Duke Research Blog

Following the people and events that make up the research community at Duke.

Category: Global Health (Page 1 of 7)

First Population Health Conference Shares Energy, Examples

Logo: Population Health at Duke‘Population Health’ is the basis of a new department in the School of Medicine, a byword for a lot of new activity across campus , and on Tuesday the subject of a half-day symposium that attempted to bring all this energy together.

For now, population health means a lot of different things to a lot of different people.

The half-day symposium drew an overflow crowd of faculty and staff. (photo – Colin Huth)

“We’re still struggling with a good definition of what population health is,” said keynote speaker Clay Johnston, MD, PhD, dean of the new Dell School of Medicine in Austin, Texas. Smoking cessation programs are something most everyone would agree is taking care of the population outside of the clinic. But improved water quality? Where does that fit?

“We have an intense focus on doctors and their tools,” Johnston said. Our healthcare system is optimized for maximum efficiency in fee-for-service care, that is, getting the most revenue out of the most transactions. “But most of health is outside the clinic,” Johnston said.

Perhaps as a result, the United States pays much more for health care, but lives less well, he said. “We are noticeably off the curve,” when compared to health care costs and outcomes in other countries.

This graphic from a handout shared at the conference shows how population health spans the entire university.

This graphic from a handout shared at the conference shows how population health spans the entire university.

As an example of what might be achieved in population health with some re-thinking and a shift in resources, the Dell School went after the issue of joint pain with input from their engineering and business schools. Rather than diagnosing people toward an orthopedic surgery – for which there was a waitlist of about 14 months – their system worked with patients on alternatives, such as weight loss, physical therapy and behavioral changes before surgery. The 14-month backlog was gone in just three months. Surgeries still happen, of course, but not if they can be comfortably delayed or avoided.

“Payment for prevention needs serious work,” Johnston said. “You need to get people to buy into it,” but in diabetes or depression for example, employers should stand to gain a lot from having healthier employees who miss fewer days, he said.

Health Affairs Chancellor Eugene Washington commented several times, calling the discussion “very interesting and very valuable.” (photo -Colin Huth)

Other examples flowed freely the rest of the afternoon. Duke is testing virtual ‘telemedicine’ appointments versus office visits. Evidence-based prenatal care is being applied to try to avoid expensive neonatal ICU care. Primary care and Emergency Department physicians are being equipped with an app that helps them steer sickle cell patients to appropriate care resources so that they might avoid expensive ED visits.

Family practitioner Eugenie Komives, MD, is part of a team using artificial intelligence and machine learning to try to predict which patients are most likely to be hospitalized in the next six months. That prediction, in turn, can guide primary care physicians and care managers to pay special attention to these patients to help them avoid the hospital. The system is constantly being evaluated, she added. “We don’t want to be doing this if it doesn’t work.”

Community health measures like walkability and grocery stores are being mapped for Durham County on a site called Durham Neighborhood Compass, said Michelle Lyn, MBA, chief of the division of community health. The aim is not only to see where improvements can be made, but to democratize population health information and put it in peoples’ hands. “(Community members) will have ideas we never could have thought of,” Lyn said. “We will be able to see change across our neighborhoods and community.”

Patient input is key to population health, agreed several speakers. “I don’t think we’ve heard them enough,” said Paula Tanabe, PhD, an associate professor of nursing and medicine who studies pain and sickle cell disease.  “We need a bigger patient voice.”

Health Affairs Chancellor and Duke Health CEO Eugene Washington, MD, has made population health one of the themes of his leadership. “We really take seriously this notion of shaping the future of population health,” he said in his introductory remarks. “When I think of the future, I think about how well-positioned we are to have impact on the lives of the community we serve.”

Lesley Curtis, PhD, chair of the newly formed Department of Population Health Sciences in the School of Medicine, said Duke is creating an environment where this kind of work can happen.

“I, as an organizer of this, didn’t know about half of these projects today!” Curtis said. “There’s so much going on at an organic level that the challenge to us is to identify what’s going on and figure out how to go forward at scale.”

