Jonathan (Yoni) Herskovitz is an MD/PhD student working with Dr. Howard Gendelman studying therapies for HIV. We were excited to talk to him about his work and his plans for the future!
Tell us a little about yourself and your career goals.
I am California native, and though pursuing a career as a physician-scientist occupies the majority of my time, I still enjoy astronomy and home renovating. After graduating with a BS from UCLA (Go Bruins!), I worked in research at a pharmaceutical company outside Los Angeles for two years. This fostered my love for translational research that I hope to integrate throughout my career. Since I still have my clinical rotations remaining, it’s hard to say what specific field of medicine appeals to me the most, but I am certainly considering fellowship in infectious disease.
Could you tell us a little about your thesis?
My research focuses on optimizing gene therapy for human immunodeficiency virus (HIV). An estimated 36.9 million individuals are infected with HIV worldwide, and unfortunately, require lifelong treatment with antiretroviral drugs. We are developing a targeted delivery scheme for CRISPR-Cas9 (pioneered by our collaborators), that could specifically excise viral DNA from human immune cells. Most importantly, this strategy bears the potential to free patients from chronic reliance on anti-HIV medications.
How do you think your current work will inform your practice of medicine in the future?
Laboratory research has instilled within me a number of disciplines that I hope to carry with me to clinical practice. I have learned how to formulate and test scientific hypotheses, just as I plan to create differential diagnoses and utilize labs to evaluate possible etiologies for illness. Although HIV infects individual cells, it has the potential to cause damage in almost every major organ system. This notion has taught me that it is important to remember that as clinicians, we treat people, not strictly diseases. Additionally, HIV impacts certain patient populations (e.g. communities in Africa, MSM, and IV drug users) with higher frequencies. It is therefore imperative to seek out opportunities to volunteer in at-risk and medically underserved areas so that I can best understand potential treatment complexities in my regular practice. Finally, my project has taught me to always think about how a particular product or finding can be improved upon. Frequently the answer to these questions requires help from others and it is this dynamic teamwork for the betterment of patients that excites me most about becoming a doctor.
Tell us something about yourself unrelated to medicine and your research.
I am an avid amateur stargazer / space enthusiast. Looking at our universe through my telescope and learning about various technologies to explore it inspires me too look past my immediate concerns towards something greater. Plus, my wife usually joins me for these astronomy outings, which is always a bonus.
We’re proud to have people like Yoni at UNMC who are furthering our understanding of complicated diseases and helping us provide the best care. If you’re interested in learning more about his work, check out his publications below:
Kinderman F, Yerby B, Jawa V, Joubert MK, Joh NH, Malella J, Herskovitz J, Xie , Ferba J, McBride H. Impact of Precipitation of Antibody Therapeutics following Subcutaneous Injection on Pharmacokinetics and Immunogenicity. J Pharm Sci. doi: 10.1016/j.xphs.2019.01.015 (2019).
Herskovitz J, & Gendelman, HE. HIV and the macrophage: from cell reservoirs to drug delivery to viral eradication. J Neuroimmune Pharmacology. doi: 10.1007/s11481-018-9785-6 (2018).
Herskovitz J, Ryman J, Thway T, Lee S, Zhou L, Chirmule N, Meibohm B, & Jawa V. Immune Suppression During Preclinical Drug Development Mitigates Immunogenicity-Mediated Impact on Therapeutic Exposure. J AAPS 19, 447-455, doi:10.1208/s12248-016-0026-8 (2017).
Joubert MK, Deshpande M, Yang J, Reynolds H, Bryson C, Fogg M, Baker MP, Herskovitz J, Goletz TJ, Zhou L, Moxness M, Flynn GC, Narhi LO, & Jawa V. Use of In Vitro Assays to Assess Immunogenicity Risk of Antibody-Based Biotherapeutics. PLoS One 11, e0159328, doi:10.1371/journal.pone.0159328 (2016).
Pandey P, Sliker B, Peters HL, Tuli A, Herskovitz J, Smits K, Purohit A, Singh RK, Dong J, Batra SK, Coulter DW, & Solheim, J. C. Amyloid precursor protein and amyloid precursor-like protein 2 in cancer. Oncotarget 7, 19430-19444, doi:10.18632/oncotarget.7103 (2016).
Cunningham CR, Champhekar A, Tullius MV, Dillon BJ, Zhen A, de la Fuente JR, Herskovitz J, Elsaesser H, Snell LM, Wilson EB, de la Torre JC, Kitchen SG, Horwitz MA, Bensinger SJ, Smale ST, & Brooks DG. Type I and Type II Interferon Coordinately Regulate Suppressive Dendritic Cell Fate and Function during Viral Persistence. PLoS Pathog 12, e1005356, doi:10.1371/journal.ppat.1005356 (2016).
