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Symposium uses data to clear air-quality debate haze

On May 9, a conference room in the Education 1 building on the University of Colorado Anschutz Medical Campus steadily filled with smoke, ozone, particulate matter and a brew of other pollutants.

Well, not literally. The aforementioned air pollution agents were the focus of an Air Quality & Health Symposium hosted by the Colorado Air Quality Control Commission and the Colorado School of Public Health (ColoradoSPH). A series of speakers presented information about the most significant challenges to Colorado in maintaining safe air quality, including traffic increases, wildfires, accelerating growth and climate change, while the attending commissioners were updated on the latest evidence on air pollution and health.

Colorado is just one player in a global struggle to clean the air, noted ColoradoSPH Dean Dr. Jonathan Samet. After reviewing the scientific evidence and often contentious debate involved in setting air quality standards, Samet offered a blunt observation.

“There are billions around the world not breathing clean air,” he said.

Colorado’s efforts to reduce emissions

The symposium occurred in the aftermath of Colorado’s recently concluded legislative session, which saw passage of a number of bills aimed at reducing emissions that dirty the air. These include House Bill 1261, which establishes goals to reduce greenhouse gas emissions in the state at least 26 percent by 2025 and 90 percent by 2050. In addition, Governor Jared Polis in January issued an executive order supporting a “transition” to zero-emission vehicles in the state.

Jill Hunsaker Ryan
Jill Hunsaker Ryan, executive director of the Colorado Department of Health and Environment, said the transition to zero-emission vehicles in Colorado is “our highest priority.”

That transition is “our highest priority,” Jill Hunsaker Ryan, executive director of the Colorado Department of Health and Environment (CDPHE) told the crowd. “Transportation is the single greatest source of climate-changing emissions.”

Transportation is the only one of the big three sources of greenhouse gas emissions – power sources and the built environment round out the trio – that is expected to grow in the coming years, noted Taryn Finnessey, senior climate change specialist with the Colorado Department of Natural Resources.

Changing our sources of power

“We are changing our sources of power, but we are not necessarily changing the ways that we move as rapidly as we should be,” Finnessey said. She added that steps to “clean up our energy grid” by continuing to adopt renewable sources – there are now more than 57,000 clean energy jobs across the state – work hand-in-hand with electrifying transportation. Construction of charging stations for electric vehicles, begun in 2017, is well underway. Nearly three dozen stations, placed roughly every 50 miles along major highway corridors, are slated to be in place by 2020.

“Start car-shopping,” Finnessey quipped.

Rob McConnell, a professor at the University of Southern California (USC), pointed to the health risks posed by vehicle emissions, particularly to those who live nearby busy roadways. McConnell summarized the findings of USC’s 25-year Children’s Health Study, which followed some 12,000 children living in Southern California.

Researchers used spirometry tests to measure lung function in the participants and established a clear association between abnormally low lung function and living in communities with high particulate levels, McConnell said. The study also showed increased rates of childhood asthma among children who lived within 150 meters of a roadway.

Costs of poor air quality

The costs have been considerable: In Los Angeles County alone, some $400 million annually for asthma exacerbations attributable to pollution, and about half of that tied to near-roadway pollution, McConnell said. In the South Coast Air Basin, which encompasses much of greater Los Angeles, between 430 and 1,300 heart attacks were attributed to near-roadway pollution, generating costs of between $3.8 billion and $11.5 billion, he added.

‘There are billions around the world not breathing clean air.’ – Jonathan Samet, dean of the Colorado School of Public Health

Confronting these sobering statistics should be on the board for Colorado, McConnell said, noting the upcoming widening of I-70. He described steps taken in California to mitigate people’s exposure to pollution near roadways, including expanding mass transit, building high-density housing, and creating parks and other green spaces as buffers.

“By ignoring roadway pollution, we are missing an opportunity to improve air quality,” McConnell said.

Other speakers also noted the health risks posed by polluted air. Dr. Jennifer Peel, a professor of Epidemiology for ColoradoSPH and Colorado State University (CSU), cited data from the Health Effects Institute’s Global 2017 Burden of Disease assessment that pegged the worldwide number of premature deaths tied to fine particulate matter at 3 million. In the United States, the toll was 100,000 lives; in Colorado the number was 650, Peel said.

There is “solid evidence” tying short- and long-term exposure to particles of 2.5 microns (PM2.5) – about one-thirtieth the diameter of a human hair – to cardiovascular and respiratory disease and mortality, Peel said. But evidence is growing that these particles also have adverse effects on the central nervous system, including depression, cognitive decline and autism, she added.

