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VCU Receives Grant to Look for Indicators of Preterm Birth

By Anne Dreyfuss and Rachel Machacek/University Public Affairs

Virginia Commonwealth University has received a $378,026 grant from the Global Alliance to Prevent Prematurity and Stillbirth, an initiative of Seattle Children’s, to look for predictors of preterm birth and other adverse pregnancy outcomes in pregnant women.

The two-year Human-Microbiome Alterations Predictive of Prematurity (HAPP) study will expand on two earlier studies under the National Institutes of Health’s Human Microbiome Project that looked at microbial communities in pregnant women and how changes in communities of bacteria, viruses and human cells affect women’s health.

“We’re looking at the microbiome as women go through pregnancy to try to determine what the roles of the microbiome are and its impact on the reproductive tract,” said Gregory Buck, Ph.D., professor of microbiology and immunology at the VCU School of Medicine and director of the VCU Center for the Study of Biological Complexity.

Buck is leading the study with Jennifer Fettweis, Ph.D., assistant professor in the Department of Obstetrics and Gynecology at the VCU School of Medicine and the VCU Center for the Study of Biological Complexity. The team has been applying omics technologies to investigate both the human host cells and the microbiome.

Omics take a holistic view of the molecules that make up a cell, tissue or organism with the idea that these complex systems can be understood better if considered as a whole. In the HAPP study, Buck and Fettweis will expand upon earlier studies and deepen their analysis by also looking at global changes that occur in proteins and metabolites throughout pregnancy.

“With the high-throughput technologies we now have available, we’re able to look at things we couldn’t see before,” Fettweis said. “We think by using a systems-level approach, we have a better chance at finding biomarkers that might indicate which women are at risk for delivering preterm.”

There are already indicators of microbiome imbalances leading to preterm births in specific ethnic groups. One in six African-American babies are born too soon, and researchers now think that 40 to 50 percent of those preterm births have a component that is associated with an imbalance of microbiome in the vaginal community.

By identifying these imbalances and biomarkers, researchers could potentially move into treatment to help prevent babies from being born to soon.

Preterm birth is a global problem. According to the World Health Organization, 15 million babies are born premature every year, and more than 1 million premature babies die. Babies who do survive stay in the hospital longer and face health complications including cerebral palsy, developmental delays and respiratory issues.

Joining Buck and Fettweis on the research team are Adam Hawkridge, Ph.D., assistant professor, Department of Pharmaceutics, School of Pharmacy; Dayanjan S. Wijesinghe, Ph.D., assistant professor, Department of Pharmacotherapy and Outcomes Science, School of Pharmacy; and J. Paul Brooks, Ph.D., associate professor, Department of Statistical Sciences and Operations Research, College of Humanities and Sciences.

Grant Opens Way for Study of Placental Function in Pregnant Women

By Anne Dreyfuss and Rachel Machacek/University Public Affairs

The National Institutes of Health recently awarded a $4.2 million grant to Virginia Commonwealth University to study placental function in pregnant women and to develop a noninvasive device for the early detection of placental disorders such as pre-eclampsia.

The grant is part of the NIH’s Human Placenta Project, a collaborative research effort that would revolutionize the understanding of the placenta’s role in health and disease. Previous studies of the placenta have looked at the organ after delivery. This study will examine the placenta in real time, while it is doing its job.

“The goal of this study is to be able to track pregnant mothers longitudinally, starting from when she goes to the doctor to confirm she is pregnant and throughout her pregnancy,” said Charles Chalfant, Ph.D., professor and vice chair of the Department of Biochemistry and Molecular Biology in the VCU School of Medicine, and recipient of the four-year grant for his project, “The Utilization of Photonics Technology to Rapidly Detect Bioactive Lipids Associated with Pre-eclampsia Development.”

Five to seven percent of all pregnancies are affected by pre-eclampsia, a complication marked by high blood pressure and possible damage to other organ systems and the baby. Older and obese women, mothers carrying multiple babies, and those with pre-existing hypertension have a higher risk.

There is no cure for pre-eclampsia other than delivery, which can sometimes lead to preterm birth and a host of other complications. There are also long-term effects, such as an increased risk for heart disease for mothers later in life. Early detection is essential.

“What we’re hoping to do is to track and determine very early on, even before the clinician diagnoses the condition, which patients are going to have a placental disorder and which ones are not,” said Chalfant, project lead for the research team, which includes Scott Walsh, Ph.D., professor of obstetrics and gynecology and reproductive biology and research at the VCU School of Medicine; Dayanjan Shanaka Wijesinghe, Ph.D., assistant professor, Department of Pharmacotherapy & Outcomes Science, at the VCU School of Pharmacy; and Philippe Girerd, M.D., associate professor, Department of Obstetrics and Gynecology.

