnystudio.com/listener for privacy information.

Some diseases run in the family, when more than one person has the same kind of illness passed down through genes. One of those genes, called APOL1, has variations that are linked to an increased risk for kidney disease, especially in under-resourced communities of color. In today's bonus episode, we discuss how a clinical research study is looking to understand the effect of APOL1 on kidney transplant outcomes from living and deceased donors, and why it's important for you to be part of this research study. In this episode, you will hear from: Marva Moxey-Mims, MD, FASN Dr. Moxey-Mims is Professor of Pediatrics at George Washington University School of Medicine and Chief of the Division of Nephrology at Children's National Health System, Washington, D.C.  Dr. Moxey-Mims serves as the Study Chair of the APOLLO Steering Committee and Chair of the Publications & Presentation Committee. Jonah Odim, MD Dr. Odim is Chief of the Clinical Transplantation Section at the National Institute of Allergy and Infectious Diseases (NIAID). Dr. Odim serves as a representative of the National Institutes of Health (NIH) on the APOLLO Steering Committee and member of the Dissemination Working Group. Glenda V. Roberts  Glenda is the Director of External Relations & Patient Engagement for the Center for Dialysis Innovation at the University of Washington Kidney Research Institute.  Glenda serves as a member of the APOLLO Community Advisory Committee, the Recruitment Committee, and the Dissemination Working Group. Sylvia E. Rosas, MD, MSCE Dr. Rosas is a nephrologist and epidemiologist at the Joslin Diabetes Center and the Beth Israel Deaconess Medical Center. Sylvia serves as the Principal Investigator of APOLLO Clinical Center 09 (Harvard University) and member of the Dissemination Working Group. Krista Lentine, MD, PhD, FAST, FAST Dr. Lentine is Medical Director of Living Donation, Co-Director of Clinical Research, and Mid-America Transplant/Jane A. Beckman Endowed Chair in Transplantation at Saint Louis University (SLU). Krista serves as co-Principal Investigator for APOLLO Clinical Center 03 (Johns Hopkins | SLU), member of the Data, Ancillary Studies, and Publications & Presentation Committees, and chair of the Dissemination Working Group. Denay Richards Ms. Richards and her family were born in the Caribbean when her mother was diagnosed with ESRD. They moved to the United States, where her mother was told that she had about 3 months to live. On August 29th, 2000, Denay's father donated a kidney to her and in 2020 they celebrated their 20 year - “kidneyversary.” As a child, Denay loved helping her mother with the dialysis process, organizing medications, and attending hospital visits. It was this exposure to the medical field that encouraged Denay to pursue a career in surgery. In 2019 she graduated from Princeton University with a degree in Molecular Biology and as of 2021 is an MD/PhD student in a dual degree program with Robert Wood Johnson Medical School and Princeton University. In 2019, she earned a double board qualification as a fitness nutrition specialist and personal trainer under the International Sports Sciences Association. In 2020, Denay was diagnosed with an APOL1 mutation that is more prevalent in the African American community and has been linked to early kidney failure. Denay says that her diagnosis has empowered her to expand education about renal health, fitness/nutrition, and genetic predispositions for kidney failure to the world, especially disenfranchised populations that are at greater risk.   Genetics and kidney disease: https://www.kidney.org/atoz/content/genetics-kidney-disease

Tiffany Jones-Smith is a people connector. With over 20 years of experience in nonprofit and private business, she has a reputation for opening the lines of communication between clients, organizations and businesses. She leverages influence and experience to form strategic alliances. Jones-Smith is the host of the popular 930 AM radio show and VLOG On the Record with Tiffany. She holds a Public Leadership Credential from Harvard Business School Online along with a BA in Journalism and Foreign Service from Baylor University and a certificate in Italian studies from L'Universita per Stranieri in Perugia, Italy. Tiffany attended high school at MaryMount International School in Rome, Italy. Tiffany is a journalist, businesswoman, and healthcare advocate. “The United States has a broken healthcare system. The current system compensates providers for taking care of people who are sick. We need a healthcare system that compensates providers for making patients better. My goal is to fix the broken system.” She strives to close the gap in healthcare disparities by addressing obesity, diabetes, hypertension and social determinants of health. She believes we have a broken healthcare system. An ideal system would reward providers based on improved health outcomes for patients. With 140 million Americans below the poverty line, addressing healthcare outcomes is her focus. Jones-Smith is a writer and advocate. She draws from her professional and personal experiences when writing. She has been published in national, state and local publications. Her recent work is a research paper authored with 18 colleagues as a member of the APOL1 in Chronic Kidney Disease (CKD) Delphi Consensus, a group of investigators dedicated to the study of APOL1, the first CKD genetic link to descendants of West Sub-Saharan Africa.  Delphi consensus and systematic review on diagnosis, education and care of patients with APOL1-associated nephropathy will be published in 2020. Jones-Smith was recently appointed by Governor Greg Abbott to the Texas Chronic Kidney Disease Task Force. She also belongs to the We Work for Health Texas Coalition, Honor the Gift Campaign, SAAACAM, San Antonio Business Journal Leadership Trust, American Association of Kidney Patients, and the San Antonio Hispanic Chamber of Commerce. Jones-Smith serves as the President and Chief Executive Officer of Dynamic Life Press. She is also the CEO of the Texas Kidney Foundation. See omnystudio.com/listener for privacy information.

Credits: 0.5 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/coffee-with-chopra-ep-4 Overview: Join Dr. Sanjiv Chopra in this installment of Coffee with Chopra, as he interviews his guest, Dr. Melanie Hoenig, about advances in nephrology. In this session, the duo will discuss topics including: race and kidney function, HIV and HCV on kidney function, and the relationship between APOL1 and kidney failure.  Episode resource links: https://jamanetwork.com/journals/jama/article-abstract/2735726 https://www.kidney-international.org/article/S0085-2538(17)30823-2/fulltext https://www.jci.org/articles/view/46263/figure/1 https://www.nytimes.com/2020/06/17/health/many-medical-decision-tools-disadvantage-black-patients.html Guest: Melanie Hoenig, MD

Best of from 3-4-21 Show Megan R Williams Khmelev, MD Dr. Williams is on a mission to help people achieve happy and healthier lives. Board certified in Obesity and Family Medicine, she has over 10 years of experience treating patients of all ages from newborns to older adults. Her passion for treating obesity started while serving in the US Air Force as a family physician where she noted the huge impact being overweight had on chronic medical problems and overall quality of life of her patients. A recipient of the Air Force Meritorious Service Medal, she has been also been an expert contributor on the topic of obesity in magazines like Reader’s Digest and Healthzette. A native Coloradan, she got to Texas as soon as she could and has lived in San Antonio for nearly 15 years. In her “spare” time Dr. Williams enjoys time with her husband and three young children. Swimming, spending time outdoors and answering the question “why” are some common activities. She also enjoys running, strength training and learning new languages. She is fluent in Spanish. Tiffany Jones-Smith Tiffany Jones-Smith is the CEO of the Texas Kidney Foundation. As a people connector, with over 20 years of experience working in the c-suite of businesses, she has a reputation for opening the lines of communication between clients, organizations and businesses. She leverages influence and experience to form strategic alliances. Jones-Smith is the host of the popular 930 AM radio show and VLOG On the Record with Tiffany. She uses her platform to explore healthcare topics, social issues and community heroes. Jones-Smith was recently appointed by Governor Greg Abbott to the Texas Chronic Kidney Disease Task Force. She also belongs to the We Work for Health Texas Coalition, Honor the Gift Campaign, SAAACAM, San Antonio Business Journal Leadership Trust, American Association of Kidney Patients, and the San Antonio Hispanic Chamber of Commerce. She holds a Public Leadership Credential from Harvard Business School Online along with a BA in Journalism and Foreign Service from Baylor University and a certificate in Italian studies from L’Universita per Stranieri, in Perugia, Italy. Tiffany attended high school at Mary Mount International School in Rome, Italy. Tiffany is an entrepreneur, journalist, and healthcare advocate. According to Smith, “The United States has a broken healthcare system. We need a system with compensation models that are outcomes based.” She strives to close the gap in healthcare disparities by addressing obesity, diabetes, hypertension and social determinants of health. She believes an ideal system would be data driven with emphasis on positive patient outcomes. She believes prevention and early disease detection are essential first steps to creating a healthy community. There are 140 million Americans living below the poverty line, addressing healthcare outcomes is her priority. As a writer and advocate, Jones-Smith has a wealth of professional experience. She has been published in national, state and local journals. Her recent work is a research paper authored with 18 colleagues as a member of the APOL1 in Chronic Kidney Disease (CKD) Delphi Consensus, a group of investigators dedicated to the study of APOL1, the first CKD genetic link to descendants of West Sub-Saharan Africa. Delphi consensus and systematic review on diagnosis, education and care of patients with APOL1-associated nephropathy will be published in 2020. Jones-Smith also serves as the President and Chief Exe See omnystudio.com/listener for privacy information.

In this episode of the Better Edge Podcast, Aneesha Shetty, MD, MPH, assistant professor of Medicine in the Division of Nephrology and Hypertension, discusses finding from a recent case report published in the Journal of the American Society of Nephrology.This study highlights an emerging COVID-19 related kidney disease that is characterized by podocytopathy and/or collapsing FSGS. In investigating this phenomenon among six patients with proteinuria collapsing FSGS and COVID-19 infection, it was observed that the patients were all of recent African ancestry. This led to further investigation into whether this kidney disease is associated with the high risk APOL1 genotype. This association may help predict how a patient will do with COVID-19, their needs after infection recovers, and sheds light on APOL1 genotypes and kidney disease.