Post by Karl Leif Bates

Obesity: Do Your Cells Have a Sweet Tooth?

Obesity is a global public health crisis that has doubled since 1980. That is why Damaris N. Lorenzo, a professor of  Cell Biology and Physiology at UNC-Chapel Hill, has devoted her research to this topic.

Specifically, she examines the role of ankyrin-B variants in metabolism. Ankyrins play a role in the movement of substances such as ions into and out of the cell. One of the ways that ankyrins affect this movement is through the glucose transporter protein GLUT4 which is present in the heart, skeletal muscles, and insulin-responsive tissues. GLUT4 plays a large role in glucose levels throughout the entire body.

Through her research, Lorenzo discovered that with modern life spans and high calorie diets, ankyrin-B variants can be a risk factor for metabolic disease. She presented her work for the Duke Developmental & Stem Cell Biology department on March 7th.

Prevalence of Self-Reported Obesity Among U.S. Adults by State, 2016

GLUT4 helps remove glucose from the body’s circulation by moving it into cells. The more GLUT4, the more sugar cells absorb.

Ankyrin-B’s role in regulating GLUT4 therefore proves really important for overall health. Through experiments on mice, Lorenzo discovered that mice manipulated to have ankyrin-B mutations also had high levels of cell surface GLUT4. This led to increased uptake of glucose into cells. Ankyrin-B therefore regulates how quickly glucose enters adipocytes, cells that store fat. These ankyrin-B deficient mice end up with adipocytes that have larger lipid droplets, which are fatty acids.

Lorenzo was able to conclude that ankyrin-B deficiency leads to age-dependent obesity in mutant mice. Age-dependent because young ankyrin-B mutant mice with high fat diets are actually more likely to be affected by this change.

Obese mouse versus a regular mouse

Ankyrin-B has only recently been recognized as part of GLUT4 movement into the cell. As cell sizes grow through increased glucose uptake, not only does the risk of obesity rise but also inflammation is triggered and metabolism becomes impaired, leading to overall poor health.

With obesity becoming a greater problem due to increased calorie consumption, poor dietary habits, physical inactivity, environmental and life stressors, medical conditions, and drug treatments, understanding factors inside of the body can help. Lorenzo seeks to discover how ankyrin-B protein might play a role in the amount of sugar our cells internalize.

Post by Lydia Goff

Growing “Mini Brains” To Understand Zika’s Effects

You probably remember what the Zika virus is because of the outbreak in 2015 that made global headlines.

microcephaly illustration

An infant with microcephaly (left) with a reduced head circumference, as compared to an infant born with a regular head circumference (right) Picture credit: https://commons.wikimedia.org/w/index.php?curid=63278345

The serious nature of the virus was apparent when hundreds of infants across South America were born with microcephaly – a condition characterized by a very small head circumference as a result of abnormally slow brain growth.

The sudden outbreak of Zika in South America led to a panic of the possibility of spread into the United States as well as beyond – and thus, research into learning more about the disease mechanisms of Zika expanded. However, one of the problems in studying a disease like Zika is the difficulty of modeling a complex organ like the developing brain.

Until now, the current way to model the brain was with a brain organoid – a brain grown in a lab. Organoid structures attempt to mimic whole developing organs – however, current brain organoid technology required the use of a large spinning bioreactor to facilitate nutrient and oxygen absorption to mimic the function of the vascular system in our brains. Large spinning bioreactors are expensive to run and bulky—they require large volumes of expensive media that mimic brain fluid. The size and cost has meant that only a few organoids can be grown and studied at once.

Guo-li Ming, University of Pennsylvania

Dr. Guo-li Ming, a professor of neuroscience from the Perelman School of Medicine at the University of Pennsylvania, set out to work on finding a way to solve this problem. She came down to Duke University last week to give a talk on her findings.  As she spoke, I could feel the minds of the audience firmly captivated by her words. It was truly fascinating stuff – Ming was actually growing brains in the lab!

