Michael Ferrandino

Positions:

Associate Professor of Surgery

Surgery, Urology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2001

New York University

Residency, Urology

State University of New York, Downstate Medical Center

Fellowship, Laparoscopy, Robotics, And Endourlogy

Duke University

Grants:

HERO: A multinational phase 3 randomized, open-label, parallel group study to evaluate the safety and efficacy of Relugolix in men with advanced prostate cancer

Administered By
Duke Cancer Institute
Awarded By
Myovant Science Inc.
Role
Principal Investigator
Start Date
End Date

Pronounce

Awarded By
Ferring Pharmaceuticals
Role
Principal Investigator
Start Date
End Date

Provent SIP-T

Awarded By
Dendreon Corporation
Role
Principal Investigator
Start Date
End Date

Fundamentals of Robotic Surgery: Curriculum and Technical Validation Skills

Awarded By
Institute for Surgical Excellence
Role
Co-Principal Investigator
Start Date
End Date

Duke Endourology Fellowship

Administered By
Surgery, Urology
Awarded By
Boston Scientific Corporation
Role
Principal Investigator
Start Date
End Date

Publications:

Cerebrospinal Fluid Proteome Changes in Older Non-Cardiac Surgical Patients with Postoperative Cognitive Dysfunction.

BACKGROUND: Postoperative cognitive dysfunction (POCD), a syndrome of cognitive deficits occurring 1-12 months after surgery primarily in older patients, is associated with poor postoperative outcomes. POCD is hypothesized to result from neuroinflammation; however, the pathways involved remain unclear. Unbiased proteomic analyses have been used to identify neuroinflammatory pathways in multiple neurologic diseases and syndromes but have not yet been applied to POCD. OBJECTIVE: To utilize unbiased mass spectrometry-based proteomics to identify potential neuroinflammatory pathways underlying POCD. METHODS: Unbiased LC-MS/MS proteomics was performed on immunodepleted cerebrospinal fluid (CSF) samples obtained before, 24 hours after, and 6 weeks after major non-cardiac surgery in older adults who did (n = 8) or did not develop POCD (n = 6). Linear mixed models were used to select peptides and proteins with intensity differences for pathway analysis. RESULTS: Mass spectrometry quantified 8,258 peptides from 1,222 proteins in > 50%of patient samples at all three time points. Twelve peptides from 11 proteins showed differences in expression over time between patients with versus withoutPOCD (q < 0.05), including proteins previously implicated in neurodegenerative disease pathophysiology. Additionally, 283 peptides from 182 proteins were identified with trend-level differences (q < 0.25) in expression over time between these groups. Among these, pathway analysis revealed that 50 were from 17 proteins mapping to complement and coagulation pathways (q = 2.44*10-13). CONCLUSION: These data demonstrate the feasibility of performing unbiased mass spectrometry on perioperative CSF samples to identify pathways associated with POCD. Additionally, they provide hypothesis-generating evidence for CSF complement and coagulation pathway changes in patients with POCD.
Authors
VanDusen, KW; Li, Y-J; Cai, V; Hall, A; Hiles, S; Thompson, JW; Moseley, MA; Cooter, M; Acker, L; Levy, JH; Ghadimi, K; Quiñones, QJ; Devinney, MJ; Chung, S; Terrando, N; Moretti, EW; Browndyke, JN; Mathew, JP; Berger, M; MADCO-PC Investigators,
MLA Citation
VanDusen, Keith W., et al. “Cerebrospinal Fluid Proteome Changes in Older Non-Cardiac Surgical Patients with Postoperative Cognitive Dysfunction.J Alzheimers Dis, vol. 80, no. 3, 2021, pp. 1281–97. Pubmed, doi:10.3233/JAD-201544.
URI
https://scholars.duke.edu/individual/pub1475476
PMID
33682719
Source
pubmed
Published In
J Alzheimers Dis
Volume
80
Published Date
Start Page
1281
End Page
1297
DOI
10.3233/JAD-201544

Immunomodulatory lipid mediator profiling of cerebrospinal fluid following surgery in older adults.

