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Donald Leung, MD, pioneers new eczema treatments

The battle between good and evil is a theme usually reserved for blockbuster movies or literature. However, biomedical researcher Donald Leung, MD, PhD, is engaged in his own epic battle, pitting good bacteria against bad in order to treat atopic dermatitis or eczema – the world’s most common skin disease.

Donald Leung, MD, PhD
Donald Leung, MD, PhD

“The beneficial bacteria actually make natural antibiotics that kill staph aureus, the bad bacteria on the skin,” says Leung, medical director of the Clinical and Translational Research Center of the Colorado Clinical and Translational Sciences Institute (CCTSI)  and head of the Division of Pediatric Allergy & Immunology at National Jewish Health. “We know that eczema patients don’t have the good bacteria on their skin that’s needed to kill staph aureus. Our research has also shown that their skin immune system is also ineffective at eradicating staph aureus, so there is a double whammy plaguing these patients.”

Leung has been studying – and treating – atopic dermatitis for 30 years. Twenty percent of children and 10 percent of adults have it. And without effective treatment options, patients may suffer a lifetime of painful, itchy and often infected skin. The majority of these patients develop a problem with staph infections and receive treatment with antibiotics. As a result, many patients develop antibiotic resistant bacteria on their skin, which can be very dangerous.

‘Probiotic for the skin’

“Think of the good bacteria sort of like a probiotic for the skin,” says Leung. It may seem counterintuitive to apply bacteria to skin that is frequently plagued by bacterial infections, but the hope is that by applying good bacteria in a cream to eczema patients’ skin, a healthy bacterial balance will be restored.

Staph aureus
Staph aureus

Researchers hope that using the microbiome cream will offer a long-term solution where other treatments fall short. Powerful antibiotics are commonly prescribed for eczema, but they kill good bacteria on patients’ skin along with the bad. Creams containing corticosteroids are also often prescribed to eczema patients, but they come with harsh side effects, and patients usually can’t tolerate using them for long periods of time.

Eliminating bad bacteria

In a study that is being led by Leung and Richard Gallo, MD, PhD, of University of California San Diego, patients apply the bacteria-infused cream twice a day. Researchers are then able to analyze patients’ skin DNA to see if the bad bacteria have been reduced. The goal is to eliminate the bad bacteria on the skin altogether. The cream helps to restore the natural balance of bacteria on the skin, which will help improve the skin barrier required to keep harmful bacteria out.

Leung says in addition to strengthening the skin by using the good bacteria to restore a healthy microbiome, the study could also ultimately help people with antibiotic resistant staph infections such as MRSA who are running out of treatment options. For more information on how to participate in this study, or other eczema-related research at National Jewish Health, contact Sussmanj@njhealth.org.

Guest contributor: Wendy Meyer, director of communications and marketing, CCTSI.

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Fear fighter: Phobias, anxiety take center stage in early VR testing


VR logoEditor’s note: This is the third in a periodic series of articles focused on the potential of virtual reality technology in the medical setting. With its unique attributes, the University of Colorado Anschutz Medical Campus could lead the way in ensuring responsible and effective implementation of the gaming technology in health care.

 

Sitting in a soft, blue armchair in a quiet campus office, Nick Harrell slowly tensed. In his mind, the Denver librarian was standing on a busy airport curb near a line of passengers waiting their turn at a baggage check-in counter. The scene was enough to ignite his fear.

Hubley and Harrell VR session
Sam Hubley, PhD, guides Nick Harrell, a Denver librarian, through an exposure session using a virtual reality program aimed at overcoming a fear of flying.

“Nick, what sensations are you feeling?” asked psychologist Sam Hubley, PhD, who had been monitoring Harrell’s virtual airport visit from an identical chair arms-length away.

“My chest feels warm, and my throat feels tight,” said Harrell, his eyes covered by a boxy, maroon headset. Without hesitation, Hubley begins guiding his patient through relaxation exercises, helping him confront his fear of flying while averting a full-blown panic attack.

Jumping hurdles

The technique, called exposure therapy (ET), is not new. Experts have considered it the gold standard of treatment for an array of anxiety-related disorders for years. But Hubley and his colleagues on the University of Colorado Anschutz Medical Campus hope that by adding virtual reality (VR), they can make an effective therapy better.