Effect of a Single Apolipoprotein L1 Gene Nephropathy Variant on the Risk of Advanced Lupus Nephritis in Brazilians Gisele Vajgel, Suelen Cristina Lima, Diego Jeronimo S. Santana, Camila B.L. Oliveira, Denise Maria N. Costa, Pamela J. Hicks, Maria Alina G.M. Cavalcante, Carl D. Langefeld, Lucila Maria Valente, Sergio Crovella, Gianna Mastroianni Kirsztajn, Barry I. Freedman and Paula Sandrin-Garcia The Journal of Rheumatology August 2020, 47 (8) 1209-1217; DOI: https://doi.org/10.3899/jrheum.190684

Jennifer Milton is a Clinical Assistant Professor and the Chief Administrative Officer at the University Transplant Center, where she is charged to integrate the business, operational, quality, and strategic efforts for University of Texas Health San Antonio and the University Health System.  UTC is an adult and pediatric lung, liver, kidney transplant as well as the home of the UTC Advanced Endoscopy Center, Texas Liver Tumor Center, Pancreas Tumor Center, Interventional Pulmonary and several other end stage organ programs. UTC has doubled in size and scope over the last five years through innovative programs and zealous outreach.  UTC is the second largest living liver program in the US, the first program in the US and second worldwide to perform Paired Living Liver Donation Exchanges and six months ago, UTC open the Center for Life – the countries most comprehensive dedicated organ and tissue recovery center built with a multi-bed ICU, a cadre of operating and pulsatile perfusion suites with comprehensive educational and research funding, facilities and staff.  Jennifer entered the field of transplantation twenty-six years ago as an organ donation nurse coordinator.   Over the years, Jennifer has done extensive work on issues impacting financial, regulatory and operations at transplant centers and organ and tissue donation and has published on issues surrounding outcomes and living donation. Jennifer has served on numerous local and national nonprofit boards including her current positions, Immediate Past Chair of the UNOS Policy Oversight Committee and Chair of Donate Life America which will be launching the National Living Donor Registry in the upcoming months!   Tiffany Jones-Smith is a people connector. With over 20 years of experience in nonprofit and private business, she has a reputation for opening the lines of communication between clients, organizations and businesses. She leverages influence and experience to form strategic alliances. Jones-Smith is the host of the popular 930 AM radio show and VLOG On the Record with Tiffany. She holds a Public Leadership Credential from Harvard Business School Online along with a BA in Journalism and Foreign Service from Baylor University and a certificate in Italian studies from L’Universita per Stranieri in Perugia, Italy. Tiffany attended high school at MaryMount International School in Rome, Italy. Tiffany is a journalist, businesswoman, and healthcare advocate. “The United States has a broken healthcare system. The current system compensates providers for taking care of people who are sick. We need a healthcare system that compensates providers for making patients better. My goal is to fix the broken system.” She strives to close the gap in healthcare disparities by addressing obesity, diabetes, hypertension and social determinants of health. She believes we have a broken healthcare system. An ideal system would reward providers based on improved health outcomes for patients. With 140 million Americans below the poverty line, addressing healthcare outcomes is her focus. Jones-Smith is a writer and advocate. She draws from her professional and personal experiences when writing. She has been published in national, state and local publications. Her recent work is a research paper authored with 18 colleagues as a member of the APOL1 in Chronic Kidney Disease (CKD) Delphi Consensus, a group of investigators dedicated to the study of APOL1, the first CKD genetic link to descendants of West Sub-Saharan Africa.  Delphi consensus and systematic review on diagnosis, education and care of patients with APOL1-associated nephropathy will be published in 2020. Jones-Smith was recently appointed by Governor Greg Abbott to the Texas Chronic Kidney Disease Task Force. She also belongs to the We Work for Health Texas Coalition, Honor the Gift Campaign, SAAACAM, San Antonio Business Journal Leadership Trust, American Association of Kidney Patients, and the San Antonio Hispanic Chamber of Commerce. Jones-Smith serves as the President and Chief Executive Officer of Dynamic Life Press. She is also the CEO of the Texas Kidney Foundation. See omnystudio.com/listener for privacy information.

Deborah Omowale Jarmon, Executive Director; The SAAACAM saaacam.org/leadership/ Teresa Van Hoy joined the History Department at St. Mary’s University in 2007 and published her first book, Peons, Prisoners, and Priests: A Social History of Mexico’s Railroads. For the period 2011-2014, she held the O’Connor Chair for the History of Hispanic Texas and the Southwest during which she conducted the research for a new book project and piloted the first Public History initiatives at St. Mary’s University. www.stmarytx.edu/academics/faculty/teresa-van-hoy/ Tiffany Jones-Smith is a people connector. With over 20 years of experience in nonprofit and private business, she has a reputation for opening the lines of communication between clients, organizations and businesses. She leverages influence and experience to form strategic alliances. Jones-Smith is the host of the popular 930 AM radio show and VLOG On the Record with Tiffany. She holds a Public Leadership Credential from Harvard Business School Online along with a BA in Journalism and Foreign Service from Baylor University and a certificate in Italian studies from L’Universita per Stranieri in Perugia, Italy. Tiffany attended high school at MaryMount International School in Rome, Italy. Tiffany is a journalist, businesswoman, and healthcare advocate. “The United States has a broken healthcare system. The current system compensates providers for taking care of people who are sick. We need a healthcare system that compensates providers for making patients better. My goal is to fix the broken system.” She strives to close the gap in healthcare disparities by addressing obesity, diabetes, hypertension and social determinants of health. She believes we have a broken healthcare system. An ideal system would reward providers based on improved health outcomes for patients. With 140 million Americans below the poverty line, addressing healthcare outcomes is her focus. Jones-Smith is a writer and advocate. She draws from her professional and personal experiences when writing. She has been published in national, state and local publications. Her recent work is a research paper authored with 18 colleagues as a member of the APOL1 in Chronic Kidney Disease (CKD) Delphi Consensus, a group of investigators dedicated to the study of APOL1, the first CKD genetic link to descendants of West Sub-Saharan Africa.  Delphi consensus and systematic review on diagnosis, education and care of patients with APOL1-associated nephropathy will be published in 2020. Jones-Smith was recently appointed by Governor Greg Abbott to the Texas Chronic Kidney Disease Task Force. She also belongs to the We Work for Health Texas Coalition, Honor the Gift Campaign, SAAACAM, San Antonio Business Journal Leadership Trust, American Association of Kidney Patients, and the San Antonio Hispanic Chamber of Commerce. Jones-Smith serves as the President and Chief Executive Officer of Dynamic Life Press. She is also the CEO of the Texas Kidney Foundation. See omnystudio.com/listener for privacy information.

Bexar County Criminal District Attorney Joe Gonzales took office in January of 2019 on a pledge to reform the office, restore public confidence, and make the office more accountable to the voters. The primary duty of the District Attorney is to seek justice. In the course of its work, the Criminal District Attorney's Office works closely with victims of crime, law enforcement agencies, and the local community.  The Criminal District Attorney's Office analyzes all felony and most misdemeanor charges filed by law enforcement agencies in Bexar County, reviews these charges to decide if enough evidence exists for further prosecution, and determines how best to proceed in the interests of justice. The District Attorney seeks to require defendants who are found guilty of a crime to take responsibility for their actions and for any harm they have caused, but also works to lessen recidivism, prevent crime, and make Bexar County a safer and better place to live, work and raise children. In addition to responsibility for criminal prosecutions in Bexar County, the District Attorney also serves as legal counsel for Bexar County, county officials, and county employees in all matters related to their governmental functions.   Tiffany Jones-Smith is a people connector. With over 20 years of experience in nonprofit and private business, she has a reputation for opening the lines of communication between clients, organizations and businesses. She leverages influence and experience to form strategic alliances. Jones-Smith is the host of the popular 930 AM radio show and VLOG On the Record with Tiffany. She holds a Public Leadership Credential from Harvard Business School Online along with a BA in Journalism and Foreign Service from Baylor University and a certificate in Italian studies from L’Universita per Stranieri in Perugia, Italy. Tiffany attended high school at MaryMount International School in Rome, Italy. Tiffany is a journalist, businesswoman, and healthcare advocate. “The United States has a broken healthcare system. The current system compensates providers for taking care of people who are sick. We need a healthcare system that compensates providers for making patients better. My goal is to fix the broken system.” She strives to close the gap in healthcare disparities by addressing obesity, diabetes, hypertension and social determinants of health. She believes we have a broken healthcare system. An ideal system would reward providers based on improved health outcomes for patients. With 140 million Americans below the poverty line, addressing healthcare outcomes is her focus. Jones-Smith is a writer and advocate. She draws from her professional and personal experiences when writing. She has been published in national, state and local publications. Her recent work is a research paper authored with 18 colleagues as a member of the APOL1 in Chronic Kidney Disease (CKD) Delphi Consensus, a group of investigators dedicated to the study of APOL1, the first CKD genetic link to descendants of West Sub-Saharan Africa.  Delphi consensus and systematic review on diagnosis, education and care of patients with APOL1-associated nephropathy will be published in 2020. Jones-Smith was recently appointed by Governor Greg Abbott to the Texas Chronic Kidney Disease Task Force. She also belongs to the We Work for Health Texas Coalition, Honor the Gift Campaign, SAAACAM, San Antonio Business Journal Leadership Trust, American Association of Kidney Patients, and the San Antonio Hispanic Chamber of Commerce. Jones-Smith serves as the President and Chief Executive Officer of Dynamic Life Press. She is also the CEO of the Texas Kidney Foundation. See omnystudio.com/listener for privacy information.

Dr. Richard Gibney, MD Dr. Richard Gibney, MD is a Nephrology Specialist in Hillsboro, TX.  Dr. Gibney has more experience with Nephrological Conditions than other specialists in his area.  He is affiliated with medical facilities Ascension Providence Health Center and Baylor Scott and White Medical Center Hillcrest. Mother, Business Woman, and Health Advocate, Tiffany Jones-Smith inspires listeners with interviews with the heroes that are transforming lives in San Antonio. Tiffany Jones-Smith is a people connector. With over 20 years of experience in nonprofit and private business, she has a reputation for opening the lines of communication between clients, organizations and businesses. She leverages influence and experience to form strategic alliances. Jones-Smith is the host of the popular 930 AM radio show and VLOG On the Record with Tiffany. She holds a Public Leadership Credential from Harvard Business School Online along with a BA in Journalism and Foreign Service from Baylor University and a certificate in Italian studies from L’Universita per Stranieri in Perugia, Italy. Tiffany attended high school at MaryMount International School in Rome, Italy. Tiffany is a journalist, businesswoman, and healthcare advocate. “The United States has a broken healthcare system. The current system compensates providers for taking care of people who are sick. We need a healthcare system that compensates providers for making patients better. My goal is to fix the broken system.” She strives to close the gap in healthcare disparities by addressing obesity, diabetes, hypertension and social determinants of health. She believes we have a broken healthcare system. An ideal system would reward providers based on improved health outcomes for patients. With 140 million Americans below the poverty line, addressing healthcare outcomes is her focus. Jones-Smith is a writer and advocate. She draws from her professional and personal experiences when writing. She has been published in national, state and local publications. Her recent work is a research paper authored with 18 colleagues as a member of the APOL1 in Chronic Kidney Disease (CKD) Delphi Consensus, a group of investigators dedicated to the study of APOL1, the first CKD genetic link to descendants of West Sub-Saharan Africa.  Delphi consensus and systematic review on diagnosis, education and care of patients with APOL1-associated nephropathy will be published in 2020. Jones-Smith was recently appointed by Governor Greg Abbott to the Texas Chronic Kidney Disease Task Force. She also belongs to the We Work for Health Texas Coalition, Honor the Gift Campaign, SAAACAM, San Antonio Business Journal Leadership Trust, American Association of Kidney Patients, and the San Antonio Hispanic Chamber of Commerce. Jones-Smith serves as the President and Chief Executive Officer of Dynamic Life Press. She is also the CEO of the Texas Kidney Foundation. See omnystudio.com/listener for privacy information.

