Research
Research Center
Israel, despite its small size, has grown into a major player on the world science stage: According to an analysis in Science (7 February 1997 p. 793). Israel ranks second behind Switzerland in scientific papers per capita and third behind Switzerland and Sweden in citations per capita (7 May Science 1999 p. 894).
Herzog Hospital
Israel’s foremost center for geriatric and mental health care, Sarah Herzog Hospital combines exceptional medical care with outstanding research achievements. Herzog Hospital, established in 1895, treats the effects of advancing age and mental instability with the best medical technologies combined with professional expertise, compassion and care. With 340 beds, Herzog Hospital is the third largest hospital in Jerusalem.
For the past 30 years the Hospital has been at the forefront of biomedical and behavioral genetics research. Research done at Herzog Hospital is interdisciplinary, and combines a broad approach to studying complex behaviors, mental illness and aging, using techniques of molecular genetics and psychology
Current research projects include: Molecular Genetic Investigations of Schizophrenia, Bipolar Disorder and Autism; in neurological domains such as degenerative diseases including Alzheimer’s and Parkinson’s Diseases, stroke; ataxia; epilepsy and genetic studies of aging; Molecular Genetic Studies of Normal Personality and Schizophrenia; Molecular Genetic and Personality Aspects of Substance Abuse including Smoking; Psychological and Genetic Aspects of Eating Disorders, especially Anorexia Nervosa, and Mapping Genes to Attention Deficit Hyperactivity Disorder.
The Hospital’s doctors and scientists are widely published in a multitude of international scientific journals and books.
Goals
Problems of aging and mental health are an increasing burden in all societies. We believe that the scientific research is the best hope for resolving these problems in a satisfactory and human way. Herzog Hospital strives to be at the forefront of this battle.
In order to maintain the Hospital at the forefront of this scientific revolution in human genetics and disease, and to continue to contribute to the excellence of Israeli science, we are now embarking on an ambitious plan to strengthen the research infrastructure. A major goal is the building and furnishing of a new Research Center to continue to maintain its cutting edge biomedical research in Israel and in the world.
The Plan
The proposed Research Center will ultimately encompass an area of about 1000 square meters of laboratory space on one level. The recent construction of the Aaron Beare Research Laboratories has enabled the research staff to move into the first 250 meters of new, expanded space.
The Next Phase -The New Research Center
The second phase will be to construct the additional 750 square meters to complete the new Research Center. This will extend the capabilities of the laboratories to include, among other functions, basic aging research, neurophysiology, neuro-psychology, nutritional function and complex behavior/neurobiology and include part of the molecular genetics laboratories, and special tissue culture laboratory (biohazard clean areas).
The Nutrition and Brain Function Laboratory
Directed by Dr. Shai Shoham, it focuses on how manipulation of nutrition can benefit brain function in a variety of medical problems including Parkinson’s and Alzheimer’s disease, stroke, epilepsy, ataxia and age-associated cognitive decline. His research is based on animal models of the above mentioned diseases since several questions about brain structure and function cannot be studied in human subjects. Dr. Shoham is one of the top experts on brain anatomy in Israel. Research projects currently underway in his laboratory are:
Neurodegenerative Diseases and Aging
The major neurodegenerative diseases associated with aging are Alzheimer’s and Parkinson’s disease. Stroke and epilepsy also are diseases that involve neurodegenerative processes. Oxidative stress and glial activation are ubiquitous in neurodegenerative diseases. The work focuses on understanding how these processes cause damage to the brain and disrupt normal behavior. One strategy focuses on attenuation of oxidative stress. One element of the research includes attenuation of oxidative stress via nutritional manipulations such as reducing dietary iron content and treatment with drugs that attenuate oxidative stress. A new project launched in the lab explores nutritional treatments in a strain of mice with accelerated aging – senescence accelerated mouse (SAM). Another strategy is to increase neurotrophic activity in brain.
Ataxia and Excercise
A project recently initiated by Dr. Shoham examines the effects of exercise on recovery in a model of neurodegeneration in the cerebellum of mice. As part of this project, mice models of cerebellum ataxia are being studied. Exercise has been shown to exert effects of brain that are attributed to increased neurotrophic activities. In all these projects, a major emphasis is on understanding the relation between changes at the neuroanatomical level and changes at the behavioral level.
Effects of stress on brain and behavior
Stress can affect the brain via several and complex pathways involving both hormones and neurotransmitters, and is believed to be partially responsible for several behavioral disorders. However, the great complexity of these pathways makes it difficult to sort out the mechanisms and how they are responsible for different types of behavioral abnormalities. In collaboration with Prof. Hermona Soreq from the Hebrew University, Dr. Shoham’s lab is characterizing the effect of one stress signal increase in activity of the enzyme acetylcholinesterase on brain and behavior. Stereotypic behavior, namely repetitive and apparently purposeless patterns of motor behavior, make this transgenic mouse a potential model for a group of psychiatric disorders in which such behavior is displayed including Tourette, Autism, Schizophrenia and pervasive developmental disorder. Furthermore, relative resistance of this strain of mice to neurodeterioration in aging suggests that this variant of acetylcholinesterase may moderate stress-like aspects of aging. A major contribution from these projects is expected to be a better understanding of the neuroanatomical principles underlying the impact of emotional stress.