Arachidonic acid (AA), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA) derived lipids play key roles in initiating and resolving inflammation. Neuro-inflammation is thought to play a causal role in perioperative neurocognitive disorders, yet the role of these lipids in the human central nervous system in such disorders is unclear. Here we used liquid chromatography-mass spectrometry to quantify AA, DHA, and EPA derived lipid levels in non-centrifuged cerebrospinal fluid (CSF), centrifuged CSF pellets, and centrifuged CSF supernatants of older adults obtained before, 24 h and 6 weeks after surgery. GAGE analysis was used to determine AA, DHA and EPA metabolite pathway changes over time. Lipid mediators derived from AA, DHA and EPA were detected in all sample types. Postoperative lipid mediator changes were not significant in non-centrifuged CSF (p > 0.05 for all three pathways). The AA metabolite pathway showed significant changes in centrifuged CSF pellets and supernatants from before to 24 h after surgery (p = 0.0000247, p = 0.0155 respectively), from before to 6 weeks after surgery (p = 0.0000497, p = 0.0155, respectively), and from 24 h to 6 weeks after surgery (p = 0.0000499, p = 0.00363, respectively). These findings indicate that AA, DHA, and EPA derived lipids are detectable in human CSF, and the AA metabolite pathway shows postoperative changes in centrifuged CSF pellets and supernatants.
Authors
Terrando, N; Park, JJ; Devinney, M; Chan, C; Cooter, M; Avasarala, P; Mathew, JP; Quinones, QJ; Maddipati, KR; Berger, M; MADCO-PC Study Team,
MLA Citation
Terrando, Niccolò, et al. “Immunomodulatory lipid mediator profiling of cerebrospinal fluid following surgery in older adults.Sci Rep, vol. 11, no. 1, Feb. 2021, p. 3047. Pubmed, doi:10.1038/s41598-021-82606-5.
URI
https://scholars.duke.edu/individual/pub1473574
PMID
33542362
Source
pubmed
Published In
Scientific Reports
Volume
11
Published Date
Start Page
3047
DOI
10.1038/s41598-021-82606-5

Implementation and Impact of a Risk-Stratified Prostate Cancer Screening Algorithm as a Clinical Decision Support Tool in a Primary Care Network.

BACKGROUND: Implementation methods of risk-stratified cancer screening guidance throughout a health care system remains understudied. OBJECTIVE: Conduct a preliminary analysis of the implementation of a risk-stratified prostate cancer screening algorithm in a single health care system. DESIGN: Comparison of men seen pre-implementation (2/1/2016-2/1/2017) vs. post-implementation (2/2/2017-2/21/2018). PARTICIPANTS: Men, aged 40-75 years, without a history of prostate cancer, who were seen by a primary care provider. INTERVENTIONS: The algorithm was integrated into two components in the electronic health record (EHR): in Health Maintenance as a personalized screening reminder and in tailored messages to providers that accompanied prostate-specific antigen (PSA) results. MAIN MEASURES: Primary outcomes: percent of men who met screening algorithm criteria; percent of men with a PSA result. Logistic repeated measures mixed models were used to test for differences in the proportion of individuals that met screening criteria in the pre- and post-implementation periods with age, race, family history, and PSA level included as covariates. KEY RESULTS: During the pre- and post-implementation periods, 49,053 and 49,980 men, respectively, were seen across 26 clinics (20.6% African American). The proportion of men who met screening algorithm criteria increased from 49.3% (pre-implementation) to 68.0% (post-implementation) (p < 0.001); this increase was observed across all races, age groups, and primary care clinics. Importantly, the percent of men who had a PSA did not change: 55.3% pre-implementation, 55.0% post-implementation. The adjusted odds of meeting algorithm-based screening was 6.5-times higher in the post-implementation period than in the pre-implementation period (95% confidence interval, 5.97 to 7.05). CONCLUSIONS: In this preliminary analysis, following implementation of an EHR-based algorithm, we observed a rapid change in practice with an increase in screening in higher-risk groups balanced with a decrease in screening in low-risk groups. Future efforts will evaluate costs and downstream outcomes of this strategy.
Authors
Shah, A; Polascik, TJ; George, DJ; Anderson, J; Hyslop, T; Ellis, AM; Armstrong, AJ; Ferrandino, M; Preminger, GM; Gupta, RT; Lee, WR; Barrett, NJ; Ragsdale, J; Mills, C; Check, DK; Aminsharifi, A; Schulman, A; Sze, C; Tsivian, E; Tay, KJ; Patierno, S; Oeffinger, KC; Shah, K
MLA Citation
Shah, Anand, et al. “Implementation and Impact of a Risk-Stratified Prostate Cancer Screening Algorithm as a Clinical Decision Support Tool in a Primary Care Network.J Gen Intern Med, vol. 36, no. 1, 2021, pp. 92–99. Pubmed, doi:10.1007/s11606-020-06124-2.
URI
https://scholars.duke.edu/individual/pub1441099
PMID
32875501
Source
pubmed
Published In
J Gen Intern Med
Volume
36
Published Date
Start Page
92
End Page
99
DOI
10.1007/s11606-020-06124-2

A protocol to reduce self-reported pain scores and adverse events following lumbar punctures in older adults.