Bexar County Criminal District Attorney Joe Gonzales took office in January of 2019 on a pledge to reform the office, restore public confidence, and make the office more accountable to the voters. The primary duty of the District Attorney is to seek justice. In the course of its work, the Criminal District Attorney's Office works closely with victims of crime, law enforcement agencies, and the local community.  The Criminal District Attorney's Office analyzes all felony and most misdemeanor charges filed by law enforcement agencies in Bexar County, reviews these charges to decide if enough evidence exists for further prosecution, and determines how best to proceed in the interests of justice. The District Attorney seeks to require defendants who are found guilty of a crime to take responsibility for their actions and for any harm they have caused, but also works to lessen recidivism, prevent crime, and make Bexar County a safer and better place to live, work and raise children. In addition to responsibility for criminal prosecutions in Bexar County, the District Attorney also serves as legal counsel for Bexar County, county officials, and county employees in all matters related to their governmental functions.   Tiffany Jones-Smith is a people connector. With over 20 years of experience in nonprofit and private business, she has a reputation for opening the lines of communication between clients, organizations and businesses. She leverages influence and experience to form strategic alliances. Jones-Smith is the host of the popular 930 AM radio show and VLOG On the Record with Tiffany. She holds a Public Leadership Credential from Harvard Business School Online along with a BA in Journalism and Foreign Service from Baylor University and a certificate in Italian studies from L’Universita per Stranieri in Perugia, Italy. Tiffany attended high school at MaryMount International School in Rome, Italy. Tiffany is a journalist, businesswoman, and healthcare advocate. “The United States has a broken healthcare system. The current system compensates providers for taking care of people who are sick. We need a healthcare system that compensates providers for making patients better. My goal is to fix the broken system.” She strives to close the gap in healthcare disparities by addressing obesity, diabetes, hypertension and social determinants of health. She believes we have a broken healthcare system. An ideal system would reward providers based on improved health outcomes for patients. With 140 million Americans below the poverty line, addressing healthcare outcomes is her focus. Jones-Smith is a writer and advocate. She draws from her professional and personal experiences when writing. She has been published in national, state and local publications. Her recent work is a research paper authored with 18 colleagues as a member of the APOL1 in Chronic Kidney Disease (CKD) Delphi Consensus, a group of investigators dedicated to the study of APOL1, the first CKD genetic link to descendants of West Sub-Saharan Africa.  Delphi consensus and systematic review on diagnosis, education and care of patients with APOL1-associated nephropathy will be published in 2020. Jones-Smith was recently appointed by Governor Greg Abbott to the Texas Chronic Kidney Disease Task Force. She also belongs to the We Work for Health Texas Coalition, Honor the Gift Campaign, SAAACAM, San Antonio Business Journal Leadership Trust, American Association of Kidney Patients, and the San Antonio Hispanic Chamber of Commerce. Jones-Smith serves as the President and Chief Executive Officer of Dynamic Life Press. She is also the CEO of the Texas Kidney Foundation. See omnystudio.com/listener for privacy information.

Dr. Richard Gibney, MD Dr. Richard Gibney, MD is a Nephrology Specialist in Hillsboro, TX.  Dr. Gibney has more experience with Nephrological Conditions than other specialists in his area.  He is affiliated with medical facilities Ascension Providence Health Center and Baylor Scott and White Medical Center Hillcrest. Mother, Business Woman, and Health Advocate, Tiffany Jones-Smith inspires listeners with interviews with the heroes that are transforming lives in San Antonio.   Henry Cisneros, (born June 11, 1947, San Antonio, Texas, U.S.), American politician who, as mayor of San Antonio (1981–89), was the first Latino to serve as mayor of a major U.S. city in the 20th century and who served as secretary of housing and urban development (1993–97) under U.S. Pres. Bill Clinton.   Tiffany Jones-Smith is a people connector. With over 20 years of experience in nonprofit and private business, she has a reputation for opening the lines of communication between clients, organizations and businesses. She leverages influence and experience to form strategic alliances. Jones-Smith is the host of the popular 930 AM radio show and VLOG On the Record with Tiffany. She holds a Public Leadership Credential from Harvard Business School Online along with a BA in Journalism and Foreign Service from Baylor University and a certificate in Italian studies from L’Universita per Stranieri in Perugia, Italy. Tiffany attended high school at MaryMount International School in Rome, Italy. Tiffany is a journalist, businesswoman, and healthcare advocate. “The United States has a broken healthcare system. The current system compensates providers for taking care of people who are sick. We need a healthcare system that compensates providers for making patients better. My goal is to fix the broken system.” She strives to close the gap in healthcare disparities by addressing obesity, diabetes, hypertension and social determinants of health. She believes we have a broken healthcare system. An ideal system would reward providers based on improved health outcomes for patients. With 140 million Americans below the poverty line, addressing healthcare outcomes is her focus. Jones-Smith is a writer and advocate. She draws from her professional and personal experiences when writing. She has been published in national, state and local publications. Her recent work is a research paper authored with 18 colleagues as a member of the APOL1 in Chronic Kidney Disease (CKD) Delphi Consensus, a group of investigators dedicated to the study of APOL1, the first CKD genetic link to descendants of West Sub-Saharan Africa.  Delphi consensus and systematic review on diagnosis, education and care of patients with APOL1-associated nephropathy will be published in 2020. Jones-Smith was recently appointed by Governor Greg Abbott to the Texas Chronic Kidney Disease Task Force. She also belongs to the We Work for Health Texas Coalition, Honor the Gift Campaign, SAAACAM, San Antonio Business Journal Leadership Trust, American Association of Kidney Patients, and the San Antonio Hispanic Chamber of Commerce. Jones-Smith serves as the President and Chief Executive Officer of Dynamic Life Press. She is also the CEO of the Texas Kidney Foundation. See omnystudio.com/listener for privacy information.

Patient Empowerment, behavioral health and Life coaches are the next steps in creating a healthy population. Guests Dr. Richard Gibney and Arlet Polack share their expertise with our listeners.   Arlet Polack Bilingual public health professional with Masters in Health Education, certifications including Certified Health Education Specialist (CHES), Community Health Worker Instructor (CHW-I), and qualified to facilitate a variety of health promotion curricula.  Over 4 years of professional experience working to advance access to health promotion and prevention services across populations. Living Healthier: https://healthiertexassummit.com/ (our phone number: 844-262-6224) Stronger Austin: https://strongeraustin.org/activities/  Healthier Texas Summit:  https://healthiertexassummit.com/   Dr. Richard Gibney, MD Dr. Richard Gibney, MD is a Nephrology Specialist in Hillsboro, TX.  Dr. Gibney has more experience with Nephrological Conditions than other specialists in his area.  He is affiliated with medical facilities Ascension Providence Health Center and Baylor Scott and White Medical Center Hillcrest. Tiffany Jones-Smith is a people connector. With over 20 years of experience in nonprofit and private business, she has a reputation for opening the lines of communication between clients, organizations and businesses. She leverages influence and experience to form strategic alliances. Jones-Smith is the host of the popular 930 AM radio show and VLOG On the Record with Tiffany. She holds a Public Leadership Credential from Harvard Business School Online along with a BA in Journalism and Foreign Service from Baylor University and a certificate in Italian studies from L’Universita per Stranieri in Perugia, Italy. Tiffany attended high school at MaryMount International School in Rome, Italy. Tiffany is a journalist, businesswoman, and healthcare advocate. “The United States has a broken healthcare system. The current system compensates providers for taking care of people who are sick. We need a healthcare system that compensates providers for making patients better. My goal is to fix the broken system.” She strives to close the gap in healthcare disparities by addressing obesity, diabetes, hypertension and social determinants of health. She believes we have a broken healthcare system. An ideal system would reward providers based on improved health outcomes for patients. With 140 million Americans below the poverty line, addressing healthcare outcomes is her focus. Jones-Smith is a writer and advocate. She draws from her professional and personal experiences when writing. She has been published in national, state and local publications. Her recent work is a research paper authored with 18 colleagues as a member of the APOL1 in Chronic Kidney Disease (CKD) Delphi Consensus, a group of investigators dedicated to the study of APOL1, the first CKD genetic link to descendants of West Sub-Saharan Africa.  Delphi consensus and systematic review on diagnosis, education and care of patients with APOL1-associated nephropathy will be published in 2020. Jones-Smith was recently appointed by Governor Greg Abbott to the Texas Chronic Kidney Disease Task Force. She also belongs to the We Work for Health Texas Coalition, Honor the Gift Campaign, SAAACAM, San Antonio Business Journal Leadership Trust, American Association of Kidney Patients, and the San Antonio Hispanic Chamber of Commerce. Jones-Smith serves as the President and Chief Executive Officer of Dynamic Life Press. She is also the CEO of the Texas Kidney Foundation. See omnystudio.com/listener for privacy information.

Tiffany Jones-Smith is a people connector. With over 20 years of experience in nonprofit and private business, she has a reputation for opening the lines of communication between clients, organizations and businesses. She leverages influence and experience to form strategic alliances. Jones-Smith is the host of the popular 930 AM radio show and VLOG On the Record with Tiffany. She holds a Public Leadership Credential from Harvard Business School Online along with a BA in Journalism and Foreign Service from Baylor University and a certificate in Italian studies from L’Universita per Stranieri in Perugia, Italy. Tiffany attended high school at MaryMount International School in Rome, Italy. Tiffany is a journalist, businesswoman, and healthcare advocate. “The United States has a broken healthcare system. The current system compensates providers for taking care of people who are sick. We need a healthcare system that compensates providers for making patients better. My goal is to fix the broken system.” She strives to close the gap in healthcare disparities by addressing obesity, diabetes, hypertension and social determinants of health. She believes we have a broken healthcare system. An ideal system would reward providers based on improved health outcomes for patients. With 140 million Americans below the poverty line, addressing healthcare outcomes is her focus. Jones-Smith is a writer and advocate. She draws from her professional and personal experiences when writing. She has been published in national, state and local publications. Her recent work is a research paper authored with 18 colleagues as a member of the APOL1 in Chronic Kidney Disease (CKD) Delphi Consensus, a group of investigators dedicated to the study of APOL1, the first CKD genetic link to descendants of West Sub-Saharan Africa.  Delphi consensus and systematic review on diagnosis, education and care of patients with APOL1-associated nephropathy will be published in 2020. Jones-Smith was recently appointed by Governor Greg Abbott to the Texas Chronic Kidney Disease Task Force. She also belongs to the We Work for Health Texas Coalition, Honor the Gift Campaign, SAAACAM, San Antonio Business Journal Leadership Trust, American Association of Kidney Patients, and the San Antonio Hispanic Chamber of Commerce. Jones-Smith serves as the President and Chief Executive Officer of Dynamic Life Press. She is also the CEO of the Texas Kidney Foundation. See omnystudio.com/listener for privacy information.