“There are some major logistical issues with exposure therapy,” said Hubley, who works with the National Mental Health Innovation Center on campus testing virtual reality in a therapy setting. “And that’s putting it lightly.”

Hubley, who uses VR-assisted exposure therapy (VRET) at the University Family Medicine Practice in Boulder and at the Helen and Arthur E. Johnson Depression Center on the CU Anschutz Medical Campus, said the gaming technology could help overcome many obstacles that prevent some people from getting the mental health care they need.

Transporting patients

With ET, therapists begin by gradually exposing patients to places or things that trigger their fears while teaching them coping skills, eventually reaching the grand finale, whether it’s a scene of a deadly car accident for a traumatized survivor, a beer-flowing pub for an alcoholic or a bumpy airplane flight for a phobia patient.

“The center has been phenomenal in introducing us to mental health clinics and helping us put together a really good list of problems that we can help solve with virtual reality.” – Ben Lewis, Limbix Inc., co-founder

“How are we going to help somebody practice those things like deep breathing and cognitive skills while on an airplane? The short answer is: In the moment, we can’t, unless we have virtual reality,” said Hubley, assistant professor in the Department of Family Medicine in the CU Anschutz School of Medicine.

The NMHIC has launched pilot studies in 13 area mental health clinics so far, a number Executive Director Matt Vogl, MPH, said will continue to grow. Using cellphone VR technology with a platform created by Limbix, Inc., a Palo Alto, Calif., company focused solely on mental health issues, these therapists can now transplant their patients into numerous scenarios straight from their office chairs.

Feeling virtually real

Limbix applies panoramic pictures and videos of real places for an immersive, life-like experience. As an example, Vogl explained how Limbix employees mounted a 360-degree VR camera on the roof of a car and traveled to San Francisco, driving over the Golden Gate Bridge, inside heavy highway traffic, and through hill country at night, all common driving phobia triggers.

VR can induce the same feelings and physiological reactions as the real thing, Vogl said. For example, a colleague of his created a virtual crack house and did CT scans on the patients in the environment that showed they were experiencing real cravings, he said.

Enhancing therapy

Limbix was chosen as a NMHIC partner because of its emphasis on evidence-based therapies. The company shares its equipment and programs with researchers and qualified therapists only. “This is a tool designed to enhance therapy and make it more efficient and easier to access,” said Ben Lewis, Limbix co-founder. “It is not designed to replace therapists.”

Lewis said the NMHIC stands out as a leader in implementing the innovative technology in mental health care and beyond. “The center has been phenomenal in introducing us to mental health clinics and helping us put together a really good list of problems that we can help solve with virtual reality.” The company has at least 15 different exposure-therapy programs and anticipates substantial growth, Lewis said.

Matt Vogl mug
Matt Vogl, MPH

After completing seven VRET sessions, Harrell said his virtual trips to airports, including San Francisco and Denver International airports, felt real enough, one time coming close to inciting a full panic attack in the office. But he said the time-savings of VRET was the most attractive aspect.

Easing the load

“It feels less like homework,” said Harrell, one of the more than 75 million Americans who will experience some form of anxiety-related disorder in their lifetimes. Harrell, a former CU Boulder librarian, suffered a highly unexpected mid-flight panic attack about six years ago.

With a mother in the Air Force, Harrell grew up flying. “Getting on a plane was like hopping in a car,” he said, adding that he’d continued to fly for work and for pleasure as an adult, logging 40,000-plus air miles before the life-changing event.

A thwarted trip to Paris with his wife and some long train rides later, Harrell sought professional help, which gradually got him back on a plane. But it took intense dedication on his part.

“It’s really, really hard work,” Hubley said of exposure therapy. About 75 percent of people who complete exposure therapy get well and stay well, Hubley said. “But a lot of people drop out.”

Working with Hubley on his flying phobia before VR was introduced, Harrell would spend two-plus hours periodically busing to DIA for exposure work and practicing calming techniques. “It was really time-consuming,” Harrell said of the exercises he did alone in addition to his office sessions with Hubley.

Meeting a need

Hubley debriefs Harrell
Nick Harrell, left, and Sam Hubley discuss Harrell’s progress using cognitive therapy and relaxation techniques to tackle a flying phobia.

