Gyorgy Csako, MD
Entry Id: TP-7

Overview
The Clinical Chemistry Fellowship is a 2-year program providing in-depth training in the various aspects of clinical chemistry. The Clinical Chemistry Service at the NIH provides all the chemical diagnostic testing for the patients in the Clinical Center, as well as for outpatient clinics. The senior staff is composed of four individuals with M.D. and/or Ph.D. degrees and usually there are two postdoctoral ( MD and/or PhD) Fellows in training. Approximately 260,000 tests are performed per month by a technical staff of 40 medical technologists and chemists.

Structure of the Clinical Training Program
The first two months of the program are devoted to rotations through various Clinical Chemistry sections that provide services with general chemistry, immunoassay, electrophoretic, urinalysis, high-performance liquid chromatography (HPLC), and molecular biology (e.g., genotyping and HIV viral load) methodologies. The fellow is then expected (on a rotating basis) to handle inquiries to the Clinical Chemistry Service from patient-care physicians and is encouraged to attend working patient rounds. Throughout the training, special emphasis is placed on the correlation of laboratory data with the status of patients in the Clinical Center. After the initial training, the fellow regularly works up and presents patient cases.

Structure of the Research Training Program
In the second phase of the program, the fellow meets with and discusses the research and service responsibilities of each senior staff member. The individual is encouraged to choose a research project for independent investigation under the supervision of a senior staff member, or to participate in an ongoing research project. The fellow is also responsible for developing one or two methods for implementation by the Clinical Chemistry Service. The project for method development is determined by the needs of the Service at the time. The Clinical Chemistry Service collaborates in clinical research of a chemical nature and conducts extensive research and development in analytical methodology, automation, and computerization. Examples of areas of investigation are the following:

• Development of new analytical assays (e.g., sequential automated assays for lipid/lipoprotein testing, rapid hormone immunoassays for intra-operative use, new macromolecular substrates for improved enzyme activity measurements).
• Drug interference with clinical laboratory tests.
• Assessment of the clinical relevancy of laboratory test results.
• Instrument evaluation and automation.
• Study of the genes involved in reverse cholesterol transport, atherogenicity, and Alzheimer disease.
• Magnesium metabolism.
• Assessment of thyroid function tests.

• Gyorgy Csako, MD. Lipid metabolism, thyroid function, electrophoresis, high performance liquid chromatography (HPLC), and molecular biology.
• Glen L. Hortin, MD, PhD. High performance liquid chromatography (HPLC), capillary electrophoresis, analytical interferences, biosynthetic processing of proteins, and serum markers for cancer.
• Nadja N. Rehak, PhD. Ionized magnesium and calcium, electrolytes, acid-base balance, blood gases and pH, analytical interferences, and instrumentation/automation.
• Alan Remaley, MD, PhD. Lipid metabolism, high-density lipoprotein cholesterol (HDL-C), Tangier disease, molecular biology, analytical methodology, and laboratory automation.

