In January 2021, Dodger Stadium was one of California’s largest COVID-19 vaccination sites, dispensing vaccines to up to 12,000 people daily.

Cars lined up throughout the stadium parking lot as volunteers and staff from USC, the Los Angeles Fire Department and the nonprofit Community Organized Relief Effort prepped doses for L.A. residents.

Throughout the pandemic, the USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences partnered with Keck Medicine of USC, the Keck School of Medicine of USC, other health-related USC entities and L.A. city and county officials to spearhead a massive, multidisciplinary COVID-19 response that went far beyond Dodger Stadium — establishing mobile clinics, making door-to-door visits, busing patients to vaccination centers and hiring community vaccine facilitators.

The collaborative effort highlighted the university’s role in building local connections and championing the health and well-being of its adjacent communities. “Everyone stepped up,” says Vassilios Papadopoulos, dean of USC Mann.

“Everyone shared the same mission of getting the vaccines out into the community.” Richard Dang, an assistant professor of clinical pharmacy and assistant director of the residency programs at USC Mann, helped lead mass vaccination efforts throughout the city. “At the time, USC was recognized as the institution providing this moment of hope,” Dang says.

Despite the unprecedented scale of the pandemic, Dang adds that USC Mann is accustomed to being a good neighbor to local communities, frequently organizing free health education and screening programs. “We also provide free access to tests for diabetes, high cholesterol, and high blood pressure, and distribute Naloxone for opioid overdoses,” he says.

After all, the good health of its neighbors is an essential metric of success for USC’s health sciences schools and its medical enterprise (which includes Keck Medicine of USC’s four hospitals and more than 100 clinics).

The university’s constellation of health sciences schools demonstrates just how far that health extends beyond the hospitals: They include the USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences; the USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy; the USC Division of Biokinesiology and Physical Therapy; the Herman Ostrow School of Dentistry of USC; the Keck School of Medicine of USC; the USC Leonard Davis School of Gerontology; and the USC Suzanne Dworak-Peck School of Social Work.

Trojans as good neighbors

USC’s community-based work includes a consortium of scientists, researchers and clinicians committed to tackling health disparities and making a visible, positive impact on the neighborhoods surrounding the University Park and Health Sciences campuses by providing access to high-quality medical and social services.

“We’re always thinking about how we can bring all our expertise and work with the community to improve the health of our neighbors,” says Rodney B. Hanners, CEO of Keck Medicine of USC, the university’s health system.

At Ostrow School, oral health initiatives combine dental care with social services. At the Keck School of Medicine, a street medicine program seeks to reach the county’s unhoused population. USC Leonard Davis faculty and graduate students use advocacy and research to illuminate the gaping holes in our social safety net for elder care.

This ongoing relationship with local communities is mutually beneficial: Patients receive highly specialized care from the academic health system and have the opportunity to engage with health science practitioners through research, clinical trials and more.

Community members that choose to participate in USC studies contribute to more comprehensive and applicable insights that researchers and clinicians can use to inform patient care and drive innovation. Varied in their ethnicity, housing status, complexity of disease and other metrics, their participation leads to a better understanding of all communities. This kind of translational research has the power to transform basic discoveries into treatment directly beneficial to patients suffering from complex diseases such as Alzheimer’s disease or cancer.

Prioritizing access to care

While innovation and evidence-based care form two pillars of USC’s community-oriented health care philosophy, accessibility is an important third pillar.

The most significant driver of health disparities is access to health care,” says Raffi Svadjian, PharmD/MBA ’03, assistant professor of clinical pharmacy at USC Mann.

Since 2017, Svadjian has served as USC’s executive director of community pharmacies, supervising the three pharmacies operated by USC Mann: one on the University Park Campus, one on the Health Sciences Campus and one next to USC Verdugo Hills Hospital.

The school-operated pharmacies are an essential resource for both the USC community and those living around the university’s campuses and health facilities who would otherwise have few points of access to health care. Svadjian and his colleagues at USC Mann emphasize the power that pharmacists have to address health care access issues in under-resourced populations as first-line health care providers who are essential fixtures in communities.

