Showing posts with label ADRN. Show all posts
Showing posts with label ADRN. Show all posts

Wednesday, July 17, 2013

New NEA post: Atopic Dermatitis Research Network needs trial participants

This week you'll find me blogging over at the National Eczema Association website. I interviewed Donald Leung of National Jewish Health about the Atopic Dermatitis Research Network. Three years in to a $42M program to investigate the links between genetics and our susceptibility to skin infections, the ADRN is registering patients with the NIH before proceeding with clinical trials.

They still need black and Hispanic patients to sign up--eczema, genetics, and skin pathogens are different for different ethnic groups. The better your demographic is represented in the trials, the more that scientists will learn that applies to you.

The ADRN has centers in Boston, Chicago, Denver, Los Angeles, Portland OR, and Rochester NY.

If you're interested in participating, email Judy Lairsmith at National Jewish or call 1-888-413-5852.

Thursday, June 20, 2013

Three years in: what has the $42M Atopic Dermatitis Research Network produced?

In July it will be three years since the NIH awarded National Jewish Health in Denver, CO $31 million to create and administer the Atopic Dermatitis Research Network, a consortium of five academic sites across the US. A contractor, Rho Federal Systems of Chapel Hill, NC, won an $11 million contract to operate a center to coordinate statistics and clinical trials for the project.

That makes $42 million—spread over five years—which puts the project on the large end of NIH funding for individual biomedical efforts. The typical NIH research grant ranges from $100 thousand to $2 million, and anything bigger is fodder for university news releases. Which raises the question: what have US taxpayers gotten in return?

I ask this as a patient who is grateful that these scientists are working to understand a disease that affects me, my family, and millions in the US and worldwide.

The answer is not obvious, since the publications page on the ADRN website hasn’t been updated since July 2011.

According to the website:
The Atopic Dermatitis Research Network (ADRN) is a consortium of academic medical centers that will conduct clinical research studies in an attempt to learn more about skin infections associated with atopic dermatitis (AD). The studies will focus on antibiotic-resistant Staphylococcus aureus infections and widespread viral infections of the skin, both of which are more prevalent among AD patients. The ADRN will build on the work of the Atopic Dermatitis and Vaccinia Network (ADVN) which conducted clinical studies focused on making smallpox vaccinations safer for people with AD. 
This research will lead to a greater understanding of the immune system in AD patients and may lead to novel therapeutic strategies to manage or prevent infectious complications associated with this disease. 
The ADRN will conduct a number of clinical studies over the next five years and will be enrolling large numbers of people with AD.
A search on clinicaltrials.gov returns two entries for the ADRN: one (open) to create a database of patients for the study of genetic markers connected to susceptibility to infections, and one (completed) to look into how AD patients respond to a new flu vaccine.

The ADRN’s NIH contract number is HHSN272201000020C. A search in the NIH’s PubMed database returns 12 papers that acknowledge funding by that contract number. Three of those are review papers (which did not involve new research).

So that makes  two clinical trials and nine research papers, three years into a five-year $42 million project.

Should US taxpayers expect more; be satisfied; or be impressed?

The answer is probably that we will have to wait to find out.

In each year, a typical top university research lab operates on about $2-3M a year and publishes somewhere around ten papers. That’s roughly $200k a paper.

Three of the five years in the ADRN contract are up; three-fifths of $42M is around $24M. We might therefore naively estimate that we should have seen upwards of 100 papers produced so far.

Most likely the reasons there are only 12 at the moment are that you don't start publishing papers right at the outset of a project. The research must be done first and then written up; and the process of getting accepted to a journal takes months. And the ADRN appears largely to rely on clinical trials--which take time to set up.

So why do we only see two trials listed on clinicaltrials.gov?

I've never had anything to do with a clinical trial, but when I was a researcher, I conducted animal experiments, and there were formidable administrative hurdles to get over before I could start work. I imagine that trials with human subjects are heavily regulated by the government, and for good reason. So the apparently small output of the ADRN to date is, I'm guessing, because it takes a long time to plan trials, get approval, and conduct them, before you can begin analyzing data and reporting it.
Still, let's keep in mind that the ADRN is an extension of the ADVN. It’s not like the ADRN began from scratch—the scientists had the momentum of existing expertise and administration and research aims.

Looking at the titles of the published papers, I can't immediately judge which are the most important. So I emailed Donald Leung, the principal investigator for the ADRN (he's a professor and head of the Division of Pediatric Allergy and Immunology at National Jewish Health), and asked him whether he could summarize the consortium’s findings so far and highlight key points. I hope to hear back from him soon and perhaps to interview him on the phone.