The work began by finding a way to take the large spinning reactor that the existing brain organoid required and make it smaller. Three clever high school students working in her lab used a 3D printer and a small motor that involved spinning 12 tiny interconnected paddles within 12 small cell culture wells. Each of the wells contain a paddle that is spun by one gear.  All of the individual gears connect to a continually rotating central gear driven by a motor.

Bioreactor schematic

The Spin bioreactor. Source: http://www.cell.com/cell/abstract/S0092-8674(16)30467-6

After many optimizations, the final design was called SpinW,  which ultimately required a mere 2 ml of media per well, resulting in a net 50-fold reduction in media consumption, as well as dramatically reduced incubator space. The large number of wells, combined with dramatically reduced cost of the apparatus and media consumption, allowed for optimal conditions to run multiple test scenarios with ease – essentially meaning that 12 “mini brains” could be tested at the same time.

The design of SpinW costed a mere $400, while the commercial design costs over $2,000, with the added burden of consuming 50 times more media. The success of the design only serves to prove that age doesn’t matter when it comes to great ideas!

A brain organoid infected with Zika virus. ZIKV envelope protein is shown in green; neural progenitor cells marked by SOX2 are shown in red; neurons marked by CTIP2 are shown in blue.
CREDIT: Xuyu Qian/Johns Hopkins University

Dr. Ming and her team used the apparatus to model the Zika virus’s impact on the brain.

The findings indicate that Zika works by killing off neural stem cells, as well as causing a thinning of key brain structures. One of the observations was that, by day 18 of Zika infection of a brain organoid, there was an overall decrease in size, which points to the link of Zika causing microcephaly. The Zika infection of early-stage organoids corresponded to the first trimester of human fetal development.

The brain is the most complex organ in the body, and one of the least understood. The work Dr. Ming and her team has done goes a long way towards helping us understand the way the human brain develops and works, as well modeling its reaction to things like viruses. It was a pleasure and honor to hear Dr. Ming talk to us about her work –I am eager to hear about further developments in this field!

Post by Thabit Pulak

Leonor Corsino: Research and Care Toward Alleviating Diabetes

Dr. Leonor Corsino works to relieve the prevalent issues regarding diabetes and obesity. An endocrinologist and professor at the Duke School of Medicine, her passions lie in understanding the struggles that diabetics face through comprehensive patient care and communication.

Leonor Corsino

Her interests in endocrinology began at a young age. She grew up watching her father and many other members of her family challenged with balancing a normal life alongside diabetes. When she progressed to medical school, she was fascinated by the workings of the hormonal system, one of the most neatly regulated of all the biological systems.

“When it works in harmony, everything is perfect, but when something goes off, it affects many other organs,” she says.

Corsino believes that patient-provider communication is the most important thing for the makings of a good endocrinologist. As the Associate Director for Masters in Biomedical Sciences, she aims to teach students pursuing a career as a healthcare professional to be empathetic. “[A student] can be the smartest person in world, but if [they] don’t know how to communicate with the patient, their ability to provide care gets compromised.”

Another factor that plays a role in providing good patient care is the amount of time available to treat each person, according to Corsino. Although Corsino always aspires to treat her patients to the best of her abilities, occasionally, the limited time she has with each individual can impose difficulties with empathizing and treating patients. However, many regular patients don’t mind when their appointments are delayed because they know that they will receive better care when they are able to get her undivided attention.

Beyond her clinical expertise, Corsino’s research focuses on similar issues. Through her research, she intends to improve the healthcare of minorities in the country, as they are the groups that are most affected by diabetes. In the past 11 years, she has introduced interventions to improve and maintain weight loss and worked with pharmaceutical companies to look at potential drugs to treat diabetes. She intends to answer the questions “How do we motivate people to exercise? What is the reason some people struggle with diabetes and other people don’t?”

Corsino has found that biological factors play an equal role to environmental factors in the risk of getting diabetes. Sometimes, even if a patient strictly adheres to the prescribed treatment, they still don’t see the same results and progress as others do. This distinction can be attributed to things like differences in fat distribution and insulin resistance.