In an already strapped mental health care system, doing that type of exposure with patients is just not feasible, Vogl said. “I had a woman with a fear of flying call me shortly after we started doing VR saying: I can’t find a therapist in the state who will do exposure therapy with me,” he said.

But with VR, therapists can walk patients through the whole exposure process virtually, from buying a plane ticket, to packing the bags, to standing in the security line. Thanks to Limbix’s fear-of-flying program that includes some DIA-specific environments, Hubley has even “stood by” Harrell, as he confronted a terminal gate that reminded him of his last full panic attack.

“The more you can really let your brain experience those triggers, stick with the exposure, and reframe the negative thinking that so often goes along with anxiety, the more confidence we have about long-term protections against future relapse,” Hubley said, adding that expert guidance is critical.

“Without the right doses of exposure, re-traumatization can occur, potentially sabotaging a patient’s chance of recovery. And there’s a fine line,” he said, adding that the gaming technology makes managing the intensity level of exposures easier.

Finding the help

Harrell, who was prepping for a June plane trip with his wife with his recent sessions, said he believes there has been some improvements with the VR therapy.

“Two years ago, an exposure session at DIA would get me pretty amped up. Last time I went, I couldn’t get worked up. And the terminal VR exercises don’t bring up the same reactions and memories that they used to,” he said.

Whether using VR-assisted or traditional exposure therapy, people should seek care rather than missing out on life, Harrell said. “It might not always be pleasant, but it’s worth it,” he said. “I can say with pretty high confidence that I’m going on this next flight, whereas two years ago, I’d book a flight and say: We’ll see.”

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Insights into liver disease caused by intravenous nutrition

Research by physician-scientists at the University of Colorado Anschutz Medical Campus offers hope for improved quality of life for people who rely on intravenous nutrition due to intestinal damage.

Kasmi and Sokol
Karim C. El Kasmi, MD, PhD, and Ronald Sokol, MD, professor of pediatrics

Karim C. El Kasmi, MD, PhD, assistant professor of pediatrics, and Ronald Sokol, MD, professor of pediatrics, both of the CU School of Medicine, are authors of an article in the April 2018 Nature Communications that sheds light on the underlying cause of intestinal failure-associated liver disease and suggests new therapeutic approaches.

Intestinal failure is a condition that occurs when a person’s intestines are injured, damaged, or surgically shortened resulting in the need for the person to receive daily intravenous (IV) nutrition to sustain health. This IV nutrition, called parenteral nutrition, can be given in the hospital or at home through semi-permanent IV catheters.

Side effects of this form of nutrition are jaundice, liver injury called cholestasis, and eventually scarring in the liver. Intestinal failure-associated liver disease could eventually become so severe that the person would need a liver transplant or a combined liver and intestinal transplant to survive.

Until recently, there has been no effective therapy because of a poor understanding of how intestinal failure related to the development of the liver disease. Over the past decade, investigators have learned that reducing or changing the IV lipids can have a beneficial effect on some, but not all, patients.

Drs. El Kasmi and Sokol developed a mouse model that mimics the situation in humans with intestinal failure who depend on IV nutrition. Mice with intestinal injury that are given PN through a central venous catheter for 7 to 28 days develop decreased liver function, called cholestasis, and liver injury.

The researchers were able to show that products from bacteria in the intestine of the mice, called lipopolysaccharides (LPS), are absorbed through the injured intestine and activate the immune system in the liver to produce a cytokine, IL-1 beta, leading to cholestasis. The combination of IV lipids and intestinal injury lead to the intestinal failure-associated disease.

With this understanding, the researchers identified three possible new targets for drug intervention to prevent or treat intestinal failure-associated disease. Several drugs that target these disease-causing pathways are already approved or in development. Further testing in clinical trials with affected patients is required, but this research opens the possibility of treating patients who need long-term IV nutrition without the worry of developing serious liver damage.

Guest contributor: Mark Couch, CU School of Medicine.

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Antioxidant supplement helps cystic fibrosis patients, study finds

Researchers at Children’s Hospital Colorado (Children’s Colorado) and the University of Colorado School of Medicine have found that taking a specially formulated antioxidant-enriched multivitamin may decrease respiratory illnesses in people with cystic fibrosis (CF).

