Black, Keith Lanier 1955–

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Keith Lanier Black 1955–

Neurosurgeon

Taught to Love Learning

Residency and Research

Challenge of the Blood-Brain Barrier

Became a Full Professor

On to Cedars-Sinai

Selected writings

Sources

Not less than ten years ago, any patient given a diagnosis of brain cancer felt he was doomed. Today, the malady is still devastatingly frightening, but the prognosis may not be quite so bleak. Advances in neurosurgical technique must certainly take some of the credit for the new hope of a longer life. But a large part of the kudos must also go to medical research, which has taught physicians a great deal about how malignant tumors grow. Along with this knowledge have come two innovative treatment methods for brain-cancer sufferers. One is a novel way to penetrate the protective mesh of capillaries that shields the brain from toxins. The other, based on the 200-year-old inoculation principle, is a promising new “vaccine,” by which cells can be withdrawn from a tumor, genetically engineered to rev up the body’s own disease-fighting mechanisms, and then replaced in order to attract these disease-fighters to the tumor itself. Both these techniques have been pioneered in part by Dr. Keith Black, head of the Neurosurgical Institute at Cedars-Sinai Medical Center.

Taught to Love Learning

Keith Black was born in 1957 in Tuskegee, Alabama. His father, Robert, was a school principal who was determined to prepare his students for a more resourceful academic future than they were then expected to achieve. Unlike other grade-schoolers, children at the Boykin Street Elementary School started learning French when they entered fourth grade. They also became accustomed to an integrated faculty, even though the law prevented them from studying alongside their white counterparts.

An educator through and through, Robert Black did not leave his innovative ideas behind when his day at the Boykin Street School came to an end. He taught his sons courage, by encouraging them to defy the ban on swimming in the all-white community pool. In addition, he taught them to fulfil their curiosity and follow their interests. On one occasion, noting Keith’s early interest in science, his father brought home a cow’s heart from a slaughterhouse, and gave it to him to dissect.

Black was 13 years old when the family moved to Cleveland, Ohio, the home of Case Western Reserve University. Revelling in science even at this early age, he spent so many hours in the science laboratories there that he was able to replace heart valves and perform transplants on animals by the time he was in high school; at age 17, he published his first scientific paper on red blood-cell damage suffered by patients who had undergone heart-valve replacements. By the time he graduated from high school, Black was able to navigate his way with ease through the intricately detailed fields of biochemistry and surgical technique. So it is unsurprising to note that he easily gained admission into the University of Michigan accelerated program, which offered a six-year degree in biomedical science and medicine.

At a Glance…

Born Keith Lanier Black in Tuskegee, Alabama, September 13, 1957; married, Carol J. Bennet, M.D; two children. Education: Shaker Heights Senior High School, 1975; University of Michigan Medical School, BS, 1981; Intemship, University of Michigan, Ann Arbor, 1981-82; Residency in neurological surgery, University of Michigan, Ann Arbor, 1982-87; board-certified neurosurgeon, 1990.

Career: UCLA asst. professor, 1987-1991, associate professor, 1991-94, Dept of Surgery, Ruth and Raymond Stotter Chair, 1992, Division of Neurosurgery, professor, 1994; Institute of Neurosurgery, Cedars-Sinai Medical Center, director, 1997; Patent Awarded: Method for selective opening of abnormal brain tissue capillaries, 1994; Editorial Board Member: Journal of Neuro-Oncology; Neurological Research; Perspectives in Neurological Surgery; Critical Reviews in Neurosurgery; lournal of Radiosurgery. National Institutes of Health, Board of Scientific Counselors for Neurological Disorders and Stroke.

Awards: Westinghouse Science Award, 1975; American College of Surgeons, Schering Scholar, 1985; Richard F. and Eleanor W. Dwyer Award for Excellence in Cancer Research, 1990; Charles R. Drew University of Medicine and Science Medal of Honor, 1995; Charles M. Drew Medical Society President’s Medal of Honor, 1998.