In her work, Dr. Corsino tries to alleviate the stress and difficulties that those with diabetes and obesity encounter. As a doctor and professor, she inspires others to pursue a career in public health and provide healthcare to those who need it.

Sindhu PolavaramGuest Post by Sindhu Polavaram, a senior at North Carolina School of Science and Math

Scavenger Receptors in Environmental Lung Disease

“Lung disease causes 15% of deaths worldwide” Kymberly Gowdy explained in her lecture at Duke,  “Clean Up and Clear Out: A Novel Role for Scavenger Receptors in Environmental Lung Disease.”

In her research, she applies her training as an immunologist to analyze immune responses to environmental challenges and their role in lung disease. Gowdy is an Assistant Professor at East Carolina University where her research specifically focuses on scavenger receptors (SRs). SRs are pattern recognition receptors that recognize and bind cellular debris and pathogens. Gowdy’s research focuses on scavenger receptor SR-B1 and SR-CD163.

Kymberly Gowdy of East Carolina University

Kymberly Gowdy of East Carolina University

Her experiments with SR-B1 have shown that knockout mice (mice without the scavenger receptor B1) have increased mortality rates after pulmonary infection, as shown in the figure below. After examining different causes of this increase in mortality, Gowdy and her lab concluded that the cause was an increase in bacterial burden.

The pattern they detected revealed that an increase of bacteria in the blood correlates to both an increase in cytokines (substances secreted by immune cells that create inflammation and respond to infections) and an increase in mortality. Gowdy also associated a decrease in clearance in the lungs with this trend, which explains why pneumonia does not heal and therefore leads to death.

Gowdy’s lab also explored the possibility for a connection between SR-B1 and ozone-induced respiratory and cardiovascular inflammation. She discovered a positive correlation between SR-B1, the oxidization of lipids in the lungs, and pulmonary inflammation. She concludes that SR-B1 expression is protective against air pollutant exposure such as ozone.

Mice lacking SR-B1 (dashed line) only survived two days after an infection challenged their lungs.

Gowdy has also investigated a receptor called SR-CD163 which clears hemoglobin and haptoglobin (Hb-Hp) from the lungs. This receptor protects organs from cell-free hemoglobin preventing damage. When she exposed knockout mice without SR-CD163 to ozone, she discovered an increase in the pulmonary levels of cell-free hemoglobin. Similarly to experiments with SR-B1, the CD163-deficient mice demonstrated patterns of increased lung damage as they experienced increased exposure to ozone.

Through her collaboration with laboratories at Duke, Gowdy has been able to discover that ozone exposure increases the response of pulmonary CD163 in mice and humans.

Gowdy’s work has shown the existence of direct relationships between environmental factors such as ozone and the levels of scavenger receptors such as B1 and CD163 in the lungs. The complex association between immune responses and lung diseases creates an interesting field of research, particularly when explored through the lens of environmental triggers.

Gowdy’s results reveal the intricacy of the immune system. An inflammatory response is meant to protect an individual’s health, but too much immune activation in the lungs can lead to disease.

Post by Lydia Goff.

Long-Term Study Sees the Big Picture of Cannabis Use

Seventy percent of the United States population will have tried marijuana by the age of 30. As the debate on the legalization of the most commonly used illicit drug continues throughout the country, researchers like William Copeland, PhD, and Sherika Hill, PhD, from the Duke Department of Psychiatry and Behavioral Sciences are interested in patterns of marijuana use and abuse in the first 30 years of life.

Marijuana is the most commonly used illicit drug.

The Great Smoky Mountain Study set out in 1992 to observe which factors contributed to emotional and behavioral problems in children growing up in western North Carolina. The study included over 1,000 children, including nearly 400 living on the Cherokee reservation. In addition to its intended purpose, the data collected has proven invaluable to understanding how kids and young adults are forming their relationship with cannabis.