Bringing the pharmacy to the community

The issue of access also informs USC Mann’s decision-making and civic engagement. In 2017, Papadopoulos approached Svadjian about opening a new pharmacy in South Los Angeles after pharmacy alumni highlighted the significant need in the area. Svadjian and his team surveyed more than 10 potential sites, guided by research from colleague Dima M. Qato, assistant professor of clinical pharmacy and spatial sciences and a leading researcher in pharmacy access. Qato most recently developed an interactive tool to map “pharmacy deserts” and determined that 25% of neighborhoods lack reliable access to pharmacies.

The team settled on a location next to where a Rite Aid had recently closed. Svadjian says the South L.A. pharmacy — which aims to open next year — represents a long-term commitment to the community, going beyond shorter engagements such as health fairs and workshops.

He hopes the new pharmacy’s impact will extend beyond dispensing prescriptions: His goal is to increase health education in the community while also providing an avenue for USC Mann students to learn from and interact with their neighbors.

“Obviously, one pharmacy is not going to change the world, but we have to start somewhere,” Svadjian says. He explains that by establishing a new pharmacy in a community that large corporations such as Rite Aid and CVS have avoided or left, the project furthers the university’s efforts to be a “good neighbor” to the communities surrounding its campuses and health facilities.

Letting the community fuel the research

Lourdes Baezconde-Garbanati, a Distinguished Professor of Population and Public Health Science at the Keck School of Medicine, also believes that addressing access to care is key when tackling health disparities.

Her collaborative approach to community health closely aligns with USC President Carol Folt’s Health Sciences 3.0 “moonshot”: She leads teams on community engagement within the USC Norris Comprehensive Cancer Center, the Southern California Center for Latino Health, the Center for Health Equity in the Americas, the Department of Population and Public Health Sciences, and other health institutes in Southern California to efficiently translate academic research into health care treatments, public health practice and policy. She also works with more than 100 USC faculty and over 190 community partners to transform community research into solutions that address the entire spectrum of disease prevention.

“It typically takes eight to 10 years for scientific discoveries and advances in medicine to make it out into the community,” says Baezconde-Garbanati, “but we’re really trying to accelerate that so people can live longer and healthier lives.”

She also works with the All of Us research initiative via the National Alliance for Hispanic Health to encourage community participation in research and clinical trials. She argues that in the age of artificial intelligence in health care, it is “especially urgent” for the needs and data of traditionally underrepresented communities to be reflected in emerging databases.

“USC is an anchoring institution in community health care, and we’re developing various ways to further engage with our neighbors so we can develop great innovation and amazing discoveries together with our community partners,” Baezconde-Garbanati says. “I feel like it’s a renaissance moment at USC, and I’m very proud to be part of that.”

Inclusion as a strength

In an effort to build a more equitable, culturally competent and compassionate health care system, the Keck School of Medicine also partners with the USC Dornsife College of Letters, Arts and Sciences for a master’s program in narrative medicine that brings health professionals into local communities to better understand the importance of storytelling for individuals, community wellness and the health care system.

One of only two such programs in the country, students in the program — often from the creative writing or medical fields — have workshop opportunities to teach and learn from community partners in topics such as strategies for challenging the hierarchy between patient and clinician.

This year, Keck Medicine of USC hospitals and USC Student Health earned an LGBTQ+ Healthcare Equality Leader designation from the Human Rights Campaign Foundation’s 2024 Healthcare Equality Index (HEI) survey. The survey found that Keck Medicine of USC — which is earning the distinction for the seventh time in recent years and includes Keck Hospital of USC, the USC Norris Comprehensive Cancer Center, and community hospitals USC Verdugo Hills Hospital and USC Arcadia Hospital — deserved a top score due to its health care facility policies and practices that are dedicated to the equitable treatment and inclusion of LGBTQ+ patients, visitors and employees.

The USC Gender-Affirming Care Program embodies this commitment by featuring a centralized program with specialists and staff who tailor comprehensive health care to transgender, nonbinary and gender-diverse patients.

This includes individualizing patients’ health needs based on their personal goals, which could include hormone therapies and surgical interventions, but also routine care such as preventative medicine and mental health care.

Program leaders developed early partnerships with community organizations such as The TransLatin@ Coalition, one of the largest trans-led nonprofit organizations in the country, to ensure that community members have a say in solidifying the program’s vision. USC clinicians and staff also host regular bilingual focus groups both at USC facilities and at The TransLatin@ Coalition’s headquarters in Koreatown to continue to promote mutual listening between the health system and the community.

