Pediatric Endocrinology Fellowship

Fellows in the Pediatric Endocrinology Fellowship Program at MassGeneral Hospital for Children have the opportunity to work with faculty whose interests include the neuroendocrine maturation of human puberty and modulating transcription factor function in the pancreatic beta cell.

Faculty Research Interests

Paul A. Boepple, MD

My research contributions have focused on the neuroendocrine maturation of human puberty and the modulation of childhood and adolescent growth through the interactions between the reproductive and growth hormone axes.  Investigations have predominantly employed clinical models of human puberty, including children with sexual precocity, adolescents with delayed puberty, and adults with deficiencies of gonadotropin-releasing hormone.  In addition to providing physiological insights, the data we compiled in our studies of children with precocious puberty (CPP) were the basis for the first FDA approval of the use of GnRH agonists for this indication. Since that approval in 1991, GnRH agonist therapy of children with CPP has become the standard of care around the world. Subsequently, investigations undertaken with colleagues in the MGH Reproductive Endocrine Unit helped elucidate the complex interaction of GnRH, sex steroids, and inhibin in the differential regulation of LH and FSH in the human male through the study of a variety of clinical research models (children with CPP before, during, after treatment with GnRH agonists; men with GnRH deficiency before and after restoration of a normal, adult testosterone levels by administration of pulsatile GnRH; adult male volunteers before and after short-term, reversible “biochemical castration” achieved by high-dose ketoconazole). I continue to contribute to clinical research studies in the MGH Reproductive Endocrine Unit that characterize the phenotype/genotype correlations in adult subjects with hypogonadotropic hypogonadism and then seek insights into the genetic basis for variations in pubertal timing and reproductive disorders.  Most recently, sequencing of a set of genes known to underlie GnRH deficiency was undertaken in patients with delayed puberty and hypothalamic amenorrhea. 

Lynne L. Levitsky, MD

My laboratory was the first to describe the use of alternative substrates to glucose by the neonatal primate brain, and to document gluconeogenesis in fetal life. We now work on modulating transcription factor function in the pancreatic beta cell in order to reconstruct the beta cell in other cell types. My major clinical research work focuses on the TODAY study, an NIH-funded trial of treatments for type 2 diabetes in children and Adolescents. In addition, I am a co-investigator in the pediatric arm of a closed loop bihormonal insulin and glucagon pump trial (www.artificialpancreas.org), a national data study on type 1 diabetes (T1D study), and collaborate with Dr. Nicole Sherry on her studies of immune modulation in type 1 diabetes. Our group participated in the Type 2 Diabetes Exchange and other national studies of the natural history and modulation of type 1 diabetes.

Michelle Katz, MD, MPH

My research interests surround improving health care practice and delivery to diminish the impact of type 1 diabetes on families and to decrease the rate of diabetes complications. In a national data set, I have studied the association of health care delivery consistent with the medical home model with a family's ability to continue working, decrease out-of-pocket medical expenses, and diminish financial and time-related demands. I am currently working on a study to determine if frequent outreach to patients in addition to psycho-education improves diabetes related quality of life and glycemic control (A1c). I have also looked at the optimal insulin regimen to decrease the frequency of severe hypoglycemia in contemporary adolescents with type 1 diabetes.

Rose Marino, MD

Dr. Marino has worked with Dr. Baron’s group at the NIH in characterizing the physiology and endocrine regulation of the growth plate. She has demonstrated that catch-up growth after hypothyroidism is consequent to delayed growth plate senescence. Her current research interests lie in examining the endocrine consequences of proton beam radiation therapy administered for treatment of pediatric brain tumors. She is also looking at the natural history of the endocrine manifestations in adrenal leukodystrophy.

Madhusmita Misra, MD, MPH

My research to date has focused on clarifying neuroendocrine, body composition and bone alterations in conditions that span the nutritional spectrum from nutritional deprivation (anorexia nervosa) to excess (obesity). My research has contributed significantly to the understanding of low bone mass accrual in teenagers with anorexia nervosa, and in addition to low bone density, I have reported impaired bone microarchitecture and decreased bone strength (assessed using finite element analysis) in this population. I have worked on therapeutic strategies to optimize bone accrual in this population, and have just completed a large study examining the efficacy of physiological estrogen replacement in increasing bone accrual in girls with anorexia nervosa. I have also examined the impact of rhIGF-1 in increasing bone formation rates in this condition of undernutrition. More recently, I have expanded my work to teenage athletes in order to understand the impact of subtle energy deficit states on the hypothalamo-pituitary-gonadal (H-P-G) axis and bone accrual, and my studies indicate that adipokines and certain appetite regulating peptides affected by energy status are possible mediators of the association between low fat mass and suppression of the H-P-G axis in amenorrheic athletes, and may contribute to low bone density. My current grant aims at developing therapeutic strategies to optimize bone health in female amenorrheic athletes in the critical teenage years, when disruption of bone accrual may lead to permanent deficits in peak bone mass, an important determinant of long-term bone health. At the other end of the nutritional spectrum, I have examined neuroendocrine predictors of site specific fat depots in obese adolescents, an important determinant of the metabolic syndrome, and the implication of specific macronutrients on hunger and food intake. I am currently principal investigator and co-investigator of various NIH and industry sponsored (investigator initiated) studies.