The Great Smoky Mountains Study collected extensive medical and behavioral research from 11 counties in western North Carolina.

Using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and patterns of daily use of the drug, Copeland and Hill found some unsurprising patterns: peak use of the drug is during young adulthood (ages 19-21), when kids are moving out of the home to college or to live alone.

But while most people adjust to this autonomy and eventually stop their usage of the drug, a small percentage of users (7%) keep using into their adulthood. Hill and Copeland have observed specific trends that apply both to this chronic user group as well as an even smaller percentage of users (4%) who begin using at a later stage in life than most people, termed the delayed-onset problematic users.

Looking at the demographics of the various types of users, Hill and Copeland found that males are twice as likely to engage in marijuana use to any extent than females. Of those who do use the drug, African Americans are five times more likely to be delayed-onset users, while Native Americans are twice as likely to decrease their use before it becomes problematic.

For both persistent and delayed-onset problematic users, family instability during childhood was 2-4 times more likely than in non-problematic users.

Persistent users were more likely to have endured anxiety throughout childhood, and delayed-onset users were more likely to have experienced some kind of trauma or maltreatment in childhood than other types of users.

The identification of these trends could prove a vital tool in predicting and preventing marijuana abuse, and the importance of this understanding is evidenced in the data collected that elucidates outcomes of marijuana use.

Looking at various measures of social and personal success, the team identified patterns with a resounding trend: recent use of marijuana is indicative of poorer outcomes. Physical health and financial or educational outcomes displayed the worst outcomes in chronic and delayed-onset users. Finally, criminal behavior was increased in every group that used; in other words, regardless of the extent of use, every group with use of marijuana fared worse than the group that abstained.

The results of Copeland and Hill’s work has important implications as legislators debate the legalization of marijuana. While understanding these patterns of use and their outcomes can provide useful insight on the current patterns of usage, decriminalization will certainly change the way marijuana is manufactured and consumed, and will thus also affect these patterns.
By Sarah Haurin

Opportunities at the Intersection of Technology and Healthcare

What’d you do this Halloween?

I attended a talk on the intersection of technology and healthcare by Dr. Erich Huang, who is an assistant professor of Biostatistics & Bioinformatics and Assistant Dean for Biomedical Informatics. He’s also the new co-director of Duke Forge, a health data science research group.

This was not a conventional Halloween activity by any means, but I felt lucky to be exposed to this impactful research surrounded by views of the Duke forest in fall in Penn Pavilion at IBM-Duke Day.

Erich Huang

Erich Huang, M.D., PhD. is the co-director of Duke Forge, our new health data effort.

Dr. Huang began his talk with a statistic: only six out of 53 landmark cancer biology research papers are reproducible. This fact was shocking (and maybe a little bit scary?), considering  that these papers serve as the foundation for saving cancer patients’ lives. Dr. Huang said that it’s time to raise standards for cancer research.

What is his proposed solution? Using data provenance, which is essentially a historical record of data and its origins, when dealing with important biomedical data.

He mentioned Duke Data Service (DukeDS), which is an information technology service that features data provenance for scientific workflows. With DukeDS, researchers are able to share data with approved team members across campus or across the world.

Next, Dr. Huang demonstrated the power of data science in healthcare by describing an example patient. Mr. Smith is 63 years old with a history of heart attacks and diabetes. He has been having trouble sleeping and his feet have been red and puffy. Mr. Smith meets the criteria for heart failure and appropriate interventions, such as a heart pump and blood thinners.

A problem that many patients at risk of heart failure face is forgetting to take their blood thinners. Using Pillsy, a company that makes smart pill bottles with automatic tracking, we could record Mr. Smith’s medication taking and record this information on the blockchain, or by storing blocks of information that are linked together so that each block points to an older version of that information. This type of technology might allow for the recalculation of dosage so that Mr. Smith could take the appropriate amount after a missed dose of a blood thinner.

These uses of data science, and specifically blockchain and data provenance, show great opportunity at the intersection of technology and healthcare. Having access to secure and traceable data can lead to research being more reproducible and therefore reliable.