Addresses: Director, Cedars-Sinai Neurosurgical Institute, P.O. Box 48750, Los Angeles, CA 90048-1869.

From the time he was a freshman, Black’s main interest was the human brain, so he took every course in neuroscience that the university offered. “There’s a saying,” he told Time magazine’s Michael Lemonick: “If you want to understand the artist, you study his art. If you want to understand God, you study the anatomy of the brain.” At first his interest lay in discovering the relationship between the brain and the conscious mind. To try and find the meeting point between the three disciplines, he took all the courses he could find in neuroanatomy, Physiology and even mysticism. However, when he was 24 years old he was frightened by an out-of-body experience. This intriguing occurrence tempted him to explore further, but he prudently braked his first impulse. “I chickened out and realized that maybe I should focus my research on some things that can help people for the time being,” he later told the distinguished television journalist, Bill Kurtis, and turned back to more practical research.

By now, Black knew that his definite choice for specialization was neurosurgery. All neurosurgeons wishing to practice in the United States must be certified by the American Board of Neurological Surgery. His top priorities were to fulfil the five years of residency that this gruelling specialty demanded, and to pass the Board’s rigorous written and oral examinations.

Residency and Research

After finishing an internship in general surgery at the University of Michigan, Black entered the residency program for neurosurgery. Here he met many patients with malignant brain tumors, which are among the most difficult cancers to cure. The most widely recognized treatment for them is surgery, although this method can be perilous if the tumor has grown in the area of the brain controlling speech, thought, movement or vital functions such as respiration. The surgeon always walks a fine line between cutting just an infinitesimal amount too much, which can impair the patient’s functioning, or too little, which presented the possibility that a few cancer cells will be left behind to grow again, like deadly weeds. Always one to enjoy a challenge, Black jumped at the chance to learn the complex surgical techniques necessary to remove brain cancers. And although the residency years of a surgeon’s training are extremely busy ones, the well-organized Black somehow even found time for additional research on the biochemistry of tumors and the ways in which they grow.

Another facet of his rapidly-expanding knowledge concerned the use of drugs for treating brain cancers. As he was well aware, these days there are powerful potions which help in the fight against various types of malignancy. But unfortunately, treating brain cancers with drugs is almost as tough a job as removing them surgically. The big problem here is a protective shield formed by the blood vessels and certain cells, which is called the blood-brain barrier. By its very nature, the blood-brain barrier is a physical “security system,” which makes it difficult for medications to cross over from bloodstream to brain tissue.

Black was fascinated by these medical puzzles. His interest grew even further as he plunged deeper into the scientific literature describing the latest advances in immunology—the branch of medicine concerned with the body’s own defense mechanisms against disease. It was a field much in the news during the years of Black’s residency, since a shared Nobel Prize for Medicine or Physiology work had gone to biochemist Bengt Ingemar Samuelsson in 1982.

Challenge of the Blood-Brain Barrier

Samuelsson’s research centered around prostaglandins, a group of several compounds manufactured by many different cells in the human body. Prostaglandins were not Black’s main focus at this time. Nevertheless he studied them intently and this research led to leukotrienes. Appearing briefly when a patient has a heart attack, a stroke, or an injury from some other cause such as a traffic accident, leukotrienes start the process of inflammation by causing blood vessels to leak.

Black thought long and hard about this. He was well aware that leaky blood vessels and swelling are a nuisance in most wounds. Still, he felt they might be formidable weapons to use in the fight against brain cancers. After all, leaky blood vessels are a chink in blood-brain barrier’s armor—they can be used to carry powerful medications directly to tumors.

His research uncovered a natural body peptide called bradykinin. Recognized since the turn of the century, bradykinin had been the subject of biochemical research since the 1950s, although nobody had yet realized its potential for fighting malignancies. Like the leukotrienes, it opens the body’s blood-brain barrier by encouraging capillaries to leak, but Black found it far more efficient at its task than the leukotrienes are. “The fantastic thing about bradykinin,” Black told Time magazine, “is that it does not open the barrier to the normal brain—onlytumors.” As many patients previously doomed to death by a diagnosis of brain cancer, Black’s discovery is a fantastic breakthrough. It means that cancer-fighting chemotherapy can now be concentrated purely on the tumors themselves, without fear of harming other areas of delicate brain tissue.

