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Scientists use high tech microscope to find clue to an autoimmune disease

Using a unique microscope capable of illuminating living cell structures in great detail, researchers at the University of  Colorado Anschutz Medical Campus have found clues into how a destructive autoimmune disease works, setting the stage for more discoveries in the future.

The scientists were trying to visualize antibodies that cause neuromyelitis optica (NMO), a rare autoimmune disorder that causes paralysis and blindness. Using a custom STED (Stimulated Emission Depletion) microscope built at CU Anschutz, they were able to actually see clusters of antibodies atop astrocytes, the brain cell target of the autoimmune response in NMO.

Dr. Jeffrey Bennett, MD, PhD, is senior author of the study.
Dr. Jeffrey Bennett, MD, PhD, is senior author of the study.

“We discovered that we could see the natural clustering of antibodies on the surface of target cells. This could potentially correspond with their ability to damage the cells,” said Professor Jeffrey Bennett, MD, PhD, senior author of the study and associate director of Translational Research at the Center for NeuroScience at CU Anschutz. “We know that once antibody binds to the surface of the astrocyte, we are witnessing the first steps in the disease process.”

When that domino effect begins, it’s hard to stop. But Bennett said the ability to see the antibodies on the brain cells offers a chance to develop targeted therapies that do not suppress the body’s immune system like current treatments for the disease do.

“By applying this novel approach we can see firsthand how these antibodies work,” said the study’s lead author, John Soltys, a current student in the Medical Scientist Training Program at CU Anschutz. “We are looking at the initiation of autoimmune injury in this disease.”

The breakthrough was made possible with the STED microscope, a complex instrument that uses lasers to achieve extreme precision and clarity. It was built by physicist Stephanie Meyer, PhD, at CU Anschutz. This is the first time it has been used in a research project here.

“This would have been impossible to see with any kind of normal microscope,” said study co-author Professor Diego Restrepo, PhD, director of the Center for NeuroScience.  “We are inviting other scientists with research projects on campus to use the STED microscope.”

According to Meyer, lower resolution microscopes are blurrier than the STED due to diffraction of light. But the STED’s lasers illuminate a smaller area to acquire a higher resolution image . Unlike electron microscopes, STED users can see entire living cells at super high resolution, as they did in this study.

Restrepo said there are only a handful of STEDs in the nation and just one in Colorado.

The researchers said the discovery is the result of a unique partnership between clinical neurology, immunology and neuroscience coming together to solve a fundamental question of how antibodies can initiate targeted injury in an autoimmune disease.

“These are the building blocks that we can use to carry our research to the next level,” Bennett said.

The study was published this week in Biophysical Journal.

 

 

 

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Cannabinoids may soothe certain skin diseases, say CU Anschutz researchers

Cannabinoids contain anti-inflammatory properties that could make them useful in the treatment of a wide-range of skin diseases, according to researchers at the University of Colorado Anschutz Medical Campus.

The new study, published online recently in the Journal of the American Academy of Dermatology, summarizes the current literature on the subject and concludes that pharmaceuticals containing cannabinoids may be effective against eczema, psoriasis, atopic and contact dermatitis.

Dr. Robert Dellavalle, associate professor of dermatology, is senior author of the study.
Dr. Robert Dellavalle, associate professor of dermatology, is senior author of the study.

Currently, 28 states allow comprehensive medical cannabis programs with close to 1 in 10 adult cannabis users in the U.S. utilizing the drug for medical reasons. As researchers examine the drug for use in treating nausea, chronic pain and anorexia, more and more dermatologists are looking into its ability to fight a range of skin disease.

“Perhaps the most promising role for cannabinoids is in the treatment of itch,” said the study’s senior author Dr. Robert Dellavalle, MD, associate professor of dermatology at the University of Colorado School of Medicine.

He noted that in one study, eight of 21 patients who applied a cannabinoid cream twice a day for three weeks completely eliminated severe itching or pruritus. The drug may have reduced the dry skin that gave rise to the itch.

Study shows cannibinoids may ease some skin disease
Study shows cannibinoids may ease some skin disease.