The study, which was recently published online in the American Journal of Respiratory and Critical Care Medicine, looked at the effects of a ‘cocktail’ of multiple antioxidants on inflammation and health outcomes in patients with CF. Inflammation is an important contributor to lung damage in CF, and contributes to progressive lung function decline.

The 16-week study consisted of 73 pancreatic-insufficient CF patients ages 10 years and older (average age 22 years). These patients ordinarily do not adequately absorb important dietary antioxidants including carotenoids such as beta(β)-carotene, tocopherols (vitamin E), coenzyme Q10 (CoQ10), and selenium that help to neutralize inflammation in the body. To address this issue, the antioxidants used in the study were delivered in a capsule specifically designed for individuals with difficulties absorbing fats and proteins, including those with CF.

Scott D. Sagel
Scott D. Sagel, MD, PhD, pediatric pulmonologist at Children’s Colorado

Antioxidant supplementation was safe and well-tolerated. Supplemental antioxidants increased antioxidant concentrations in the bloodstream in treated subjects and temporarily reduced inflammation in the blood at four weeks but not 16 weeks. Importantly, antioxidant treatment appeared to both prolong the time to the first respiratory illness requiring antibiotics and reduce the frequency of respiratory illnesses they experienced.

Specifically, half as many of the patients taking the supplemental antioxidants experienced a pulmonary exacerbation (or respiratory illness) requiring antibiotics compared to the group taking the control multivitamin without added antioxidants at 16 weeks. In addition, the antioxidant treated group experienced a lower frequency of respiratory illnesses compared to the control group.

“Single oral antioxidant formulations have been previously tested in CF with mixed results. However, there had not been a well-designed, randomized controlled trial of an antioxidant ‘cocktail’ that included multiple antioxidants in a single formulation,” said Scott D. Sagel, MD, PhD, pediatric pulmonologist at Children’s Colorado and professor of pediatrics at the University of Colorado School of Medicine. “While more research certainly needs to be done to find a treatment that delivers a sustained anti-inflammatory effect, we believe the fact that this antioxidant supplement prolonged the time patients had before their first illness is meaningful. It offers a simple, relatively inexpensive means for restoring and maintaining normal antioxidant levels in people who would otherwise have trouble doing so.”

This clinical trial, funded by a grant from the Cystic Fibrosis Foundation, was designed and led by Dr. Sagel. It was conducted from September 2013 to October 2015 at 15 CF centers across the U.S. affiliated with the CF Foundation Therapeutics Development Network.

Guest contributors: Mark Couch, CU School of Medicine, and Hollon Kohtz, Children’s Hospital Colorado.

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Infant growth patterns affected by type of protein consumed

A new study by CU School of Medicine researchers has determined that choices of protein intake from solid foods has a significant impact on infant growth during the first year of life.

The study tested whether dairy-based or meat-based protein in an infant’s diet contributed to growth and weight gain. Sixty-four formula-fed infants were involved in the study, with the group evenly divided between those who ate dairy and those who ate meat in addition to their formula, fruits, vegetables and infant cereals.

“Although breastfeeding should be the norm, majority of the U.S. infants are formula fed and limited research has focused on formula-fed infants. We found that the source of protein may have an important role in regulating growth,” said Minghua Tang, PhD, assistant professor of pediatrics, who led the study. “Infants who consumed meat-based solid foods had a greater length gain while both groups gain similar weight.”

The study, published recently by the American Journal of Clinical Nutrition, is perhaps the first of its kind to evaluate the effect of protein from different food sources on growth in formula-fed infants during the first year of life. Such studies can provide evidence-based feeding guidance that can yield long-term benefits for optimal growth and obesity prevention.

Recruiting families

To conduct the study, the investigators recruited families in metro Denver with full-term, formula-fed infants who were three to five months old. If eligible, they were screened with a baseline visit and once enrolled they were randomized into dairy-based and meat-based groups. Those on the meat-based diet complemented their usual eating with commercially available pureed meats, while the dairy-based added infant yogurt, cheese and a powdered concentrate of whey protein.