Tiffany Jones-Smith is a people connector. With over 20 years of experience in nonprofit and private business, she has a reputation for opening the lines of communication between clients, organizations and businesses. She leverages influence and experience to form strategic alliances. Jones-Smith is the host of the popular 930 AM radio show and VLOG On the Record with Tiffany. She holds a Public Leadership Credential from Harvard Business School Online along with a BA in Journalism and Foreign Service from Baylor University and a certificate in Italian studies from L’Universita per Stranieri in Perugia, Italy. Tiffany attended high school at MaryMount International School in Rome, Italy. Tiffany is a journalist, businesswoman, and healthcare advocate. “The United States has a broken healthcare system. The current system compensates providers for taking care of people who are sick. We need a healthcare system that compensates providers for making patients better. My goal is to fix the broken system.” She strives to close the gap in healthcare disparities by addressing obesity, diabetes, hypertension and social determinants of health. She believes we have a broken healthcare system. An ideal system would reward providers based on improved health outcomes for patients. With 140 million Americans below the poverty line, addressing healthcare outcomes is her focus. Jones-Smith is a writer and advocate. She draws from her professional and personal experiences when writing. She has been published in national, state and local publications. Her recent work is a research paper authored with 18 colleagues as a member of the APOL1 in Chronic Kidney Disease (CKD) Delphi Consensus, a group of investigators dedicated to the study of APOL1, the first CKD genetic link to descendants of West Sub-Saharan Africa.  Delphi consensus and systematic review on diagnosis, education and care of patients with APOL1-associated nephropathy will be published in 2020. Jones-Smith was recently appointed by Governor Greg Abbott to the Texas Chronic Kidney Disease Task Force. She also belongs to the We Work for Health Texas Coalition, Honor the Gift Campaign, SAAACAM, San Antonio Business Journal Leadership Trust, American Association of Kidney Patients, and the San Antonio Hispanic Chamber of Commerce. Jones-Smith serves as the President and Chief Executive Officer of Dynamic Life Press. She is also the CEO of the Texas Kidney Foundation. See omnystudio.com/listener for privacy information.

Tiffany Jones-Smith is a people connector. With over 20 years of experience in nonprofit and private business, she has a reputation for opening the lines of communication between clients, organizations and businesses. She leverages influence and experience to form strategic alliances. Jones-Smith is the host of the popular 930 AM radio show and VLOG On the Record with Tiffany. She holds a Public Leadership Credential from Harvard Business School Online along with a BA in Journalism and Foreign Service from Baylor University and a certificate in Italian studies from L’Universita per Stranieri in Perugia, Italy. Tiffany attended high school at MaryMount International School in Rome, Italy. Tiffany is a journalist, businesswoman, and healthcare advocate. “The United States has a broken healthcare system. The current system compensates providers for taking care of people who are sick. We need a healthcare system that compensates providers for making patients better. My goal is to fix the broken system.” She strives to close the gap in healthcare disparities by addressing obesity, diabetes, hypertension and social determinants of health. She believes we have a broken healthcare system. An ideal system would reward providers based on improved health outcomes for patients. With 140 million Americans below the poverty line, addressing healthcare outcomes is her focus. Jones-Smith is a writer and advocate. She draws from her professional and personal experiences when writing. She has been published in national, state and local publications. Her recent work is a research paper authored with 18 colleagues as a member of the APOL1 in Chronic Kidney Disease (CKD) Delphi Consensus, a group of investigators dedicated to the study of APOL1, the first CKD genetic link to descendants of West Sub-Saharan Africa.  Delphi consensus and systematic review on diagnosis, education and care of patients with APOL1-associated nephropathy will be published in 2020. Jones-Smith was recently appointed by Governor Greg Abbott to the Texas Chronic Kidney Disease Task Force. She also belongs to the We Work for Health Texas Coalition, Honor the Gift Campaign, SAAACAM, San Antonio Business Journal Leadership Trust, American Association of Kidney Patients, and the San Antonio Hispanic Chamber of Commerce. Jones-Smith serves as the President and Chief Executive Officer of Dynamic Life Press. She is also the CEO of the Texas Kidney Foundation. See omnystudio.com/listener for privacy information.

Tiffany Jones-Smith is a people connector. With over 20 years of experience in nonprofit and private business, she has a reputation for opening the lines of communication between clients, organizations and businesses. She leverages influence and experience to form strategic alliances. Jones-Smith is the host of the popular 930 AM radio show and VLOG On the Record with Tiffany. She holds a Public Leadership Credential from Harvard Business School Online along with a BA in Journalism and Foreign Service from Baylor University and a certificate in Italian studies from L’Universita per Stranieri in Perugia, Italy. Tiffany attended high school at MaryMount International School in Rome, Italy. Tiffany is a journalist, businesswoman, and healthcare advocate. “The United States has a broken healthcare system. The current system compensates providers for taking care of people who are sick. We need a healthcare system that compensates providers for making patients better. My goal is to fix the broken system.” She strives to close the gap in healthcare disparities by addressing obesity, diabetes, hypertension and social determinants of health. She believes we have a broken healthcare system. An ideal system would reward providers based on improved health outcomes for patients. With 140 million Americans below the poverty line, addressing healthcare outcomes is her focus. Jones-Smith is a writer and advocate. She draws from her professional and personal experiences when writing. She has been published in national, state and local publications. Her recent work is a research paper authored with 18 colleagues as a member of the APOL1 in Chronic Kidney Disease (CKD) Delphi Consensus, a group of investigators dedicated to the study of APOL1, the first CKD genetic link to descendants of West Sub-Saharan Africa.  Delphi consensus and systematic review on diagnosis, education and care of patients with APOL1-associated nephropathy will be published in 2020. Jones-Smith was recently appointed by Governor Greg Abbott to the Texas Chronic Kidney Disease Task Force. She also belongs to the We Work for Health Texas Coalition, Honor the Gift Campaign, SAAACAM, San Antonio Business Journal Leadership Trust, American Association of Kidney Patients, and the San Antonio Hispanic Chamber of Commerce. Jones-Smith serves as the President and Chief Executive Officer of Dynamic Life Press. She is also the CEO of the Texas Kidney Foundation. See omnystudio.com/listener for privacy information.

Tiffany Jones-Smith is a people connector. With over 20 years of experience in nonprofit and private business, she has a reputation for opening the lines of communication between clients, organizations and businesses. She leverages influence and experience to form strategic alliances. Jones-Smith is the host of the popular 930 AM radio show and VLOG On the Record with Tiffany. She holds a Public Leadership Credential from Harvard Business School Online along with a BA in Journalism and Foreign Service from Baylor University and a certificate in Italian studies from L’Universita per Stranieri in Perugia, Italy. Tiffany attended high school at MaryMount International School in Rome, Italy. Tiffany is a journalist, businesswoman, and healthcare advocate. “The United States has a broken healthcare system. The current system compensates providers for taking care of people who are sick. We need a healthcare system that compensates providers for making patients better. My goal is to fix the broken system.” She strives to close the gap in healthcare disparities by addressing obesity, diabetes, hypertension and social determinants of health. She believes we have a broken healthcare system. An ideal system would reward providers based on improved health outcomes for patients. With 140 million Americans below the poverty line, addressing healthcare outcomes is her focus. Jones-Smith is a writer and advocate. She draws from her professional and personal experiences when writing. She has been published in national, state and local publications. Her recent work is a research paper authored with 18 colleagues as a member of the APOL1 in Chronic Kidney Disease (CKD) Delphi Consensus, a group of investigators dedicated to the study of APOL1, the first CKD genetic link to descendants of West Sub-Saharan Africa.  Delphi consensus and systematic review on diagnosis, education and care of patients with APOL1-associated nephropathy will be published in 2020. Jones-Smith was recently appointed by Governor Greg Abbott to the Texas Chronic Kidney Disease Task Force. She also belongs to the We Work for Health Texas Coalition, Honor the Gift Campaign, SAAACAM, San Antonio Business Journal Leadership Trust, American Association of Kidney Patients, and the San Antonio Hispanic Chamber of Commerce. Jones-Smith serves as the President and Chief Executive Officer of Dynamic Life Press. She is also the CEO of the Texas Kidney Foundation. See omnystudio.com/listener for privacy information.