Dellavalle believes the primary driver in these cannabinoid treatments could be their anti-inflammatory properties.  In the studies he and his fellow researchers reviewed, they found that THC (tetrahydrocannabinol) the active ingredient in marijuana, reduced swelling and inflammation in mice.

At the same time, mice with melanoma saw significant inhibition of tumor growth when injected with THC.

“These are topical cannabinoid drugs with little or no psychotropic effect that can be used for skin disease,” Dellavalle said.

Still, he cautioned that most of these studies are based on laboratory models and large-scale clinical trials have not been performed. That may change as more and more states legalize cannabis.

Dellavalle said for those who have used other medications for itch and skin disease without success, trying a cannabinoid is a viable option especially if it has no psychotropic effect. He did not recommend such medications for cancer based on current evidence.

“These diseases cause a lot of problems for people and have a direct impact on their quality of life,” he said. “The treatments are currently being bought over the internet and we need to educate dermatologists and patients about the potential uses of them.”

The other authors of the study include Jessica S. Mounessa, BS, Julia A. Siegel, BA and Cory A. Dunnick, MD.

 

 

 

 

 

 

 

 

 

 

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MS, macular degeneration and nanoparticle researchers win Gates grants

The Gates Center for Regenerative Medicine and CU Innovations have awarded three researchers at the University of Colorado Anschutz Medical Campus $350,000 grants with the hope they will strike scientific gold.

The grants come from the Gates Grubstake Fund, which backs scientists at CU Anschutz who research regenerative medicine and stem cell technologies. The name of the fund comes from the Gold Rush. Investors would give prospectors seed money known as grubstakes to buy food and supplies so they could survive while they searched for gold. In exchange, the investors would get a share of future profits.

Trap and Zap
A rendering of the “Trap and Zap” device Jeffrey Olson, MD, is developing to treat age-related macular degeneration. The device, shown in yellow, would trap the proteins that cause the condition.

The Gates Center and CU Innovations hope the grants do something similar for recipients, said Heather Callahan, the Gates Center’s entrepreneur-in-residence and a portfolio manager with CU Innovations. The grants are for projects that are in the early stages of work and will provide support for researchers until they are ready to seek larger grants and potentially money from investors.

“This amount of money can hopefully bring researchers to an inflection point or a point where they are able to get additional funding to move on to the next step,” Callahan said.

In the big picture, the Gates Grubstake Fund will support innovation at CU Anschutz and lead to the development of new therapies or devices that help patients. Researchers could commercialize their discoveries by working with private companies or create spin-off companies, Callahan said.

The program is open to researchers affiliated with the University of Colorado. There were 26 applications for grants this year, up from three applications last year. Callahan said the number and quality of applications are good indications of the work being done at CU Anschutz.

“It made it clear that we have a pipeline, and there’s robust research in regenerative medicine,” she said.

The three winning projects could lead to treatments for multiple sclerosis, age-related macular degeneration, and the wounds and skin ulcers that are a complication of diabetes.

David Wagner, PhD
David Wagner, PhD

Protecting the nervous system

David Wagner, PhD, is an associate professor at the CU School of Medicine (SOM) whose research could lead to new therapies that regenerate parts of nerve cells. One application for his research could be treating multiple sclerosis (MS), an autoimmune condition in which immune cells called T cells attack the nerves, specifically the myelin sheath that protect neurons. Wagner’s lab has identified a T-cell type that attacks the brain and spinal cord, as well as a drug candidate that might stop the disease and undo the damage.

“People with MS have such debilitating problems because myelin loss causes severe damage in brain and spinal-cord control centers,” Wagner said. “Controlling the inflammation may restore myelin, but should restore some or all of the damaged areas. Theoretically, this will re-establish normalcy.”

The therapy is in the early stage of development. A drug candidate has been identified, and it would take many years of clinical testing before a medication is available, Wagner said.

