Fellowship Program Director: David S. Goldstein, MD, PhD
Qualified candidates for a Clinical Fellowship position (with privileges in the NIH Clinical Center) should be licensed to practice medicine in the United States and have a serious interest in patient-oriented clinical research. Qualified candidates for a Pre-Clinical Fellowship position should have an advanced degree in biochemistry, neurochemistry, physiology, or similar subject matter or have demonstrable skills in bench laboratory techniques relevant to the research of the Autonomic Medicine Section; and should have a serious interest in one of the above scientific topics.
This program in the Autonomic Medicine Section offers a clinical fellowship that is accredited by the United Council for Neurologic Subspecialties (UCNS) and trains Fellows in patient-oriented and translational research about disorders of autonomic and catecholaminergic systems. Because of the myriad roles of these systems in homeostasis, drug effects, and multi-disciplinary acute and chronic disorders of regulation, autonomic medical research requires thinking in terms of integrative physiological concepts. The clinical research consists of developing and testing diagnostic and pathophysiologic biomarkers, natural history studies, and pathophysiologically relevant therapeutic interventions. Major emphasis is on catecholaminergic deficiencies in the brain and periphery in Parkinson disease, dementia with Lewy bodies, pure autonomic failure, and other synucleinopathies evaluated by physiological, neurochemical, neuroimaging, microscopic, and genetic approaches. The translational research focuses on autotoxicity exerted by the dopamine metabolite 3,4-dihydroxyphenylacetaldehyde (DOPAL) and harmful DOPAL-induced modifications of intracellular proteins such as alpha-synuclein. The program uses a variety of clinical assessment techniques such as physiological autonomic function testing, catecholamine neurochemistry, visualization of catecholaminergic innervation by positron emission tomography (PET) scanning, and immunofluorescence confocal microscopy to examine alpha-synuclein deposition in sympathetic nerves. A recent urgent extension of the research is to autonomic/catecholaminergic functions in post-acute SARS-CoV2. The section runs a world-renowned Clinical Neurochemistry Laboratory.
Areas of Current Research
- Diagnostic biomarkers and mechanisms of catecholaminergic neurodegeneration in autonomic failure
- Relationships of autonomic failure to non-motor and pre-motor aspects of Lewy body diseases
- Clinical laboratory diagnosis and natural history of neurogenic orthostatic hypotension
- Collaborative clinical and preclinical studies of autonomic rare diseases
- Computer modeling of cardiac sympathetic functions and mechanisms of catecholamine deficiency
- Clinical autonomic function testing
- Collaborative clinical and preclinical studies of catecholamine systems