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Science, Stanford News

New website chronicles tales of collaborative research

New website chronicles tales of collaborative research

interdis_DSC_1526_Scope

One thing you notice working at Stanford is how close you are to other areas of research. A short lunchtime walk from the medical school campus can involve coffee at the School of Engineering or a sandwich at the business school.

This proximity matters for more than just lunch. Many important medical advances have come out of collaborations between faculty members from very different backgrounds. These collaborations have produced medical technologies, revealed the inner working of our brains, and generated strategies for solving international health crisis, and that’s just collaborations involving medical school faculty.

Institutes across Stanford support similarly interdisciplinary approaches to solving many of the grand challenges we face today in environmental research, security, economic policy and energy. Technology like virtual reality (above) is being applied to environmental research, questions of empathy, and athletics.

We’ve collected many of these stories and videos of boundary-crossing research on a new website that chronicles the results of venturing outside departmental silos. We’ve launched with stories about decision-making, water policy, intersections with the arts, and interdisciplinary undergraduate research, all of which span schools and departments to tackle real world problems.

Photo of virtual reality research by Linda Cicero

Events, Grand Roundup, Health Disparities, Rural Health

A quest to cure the world’s blind

A quest to cure the world's blind

Geoff TabinI recently had the pleasure of organizing a global-health seminar with a special visitor to campus: Geoff Tabin, MD. A renowned ophthalmologist, world-class climber and humanitarian, Tabin shared his circuitous road through global medicine and his vision to eradicate unnecessary world blindness.

“Most of the blindness on our planet could have been prevented or is easily treated,” Tabin told the audience. “It’s one of the few areas of global public health that we can really do a lot about – and, when you cure someone, they’re 100 percent cured.”

Blindness disproportionately impacts people in developing countries where malnutrition, poor water quality and lack of sanitation and health-care infrastructure lead to high incidence of eye disease. It comes with a heavy economic burden – Tabin explained that in the developing world, blindness is associated with a two-thirds reduction in life expectancy, or typically less than 10 years.

But tackling world blindness is also a story of hope. Cataract – which accounts for more than half of world blindness, according to the World Health Organization – can easily be treated with a low-cost, one-time procedure that restores full sight. A person who undergoes cataract surgery can go from being blind to being able to pass his or her driver’s test the next day.

Through a serendipitous series of events, Tabin co-founded the Himalayan Cataract Project with Nepali ophthalmologist Sanduk Ruit, MD, with the vision of restoring sight to as many of the world’s 18 million cataract patients awaiting care as possible. Since 1995, the organization’s doctors have performed over 445,000 cataract surgeries in the developing world.

Ruit had started an intraocular lens factory in Kathmandu that dramatically reduced the cost of cataract surgery. In the 1980s, the standard procedure for cataract surgery in the U.S. involved replacing the eye’s natural lens with an intraocular lens. However, the costly implants were not accessible to cataract patients in the developing world. That was until Ruit who, seemingly overnight, brought the cost of an intraocular lens from $200 to $4 on the world market. Today, the life-changing procedure can be completed in less than 10 minutes at a cost of just $25 per surgery.

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Aging, Immunology, Infectious Disease

Found: A molecule mediating memory meltdown in aging immune systems

Found: A molecule mediating memory meltdown in aging immune systems

persistence of memoryEven perfectly healthy older people don’t always remember names as quickly as they did when they were younger. So what. They also don’t walk as fast. Big deal.

A bigger deal: Older immune systems don’t respond as quickly or as well to invasions by pathogens. That’s in large part because they fail to remember previous encounters with pathogens (or their defanged doppelgängers, which we call vaccines). Why do they forget? Stanford immunologist Jorg Goronzy, MD, may have a handle on part of the reason.

In a study published in Cell Reports, Goronzy and his colleagues have shown that immune cells of a particular type are more likely to be marked, in older people, by a surface protein that sparks apoptosis, or cellular suicide. As a result, the immune system’s memory of pathogens or vaccinations of yore gets cloudy, leaving the door open to a repeat attack by intruders that a more adept immune system would have summarily squelched.

A healthy immune system bulks up vigorously in response to pathogens or vaccines. Different types of immune cells that are skilled at recognizing and/or warring with the foreign body start to multiply and morph. Many of these cells effectively become front-line warriors, throwing themselves into battle against the invading pathogen (or its harmless vaccine lookalike). Others are more like archers lobbing darts that can knock off the bad guys while sparing innocent bystanders (the body’s own tissues). Still others, known as CD4 cells, coordinate the whole counterattack, sending chemical signals to other cells, or rubbing up against them at close range to whisper secret instructions.

