Get to Know: Recent DOD Grant Recipient – Dr. Lauren Tabor Gray

Lauren Tabor Gray, Ph.D., CCC-SLP is an assistant professor and the co-director of the ALS clinic at the NSU Health Neuroscience Institute. She co-directs the clinic with Eduardo Locatelli, M.D., MPH and she also teaches a dysphasia course, which is a class on swallowing disorders, in the communication sciences and disorders master’s program. Dr. Lauren Tabor Gray was recently awarded a Department of Defense grant to implement an early intervention, which in this case is a combined lung volume recruitment and expiratory muscle strength training, to improve breathing, airway protection, and clearance in ALS patients.

 

What has been your journey that has led you to NSU?

I started working as a speech language pathologist in 2010. During my master’s at the University of South Florida, in Tampa, I met a researcher by the name of Emily Plowman who became my mentor and is still my mentor to date. When I did my masters with her, I worked clinically for a few years as a speech language pathologist. Then, I went back and did my PhD at the University of Florida, in Gainesville. My PhD is in neurorehabilitation. It was an interdisciplinary program, working with basic science and translational, kind of, bench to bedside was the idea which led me into my current research interests, which are and have always been, with neuromuscular disease. I’ve been working with ALS patients for my entire career.

In the past, when I’ve had my own line of research, it’s been this kind of programmatic line of research, looking at ways to improve airway protection and breathing in these individuals. In our patients, respiratory impairment is the leading cause of death, and it’s often due to a pneumonia or respiratory insufficiency. So, we’re trying to develop respiratory interventions that are exercise based that are implemented really early in the disease to improve function over time and try to mitigate the loss of those really crucial breathing and swallowing functions.

 

Where did you find inspiration to pursue a career as a clinician scientist, and in the field that you’re describing?

It kind of goes back to the beginning of what I was just mentioning in 2010, I started working in an ALS clinic as a student just seeing how things work. This was in Tampa, at the University of South Florida, and as a speech pathologist we had no, and, even as a respiratory therapist, we had no interventions.

As you know, the loss of breathing and inability to clear the airway is the leading cause of death, and we had absolutely nothing to offer these patients. All the interventions we did have were really reactive in nature. We waited until their breathing got really bad, and gave them an exterior breathing device, like a noninvasive volume ventilator, or a cough assist to try to help them breathe. And the thought was, why can’t we be doing something more? Something a little bit more proactive in nature.

Across other diseases that are considered a little less fragile, like Parkinson’s disease, we’ve had exercise programs for these patients for decades. The LSVT programs for physical therapy and for speech therapy have been around for a while. But we had nothing along those lines to offer our patients with ALS, and it felt like a real disservice at the time. I decided to just explore that a little bit, and it led me down the road to my entire doctoral degree, and then subsequent study.

 

Congratulations again on your DOD grant. We understand that there could be some confidentiality around this type of grant, but could you offer us any information on the scope of this research?

The primary question is, can we implement an early intervention which in this case is a combined lung volume recruitment and expiratory muscle strength training to improve breathing, airway protection, and clearance in these patients.

It fills a very important gap in our current literature, that we don’t know if we can intervene early, and it’ll help and/or change the trajectory of the decline. Since respiratory failure is the leading cause of death in ALS patients, if you’re not breathing, you’re not doing very well. The idea is that we will bring all of these patients in once they’re enrolled, and they’ll go through a 5-week lead-in period during which time there will be no intervention.

Then, they’ll start an active training period, which is a combined respiratory strength training regimen and they’ll come back after their strength training regimen and be assessed again. We’re going to be looking at a nasolaryngoscopy, which is when they stick a little camera down your nose and take a look at your vocal cord. That’s how we’re going to assess cough and airway protection during swallowing. They are also going to be doing a whole bunch of respiratory assessments with a respiratory therapist. It’s a fairly short study, which is a good thing for a treatment study, and then we’ll be following the patients long-term to look at some long-term outcome measures.

One particularly exciting thing about the grant is that we’re working with a respiratory physiotherapist who has been a colleague of mine for a long time. She lives in Melbourne, Australia, and she’s been doing lung volume recruitment on patients with ALS for a while, but we actually don’t do it in the United States at all. It’s not standard of care. Despite the fact that it’s been shown to be efficacious on its own, we’ve never done it in this country, so it is new and fun.

 

What are your future predictions of these efforts on the scientific community and in people’s lives?

What I like about the research that we do is that you can implement it pretty directly afterward. There aren’t a lot of steps in between what we’re doing in this grant and being able to use this in a clinic with an actual patient. So, the devices that we’re using are already FDA approved and they’re somewhat commercially available.

However, they’ve never been combined together. They’ve been studied in isolation in other patient populations, but never in ALS in this country and we’re looking to see if it works.

 

Was that purposeful to choose items that can be implemented almost immediately?

Yes, definitely. One of the main goals of our research is that it’s tangible.

 

What is the most rewarding part of your job?

I think it’s twofold. The first one is being able to offer something that can potentially help others, and I feel like we have the ability to empower patients by implementing early in a disease where they lose a piece of independence every single day.

It’s nice to have something to say while a patient is fully functioning and non-disabled, that if you start this now, maybe we can help early.

I think what we are doing is relatively novel, and it feels good on the provider, but also I’m sure for the patients and caregivers as well. We have gotten a really good response with our treatment and it has been relatively easy to get participants to enroll in something like this.

