She’s a medical doctor who grew up in Pierre, the capital city of South Dakota. He earned his Ph.D. where he grew up, in Manitoba’s capital city of Winnipeg.
Now, after taking different paths to get there, they collaborate at Sanford Research in Sioux Falls, South Dakota. A common goal unites them: to reduce the risk of heart disease in adults — long before adulthood.
As they take turns explaining their roles and approaches to science, it’s easy to recognize their passion for their research and their fondness for working with each other.
“We are the cardiovascular crew,” one says.
The other immediately confirms, “We are, we are.”
Here’s a look at how heart research work links Dr. Michelle Baack, a Sanford USD Medical Center neonatologist and Sanford Research principal investigator, with fellow Sanford Research principal investigator Dr. Randy Faustino.
Backgrounds led to heart research
Dr. Baack started her career path by earning a pharmacy degree from South Dakota State University, then a medical degree from the University of South Dakota Sanford School of Medicine. After a pediatric residency, she worked as a pediatrician for a decade in Pierre.
A significant life event steered her in a new clinical direction.
“My first baby passed away,” she said. “So I always had a heart to help babies and to help moms and dads go through that journey of having a sick baby, and that’s what got me excited about neonatology.”
Dr. Baack made a discovery about herself during her fellowship in neonatology. “That’s where I learned that I really loved and had a passion for science and for research,” she said.
She explains her approach to research as taking a question about a patient to the lab, finding the answer there and then translating it back to the patient. “It’s patient to bench to bedside,” she said.
Dr. Faustino, meanwhile, arrived a little more recently to Sanford Research, in 2016. Before that, he attended the University of Manitoba, where he earned his bachelor’s degree in microbiology and figured he would go on to medical school. When that didn’t work out, time he spent volunteering in a lab made him consider graduate school and research. Master’s work at the University of Manitoba evolved into a Ph.D. in physiology, and postdoctoral training followed at Mayo Clinic in cardiac stem cell biology and bioinformatics.
But Dr. Faustino found the Sanford Research location ideal, for proximity to family and for weather. “This is moving south for me,” he said.
Working together to find answers
Dr. Baack’s research team studies developmental programming, or how a person’s genes and environment when they are a fetus can cause diseases, or raise or lower the risk of diseases. Specifically, Dr. Baack looks at things that can be done during the pregnancy of a woman with type 1, type 2 or gestational diabetes, or after birth, to help prevent the baby from developing heart disease. These babies are at higher risk of having heart disease both in infancy and later as adults.
“I’m trying to prevent heart disease within the womb,” she said.
Dr. Faustino’s team tackles this from the genetic side compared to Dr. Baack’s environmental focus.
“We pair together to say, ‘How does my environment change your genes to make the risk of disease?’” Dr. Baack said.
That leads to this question, Dr. Faustino said: “How does this ultimately affect an individual’s susceptibility as they progress through life?”
With heart research questions as complex as the ones Dr. Baack and Dr. Faustino are asking — stretching a span of time from development in utero to midlife — “it’s a team sport” to find answers, Dr. Baack said.
Dr. Baack provides the patient perspective; Dr. Faustino provides the cellular expertise.
A closer look at Dr. Baack’s work
Currently, Dr. Baack said, the only thing treated during pregnancies involving diabetes is blood sugar, with insulin or medication. But she said higher levels of lipids, or fats, also circulate in the diabetic mother’s blood.
“We were able to find that by having both high lipids and high glucose, that exacerbates the risk of heart disease in the babies,” she said.
The timing of the onset of diabetes factors into her heart research studies as well. Type 1 and type 2 diabetes that exist before a pregnancy could affect the ovary, sperm, developments in the embryo including the heart, fetal growth and the placenta, Dr. Baack said. Meanwhile, gestational diabetes, developing in the latter half of pregnancy, could affect the infant heart’s metabolism and function.
“We found that we have to not only study the genes and the environment, but what timing do we have to intervene?” Dr. Baack said. “Do we have to intervene before a mom gets pregnant, or do we have to intervene when she finds out she has gestational diabetes, or can we intervene after the baby is born and make a difference?”
For example, her rat models have shown that lowering carbohydrates and saturated fats in the diet can make a difference in heart disease risks. So one intervention in a diabetic pregnancy could be dietary.
They’ve determined that the mitochondria in cells, which turn nutrients into energy, get “sick” from the excess lipids and can’t produce enough energy for a beating heart. So the lab is transplanting mitochondria from healthy cells to cells exposed type 1 or type 2 diabetes and high fats to restore mitochondrial function.
“Potentially, mitochondrial therapy would be something that is in the future. It is feasible,” Dr. Baack said.
A closer look at Dr. Faustino’s work
Dr. Faustino came to Sanford Research to tackle heart disease from a lab bench. His team studies the mechanisms that control cardiac formation and development.