The West Is hotter than ever

Peel cited wildfires as an important source of health-threatening particulate matter. As Finnessey and others noted, fires in Colorado and the West are more frequent and hotter than ever before.

Jonathan Samet at symposium
Dr. Jonathan Samet, dean of the Colorado School of Public Health (far left), fields a question from an audience member at the Air Quality & Health Symposium.

“The size and severity of wildfires has increased significantly over the past four decades,” Finnessey said. “And they are projected to continue to increase.” She noted that “science agrees” that without significant changes, the climate is expected to warm 2 to 6 degrees Fahrenheit by 2050. That rise will contribute to ever-thirstier and more heavily stressed ecosystems that are more vulnerable to prolonged drought and more intense wildfires.

And where there is fire there is smoke that can spread across states and regions. Dr. Colleen Reid, assistant professor in the Department of Geography at CU-Boulder, described her studies of the impacts of wildfires on air pollution and health. She said there is “clear evidence” associating wildfire smoke with respiratory health, including exacerbations of COPD and asthma. More studies of the long-term effects of exposure to wildfire smoke and possible public health interventions are needed, Reid added.

An important part of that effort is figuring out what exactly makes up that smoke. That’s the goal of Dr. Emily Fischer, assistant professor in the Department of Atmospheric Science at CSU. Fischer said wildfires often elevate PM2.5 levels on the ground, creating new emission-control challenges.

“Sporadic smoke events are offsetting improvements in mean PM2.5 air quality in some areas,” Fischer said.

‘Rivers of smoke’

Fischer led a National Science Foundation project called WE-CAN, which aimed to understand wildfire smoke by going to the source. She and fellow CSU scientists boarded a research airplane in 2018 that flew through “rivers of smoke” produced by western wildfires, with the aim of studying the composition of the thick plumes. Among the questions: how does the composition of smoke change as it ages and how does it contribute to rising levels of ozone, another primary air pollution issue.

The efforts to improve air quality also proceed on the ground. Dr. John Volckens, professor of Environmental and Occupational Health for ColoradoSPH and in CSU’s Department of Mechanical Engineering, described work with his team to develop an Ultrasonic Personal Aerosol Sampler (UPAS) that uses cell phone-assisted technology to measure individuals’ exposures to PM2.5. About 1,000 of the relatively inexpensive units are in operation around the globe, Volckens said.

Even more ambitiously, CSU partnered with NASA on a “citizen-science” initiative called CEAMS (Concerned and Engaged Community Members) that set up a network of air-monitoring stations around Fort Collins. The stations, manned by citizen volunteers, gather real-time air-quality data that supplement satellite imaging and the computer analysis that NASA uses to develop predictive air-pollution models.

The information from the monitoring network produced much useful information, Volckens said. For example, the team noticed elevated particle levels in the Old Town section of Fort Collins on cold winter nights. The reason: on those nights, the residents of the mostly old homes were lighting plenty of wood-burning fires.

“Science presents an opportunity to learn more about behavior and about how behavior and exposures [to air pollution] affect each other,” Volckens said. “I think we are only at the beginning of scratching the surface of that opportunity.”

Cleaner air on the horizon

But Volckens also cautioned that changing behavior is no easy task. And while Colorado now has plenty of initiatives on the table to address air-quality issues and climate change, the hard work of implementation is only beginning, Finnessey said.

“The challenge comes in figuring out what this all means and how do we achieve our goals,” she said.

Samet noted the “huge number of adverse” effects attributed to air pollution and the need for science to continue to generate as much evidence as possible about the risks dirty air poses. But in the end, he said, deciding on what to do with the data lies in policymakers’ unpredictable hands.

“The data still leaves those who make the decisions left to make those decisions,” Samet said.

This story was written by guest contributor Tyler Smith.

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Transforming Health Care Series: Organ Transplant and Colorado Altruism

Did you know the CU Anschutz Medical Campus has the longest-running transplant program in the country? It has literally given life to thousands of patients, trained generations of surgeons and brought new and innovative techniques and therapies to clinical use.

Chancellor Don Elliman kicked off the second of the 2019 Transforming Health Care lecture series, “Giving Life and Health: The Impact of Altruism on Colorado’s Organ Transplant Community.” About 80 people attended the session in Krugman Conference Hall on May 7. Guests heard from renowned doctors and panelists, including Richard Schulick, MD, director of the CU Cancer Center, Elizabeth Pomfret, MD, PhD, chief of transplant surgery, and Amrut Ambardekar, MD, director of cardiac transplantation, Department of Medicine.