Jeffrey Olson, MD
Jeffrey Olson, MD

Preventing blindness

Jeffrey Olson, MD, is an associate professor of ophthalmology in SOM who is developing a medical device that could treat age-related macular degeneration, which is the leading cause of blindness in the industrialized world. The tiny device would be implanted in patients’ eyes and trap and destroy the proteins that cause the blindness.

Olson said he has done preliminary studies using prototypes and seen positive results. If the device comes to market, it would be a breakthrough for patients—only about 10 percent of people with macular degeneration have the form of the disease that can be stopped before it causes blindness. The current treatment requires patients to receive monthly injections in their eyes to treat the disease. Olson thinks the device could work in most patients with the condition and remove the need for continuing injections.

It could also lead to major savings for patients and Medicare. Current treatments cost about $22,000 per year per patient, which adds up to $5 billion annually. Medicare spends more money on that treatment than any other medication, Olson said.

Ken Liechty, MD
Ken Liechty, MD

Healing wounds with nanoparticles

Kenneth Liechty, MD, is a SOM professor who researches wound healing and regenerative medicine. His grant is for research on nanoparticles, which are nanometers in size and smaller than human cells. Liechty is trying to show that nanoparticles can decrease the inflammation around wounds, which slows the healing process. His lab is testing a conjugate of cerium oxide and regulatory microRNA, which he’s named Nanoceria.

Liechty has focused on the slow-healing open sores and wounds from which many diabetic patients suffer. His lab has shown that chronic inflammation accompanies diabetic wounds and impairs the healing process. Tests on mice with diabetes have shown the nanoparticle can correct the impaired wound healing. Liechty said it could take three to five years before human trials could begin as additional optimization and toxicity studies are needed.

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Sarcoma research gets boost from fundraising race led by Denver City Council President Brooks

For a debut event, last fall’s First Denver Race to Cure Sarcoma 5K Run/Walk proved a smashing success, attracting almost 600 participants and raising $110,000 for sarcoma research.

Sarcoma research check presentation at CU Cancer Center
Pictured at the check presentation at the CU Cancer Center are, from left, volunteer and sarcoma survivor Susan Rawley; Michaela Mueller, Sarcoma Foundation of America; Dr. Victor Villalobos, assistant professor, CU School of Medicine; volunteer and sarcoma survivor Toni Baltizar; and Albus Brooks, CU alumnus, sarcoma survivor and Denver City Council president. Photos by Erika Matich, CU Cancer Center.

“It was awesome – the turnout was huge,” said Victor Villalobos, MD, PhD, assistant professor, medicine-medical oncology, University of Colorado School of Medicine (SOM). “It also helped raise awareness. A lot of people have never heard of sarcoma before.”

On April 10, Villalobos, who is also director of Sarcoma Medical Oncology for the CU Cancer Center, joined run/walk Chairman Albus Brooks and two other local sarcoma survivors as well as Michaela Mueller, event manager of the Sarcoma Foundation of America (SFA), for a check presentation to the CU Cancer Center. The event proceeds were evenly split between CU and the SFA, minus administrative expenses and fees, leaving an award of $40,400 to the university.

The SFA organized three new fundraiser run/walks across the country last year, and Denver’s race, which got a late start being put together, ended up with the largest participation.

‘Great event’

“It was a great event,” said Brooks, who is president of the Denver City Council and a former CU Buffaloes linebacker. “For a last-minute race to raise over a hundred grand and have that many participants is truly remarkable. Now that we have an elongated time frame to plan for the next race (Sept. 16) we can really get after it.”

Denver Race to Cure Sarcoma 5K Run
Almost 600 participants took part in the First Denver Race to Cure Sarcoma 5K Run/Walk last September along Cherry Creek Dam Road.

Brooks got the shock of his life last summer when, after feeling pain in his lower back while running a couple road races, he went to his doctor. A 15-pound malignant tumor – chondrosarcoma – was found in his lower back. A CU Anschutz team, including Villalobos, Ana Gleisner, MD, PhD, assistant professor, surgical oncology, and Evalina Burger, MD, professor, orthopedics, treated Brooks, who said, “I’ve never had care like that. It was incredible.”