At the end of his presentation, Dr. Huang suggested as much collaboration in research between IBM and Duke as possible, especially in his field. Seeing that the Research Triangle Park location of IBM is the largest IBM development site in the world and is conveniently located to one of the best research universities in the nation, his suggestion makes complete sense.

By Nina Cervantes        

Global Health Research from Zika to Economics

Brazil, Kenya and China: this week, the sixth annual Global Health Research Showcase proved that Global Health majors truly represent global interests.

This past summer, Duke PhD student Tulika Singh explored complementary diagnosis techniques for Zika virus pregnant women in Vitoria, Brazil. Zika is difficult to diagnose “because the PCR-based test can only tell if you’ve had Zika virus within about ten days of the infection,” Singh said. “That’s a big problem for enrolling pregnant women into our study on Zika transmission and maternal immunity.”

To combat this issue, Singh and her thesis advisor Sallie Permar trained collaborators to use the whole virion ELISA (WVE) laboratory technique which may reveal if an individual has been exposed to Zika. ELISA detects Zika through testing for the antibodies that most likely would have been produced during a Zika infection. Singh’s work allows the research team to better assess whether women have been exposed to Zika virus during pregnancy, and will ultimately guide Zika vaccine design. 

Master of Science in Global Health candidate Carissa Novak examined why some HPV positive women in Western Kenya are not seeking preventive measures against cervical cancer. All the women diagnosed with HPV were referred to the Country Hospital but only “33 to 42 percent actually sought treatment” leading to Novak’s main research question, “Why did so few women seek treatment?” To answer this question, she sent out quantitative questionnaires to 100 women and then followed up by interviewing 20 of them. She surveyed and interviewed both women who had and had not sought treatment. Her results showed that transportation and cost hinder treatment acquirement and that the women who did seek treatment were often directed to by a health worker or actively trying to prevent cervical cancer. Novak believes that increasing women’s trust and understanding of the health care system will assist in improving the percentage who seek treatment.

In Kunshan, China, Brian Grasso evaluated the development of Kunshan’s health system in relation to its economic development. “Kunshan is now China’s richest county-level city and it used to be a small farm town…My main take away was that economic growth has strengthened Kunshan’s health systems while also creating new health challenges,” Grasso said. What are some of these new health challenges? Some of them include air pollution, increased stress in manufacturing jobs and more car accidents. Grasso determines that other developing health systems should learn from Kunshan that without proper regulations poor health can result in the midst of progress.

Post by Lydia Goff

Smoking Weed: the Good, Bad and Ugly

DURHAM, N.C. — Research suggests that the earlier someone is exposed to weed, the worse it is for them.

Very early on in our life, we develop basic motor and sensory functions. In adolescence, our teenage years, we start developing more complex functions — cognitive, social and emotional functions. These developments differ based on one’s experience growing up — their family, their school, their relationships — and are fundamental to our growth as healthy human beings.

This process has shown to be impaired when marijuana is introduced, according to Dr. Diana Dow-Edwards of SUNY Downstate Medical Center.

Sure, a lot of people may think marijuana isn’t so bad…but think again. At an Oct. 11 seminar at Duke’s Center on Addiction & Behavior Change, Dow-Edwards enlightened those who attended with correlations between smoking the reefer and things like IQ, psychosis and memory.

(https://media.makeameme.org/created/Littering-and-SMOKIN.jpg)

Dow-Edwards is currently a professor of physiology and pharmacology and clearly knows her stuff. She was throwing complicated graphs and large studies at us, all backing up her primary claim: the “dose-response relationship.” Basically the more you smoke (“dose”), the more of a biological effect it will have on you (“response”).

Looking at pot users after adolescence showed that occasionally smoking did not cause a big change in IQ, and frequently smoking affected IQ a little. However, looking at adults who smoked during adolescence correlated to a huge drop of around 7 IQ points for infrequent smokers and 10 points for frequent smokers. Here we see how both age and frequency play a role in weed’s effect on cognition. So if you are going to make the choice to light up, maybe wait until your executive functions mature around 24 years old.