First-ever liver transplant

Dr. Schulick began with highlighting the history of transplantation. In fact, the first liver transplantation took place at the University of Colorado in 1963 by Dr. Tom Starzl.

Dr. Pomfret provided facts about liver and kidney transplantation. There are nearly 94,845 patients on the kidney transplant waiting list and the survival rate for transplant patients is higher with a living donor rather than a deceased donor. Pomfret then introduced the inspiring Molly Conneen, who altruistically donated her kidney to a stranger in need. Conneen’s decision to donate her kidney sparked a chain that involved five different centers across four states.

“If I can live with just one kidney, why wouldn’t I share my spare with someone else to improve their quality of life?” Conneen said. “If my one kidney could set off a series of donations across the country, that is the best return on investment I could make.”

‘Someone was at an even higher risk of dying’

Dr. Pomfret then introduced two women, Judi Altman, who needed a liver transplant, and Carissa Vinovskis, an employee at Children’s Hospital Colorado, who donated the right lobe of her liver to Judi, who she did not know before the surgery. Judi was so grateful “to know that someone so young and someone willing to sacrifice her life for me really took me by surprise.”

Vinovskis never hesitated. “Whereas there was a risk for me to go through that surgery, I knew that somebody, somewhere in the world was at an even higher risk of dying than I was, and he or she needed a liver, and I had one.”

Vinovskis even joked, “I would do it again in a heartbeat, but it’s a one-and-done thing, or so I’m told!”

A new heart

Amrut Ambardekar, MD, discussed heart transplantation and the huge supply-demand mismatch. He introduced an extraordinary woman, Christine Befort, who was a healthy middle-aged woman who suffered a heart attack from a rare coronary dissection, which is caused by a tear in the artery that created a large clot formation. She underwent emergency bypass surgery and was transferred to University of Colorado Hospital where she received a left ventricular assist device, which is an artificial heart pump, while she awaited a heart transplant.

She finally received a phone call in the middle of the night announcing that they had a heart transplant for her. Recovery was successful and she was able to go back to her normal life. Befort “gives all the gratitude and all the good wishes back to the university” because everyone she worked with was “outstanding.” She even donated her own heart to the Colorado Center for Personalized Medicine’s Biobank for research purposes.

It’s easy to see the generosity of Coloradans, after hearing from so many inspiring examples of altruistic organ donation.

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Students win CU Anschutz Excellence Awards

The CU Anschutz Student Senate recently presented 10 awards to students and organizations, recognizing their outstanding contributions to the campus community.

Attendees at the “CU Anschutz Excellence Awards” on May 1 at the Shore Family Forum included Provost Roderick Nairn, PhD; Jan Gascoigne, PhD, assistant vice chancellor for Student Affairs; and Carl Johnson, director of student engagement. Michael Clemens, president of the CU Anschutz Student Senate, alternated presenting the awards with Gascoigne.

This year, the Student Senate partnered with Student Affairs and the schools and colleges on campus to recognize five students who embody the “Spirit of Anschutz.”

Students were nominated for the awards by members of the CU Anschutz community.

Here are the winners:

Outstanding commitment to community service by a student: Daewoong Kim, who founded Knowledge Base, an organization that has had a positive impact on first-year medical education in the CU School of Medicine.

Outstanding commitment to community service by a student organization: Biostatistics Student Association, which maintained a mentoring relationship with two area middle schools, developing a biostatistics and public health curriculum for eighth-graders.

Outstanding leadership by a student: Lynn Doan, who has participated in many leadership roles in the CU School of Dental Medicine. She also joined a group that met with congressional members in Washington, D.C., to discuss legislative issues facing dentistry.

Outstanding leadership by a student organization: Knowledge Base, a student-driven organization that supports first-year medical students as they prepare for their pre-clinical exams.

Outstanding service to the university by a student: Johnny Layne, who has been involved in his medical class council and serves as a member of the IPED Curriculum Design team and the Disability Curriculum Design team.

Spirit of Anschutz: Dane Olsen, a College of Nursing student who has participated in numerous outreach and recruitment events both for both the college as well as CU Anschutz-affiliated organizations.

Spirit of Anschutz: Luke Patten, a student leader who has been active in the Colorado School of Public Health Student Council and has helped build awareness of public health and increase the visibility of co-curricular student engagement activities across campus.

Spirit of Anschutz: Sam Lynass, who has been treasurer of his class and the Health and Wellness chair of the American Student Dental Association. He has been involved with Project Smile, where his experiences led to a document that was featured in the Colorado Dental Association.

