Sunday, August 21, 2011

The Empty Cradles Series: a newspaper's effort to confront Milwaukee's infant mortality problem

ARTICLE:  "Milwaukee-based researchers study prenatal exposure to toxins:  tiniest preemies appear more susceptible"  Milwaukee Journal Sentinel [Milwaukee] 16 August 2011, E1-2.

TAKE HOME MESSAGE:  This year the Journal Sentinel is focusing on addressing the issue of infant mortality in some of Milwaukee's most impoverished zip codes.  This idea to profile basic and translational research that may one day improve this situation was mostly inspired by a meeting I attended with the mayor of Milwaukee and a small group of reporters.  I walked away wondering how I could contribute to this important undertaking.  I did the one thing I think I did best this summer:  I told researchers' stories.


Investigator #1

1)      Are you thinking that the mechanisms by which TCDD is modulating developmental programming might be epigenetic?  If so (and if you’d allow it), it would be fun to describe the concept of the epigenome. 

2)      Can I discuss findings that are “unpublished” or “observed” in very general terms?  (eg hematopoietic stem cells undergoing senescence; increased susceptibility of disease in mice)

3)      What is the significance of stem cells senescing (as opposed to undergoing apoptosis)?

4)      I’m curious about your models (in vitro, in vivo) and the types of techniques or equipment you use in the lab routinely?  (I like to try to communicate something about technology used in research.)

5)      Can you give me some context for describing the rise in the incidence of immunological based diseases in children?  Any review papers that might summarize some of these findings?

6)      I’m interested in the types of translational questions you could ask if your hypotheses prove true.

7)      So what motivates you to pursue these types of questions?  I’m always intrigued by how one ends up choosing a particular line of research.

Investigator #2

1)      I’m not sure if this is explicitly stated, but NFKB1 (g-24519delATTG) sounds like it codes for the NFKB1 promoter region?

2)      This seems like a functional polymorphism or isn’t it?  I noticed that in Table 2 there is no change to the peptide.  So what role (if any) does this variant play in the actual pathophysiology of NEC?

3)      Is NEC a phenotype of the variant allele?

4)      You state that this variant is necessary but not sufficient to produce NEC.  What sort of environmental factors would interact with this gene variant to render preterm infants more susceptible to NEC?

5)      Susceptibility is a difficult concept to explain to a lay audience.  How do you describe the term?

6)      Would you say that polymorphic NFKB1 is a reasonable biomarker of NEC susceptibility?

7)      Could this variant contribute to other factors leading to preterm labor—perhaps alter the response of gestational membranes to bacteria?

8)      What type of mechanistic studies are going on to better understand how this variant is contributing to NEC susceptibility? 

9)      In Table 1, were more infants African American because of demographics or because preterm African American infants are more likely to develop NEC?  In other words, is this a disease where there is  racial disparity?

10)  NEC is described as a sign of disease, but is not itself consider a disease?  Is this the consequence of unresolved inflammation?

11)  Can you describe some of the behavioral aspects of NEC?  Do infants exhibit pain?

12)  Can you describe some of the medical or surgical interventions for NEC?

13)  Can you describe how NEC is diagnosed?

14)  If these infants survive—and it appears that many can die--what is their prognosis in adulthood?

15)  Tell me how this work led to your focus on oxygen toxicity—obviously, a real concern in preterm infants.

16)  How is oxygen toxicity associated with environmental exposures?  Can you describe some of those exposures?   Is this something that is mediated by over-production of ROS, say, during uncontrolled inflammation?

17)  What types of studies are you proposing?

Outside Source

I am interested in an outside perspective on Dr. Sampath’s work, which has implications for NEC susceptibility.  I am wondering if you are willing to comment on some of the implications of this work.  I am also interested in knowing how this work progresses the field; what some of the pitfalls of this type of research might be; and how these findings may be applied to other conditions in the very low birth weight infant.

Center Grant Director

Would you be willing to offer me just a few lines I can quote regarding the role this grant money plays in research that may one day help lower the infant mortality rate in Milwaukee and beyond?