I’d like to know what ADRN scientists have found that surprises them. What have they learned that is truly new?

And what is going to be truly useful to patients in the end? Publishing papers should not be the be-all and end-all of scientific research. What about patents? I’d like to know whether anyone in the ADRN has thought about controlling intellectual property and commercialization. While it’s true that clinical studies may highlight the ideal dosing amount or schedule for existing therapies, and this does not involve creating a new commercial enterprise, most medical technology must pass through the marketplace before it can benefit the consumer/patient.

Someone has to do the dirty work of developing scientific discovery into therapy, and it’s not academic scientists.

More to come.

Wednesday, May 1, 2013

Anomalies in the immune system of patients who have experienced eczema herpeticum

Scientists have discovered that eczema patients who have suffered an outbreak of eczema herpeticum possess a subset of T cells that appear to be less effective at fighting viruses than T cells in the rest of the population. The results, published online in the British Journal of Dermatology, may point to an impaired arm of the immune system, a weakness that enables the herpes simplex virus (HSV), the agent of eczema herpeticum, to thrive.

Eczema herpeticum (EH) is a nasty skin infection caused by the HSV. The researchers, led by Donald Leung at National Jewish Health in Denver, took T cells (specifically, the class of T cells that fights viral infection) from 24 eczema patients who had experienced EH. The scientists analyzed various aspects of the T cells, comparing them to T cells taken from control patients—with and without eczema—who had not been infected by HSV. The scientists found that T cells from the EH group were producing less of a signaling molecule called “interferon-gamma” than those from the control groups.

Interferon-gamma is known to play many important roles in the immune response, especially in fighting viral infections.

The researchers also tested the DNA of the patients and found that the EH group were statistically more likely to possess copies of genes encoding “HLA B7” proteins, which hold chopped-up viral fragments on the cell membrane as markers so that T cells can identify and destroy infected cells.

It seems clear to me that a lack of interferon-gamma might be a liability against viruses. (I wouldn't expect this deficiency to be an effect of EH infection rather than a contributing cause, but the authors don't discuss the possibility.)

Owning a copy of HLA B7 might seem to improve your ability to fight infection--especially since that group of proteins have been shown to present fragments of vaccinia virus. However, as Leung pointed out to me in an email, having HLA B7 didn't prevent many of the patients in this study from getting eczema herpeticum.

These results don't have any immediate application to helping patients, but the area they highlight might prove important in protecting patients from eczema herpeticum in the future.

This is the first paper I have seen that acknowledges funding by the Atopic Dermatitis Research Network. I am sure there are many more papers out there, but this is the first I have noticed since the inception of the $31 million program, founded in 2010 to explore skin infections related to eczema.

Tuesday, December 21, 2010

Fingernails again/Atopic Dermatitis Research Network update

A nail-cutting night again for Voov. She's been mangling herself again. Not too terribly, but her hands have gotten all red and rough. On nail-cutting nights, at bathtime Hidden B closes the toilet lid and sits on the top with Voov in her lap, and cuts her nails with the clippers. Shmoop's job is to choose a pile of books for me to read to distract Voov. This he is very good at-- he picks the baby books, such as "The Going to Bed Book" or "Moo Baa La La La," rather than the ones he wants me to read when he gets HIS nails cut: National Geographic illustrated titles such as "Eurasia" or "The Mammals" (he likes the exotic animal pictures).

There's one issue with Voov that is somewhat disconcerting to us. Her back is, to put it delicately...um...a little hairy. There's no doubt that she's a mammal. Occasionally we wonder whether the steroids we're putting on her--which are relatively mild, but still known to have hormone-mimicking side effects--are doing something weird. Or that maybe the stronger steroids I put on myself are lingering on my hands and somehow getting into her system.

But the furry bits (we're talking downy, not out-and-out hirsute) bear no relation to where the steroids are going on. We haven't been putting steroids on all over her, which is when systemic effects are supposed to occur. And Hidden B tells me that her sister was always "downy," so maybe it runs in the family.
* * *
I was wondering what was going on with the Atopic Dermatitis Research Network, the $31 million multicampus NIH-funded consortium to investigate why eczema patients are vulnerable to MRSA. The ADRN is the new version of the Atopic Dermatitis and Vaccinia Network, a large study now wrapping up.