From five to 12 months, the infants were measured for length, weight and head circumference. Blood samples were collected at baseline visit and again at the end of the study. Sources of protein did not seem to affect intake because both groups reported similar amounts of total calories, protein and fat consumption.

Based on the measurements, meat-based complementary foods promoted greater length. The analysis showed the length-for-age increased in the meat group and declined in the dairy group relative to the growth charts. At the same time, the weight-for-length measurements, similar to a “Body Mass Index” for infants, significantly increased in the dairy group compared with the meat group.

In addition to Tang, authors on the paper were Audrey E. Hendricks, PhD, assistant professor of biostatistics and informatics at the Colorado School of Public Health, and Nancy F. Krebs, MD, professor of pediatrics. The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases, the National Center for Advancing Translational Sciences Colorado Clinical and Translational Science Awards, Abbott Nutrition, the American Heart Association, the Beef Checkoff through the National Cattlemen’s Beef Association, Leprino Foods and the National Pork Board.

Guest contributor: Mark Couch, chief of staff and director of communications, CU School of Medicine.

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Invasive procedures should be reserved for a sub-group of acid reflux patients, study says

As the number of Americans with acid reflux grows, a study by researchers at the University of Colorado Anschutz Medical Campus says invasive procedures to treat those who don’t respond to medication should be done for select patients.

“When you have a subset of patients who are not responding to drug therapy you need to respond in a thoughtful way,” said the study’s lead author, Rena Yadlapati, MD, MHS, assistant professor of medicine-gastroenterology at the University of Colorado School of Medicine. “Only a select few should be referred to surgery.”

The paper was published recently in The American Journal of Gastroenterology.

Rena Yadlapati, MD, MHS, assistant professor of gastroenterology.
Rena Yadlapati, MD, MHS, assistant professor of gastroenterology.

Currently, about 30 percent of the U.S. population suffers from gastroesophageal reflux disease (GERD) and most are treated with drugs like Nexium known as a proton pump inhibitors. Yet for 10-40 percent of patients, medication doesn’t eliminate symptoms. And for some, a hypersensitivity to symptoms may lead them to believe their acid reflux is worse than it is.

Yadlapati and her colleagues surveyed a panel of 14 gastroenterologists on treatment options when typical acid reflux drugs don’t work. They constructed a number of hypothetical scenarios involving patients who did not respond to double dose proton pump inhibitors.

“A nuanced understanding of both the literature and the patient’s unique physiologic profile is critical to appropriate decision-making, as inappropriate recommendations may compromise outcomes and patient safety,” Yadlapati said.

The panel investigated each hypothetical case and ranked the appropriateness of four invasive anti-reflux options. They also ranked their preference for drug and behavioral health treatment options.

“In the majority of cases, an invasive anti-reflux intervention was ranked as an inappropriate option,” the study said.

For patients with true refractory acid reflux demonstrated by ongoing abnormal esophageal acid exposure despite proton pump inhibitors more invasive options were recommended like laparoscopic fundoplication, where part of the stomach is wrapped around the lower end of the esophagus and stitched into place.

The researchers found that some patients who didn’t respond to acid reflux drugs had a hypersensitivity to the symptoms. In these cases, Yadlapati said, invasive procedures are unlikely to improve outcomes while possibly increasing morbidity, decreasing quality of life and adding up to higher health-care costs.

She said low-doses of antidepressants have a role in modulating symptoms.

“Behavioral modification and relaxation therapy are also potentially effective,” she said. “In a study of nine patients with functional heartburn, esophageal-directed hypnotherapy was associated with significant improvements in symptoms, visceral anxiety and quality of life.”

Ultimately, Yadlapati said, treatment options should be personalized for each patient. Surgery may be called for in some cases but it’s not usually the preferred option.

“We are not opposed to surgery for the right patients,” she said. “But we should not be reflexively referring patients for these invasive treatments before considering all of the options.”

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Researchers say issues of dementia and gun ownership need more discussion

As the number of adults with Alzheimer’s disease and dementia steadily increases, questions around their access to firearms remain largely unaddressed, according to a study by researchers at the University of Colorado Anschutz Medical Campus.