The second, maybe slightly more selfish reason is because it really gives you a lot of perspective in your life. When you’re having a hard day, or when your kids are sick or crying, or you’re in a fight with someone, you always remember, you’re doing pretty good in the grand scheme of things. So, our patients always constantly provide us with a sense of perspective.

 

How has NSU helped you pursue and achieve your personal and professional goals that you’ve set for yourself?

Previously, I was at an academic institution and then I was at a non-academic institution, and now I’m back in academics, so I have become aware of the juxtaposition in resources from a research standpoint in each setting.

I started at NSU on April 1st of 2022. I’ve had some research-related ideas for a while and we’ve gotten some smaller foundation grants in the past, but this was the first large NIH-, DOD-like grant that I’ve submitted where you need an administrative research team to help you get all of these ancillary documents in place. It was really exciting. I mean, everyone really rallies behind you from the Research Administration standpoint, and Melanie Bauer was incredible. When I first got here, I started going to the Grant Lab Chats. I was seeing all the things that were possible and that people were here to help. It was a great way to connect the silos that can be at a university.

Cathy Harlan is amazing. Magalie Thomas, amazing. Ashley Whitaker, awesome. All these people and more helped me with my grant. I’m so thankful for support, because I don’t have the skill set to do that by myself.

Additionally, support from my leadership at the Neuroscience Institute was important. The executive director, Dr. Eduardo Locatelli, helped me find the time to grant write, so I really appreciate the carving out of time for research writing.

My personal experience has been great. You know we’ve submitted this DOD Grant, which was a massive undertaking, and there’s so much red tape with these Federal grants, the assistance made it as easy as possible.

With our ALS Association Grant, it’s a little bit different. It’s like an infrastructure grant and the Grants team has also been incredible with those. I feel fortunate, and I’m happy to work with really nice people.

Also, if they didn’t know the answer to something, which was rare, they would say “let me ask so and so, and get back to you with an answer”. It’s a team, and it’s nice.

 

Are there any other grant funded projects or clinical trials that you’re working on right now that you’d like to share any information about or give updates on?

Well, the ALS Association Grant is a grant with Dr. Locatelli and myself, we’re co-principle investigators. It’s an infrastructure grant looking at expanding clinical trial access to Hispanic and black populations in South Florida. This is a historically underserved and under enrolled patient population, particularly in ALS. Everything will be translated in Spanish and Portuguese as well. We’re looking to expand our enrollment in this population to make the trial results a little bit more representative across race and ethnicity. It’s a really exciting project that’ll begin in January of 2023.

We have another project that we’re about to submit. We ran a pilot study, looking at the impact of NUEDEXTA, which is a pharmacologic intervention to improve speech and swallowing. It’s also FDA approved. We ran the pilot study with really promising data that we presented at NEALS, which is the one of the largest ALS conferences in the country, the Northeastern ALS Consortium. That was in November of this year. It was really well received. So, now we’re seeing if we can partner with the pharmaceutical company to run a larger trial and that’s something that’s kind of in the pipeline.

 

What is your fondest memory or experience in your current or previous positions that you had?

Oh, that’s a good one. Well, one of my fondest is getting this DOD Grant because I’ve been wanting to do this study for a really long time, and we’ve collected pilot data with these patients. I’ve been doing this training with patients already and that is honestly probably among the fondest memories. Because again, we don’t have that much to offer when it comes to interventions for breathing and swallowing, so for a patient to come in, and for me to be able to offer them something, you know as soon as they get diagnosed is great for the patient. It’s shown not to be harmful, so pretty much anyone can do it, it’s safe and now we know it’s potentially effective. The more recent things in my career are fond, despite the fact that I’ve been working with ALS patients for 12 years, because it’s nice to have this opportunity now.

 

How long has this study been on your mind or has been an idea that you have wanted to look into?

I would say, probably for the past 5 and a half years. My mentor started the expiratory muscle strength training with ALS patients back in 2011. That’s one of the trainings that we’re combining with the lung volume recruitment. I’ve been working with these respiratory exercises for a while, but we were just improving one aspect of the system. The breathing out aspect, but you have to be able to breathe in, of course, to effectively breathe out. That’s where the combination comes in. Having the DOD Grant, we really needed resources. I needed to be able to collaborate with people and hire them for their expertise. The DOD Grant mechanism allows me to do that. I think this will be a really well done study which is exciting.

 

How can NSU better serve you to keep achieving your personal and professional goals?

I really enjoyed Dr. Delaney coming in and speaking in person from the NIH. I think Melanie Bauer organized that not too long ago. It was a face-to-face NIH Grants officer that came down and did a presentation. You could ask questions. It was interactive. You get things that people probably can’t write in an email, kind of those off the cuff comments and advice that you didn’t even know to ask a question about, but you get the information. I thought that presentation was incredibly helpful and also you’re sitting around a table with a lot of other people in your position or maybe people with more experience or have Grant funding under their belt that you can talk to. Getting other investigators together from other colleges that are interested in investigator-initiated research was amazing and I would love to see more of that.

 

Can you offer any advice for someone who would be pursuing a career as a clinician scientist?

You get your PhD or you get your MD and then you think there’s this career ladder that’s very straight and narrow, but there are a 1,000 different directions you can go in and you really have to try to figure out if it’s for you. I would say, be a self-starter, have tough skin, be resilient, and try to form a support group for yourself whether it be colleagues who are also in your field, or out of field, or a mentor. Try to always surround yourself with people that you can vent to and talk about obstacles. Having a support system is crucial, because grant writing can be a very isolating experience. It’s like just you and your ideas. But with other people there too. Try to be collaborative.