One tool the lab uses is bioinformatics, or data analysis. The lab also uses stem cell models that illustrate the evolution into a cardiac cell, “which we can get beating in a dish,” Dr. Faustino said.
They can look at different molecules that change over time, how they interact and how they produce a normal heart, he said. They can also look at what leads to electrical disorders in the heart, such as arrhythmia.
It’s more complex, Dr. Faustino explains, than the natural pacemaker of the heart simply forming properly. “Even if that pacemaker’s OK, then you have to worry about all the connections of all of the cells to one another within your heart,” that they’re all communicating properly, too.
While lab experiments can show what’s happening at the cellular level, “I need to be able to understand that in the context of a living organism,” Dr. Faustino said.
“So that’s where I need Michelle’s help,” he added. She has the expertise to answer questions like: “My cells are acting weird. What do they look like in an actual heart?”
One of Dr. Faustino’s lab scientists is starting a project to try to separate out the pacemaker cells and study what might cause arrhythmias.
“What we’re hoping is that once we get this purified population, we can actually do a co-culture with Michelle’s cells and help her cells start to beat in culture,” Dr. Faustino said. “So it’s fun doing all this stuff. Because in a way, it’s almost like you’re a kid again. … ‘Let’s try this. Let’s see what works.’”
Helping now to help later
In her role as a neonatologist, Dr. Baack relates to the parents of the babies she’s taking care of. She’s also grateful when they get involved in research studies.
“I can’t tell you how appreciative we are of moms and families that are willing to participate. … Maybe it might not help their baby directly. Maybe it will. But it could help others in the future,” she said.
In his role, Dr. Faustino doesn’t just stick to his lab or his office either. He relishes participating in outreach efforts for Sanford Research, to explain to the public the research that’s going on and what a scientist actually does.
A recent encounter he had echoes Dr. Baack’s experience. “People here are not only appreciative, they’re proponents of this work that we do,” Dr. Faustino said.
Dr. Faustino had been speaking to a group of college students about his heart research, and one of them approached him after his talk. “I just want to say thank you for what you’re doing,” she said.
It turned out the young woman had recently needed an artificial pacemaker placed in her chest. She told him the work he’s doing now could help someone else, even her children, with a similar problem in the future.
“I love what I do, but stuff like that just makes it better,” Dr. Faustino said.
The role research plays in battling diseases comforts Dr. Faustino personally as well. He lost his mom two years ago to leukemia. “Not as a scientist but as the son of someone, I was encouraged that I knew we have people working on this because it’s horrible how it affects families,” he said.
As a scientist, it provides motivation. “We won’t give up,” he said. “We’ll find a way to answer these questions because we know how much it hurts.”
Dreams for their research
Dr. Baack wants to lower the risk of cardiovascular disease in adults by improving interventions during pregnancy and early infanthood.
Her team hopes to find the biomarkers that would indicate which babies will be at risk for developing heart disease later. To this end, they have been collecting stem cells from umbilical cords of all types of pregnancies — moms with various types of diabetes, moms without, moms on medication, moms not on medication, moms who are obese, moms who are not obese. Then the stem cells can be grown into heart muscle cells “that then will act a different way depending on their exposure,” Dr. Baack said.
And someday, she hopes, a blood sample from a baby could predict the risk of having a heart attack in his or her 40s, rather than waiting for symptoms to develop as an adult. Then, interventions could begin immediately to lower the risk.
Dr. Faustino would like to help address sudden cardiac death, particularly in young athletes. If his heart research could be part of a solution that lessens that, he reasons it would help many other people, too. “It will have implications for cardiac rehabilitations. It will have implications for other people who have electrical disorders of the heart,” he said.
Artificial pacemakers have been, and still are, “this huge clunky thing,” he said. He’s intrigued by the idea of developing a biological pacemaker.
“Can we take a patient’s own cells, fix what’s wrong with theirs, then reintroduce it?” he asked. “It’s almost in the realm of sci-fi, but there’s work moving towards that idea. I would love to contribute to that.”
‘I just had this idea’
Dr. Baack and Dr. Faustino’s contributions to science also include the undergraduate and graduate students, and even high school students, they work with in their labs. They enjoy teaching the students to love the discoveries of science, too.
“Every person that we train is also going to go out there and make a difference for your patients,” Dr. Baack said.
The collaboration between the two researchers also extends to the scientists who work in their labs, writing joint journal submissions and joint grant applications and participating in joint discussion groups.
Conversations between the two of them often start off, “I just had this idea …” And then suggestions and plans spill out from there.
Based on their descriptions and banter, their heart research collaboration seems to work well.
“The directions I can take (research) with my partnership with Michelle,” said Dr. Faustino, “is so much more than what I ever anticipated.”
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