Smoking weed earlier in life also showed a strong correlation with an earlier onset of psychosis, a very serious mental disorder in which you start to lose sense of reality. Definitely not good. I’m not trynna get diagnosed with psychosis any time soon!

One perhaps encouraging study for you smokers out there was that marijuana really had no effect on long-term memory. Non-smokers were better at verbal learning than heavy smokers…until after a three week abstinence break, where the heavy smokers’ memories recovered to match the control groups’. So while smoking weed when you have a test coming up maybe isn’t the best idea, there’s not necessarily a need to fear in the long run.

(Hanson et al, 2010)

A similar study showed that signs of depression and anxiety also normalized after 28 days of not smoking. Don’t get too hyped though, because even after the abstinence period, there was still “persistent impulsivity and reduced reward responses,” as well as a drop in attention accuracy.

A common belief about weed is that it is not addicting, but it actually is. What happens is that after repetitively smoking, feeling high no longer equates to feeling better than normal, but rather being sober equates to feeling worse than normal. This can lead to irritability, reduced appetite, and sleeplessness. Up to 1/2 of teens who smoke pot daily become dependent, and in broader terms, 9 percent of people who just experiment become dependent.

In summary, “marijuana interferes with normal brain development and maturation.” While it’s not going to kill you, it does effect your cognitive functions. Plus, you are at a higher risk for mental disorders like psychosis and future dependence. So choose wisely, my friends.

By Will Sheehan

Will Sheehan

Rare Cancers and Precision Medicine in Southeast Asia

Data collected through genomics research is revolutionizing the way we treat cancer. But a large population of cancer patients are being denied the benefits of this research.

Patrick Tan MD, PhD is a professor of cancer and stem cell biology at Duke-NUS Medical School in Singapore.

In 2016, less than one percent of all the existing genomic data came from the 60% of the world population living outside of the US, Europe, and Japan. Furthermore, 70% of patients who die from cancer this year will come from Asia, Africa and Central and South America.

Patrick Tan, M.D., Ph.D., and the Duke-National University of Singapore (Duke-NUS) Medical School are key players in an effort to rectify this discrepancy, specifically as it exists in Southeast Asia.

In his talk, sponsored by the Duke Center for Applied Genomics and Precision Medicine, Tan focused specifically on his work in northeast Thailand with cholangiocarcinoma (CCA), or bile duct cancer.

Liver fluke

Liver flukes like this are parasites of fish that migrate to human hosts who eat the fish raw, leading to a form of bile duct cancer.

While CCA is rare in most of the world, it appears at 100 times the global rate in the region of Thailand where Tan and his colleagues work. Additionally, CCA in this region is of a separate and distinct nature.

CCA in this region is linked with a parasitic infection of the bile ducts called a liver fluke.  Residents of this area in Thailand have a diet consisting largely of raw fish, which can be infected by the liver fluke and transmitted to the person who eats the fish.

Because of the poverty in this area, encouraging people to avoid eating raw fish has proven ineffective. Furthermore, healthcare is not readily available, so by the time most patients are diagnosed, the disease has progressed into its later and deadly stage.

The life cycle of liver flukes. (Graphic U.S. Centers for Disease Control)

Tan’s genomic research has discovered certain factors at the gene level that make liver-fluke positive CCA different from other CCA. Thus genomic data specific to this population is vital to improve the outcomes of patients with CCA.

Duke-NUS Precision Medicine (PRISM) has partnered up with the National Heart Research Institute Singapore (NHRIS) in SPECTRA, a program designed to create a database of genomic data from the healthy Asian population. SPECTRA is sequencing the genomes of 5,000 healthy Asians in order to create a baseline to which they can compare the genomes of unhealthy individuals.

These and other programs are part of a larger effort to make precision medicine, or healthcare tailored to an individual based on factors like family history and genomic markers, accessible throughout southeast Asia.

By Sarah Haurin

 

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