Meeting people where they’re at

The COVID-19 pandemic revealed that sometimes, health care workers have to serve their communities even when face-to-face interaction isn’t possible.

Prior to the pandemic, the USC Suzanne Dworak-Peck School of Social Work’s telebehavioral health program was fairly small, with graduate students providing online mental health counseling to a mostly migrant worker population through a contract with Monterey County. Students also provided some pro bono services to local residents in L.A.

When the COVID-19 pandemic hit, the school was able to pivot and rapidly expand its online services and provide remote practicum opportunities for its graduate students who could no longer practice in person.

“There was this huge mental health need, with people dealing with the stresses related to COVID-19, such as grief and health issues,” says Professor Ruth Supranovich, associate dean of community and clinical programs at the school. “We were able to respond both to the need for the students, but also to the need in the community.”

Since that initial expansion, the program has partnered with CALHOPE, a crisis counseling assistance and training program that receives funding from the Federal Emergency Management Agency (FEMA) and is run by the California Department of Health Care Services to provide crisis support and counseling to the entire state. Through CALHOPE@USC, USC’s Telebehavioral Health Clinic — which opened in 2012 — provides inclusive individual and group counseling to anyone age 12 and older who lives in California. Services are free to the public and designed to be short term — the limit is six sessions per person.

Beyond short-term counseling, the clinic also connects community members to longer-range resources such as food assistance, mental health services, housing assistance and other forms of support.

The school also applied for and received funding from the California Victims Compensation Board to open a trauma recovery center for victims of violent crime. With the funding, USC therapists — including many graduate students and graduates of the master’s in social work program — provide evidence-based mental health treatment for trauma along with case management.

In addition to referrals from nonprofits, legal offices and word of mouth, the program receives client referrals from Keck Medicine of USC, USC’s occupational and physical therapy programs, the USC Department of Public Safety, and L.A. General Medical Center’s Hospital Violence Intervention and Prevention program.

With Trojans of all disciplines engaging in community-based initiatives and research, the university is well-poised to help Angelenos live longer, healthier lives.

“The stars are aligned — from the president’s office to our deans and faculty and to our students — in embracing our communities so its members can lead healthier lives,” Baezconde-Garbanati says. “There’s so much that we still need to do, and it really is going to take all of us coming together.”

This spring, scientists from the Keck School of Medicine of USC opened a new window into understanding the brain — literally.

Thirty-nine-year-old Jared Hager had injured his brain in a skateboarding accident. During emergency surgery, half of Hager’s skull was removed to relieve pressure on his brain, leaving part of the organ covered only with skin and connective tissue. A team at the Keck Medical Center of USC reconstructed his skull using a custom prosthesis that contained a transparent window.

The window, designed in collaboration with colleagues at California Institute of Technology, allowed the researchers to evaluate Hager’s brain function in a remarkable new way. While Hager played video games and strummed a guitar, the research team collected high-resolution brain data using functional ultrasound imaging. This type of imaging reveals brain changes that occur when a patient is performing a task — information that can be critical for assessing and treating traumatic brain injury.

“Functional ultrasound imaging can’t be done through the skull or a traditional prosthesis,” says Charles Liu, a professor of clinical neurological surgery, urology and surgery at the Keck School of Medicine and director of the USC Neurorestoration Center, who led the research team. “This is the first time physicians have been able to do it noninvasively in an awake patient through a window. The window allows us to monitor brain function and guide treatment in ways that were not possible before,” he says.

Effective treatment options for brain injuries and diseases have long been elusive. That’s in part because the brain — the command center of thinking, sensing, movement and emotion — is so complex to understand. The brain is also challenging to observe and study, especially in living humans.

Liu’s team at the USC Neurorestoration Center, which specializes in developing novel strategies to restore neurological function in those with injured or diseased nervous systems, is one of the many research groups at USC working to address the formidable challenges presented by brain diseases, from traumatic brain injuries and epilepsy to Alzheimer’s disease and other forms of dementia. Using advanced technologies and methodologies, they’re finding revolutionary ways to bring new clarity to the mysteries of our gray matter.

MAPPING THE BRAIN

Alzheimer’s disease is one of the most enigmatic brain afflictions and among the greatest health care challenges facing the nation. It affects nearly 7 million Americans — a number expected to double by 2060 — and there’s no known cure.