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Grand Roundup

Grand Roundup: Top posts from January

Grand Roundup: Top posts from January

It’s time to look back at last month’s five-most read stories on Scope. They were:

The real reason why med students only talk about school: In the latest installment of Stanford Medicine Unplugged, second-year medical student Nathaniel Fleming writes about the reason that medical students talk about school so much. He notes that “being able to debrief openly and honestly couldn’t be more important in a profession like medicine.”

The importance of providing patient support in the face of a life-threatening illness: In this first-person piece, Sara Wyen, a survivor raising awareness about the devastating effects of blood clots, shares how her physician helped her heal both physically and emotionally after a scary medical diagnosis.

When Breath Becomes Air: A conversation with Lucy Kalanithi: The memoir “When Breath Becomes Air” was written by Stanford neurosurgeon Paul Kalanithi, MD, who died of lung cancer at the age of 37. In a recent 1:2:1 podcast, Paul’s wife, Stanford physician Lucy Kalanithi, MD, talks about the words that Paul left behind and what life has been like since Paul died last spring.

NBC Dateline to explore the “extraordinary situation” facing one Packard Children’s transplant family: A national news program recently caught up with the Binghams, a family with three children with cardiomyopathy, a life-threatening disease that reduces the heart’s ability to pump normally. Family members have undergone three heart transplants at Lucile Packard Children’s Hospital Stanford, and their youngest son is awaiting a donor heart.

New perspective: Potential multiple sclerosis drug is actually old (and safe and cheap): This post highlights a new study led by Paul Bollyky, MD, PhD, showing that blocking production of a naturally made substance in the body may be beneficial in multiple sclerosis.

And still going strong – the most popular post from the past:

Eating for good blood: Tips for boosting iron levels and hemoglobin: This entry from the Stanford Blood Center discusses hemoglobin levels and offers ways to boost levels prior to blood donation.

Ethics, Genetics, In the News, Research

Cautious green light for CRISPR use in embryos in the U.K.; Stanford’s Hank Greely weighs in

Cautious green light for CRISPR use in embryos in the U.K.; Stanford's Hank Greely weighs in

balance-154516_1280Big news out of the United Kingdom today about the gene editing technology known as CRISPR/Cas9. Stanford law professor Hank Greely, JD, posted a brief take on his blog this morning applauding the move by the British Human Fertilisation and Embryology Authority to allow researcher Kathy Niakan, PhD, of the Francis Crick Institute to conduct gene editing experiments in early human embryos.

The BBC News and Nature each have good summaries of the science side of the ruling. Greely, who directs Stanford’s Center for Law and the Biosciences, breaks down the ethics. From his post:

This is important research that can only be done with human embryos, it is being done with surplus IVF embryos whose prospective parents agreed to this kind of use, and the researchers are forbidden to to try to produce human gene-edited babies.

Niakan’s experiments, tailored to increase our understanding of the very earliest stages of human development, will allow the modified embryos to develop for only 14 days, or until they consist of just a few hundred cells. She hopes that her findings will shed light on infertility and miscarriage.

Previously: Using CRISPR to investigate pancreatic cancer, CRISPR marches forward: Stanford scientists optimize use in human blood cells and CRISPR critters and CRISPR conundrums
Image by OpenClipartVectors

Autoimmune Disease, Pregnancy, Research, Stanford News, Women's Health

The latest on the pregnancy risks for women with lupus

The latest on the pregnancy risks for women with lupus

2892182827_accf82f274_zWomen with lupus, an autoimmune disorder that can attack a variety of tissues, were once counseled to avoid pregnancy. Now, physicians tailor their advice to each patient’s case. In many instances, however, it’s difficult for physicians to gauge what types of risk their patient might be facing.

A new study designed to clarify those risks found that women with lupus during pregnancy — and even women who may soon be diagnosed with lupus — are more likely to experience preeclampsia, stroke and infection than women without lupus. Infants born to mothers with lupus or pre-lupus are also more likely to be born preterm, have infections, or be small for gestational age, according to the paper, which was published today in Arthritis Care and Research.