“Firearm access, like driving, can pose a risk of injury or death to both cognitively- impaired individuals and those with whom they interact,” said the study’s lead author Marian (Emmy) Betz, MD, MPH, of the University of Colorado School of Medicine. “How can health care providers, family members and friends balance firearm-related safety concerns with the rights and wishes of the individual?”

The study was published Monday in the Annals of Internal Medicine.

Betz and her colleagues from institutions including Johns Hopkins University, the University of Michigan and the University of California Davis, examined clinical perspectives relating to assessment and counseling about firearm access for those with dementia or other cognitive impairment.

They found that nearly 4.7 million adults had Alzheimer’s in 2010 and that number was expected to grow to 13.8 million by 2050. The disease accounts for about 70 percent of all dementia cases. That means the total number of people with cognitive impairment and a firearm at home will also grow.

The study noted that even in the highly politicized atmosphere surrounding gun ownership, about 89 percent of Americans support limiting firearm purchases and access to those with a mental illness. Americans also support temporarily reducing gun access in times of elevated suicide risks.

Dr. Emmy Betz, associate professor of emergency medicine.
Marian Betz, MD, associate professor of emergency medicine

“The primary firearm injury risk for individuals with dementia is likely to be death by suicide,” said Betz, an associate professor of emergency medicine at the CU School of Medicine. “Some 91 percent of older adults’ firearm deaths are due to suicide, and firearms are the most common method of suicide among people with dementia.”

People with dementia can experience hallucinations, delusions, agitation or aggression. If a person is delusional and believes people are breaking into their home, they may feel caregivers and family members are intruders and confront them with a gun.

Betz said conversations about guns in these situations are similar to talks with older drivers.

“When is it time to give up the keys, be they to a gun safe or a car?” she asked. “What are the relevant state and national laws? When and how should conversations occur?”

Right now there are no validated screening tools for assessing firearm access among cognitively-impaired people. For those with milder forms of dementia, some experts recommend discussions with the patient and family about setting a `firearm retirement date.’

Caregivers can also ensure that guns are securely locked so the patient can’t have access without supervision. They can reduce risks of gun injury by making firearms less lethal – removing ammunition from the home, storing firearms unloaded or having trigger mechanisms removed.

Betz said physicians have a right and a duty to ask and counsel patients about potential health risks so long as they balance the welfare of the person with the health and safety of the public.

Federal law forbids the sale of a gun to someone judged `mentally defective’ or who has been committed to a mental institution. Still, federal and state laws don’t explicitly prohibit those with dementia from buying guns.

Betz said working with stakeholders in the dementia and firearms community would go a long way toward creating effective materials and programs to address this problem.

She and her colleagues have developed a sample family firearm document. The person with dementia would be able to sign the agreement before symptoms become too severe. The agreement says that when the person with dementia can no longer make the best safety decisions, the family can control the possession of his or her firearm.

“It’s best to have these conversations early and be aware that you have to take action at some point,” Betz said. “This is not about the government or anyone else seizing guns, but about a family making the best decision for everyone involved.”

The co-authors of the study include Alexander McCourt, JD, MPH, Johns Hopkins Bloomberg School of Public Health; Jon S. Vernick, JD, MPH, Johns Hopkins Bloomberg School of Public Health; Megan L. Ranney, MD, MPH, Rhode Island Hospital/Alpert Medical School; Donovan T. Maust, MD, MS, Department of Psychiatry, University of Michigan Center for Clinical Management Research, VA Ann Arbor Healthcare System; Garen J. Wintemute, MD, MPH, University of California, Davis School of Medicine.

 

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CU Anschutz wins $46.5 million NIH grant

The National Institutes of Health (NIH) recently awarded $46.5 million to the University of Colorado Anschutz Medical Campus and its Colorado Clinical and Translational Sciences Institute (CCTSI), a research partnership designed to speed up development of new treatments to address the greatest health needs of Coloradans.

In 2008, the CCTSI was launched with a grant of $76 million—the largest biomedical research and training award in the state’s history. This new five-year award brings the total funding from NIH to the CCTSI to more than $187 million.