So I wrote to Donald Leung, the scientist in charge of the ADRN. (He's at National Jewish Health Center in Denver.) Judy Lairsmith, the ADRN's program manager, responded:
We are still working on setting up the Registry/Genetics protocol for the Atopic Dermatitis Research Network. This is a long process as you can gather. The protocol has to incorporate input from all the participating centers, plus the data coordinating center Rho, Inc., and has to go through several layers of approval at the NIH. Current plans are to start enrolling in February or March. Once the study is approved by NIH it must be approved by the [institutional review boards] at each of the institutions where subjects will be enrolled.
During my Ph.D. I had to get an animal experimentation protocol approved by a national laboratory. I filled out a lot of forms. My brain boggles at extrapolating from my experiment to the Kafkaesque bureaucratic demands of a 10-institution trial in human subjects. Judy must be a machine.

We'll have to wait a couple months yet to see exactly what trials will be done where. Participating institutions are all over the U.S. (list at the bottom of this link) so there's a good chance there's one near you.

I'm taking a break from blogging until January 3rd. Back just in time for New Year's resolutions! I know you'll be making some. Until then, enjoy the holidays.

Friday, October 15, 2010

Eczema sufferers thank you, Dr. Anthrax

Voov and I are in a good stretch-- neither of us has any eczematous patches right now. Of course, that can change overnight. But when eczema isn't bothering you, you tend not to think about it-- you get to pretend everything's normal, and wear clothing that nobody but an eczema patient would find daring-- t-shirts, collarless "shirtly sweaters" (you know, those thin pullovers that were a fad a few years ago). Maybe go swimming.

Not to go on about this Atopic Dermatitis Research Network too much, but I had a thought. Why is this grant so big? One clue, maybe, is the story I mentioned yesterday (NYTimes version) about the 2-year-old son of a US soldier who developed eczema vaccinatum after his father was inoculated with vaccinia virus, the live smallpox vaccine.

The episode must have opened a lot of eyes to the danger this vaccine poses to eczema patients. But the NIH was aware of the problem beforehand. ADRN is the sequel to the ADVN, which was established as early as 2004 and perhaps before. Almost certainly the whole ADVN/ADRN focus on vaccines and eczema is a direct consequence of the 2001 anthrax attacks.

So, eczema sufferers, we can thank Bruce Ivins if, in a few years' time, drugs or other therapies start filtering down the pipeline to protect us against MRSA. Bioterror is big money. I don't know exactly how the NIH receives its funding, but the US civilian biodefense budget for financial year 2011 is about $6.5 billion. $32 million is peanuts. We should angle for more!

For me, although MRSA or staphylococcus in general is a continual concern, I feel that it would be a shame if a huge expenditure of research dollars removed the danger of eczema infection but left us all itching and scratching without relief. Let's not forget that.

A postscript: I asked a mathematical epidemiologist, Jamie Lloyd-Smith, an assistant professor at  UCLA, what fraction of the US population would have to be vaccinated against smallpox to shut down an epidemic. His answer, which he stresses is a back-of-the envelope calculation (I leave out the math):
"You can prevent an epidemic--or eliminate an endemic disease--by vaccinating a high enough proportion of people that Reff<1. This gives herd immunity...you'd need to vaccinate 70-83% of people to eliminate smallpox."
Since, including children, about 20% of the US population has experienced eczema in some form--and, say, there are three people in the average family, and even if you don't have eczema, you can't expose your child to viral danger-- it is clear that the government cannot vaccinate 70% of the population in the event of a smallpox attack without putting a small fraction at real risk of developing eczema vaccinatum. Given the loud objections of the anti-vaccination fringe to protecting their kids against measles and whooping cough--with vaccines for which the benefit overwhelmingly outweighs any imagined risk--you can imagine the trouble the government would run into if it tried to jab us all with smallpox vaccine.

Thursday, October 14, 2010

Say no to smallpox vaccine

In March 2007 a two-year-old boy in Chicago contracted the smallpox virus from his father, a soldier who had recently been vaccinated prior to a tour of duty in Iraq. Only an all-out response from a Who's Who of U.S. infectious disease experts saved the boy, who had become a victim, it appears, because of an immune defect associated with eczema.

Why does this matter to you? Or to me? I read this article in Science (sorry about the paywall) at the time and the story just leaped off the page at me. It's scary. If you have eczema, you basically shouldn't get vaccinated for smallpox because the risk of dying is too high. And the effects aren't pretty.

(You may notice that I never post images of this stuff. That's my policy. I have eczema, and it grosses me out enough on my own body that I don't need to see it on anyone else's. I eat dinner after writing these posts.)