Dr. Yakir Kaufman, the Director of the Department of Behavioral Neurology conducts research on behavioral changes in the elderly caused primarily as a result of dementia, Alzheimer’s and Parkinson’s Disease.
Lack of understanding of the relationship between psychogeriatrics, neurology and general medicine.
Sarah Herzog Hospital in Jerusalem is currently the only facility in Israel to combine neurological and behavioral approaches in treating the full range of geriatric illnesses.
Neurological diseases such as Alzheimer’s and Parkinson’s Diseases and dementia have a significant role in causing disability in the elderly. Of those aged over 65 with disabilities, almost half have neurological disorders that account for their infirmity, as do 90% of those who are totally disabled. Recent studies show that disability can either be prevented or the rate of its progression can be decelerated by early intervention, an accurate diagnosis, and comprehensive treatment. We believe that the existing clinical knowledge in neurology and its flanking medical specialties should enable much better all round diagnosis and treatment of the elderly.
In the elderly, a psychiatric syndrome (e.g. depressive behavior) is often the result of neurological and/or medical disease which affects the brain and is not just a psychiatric state. For example, a drug toxic effect on the brain might be quite frequent. Thus, a neurological/medical background of behavioral syndromes should be carefully looked for and is often not investigated.
The objectives of the research programs are:
* Ongoing evaluation and refinement of services provided by all three divisions.
* Development of new diagnostic and therapeutic strategies using a neurobehavioral approach.
* Continuation of research on clinical and brain-behavior that can be applied to both geriatric and non-geriatric populations.
* Expansion of current research on early indicators of Alzheimer’s Disease and other dementias.
* Clinical research of psychogeriatric syndromes and the influence of different therapeutic treatments on them.
Funding for the daily activities of the research department derive from a variety of public granting agencies including the Israeli Ministry of Health, the Israeli Center for Psychobiology, the Israeli Academy of Sciences, NARSAD-the National Alliance for Research on Schizophrenia and Depression, the U.S. National Institute of Mental Health, the German Research Foundation (DFG), and private donors.
Research is conducted by a multi-disciplinary team incorporating outside experts in the relevant fields. The new Research Center will obtain the most advanced equipment to enable our doctors and scientists to conduct the highest level of research.
Osteoporosis
Osteoporosis Testing and Diagnosis for Holocaust Survivors
Prof. Jacob Menczel, Director of the Osteoporosis Unit, is providing free bone-density examinations to Holocaust survivors, and diagnosing their level of Osteoporosis. This public service is part of the special research project that proactively identifies and treats Holocaust survivors suffering from Osteoporosis.
New Research at Herzog Hospital:
Osteoporosis in Depression Patients
A study of the prevalence of osteoporosis in patients suffering from depression was started at the Herzog Hospital. The investigation is a collaborative study between the Hospital’s Schonbaum Department for Treatment Resistant Depression under the directorship of Prof. Baruch Shapira and its Osteoporosis Unit, headed by Israel’s leading expert in the field, Prof. Jacob Menzcel, formerly Herzog Director General.
The research is based on the theory that there is a higher incidence of falls and fractures reported in patients suffering from depression, with a possible higher incidence of osteoporosis.
Depressive disorders are a high incidence health problem and can reach between 10-25% in women and 5-12% in men. Depression covers a wide range of changes in affective state, ranging in severity from normal mood fluctuations of everyday life, to severe melancholic episodes related to psychodynamic mechanisms of loss and repression. Depressive people suffer from diminished interest or pleasure in almost all activities with withdrawal from friends and family.
Osteoporosis, reduction of bone mass and density of the skeleton, affects a large proportion of the population. The prevalence is higher in women than in men, and in persons who are not physically active. The complications of osteoporosis are kyphosis, loss of height, low-back pain and fractures, which require surgical orthopedic intervention, as well as a long period of rehabilitation.
Osteoporosis can be prevented or treated. Bone density measurements have proven to be a very effective method of diagnosis. The new DEXA bone density machine donated by the Koschitzky Family of Toronto is one of the most advanced available and enables the hospital to conduct this research.
Research proposals:
1. Epidemiological studies on osteoporosis in the Jerusalem population, especially after menopause. There have not been any studies done for the past 30 years on the correlation
between the degree of osteoporosis and demographic factors, blood levels and way of life
(i.e. sedentary or active). The project will enable us to initiate our genetic studies in the field. Dr. Richard Ebstein, the Director of the Department of Research at Herzog Hospital
is internationally recognized for his work in genetics.
2. Herzog Hospital has the unique opportunity to utilize its geriatric, psychiatric and depression departments to combine these disciplines in conducting research in osteoporosis. A significant number of patients with depression suffer from osteoporosis.
The correlation of depression with osteoporosis will be investigated as well as the effect of physical activity.
3. Immobilization is one of the main causes of osteoporosis. With geriatric patients tending to be hospitalized for long periods of time, we wish to conduct a study on the best ways to increase movement to limit osteoporosis.