David Rhoads, PhD

We have two major research interests. First, in an effort to engineer cells capable of regulated insulin secretion, we are examining strategies to exploit pancreatic β-cell transcription factors to reconstruct this function in other cell types. To this end, we are engineering key transcription factor genes able to convert (reprogram) cells toward β-cell functionality. In an important advance, we developed a technique to boost native gene promoter activities several hundred-fold. Driving engineered genes with “augmented” native promoters is anticipated to preserve innate control of expression and avoid the untoward side-effects observed with the strong, constitutive viral promoters in current gene therapy vectors. Ultimately, incorporating intrinsic control mechanisms could greatly expand the therapeutic potential of gene transfer protocols. Second, in collaboration with a bariatric surgeon at Brigham and Women’s Hospital, we are characterizing mechanisms by which Roux-en-Y gastric bypass (RYGB) improves metabolic function within days of surgery, independent of weight loss. The increasing incidence of obesity and associated type 2 diabetes (DM2) is an urgent health crisis. Currently, bariatric surgery is the only proven weight-loss therapy, with RYGB providing the best outcomes and, remarkably, rapidly resolving or improving DM2 when present in obese bariatric patients. To understand this metabolic benefit, we are examining intestinal glucose sensing and absorption, known to be dysregulated in obesity and DM2, as central to the effect of RYGB. We have shown that RYGB restores regulation in a rodent surgical model. Current efforts are directed to determine how this occurs and to reproduce beneficial changes pharmacologically. These studies are hoped to reveal less invasive alternatives suitable for a wider range of patients and/or to enhance surgical outcomes.

Eray Savgan-Gurol, MD

Dr. Savgan-Gurol has worked on maternal vitamin D gene polymorphisms that may predispose to premature birth, and on techniques used to assess regional body composition to best determine clinical and DXA surrogates for visceral and subcutaneous fat and intramyocellular lipid, as analyzed by MRI and MRS techniques.

Nicole Sherry, MD

Dr. Sherry's research interests include type 1 diabetes, especially research related to immune therapy to alter the autoimmune response in type 1 diabetes. She is the principal investigator in several Phase I/II/III trials involving novel immune modulatary therapies in recent onset type 1 diabetes. She is also a co-investigator in the development of a drug delivery device currently in trials in adolescents and adults with type 1 diabetes at MGH. This is a device that responds to glucose concentrations to automatically avoid both high and low blood glucose, a so-called artificial endocrine pancreas. It uses frequent measurements of blood glucose concentration along with subcutaneous delivery of both rapid-acting insulin and glucagon (to raise blood glucose, if necessary) as directed by a computer algorithm. She is involved in the Type 1 Diabetes Exchange, an information exchange designed to drive a better understanding of the disease, improve care and accelerate new therapies for type 1 diabetes through the promotion of collaborative research and data sharing, as well as the TODAY study (Treatment Options for type 2 Diabetes in Adolescents and Youth). She is interested in research involving practice improvements to improve quality and safety of diabetes care in the MGHfC inpatient and outpatient settings.

Takara Stanley, MD

My research interest is the clinical investigation of metabolic and endocrine perturbations associated with abnormal body composition, particularly in HIV-infection and obesity. I am particularly interested in the interactions between growth hormone dynamics and body composition, ectopic fat accumulation, lipid metabolism, glucose homeostasis. My current project investigates growth hormone dynamics in patients with HIV lipodystrophy, with special attention to the effects of exogenous Growth Hormone and Growth Hormone Releasing Hormone (GHRH) on endogenous growth hormone secretion, insulin sensitivity, and ectopic fat accumulation in liver and muscle. I am also interested in the process of evaluating growth hormone deficiency in children, the effect of body composition on endogenous GH secretion, and the use of growth hormone in pediatric populations, including children with Prader Willi, small for gestational age, and Turner syndrome.

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