Spirit of Anschutz: Harris Butler, a public health student whose teaching background and expertise has been greatly valued in the Biostatistics Student Association. He helped develop lesson plans to teach eighth-graders about biostatistics and public health.

Spirit of Anschutz: Nicola Maude, a pharmacy student who has served as the vice president of her class and the executive vice president for the Skaggs School of Pharmacy and Pharmaceutical Sciences.

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Clinical trial at CU Anschutz will test injectable vs. oral medications to treat HIV

Oral Medication

Researchers at the University of Colorado Anschutz Medical Campus, working with the National Institutes of Health, will conduct a clinical trial beginning this month to determine if monthly injections of anti-viral drugs are more effective at suppressing the HIV virus than daily pills in a population for whom daily adherence has been a challenge.

Over the years, HIV has moved from a nearly uniformly fatal disease to a chronic one that can be managed with medication. But many patients still face obstacles to taking the daily medications which keep the virus dormant, leading to a potentially dangerous flare up.

Jose Castillo-Mancilla, MD, associate professor of medicine at the University of Colorado School of Medicine
Jose Castillo-Mancilla, MD, associate professor of medicine at the University of Colorado School of Medicine

“When they are taking their pills, the virus becomes undetectable,” said Jose Castillo-Mancilla, MD, associate professor of medicine at the University of Colorado School of Medicine. “But you need to take your pills. And sometimes taking pills is hard due to life circumstances.”

The trial is called Long-Acting Therapy to Improve Treatment Success in Daily Life or LATITUDE. It will examine whether two experimental injectable drug formulations of antiretroviral therapy (ART) are more effective than daily pills.

Castillo-Mancilla, an infectious disease expert, is co-chair of LATITUDE.  He said the injectables could keep steady drug concentrations in the blood, unlike oral medications if doses are missed.

The injectable drugs, rilpivirine (RPV) and cabotegravir (CAB), will be given every four weeks. Investigators will measure the virus in the blood throughout the study and compare it with those taking pills.

Approximately 350 volunteers with documented treatment lapses within the last 18 months will be enrolled in the trial for 52 weeks.

Currently, there are about 1.1 million people with HIV in the U.S. That number is approximately 40 million worldwide.

“It is not a curable epidemic but it is a controllable one,” Castillo-Mancilla said. “We believe we can get to zero transmission. The generous volunteers who enroll in this study will help ensure that more people living with HIV may have more effective treatment regimens that work for them.”

The trial is being conducted by the AIDS Clinical Trials Group with additional support from the NIH’s National Institute of Allergy and Infectious Diseases; National Institute of Mental Health; the National Institute on Drug Abuse; ViiV Healthcare and the Janssen Pharmaceutical Companies of Johnson & Johnson.

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Farley Center brief: What are potential solutions to the gun violence epidemic?

This timely report from the Eugene S. Farley, Jr. Health Policy Center at CU Anschutz examines current gun safety policies throughout the United States and presents evidence-based opportunities to strengthen gun safety legislation.

The health policy brief, “Protecting Colorado Youth from Gun Violence,” reviews the impact of gun violence on youth in Colorado and across the nation. It notes that addressing the epidemic will require a multi-pronged approach. The brief assesses opportunities and potential legislation to protect Colorado youth from suicide, homicide and accidental gun death.

The report is the work of Jennifer Mijer, pediatric senior resident, and Shale Wong, professor of pediatrics and family medicine, in the CU School of Medicine.

Click here to read the full brief.

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Chronic kidney disease epidemic may be result of high heat, toxins

farm workers

A mysterious epidemic of chronic kidney disease among agricultural workers and manual laborers may be caused by a combination of increasingly hot temperatures, toxins and infections, according to researchers at the University of Colorado Anschutz Medical Campus.

The study was published today in the New England Journal of Medicine.

Professor Lee Newman, MD, MA
Professor Lee Newman, MD, MA

In recent years, chronic kidney disease has emerged as a major illness among workers in hot climates. It was first identified in the 1990s by clinicians treating sugar cane workers in Central America. In 2012, it claimed roughly 20,000 lives and has now been identified in California, Florida and in Colorado’s San Luis Valley.

But the exact cause has been hard to determine.

“We looked at all the available literature on the subject and asked, `What do we know today? Where are the gaps?” said the study’s lead author Lee Newman, MD, MA, director of the Center for Health, Work & Environment  and professor in the  Dept. of Environmental & Occupational Health at the Colorado School of Public Health. “We were hoping to synthesize everything we know so far for a framework for moving forward.”