‘It’s nice for people to know they have a sarcoma clinic here.’ – Toni Baltizar, sarcoma survivor

On July 5, Brooks underwent an eight-hour surgery at the University of Colorado Hospital, where the large tumor was removed by Gleisner.

Brooks and a couple other sarcoma survivors who helped organize the Denver Race to Cure Sarcoma – Toni Baltizar and Susan Rawley – praise the sarcoma expertise available through the CU Anschutz Medical Campus and the CU Cancer Center. “It’s nice for people to know they have a sarcoma clinic here rather than have to travel to MD Anderson Cancer Center (Houston) or Memorial Sloan Kettering Cancer Center (New York),” said Baltizar, who had a 10-pound tumor removed seven years ago.

Dedicated to new research

Rawley said that at this stage – she was diagnosed with a 3-pound sarcoma a year ago – “what I really need is someone like Dr. Villalobos, because he’s a scientist who is dedicated to doing new research and helping raise money for even more research.”

Dr. Villalobos and Denver City Council President Albus Brooks
Dr. Victor Villalobos, left, is part of the medical team that treated Denver City Council President Albus Brooks when a 15-pound tumor was found in his lower back last summer.

Villalobos said events such as the Denver Race to Cure Sarcoma take on greater importance in today’s political climate. “There’s a possibility of losing more funding for scientific research,” he said. “So we have to look more toward charitable foundations and events like this to actually further the science. This helps us develop the science that it takes to get more funding.”

He said money raised through the race will help fund a couple clinical trials currently in development at the CU Cancer Center. The trials include a combination of targeted therapy and immunotherapy that could have applications for several types of sarcoma.

While there are 80 different types of sarcoma, Villalobos said, many share a genetic imprint that can be targeted with similar therapies.

He also hopes to work with the Sarcoma Alliance to strengthen peer support for patients. “That’s something I really want to accomplish. We need to develop a really good patient support network,” Villalobos said. “I think that’s probably one of the biggest things we’re lacking.”

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Most remaining smokers in US have low socioeconomic status

After decades of declining US smoking rates overall, most remaining smokers have low income, no college education, no health insurance or a disability, according to research from the Colorado School of Public Health at CU Anschutz.

About 15 percent of US adults – more than 36 million – continue to smoke cigarettes. Half to three-fourths of them have one or more low-socioeconomic disadvantages, and the lowest socioeconomic categories have the highest smoking rates. The study concludes that continuing tobacco use is now concentrated among the least advantaged portion of society.

“It’s unusual to find part of the population experiencing high rates of a health problem and also representing the majority of affected people,” said study author Arnold Levinson, associate professor of community and behavioral health at the Colorado School of Public Health at CU Anschutz. “But with smoking, we have this unusual situation: Americans with lower socioeconomic status today are suffering from epidemic smoking rates, and they make up nearly three-fourths of all our remaining smokers.”

The research, published February in the Journal of Health Care for the Poor and Underserved, used data from a national survey which the University of Colorado directed in 2012.

The continued epidemic can’t be blamed on lack of desire to quit or efforts to quit. According to the report, numerous studies have found no socioeconomic differences in smokers’ desires to quit or attempts to quit. Instead, the disparities persist and have widened because lower socioeconomic smokers who try to quit are less likely to succeed.

“In the last half-century, public health efforts helped cut the smoking rate by more than half, but we probably need to change our strategies for helping smokers quit,” Levinson said. “The methods that worked for the upper half of society don’t seem to be working well for the other half.”

According to the Centers for Disease Control, cigarette smoking remains the leading cause of preventable disease and death in the US, causing more than 480,000 premature deaths every year, or one of every five deaths.

Levinson said, “Now the nation’s public health system has a dual moral obligation toward smokers of low socioeconomic class. We must eliminate the disparity in smoking rates, and we must provide cessation-supporting services to the new majority of smokers.”

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States can lower risk of measles outbreak by strengthening exemption policies

States with weaker non-medical exemption policies for vaccinations can reduce the likelihood of a measles outbreak 140 to 190 percent by strengthening them, a new study from the University of Colorado Anschutz Medical Campus shows.