Dr. Shikha Sundaram“The general public may not know the CCTSI name,” says Ronald Sokol, MD, CCTSI director and professor of pediatrics in the School of Medicine. “But they have probably benefited from the research that has come out of our institute over the past 10 years.” Examples include:

  • A cure for hepatitis C, which was made possible in part by dozens of clinical trials that were conducted by CCTSI investigators in our facilities over the past 15 years.
  • Precision medicine treatments for cystic fibrosis that target the defective protein caused by specific gene mutations and which have transformed the lives of patients.
  • Boosting the rates of health screenings that save lives in underserved Colorado communities, such as urban Latino, urban African American and rural eastern Colorado.
  • Decreased mortality rates in five Denver neighborhoods by developing community-based, culturally responsive approaches to tailor educational programs for cardiopulmonary resuscitation (CPR).

“The CCTSI is an engine that has enhanced the research enterprise on the Anschutz Medical Campus for many years,” says Dean John J. Reilly, Jr., MD, of the University of Colorado School of Medicine. “We are proud of their work and confident they will continue to provide essential support and leadership for the next generation of physicians and researchers.”

Over the next five years, the CCTSI will:

  • Develop, educate and sustain a diverse translational science workforce to ensure the highest research innovation, quality and safety.
  • Create a translational research environment in which team science and collaboration both locally and nationally are facilitated, supported and valued.
  • Engage local and national communities and stakeholders in all phases of the translational research process.
  • Create novel methodologies and resources to support and integrate research in special populations, including children, the elderly, the underserved and those with rare diseases.

“The grant will further establish the University of Colorado Anschutz Medical Campus, and all of our institutional partners, as biomedical research leaders, pioneers and innovators,” says Sokol. “We are thrilled to have the opportunity to continue to engage in the full spectrum of translational science to achieve our ultimate goal of getting more treatments to more patients more quickly.”

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Study shows prenatal cannabis use associated with low birth weights

With marijuana use during pregnancy on the rise, a new study led by the Colorado School of Public Health shows that prenatal cannabis use was associated with a 50 percent increased likelihood of low birth weight, setting the stage for serious future health problems including infection and time spent in Neonatal Intensive Care Units.

Cannabis Sativa leaf
New study shows association between prenatal cannabis use and low birth weights.

“Our findings underscore the importance of screening for cannabis use during prenatal care and the need for provider counselling about the adverse health consequences of continued use during pregnancy,” said the study’s lead author Tessa Crume, PhD, MSPH, assistant professor of epidemiology at the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus.

The study was published last month in The Journal of Pediatrics.

Crume and her colleagues utilized survey data from 3,207 women who participated in the Colorado Pregnancy Risk Assessment Monitoring System in 2014 and 15. They found the prevalence of marijuana use in the state of Colorado was 5.7 percent during pregnancy and 5 percent among women who were breastfeeding.

Tessa Crume, assistant professor of epidemiology at the Colorado School of Public Health
Tessa Crume, PhD, MSPH, assistant professor of epidemiology at the Colorado School of Public Health

They also discovered that prenatal marijuana use was associated with a 50 percent increased chance of low birth weight regardless of tobacco use during pregnancy. Prenatal marijuana use was three to four times higher among women who were younger, less educated, received Medicaid or WIC, were white, unmarried and lived in poverty.

Crume said the numbers are surprising but also reflect changing attitudes toward marijuana, especially in a state like Colorado where it is legal.

“There is increased availability, increased potency and a vocal pro-cannabis advocacy movement that may be creating a perception that marijuana is safe to use during pregnancy,” Crume said.

The National Survey on Drug Use and Health suggests that cannabis use among pregnant women has increased as much as 62 percent between 2002 and 2014. At the same time, the potency of the drug has increased six or seven fold since the 1970s along with the ways it is consumed – eating, vaping, lotions etc.

“Growing evidence suggests prenatal cannabis exposure has a detrimental impact on offspring brain function starting in the toddler years, specifically issues related to attention deficit disorder,” Crume said. “But much of the research on the effects of prenatal cannabis on neonatal outcomes was based on marijuana exposures in the 1980s and 1990s which may not reflect the potency of today’s cannabis or the many ways it is used.”

The study found that 88.6 percent of women who used cannabis during pregnancy also breastfed. The risk of cannabis to the infant through breastmilk remains unknown. Various studies have found that cannabinoids are passed to the baby in this way. One of the study’s co-authors, Dr. Erica Wymore, MD, MPH, from Children’s Hospital Colorado and the CU School of Medicine, is currently conducting a study to evaluate this issue.