“We’ve confirmed previous findings while strengthening the data to show that lupus is associated with a variety of adverse pregnancy outcomes both to the mother, and to the infant,” said senior author Julia Simard, ScD, assistant professor of health research and policy at Stanford.

The research team, which included collaborators in Sweden and at several U.S. universities, examined data from population-based Swedish registers. That data set allowed the researchers to identify patients who had babies several years before being diagnosed with lupus.  From 13,598 single, first-time births, the team identified 551 women with existing lupus and 198 who presented with lupus within five years after giving birth.

For women who have not yet been diagnosed, it’s possible that autoantibodies implicated in the disease may lead to some of the adverse outcomes, but the exact mechanisms remain unknown, Simard said.

She and others are also working to clarify the clinical ramifications of the work, which may help refine physicians’ recommendations and care of pregnant women with lupus, and may lead to earlier diagnoses.

This is a descriptive study, Simard cautioned. Lupus is a challenging condition to study, because it can manifest differently in every patient. As with other chronic diseases, it’s also difficult to distinguish between conditions that could strike anyone, and conditions that might be caused by lupus, she said.

Previously: Empowered is as empowered does: Making a choice about living with lupus, Women and men’s immune system genes operate differently, Stanford study shows Lupus and rheumatoid arthritis may mean fewer children for female patients and Why some autoimmune diseases go into remission during pregnancy
Photo by J.K. Califf

Genetics, Pediatrics, Precision health, Research

New cystic fibrosis screening test developed at Stanford

New cystic fibrosis screening test developed at Stanford

LungsStanford researchers have invented a new technique to detect cystic fibrosis in infants. The test, described in a paper published today in The Journal of Molecular Diagnostics, is more comprehensive, faster and cheaper than current newborn screening methods.

CF, which causes buildup of sticky mucus in the lungs and digestive organs, is the country’s most common fatal genetic disease. Newborn screening for the disease has been conducted in every U.S. state since 2010 and has mostly been a success story: Early diagnosis helps doctors start CF therapy more quickly, which can keep patients healthier longer. With good medical care, such as that provided by the CF experts at Lucile Packard Children’s Hospital Stanford, many people with CF now live into their 40s or beyond.

“Kids who are diagnosed early [with genetic screening tests] do not have a symptom-based diagnosis, so they don’t have to recover from any health insults,” study co-author Iris Schrijver, MD, told me when we discussed the research.

But there are limitations to the current screening tests. One big problem is that they can miss rare mutations in the CF gene, particularly those that prevail in nonwhite populations about whose CF changes scientists have limited knowledge. That’s especially an issue in California, where the 500,000 babies born each year have very diverse heritages. In fact, to help illuminate the problems of older CF tests, Schrijver recently published another study about the difficulty nonwhite CF patients face in receiving timely diagnosis.

In contrast to the current screening tests, the new test will detect virtually all CF-causing mutations in one step, which should make it far easier to find every affected newborn.

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Ask Stanford Med, Pregnancy, Women's Health

A look at hypertension in pregnancy

A look at hypertension in pregnancy

Most people know that hypertension, or high blood pressure, is a common condition. What many might not know is that it’s also one of the most common complications in pregnancy: It is prevalent in 5-10 percent of pregnant women.

In a recent Q&A session, Sandra Tsai, MD, MPH, spoke with BeWell at Stanford about this condition and its effects:

Hypertension in pregnancy — especially the more severe forms (preeclampsia and eclampsia) — increases the risk for complications such as placenta abruption, acute kidney injury, and death. Longer-term, women diagnosed with hypertension in pregnancy are at risk for future cardiometabolic diseases — including hypertension, diabetes, stroke, and heart attacks.

Tsai also delved into ways to prevent hypertension and discussed her own work in this area:

Lifestyle behaviors — such as a healthy diet, regular exercise, starting pregnancy with a normal weight — may reduce, but may not entirely prevent, a woman’s risk for developing hypertension in pregnancy.

I am interested in helping women maintain a healthy weight throughout pregnancy. Women who start their pregnancy with excess weight are at increased risk for gaining more weight than the Institute of Medicine recommends. If these women can remain within the weight gain guidelines, they may be at less risk of developing pregnancy complications such as gestational hypertension and preeclampsia.

Alex Giacomini is a social media intern in the medical school’s Office of Communication and Public Affairs. 