Became a Full Professor

In 1987 Black completed his residency and moved to the University of California at Los Angeles, where he completed his board certification. As is always the case in medical staff attached to universities, he began on the lowest rung, as an assistant professor. In 1991 he was promoted to the rank of associate professor of surgery in the Division of Neurosurgery, a post that brought him an endowed chairmanship of surgery just one year later. In 1994, at the age of 37, Keith Black became a full professor.

As a result of his new status, Keith Black became busier than ever. Whether they are physicians or surgeons, doctors employed by universities are expected to perform a certain amount of research in addition to seeing patients. Then, this research must be published in professional journals, whose special mission is to keep their readers on the cutting edge of medical science and technology. Black took these responsibilities so seriously that by 1995 he was well on his way to a publications list of 100 articles.

His work was the focus of a television show called “Outsmarting the Brain,” an episode in a series called The New Explorers, hosted by Chicago journalist Bill Kurtis. At the time the show aired, Dr. Black was Chairman of Surgery at the University of California, Los Angeles (UCLA). He was conducting clinical trials, in which three of his patients were featured on “Outsmarting the Brain.” Like many of Black’s other patients, these three desperate people had exhausted all other treatment options and were pinning their hopes on his expertise. Two of them won their brave gamble. The third was not quite so lucky. Still, his valiant battle for life will help physicians to prolong the lives of patients who come after him.

On to Cedars-Sinai

In July of 1997, Black moved from UCLA to head a new neurosurgical hospital at Cedars-Sinai Medical Center, a Los Angeles medical complex which has been worldrenowned since the 1920s. There a multi-million-dollar facility awaited him, featuring state-of-the-art operating rooms, plus carte-blanche to recruit the world’s best neurosurgeons and neurologists. Streamlined as it is, the Neurosurgical Institute has very serious goals. “Our mission,” Black noted in Cedars-Sinai’s online brochure, “is to provide sophisticated, compassionate care for adult and pediatric patients with the full range of neurosurgical conditions.” The Institute is as good as its word. Desperate patients from all over the world, often dismissed by other doctors as too ill for improvement, found surgeons and physicians on the Institute staff able to help them with brain tumors.

In addition to the surgery and bradykinin treatments which are promising, other patients are receiving even more innovative therapies. One such treatment, also pioneered in part at the Institute, is geared towards enhancing the body’s own immune response to braintumors. Normally, according to Black, most of us develop cancers, but our immune systems recognize them and destroy them. But brain tumors thrive because they release a protein called TGF Beta 2 that shuts the immune system down. This new method, currently undergoing clinical trials, calls for injection of certain brain tumor tissue, which is genetically engineered to prevent the release of TGF Beta 2, so that the patient’s immune system recognizes these cancer cells and destroys them along with the others.

Despite the demanding research schedule he heads plus a schedule of about 200 delicate brain operations he performs each year, Black is now a distinguished editorial board member of several professional journals. He seeks out challenges—even on his vacations. Black has skydived, trekked through the Himalayas, rafted down the Zambezi River in Zimbabwe, even climbed Mount Kilimanjaro. In whatever challenge Dr. Keith Black seeks, he is out to conquer.

Selected writings

“Placebo-controlled trial of safety and efficacy of intraoperative controlled delivery by biodegradable polymers of chemotherapy for recurrent gliomas,” The Lancet, April 22, 1995, p. 1008.

Inamura, T., Black, KL: “Bradykinin selectively opens blood-brain barrier in tumors,” Journal of Cerebral Blood Flow Metabolism, 14 (5):862-870, 1994.

Black, KL, Baba T, Pardridge, W.M., “Enzymatic barrier protects brain capillaries from leukotriene C_4,” Journal of Neurosurgery, 81, (5): 745-751, 1994.