During the first phase of the study, the clinical team led by Walsh will track patients at the high-risk clinic, where 50 percent of patients will have some kind of placental disorder. The team will look at patients on the biochemical level, specifically their bioactive lipids, a type of hormone that goes into dysregulation as a result of pre-eclampsia. The team will also determine if the problem is coming from the mother or the placenta, and all the data will go toward refining a lipid “fingerprint” specific to pre-eclampsia.

The refined fingerprint will then allow Wijesinghe to develop the detection device using Raman spectroscopy, a technology that measures light frequency. In this case, researchers would use it to detect the pre-eclampsia lipid fingerprint in biological fluids like urine and blood.

Phase two will be a blind prospective study of pregnant women in the regular clinic who are not in the high-risk pool for pre-eclampsia. “We are going to try to tell who is a patient [with pre-eclampsia], and the statisticians will tell us if we are correct or not,” said Chalfant. Results will confirm their ability to accurately predict at-risk patients prior to clinical manifestation of symptoms.

By the end of the study, the team hopes to have developed a noninvasive device that detects pre-eclampsia and possibly other placental disorders before the onset of symptoms. A pregnant woman could be sent home with an affordable and portable machine to test their urine. “They put a drop of urine on it, and it will say either red light or green light,” Chalfant said. “If it’s a red light, you call your doctors and see them immediately. If it’s a green light, you just go on to your next appointment with your OB-GYN as long as you’re not experiencing any other irregular symptoms.”

The device could change the standard of care for obstetrics. Early detection of pre-eclampsia means doctors can begin treating the mother (usually with low-dose aspirin) before it is too late. Chalfant also hopes to find different patterns of placental disorders to learn what causes them. This information could also lead to new treatments.

NIH awarded grants to 18 other research institutions across the United States and Canada to participate in the $46 million initiative that will ultimately improve pregnancy outcomes and long-term health for mothers and babies.


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Research Offers Evidence of Gender Differences in Insomnia Heritability

By Anne Dreyfuss/University Public Relations

Genes may contribute more to the development of insomnia symptoms in females than in males, according to a new study led by a Virginia Commonwealth University graduate student.

Drawing on pre-existing data from the Virginia Adult Twin Studies of Psychiatric and Substance Use Disorders (VATSPSUD), a large data set collected by VCU psychiatry professor Kenneth S. Kendler, M.D., Mackenzie Lind found evidence that the heritability of insomnia could be higher for females than it is for males, suggesting that genes influence sleep problems more for women.

“We found evidence for these differences between the sexes, which hadn’t been formally shown before,” Lind said. Lind is the first author in the study, “A Longitudinal Twin Study of Insomnia Symptoms in Adults,” which was published Sept. 1 in the journal Sleep, a joint publication of the Sleep Research Society and the American Academy of Sleep Medicine. She conducted the analyses under the guidance of her academic advisers, Kendler and Ananda B. Amstadter, Ph.D., associate professor, Department of Psychiatry, VCU School of Medicine.

The VATSPSUD includes data on approximately 7,500 male and female adult twins who have undergone thorough psychiatric interviews and completed self-reports on their current and lifetime mental health history. Lind, who is in the third year of the graduate Ph.D. phase within the M.D.-Ph.D. program at VCU, isolated three items from the data set that are reflective of the diagnostic criteria for insomnia — difficulty falling asleep, restless or disturbed sleep, and early morning awakenings. She then analyzed the data to determine the degree to which genetic and environmental factors influence insomnia symptoms in adults.

“I expected that we might find the sex difference because if you look in the literature the prevalence of sleep complaints is higher for females than for males,” Lind said. “More women have disturbed sleep generally, but that alone would not necessarily mean that genes play more of a role. This paper shows that genes may be playing more of a role for females.”

Nearly 10 percent of the U.S. population experiences chronic insomnia, according to the Centers for Disease Control and Prevention. The American Academy of Sleep Medicine reports that women are more likely than men to develop insomnia.

“The existence of evidence for these potential sex differences suggests that clinicians should target females for sleep interventions since it looks like there may be more of a genetic risk for experiencing them,” Lind said, adding that having chronically disturbed sleep can lead to many negative consequences for physical health, mental well-being and occupational health.

“Sleep translates into a lot of different areas,” she said. Insomnia can be a risk factor for developing psychiatric conditions such as depression and anxiety and it can manifest as a symptom of those conditions. But even when genes play a role in the development of insomnia, it is treatable and good sleep relates to good health physically and mentally.

Lind, who is pursuing a Ph.D. in clinical and translational sciences with a concentration in psychiatric, behavioral and statistical genetics through the VCU Center for Clinical and Translational Research, plans to enroll in a research-focused psychiatry residency after graduating from medical school. This is her first peer-reviewed journal publication, and she is currently working on a follow-up study that she hopes will publish within the next year. It investigates the genetic overlap between insomnia and other psychiatric conditions. “It’s a logical next step,” she said.