The disease is characterized by two hallmark changes in the brain: plaques made of a protein called beta-amyloid and tangles made of a protein called tau. Scientists have yet to discover what causes these proteins to accumulate. Some have speculated that dysfunction in the blood-brain barrier (a membrane that keeps harmful substances in the blood from reaching the brain) and inflammation of the brain’s blood vessels may set the stage for protein buildup.

Arthur Toga — Provost Professor of ophthalmology, neurology, psychiatry and the behavioral sciences, radiology and engineering and the Ghada Irani Chair in Neuroscience at the Keck School of Medicine — has developed cutting-edge imaging techniques that offer new insight into these parts of the brain.

At the Laboratory of Neuro Imaging (LONI) in the USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Toga and his research team program the radio frequency pulses used in magnetic resonance imaging (MRI) to observe the blood-brain barrier and the fluid-filled spaces around the brain’s blood vessels.

“These innovative techniques are really improving our ability to look at the most minute features of brain organization and brain function that may be affected by this disease process,” Toga says.

As Toga’s team works to create the most detailed neurological maps in existence, they’re also adding to LONI’s Image and Data Archive, a tool developed by Toga and his collaborators to facilitate real-time data sharing among thousands of researchers worldwide. Toga believes that such cross-institutional collaboration is essential for solving the riddle of Alzheimer’s.

He is one of the principal investigators on the Health and Aging Brain Study – Health Disparities (HABS-HD), a joint effort among five institutions to address the lack of diversity in Alzheimer’s disease research. Hispanic and African American populations experience a significantly greater risk of developing Alzheimer’s disease than non-Hispanic whites, yet much of what is known about the disease is based on data gathered among the latter group. HABS-HD has enrolled thousands of participants from underrepresented groups and is generating the world’s largest repository of data describing these populations.

“The path to discovery is paved with data,” Toga says.

PREVENTION IN PILL FORM

Thanks in part to the Image and Data Archive, the first drug to slow progression of Alzheimer’s disease — lecanemab — came on the market last year.

Pharmaceutical companies used data from the archive to develop the drug and design clinical trials. Those trials have shown that lecanemab, which targets and removes abnormal beta-amyloid deposits in the brain, slows down declines in memory and thinking by about 30% in those with early-stage Alzheimer’s.

For Paul Aisen, professor of neurology at the Keck School of Medicine and the founding director of the Alzheimer’s Therapeutic Research Institute, 30% improvement is not enough. “We’re very focused on research to find the best drugs to do better,” says Aisen, who leads research into evaluating drugs to treat — and even prevent — the disease’s underlying pathology in the brain.

Lecanemab is approved for people who have a confirmed diagnosis of Alzheimer’s disease in its mildest symptomatic stages. Aisen’s team is investigating the drug’s potential use in those whose brains are beginning to show Alzheimer’s changes but do not yet have any symptoms. “We believe if we remove the beta-amyloid as it’s starting to accumulate, while the brain is still functioning normally, we’re going to have an impact that is much better than a 30% slowing of disease progression,” Aisen says.

Another of the institute’s projects focuses on using lecanemab in conjunction with drugs that target brain tangles made of tau. By targeting both tau and beta-amyloid deposits at once, Aisen’s team aims to put the brakes on the disease even more effectively.

Aisen believes that within a decade, such pharmaceutical advances may make Alzheimer’s disease a thing of the past. He sees a future where clinicians will monitor everyone starting in middle age, identifying those who are at risk for the disease and prescribing drugs that can keep proteins from accumulating abnormally in the brain.

“It will be like checking your cholesterol and treating high levels in midlife so that you don’t get heart attacks and strokes in later life,” he says. “We think we can prevent Alzheimer’s disease the way statins [drugs that lower cholesterol] have dramatically lowered the occurrence of heart attacks.”

BESPOKE BRAIN FITNESS

While Aisen envisions routine Alzheimer’s prevention for all, researchers at the USC Center for Personalized Brain Health at the Keck School of Medicine are focusing their prevention efforts on a subset of people who are known to have a high risk of developing the disease: those who are carriers of a fairly common genetic variant called APOE ε4.

Roughly one in four people carry one copy of the gene, elevating their risk of Alzheimer’s. Those who have two copies of the gene — 2% to 3% of the population — face eight to 12 times the risk for the disease.