  Dr. Carolyn Lam: Welcome to Circulation On The Run, your weekly podcast summary and backstage pass to the Journal and its editors. I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: I'm Greg Hundley, associate editor from the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr. Carolyn Lam: Greg, you know I'm vegetarian and any paper on plant-based diet will always interest me, and of course, we have one as a featured paper this week, very interestingly talking about changes in plant-based diet quality, meaning that there could be good plant-based diets and not so good plant-based diets. I mean we all know that potato chips, for example, are still plant-based. But, anyways, so this feature paper discusses the changes in these plant-based diet quality and association with total and cost-specific mortality. Neat, huh? Dr. Greg Hundley: Yeah. I can't wait to hear about that one. I know that's a favorite topic of yours. How about if we have a sip of coffee and jump into our other articles? Dr. Carolyn Lam: Sure. I'm sipping away, and have already picked my first paper. This talks about mutations in plakophilin 2, which are the most common cause of gene-positive familial arrhythmogenic right ventricular cardiomyopathy. Dr. Greg Hundley: No quizzes for me on plakophilin 2, please. Dr. Carolyn Lam: All right, well, let me tell you all about it. Plakophilin 2 is classically defined as a protein of the desmosome, which is an intracellular adhesion structure. Studies though have suggested that plakophilin 2 also translates information at the initiation. Recent studies have also shown that plakophilin 2 translates information initiated at the site of cell to cell contact into intracellular signals that maintain structural and electrical homeostasis. Now, the important thing is that mutations in plakophilin 2 associated with most cases of gene-positive arrhythmogenic right ventricular cardiomyopathy or ARVC. However, the molecular and cellular mechanisms responsible for arrhythmias in ARVC remain unclear. Dr. Carolyn Lam: In today's paper, Doctors Delmar and Cerrone from New York University School of Medicine and their colleagues studied the role of cardiomyocyte plakophilin-2 expression in cardiac function. To do that, they utilized a cardiomyocyte-specific, tamoxifen-activated, plakophilin-2 knockout murine line. They found that loss of plakophilin-2 expression caused, as an early event and predominantly in the right ventricle, a non-transcriptional and likely arrhythmogenic, connexin-43-dependent disruption of calcium homeostasis. Dr. Carolyn Lam: The phenotype included accumulation of calcium in three intracellular compartments, the junctional sarcoplasmic reticulum, the cytoplasm, and the mitochondria. Right ventricular myocytes also showed increased eagerness of ryanodine-receptor-2 channels to release calcium from the sarcoplasmic reticulum. Intrinsic ryanodine-receptor-2 properties were also modified further contributing to the pro-arrhythmogenic state. In summary, the authors postulated that disruption of calcium homeostasis in the right ventricle is a major arrhythmia trigger in patients with ARVC. The data identified both the ryanodine-receptor-2 channel and the connexin-43 hemichannel as targets for antiarrhythmic therapy in this population. Dr. Greg Hundley: Very interesting that ARVC is such a worrisome concern, and gathering this mechanistic information is just so helpful. Dr. Carolyn Lam: Exactly. Dr. Greg Hundley: I have a basic science paper, but it was actually interesting because of the conduct was in many, many human subjects. It emanates from the large Million Veteran Program. There are a whole list of coauthors that are recognized as equal contributors, but Scott Damrauer actually serves as the corresponding author from the VA Medical Center. What it's addressing, about 13% of African American individuals carry two copies of the APOL1 risk alleles, G1 or G2, that are associated with a one and a half to two and a half fold increase in the risk of chronic kidney disease. Dr. Greg Hundley: There've been conflicting reports as to whether an association exists between these APOL1 risk alleles and cardiovascular disease independent of the effects of the APOL1 on kidney disease. Here, the investigators thought to test the association of these G1 and G2 alleles with coronary artery disease, peripheral arterial disease, and stroke among African American individuals in the Million Veterans Program. Dr. Carolyn Lam: Seems like a great study population and designed to look at this. What did they find? Dr. Greg Hundley: Among 30,903 African American Million Veterans Program participants, 3,941 or about 13% carried the two APOL1 risk allele, high-risk genotype. Individuals with normal kidney function at baseline with the two risk alleles had a slightly higher risk of developing coronary artery disease compared to those with no risk alleles. Similarly, modest associations were identified with incident stroke and peripheral arterial disease. However, when modeling both cardiovascular and renal outcomes, APOL1 was strongly associated with incident renal disease while no significant association with the cardiovascular disease endpoints could be detected. In conclusion, what the authors are indicating is that the APOL1 risk variants display a modest association with cardiovascular disease, and this association is likely mediated by the already previously known association of APOL1 with chronic kidney disease. Dr. Carolyn Lam: Interesting. Dr. Carolyn Lam: My next paper also has to do with chronic kidney disease and this time looking at metformin use and clinical outcomes in patients with diabetes with or without heart failure or kidney dysfunction. We know that metformin is the first-line therapy for type 2 diabetes, although its effects on the cardiovascular system are actually, not fully proven. In this next paper, the authors examine metformin use in the SAVOR-TIMI 53 Trial. Dr. Greg Hundley: Tell us a little bit about that SAVOR-TIMI 53 Trial. How is that organized? Dr. Carolyn Lam: Just as a reminder, the SAVOR-TIMI 53 trial was a multinational, randomized, controlled cardiovascular outcomes trial that compared the dipeptidyl peptidase-4 or DPP4 inhibitor, Saxagliptin, with placebo, enrolling almost 16,500 patients with type 2 diabetes and cardiovascular disease or elevated cardiovascular risk. Dr. Carolyn Lam: Now, in the current paper led by Dr. Bergmark from TIMI study group in Brigham and Women's Hospital and Harvard Medical School, the authors performed the post hoc analysis and looked at patients in SAVOR-TIMI 53 with baseline biomarker samples of whom there were more than 12,000 patients and classified these patients as ever versus never taking metformin during the trial period. The associations between metformin exposure and outcomes were estimated using inverse probability of treatment weighting, Cox modeling. Dr. Carolyn Lam: They found that among patients with type 2 diabetes and high cardiovascular risk in the SAVOR-TIMI 53 trial, metformin use was associated with lower rates of all-cause mortality including after adjustment for clinical variables and biomarkers, however not lower rates of the composite endpoint of cardiovascular death, MI or stroke. This association was most apparent in patients without prior heart failure or moderate to severe chronic kidney disease. Dr. Greg Hundley: Excellent. Dr. Greg Hundley: I'm going to transition to another clinical trial and this one is looking at ezetimibe in elderly patients and looking at efficacy for preventing cardiovascular-related events. The paper comes from Yasuyoshi Ouchi from Toranomon Hospital in Japan. Evidence regarding the primary prevention of coronary artery disease events by LDL-C/lipid-lowering therapy in order individuals that are above the age of 75 years, is somewhat incomplete. This trial tested whether LDL-C lowering with ezetimibe is useful for the primary prevention of cardiovascular events in older patients. They implemented a multicenter, prospective, randomized but open-label, blinded, endpoint, however, evaluation design conducted among 363 medical institutions in Japan. Dr. Greg Hundley: In the study, there're 3,796 patients that are aged greater than 75 years with elevated LDLC without a history of coronary artery disease that already were receiving dietary counseling. They're randomly assigned one-to-one to receive as ezetimibe 10 milligrams once daily versus usual care with their randomization stratified in a block design on age, sex, and baseline LDL-C. The primary outcome is the composite of sudden cardiac death, myocardial infarction, coronary revascularization, and stroke. Dr. Carolyn Lam: Ooh, so tell us the results. Dr. Greg Hundley: There were several patients that had to be excluded, so what ended up happening, there's 1,716 and then 1,695 that are included in each of the two respective arms for the primary analysis. What they found is that as ezetimibe reduced the incidents of the primary outcome. Then, regarding some secondary outcomes, the incidents of composite cardiovascular events and coronary revascularization were lower in the ezetimibe group than in the control group. But, there was no difference in the incidents of stroke, all-cause mortality, or adverse events in the two different groups. Dr. Carolyn Lam: Can you sum it up for us, Greg? What should we take home regarding ezetimibe and what further do we need to do? Dr. Greg Hundley: Good point, Carolyn. I think what we can take away from this study is that LDL-C lowering therapy with ezetimibe prevented cardiovascular events, suggesting the importance of LDL-C lowering for primary prevention in individuals greater than 75 years of age with an elevated LDL-C. However, remember, it was open label, so I think a placebo, controlled, randomized clinical trial will be required to validate the data that were obtained in this study. I think another study is probably going to be needed. Dr. Carolyn Lam: Thanks, Greg. Well, let's move on to our feature discussion, shall we? Dr. Carolyn Lam: Today's feature paper is of personal interest to me and I'm sure of widespread interest to everybody. Why? It's on plant-based diet. We've heard a lot about it. I'm vegetarian and very, very loudly self-confessed, but does the quality of a plant-based diet actually matter? Such an important question. Dr. Carolyn Lam: I'm so pleased to have the authors of this very remarkable paper, Dr. Megu Baden as well as Dr. Shilpa Bhupathiraju, both from the Harvard T.H. Chan School of Public Health; and our associate editor, Dr. Mercedes Carnethon from Northwestern University Feinberg School of Medicine. Welcome, ladies. What a nice chat we're going to have on this very personal topic to me as well. Dr. Carolyn Lam: First of all, maybe, could I ask, Shilpa, do we need another study on plant-based diet? Could you tell us the rationale for what you did this time? Dr. Shilpa Bhupathiraju: Like you said, when we talk about plant-based diets and what people usually think is, well, it's vegetarian or not. But, I think there's much more to a vegetarian diet. It's the quality that matters. Previous studies really then differentiate the quality of a vegetarian diet. To this extent, we developed plant-based diet indices, which actually capture the quality of a plant-based diet, so we have an overall plant-based diet index which captures the amount of plant-based foods; a healthy plant-based diet index, which captures the quantity of healthy plant-based foods; and again, the unhealthy plant-based diet index, which captures the quantity of unhealthy, plant-based foods. Dr. Carolyn Lam: Thanks. Meg, if you don't mind, I know everybody is asking this as they're listening. Could you give us some examples of what an unhealthy plant-based diet index would consist of compared to healthy? Then, perhaps, tell us a little bit about your study and what you found. Dr. Megu Baden: First of all, let me explain again. In this study, we use three versions of plant-based diet indices that can assess the quality of plant foods in general population. The first index is an overall plant-based diet index, PDI for short. A second one is a healthful plant-based diet index, HPDI. The third one is an unhealthful plant-based diet index, UPDI. In order to create these indices, we divide all food groups into three larger categories. One is the healthy plant foods, which contains whole grains, fruits, vegetables, nuts, legumes, vegetable oils, tea, and coffee; less healthy plant foods such as fruits juice, refined grains, potatoes, sugar-sweetened beverages, and sweets or desserts; and animal foods, which is animal food, dairy, eggs, fish, meat, miscellaneous animals-based food. Dr. Megu Baden: We investigated the association between preceding trailblazing changes in these indices and subsequent total and cause basic mortality in two large US cohorts. We found that compared with participants whose diet remained stable, the hazard ratio for total mortality, among those risks, the greatest increase in PDI was 0.95; for the greatest increase in HPDI, the healthful versions of the PDI was 0.90; and the greatest increasing in unhealthful PDI was 1.12. In contrast, the hazard ratio among participants with the greatest difficulty is in PDI, was 1.09; the greatest decrease in healthful PDI was 1.10; and the greatest decreasing in unhealthful PDI was 0.93. For CVD mortality, the risk was 7% lower for our 10 point increase in PDI, and 9% lower for HPDI and 8% higher for UPDI. Dr. Megu Baden: In summary, we found that improving plant-based diet quality over a 12-year period was associated with a lower risk of total and CVD mortality, whereas increased consumption of unhealthful plant-based diet was associated with a higher risk of total and CVD mortality. Dr. Carolyn Lam: Could I ask, Shilpa, to maybe add a line of ... have you applied this information in any way yourself or with patients, or is there an overwhelming take-home message you'd like people to remember? Dr. Shilpa Bhupathiraju: Yeah, I'm not a clinician myself, but I'm a public health researcher. I'm in India currently and I'm giving a talk to South Asians and the emphasis on vegetarianism. But, again, the quality of the vegetarianism is important. Being a vegetarian is not enough, but what goes into it is really important. If it's a white rice and sugar-sweetened beverages, it's not good, so really the emphasis should be on whole grains, consuming more nuts and legumes. I think that's important. Dr. Carolyn Lam: Oh, that's great. Mercedes, we've discussed this paper as associate editors, so proud to be publishing this in circulation. Could you share some of your thoughts on the implications of these findings? Dr. Mercedes Carnethon: The authorship team has done an outstanding job of clarifying a very complicated issue. I think what we really like about this and the ways in which it really adds to the literature, what you point out, that every vegetarian diet isn't the same. I was very impressed with the thought that went into classifying vegetarian foods as healthy or unhealthy. I would be interested in hearing more from the authors, particularly, since I feel they did a good job of how they dealt with complicated foods or mixed foods. I think one example given was a pizza, which has tomato sauce, but it also has other things, so I would love to hear from the authors how they classified complicated foods. Dr. Shilpa Bhupathiraju: The decision to classify pizza as an animal food was somewhat, I would say, arbitrary. I do agree that there's lots of tomato sauce, but again, I think the decision that went to it, it does have a ton of cheese, processed cheese, I think that's why we classified that as an animal food. The other complicated foods are mixed dishes that we struggled with were cream soups. We thought about what the base was or what the general preparation of that would be. Given that heavy cream is a major ingredient, so those were again, classified as animal foods. Dr. Mercedes Carnethon: I think there's a lot of logic in that and I really like the thought and care that you put into that. The other questions I have, I feel that you did a really nice job of, are even portion sizes. Tell me how you handled portions. Dr. Megu Baden: We basically take the information from our food frequency questionnaire. All of them are per the serving sizes, so we considered how participants reported how often on average they had consumed each food of our standard portion size in the past year. I know it's difficult to indicate the portion size. Shilpa, would you add something for the portion size for that? Dr. Shilpa Bhupathiraju: Yes. Like Megu said, we use standardized portioning sizes, so a cup of fruit, a cup of vegetables, an eight-ounce, or a cup of tea or coffee, so that's how we use what people use in general. The portion sizes are all specified on the food frequency questionnaire, so the nurses or the health professionals, they understand exactly what they're reporting. Is it a glass of fruit juice or half a glass? Then, we can word those frequencies into standardized serving sizes onto servings per day. Dr. Carolyn Lam: Great. Shilpa, could I follow up from Mercedes very important question? How does the index account for portion size too, as an is too much of even a good thing become a bad thing? You know what I mean? Dr. Shilpa Bhupathiraju: The index itself is a score. The way we capture it, as you know, everything is converted from frequencies into servings per day for each participant. Then, what we did was we divided the participants based on the distribution of the data into quintiles. Those in the highest category of the healthy plant foods received the highest points. The scoring varied a little bit based on which index we were calculating. But, in general, what we did was we divided everybody into five groups or quintiles. Then, the scoring varied depending on what we were calculating. For the HPDI, which is the healthy plant-based diet index, those in the fifth group or the highest intake received the maximum number of points, which was five. For the unhealthy plant-based diet index, those people received the reverse scoring, so they received zero points. Essentially, the participants were divided into quintiles and the scoring was done accordingly. Dr. Carolyn Lam: Maybe I could ask you a question on a different track, and I'm not sure if you have some answers here, but I noticed that your study population was impressive, almost 49,500 women from the Nurses' Health Study, almost 26,000 men from the Health Professionals Follow-up Study. Did you find any sex differences? Dr. Shilpa Bhupathiraju: We didn't find any sex differences. We did some sensitivity analysis by cohort and we didn't find a statistically significant interaction, which is I think good to note because we would expect the effects to be similar in men and women. Dr. Carolyn Lam: I think both men and women need to hear that. None of us are excused from, I suppose, trying to gear towards a healthy plant-based diet. I think that's what I'm hearing. Mercedes, do you have more thoughts to add? Dr. Mercedes Carnethon: I do. One thing I really like about this particular paper is the way the you acknowledge some of the limitations that we face when interpreting findings from observational studies, particularly observational studies of a health behavior when we know that health behaviors often cluster or correlate with other health behaviors. Can you tell us a little bit about some of the cautions and interpretation that you certainly acknowledged and presented very well? Dr. Shilpa Bhupathiraju: Sure. Our primary analysis was looking at changes, so long-term changes. When people change a diet or their lifestyle, they change something else. As you can see from our paper, those who improve the plant-based diet quality, we're also, in general, tended to be healthier. This being an observational study, we tried to control for those as to the greatest extent possible, but again, they could be residual confounding. We maybe failed to measure for certain things that we were unaware of or that we did not measure. I think we really can't get at causality, but I think the consistency of the evidence from our previous papers and from this paper point to a suggestion that improving plant-based diet quality is definitely associated with better health outcomes and a lower risk of death. But, again, it is important to know that this is observational and there could be changes in other health behaviors that we did not measure that could explain this association. But, we did as well of a job as we could in trying to control for these changes and other behaviors, lifestyles or even health conditions. Dr. Mercedes Carnethon: Thank you. Dr. Carolyn Lam: Thank you so much, Meg and Shilpa. You've been listening to Circulation on the Run. Don't forget to tune in again next week. Dr. Carolyn Lam: This program is copyright American Heart Association 2019