The disease is more prevalent in sugar cane workers and other agricultural employees including cotton and corn workers, shrimp farmers and miners. It is less common at higher elevations.

Newman and study co-author Richard Johnson, MD, of

the University of Colorado School of Medicine, said the disease could be caused by heat, a direct health impact of climate change, as well as pesticides like glyphosate.

“Some pesticides are nephrotoxic, and these could possibly contaminate the water supply,” Johnson said. “Indeed, there are studies showing the epidemic in Sri Lanka is greatest in areas where there are shallow wells in which toxins might become concentrated.”

Dr. Rick Johnson of CU Anschutz
Professor Richard Johnson, MD

Sri Lankan farmers exposed to glyphosate showed an increased risk for chronic kidney disease. Still, the levels in wells were very low and studies in Central America turned up little glyphosate. Along with pesticides, the researchers looked at heavy metals as a possible culprit. Lead and cadmium, known to cause kidney injury, have been reported in the soils of Sri Lanka and Central America.

Other potential causes include infectious diseases that can hurt the kidneys such as the hanta virus and leptospirosis, common in sugar cane workers. Genetic factors are also a possibility.

“The common factors are heat exposure and heavy labor,” Newman said.

Heat stress and persistent dehydration can cause kidney damage.

The disease is moving into the U.S. with agricultural workers in Florida, California’s Central Valley and Colorado’s San Luis Valley reporting incidences of the illness.

“This is not the usual kidney disease we see in the U.S.,” Newman said. “It is not caused by high blood pressure or diabetes. The usual suspects are not the cause.”

Johnson pointed out that CU Anschutz has two major efforts underway that are investigating worker health and the impact of climate change on disease.

“This disease is not confined to the southern hemisphere, it is coming here and in fact it is already here,” Johnson said. “It is my opinion that climate change plays a role in this epidemic.”

Those impacted are mostly agricultural workers, the people who grow and harvest the world’s food.

“They are the people who feed the planet,” Johnson said. “If climate change continues like this who is going to feed us?”

Newman and Johnson believe the epidemic is caused by a combination of heat and some kind of toxin and they recognize the need to take preventative action immediately.  That means ensuring workers get adequate breaks, drink enough fluids and spend time in the shade. It also means maintaining a clean water supply, free of chemicals toxic to the kidneys.

“When clinicians detect clusters of patients with chronic kidney disease who work for the same employer or in similar jobs,” the authors said, “they should contact occupational health and safety and public health professionals to promote investigations of workplace conditions.”

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Mental Health Month 2019: Marcus Institute for Brain Health

Born out of the D-Day invasion, the motto of the US Army Rangers is “Rangers lead the way.”

But even the toughest among us sometimes need help.

In 2006, Nathan was a Ranger whose platoon had a suicide vest detonate nearby. After the incident, Nathan began experiencing some problems. “After that I started noticing some kind of weird things going on,” Nathan says. “I was having a lot of problems with headaches. I started noticing a lot of balance issues as I go throughout my day. Towards the end of my day I would have a really hard time even putting one foot in front of the other. I started figuring out that I really needed to start getting some help.”   

Nathan turned to the Marcus Institute for Brain Health (MIBH) here at CU Anschutz, which leads the way in providing innovative veteran mental health services to help our vets heal from the “invisible wounds” of traumatic brain injuries and psychological health changes.

He was able to find both an interdisciplinary expertise and an individualized approach at MIBH, where the traditional clinical approach, which includes neurology and physical therapy, is merged with integrative therapies, such as yoga and canine therapy.

No one patient or person is the same, so the focus at MIBH is about comprehensive, personalized treatments to complex problems with an emphasis on sharing information to help elevate care.

May is Mental Health Month. Hear how the Marcus Institute for Brain Health helped Nathan heal and become better prepared for being a dad in the video below.

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Science vs. monsters: the opioid epidemic

Shawna Matthews, postdoc

As a breast cancer scientist with a PhD in cell and molecular biology, typically when I stand in front of an audience, I know what the hell I’m talking about. And yet, I recently found myself talking about monsters in front of an audience of community members at an event called “Science in the News: The Opioid Epidemic”, part of a monthly series aimed at demystifying hot topics in science to the general public.