“When people take a genetic test and find out they have the APOE ε4 gene, they are often scared and unsure of what to do — especially if they have a family member who already has dementia,” says Hussein Yassine, professor of neurology and gerontology at the Keck School of Medicine and director of the center. “We’re trying to fill this gap by providing resources to help patients do what they can to prevent the disease.”

The center has two components that inform one another: a clinic that develops personalized diet and exercise interventions for each patient to potentially slow cognitive decline, and a research wing focused on the development of new drugs. “This bridge between research and the clinic is quite novel,” Yassine says.

One example of the center’s translational approach is a multi-pronged investigation into the role of omega-3 fatty acids, which are found in foods like salmon and walnuts, in the brain health of APOE ε4 carriers. Imaging studies have shown that the brains of APOE ε4 carriers are deficient in omega-3s years before Alzheimer’s brain changes set in. Yassine launched a clinical trial to test whether early omega-3 supplementation in people with APOE ε4 can slow down disease progression. He also partnered with Kai Chen, professor of research radiology at the Keck School of Medicine, to invent a new imaging technique that traces omega-3s in the brain.

AI SEE YOU

High-resolution imaging techniques like those used by Liu, Toga and Yassine help researchers visualize the intricacies of brain tissue in never-before-seen ways. Yet the human eye itself has limitations that affect how brain images are interpreted. Andrei Irimia, associate professor of gerontology at the USC Leonard Davis School of Gerontology, is using artificial intelligence to push past those limits.

Irimia and his colleagues use an AI technology called deep neural networks to analyze MRI brain scans. The AI model allows Irimia’s team to identify subtle patterns in the brain scans that the human eye might not be able to detect.

One application of the technology is assessing biological brain age, an important factor in the development of Alzheimer’s disease and other forms of dementia. While the risk of developing these neurodegenerative diseases increases with age, not everyone’s brain ages at the same rate. “A person who is very fit and has a healthy lifestyle might experience low and relatively much slower rates of atrophy in the brain compared to more sedentary individuals,” Irimia explains.

He notes that traditional measures of brain aging, which include judging brain age by the thinning of the cerebral cortex, may not offer the fullest picture.

“By identifying patterns in a very large array of changes pertaining to brain anatomy, these deep neural networks can estimate brain age a lot better than we could based on measures that have been identified by humans,” Irimia says.

THE BRAIN ELECTRIC

At the Keck Medical Center of USC, where Liu and his colleagues implanted the transparent skull prosthetic, digital technologies are being integrated into the brain itself to help restore function in those with brain and spinal cord injuries.

In collaboration with colleagues at Caltech and the University of California, Irvine, Liu’s team is developing brain-computer interfaces to help paraplegic patients regain feeling in their legs and walk again. These interfaces offer a bidirectional communication link between the brain’s electrical signals and a bionic bodysuit (aka “robot exoskeleton”) worn by patients that can aid in movement.

Patients control the movement of the exoskeleton with their thoughts. Electrodes implanted in the brain record electrical impulses that orchestrate movement, which are then translated into commands that control the robotic suit. Not only do patients move, they can feel the motion. “When the robot exoskeleton moves, patients feel every step because key areas of the brain are stimulated,” Liu says.

Implantable brain devices are also being used for epilepsy treatment at the center. Responsive neurostimulation (RNS) implants monitor waves in parts of the brain where seizures begin, detect unusual electrical activity that can lead to a seizure and, within milliseconds, deliver small bursts of electrical stimulation to “stop the seizure in its tracks,” says Christianne Heck, professor of clinical neurology at the Keck School of Medicine, medical director of the USC Comprehensive Epilepsy Program and co-director of the USC Neurorestoration Center.

Keck Medical Center was the world’s first medical center to implant the FDA-approved RNS device in an epilepsy patient, setting an important precedent for the approval of all brain computer technologies worldwide. After nearly two decades of researching RNS, Heck believes these responsive brain devices hold promise for treating other neurological conditions such as stroke and for advancing neuroscience as a whole.

“RNS is a great window to what’s going on in the brain and has great potential for us to understand basic questions about how complex the interconnections are from one part of the brain to another,” Heck says.

Whether the windows that USC researchers are opening are literal or figurative, they’re not just illuminating the brain’s inner workings — they’re defining the next frontier of brain science.