Secondary Appointments

National Center for Regenerative Medicine, Case Center for Imaging Research, Urological Institute

Education

  • MD, The Ohio State University, 2001

Research Summary

We have three major projects currently underway.

First, the image guided percutanous delivery of mesenchymal stem cells for the treatment of symptomatic degenerated intervertebral discs. Briefly, the long term objective of this research is the clinical establishment of percutaneous image guided injection and biointegration of autologous mesenchymal stem cells (MSCs) to symptomatic degenerated intervertebral discs (IVDs), resulting in chondrocyte differentiation, extracellular matrix production, and functional-morphologic disc restoration for symptom relief. Our initial goal is to establish the feasibility (regarding the image guided needle injection of MSCs), safety (as reflected by the local delivery and containment of MSCs into the IVD), and efficacy (manifested as changes in matrix gene production and MR signal characteristics) of this technique in a porcine model. To follow, the clinical interventional radiology technique of percutaneous needle access to the IVD under fluoroscopic guidance is well established and regularly performed by the principle investigator at our institution. Our center has extensive expertise in the isolation, expansion, characterization, and labeling of MSCs. What remains to bridge these technologies are data addressing the feasibility, safety, and efficacy of image guided percutaneous mesenchymal stem cell needle injection to the intervertebral disc in humans - a trial we are preparing to execute.

Second, we have developed a technique for thermal ablation of the dorsal penile nerve under CT guidance for the treatment of premature ejaculation. Again, briefly - there are multiple ways to inhibit transmission from peripheral nerves, from transient blocks with pharmacologic agents to more permanent options which destroy the nerve directly. Among the longer lasting treatments, surgical resection, alcohol or phenol ablation, and heat ablation via radiofrequency energy are associated with neuroma formation. However, cryoablation offers lasting results without the complication of neuroma formation. Cryoablation has been used successfully to treat patients with chronic pelvic pain (pudendal ablation [CT guidance]), inguinal pain (genitofemoral nerve ablation [ultrasound guidance]), and for post thoracotomy syndrome (intercostal nerve ablation). We have been, under IRB 07-10-25, unilaterally cryoablating the DPN under CT guidance in patients with PE as a natural extension of established techniques with positive initial outcomes. Two pathways of potential collaboration and advancement have presented themselves through this study: 1) the question of axonal regeneration following cryoablation – and the subsequent return of symptoms and need for repeat procedures, and 2) the need to execute a larger prospective multicenter trial, both of which are being developed.

Third, percutaneous image guided thermal ablation as recently emerged as potential therapy for patients with painful osseous metastases. Currently the standard of care for local treatment of extraspinal osseous metastases is external beam radiation therapy. Fifty percent of patients who undergo this therapy achieve complete response/resolution of their symptoms. Of the remaining, half fail therapy (20-30% of the total), ten percent require retreatment, and 1-3% experience debilitating complications such as fracture of the treated bone. Of those who respond, the time to symptom relief is typically 2-4 weeks, and 50% experience at least transient pain by 15 weeks. Moreover, these patients are required to maintain multiple treatment appointments often over weeks, and undergo interruptions of their systemic chemotherapy regimens. Multiple single arm studies have suggested faster time to relief, improved quality of life, and structural stability associated percutaneous management. We have initiated a prospective multicenter randomized comparative trial to evaluate this therapy vs. stereotactic body radiation therapy.

Awards and Honors

2012: Distinguished Plenary Presentation Award, Society for Interventional  Radiology
2004-2005: Chief Resident, University Hospitals Case Medical Center            Radiology Training Program
2004: Philips Award for Outstanding Research by a Resident/Fellow in CT
2003: RSNA Roentgen Resident/Fellow Research Award
1998: National Student Research Forum Award

Publications

Prologo JD, Pirasteh A, Tenley N, Yuan L, Corn D, Hart D, Love Z, Lazarus HM, Lee Z..  Percutaneous Image-guided Delivery for the Transplantation of Mesenchymal Stem Cells in the Setting of Degenerated Intervertebral Discs.  J Vasc Interv Radiol. 2012 Jun 25.  [Epub ahead of print]

Dar SA, Love Z, Prologo JD, Hsu DP.  CT-guided cryoablation for palliation of secondary trigeminal neuralgia from head and neck malignancy.  J Neurointerv Surg. 2012 Mar 30. [Epub ahead of print]

Prologo JD, Dogra VS, Farag R. CT Diagnosis of fat embolism. Am J Emerg Med 2004; 22(7): 605-606.

Pirasteh A, Snyder LL, Lin R, Rosenblum D, Reed S, Sattar A, Passalacqua M, Prologo JD.  Temporal assessment of splenic function in patients who have undergone percutaneous image-guided splenic artery embolization in the setting of trauma.  J Vasc Interv Radiol. 2012 Jan;23(1):80-2. Epub 2011 Oct 26.

Pirasteh A, Snyder L, Boncher N, Prologo JD. Comparative analysis of outcomes following percutaneous CT guided ablation of renal cell carcinomas with either radiofrequency or cryoablative techniques. Acad Radiol 2011 Jan;18(1):97-100.

Prologo JD, Dogra VS. Pulmonary embolism. In: Strang J, Dogra VS, ed. Body CT Secrets. Elsevier Science, 2007.

Prologo JD, Gilkeson RC, Diaz M, et al. The effect of single vs. multi-detector CT imaging on clinical outcomes in patients with suspected acute pulmonary embolism and negative CT pulmonary angiogram. AJR 2005;184(4):1231-1235

Prologo JD, Gilkeson RC, Novak RD. CT pulmonary angiography: a comparative analysis of utilization patterns in hospitalized and emergency department patients during 1998 vs. 2001. AJR 2004;183:1093-1096.

Prologo JD, Dogra VS, Farag R. CT Diagnosis of fat embolism. Am J Emerg Med 2004; 22(7): 605-606.

Prologo JD, Glauser J. Variable diagnostic approach to suspected pulmonary embolism in the ED of a major academic tertiary care center. Am J Emerg Med 2002;20(1):5-9.

Bumgardner GL, Li J, Prologo JD, et. al. Patterns of immune responses evoked by allogeneic hepatocytes: evidence for independent co-dominant roles for CD4+ and CD8+ T-cell responses in acute rejection. Transplantation 1999;68(4):555-62.




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Email
david.prologo@uhhospitals.org
 
Phone
216-983-4866
Fax
 
Mailing Address
University Hospitals Case Medical Center, Department of Radiology, 11100 Euclid Avenue, BSH 5056, Cleveland, Ohio 44106
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