'Behind the Blue': Philip A. Kern Discusses UK’s Center for Clinical and Translational Science

KODY KISER: Welcome to Behind the Blue. I'm Kody Kiser with University of Kentucky Strategic Communications, and I'm joined by my colleague Mallory Olson. Within UK's role as Kentucky's flagship land grant University, the University of Kentucky Center for Clinical and Translational Science or CCTS unites clinicians, researchers, and communities to accelerate the translation of basic science discoveries to tangible improvements in health.

Since 2006, the CCTS has focused on addressing chronic health disparities in rural and underserved populations throughout the Commonwealth and the central Appalachian region. They work closely with institutional and community partners to collaboratively identify local challenges and opportunities to improve well-being. Our guest today on Behind the Blue is the Director of CCTS, Dr. Philip A. Kern. Since his recruitment to UK in 2009, Dr. Kern has been continuously funded for both his own NIH funded research program, as well as his leadership of the CCTS. He has served as a mentor, colleague, and collaborator on numerous other projects. In addition, he continues to provide clinical and educational services within the Barnstable Brown Diabetes Center and Division of Endocrinology.

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Dr. Kern, welcome to Behind the Blue.

PHILIP A. KERN: Great to be here. Thank you.

KODY KISER: First off, you came to UK in 2009, but tell us a little bit about your background. Where are you from originally, and talk a little bit about the work that you did before you came to UK.

PHILIP A. KERN: OK, so I grew up in New England and Rhode Island. I went to college in Boston and medical school in New York. Although I think I've lost most of my accent, if you're looking for that. And my fellowship was in Colorado, and then my first faculty position was actually at UCLA at Cedars-Sinai in Los Angeles. And that's where I started to work on fat tissue, insulin resistance, and trying to understand the mechanisms of what causes-- what's the link between obesity and diabetes and abnormal lipid metabolism.

So I was there for about 11 years. And then I took a position at the University of Arkansas for Medical Sciences, continued that work, and then I came here, came to UK, in 2009. And since that time, I've-- my research has always been focused on adipose biology, insulin resistance, and metabolism. It's changed in terms of its focus a few times. I was interested in inflammation for a while. Right now, I'm actually studying brown fat, brown and beige fat, and trying to understand how that impacts diabetes and prediabetes.

KODY KISER: So what was it that brought you here to the University of Kentucky? Was there something specific that appealed to you? So at the time, the Barnstable Brown Diabetes and Obesity Center was just forming with some generous donations from the family, and so I was recruited here to be the inaugural director of the Barnstable Brown diabetes program.

PHILIP A. KERN: Soon after I came here, UK was trying to get the grant, the CTSA grant, so the CCTS is the Center, but the grant that funds it is from the NIH. It's called a CTSA grant. And the provost and the Dean at the time then asked me to take over the effort to try to get that grant, which is a highly competitive grant. And so I was Director of both CCTS and Barnstable Brown for a while. And then with the recruitment of John Fowlkes, then I gave up the Barnstable directorship and focused entirely on the CCTS. So it was really the Barnstable Brown Diabetes Center that really got me here in the first place, but then I started-- then I took over the CCTS.

KODY KISER: So let's talk a little bit about the CCTS. And I guess maybe from a broader kind of pullback perspective first, kind of talking about how clinical trials work and the idea of experimental testing, especially now because it's become so controversial in this day and age with the COVID era. Can you give us kind of a 30,000 foot view of basically how clinical trials work in a rough sense?

PHILIP A. KERN: Well sure. You can do experiments in mice. You can do experiments in cells and culture. But ultimately if you really want to advance medicine, you have to do something in humans. I mean, I have jokes, I have cartoons, showing a mouse at the bedside of a sick patient saying, "well, it worked on me." So ultimately, you have to translate this into humans. Now sometimes people cynically say well then you're using humans as Guinea pigs. The process is highly regulated. It's highly ethical, and done in a very humane fashion. Nobody is ever asked to do anything that they don't want to do.

And of course, we have a human subjects review committee, the IRB, which supervises everything. And so clinical trials sometimes involve new drugs into treatments. Sometimes they involve behavioral treatments, and therapies, diet, exercise, nutrition. Sometimes they're just studies of normal physiology in normal control people and normal subjects. So it really runs the gamut of the kinds of things that you might want to do.

More and more, clinical research and clinical trials are trying to become more relevant, or trying to get out into the community. So it's one thing-- in clinical research, you could do things in a very controlled setting, in a clinical laboratory setting, but then people often ask the question, "is that the real world?" Because people have-- we're free-range humans. We do all kinds of things. And so more and more, clinical trials are really trying to engage the community and do things in a more informative way in the community.

KODY KISER: A lot of times we hear about something being rushed, a trial or treatment that has come to the forefront. But we're talking about years of preparation before we ever get to that point of actual human trials, I would think. There's a lot of background work that goes on before we even get there, right?

