University of Manitoba neurologist wins Barancik Prize for Innovation in MS Research

Dr. Ruth Ann Marrie honored for deepening our understanding of factors that influence multiple sclerosis

Grant and Award Announcement

NATIONAL MULTIPLE SCLEROSIS SOCIETY

 

IMAGE: RUTH ANN MARRIE, MD, PHD, OF THE UNIVERSITY OF MANITOBA, IS THIS YEAR'S WINNER OF THE BARANCIK PRIZE FOR INNOVATION IN MS RESEARCH. HER RESEARCH TAKES A HOLISTIC APPROACH TO UNDERSTAND HOW MS AFFECTS INDIVIDUALS IN THE CONTEXT OF THEIR UNIQUE LIFETIME EXPERIENCES AND EXPOSURES. THESE MAY INCLUDE ADVERSE CHILDHOOD EXPERIENCES, SOCIAL CIRCUMSTANCES, COMORBIDITIES (OTHER DISORDERS ALONG WITH MS), HEALTH BEHAVIORS, AND OTHER FACTORS. UNDERSTANDING HOW DIFFERENT FACTORS IMPACT THE ONSET AND EVOLUTION OF MS MAY OFFER NEW AVENUES FOR PERSONALIZED APPROACHES TO STOPPING MS AND FOR FINDING WAYS TO PREVENT IT. view more 

CREDIT: UNIVERSITY OF MANITOBA

[New York, February 1, 2023] - Ruth Ann Marrie, MD, PhD, a neurologist and researcher at the University of Manitoba, is winner of this year’s Barancik Prize for Innovation in MS Research. The National Multiple Sclerosis Society (U.S.) awarded Marrie for watershed discoveries that deepen the understanding of how and when multiple sclerosis evolves, paving the way to more personalized medicine to stop and even prevent MS.

Marrie is a Professor of Internal Medicine at the Max Rady College of Medicine, University of Manitoba, where she holds the Waugh Family Chair in Multiple Sclerosis. She is also a Professor in the department of Community Health Sciences, and an Adjunct Scientist at the Manitoba Centre for Health Policy at the University of Manitoba.

Marrie’s research takes a holistic approach to understand how MS affects individuals in the context of their unique lifetime experiences and exposures. These may include adverse childhood experiences, social circumstances, comorbidities (other disorders along with MS), health behaviors, and other factors. Understanding how different factors impact the onset and evolution of MS may offer new avenues for personalized approaches to stopping MS and for finding ways to prevent it.

The impact of comorbidities had not been meaningfully explored in MS before Marrie began her work. In 2010, she published the first report suggesting that comorbidities such as diabetes, high blood pressure, heart disease and high cholesterol could increase disability and its progression in people with MS. Her team has since shown that various comorbidities affect all aspects of the MS experience including time to diagnosis, severity of disability at diagnosis, the use of health care, relapse rates and mortality. Her findings have informed treatment guidelines by the American Academy of  Neurology, the Canadian Network of MS Clinics, and the international MS Brain Health group.

Marrie broke new ground in 2012 with the publication of a landmark paper showing that people with MS increased their use of health care (doctor visits) during the five years before their first symptoms of MS occurred. These key findings led to the recognition that MS has a “prodrome,” an early phase of unspecific symptoms indicating a high risk for future diagnosis of MS. Further work to map out the prodrome may enable opportunities to intervene and prevent the development of full-blown MS.

“Dr. Marrie brings her perspective as a neurologist to ask research questions that are very relevant to improving people’s quality of life and providing answers that will increase our ability to stop and even prevent MS in the future,” said Bruce Bebo, Ph.D., Executive Vice President of Research Programs at the National MS Society, which administers the award. “She is also incredibly generous and very effective as a volunteer who provides critical leadership to MS research initiatives on a global scale.”

“It is an honor to receive this award recognizing the contributions of our team, and I am grateful to the Awards Committee and the Barancik Foundation” said Marrie.

Marrie is a coauthor of the Pathways to MS Cures Roadmap, a global collaboration led by the National MS Society that outlines the most promising research to stop MS, restore function, and end MS by prevention. She also played a key role in the National MS Society’s MS Prevalence Initiative, in which leading experts developed a feasible estimate of the number of people living with MS in the U.S. They showed that nearly 1 million people are living with MS in the U.S. – more than twice the previous estimate.

“Dr. Marrie is truly an exceptional clinician scientist whose work in MS research has  demonstrated outstanding innovation and originality,” said Helen Tremlett, PhD, Professor, Division of Neurology, at the University of British Columbia, who nominated Marrie for the Barancik Prize.

Marrie received her undergraduate degree in chemistry and her medical degree from Dalhousie University, both with Distinction. She completed neurology training at McGill University. This was followed by a fellowship in MS at the Cleveland Clinic, supported by a Sylvia Lawry Physician Fellowship Award from the National MS Society. She later obtained a PhD in Epidemiology from Case Western Reserve University. Marrie serves in several leadership roles including Vice Chair of the Scientific Steering Committee for the International Progressive MS Alliance and Scientific Director of the NARCOMS Registry. She is past Chair of the International Advisory Committee on Clinical Trials in MS and former Chair of the Medical Advisory Committee for the MS Society of Canada. Marrie has been named a Fellow of the Canadian Academy of Health Sciences, and is a recipient of the Women’s Executive Network’s Top 100 Most Powerful Women in Canada Award and the Canadian Society for Clinical Investigation Distinguished Scientist Award.