Shawna Matthews of CU Anschutz
Shawna Matthews, a postdoctoral fellow at CU Anschutz

My name is Shawna Matthews, and I am a postdoctoral fellow in the Department of Pathology at CU Anschutz. I am not an expert on opioids and substance abuse disorders, unlike my fellow panelists of the night. Dylan Verden, a PhD student in the CU Anschutz Neuroscience Program, started the event by giving a talk titled “Opioids in the Brain”. Rourke Weaver, director of Business Development at Red Rocks Recovery Center, concluded by talking about how those struggling with substance abuse disorders can achieve recovery in a talk titled “Addiction and Community”.

So, why did I feel compelled to participate in this seminar? Because of monsters. As a scientist, I know that addiction, formally known as substance abuse disorder, is a disease. However, until recently, I secretly suspected those struggling with substance abuse would do anything and hurt anyone to get what they needed; I might have almost called them monsters.

I admit this not because I’m proud of what I used to believe, but because I want to tell you how my son, who is almost 3, changed my mind.

Neonatal abstinence syndrome

My son’s birth mom struggled with opioid abuse while she was pregnant. My son spent 92 days, nearly 14 weeks, in the neonatal intensive care unit (NICU) with neonatal abstinence syndrome. This is the medical term for withdrawal symptoms in babies exposed to opioids in the womb, including digestive problems, irregular heartbeat, extreme irritability, and, in some cases, seizures. During his time in the NICU, he needed daily morphine to control his withdrawal symptoms.

After he was released from the hospital, his birth mom was keeping up with her treatment program and worked closely with Child Protective Services. However, at some point, she relapsed into heroin use, and in December 2016, right before my son’s first Christmas, she overdosed and died. She was 20 years old, and my son was 7 months old.

Graphic on infant opioids exposure
This graphic shows the steep rise in infant exposure to opioids in the United States.

Tragic though it was, surely the untimely death of my son’s birth mom was a rare incident. Surely this family’s precise pain could not be commonplace in an advanced society like ours, right?

Complicated locks with sticky keys

Wrong. According to the Centers for Disease Control, more than 130 people in the United States die every day of opioid overdose. To put that in context, the risk of death due to opioid overdose is higher than the risk of death due to car accident (odds: 1 in 96 vs. 1 in 103, respectively). What is responsible for this systematic increase in opioid use and overdose? At the Science in the News seminar, neuroscience student Dylan Verden gave some clues by describing the vicious biology of opioid addiction.

Verden described how our bodies employ a lock-and-key system to find pain relief. “Our brain releases chemicals called endorphins (the key), which fit into opioid receptors in parts of our body needing pain relief (the lock),” he said.

Opioids such as morphine provide very effective pain relief because they are extra-sticky keys for the locks, compared to the endorphins our bodies naturally produce. Verden was careful to note problematic side effects of these sticky keys, including high rates of addiction and off-target effects including suppressed breathing, which contributes to death by overdose.

Dylan Verden, CU Anschutz PhD student
Dylan Verden, a PhD student in the CU Anschutz Neuroscience Program, talks about “Opioids in the Brain” as part of the “Science in the News” presentation.

Verden detailed how our brains very quickly learn to associate certain people, places and events with the euphoria that comes from opioid use, and conversely, how disappointment sets in when the environment does not deliver on the expectation. Consider also the extreme physical and mental symptoms of opioid withdrawal, which peak at 72 hours but last over a month, and it makes for an addiction cycle that is incredibly hard to disrupt.

The final panelist of the night, Rourke Weaver from Red Rocks Recovery Center, self-identifies as a person in recovery. Rourke spoke on the power of community and quoted the writer Johann Hari as saying, “The opposite of addiction is not sobriety. The opposite of addiction is connection.” Weaver called for more programs aimed at creating community so people suffering from substance use disorder can find a connection as they move toward recovery.

The crucible of parenthood

Establishing community seems especially difficult in new mothers struggling with recovery. Studies suggest that these women have higher rates of postpartum depression and an increased risk of stopping medication-assisted treatment early. With all factors considered, it is painfully unsurprising that accidental overdose is a leading cause of death in new moms who are struggling with substance abuse within the first year of their child’s life.

Returning to my son, here’s the rest of his “monster” story. When he was born, his birth mom was 20 and a single parent. In spite of having no maternity leave and returning to work at a minimum-wage job less than three weeks after giving birth, she was devoted to him and visited him in the hospital every day. She tried so hard to stay on her path to recovery but she ultimately relapsed and died of her disease.

The more I learned about my son’s birth mom, the more I felt my anger at her prenatal opioid use turn to grief at the loss of a young life and sorrow for a mother who would never know her child. As the saying goes, it’s hard to hate people up close.