Wilson EB1, Yamada DH, Elsaesser H, Herskovitz J, Deng J, Cheng G, Aronow BJ, Karp CL, Brooks DG. Blockade of chronic type I interferon signaling to control persistent LCMV infection. Science. 340(6129):202-7. doi: 10.1126/science.1235208.
Bianca’s project is a retrospective cohort study identifying the demographic features and virologic outcomes associated with health insurance enrollment among AIDS Drug Assistance (ADAP) participants in Nebraska. The study found that ADAP users who received insurance in addition to ART supply were more likely to achieve virological suppression than those who only received ART supply. She presented her capstone project at the the American Conference for the Treatment of HIV in Chicago in April 2018, and will be submitting her work for publication. You can read more information about Bianca 
Travis’ project looked at characterizing HIV practitioners’ recommendations regarding treatment as prevention, pre-exposure prophylaxis and condom use. The study found that most practitioners commonly or always recommend condoms despite the fact that most acknowledge the validity of data that successful treatment of HIV or use PrEP prevents transmission. Travis was the first author on the resulting paper entitled: “U.S. HIV practitioners’ recommendations regarding condom-free sex in the era of HIV pre-exposure prophylaxis and treatment as prevention“, published in 
Congratulations again to Bianca and Travis, we are proud of you! And congratulations to all M4s out there who found out where they matched today!
Our department is proud to participate in UNMC College of Medicine’s Enhanced Medical Education Track (EMET) program! EMETs are enrichment opportunities to explore interdisciplinary fields of medicine with in small groups and with close faculty mentorship. Two students from each medical school class are selected to participate in our Comprehensive HIV Medicine EMET, a program that spans their four years in medical school and includes journal clubs, seminars, and clinical experiences culminating in a capstone project focused on an aspect of HIV care. Today we’re excited to feature Bianca Christensen, an M4 completing her EMET experience!
Yadav et al. conducted a quasi-experimental quality improvement study to determine the impact of implementing an “Expected Practice” (EP) method to alter antibiotic prescribing practices towards favoring shorter duration of therapy (DOT). This method leverages the prescriber’s desire to meet their own institutional expectations, which may be viewed as more authoritative than external medical society guidelines. The authors chose DOT as the endpoint because clinicians were concerned about potential poor outcomes with shorter DOT.
In the 12 months after implementing EP, the average antibiotic DOT decreased by 10%, 11%, 11%, and 27% for UTI, SSTI, CAP and VAP respectively, with concomitant decreases in total antibiotic exposure measured in total milligrams administered. This impact was statistically sustained by the end of that year for UTI and CAP, but seemed to wane toward the end of the year for SSTIs and VAP.
One of the studies I will lead next year will be in assessing proper utilization of chlorhexidine. Chlorhexidine gluconate is a broadly active, biguanide antimicrobial disinfectant that appears to decrease hospital-acquired infections when it is used to bathe patients in intensive care units. However, it remains unclear what the best method is for applying CHG. We seek to evaluate two methods of CHG bathing 2% CHG impregnated cloths and 4% solution with regard to residual CHG skin concentration and quantitative skin microbial burden.
In order to provide me this opportunity the Internal Medicine department graciously awarded me the Scientist Development Award. I am honored that they selected me, in order to provide me the opportunity to continue to developing my skills as a clinical researcher. Beyond leading several studies in the upcoming year, I am looking forward to beginning work towards a Masters in Public Health with a focus in biostatistics, which I believe will further augment my training.
“Richard has been a real asset for our fellowship and it is very gratifying to see him succeed. He has worked hard to grow as an Infectious Disease clinician and scientist and this award is validation of those efforts. I am looking forward to working with Richard on his projects next year.” – Dr. Trevor Van Schooneveld (ID Fellowship Program Director, Infection Control Associate Medical Director, and one of Dr. Hankins’ mentors)
“I have been a research and career mentor for Dr. Hankins starting in his final year of residency and through fellowship thus far, and supported his completion of several projects, presentations and manuscripts. Dr. Hankins has been motivated to create an academic, research career; with ongoing guidance, he will absolutely succeed in that role and I am pleased to play a part in his career development.” – Dr. Kelly Cawcutt (Infection Control Associate Medical Director, and one of Dr. Hankins’ mentors)
“This is a terrific honor for Rich and will enable him to join the ID division faculty as an instructor and devote significant time to career development. Rich’s research project will greatly expand our knowledge regarding this important infection prevention intervention, and take advantage of UMMC faculty development opportunities to hone his teaching and research skills.” – Dr. Mark Rupp (Infectious Diseases Division Chief, Infection Control Medical Director, and Dr. Hankins’ primary mentor)
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