The researchers recommend that health care providers ask pregnant women about their cannabis use and advise them to stop during pregnancy and lactation.

“Obstetric providers should refrain from prescribing or recommending cannabis for medical purposes during preconception, pregnancy and lactation,” Crume said. “Guidance and messaging about this should be incorporated into prenatal care. And screening of pregnant women at risk for cannabis dependency should be linked to treatment options.”

The study co-authors include Ashley L. Juhl MSPH, of the Colorado Dept. of Public Health and Environment; Ashley Brooks-Russell, PhD, MPH, of the Colorado School of Public Health; Katelyn E. Hall, MPH, of the Colorado Dept. of Public Health and Environment; Erica Wymore, MD, MPH of the University of Colorado School of Medicine and Children’s Hospital Colorado and Laura M. Borgelt, PharmD, of the CU Skaggs School of Pharmacy and Pharmaceutical Sciences.

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CU Anschutz stem-cell scientists awarded $3.8 million DOD grant

Scientists from the Gates Center for Regenerative Medicine at the University of Colorado School of Medicine are part of a consortium awarded $3.8 million from the U.S. Department of Defense (DOD) to move discoveries in stem cell-created skin grafts into the manufacturing stage, bringing further hope to victims of debilitating inherited skin diseases.

The major grant for the Epidermolysis Bullosa (EB) iPS Cell Consortium, which includes research teams from the University of Colorado Anschutz Medical Campus, Stanford University School of Medicine and Columbia University Medical Center, will move production of stem cells into the Gates Biomanufacturing Facility at CU Anschutz.

The $3.8 million grant follows recent awards for the same investigators by the 21st Century Cures Act and the California Institute of Regenerative Medicine, boosting research that could not only benefit EB sufferers, but also countless patients with severe chronic skin wounds.

In February, CU Anschutz’s EB researchers reported a more efficient approach to reprogramming a patient’s diseased skin cells into stem cells, raising hopes for future clinical trials and potential cures. The results were published in Nature Communications.

‘Cutting-edge science’

In announcing the new grant, DOD reviewers issued one of the most emphatic research endorsements possible, saying, “This study is based on the strongest cutting-edge scientific rationale in the field of wound care and dermatology. It is also a collaborative effort among top physician-scientists, scientists, health care providers, epidermolysis bullosa patients, families, and charities across the United States.”

One evaluator wrote: “The proposed research has the highest probability of success of bringing gene-corrected tissue to patients in the hospital  . . .”

The DOD award will allow the EB research team to further investigate best manufacturing practices for larger-scale production of stem cell-created skin grafts, utilizing the best-in-class resources of the Gates Biomanufacturing Facility on the CU Anschutz Medical Campus.

Seeking a permanent cure

The goal now is to move the technology from the laboratory into clinical trials. Gates Center Director Dennis Roop, PhD, is a lead researcher on the team making great progress on promising new corrective stem cell-based therapies for currently incurable diseases, such as Epidermolysis Bullosa (EB).

Research team at Gates Center for Regenerative Medicine
The research team includes, from left, Igor Kogut, PhD, Ganna Bilousova, PhD, and Dennis Roop, PhD.

Roop has had a long-standing interest in finding a permanent cure for EB, a group of inherited skin diseases that results in severe blistering and scarring. EB affects thousands of people across the United States and worldwide, and is characterized by chronic skin wounds similar in property to thermal burns, and indistinguishable from burns induced by chemical agents such as mustard gas. Many children afflicted with recessive dystrophic EB, one of the most painful and disfiguring forms of the condition, do not survive their teens after lives compromised by chronic, debilitating pain.

The consortium is funded by the U.S.-based EB Research Partnership (EBRP), EB Medical Research Foundation (EBMRF) and the Sohana Research Fund from Great Britain.

“We are very excited to receive such a strong endorsement from the U.S. Department of Defense,” said Ganna Bilousova, PhD, assistant professor of Dermatology at the CU School of Medicine and member of the EB Consortium. “It is extremely difficult to advance any type of novel therapies into the clinic without the benefit of compelling government interest and support.”

Guest contributor: Michael Booth wrote this story.

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