Researchers said the magnitude of those outbreaks can also be cut in half by strengthening exemption policies for children.

“In the year 2000 measles was no longer being transmitted in the U.S.,” said the study’s lead author Melanie Whittington, PhD., a health services researcher. “Compare that to 2015 when we had over 150 cases in the first three months. Suddenly measles is an issue again despite having an effective vaccine.”

Jonathan Campbell, associate professor at the CU Skaggs School of Pharmacy and Pharmaceutical Sciences
Jonathan Campbell, associate professor at the CU Skaggs School of Pharmacy and Pharmaceutical Sciences, is senior author of the paper.

Whittington and her colleagues, including the study’s senior author Jonathan Campbell, PhD, associate professor of clinical pharmacy at the CU Skaggs School of Pharmacy and Pharmaceutical Sciences, wanted to find out why.

Using mathematical models, they simulated the magnitude, likelihood and cost of a measles outbreak under different non-medical vaccine exemption policies.

Every state has such policies. Those with “easy” exemption policies typically only require a parent signature on a standardized form. States with “medium” exemption policies require parents to obtain a form from a health department and/or attend an educational session on vaccinations, or write a statement of objection. Finally, states with “difficult” exemption policies require parents to get a standardized form or statement of objection notarized.

The researchers, using data from the Centers for Disease Control and Prevention’s National Immunization Study, found easier non-medical vaccine exemption policies to be associated with a greater risk for outbreaks of vaccine-preventable diseases.

The state they modeled was Colorado, which has one of the lowest vaccination rates for measles. Only 87.4 percent of children between the ages of 19-35 months are covered. And 5 percent of kindergartners report an exemption.

“We modeled an environment where the population had low vaccination coverage and then simulated measles outbreaks under different exemption policies,” said Whittington. “We found that a state like Colorado is 140 to 190 percent more likely to experience an outbreak with an easy exemption policy than if it had a medium or difficult non-medical exemption policy.  The outbreak size can also be reduced nearly by half with stronger policies.”

While the researchers focused on measles, strengthening exemption policies could benefit other vaccine-preventable diseases, such as mumps.

“There is a tradeoff here,” said Campbell, who specializes in pharmaceutical outcomes research. “It’s a trade between freedom and risk. Are we willing to give up a small piece of freedom that nudges us toward vaccination in order to halve the risk of a detrimental outbreak of a preventable disease?  I think Colorado should be willing to make that trade.”

The researchers urged the strengthening of non-medical exemption policies as a way to increase vaccination coverage.

“We are not saying you can’t have non-medical exemptions,” Campbell and Whittington said. “But if we strengthen them, we can improve health and reduce the economic impact of a potential outbreak.”

The study was published online this month in Academic Pediatrics.

The co-authors include Allison Kempe, MD, MPH; Amanda Dempsey, MD, PhD and Rachel Herlihy, MD, MPH.

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Type 2 diabetes diagnosis in youth leads to increased health complications

A new report published this month in the Journal of the American Medical Association points to a significantly higher burden of diabetes-related complications in adolescents and young adults with type 2 diabetes compared to type 1 diabetes, with greater health complications in minority youth.

The study, from researchers involved with the nationwide SEARCH for Diabetes in Youth Study, looked at five health complications and co-morbidities of diabetes, including: retinopathy (eye disease), diabetic kidney disease, peripheral neuropathy (altered sensation in the feet), arterial stiffness and high blood pressure.

The researchers studied 1,746 adolescents and young adults with type 1 diabetes and 272 with type 2 diabetes. Their findings showed that, after less than eight years following a diagnosis, approximately one-third of teenagers and young adults with type 1 diabetes and almost 75 percent of those with type 2 diabetes had at least one health complication or comorbidity. Additionally, any adjustment for differences in age, sex, race/ethnicity, and levels of glucose control over time, did not remove the excess prevalence among those with type 2 diabetes.