PHILIP A. KERN: Yes. That's true. Now with new drugs, from finding a chemical in a test tube to actually getting to the person, that often takes decades. Now people have-- and that's because of all the testing that has to go into that from animals, then to early stages in humans, et cetera. Now people have-- people talk about the COVID vaccine trials as being rushed because they happen so quickly, but in fact, there was a lot of background to these vaccines that went long before the COVID pandemic even started. So the idea of using mRNA as a vaccine, that's actually been around for a while and has been actually tested in other diseases for a while.

And with the pandemic being as bad as it is, yeah, we wanted to get the vaccines out in a hurry, "we," I mean global "we," the community. And so it happened quickly, that's true by historical standards. The other hand, medical advances are happening more quickly and our infrastructure and our ability to do things quickly has improved tremendously. So in fact, if you look at the development of the vaccines, they were highly regulated and very carefully done. Nothing was approved until trials had been done in many tens of thousands of people with very careful analysis of side effects. And of course now, how many hundreds of millions of people have received these vaccines? And for the most part, they've been extremely safe. Nothing is perfect. But the safety profile of the vaccines now looks really, really good.

KODY KISER: We touched on a broad view of the importance of clinical trials, but why a CCTS? Why the need for a Center for Clinical and Translational Sciences?

PHILIP A. KERN: So I'll give a football analogy. How would you like to have a football team where you've got really good running backs, a really good quarterback, but you have no offensive line? OK, so you see the running back go off tackle, and run into the end zone, and do his dance. And that's very nice, but do you ever-- how many people, now some people of course, some people go back and look at this, oh, look at that. That guard, he pulled, and he threw the key block that got him in there.

So you don't have-- clinical research is a team sport. This is not golf. It's a team sport. And you need the infrastructure in place to make things happen. So if you want to call a CCTS the pulling guard who makes the key block that allows the running back to get into the end zone, that's sort of in some ways what it's like. We have infrastructure in terms of regulatory people that can make sure all the Is are dotted and Ts are crossed quickly.

We have statistical people who can make sure that the trial is designed correctly in the first place. We have nurses and other people, including coordinators, who can make sure that the patients are seen. They're recruited. The blood is drawn. That everything is done properly. And all of this is essential infrastructure because a good idea is not worth anything unless you can actually implement it and get it done quickly and efficiently.

MALLORY OLSON: Speaking of, CCTS has done a lot of work in many areas, but specifically, bringing it back to COVID, last year CCTS stepped up in a huge way at the start of the pandemic. Can you talk about some of the work that you guys have done there?

PHILIP A. KERN: Right. Rick Greenberg is an infectious disease specialist here who has a long track record of doing vaccine trials. He had a small operation, and he was contacted by Johnson & Johnson to do the inaugural, major-- be a part of the inaugural vaccine trial for the J&J vaccine. So we were going to be asked to recruit a lot of people. And so CCTS stepped in. Within a matter of a month or two, we asked UK HealthCare to remodel some new space for us, which they did, right on the ground floor of Chandler.

We hired about 25 people very quickly. There's a lot of people out of work. Some of the people we hired were formerly waiters in restaurants and things. And now all of a sudden, we trained them to be coordinators to do these clinical trials. So there's a lot of training involved; hiring, training, space, all those kind of start up-- nevermind the regulatory stuff, the contracting. And from start to finish, we got this trial up and running in about 80 days which is actually is blazingly fast for complex clinical trials, I might add. And it turns out that also we recruited as partners, Baptist and Norton Healthcare in Louisville, and so it turns out, we ended up being the number one site in the world for recruitment of participants into the J&J vaccine trial.

MALLORY OLSON: That's pretty impressive. That's amazing, in the whole world.

PHILIP A. KERN: And this is all because of the infrastructure of the CCTS that we had in place, and the ability to move quickly. And yeah, we were motivated. I mean, think of where we were last June and July. I mean, things were looking awful, and the idea of a vaccine to help rescue us from this horrible situation was very appealing. So yeah, we were motivated. And of course, so were the participants who we had no trouble recruiting for this trial.

KODY KISER: The work that the CCTS does, why does this matter? And what kind of impact does the CCTS make on Kentucky and beyond? We've discussed the COVID vaccine, but there are other areas of work the CCTS reaches.

PHILIP A. KERN: So we help everybody do their research better. Also in particular in Kentucky, we're also highly focused on health disparities and getting better medical care and better research into underserved communities. We've been focused on Eastern Kentucky for a long time since UK serves Eastern Kentucky in terms of health care. But we're also very focused on other underserved communities, the African-American community, Hispanic community, and other underserved communities here in Kentucky. So we have we're putting major efforts into these communities to help get them into clinical trials.

We've shown many times over again that actually participating in a clinical trial often gets better health care for people. It gets people engaged with the health care system, and they get better care. And also, a lot of our research is focused on, how do we deliver better care, health services research. To say that we have a treatment, now you've got to get it to the right people. And so, the CCTS is not only focused on these sort of bread and butter clinical trials like we talked about with COVID, but also about how do we deliver care to the communities, especially underserved communities that traditionally aren't well served.