Banishing monsters

How do we, as parents, protect our children from monsters? It’s not enough just to say that monsters don’t exist; we turn on the light so our children can see the truth for themselves.

Here’s the truth of my son’s story: his birth mom was not a monster.

Those struggling with substance abuse disorder are not monsters.

They are just people – messy, complicated people who are fighting against monumental odds of biology, environment and society.

I would leave you with a task, if I may. When you next see a news story on the opioid epidemic and marvel at the magnitude, remember that there are people behind those numbers.

Author’s note: Video recordings of the “Science in the News: Opioid Epidemic” event can be found at http://www.projbridge.org/sitn.html. These talks will be presented again on Thursday, May 16, at 6:30 p.m., at the Denver Museum of Nature and Science as part of the “Reality Bites” event at the Science Lounge for adults 21 and up. Tickets can be purchased at https://secure1.dmns.org/science-lounge-reality-bites-ages-21.

Guest contributor: Shawna Matthews is a postdoctoral fellow at CU Anschutz.

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New disease discovered by CU Anschutz researchers

A new immunodeficiency disease caused by a novel genetic mutation has been identified by researchers at the University of Colorado Anschutz Medical Campus providing unique insights into cell biology.

The findings were published last week in The Journal of Experimental Medicine.

Elena Hsieh, MD, assistant professor of pediatrics and microbiology, immunology at the CU School of Medicine and CHCO.
Elena Hsieh, MD, assistant professor of pediatrics and microbiology, immunology at the CU School of Medicine and CHCO.

The researchers made the discovery while investigating why an infant was suffering from inflammatory bowel disease along with other conditions including eczema, food allergies, lung disease, and persistent CMV (cytomegalovirus) infection.

“Other than a specialized elemental formula, he was unable to eat any food and his gut inflammation persisted despite numerous therapies,” said the study’s co-author Cullen Dutmer, MD, an assistant professor of pediatrics specializing in allergy and immunology at the University of Colorado School of Medicine and Children’s Hospital Colorado (CHCO).

The young boy’s sister suffered from similar problems, and their collective symptoms were consistent with an immune dysregulation syndrome.  Patients suffering from these syndromes have poorly functioning immune systems which can result in serious, recurrent, or unusual infections, as well as autoimmune/inflammatory complications affecting the gastrointestinal tract, skin, lungs, and circulating blood cells.  This defective (or dysregulated) immune system may also lead to increased risk for cancer.

Cullen Dutmer, MD, an assistant professor of pediatrics specializing in allergy and immunology at the University of Colorado School of Medicine and Children’s Hospital Colorado
Cullen Dutmer, MD, assistant professor of pediatrics specializing in allergy and immunology at the CU School of Medicine and CHCO.

The researchers found that the siblings had the first known human defect in a gene called IL2RB (encoding interleukin-2 receptor beta, IL-2Rb), resulting in decreased numbers of immune cells called regulatory T cells which prevent autoimmunity. At the same time, the children had an accumulation of ‘natural killer’ cells which, if functioning normally, help protect against viral infections and cancer.

“But the mutation meant the natural killer cells were incapable of maturing properly and could not clear CMV, resulting in a persistent and debilitating infection,” said study co-author Elena Hsieh, MD, assistant professor of pediatrics and microbiology, immunology at the CU School of Medicine and CHCO.

“We tracked this disease down to a single gene and that is a fairly rare event,” Hsieh said. “Prior to our findings, there had been no documented cases of a mutation in this particular gene leading to human disease.”

Ross Kedl, PhD, professor of immunology and microbiology at the CU School of Medicine
Ross Kedl, PhD, professor of immunology and microbiology at the CU School of Medicine

Dutmer said it’s likely that others suffer from this condition but it has never been identified.

“Although clearly a rare disease, it has likely been missed in other children,” he said. “Now that it is out there, we know to look for it.”

Study co-author Ross Kedl, PhD, professor of immunology and microbiology at the CU School of Medicine agreed.

“The discovery also means that the defect could be addressed through gene therapy,” Kedl said. “We could feasibly go in, manipulate the gene, and get it back in the right sequence.”

Recent advancements in identifying genetic causes of immunodeficiency diseases have led to innovative treatments.  Gene therapy, a therapeutic approach that corrects specific genetic defects, is emerging as a viable treatment option for some immunodeficiency diseases.

A recent study showcased the use of gene therapy to treat severe combined immune deficiency or SCID caused by mutations in the gene IL2RG (Mamcarz et al., New England Journal of Medicine 2019).