Jane Ferguson:                 Hello, welcome to Getting Personal: Omics of the Heart. It is June 2018, and this is podcast episode 17. I'm Jane Ferguson, an assistant professor of medicine at Vanderbilt University Medical Center, and a proponent of precision medicine, genomics, and finding ways to prevent and treat heart disease. Jane Ferguson:                 This podcast is brought to you by Circulation: Genomic and Precision Medicine, and the AHA Council on Genomic and Precision Medicine. Jane Ferguson:                 For our interview this month, early career member, Jennie Lin talked to Beth McNally about science and careers in genomic medicine. We'll have more on that later but first I want to tell you about the cool papers we published in the journal this month. Jane Ferguson:                 First up, Orlando Gutierrez, Marguerite Irvin, Jeffrey Kopp, Cheryl Winkler, and colleagues from the University of Alabama at Birmingham, and the NIH, published an article entitled APOL1 Nephropathy Risk Variants and Incident Cardiovascular Disease Events in Community-Dwelling Black Adults. This study was conducted in over 10 thousand participants of the Reasons for Geographic and Racial Differences in Stroke, or, REGARDS Study. They examined associations between APOL1 variants and incident coronary heart disease, ischemic stroke, or composite CVD outcome. Because there are coding variants in the APOL1 Gene that are only found in individuals of African ancestry, these are hypothesized to contribute to the disparities in cardiovascular and renal disease in African Americans. Jane Ferguson:                 The authors found that carrying the risk variants was associated with increased risk of ischemic stroke, but only in individuals who did not have diabetes, or chronic kidney disease. They hypothesize that because diabetes and kidney disease already increase CVD risk, the variant does not have an additional effect on risk in individuals with existing comorbidities. But, it contributes to small vessel occlusion and stroke in individuals without diabetes. Jane Ferguson:                 They also found that the magnitude and strength of the association became stronger in a model adjusted for African ancestry, suggesting an independent effect of the APOL1 risk variants. Jane Ferguson:                 While future work is needed to study this more, this is an important step in understanding the complex relationship between APOL1 and disease. Jane Ferguson:                 Next up, Daniela Zanetti, Erik Ingelsson, and colleagues from Stanford, published a paper on Birthweight, Type 2 Diabetes, and Cardiovascular Disease: Addressing the Barker Hypothesis with Mendelian Randomization. The Barker Hypothesis considers that low birthweight as a result of intrauterine growth restriction, causes a higher future risk of hypertension, type 2 diabetes, and cardiovascular disease. However, observational studies have been unable to establish causality or mechanisms. Jane Ferguson:                 In this paper, the authors used Mendelian Randomization as a tool to address causality. They used data from the UK Biobank, and included over 237,000 participants who knew their weight at birth. They constructed genetic predictors of birthweight from published genome wide association studies, and then looked for genetic associations with multiple outcomes, including CAD, stroke, hypertension, obesity, dyslipidemia, dysregulated glucose and insulin metabolism, and diabetes. Jane Ferguson:                 The Mendelian randomization analysis indicated that higher birthweight is protective against CAD type 2 diabetes, LDL cholesterol, and high 2 hour glucose from oral tolerance test. But, higher birthweight was associated with higher adult BMI. This suggests that the association between low birthweight and higher disease risk is independent of effects on BMI later in life. While the study was limited to a well nourished population of European ancestry, and would need to be confirmed in other samples, and through non-genetic studies, it suggests that improving prenatal nutrition may be protective against future cardiometabolic disease risk. Jane Ferguson:                 Laura Muino-Mosquera, Julie De Backer, and co-authors from Ghent University Hospital, delved into the complexities of interpreting genetic variants, as published in their manuscript, Tailoring the ACMG and AMP Guidelines for the Interpretation of Sequenced Variants in the FBN1 Gene for Marfan Syndrome: Proposal for a Disease- and Gene-Specific Guideline. Jane Ferguson:                 With a large number of variants being uncovered through widespread sequencing efforts, a crucial challenge arises in their interpretation. The American College of Medical Genetics and Genomics, and the Association for Molecular Pathology put forward variant interpretation guidelines in 2015, but these were not tailored to individual genes. Because some genes have unique characteristics, the guidelines may not always allow for uniform interpretation. Jane Ferguson:                 In their manuscript, the authors focused on variants in fibrillin-1 that cause Marfan Syndrome, and reclassified 713 variants using the guidelines, comparing those classifications to previous in-depth methods which had indicated these variants' causal or uncertain significance. They find 86.4% agreement between the two methods. Jane Ferguson:                 Applying the ACMG, AMP guidelines without considering additional evidence may thus miss causal mutations. And it suggests that adopting gene specific guidelines may be helpful to improve clinical decision making and accurate variant interpretation. Jane Ferguson:                 Delving deeper into FBN1 and Marfan Syndrome, Norifumi Takeda, Ryo Inuzuka, Sonoko Maemura, Issei Komuro, and colleagues from the University of Tokyo examined the Impact of Pathogenic FBN1 Variant Types on the Progression of Aortic Disease in Patients With Marfan Syndrome. They evaluated 248 patients with pathogenic, or likely pathogenic, FBN1 variants, and examined the effect of variant subtype on severe aortopathy, including aortic root replacement, type A dissections, and related death. They found that the cumulative aortic event risk was higher in individuals with haploinsufficient type variants, compared with dominant negative variants. Jane Ferguson:                 Within individuals with dominant negative variants, those that affected Cysteine residues, or caused in-frame deletions, were associated with higher risk compared with other dominant negative mutations, and were comparable to the risk of the haploinsufficient variants. These results highlight the heterogeneity and risk of the FBN1 variants, and suggest that individuals with haploinsufficient variants, and those carrying dominant negative variants affecting Cysteine residues or in-frame Deletions, may need more careful monitoring for development of aortic root aneurysms. Jane Ferguson:                 Lydia Hellwig, William Klein, and colleagues from the NIH, investigated the Ability of Patients to Distinguish Among Cardiac Genomic Variant Subclassifications. In this study, they analyzed whether different subclassifications of variants of uncertain significance were associated with different degrees of concern amongst recipients of genetic test results. 289 subjects were recruited from the NIH ClinSeq Study, and were presented with three categories of variants, including variants of uncertain significance, possibly pathogenic, and likely pathogenic variants. Participants were better able to distinguish between the categories when presented with all three. Whereas, a result of possibly pathogenic given on its own, produced as much worry as a result of likely pathogenic. The authors conclude that multiple categories are helpful for subjects to distinguish pathogenicity subclassification, and that subjects receiving only a single uncertain result, may benefit from interventions to address their worry and to calibrate their risk perceptions.  Jane Ferguson:                 Erik Ingelsson and Mark McCarthy from Stanford, published a really nice review article entitled Human Genetics of Obesity and Type 2 Diabetes: Past, Present, and Future. Over the past decade, we've had a lot of excitement, optimism, and also disappointment in what genome-wide association studies can deliver. Doctors Ingelsson and McCarthy do a great job laying out the history and the successes in the field of genetic interrogation of obesity and diabetes, as well as acknowledging where reality may not live up to the hype, what challenges remain, and what the future may hold. They also have a figure that uses an analogy of a ski resort to emphasize the importance of taking a longitudinal perspective. And I would argue that any paper that manages to connect apres-ski with genomics is worth reading, for that alone. Jane Ferguson:                 Robert Roberts wrote a perspective on the 1986 A.J. Buer program, pivotal to current management and research of heart disease. Highlighting how the decision by the AHA in 1986 to establish centers to train cardiologists and scientists in molecular biology, has led to huge advances in knowledge and treatment of heart disease. Jane Ferguson:                 Finally, rounding out this issue, Kiran Musunuru and colleagues, representing the AHA Council on Genomic and Precision Medicine, Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Cardiovascular Radiology and Intervention, Council on Peripheral Vascular Disease, Council on Quality of Care and Outcomes Research, and the Stroke Council, published a scientific statement on Interdisciplinary Models for Research and Clinical Endeavors in Genomic Medicine. Jane Ferguson:                 This paper lays out the field of cardiovascular research in the post genomic era, highlights current practices in research and treatment, and outlines vision for interdisciplinary, translational research and clinical practice, that could improve how we understand disease, and how we use those understandings to help patients. Jane Ferguson:                 Our guest interviewer today is Dr. Jennie Lin, an Assistant Professor at Northwestern Universities Feinberg School of Medicine, and the incoming Vice Chair of the Early Career Committee of the AHA Council on Genomic and Precision Medicine. As an aside, Jennie is a great person to follow on Twitter for insights into genomics and kidney disease, and as a bonus, she also posts the occasional dog photo. So she's well worth following just for that. You can find her on Twitter @jenniejlin. As you'll hear, Jennie talked to Dr. Beth McNally about her view on genomic medicine, and Beth also shared some really great practical tips for early career investigators building their independent labs. So make sure you listen all the way to the end. Take it away Jennie. Dr. Lin:                                  Thank you for tuning in to this edition of Getting Personal: Omics of the Heart, a podcast by the Genomic and Precision Medicine Council of the American Heart Association, and by Circulation: Genomic and Precision Medicine. Today I am joined by Dr. Elizabeth McNally, the Elizabeth J Ward Professor of Genetic Medicine, and director of the Center for Genetic Medicine at Northwestern University. Beth, thank you for taking time to chat with all of us. Dr. McNally:                       Happy to be here. Dr. Lin:                                  As a successful physician scientist, you have been interviewed in the past about your life, your scientific interests, and advice for budding investigators. I don't want to rehash everything you have already stated beautifully in an interview with Circ Res, for example. But instead wanted to focus more on your views of genetic medicine and genome science today. Dr. Lin:                                  So you mentioned in that prior Circ Res interview that you started your laboratory science training and career during college, when you participated in a project focused on genetic variation among children with muscular diseases. What have you found to be most interesting about the process of identifying functional genetic variants back then, and also that on-going work now. Dr. McNally:                       Well, I think over the years I've been doing this is the tools have gotten so much better, to be able to actually define the variants much more comprehensibly than we ever could in the past. And then also to be able to study them, and very much to be able to study them in context. And so I look at the revolutions in science that will cause people to look back on this era as the era of genetics. It began obviously with PCR, we couldn't have gotten anywhere without that. Dr. Lin:                                  Right. Dr. McNally:                       And then you leap forward to things like next generation sequencing, and IPS cells, and now CRISPR/Cas gene editing. And to realize that the last three happened within a decade of each other, is going to be so meaningful when you think about the next few decades, and what will happen. So being able to take an IPS cell and actually study a mutation or a variant in context of that patient, the rest of their genome, is really important to be able to do. Dr. Lin:                                  Okay, Great. And so, where do you envision ... with taking say for example, this next gen. technology, CRISPR/Cas9, studying variants in an IPS cell, for example. How do you envision this really revolutionizing the study of human genetics for patients? And how far do you think we've come in fulfilling that vision, and what do you think should be our focus going forward? Dr. McNally:                       I think broadly thinking about human genetics we're really very much still at the beginning, which I know is hard to say and hard to hear. But, we've spent a lot of the last 15 years very focused on that fraction of the genome that has high frequency, or common variation, through a lot of the GWA studies. With those common variants, we had a lot of associations, but relatively small effects of a lot of those, causing a lot of people to focus on the missing heritability and where we might find that hiding. And of course, now that we have deep sequencing, and we have deep sequencing where we've really sampled so much more of the genome, and from so many more people, I think we're just at the beginning of really appreciating that rare variation. And beginning again to really appreciate that 80-85% of the variation that's in each of our genomes is really characterized as rare. Dr. McNally:                       And so we really each are quite unique, and that when we understand a variant we do have to understand it in the context of all that other variation. So computationally that's very challenging to do. Obviously requires larger and larger data sets. But even in doing that, you are not going to find exact replicates of the combinations that you see in any one individual. While I know everybody would love that we're going to have the computational answer to all of this, it's still going to come down to a physician and a patient and making what you think is that best decision for the patient, based hopefully on some genetic data that helps inform those decisions. Dr. Lin:                                  Right, right. So it kind of gets into this whole concept of precision medicine, which has gained a lot of popularity and buzz in recent years, and Obama has really brought it to the forefront in the public arena. You mention rare variants in ... finding rare variants in each patient, for example. And moving a little bit away from some of the common variants that we find in GWAs. What does it mean for a patient to have a rare variant and come see you in your cardiomyopathy clinic, is it going to be precision for that patient, or suing rare variants among many different individual patients to try to find function for a gene? Dr. McNally:                       It's a great question. So I think the first way we approach it is, it depends who's asking the question. So if it's somebody who comes to me who has cardiomyopathy, or has a family history of cardiomyopathy and sudden death, that's a very different question to ask what's going on with their rare variants, for example in cardiomyopathy genes. Now if you translate that over to, I have a big population of people, I don't particularly know what their phenotype is, and I see rare variants for cardiomyopathy, those are two fundamentally different questions. So we very much know a lot about how to interpret rare variants for cardiomyopathy in the context of a patient or a family who has disease, and I do emphasize the latter part of that, the family, working with families and seeing how variants segregate within families. We interpret