Examples of Recent Papers Authored by Program Faculty

• Blum A, Cannon RO 3rd, Costello R, Schenke WH, Csako G. Endocrine and lipid effects of oral L-arginine treatment in healthy postmenopausal women. J Lab Clin Med 2000;135:231-7.
• Csako G, Byrd D, Wesley RA, Sarlis NJ, Skarulis MC, Nieman LK, Pucino F. Assessing the effects of thyroid suppression on benign solitary thyroid nodules. A model for using quantitative research synthesis. Medicine (Baltimore) 2000;79:9-26.
• Hortin GL, King C, Miller KD, Kopp JB. Detection of indinavir crystals in urine: dependence on method of analysis. Arch Pathol Lab Med 2000;124:246-50.
• Hortin GL, Sullivan P, Csako G. Relationships among plasma homocysteine, cysteine, and albumin concentrations: potential utility of assessing the cysteine/homocysteine ratio. Clin Chem 2001;47:1121-4.
• Hortin GL, Warshawsky I, Laude-Sharp M. Macromolecular chromogenic substrates for measuring proteinase activity. Clin Chem 2001;47:215-22.
• Huijgen HJ, Sanders R, Cecco SA, Rehak NN, Sanders GT, Elin RJ. Serum ionized magnesium: comparison of results obtained with three ion-selective analyzers. Clin Chem Lab Med 1999;37:465-70.
• Libutti SK, Alexander HR, Bartlett DL, Sampson ML, Ruddel ME, Skarulis M, Marx SJ, Spiegel AM, Simmonds W, Remaley AT. Kinetic analysis of the rapid intraoperative parathyroid hormone assay in patients during operation for hyperparathyroidism. Surgery 1999;126:1145-50.
• Rehak NN, Cecco SA, Csako G. Biochemical composition and electrolyte balance of "unstimulated" whole human saliva. Clin Chem Lab Med 2000;38:335-43.
• Remaley AT, Rust S, Rosier M, Knapper C, Naudin L, Broccardo C, Peterson KM, Koch C, Arnould I, Prades C, Duverger N, Funke H, Assman G, Dinger M, Dean M, Chimini G, Santamarina-Fojo S, Fredrickson DS, Denefle P, Brewer HB Jr. Human ATP-binding cassette transporter 1 (ABC1): genomic organization and identification of the genetic defect in the original Tangier disease kindred. Proc Natl Acad Sci USA 1999;96:12685-90.
• Remaley AT, Stonik JA, Demosky SJ, Neufeld EB, Bocharov AV, Vishnyakova TG, Eggerman TL, Patterson AP, Duverger NJ, Santamarina-Fojo S, Brewer HB Jr. Apolipoprotein specificity for lipid efflux by the human ABCAI transporter. Biochem Biophys Res Commun 2001;280:818-23.
• Sampson ML, Aubry A, Csako G, Remaley AT. Triple lipid screening test: a homogeneous sequential assay for HDL-cholesterol, total cholesterol, and triglycerides. Clin Chem 2001;47:532-9.
• Walther MM, Rehak NN, Venzon D, Myers CE, Linehan WM, Figg WD. Suramin administration is associated with a decrease in serum calcium levels. World J Urol 2000;18:388-91.
• Warshawsky I, Hortin GL. Effect of substrate size on immunoinhibition of amylase activity. J Clin Lab Anal 2001;15:64-70.
• Woods JJ, Sampson ML, Ruddel ME, Remaley AT. Rapid intraoperative cortisol assay: design and utility for localizing adrenal tumors by venous sampling. Clin Biochem. 2000;33:501-3.
• Wu YY, Delgado RM, Sunderland T, Csako G. Semiautomated PCR-single-strand conformation polymorphism method for detection of a novel sequence polymorphism (Ile1000Val) in human alpha(2)-macroglobulin. Clin Chem 2000;46:715-8.

Program Graduates
Recent graduates of the program (and their latest positions) are listed below according to ending date of training:

• 1985-Martin H. Kroll, MD. Director of Clinical Chemistry, VA Medical Center, Dallas, Texas.
• 1988-Gyorgy Csako, MD. Assistant Chief, Clinical Chemistry Service, Clinical Pathology Department, Warren Grant Magnuson Clinical Center, Bethesda, Maryland.
• 1991-Kenneth Emancipator, M.D. - Director of Medical Affairs, Bayer Inc., Tarrytown, New York.
• 1992-Kyung N. Lee, MD. Reviewer/Medical Officer, Office of Device Evaluation, Center for Devices and Radiological Health, Food and Drug Administration, Rockville, Maryland.
• 1993-Clifford Eng, M.D. Attending Pathologist, College Station, Texas.
• 1997-Andrew Hruszkewicz, M.D., Ph.D. - Medical Officer/Reviewer, National Institutes of Cancer, National Institutes of Health, Bethesda, Maryland.
• 1999-Yan-Yun Wu, M.D., Ph.D. - Fellow, Transfusion Medicine Department, Yale University, New Haven, Connecticut.
• 2000-Ilka Warshawsky, M.D., Ph.D. - Associate Staff, Cleveland Clinic, Cleveland, Ohio.
• 2000-Jay Murthy, Ph.D. - Director of Clinical Chemistry, Brookdale Hospital, Brooklyn, New York.
• 2000-Joseph J. Woods, M.D. - Fellow, Transfusion Medicine Department, Ohio State University, Columbus, Ohio.
• 2001-Jaclyn (Xiaoyang) Hu, M.D. - Resident, Department of Pathology, Kansas University Medical Center, Kansas City, Kansas.

Qualified candidates must be U.S. citizens or permanent residents and must have an M.D. and/or Ph.D. Preference is given to individuals who are approximately two years beyond the doctoral degree, and who have obtained training in clinical pathology, clinical medicine or clinical chemistry. There is one position available each year beginning on July 1. Applications are closed on October 1 for the position that is available beginning July 1 of the following year. The expected length of the program is two years.

Electronic Application
The quickest and easiest way to find out more about this training program or to apply for consideration is to do it electronically.

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