“The high burden of early complications in youth with diabetes requires additional research to clarify the underlying causes and to identify effective intervention strategies,” said Dr. Dana Dabelea, lead author and co-chair of the national SEARCH Study and professor of epidemiology at the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus. “It is extremely useful to have these estimates of the presence of complications in adolescents and young adults who are being treated with current therapies, especially because the complications are frequent. We need to make sure each risk factor is under the best control possible to reduce future problems.”

The SEARCH for Diabetes in Youth Study has been monitoring the burden of diabetes in youth with onset less than 20 years of age since 2000. Five U.S. clinical centers and principal investigators participated, including: Seattle Children’s Hospital, (Dr. Catherine Pihoker); Kaiser Permanente Southern California, (Dr. Jean Lawrence); Colorado School of Public Health (Dr. Dana Dabelea); Cincinnati Children’s Hospital, (Dr. Larry Dolan); and the Universities of North and South Carolina Schools of Public Health, (Dr. Elizabeth Mayer-Davis, SEARCH co-chair). The central laboratory is at the Northwest Lipid Research Laboratory, (Dr. Santica Marcovina) and the Coordinating Center is at the Wake Forest School of Medicine (Dr. Ralph D’Agostino and Dr. Lynne Wagenknecht, co-directors).

SEARCH is funded by the National Institutes of Health and the Centers for Disease Control and Prevention.

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Water fluoridation saves Americans over $6 billion in dental work

Americans enjoyed savings of $32 per capita in tooth decay prevention, according to a national assessment of fluoridation by Colorado School of Public Health (ColoradoSPH) researchers published in Health Affairs.

The work updates a 2001 comprehensive study of U.S. community water fluoridation program costs and benefits. Joan O’Connell, PhD, associate professor in the Community & Behavioral Health Department of the ColoradoSPH at CU Anschutz, and coauthors developed a model to update that national study using more recent information on fluoridation costs, the incidence of tooth decay and treatment costs.

They used data from multiple sources including the Centers for Disease Control, NNER, 2013 administrative data from private dental insurers and from water systems located throughout the U.S. They estimated the types of initial and follow-up treatment for dental caries, or tooth decay, and their associated costs to treat over time.

Researchers found that in 2013 more than 211 million people had access to fluoridated water through community water systems serving 1,000 or more people. They estimated 2013 savings associated with caries averted as a result of fluoridation to be $6.8 billion, or $32 per capita. The estimated cost to community water fluoridation programs providing fluoridation was $324 million, with net savings estimated at $6.5 billion and a $20 return on investment for each $1 spent. Estimates of per capita savings associated with community water fluoridation may be used by states to estimate net savings and a return on investment using local data on fluoridation costs.

Approximately 75 percent of Coloradans served by public water systems receive optimal levels of fluoride.  Community water fluoridation has been identified as the most cost-effective method of delivering fluoride to all members of the community regardless of race/ethnicity, age, gender, educational attainment or income.

The Colorado Department of Public Health and Environment’s Oral Health Unit oversees the Community Water Fluoridation program. The Oral Health Unit, in collaboration with the Safe Drinking Water Program, administers the community water fluoridation program, ensuring that the addition of fluoride is in accordance with the latest scientific, dental and health guidelines.

The Oral Health Unit collaborates with local communities to increase awareness of the benefits, safety and efficacy of water fluoridation; provide technical assistance to communities who are considering implementing a water fluoridation program; address possible community water fluoridation rollback attempts, provide funding for new or replacement fluoridation equipment, and support public water systems that are fluoridating meet operational guidelines.

In 2015, the U.S. Public Health Service updated its recommendation on fluoridation levels to 0.7 milligrams per liter (mg/L) from the previous 1962 recommendation range of 0.7 to 1.2 mg/L. This updated recommendation was initiated in 2011 and decided by a panel of scientists from several federal agencies after public comment. The panel reviewed a substantial body of peer-reviewed evidence to ensure optimal health and reduction in tooth decay while minimizing the risk of cosmetic fluorosis in the general population.

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Data Science to Patient Value initiative strives to maximize big data

Jean Kutner, MD
Jean Kutner, MD, is one of the leaders of the Data Science to Patient Value initiative

When Jean Kutner, MD, MSPH, provides care for patients, she wishes she could spend more time talking with patients about their health and the care they want to receive—and not spending her time on a computer, trying to sort through volumes of health records.