that very differently, and I think it's appropriate to interpret that very differently in that context. And that's completely different than again, going against what is the regular population, notice I'm not calling it normal population- Dr. Lin:                                  Right. Dr. McNally:                       ... but the general population that's out there. The first step in doing that is the list of the ACMG, American College of Medical Genetics, actionable genes. So this is an interesting question in and of itself. It's 59 genes, of course that list is too small, and it should be bigger than that, and ultimately that will happen. But to take a population based approach to those actionable genes, and looking across the population, finding someone who's got variants in, lets say our favorite genes MYH7, MYBPC3. Knowing what that risk means on a population level is very different than knowing what that means in the context of a patient who comes to you, who has that variant, runs in their family, and has clear disease. Those again, really two different questions, and we have to come up with what's the best practices on that, how to answer either of those questions. Dr. McNally:                       I think the first step working with patients and families who have known disease and have clear variants that segregate with disease, I think its very powerful. I think we've probably got close to a good decade of doing that already. It's incredibly useful for those patients and families. It helps us reduce their risk. It helps us treat them early, it helps us manage their arrhythmias. There's no question that that information is incredibly valuable, but we're still learning how to process that across the population, and how to answer that question for people who are coming who don't already have disease. Dr. Lin:                                  Right, right. That makes sense. And I guess that kind of plays into a follow up question about whether or not we need to test, or think about every variant of unknown significance in lab, and ... the- Dr. McNally:                       It's a great ... You know again, you always have to very carefully consider the context in which the question's being asked. So again, if you're talking about a relatively normal population, well, walking, healthy person, and you're seeing variants of uncertain significance, that's a very different question than somebody who's coming in to you with cardiomyopathy and has a highly suspicious variant of uncertain significance that falls right within the head domain of MYH7. We know a lot about that, and we can do a lot of interpretation in that case. Dr. McNally:                       However, I would say that to put too much value on what we do in the research lab ... Just putting a regulatory hat on for a second and thinking about it, there's nothing from a regulatory standpoint that really validates what we do in the research lab, to say that we can really fairly adjudicate a VUS or not. We can't do that, that's over-valuing what we do in research lab. Dr. McNally:                       So I think, how do we consider variants among certain significance? I think it's really important to recognize that it's exactly that, it's a variant of uncertain significance. And so when you're a clinician taking that to a patient, you have to approach it from the standpoint of saying, this is a variant of uncertain significance. Which means we don't know whether it's pathogenic, but we also don't know that its benign. Because I think right now what we've seen, a lot of clinicians, and even researchers, fall into the path of this believing that variant of uncertain significance is the equivalent of benign. That's not true. It is simply ... That is a rare variant, and we don't know whether it's pathogenic or non-pathogenic. And hopefully overtime we will learn more to better assess that, and better provide the interpretation of what that means in the context of that patient. Dr. McNally:                       It's a good conversation to have. It's important to recognize they're not necessarily pathogenic, but they're also not necessarily benign. Dr. Lin:                                  Mm-hmm (affirmative). So do you see a role, for example, when you see this variant of uncertain significance, is there a role to go back into lab, for example, and try to knock that mutation to IPSC's and test to see if its pathogenic? Or is that going a step too far? Dr. McNally:                       In some cases, that is the right thing to do. Because genetics is so powerful, genetics doesn't only give you the association of a gene with an outcome, and GWAs was fabulous at doing that ... giving us a lot of variants, and often nearby genes, sometimes far away genes, but linking genes to phenotypes, and that's very powerful. But specific variants can actually tell you a lot about mechanism, about how a gene and protein actually function, and how it functions when it's broken. And so, particularly where you can gain a lot from the research front in understanding mechanism, then I think it's really powerful to take those things to the laboratory and to use that to learn about mechanism. Dr. McNally:                       Sometimes you can do it to help adjudicate whether something's pathogenic or not, but again, I think we want to be cautious in doing that. Because what we do in the res ... I always like to say, "What we do in the research lab isn't exactly CLIA certified." Dr. Lin:                                  Right. Dr. McNally:                       There isn't anything magical about what we do, but we definitely ... It is so powerful what's available out there in terms of the genetic variants, and teaching us about how genes and proteins interact. And so I think it is such a rich resource of information right now. The things I bring back to the laboratory, and get my students and trainees excited about working on, is usually where I think we can gain something new about mechanism. Dr. Lin:                                  Right, right, right. Since you are a role model physician scientist, and you think about questions in lab that will ultimately benefit your patients, and you are a genetic cardiologist. What are your thoughts on doing genome editing as a possible therapy for your patients? It's a little bit of a loaded question [crosstalk 00:21:51], it's a little bit controversial. Dr. McNally:                       So I think, no doubt CRISPR/Cas9 gene editing is transforming what we do in the research setting. It's a fantastic tool. Is it a perfect tool? No. Anybody who has been using it a lot in the lab knows that it is much better than anything we've had before, but still quite limited in fidelity and efficiency. And so imagining that we are going to do that in patients is still pretty daunting to me. We do enough gene editing in cells to know that you have to select through an awful lot of cells before you get the one that has the exact variant you are trying to make. So that's not something we can tolerate in the human setting. But we're not there yet, we know that. Dr. McNally:                       Many of the disorders I see clinically are things that are autosomal dominant due to very precise single base-pair changes. And so envisioning how we're going to correct only one copy of an allele and do in a very precise manner, we don't have those tools available yet. Now on the other hand, if you look at a disease like one of the diseases I spend a lot of time on, Duchenne muscular dystrophy, where the majority of mutations are deletions. It's X-linked, it's male, so there's only one copy of the gene, and we know a whole lot about the structure and function of the gene. We know that if we take out this other part we can skip around that mutation and make an internally truncated protein. That's actually a very good use of gene editing, because it only requires making deletions. They don't need to be very precise, and there's only one copy of it that you have to do the gene editing on. Dr. McNally:                       So I see that being something in the near term that will happen, simply because the genetics positions it well to be something where that could be successful. The hard part is still how are we going to get the guides, and how are we going to get the Cas9 in safely into all the cells that need to be treated? And ultimately that lands us back at looking at what our delivery vehicles are. Which at this point in time is still viral delivery, and still has a lot of issues around can we make enough of it? Are people immune to it? So all those questions that come with viral delivery. So still lots of hurdles, but you can see some paths where it makes sense to go forward. Dr. Lin:                                  Very interesting. Okay great. Well thank you for providing your thought on human genetics and genome science. We're going to switch gears for the last portion of this podcast, and talk about your thoughts on career development issues for young investigators. At a recent AHA Scientific Sessions meeting, you participated on a panel that was assembled to provide advice to early career scientists. When you were starting out, what were some of the biggest challenges you faced when you were transitioning to independence and building your own lab, and what's your advice to those facing the same challenges today? Dr. McNally:                       Well, even though I did it quite a few years ago, many of the things are still the same. Transitioning to independence, I think is easier if you pick up and move and start in a new place. I think it's much easier to establish your independence when you're not in the same place as your mentor. That said, we have many more people who now stay in the same place as where their mentors were and we have many more approaches towards doing that. So I think people are much more open to both possibilities as being ways of doing that. But at some level it still comes down to starting your own lab, and you hopefully have been given some start-up resources and you have to think about how to wisely spend them, and how to really get things going. I don't think this is changed either. Dr. McNally:                       I usually tell people, don't just start in one area, if you can, start in two areas because things don't work, and sometimes things do work. In reality when you look at people who are successful, they're often working in more than one area. And so the sooner you start getting comfortable working in more than one area, that's a good thing. Now ideally, they should be areas that have some relationship to each other, and then feed each other in terms of information so that they grow off each other. But what does that practically mean? I always say, "Well if you can hire two people and start them on two different paths, that's a really good way to get going." And practical things like look at all different kinds of private foundations and things like that for getting some good pilot start up money to help develop new projects in the lab. And always be looking at how can these projects help me develop a bigger data package, that's going to put me in a good competitive position for example bigger grants and federal funding, and things along those lines. Dr. McNally:                       Very much a stepwise process. People want to shoot for the moon and get the biggest things first, but sometimes just focusing on the smaller steps which are definitely achievable and building your path towards those bigger steps is the smarter way of doing it. Dr. Lin:                                  That's great advice. You also mentioned recently that young investigators should try to have as many mentors as possible. What advice would you have for, in particular, early career genomics investigators, for finding these mentors passed the postdoc phase? Some of us get introduced at the postdoc phase to maybe some other collaborating labs, but those are really collaborations of our mentors per se. Dr. McNally:                       Well I think especially in the field of genetics and genomics, collaboration is key, and I will say one of the things that has changed over since I started doing this is there is a lot more understanding of the need to collaborate. Not so many years ago, it wasn't really an independent investigator went and started a lab, and it would be your trainees and the papers would have only those people on it. Dr. McNally:                       I think these days, the best science is where you've tackled a problem from multiple different directions, one or two of those being genetics, genomics directions. And then sometimes there's other ways that you've approached that scientific problem. And by necessity, that usually involves collaborating with other people. And your role is sometimes to be the coordinator of all those collaborators, and that's where again you might be in a senior author position then doing that. But your role sometimes is to be the good collaborator. And so when I look at people being successful right now, seven, eight years in to running their own lab, I like to see that they've been the organizer of some of those, that they've collaborated with people who are even senior to them, and that they've established those good collaborations, but that they've taken the leading role in doing that. But also that they've had middle author contributions, that they've been a good collaborator as well. Dr. McNally:                       And so, part of that is not being afraid to collaborate, and to recognize the value of doing that. And what's so great about doing that is you can collaborate with people at your same institution where you are, but you can also collaborate with people all over the world, and I think that's what we do. You go to where you need somebody who is using a technique or an approach that really helps answer the question you want to have answered. And so that's reaching out to people and really establishing again that network and good collaborators which you can do by a whole bunch of ways. You can do it by meeting somebody at a meeting, scientific meeting. You can do it through emails, phone calls, Skype, all sorts of different ways that you can reach out and collaborate with people. Dr. McNally:                       It is easier than ever to share data and share ideas, but that negotiation of how to establish the terms of the collaboration and how to make it be successful is a critically important part of being a scientist. And what we now know when we look at the promotion process, is people who do that effectively, that's a really important mark of being a successful scientist, and marks them as somebody who should be promoted through the process. So great. Dr. Lin:                                  Yeah. No I agree. Certainly with the direction science is moving, it's definitely very difficult to work in a siloed manner. Dr. McNally:                       Yeah. Well you won't get very far. You'll be able to have some really good first ideas, and show some proof of principle approaches. But to really, really address an important scientific problem, we know that you have to see those signals using multiple different methods. And once you have five different ways showing you that that's the right answer, then you're much More confident that you've gotten to the right answer. Dr. Lin:                                  Right. Alright, so I think we're going to wrap up. Do you have any other final thoughts for any other young investigators or genomics researchers listening to this podcast? Dr. McNally:                       It's a great time to be doing genetics and genomics, and particularly human genetics, where we now finally have all this information on humans, and we'll have even more of it in the future. So I think humans are coming close to becoming a real experimental system. Dr. Lin:                                  Excellent. Alright well thank you so much for your time. It was a pleasure having you on this podcast. Dr. McNally:                       Great. Thank you for doing this. Jane Ferguson:                 As a reminder, all of our original research articles come with an accompanying editorial, and these are really nice to help give some more background and perspective to each paper. To read all of these papers, and the accompanying commentaries, log on to circgenetics.ahajournals.org. Or, you can access video summaries of all our original articles from the circgen website, or directly from our YouTube channel, Circulation Journal. And lastly, follow us on Twitter @circ_gen, or on Facebook, to get new content directly in your feed. Jane Ferguson:                 Okay, that is it from us for June. Thank you for listening, and come back for more next month.  

