Key Points
- Dr. Lee is a physician-scientist who specializes in addiction medicine at the US Department of Veterans Affairs (VA) Washington DC VA Medical Center.
- Learn more about her laboratory and why she’s passionate about finding non-pharmaceutical treatments for addiction and chronic pain to benefit the veteran population.
Mary Lee, MD, is a physician-scientist at the US Department of Veterans Affairs (VA) Washington DC VA Medical Center. She is trained in internal medicine and psychiatry, with a specialty in addiction medicine. Prior to joining the VA, she spent 15 years at the National Institutes of Health (NIH) Intramural Program, where she conducted transcranial magnetic stimulation (TMS) research for alcohol use disorder and cocaine use disorder. She is now investigating the use of focused ultrasound for the treatment of addiction – namely tobacco use and opioid use – as well as for anxiety and chronic pain.
We recently spoke with Dr. Lee about her work and the field of focused ultrasound neuromodulation.
How did you hear about focused ultrasound?
When I began working with the VA, I learned about focused ultrasound neuromodulation and started collaborating with researchers at the University of Virginia who were using it to target the insula for cocaine use disorder. I was then funded to investigate the use of focused ultrasound to modulate the insular cortex in smokers and in a complex patient population with opiate use disorder, anxiety, and pain. I have a third study that is investigating focused ultrasound to modulate the posterior insula in patients with chronic back pain.
Are you using the same device for all three studies?
Yes, we are using the Brainbox NeuroFUS device.
What are you hoping to achieve with these studies?
The current trials are proof-of-concept studies, so we are evaluating safety, tolerability, and target engagement rather than efficacy. The target engagement results are measured by the participants’ neural response to drug cue exposure or evoked pain.
These trials are only open to veterans. Why are these issues important for this population?
These disorders – addiction, smoking, and chronic pain – are common in the veteran population, and effective treatments are needed. If we can find a safe, noninvasive, non-pharmacologic treatment to add to the standard approaches available, then the whole system benefits.
Tell us about the people in your laboratory.
The team is beyond amazing. We have three excellent master’s level biomedical engineers from The George Washington University and Johns Hopkins University. They are essential for developing and monitoring all of the programming, modeling, and ultrasound physics needed to safely deliver focused ultrasound. We also have a research coordinator with a psychology background who handles patient scheduling and administers questionnaires and interviews.
Who are your external collaborators?
We work closely with the Georgetown University Center for Functional and Molecular Imaging where we conduct our functional magnetic resonance imaging (fMRI) studies. I also work closely with Wynn Legon, PhD, who is at Virginia Tech. We also work with Dr. Pacheco at Calgary University who has been extremely helpful with our modeling work. Kim Butts-Pauly, PhD, a physicist and expert in focused ultrasound at Stanford University has been a fantastic resource for ultrasound expertise because she is such a leader in the field of therapeutic ultrasound development.
What have been your greatest achievements in your focused ultrasound research?
It’s early days yet, but I am proud of our laboratory for developing clinically relevant protocols that answer important questions about insular function in neuropsychiatric disorders, as well as in chronic pain. We are diligently working to translate what we have seen in preclinical and human imaging studies to patients.
What is on your research wish list?
The next step – assuming the current trials establish the safety of focused ultrasound neuromodulation – is to translate the technique into therapeutic trials. The patients who want to take part in these trials, whether it be opiate use disorder or chronic pain, have a tremendous need. A non-pharmacologic treatment would be a huge benefit, and patients want that option.
There are a lot of neuromodulation devices in the market now. What attributes do you think will translate best to widespread clinical adoption?
Assuming the devices show similar efficacy, I think those that are affordable and portable will best serve a larger patient population. If it is accessible for physicians and relatively intuitive to use, more clinics will be willing to adopt the technology. I also think neuronavigation devices have an advantage over those that need real-time MRI monitoring, because MRI time is a limited resource at many institutions.
Have there been any impediments to your success?
The field of focused ultrasound neuromodulation is so new that it is important to stay in close contact with colleagues and share experiences to remain up to date with the latest findings. Meetings are essential to learn about new advances, challenges, and pitfalls in the field.
I also think that having good biomedical engineers involved is essential, and it is a challenge to find qualified candidates in the current market. I personally have been very fortunate to have found a great team.
Has the Foundation played a role in your work?
Yes. The Foundation does a great job helping to connect the community through workshops, symposia, webinars, and in-person speaking events. It is an essential resource in keeping abreast of the latest in the field.
What strikes you most about the patients you’ve treated?
I have been impressed with how open the patients are to trying something new. I also treat patients with TMS, and I have found that some are more open to trying focused ultrasound than they are to TMS. There is a lot of interest in this promising new approach among veterans.