It’s hard to overstate the significance of this moment for patients and families in Central Texas: 140 years of expertise at a Tier 1 research university is converging with some of the brightest minds in health care and medical education to build The University of Texas Medical Center.
Meet the two Mulva faculty of the six trailblazing leaders — Lief Fenno and Dave Clarke — among the many bringing Texas’ capital city into focus as a premier destination for integrated, patient-centered health care.
Nominated and selected by their peer leaders, Dell Med’s Visionaries are on a mission to revolutionize how people get and stay healthy.
With calls and texts pouring in everywhere from Kenya to the Caribbean to rural America and Central Texas, Dave Clarke’s phone never stops ringing.
Clarke, a globally recognized epileptologist aiming to improve access to care around the world, has found roots in Austin as a hub for innovation in treatment — which could soon look very different.
More than 50 million people worldwide have some form of active epilepsy — more than 3.4 million of them living in the U.S. with the disease. Adults with epilepsy can carry a risk of death up to 23 times greater than the general population. But access to care remains elusive: In particular, it’s estimated that less than 1% of patients with drug-resistant epilepsy are appropriately referred. Most Level 4 epilepsy centers in the U.S., which provide top-level care like surgery and advanced diagnostic expertise, are in major city centers on the East and West coasts, leaving large swathes of patients and providers with limited resources.
In Austin, the Comprehensive Pediatric Epilepsy Program — a Level 4 center within UT Health Austin Pediatric Neurosciences at Dell Children’s Medical Center — means families here can find answers and treatment without travel elsewhere. And Dave Clarke, M.D., who leads the center, has his mind on improving the quality of care for Central Texans, all while shifting the paradigm for the way the disease is managed globally.
“The work I do to train epileptologists and advocate for resources in Kenya and the Caribbean looks different, but is actually very similar to the work I do in Texas and with partners across the U.S.,” says Clarke, professor of neurology and pediatrics at Dell Medical School. “It’s thinking outside the box about how we train people and connect them with experts in top-level centers to do consults remotely, and get families the answers they need as fast as possible. Telemedicine and collaborative diagnostics are the new frontier for quality epilepsy care.
“If we improve access, not only do we treat the 70% of people who can be treated with nonsurgical means like medication, but we expand the number of patients that actually get to us for more timely needs like surgery.”
For Central Texans, an ‘Innovative Flair’
In Austin, Clarke has helped recruit a rare team of specialists to the Comprehensive Pediatric Epilepsy Program, with expertise ranging from genetics to neuropsychology and more. The center, which is the only dedicated pediatric epilepsy center in the region, has performed nearly 300 surgeries and monitored more than 1,800 patients through its electronic monitoring system since Clarke’s arrival — and while the majority of patients live in the 46-county region served by Dell Children’s, nearly a quarter of patients are traveling to the center from elsewhere.
“Austin has a very innovative flair, and our academic collaborations with University of Texas colleagues mean there are incredible possibilities on the horizon here,” Clarke says. “Using artificial intelligence, for example, we are looking into devices that can actually predict a seizure and send an alert to the patient’s phone before its onset.
Improving quality of life comes from all directions — for some, it’s novel solutions, while for others, it could mean just getting baseline care.”
Global Lessons for Local Impact
In 2021, Clarke received the International Epilepsy Ambassador Award for “extraordinary actions” in the field from the International League Against Epilepsy. His personal clinical impact in terms of patient lives touched ranges in the thousands across both Texas and the Caribbean, and among Clarke’s wide research portfolio is a 20-country collaborative study on how epilepsy management is understood culturally.
“It’s important to understand that this type of work is a multiway sharing of information, as no one place or person has all of the answers,” says Clarke. “There is an incredible wealth of resources and expertise in Austin. And while there are some countries that lack even a single practicing neurologist or equipment like MRIs, we still have a lot to learn about how people understand and manage this disease around the world.”
This physician-scientist has pioneered globally used tools to improve how we study the brain, all while caring for patients with substance use disorders.
Now, he looks to build novel therapies that uncover mechanisms of brain disease — setting the stage for both true precision medicine and landmark discoveries in basic research.
Molecular tools are increasingly common in everyday research and medicine — recent examples include monoclonal antibodies becoming staples in treatments for cancer and delivery of mRNA vaccines for infections like COVID-19. Yet in fields like psychiatry, advancing molecular-level treatments has lagged.
Lief Fenno, M.D., Ph.D., assistant professor in The University of Texas at Austin’s Dell Medical School and College of Natural Sciences, is finding next frontier in brain treatment and research in the interplay of basic neuroscience, clinical neuroscience and bioengineering — with direct human benefit as the nexus.
“In psychiatric illnesses the problem is often how information in the brain moves from one place to another. We can see this in the way psychiatric medicines work like dimmer switches, where they shift the weight of information moving through neural circuits,” says Fenno, who was recently appointed to a three-year term on the American Psychiatric Association’s Council on Addiction Psychiatry. “My research group and I are building new viruses and molecular tools that allow researchers to make similar changes to the ways information flows in the brain — but in a targeted way with precise control of when that happens so that we can make discoveries that are more readily transferrable to real therapies.”
‘Big Tent Neuroscience’ on the 40 Acres
For Fenno, a recent awardee of a prestigious $1 million research grant from the W.M. Keck Foundation, generating new molecules and biological tools is nothing new. Working with Karl Deisseroth, M.D., Ph.D., at Stanford University in the early 2000s, he helped pioneer the use of optogenetics, a bioengineered process that uses light to carefully control neurons in awake, behaving mammals — now a standard in neuroscience research, and hailed a “Breakthrough of the Decade” by Science in 2010. Based on optogenetics, Fenno developed a tool called INTRSECT for widespread use in the scientific community — a technique that allows researchers to selectively target, manipulate and label cells based on multiple genetic traits. The tools, ordered thousands of times by research labs across the globe, have contributed to research for understanding addiction, motor behavior, spinal cord repair, learning and memory, and other circuits.
“We live in a golden era of molecular creativity,” says Fenno. “Molecular tools like CRISPR and optogenetics are derived from organisms as different as you can be from humans. We’re taking advantage of the resources nature has given us — the universality of how DNA and proteins largely work the same regardless of the organisms that they’re produced in — and trying to create a seamless transition between basic research and human psychiatric treatment.”
Now, Fenno and his lab are focused on solving a major limitation of many engineered molecules: “A number of genetic diseases like Duchenne’s muscular dystrophy involve very large genes that don’t fit into the viruses we engineer for administering gene therapy,” says Fenno. “We’re developing a platform that allows us to solve that challenge, and it’s showing great promise in mice.”
And even while Fenno leverages the convergence of world-class expertise across the UT campus to carry his work forward, he continues practicing as a psychiatrist at UT Health Austin and Integral Care, the safety-net psychiatric provider for Travis County.
“It’s vital to work at the intersection of psychiatry, neuroscience and biomedical engineering specialties if we’re really going to push past current limits of what medicine can do to help people,” says Fenno, who also holds a courtesy appointment in the University’s Department of Biomedical Engineering. “The environment here at UT is unique in that there’s immense potential to collaborate across specialties. I had to come up with a term to describe it to colleagues elsewhere: ‘big tent neuroscience.’
“With the emergence of the new UT Medical Center, the University’s support in commercializing research, and the life sciences and biotech scene, Austin as a whole is on a special kind of velocity toward health transformation.”