Host: Jennifer Caudle, DO Guest: Ashira Blazer, MD Did you know that African Americans are three times as likely to be diagnosed with lupus than other demographic groups? To make matters worse, being diagnosed with lupus doubles their risk of kidney disease, stroke, and heart attacks. To address this growing health threat among African Americans, Dr. Jennifer Caudle is joined by Dr. Ashira Blazer, Instructor in the Department of Medicine and Rheumatologist at NYU Langone Health, to discuss diagnosis, comorbidities, and various treatment options for your lupus patients. Correction Note: Dr. Blazer has updated that in the U.S., variation homozygosity for APOL1 is present in 13% of the African American population.

The TWiPsids solve the case of the Guatemalan Positive for Rhinovirus, and reveal how to kill all African trypanosomes with a primate apolipoprotein. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Become a patron of TWiP. Links for this episode: APOLs kill all African trypanosomes (Nat Micro) Trypanocidal properties of APOL1 on TWiP 85: Channeling tryps Letters read on TWiP 142 Case Study for TWiP 142 Woman in 50s, immigrant from rural area with limited resources. Admitted to hospital with iron deficient anemia and eosinophilia. In US. Sent for colonoscopy. Note long slender serpiginous motile object, recovered, 4.5 cm long, one end slender, other large and curled but not blunt. Send worm to parasitology lab for identification. What might fit description? Is this usually associated with eosinophilia? What about anemia, is severe or mild? Would this person have come from outside the US to acquire this, or could they have acquired the infection in the US. Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

For our inaugural episode, Dr. Kenan presents an extended discussion of APOL1 gene risk variants. Article discussed: www.ncbi.nlm.nih.gov/pubmed/21997394

For our inaugural episode, Dr. Kenan presents an extended discussion of APOL1 gene risk variants. Article discussed: www.ncbi.nlm.nih.gov/pubmed/21997394

Commentary by Dr. Valentin Fuster

Joey Verdi is a PhD candidate in the lab of Dr. Jayne Raper at CUNY-Hunter College, where he is conducting research on the apolipoprotein L-1 (apoL1) gene and its variants across multiple species of primates and monkeys. The apoL1 protein produced by this gene is a part of a larger complex of proteins termed trypanosome lytic factors (TLFs), which contribute to the innate immunity of primates against African trypanosomes, a flagellated parasite. Joey's work lends itself to the Transgenic Cattle Project and in this episode we discuss his involvement in this endeavor.

Vincent, Dickson, and Daniel explain how trypanolytic factor forms membrane channels to lyse trypanosomes, and present a new case study. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Links for this episode: Human trypanolytic factor forms channels (PNAS) Human paragonimiasis (MMWR) Don't eat raw crawfish Daniel and Dickson in studio (jpg) Image credit Letters read on TWiP 85 Contact Send your questions and comments (email or mp3 file) to twip@twiv.tv Subscribe Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Dr. Martin Pollak discusses his research identifying a gene variant with African ancestry.

Dr. Martin Pollak discusses his research identifying a gene variant with African ancestry.

Dr. Martin Pollak discusses his research identifying a gene variant with African ancestry.

Dr. Martin Pollak discusses his research identifying a gene variant with African ancestry.