Influenza Expert Navigates the Long Road to a Universal Flu Vaccine
Renowned vaccine researcher and influenza expert Ted M. Ross, PhD, has dedicated much of his career to the development of a universal flu vaccine that would upend the current approach to battling this respiratory scourge. It is a mission he continues as Global Director of Vaccine Development, a newly created role at Cleveland Clinic.
“Designing the next generation of effective vaccines does not happen overnight,” says Dr. Ross of his life’s work. “It takes the contributions of many and the support of many more to achieve the medical breakthroughs that can have long-lasting impacts, which is why I’m excited to combine my efforts with Cleveland Clinic.”
A Return to Florida
Dr. Ross joined Cleveland Clinic in May and is now based at the Florida Research and Innovation Center (FRIC), a state-of-the-art research facility in Port St. Lucie, Florida, located across from Cleveland Clinic Tradition Hospital. More than a dozen of his research team from the University of Georgia, where he was director of the Center for Vaccines and Immunology, also made the move.
Together with researchers across the Cleveland Clinic enterprise, including the Global Center for Pathogen & Human Health Research, Dr. Ross and his team will work to develop novel vaccine platforms for a variety of infectious diseases, including influenza, HIV and COVID-19.
This is not the first time Dr. Ross has called Port St. Lucie home. Previously, he served as director of Vaccines and Viral Immunity at the Vaccine and Gene Therapy Institute of Florida. The now closed immunological research institute is the former occupant of what is today the FRIC. “While my surroundings are very similar, what is not the same is the strong research vision and network supporting the Florida Research and Innovation Center,” he says.
A Marathon, Not a Sprint
That vision is critical, acknowledges Dr. Ross, whose own vision for a universal flu vaccine has motivated him and his research over the years. After earning his PhD in microbiology and immunology from Vanderbilt University, he completed post-doctoral fellowships in vaccine development and immunology at Duke University and Emory University with a focus on HIV research.
While with the Emory Vaccine Center, Dr. Ross also was part of a research team investigating an H5N1 virus responsible for an outbreak of avian influenza that occurred in Hong Kong in 1997. It was his first foray into influenza vaccine research.
He later joined the University of Pittsburgh, where he spent a decade conducting research on infectious diseases and vaccine development. In 2005, Dr. Ross and his team created a new method of designing vaccines called COBRA — computationally optimized broadly reactive antigen. It uses computer modeling to map characteristics of existing viral strains and to project out potential new strains.
The Shifting Vaccine Paradigm
Since that breakthrough, Dr. Ross has applied his expertise in virology, vaccines, immunology and microbiology to developing a vaccine that can protect against multiple strains of the influenza virus.
“My most important work has been to change the flu paradigm,” confirms Dr. Ross. “Instead of a seasonal flu vaccination, we want to make it a vaccination you can get every 10 years and be protected from all the potential strains.”
Dr. Ross and his research collaborators are closing in on that goal. He points to the recently released preclinical results of a universal influenza vaccine that incorporates the proprietary COBRA technology. “We’ve demonstrated that our novel vaccine is effective against multiple strains of the influenza virus, which paves the way for human clinical trials we hope to launch next year,” he explains.
The Ripples of COVID-19
Like many facets of medical research in the last two years, the pursuit of a universal flu vaccine has been impacted by the COVID-19 pandemic. Dr. Ross leads the Cleveland Clinic arm of the prestigious Collaborative Influenza Vaccine Innovation Centers (CIVIC) network of the National Institutes of Health. While initially focused on creating a more advanced and longer-lasting flu vaccine, the program now incorporates SARS CoV-2, the virus that causes COVID-19.
“Our goal is to create a single broadly reactive respiratory vaccine for both COVID and flu,” notes Dr. Ross, who also continues to lead a 2,000-person longitudinal study in Georgia looking at long-term immunity and symptoms of COVID. He plans to expand the study and set up similar cohorts in Florida and Ohio.
Cleveland Clinic’s research mission depends on the generous support of many and Dr. Ross emphasizes it takes a long-term commitment to sustain the research needed to advance medicine. “Governmental research priorities can shift quickly to address ‘emergencies of the moment,’ which is why having public support through philanthropy is critical,” he adds.