KODY KISER: I do want to mention Kentucky and Appalachia experience some of the nation's most severe health disparities. Eight of 13 US counties recently found to have a declining life expectancy are in the Commonwealth. And the region is also currently the epicenter of the opioid epidemic with overdose deaths in Kentucky hitting record highs in 2017. How does the CCTS assist in research that goes on to help combat those types of problems like the opioid problem, things like that?

PHILIP A. KERN: Yes, so I wouldn't want people to think that all we do is COVID stuff because actually people are still dying from substance use disorder, heart disease, cancer, Alzheimer's disease, everything else. And we support trials and research in all of those areas. Just as an example, we have an inpatient unit on 5 North and Chandler, and substance use disorder researchers do very well funded, very high level research.

With some subjects, you need to admit them to the hospital for a period of time in a research unit where you can do careful studies of new drugs, and new treatments, and new behavioral therapies for substance use disorder. So we have an inpatient unit that supports that. We've supported the Sanders-Brown Center on Aging in significant ways with their studies on Alzheimer's disease. We do a lot of things to support Markey Cancer Center, and what they do. So all of these things are significant health disparities in Appalachia. And we support efforts of everybody else in their efforts to alleviate these problems.

KODY KISER: I think it's important for people to remember that COVID has become such a dominant story in our daily narrative. But just because of people fighting COVID, just because of lockdowns that we may have had, or people working from home, things like that, doesn't mean that our opioid epidemic problems just magically went away, or our cancer rates just suddenly plummeted because we were so focused on COVID, or heart disease, or diabetes, or anything like that, people are still struggling with those problems daily, as well.

PHILIP A. KERN: Yes, in fact, actually with the lockdown for COVID, and there's been significant psychological damage to many people, and the SUD, the substance use disorder epidemic, has if anything, gotten worse during this time.

MALLORY OLSON: It's very interesting how-- well not interesting. It's amazing that UK has a center like this on campus that is accessible to so many different groups. I think collaboration is really key in a lot of what you guys do, can you touch on how having your center right here on campus enables that work?

PHILIP A. KERN: Yeah, so we do things at the hospital, and some people think that we're entirely focused in medical affairs and in the College of Medicine. We're actually a campus wide center. And in fact, we support studies in essentially every college on campus. We have a number of studies that we support in Arts and Sciences, in the College of Education, the College of Ag, and so we're really a campus wide center.

Of course, the health science colleges tend to be most of our users, but we actually support a little bit of everything. And collaboration is very much what we do. As I mentioned, clinical research is a team sport, and the notion of a scientist slaving away late at night in the lab all by him or herself is just not the way things work anymore. The best research is usually done by a team of specialists, and building teams, getting people together, is actually a science in and of itself. So one aspect of what the CCTS does is actually is team science. We promote, and we study team science, and we have programs to help encourage this.

MALLORY OLSON: A lot of this work, too, needs funding, which you guys have very robust funding in a lot of different areas. And you recently, we had a big announcement of a new grant from the NIH. Tell us a little bit about that.

PHILIP A. KERN: So this is our main infrastructure grant, and it comes from the NIH. The total award is I think $23.5 million, $4.7 million per year. And this grant covers a lot of what we do. It supports career development, both at the pre-doctoral level as well as the postdoc and junior faculty career development level. It supports developing of the workforce because just like with the COVID epidemic, we had to go out and hire a lot of people in a hurry.

Well now we need to retain these people. We needed to continue to develop the translational research workforce, so there's people out there that know how to do this. And then of course, it also supports biostatistics and informatics, you know actually handling big data and being able to manage this, and many of the things that we do. So we do derive generous support from UK HealthCare and from the Vice President for Research, but this one grant from the NIH is a great part of what we do, and it's very important that we have this.

KODY KISER: What is the trajectory you see for the CCTS, say, over the next five years?

PHILIP A. KERN: So with this new funding and looking for the next five years, I think our mission is not changed tremendously. We still all of the key elements I talked about are still highly relevant. Some things are going to be focused on a little bit more, I think, our partnerships. And we want partnerships to be authentic.

It's not just a matter of getting somebody to sign a letter on a piece of paper, and say, now we've got a partnership. No we want something really to be happening, so partnerships with other universities, partnerships with community organizations, partnerships with health organizations that promote health disparities. And on the issue of health disparity, it's another focus of ours. So we've done quite a bit in this area, but we need to do more. And we need to better engage our communities, help build trust with our communities, so that we can continue to do research in them and engage communities in what we do.

KODY KISER: This is all fascinating in the context of the scope of work the CCTS is involved in. It's inspirational as far as looking at it in the University context of how the arts brings all of these different elements of our University together, different aspects of research from all over our campus. We greatly appreciate the time you've taken to come on and talk with us. Dr. Philip Kern, thank you so much for your time. We look forward to the work that the CCTS continues to do.

PHILIP A. KERN: Thank you. Thank you very much for bringing me here. Thanks.

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