“That’s probably not a good use of our valuable and limited time together,” said Kutner, a general internist and palliative care specialist, chief medical officer of University of Colorado Hospital and associate dean for clinical affairs at the University of Colorado School of Medicine (SOM).

Despite her occasional frustration, Kutner is not against technology—far from it. She wants to unlock its potential to create effective care personalized for each patient.

Kutner co-leads the Data Science to Patient Value (D2V) initiative, a new multidisciplinary program at the University of Colorado Anschutz Medical Campus. The initiative, supported with a $20 million grant from the SOM’s Transformational Research Funding program, has big ambitions.

“Our work could revolutionize how we think about how health care is provided, the patient experience, and how we make decisions,” Kutner said. “Our goal is to make CU Anschutz a leader in the intersection between data and value and the application of cutting-edge data science to the value equation.”

Personalizing big data

Right now, the volume of clinically relevant data in health records and from other sources can be overwhelming. Initiatives like D2V could fix that and develop technologies that create a new era in health care. Kutner thinks in the future supercomputers will help diagnose and treat patients, and that will lead to real improvements in their health and maximize the doctor-patient relationship.

“This is personalized medicine focused on a patient’s goals and values, and not necessarily on their genome,” Kutner said.

She gives the hypothetical example of a patient just discharged from the hospital. In a few years, a doctor could use an activity tracker like a Fitbit to see if the patient exercises and gets out of the house. The doctor would look for signs the patient is not recovering or has developed other health problems.

Kutner said the clinical team could see the data and reach out to the patient, checking on their status and, if necessary, asking the patient to come in to be evaluated. Before the visit, a supercomputer could analyze the patient’s data and compare it to data collected from tens of millions of other people. The analysis could create a personalized risk profile with suggestions for a custom treatment plan based on proven therapies. At the start of the next appointment, a doctor could see that information in single user-friendly dashboard.

“With all that data already synthesized, I could get the most value out of face-to-face time with a patient and help them make decisions about their treatment,” Kutner said. “That would be my ideal world.”

Physicians would still have important roles, Kutner said. The doctor and patient would use their time together to talk about what problems are arising and focus on their patients’ priorities. They would work together to get back on track.

Value from the patient’s perspective

While D2V is working on technological innovation in fields such as medical informatics, biostatistics and data visualization, Kutner said it also will address the more philosophical question of how to define value. It is not a simple question.

“If I’m a patient, I might define value differently than an insurer or a health care provider,” Kutner said. Patients can have unsatisfactory experiences despite being what doctors might consider success stories.

D2V will address that disconnect by including stakeholders such as patient advocates and experts in public health and the insurance industry. Kutner believes that will keep the project focused on the ultimate goal, which is improving care.

Building technology and a team

D2V started work in 2016 by recruiting experts from across CU Anschutz. Kutner wants to take advantage of CU Anschutz’s collaborative environment and current faculty members, researchers and staff.

“We have unique expertise here. We have outstanding data scientists. We have people who do world-leading work in care decision making and understanding stakeholder perspectives,” Kutner said. “We need to connect them behind a common goal.”

D2V also recruits researchers from around the world, with more people hired each month. Guest speakers from other leading institutions have given seminars to spark ideas.

Eight pilot projects are underway. They include a team trying to improve the databases that track children who have severe asthma attacks. That project’s goal is to test whether risk profiles can help create personalized predictions of when children might suffer attacks.

D2V will fund an additional six pilot projects in 2017 and is accepting project proposals through March 15.

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What is the best way to treat older HIV infected patients?

Louis and his poodle, Doodles, on one of their four walks every day
Louis and his poodle, Doodles, on one of their four walks every day

A year ago, HIV patient Louis Zimmerman considered himself sedentary. But thanks to his participation in a CU Anschutz exercise study, he now is able to walk his one-year-old poodle, Doodles, four times a day.

