Vanderbilt-Ingram Cancer Center

The VICC.ORG Directory of Doctors, Healthcare Providers & Researchers

Amosy Ephreim M'Koma, M.D., Ph.D., MS

See also:

• Surgery
• BRET: Biomedical Research Education & Training Faculty Listing
• PubMed Listing of Dr. M'Koma's Publications

Research Assistant Professor of Surgery, Colon and Rectal Surgery
Physician Scientist

Contact Information:

Vanderbilt University, Depart General Surgery
Colon and Rectal Surgery, D-5248 Medical Center North
Nashville, TN 37231-2543
615-343-4612
Fax: 615-322-5869

Profile

Education

• 1978-1984: Graduate: Kharkov Medical Institute, Kharkov, Ukraine.
• 1984 : Doctor Of Medicine Degree (M.D.) (Medicine), Kharkov Medical Institute, Ukraine. Vrach award, Reg. No. 778, ID. No. 087757
• 1985-1990: Post-Graduate & SURGICAL RESIDENCY: Karolinska University Hospital - Huddinge, Stockholm, Sweden.
• 1990: Board Certification: General Surgery. The Swedish Board of Health and Welfare [Socialstyrelsen] and Karolinska Institutet, Sweden.
• 1999: Licentiate Medical Science Degree (Med.lic) (Surgery). Karolinska Institutet, Stockholm, Sweden. Thesis title: Observations on Biochemical Data in Connection with Restorative Proctocolectomy [An analysis with specific reference to lipoproteins and gastric acids]. ISBN-91-7349-009-1.
• 2001: Doctor Of Philosophy (Ph.D) (Surgery). Karolinska Institutet, Stockholm, Sweden. Thesis title: Observations on Essential Biochemical Data Profile in Connection with Restorative Proctocolectomy in Humans. Vitamin B12 and fat absorption cited. ISBN-91-7349-007-5.
• 2004-2007: Postdoctoral Fellow: Cancer Biology. Vanderbilt University Medical Center, Nashville, TN, USA

Research Specialty

One of the greatest advances in colorectal surgery over the past three decades has been the development of restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) for patients suffering from ulcerative colitis (UC) and familial adenomatous polyposis (FAP). The development and refinement of pelvic pouch surgery now allows the entire excision of a diseased colon while maintaining transanal fecal continence. The success of RPC is largely dependent on careful patient selection combined with meticulous surgical technique. RPC is now the criterion surgical procedure, for patients with IBD. When this procedure first became the standard of care little was known about the metabolic consequences of the operation. We began several prospective studies investigating surgical complications, function of the pouches, consequences of pouch inflammation (pouchitis), new trends for ileal reservoir construction and health related quality of life (QoL) issues. We also developed several laboratory tests to detect possible metabolic effects of RPC (see publications). The patient's QoL and satisfaction are high and functional outcome is excellent, even after 20 years of functional pouches. The critical challenge we still face is the means to establish a correct diagnosis in IBD. An accurate diagnosis prior to initiating medical therapy or performing colectomy is of paramount importance in terms of evidenced personalized medical therapy, surgical intervention and prognosis, as well as delineation of IBD by non-invasive, easier, accurate and faster screening.

Research Description

The research is focused on understanding the pathophysiology of IBD, particularly on diagnostic methodologies and surgical management of UC, specifically relating to the physiology of RPC or IPAA. The current research efforts are directed towards developing strategic methodologies based on matrix-assisted laser desorption-ionization-mass spectrometry (MALDI MS), proteomics and recombinant single-chain antibodies to identify peptides that can provide discriminatory diagnostic tools for inflammatory colitis.

Patients with IBD are susceptible to long-term complications from the disease and medications prescribed. The available cure may require surgical removal of the entire colon; however there are complications such as pouchitis/ cufittis, dysplasia, stricture and/ or fistulae. Why these complications affect patients with IBD after RPC differently has not been studied. There are no known preoperative predictor(s) of these complications. The ability to predict these outcomes can allow for prophylactic measures and prevention of pathologic outcomes. Thus our future studies would need to include further elucidation/ verification of the recombinant antibodies in larger patient study cohorts in order to understand the associated biomarker(s) that will be used in future endeavors to help:

-Clarify any proteomic differences of dysplasia within colitides.

-Predict future direction of indeterminate colitis (IC) into UC or CC.

-Predict CC/UC pts that are likely to develop colitis-associated colon or/and rectal cancer.

-Predict which patients with CC are likely to develop stricture or fistulae.

-Predict which patients with UC are likely to develop pouchitis or/ and cufittis following RPC.

Clinical Research Description

The treatment options for UC and CC differ significantly. Therefore the accurate diagnosis of IBD is of paramount importance in terms of personalized medical treatment, surgical intervention and prognosis. The distinction between UC and CC cannot be differentiated in 15% of IBD patients due to the fact that the pathological features of UC and CC often overlap. As a result, the CC patients undergo RPC surgery for definitive UC and subsequently are found to develop Crohn's diseases in the pouch. This is critical because the higher complication and functional failure rates (up to 60%) often necessitates excision of the pouch resulting in a permanent end ileostomy, a complication of which both patients and doctors would like to avoid. Additionally, failure to recognize characteristic signs of CC such as granulomas and transmural inflammation often leads to errors in pathological interpretation of IBD. Another 15% cannot definitively be categorized as UC or CC. This condition is labeled as "indeterminate colitis" (IC). About 90% of patients diagnosed with IC undergo emergency surgery for fulminate colitis, contrasting with only 30% of patients in whom UC or CC are more confidently diagnose. We aim to try to identify molecular features that distinguish UC from CC. We hypothesize that, the proteomic pattern candidates that permit distinguishing UC and CC may allow predicting IC patients into UC or CC. The early accurate distinction of the pathology of IC could alleviate the discomfort in the significantly growing pediatric population. Our goal is to initiating a successful research program in the area of colorectal surgery and establishes a feasibility of identifying a panel of novel molecular signatures in IBD. The research is also focused to further pursue the understanding of the biopathophysiologic mechanisms of the identified discriminatory molecules by examining the mucosal immune response in IBD.