Previously: Attending to signs of preeclampsia in late-stage pregnancy and The importance of knowing your blood pressure level in preventing hypertension

Fertility, Pregnancy, Sexual Health, Women's Health

Fertility quiz: How well do you know your body?

Fertility quiz: How well do you know your body?

2364734203_937bfdfe48_zRemember all the rumors that you heard about sexuality and fertility as a teen (or even a 20-something or a 30-something)? It’s hard to sort fact from fiction.

According to the Institute for Reproductive Health (IRH) at the Georgetown University Medical Center, an accurate understanding of sexuality and fertility is surprisingly low around the world. That’s why IRH has created an online quiz to probe fertility awareness, called “Know Your Bod,” which poses the challenge: “You live with your body everyday. Do you really know it? Find out.”

The online quiz asks ten questions including the true-or-false query, “A woman will get pregnant only if she has sex on the same day she ovulates? ” After you select an answer, the quiz provides a simple educational summary that explains the correct answer. At the end, it shows your score and how you compare to the general population.

The quiz was officially introduced this week at the International Conference on Family Planning in Indonesia. It was developed as part of IRH’s Fertility Awareness for Community Transformation Project, which strives to increase fertility awareness and the use of family planning.

Victoria Jennings, PhD, director of IRH, explained in a recent Georgetown press release:

Accurate understanding and awareness about human fertility is surprisingly low around the world, regardless of age, sex or education level. If we could lift the taboos and improve fertility awareness, would people be informed and empowered to make better sexual and reproductive health decisions? At IRH, we believe the answer to this question is ‘yes.’

So why not take the challenge? How well do you know your bod?

Jennifer Huber, PhD, is a science writer with extensive technical communications experience as an academic research scientist, freelance science journalist, and writing instructor.

Previously:Ask Stanford Med: Expert in reproductive medicine responds to questions on infertilitySex without babies, and visa versa: Stanford panel explores issues surrounding reproductive technologies, and Med students want more sexual-health training
Photo by Scott Maxwell

Global Health, HIV/AIDS, Infectious Disease

Growing resistance to vital HIV drug raises concern

Growing resistance to vital HIV drug raises concern

tablets-193666_1280HIV resistance to the antiviral tenofovir, one of the mainstays of HIV treatment and prevention, is increasingly common following therapy, particularly in low and middle-income countries, according to a new, multi-national study.

“Public health organizations and global funders have been very effective at expanding antiretroviral drug therapy to increasing proportions of patients in need,” said Robert Shafer, MD, professor of medicine and co-author of the work. “This study highlights the need for efforts to ensure that the regimens used to treat HIV retain their effectiveness for as long as possible.”

Researchers studied 1,926 patients in 36 countries who developed virological failure after taking a first-line regimen containing tenofovir. In this group, tenofovir-resistant strains were found in 60 percent of the patients in sub-Saharan Africa, compared with fewer than 30 percent in Europe and North America. Patients most at risk for tenofovir resistance were those who started therapy late in the progression of the disease or who received tenofovir in combination with drugs less commonly used in upper-income countries.

About two-thirds of the patients with tenofovir-resistant strains also had become resistant to the other two drugs in their regimens, suggesting their treatment had become largely ineffective.

Resistance may develop when patients don’t take their medication regularly, although it may also occur in adherent patients on some of the regimens used in the developing world. People carrying resistant strains can pass them along to others, so that HIV resistance could become even more widespread, the researchers note.

“Tenofovir is a critical part of our armamentarium against HIV, so it is extremely concerning to see such a high level of resistance to this drug,” said lead author Ravi Gupta, MD, at University College London. “It is a very potent drug with few side effects, and there aren’t any good alternatives that can be deployed using a public health approach. Tenofovir is used not only to treat HIV but also to prevent it in high-risk groups, so we urgently need to do more to combat the problem of emerging resistance.”

The researchers say the results reinforce the need for increased drug resistance surveillance in both untreated and treated HIV-positive individuals. They are now working to better understand how these resistant viruses develop and spread.

The study, which involved dozens of researchers and institutions, appears today in the journal Lancet Infectious Diseases. It was co-authored by scientists at the London School of Hygiene and Tropical Medicine and funded by the Wellcome Trust.

Previously: Spread of drug-resistant HIV in Africa and Asia is limited, Stanford research finds, HIV study in Kenyan women: Diversity in a single immune-cell type flags likelihood of getting infected and Study: Chimps teach people a thing or two about HIV resistance
Image by bigblockbobber

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