Is Robotics Becoming the Backbone of Spine Surgery?
With a PhD in translational engineering and spine biomechanics, Hoon Choi, MD, PhD, offers a unique perspective on the rapid development of robotic technology that is advancing surgical spine care.
Dr. Choi is a board-certified, fellowship-trained spine neurosurgeon with Cleveland Clinic Florida’s Medical, Interventional and Surgical Spine Care Center in Weston, Florida. He specializes in minimally invasive and complex spine surgery for degenerative disease, deformity, tumor, and trauma indications.
Dr. Choi is one of the original robotic spine surgeons to use the ExcelsiusGPS® system, a highly technical surgical instrument designed to improve accuracy and optimize patient care by using robotics and navigation. Dr. Choi has amassed a number of milestones as an early adapter of the technology, including having robotically placed over 1,000 pedicle screws without complications. He also has instructed dozens of other surgeons in its use.
In 2020, Dr. Choi was the first in the world to use the system to perform percutaneous minimally invasive robotic-assisted screw placement in the upper cervical spine and to perform robotic-assisted C1-C2 fusion through 1-inch incisions. He also applied his engineering background to develop a head-clamp reference frame attachment for robotic-assisted surgery.
We sat down with Dr. Choi to find out how robotic spine surgery has evolved and what the future holds for this emerging technology.
Q. What spine procedures utilize robotic technology today?
A. Currently, robotic spine systems support very precise implant placement in all regions of the spine from the cervical spine to the pelvis. Depending on the region, a posterior, lateral, or, in rare cases, an anterior approach can be used. Any fusion procedure may benefit from a robotic insertion of instrumentation, including revision surgery performed robotically with a minimally invasive approach. I’ve used robotic-assistance in cases involving degenerative disease, failed previous surgery, deformity, tumor, and trauma.
Robotic technology supports presurgical planning that allows us to anticipate hardware needs and perform more personalized surgical care. Navigation, intraoperative imaging and robotics are integrated, maximizing the precision and minimizing the invasiveness of surgery. This advanced visualization also can be used whether performing free-hand surgery or robotic-assisted techniques.
Q. What are the advantages and disadvantages of robotic spine surgery?
A. With robotic-assisted surgery, we can achieve very precise implant placement. Smaller incisions with smaller scars, reduced tissue trauma, reduced or no opioid usage, and minimal risk of infection are all benefits of these more minimally invasive procedures. So, too, are reduced length of stay, with some surgeries now converted to outpatient procedures, and quicker recoveries and return to work. The fact that the spine doesn't need to be fully exposed for surgery is a huge benefit for patients. There’s also less radiation exposure for patients and staff, which is safer for everyone. The biggest disadvantages are the steep learning curve and high cost of the technology.
Q. What is on the horizon for robotic spine surgery?
A. Robotic spine surgery has advanced significantly over the past decade, but we’ve really only scratched the surface of what’s to come. Today robots are primarily used to guide pedicle screw placement and retractor placement, but one day delicate decompressive maneuvers may be robotically assisted or even semi-automated. Eventually we will see neurosurgical master-slave robotic systems with multiple articulating arms and remote surgeon control, and the potential for tele-surgery. Augmented reality and digital stereoscopic vision also will become integrated, as will artificial intelligence to complement surgical decision making and operative robotics.
Q. How does your dual background in neurosurgery and engineering influence your practice?
A. Understanding biomaterials and biomechanics is extremely relevant to spine surgery, and I think all spine surgeons should have a basic understanding. That’s why I pursued mechanical engineering during my medical training as a resident and completed a PhD in biomedical engineering as a practicing neurosurgeon. There is also increasing evidence that patient outcomes, in terms of function and pain, are related to sagittal balance and spine biomechanics. One of my research goals is to be able to use computational modeling to analyze biomechanics, plan surgery and anticipate surgical outcomes. Another goal is to advance minimally invasive robotic surgery by introducing novel instruments and techniques.
Support Dr. Choi’s Research
With your support, we can shape the expansion of robotic technology to provide the most advanced surgical spine care to our patients. Your gift will enable Dr. Choi to continue advancing his work so Cleveland Clinic can create the only personalized spine surgery institute in the world based on translational engineering research. Please visit our website to make a gift.