“I’m walking faster with more pep in my step,” says Zimmerman, 66, one of about 50 participants in a study of HIV-infected patients, run by Kristine Erlandson, MD, assistant professor of infectious diseases in the CU School of Medicine, with an adjunct appointment in geriatric medicine.

Kristine Erlandson, MD
Kristine Erlandson, MD

Erlandson, who is board certified in internal medicine and infectious disease, specializes in treating frail and older HIV-infected patients. Affiliated with CU Anschutz since 2008, Erlandson also conducts research studies on patients who have lived decades with HIV.

Erlandson says she became interested in learning about AIDS in high school and was an HIV educator in college. She particularly remembers Ryan White, an Indiana teen who got HIV from a blood transfusion and helped start the movement to stop AIDS discrimination.

“He was a similar age as I was and it stood out for me,” she says.

As for her interest in HIV and aging, she added:  “As a fellow during my infectious diseases training, I was most surprised by the HIV patients who would come into the hospital – they had diseases that should be impacting much older people.”

Erlandson sees commonalities in the challenges of her older HIV patients and hopes her studies will improve lives.

“Most of the people I focus my research on are those diagnosed with HIV back in the late ‘80s or early ‘90s who are now experiencing the long-term side effects of drug therapies that go back 20 or 30 years,” she says.

Zimmerman is a participant in one of Erlandson’s studies that measures how exercise can improve the health of sedentary people ages 50-75. One group is HIV-infected and the other study subjects don’t have HIV. Both groups are in stable health and work out as part of the study for six months at the university’s research gym.

During the study, Zimmerman walked on the treadmill and worked with weights three days a week.  At the end of six months, he says he felt stronger and had more energy. His outcomes are similar to other participants’ experiences, Erlandson says.

“Almost everyone has marked improvements in their strength and endurance,” she says. “And we’ve seen good improvements in basic physical function measures, such as the ability to walk a quarter mile and the speed to rise from a chair.”

A patient’s experience

Louis and Doodles
Louis and Doodles

Doctors diagnosed Zimmerman with HIV and Hepatitis C in 1996 at age 47.

A delivery person for Dolly Madison Bakeries, Zimmerman said he tried to go to work one day and collapsed.

“I couldn’t stand up any longer,” he says. He learned he had pneumocystis pneumonia, an infection fairly common in people with compromised immune systems.

At first, Zimmerman, who had many friends and acquaintances die of AIDS, thought it was a death sentence. But then he started doing research on HIV.

“I didn’t have any information prior to the diagnosis,” he says. “But I started doing research and I’ve kept it up ever since. That’s my job now.”

Zimmerman also has been active in HIV research studies. He’s participated in nine clinical trials since his diagnosis. A tough treatment regimen cured his Hepatitis C, but the early HIV treatments were harder on the body than today’s drug regimens. As a result, he’s suffered neuropathy and had fat loss (lipatrophy) in his face. He also was diagnosed with a rare form of skin cancer that has required 25 radiation treatments.

The work ahead

In addition to her exercise study, Erlandson has also studied the factors that contribute to frailty in HIV patients and how to prevent them. She’s recently started a study in conjunction with the AIDS Clinical Trials Group to look at the effect of statins on physical function in HIV patients.

Erlandson’s hope is that her work will not only help her HIV patients, but that her trainees will have a greater understanding of how to manage HIV and help prevent HIV-associated complications in aging.

“There’s still a lot of research to be done by the next generation of physician scientists,” she says. 

Living a positive life

In the nearly 20 years since Zimmerman was diagnosed with HIV, he says he’s stronger than he realized and he doesn’t give up.

“If I start thinking about anything negative, I get it out of my brain right away,” he says. “Dying is the last thing I think about.”

His advice to fellow HIV patients is to stay positive and build a social network of supportive friends and family.

Zimmerman’s year-old poodle, Doodles, is his constant companion. He laughs as he talks about how she walks on her hind legs like a bear. He says he wants to stay healthy for her.

Says Zimmerman, “A dog lives 15 years, so I have 14 more years to be alive for my puppy.”

Guest Contributor: Kathleen Bohland

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