Jacob Raphael, MD

Haptoglobin Polymorphism as a Predictor of Major Adverse Cardiac Events and Acute Kidney Injury after Coronary Artery Bypass Surgery in Patients with Diabetes

University of Virginia Health Sciences Center

As an academic cardiac anesthesiologist, Dr. Raphael’s primary research interests are in topics related to cardiac anesthesia.  At present, he is evaluating whether certain haptoglobin phenotypes increase the risk for development of myocardial and renal complications post coronary artery bypass surgery (CABG).  In recognition of the frequency and severity of these complications, as well as the multitude of patients who undergo CABG each year, Dr. Raphael aims to identify necessary associations and reduce patient mortality.

“Both basic science and clinical research have key roles in achieving an anesthesiologist’s most important mission – to provide the best clinical care to patients,” said Dr. Raphael. “Therefore, it is extremely important that academic anesthesia departments maintain high profile research programs for the benefit of the anesthesiology specialty.”

Research Overview

Dr. Raphael has focused specifically in two areas of anesthetic research:

• Animal studies: Investigating mechanisms of ischemic and anesthetic pre and post conditioning with a particular interest in signaling pathways and the mechanisms by which volatile anesthetics provide protection against myocardial ischemia and reperfusion injury.
• Clinical studies: Examining the role of perioperative hyperglycemia in post cardiac surgery outcomes in both diabetic and non-diabetic patients.

Funding and Recognition

In addition to receiving the IARS 2010 Clinical Scholar Research Award, Dr. Raphael has received two grants from the Society of Cardiovascular Anesthesiologists (SCA) for his work in myocardial preconditioning. In 2004, he was also recognized by the American Society of Anesthesiologists (ASA) for his work with HIF-1 and volatile anesthetic preconditioning.

Key Publications

Raphael J., Abedat S., Rivo J., Meir K., Beeri R., Pugatsch T., Zuo Z., Gozal Y: Volatile Anesthetic Preconditioning Attenuates Myocardial Apoptosis in Rabbits after Regional Ischemia and Reperfusion via Akt Signaling and Modulation of Bcl-2 Family Proteins. J. Pharmacol. Exp. Ther. 2006; 318(1):186-94.

Raphael J., Zuo Z., Abedat S., Beeri R., Gozal Y:Isoflurane preconditioning decreases myocardial infarction in rabbits via up-regulation of hypoxia inducible factor 1 that is mediated by mammalian target of rapamycin. Anesthesiology. 2008; 108(3):415-25.

Raphael J., Gozal Y., Navot N., Zuo Z.: Hyperglycemia Inhibits Isoflurane Postconditioning in the Rabbit Heart via Modulation of Posphatidyinositoll-3-Kinase/Akt and Endothelial Nitric Oxide Signaling. J. Cardiovasc. Pharmacol. 2010; 55(4):348-57