In the year following that nasty discovery, the NIH founded a research group called the Atopic Dermatitis and Vaccinia Network (ADVN) to look into why vaccinia virus can cause such an extreme reaction. Vaccinia is closely related to variola, the agent of smallpox, and used as the vaccine. In most people, it's benign. An ADVN group at the La Jolla Institute for Allergy and Immunology found that levels of "natural killer" cells, a class of white blood cells, are low in a strain of mice used as models for atopic dermatitis, and which develop "eczema vaccinatum," the same condition the Chicago boy nearly died from. In normal people, the theory is,  natural killer cells somehow keep the virus in check.

Science is complicated-- this is one paper, and it's a mouse model, but you can imagine that these results might point the way to studies that could find similar results in humans, and possibly therapies to boost natural killer cells to prevent deadly reactions to vaccine. (The ADVN must have published reams of papers, and right now I have no idea what their most significant findings were. Will have to find out.)

The ADVN has now morphed into the ADRN, the Atopic Dermatitis Research Network, the group that in July received $31.5 million from the NIH to conduct extensive research over five years into why patients with eczema are susceptible to deadly microbial infections. In the NIH's original request for proposals for this funding, they define four research areas; the first two are eczema vaccinatum and staph infections. The second two are vaccine reactions and infections from other organisms. The constraint was that applicants had to pick one of the first two areas, plus one to three of the remaining three. The successful consortium, led by Donald Leung at National Jewish Health in Denver, appears to have picked staph infections as their primary focus, according to their press release.

I wrote to Leung and he informed me that the group has not yet determined a protocol for its experiments, but will have done so by the end of the year. I can't wait to find out the details. It is an undertaking of huge scope-- ten academic centers involved. Staphylococcus, and MRSA, is surely a worthy enemy to vanquish. Imagine bringing up a child with eczema knowing that because of what they discovered on this project, you didn't have to worry about runaway staph infections. Life might not be all smooth sailing, but the fear factor would be a lot lower.

Initially, I called the NIH media department, asking whether they made the details of grant applications public. They do not, and the officer directed me to contact the scientists directly. "I'm an eczema sufferer myself," he told me. "I understand why you want to know."

Wednesday, October 13, 2010

Easy way to make yourself feel better: read WebMD

I just did something I shouldn't have-- but the result was, from my selfish perspective, good. Like probably 25,000 other people I got the National Eczema Association's email newsletter today. It says that CEO Julie Block is a guest expert on WebMD. Join the discussion, it said. I clicked on the link. Good Lord. Should you ever despair about your eczema, you can click on that link to instantly confirm that there are people out there doing far worse than you. Someone apparently has cactus infiltrating their entire body, pushing needles out their fingernails and reproductive organs. And then there's the tree man.

So one news item in the NEA newsletter is that the National Jewish Health Center in Denver won a $31.5 million grant to study MRSA infections in patients with eczema. This grant was awarded in July, but I broke the story two days ago. NEA, consider yourself scooped!

This in jest. There's a difference between being a blogger on your own schedule beholden to no-one and trying to get a respectable newsletter out on deadline. The NEA's newsletter and magazine are valuable resources for people like me.

I wrote to Diane Dunn, the NEA's communications and program manager, to introduce myself, and she decided to treat the anonymous internet weirdo with kid gloves. She wrote back suggesting there may be a way for us to work together. I sincerely hope so. There aren't many places you can go to to get news about eczema research. The mainstream media tends only to cover stories about dogs (this happens to be a general rule in science writing) or stories with an angle like people with eczema are "allergic to money" because there is some correlation of atopic dermatitis with higher income. Eczema is complex enough that there are results coming out of labs and clinics all the time that may pertain to your individual case. I hope to relay some of these stories.

I wrote to Adam Dormuth at National Jewish to ask him if he could give me details on the Atopic Dermatitis Research Network, a consortium of ten academic centers that was created specifically for the purpose of winning the grant, which was advertised by the NIH in a competition. If someone told me there was $31.5 million to be had, I'd call all my professor friends and get the band back together too. Anyway, haven't heard back from Mr./Dr. Dormuth. The man may prioritize his inbox the same way I do, which is

1) requests from people who really matter, like donors, politicians, ambassadors, and Newsweek  reporters
2) requests from people who matter, like faculty who have a paper coming out next week that the public affairs department doesn't have the bandwidth to write about
3) announcements about campus events featuring free food
4) spam
5) requests from anonymous bloggers

I've just wasted ten minutes trying to think of a witty ending for this post. And failing. In short: we'll get some answers about ADRN, whether it's from National Jewish or elsewhere.