“Identifying the underlying genetic causes of immunodeficiency diseases and other disorders can reveal targets for promising personalized treatment strategies like gene therapy,” Dutmer and Hsieh said. “That would allow for therapeutic interventions that are uniquely tailored to meet the needs of the individual.”

Kedl noted that this discovery illustrates the ‘bench-to-bedside’ research capacities on the CU Anschutz Medical Campus and in its graduate training programs.

One of the first authors of the study, Isabel Fernandez, is an MD/PhD student the CU School of Medicine, pursuing a PhD in Immunology in the Kedl lab. Her co-first author is Ryan Baxter, MS, who is a research assistant in the Hsieh lab.

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Cohen Clinic celebrates one-year anniversary with 5K run

Run and One Cohen Clinic run

The Steven A. Cohen Military Clinic celebrated its one-year anniversary on April 13 with a 5K run, part of a national event to raise awareness about the problem of veteran suicide. The Cohen Clinic opened in March 2018 and is located in Greenwood Village, about 15 minutes from the University of Colorado Anschutz Medical Campus.

“We chose the ‘Run as One’ event because we care about addressing the issue of veteran suicide, and we want to raise awareness about the issue of suicide within the community,” said Gillian Kaag, director of the Cohen Clinic. Additionally, at the one-year celebration, the Colorado Veterans Project presented the Cohen Clinic with a $10,000 donation, which will be used to expand access to care for veterans and their families.

Cohen Clinic one-year anniversary
The Cohen Clinic celebrated its one-year anniversary with a fun run through the Highlands neighborhood of northwest Denver.

“This donation will support the clinic’s priority on working to remove barriers to care so that veterans and their families can get the critical care they need,” Kaag said.

Medal of Honor recipient and Cohen Veterans Network ambassador Kyle White attended the celebration as the special guest of honor.

Providing low- to no-cost care

Working in relation to the core services offered by the Helen and Arthur E. Johnson Depression Center at CU Anschutz, the Cohen Clinic provides confidential, compassionate and personalized mental health care to post-9/11 veterans, National Guard and Reserves and their family members at low to no cost.

The Cohen Clinic represents a $9.8 million partnership between the University of Colorado Anschutz Medical Campus and the Cohen Veterans Network, a nonprofit philanthropic organization. Steven A. Cohen, a philanthropist and successful hedge fund manager, created the Cohen Veterans Network in 2016 to establish 25 clinics by 2020 across the United States in areas with a high population of veterans. In Colorado alone, there are currently 60,000 post-9/11 veterans who reside in the state.

There are currently 11 clinics open, with 14 set to open by the end of 2019.

“It is exciting to be connected to the local community and the broader mission of bringing access of low-cost, high-quality mental health care to veterans and their family members,” said Holli Keyser, communications and marketing manager for the Cohen Clinic.

A year of accomplishment

The Cohen Clinic has served 240 clients over the past year, with 57 percent being veterans and 33 percent being family members. The clinic is focused on removing barriers to mental health care, offering transportation to appointments, childcare in the clinic and financial assistance through the Cohen Veterans Fund.

Additionally, the Cohen Clinic offers telehealth appointments — face-to-face counseling online, which allows veterans and their families to get the critical care they need, particularly in rural or underserved areas across Colorado.

“Our team is dedicated to the mission to save lives, save families and save the futures of post-9/11 veterans and their families,” Kaag said.

Providing outreach to the local community has also contributed to the Cohen Clinic’s success, including building a network of more than 100 referral partner organizations that provide services to veterans and family members.

“We have a robust outreach team to support the veteran community and ensure that organizations know we are a trusted resource for military families in Colorado,” Keyser said.

Whole mental health

The Cohen Clinic provides services for behavior health challenges such as depression, anxiety, post-traumatic stress disorder, sleep problems, anger, grief and loss and transition issues.

However, the Cohen Clinic not only focuses on evidence-based mental health treatments and prevention, but also provides education and training, family support, case management as well as helping clients transition into civilian life.

“Military families can connect with our clinic at multiple places of health, and we offer trusted help and resources for the community locally and throughout the state,” Keyser said.

The design of the clinic also contributes to providing whole mental health care, helping clients and their families feel at home when they visit. Original artwork created by local veterans hang on the walls, and the quiet environment provides a soothing feeling from the moment someone enters the clinic.

“We have an intentional design of the clinic: a calming environment and relaxing therapy rooms for our adult clients, children and teens,” Keyser said.

For more information about the services offered at the Cohen Clinic, please visit its website. 

Guest contributor: Story by Katherine Phillips

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