OBJECTIVE: Lumbar punctures (LPs) are important for obtaining CSF in neurology studies but are associated with adverse events and feared by many patients. We determined adverse event rates and pain scores in patients prospectively enrolled in two cohort studies who underwent LPs using a standardized protocol and 25 g needle. METHODS: Eight hundred and nine LPs performed in 262 patients age ≥ 60 years in the MADCO-PC and INTUIT studies were analyzed. Medical records were monitored for LP-related adverse events, and patients were queried about subjective complaints. We analyzed adverse event rates, including headaches and pain scores. RESULTS: There were 22 adverse events among 809 LPs performed, a rate of 2.72% (95% CI 1.71-4.09%). Patient hospital stay did not increase due to adverse events. Four patients (0.49%) developed a post-lumbar puncture headache (PLPH). Twelve patients (1.48%) developed nausea, vasovagal responses, or headaches that did not meet PLPH criteria. Six patients (0.74%) reported lower back pain at the LP site not associated with muscular weakness or paresthesia. The median pain score was 1 [0, 3]; the mode was 0 out of 10. CONCLUSIONS: The LP protocol described herein may reduce adverse event rates and improve patient comfort in future studies.
Authors
Nobuhara, CK; Bullock, WM; Bunning, T; Colin, B; Cooter, M; Devinney, MJ; Ferrandino, MN; Gadsden, J; Garrigues, G; Habib, AS; Moretti, E; Moul, J; Ohlendorf, B; Sandler, A; Scheri, R; Sharma, B; Thomas, JP; Young, C; Mathew, JP; Berger, M; MADCO-PC and INTUIT Investigators Teams,
MLA Citation
Nobuhara, Chloe K., et al. “A protocol to reduce self-reported pain scores and adverse events following lumbar punctures in older adults.J Neurol, vol. 267, no. 7, July 2020, pp. 2002–06. Pubmed, doi:10.1007/s00415-020-09797-1.
URI
https://scholars.duke.edu/individual/pub1434663
PMID
32198714
Source
pubmed
Published In
J Neurol
Volume
267
Published Date
Start Page
2002
End Page
2006
DOI
10.1007/s00415-020-09797-1

The MARBLE Study Protocol: Modulating ApoE Signaling to Reduce Brain Inflammation, DeLirium, and PostopErative Cognitive Dysfunction.

BACKGROUND: Perioperative neurocognitive disorders (PND) are common complications in older adults associated with increased 1-year mortality and long-term cognitive decline. One risk factor for worsened long-term postoperative cognitive trajectory is the Alzheimer's disease (AD) genetic risk factor APOE4. APOE4 is thought to elevate AD risk partly by increasing neuroinflammation, which is also a theorized mechanism for PND. Yet, it is unclear whether modulating apoE4 protein signaling in older surgical patients would reduce PND risk or severity. OBJECTIVE: MARBLE is a randomized, blinded, placebo-controlled phase II sequential dose escalation trial designed to evaluate perioperative administration of an apoE mimetic peptide drug, CN-105, in older adults (age≥60 years). The primary aim is evaluating the safety of CN-105 administration, as measured by adverse event rates in CN-105 versus placebo-treated patients. Secondary aims include assessing perioperative CN-105 administration feasibility and its efficacy for reducing postoperative neuroinflammation and PND severity. METHODS: 201 patients undergoing non-cardiac, non-neurological surgery will be randomized to control or CN-105 treatment groups and receive placebo or drug before and every six hours after surgery, for up to three days after surgery. Chart reviews, pre- and postoperative cognitive testing, delirium screening, and blood and CSF analyses will be performed to examine effects of CN-105 on perioperative adverse event rates, cognition, and neuroinflammation. Trial results will be disseminated by presentations at conferences and peer-reviewed publications. CONCLUSION: MARBLE is a transdisciplinary study designed to measure CN-105 safety and efficacy for preventing PND in older adults and to provide insight into the pathogenesis of these geriatric syndromes.
Authors
VanDusen, KW; Eleswarpu, S; Moretti, EW; Devinney, MJ; Crabtree, DM; Laskowitz, DT; Woldorff, MG; Roberts, KC; Whittle, J; Browndyke, JN; Cooter, M; Rockhold, FW; Anakwenze, O; Bolognesi, MP; Easley, ME; Ferrandino, MN; Jiranek, WA; Berger, M; MARBLE Study Investigators,
MLA Citation
VanDusen, Keith W., et al. “The MARBLE Study Protocol: Modulating ApoE Signaling to Reduce Brain Inflammation, DeLirium, and PostopErative Cognitive Dysfunction.J Alzheimers Dis, vol. 75, no. 4, 2020, pp. 1319–28. Pubmed, doi:10.3233/JAD-191185.
URI
https://scholars.duke.edu/individual/pub1441055
PMID
32417770
Source
pubmed
Published In
J Alzheimers Dis
Volume
75
Published Date
Start Page
1319
End Page
1328
DOI
10.3233/JAD-191185