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VCU Study Examines Breast and Cervical Cancer Screenings in States Not Expanding ACA Medicaid Coverage

By Stevi Antosh/VCU Massey Cancer Center

Low-income and uninsured women in states that are not expanding their Affordable Care Act Medicaid coverage are less likely to receive breast and cervical cancer screenings compared to those in states that are implementing expansions, according to a study by Virginia Commonwealth University Massey Cancer Center researchers.

The ACA is allowing states to extend their Medicaid health insurance coverage for nonelderly adults with an annual income up to 133 percent of the federal poverty line. However, only approximately half of the states are expanding their Medicaid eligibility.

“I was interested in what the Medicaid expansion means in socio-economic terms,” said Lindsay Sabik, Ph.D., a member of the Cancer Prevention and Control research program at Massey and the study’s lead author.

The findings were published in the American Journal of Preventive Medicine and highlighted in the Journal of the American Medical Association. In the study, Sabik and colleagues Cathy Bradley, Ph.D., and Wafa Tarazi looked at the potential impact of the ACA on women’s cancer screenings for low-income and uninsured populations in the states implementing expansion and the states that are not. Bradley is associate director for cancer prevention and control and Theresa A. Thomas Memorial Foundation Endowed Chair in Cancer Prevention and Control at Massey and chair of the VCU Department of Healthcare Policy and Research. Tarazi is a doctoral candidate and graduate research assistant at the VCU School of Medicine.

Using pre-ACA, self-reported data from the 2012 Behavioral Risk Factor Surveillance System (BRFSS), the team analyzed differences of income, race and ethnicity for women ages 52-64 years who followed U.S. Preventive Services Task Force guidelines and underwent a mammogram within two years, and women ages 24-64 years who followed the task force’s recommendations and had Pap tests performed within three years. The BRFSS is a telephone survey conducted in all 50 states by the U.S. Centers for Disease Control to collect public health data.

The researchers found that women who do not have health insurance are significantly less likely to get regular mammograms and Pap tests. The study results suggest that uninsured women in nonexpansion states are less likely to receive potentially lifesaving breast and cervical cancer screenings by 7.9 percent and 4.9 percent, respectively.

Sabik points out that as Medicaid coverage expands and women in nonexpansion states, who are more likely to be low-income and African-American than in expansion states, continue to lack health insurance coverage, the disparities in breast and cervical cancer screenings may continue to widen. She advises that nonexpansion states should pay attention to existing disparities in preventive care across populations. She suggests that officials consider the costs and benefits of Medicaid expansion for these groups and whether the expansion might narrow the gap in coverage for potentially lifesaving breast and cervical screenings.

“There’s a lot that still needs to be done to make the Medicaid program more consistent across states to give all women fair access to cancer screenings,” said Sabik, who is also an assistant professor of health care policy and research at the VCU School of Medicine.

Sabik is currently working on a National Cancer Institute-funded Medicaid policy research study about breast and cervical cancer screenings for low-income women. In that study, she is looking into Medicaid administrative data as well as cancer registry data across states to determine how Medicaid impacts these screenings for low-income women and to determine any racial and ethnic differences in treatment.

This study was supported by a National Institutes of Health grant No. R01CA178980, co-funded by the National Cancer Institute and the Office of Behavioral and Social Sciences Research, and, in part, by VCU Massey Cancer Center’s NIH-NCI Cancer Center Support Grant P30 CA016059.

The full manuscript of this study is available here.

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Bodnar-Deren Receives 2 Grants

Dr. Susan Bodnar-Deren, an assistant professor in Virginia Commonwealth University’s Department of Sociology, has been awarded two grants.

Bodnar-Deren received a $19,149 award from the VCU Council on Community Engagement for a project entitled “A CBPR Evaluation of the ‘Mommies, Babies, Bellies & Daddies – The ABCs of Breastfeeding’ – a targeted intervention to encourage inform, and empower mothers to care for themselves, their babies and to increase breastfeeding initiation and duration.”

The project represents a collaboration between VCU Sociology, the Institute for Women’s Health and two community partners: Healthy Hearts Plus II and Kinfolks Community.

She also received an award of $9,116 Quest Global Impact Award for her proposal “Forging Cultures of Resistance: History, Health and Education in Communities of Struggle: A comparative study of Richmond Virginia and Pietermaritzburg, South Africa.”

This Quest Global Impact Award will enable Bodnar-Deren and Dingani Mthethwa, a professor of World Studies,to develop and deliver a virtual global classroom, which will link students from VCU and the University of KwaZulu Natal (UKZN).  The course will focus on a cross-cultural/multidisciplinary examination of social stratification, access and opportunities in both nation-states.

Students from VCU and South Africa will  work directly with community organizations to engage in global conversations, with the explicit goals of mobilizing the ideas, skills and passions of community organizations and the two universities.


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