Marrie will be honored and deliver the Prize lecture at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum on February 24, 2023.   

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About the Barancik Prize for Innovation in MS Research The Barancik Prize seeks to recognize and encourage exceptional innovation and originality in scientific research relevant to multiple sclerosis, with emphasis on impact and potential of the research to lead to pathways for the treatment and cure for MS, and scientific accomplishments that merit recognition as a future leader in MS research. The international prize is administered through the National MS Society (U.S.) and made possible by the generosity of the Charles and Margery Barancik Foundation.   

About the National Multiple Sclerosis Society (U.S.) The National MS Society, founded in 1946, funds cutting-edge research, drives change through advocacy, and provides programs and services to help people affected by MS live their best lives. Connect to learn more and get involved: nationalMSsociety.org, Facebook, Twitter, Instagram, YouTube or 1-800-344-4867.   

About Multiple Sclerosis  Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system. There is currently no cure for MS. Symptoms vary from person to person and range from numbness and tingling, to mobility challenges, blindness and paralysis. An estimated 1 million people live with MS in the United States. Most people are diagnosed between the ages of 20 and 50, and it affects women three times more than men. 

Kessler Foundation team to study impact of strategy-based cognitive training on new learning and memory in individuals with multiple sclerosis  

Double-blind randomized clinical trial will assess efficacy of a protocol based on Kessler Foundation Strategy-based Training to Enhance Memory (KF-STEM™)    

Peer-Reviewed Publication

KESSLER FOUNDATION

 

IMAGE: DR. CHIARAVALLOTI IS DIRECTOR OF THE CENTERS FOR NEUROPSYCHOLOGY, NEUROSCIENCE, AND TRAUMATIC BRAIN INJURY RESEARCH AT KESSLER FOUNDATION. view more 

CREDIT: KESSLER FOUNDATION

East Hanover, NJ. February 1, 2023. Despite the prevalence of disabling cognitive deficits in the population with multiple sclerosis (MS), few treatment protocols are supported by Class I research evidence. To address this need, MS researchers at Kessler Foundation plan a double-blind, randomized trial of an 8-session protocol for cognitive rehabilitation based on the Kessler Foundation Strategy-based Training to Enhance Memory (KF-STEM™).

Their open access article, "Kessler Foundation strategy-based training to enhance memory (KF-STEM™): Study protocol for a single-site double-blind randomized clinical trial in multiple sclerosis” (doi: 10.1016/j.conctc.2022.101026) was published online November 3, 2022, in Contemporary Clinical Trials Communications. (https://www.sciencedirect.com/science/article/pii/S2451865422001430. The authors are Nancy D. Chiaravalloti, PhD, Erica Weber, PhD, Ekaterina Dobryakova, PhD, Amanda Botticello, Ph, MPH, Yael Goverover, PhD, Nancy B. Moore, MA, and John DeLuca, PhD, of Kessler Foundation.

The team plans to enroll 120 individuals with MS-related impairments in new learning and memory. All will undergo neuropsychological evaluation (for objective cognitive performance), assessment of global functioning (to assess everyday functioning and quality of life), functional magnetic resonance imaging (to examine impact of treatment on patterns of cerebral activation). Longer term efficacy will be assessed by 6-month follow up, and whether booster sessions can maintain efficacy over time.

Cognitive deficits often have a negative impact on the lives of persons with MS, according to Dr. Chiaravalloti, director of the Centers for Neuropsychology, Neuroscience, and Traumatic Brain Injury Research. “Treating these deficits can improve how they function in their everyday lives, at home, at work, and in their communities. Through this rigorously designed trial, we plan to complete the bench-to-bedside translation of our scientific research and maximize its real-world benefits for individuals living with MS.”

This research was supported by National Institutes of Health (1R01HD095915).

About Kessler Foundation

Kessler Foundation, a major nonprofit organization in the field of disability, is a global leader in rehabilitation research that seeks to improve cognition, mobility, and long-term outcomes, including employment, for people with neurological disabilities caused by diseases and injuries of the brain and spinal cord. Kessler Foundation leads the nation in funding innovative programs that expand opportunities for employment for people with disabilities. For more information, visit KesslerFoundation.org.

Stay Connected

Twitter | http://Twitter.com/KesslerFdn 
Facebook | http://Facebook.com/KesslerFoundation 
YouTube | http://Youtube.com/user/KesslerFoundation 
Instagram | http://Instagram.com/kesslerfdn

iTunes & SoundCloud | http://Soundcloud.com/kesslerfoundation

To interview an expert, contact:

Deborah Hauss, DHauss@kesslerfoundation.org;

Carolann Murphy,  CMurphy@KesslerFoundation.org.

Graphic: Nancy D. Chiaravallotti, PhD

Caption: Dr. Chiaravalloti is director of the Centers for Neuropsychology, Neuroscience, and Traumatic Brain Injury Research at Kessler Foundation.

 

 

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JOURNAL

Contemporary Clinical Trials Communications

DOI

10.1016/j.conctc.2022.101026 

METHOD OF RESEARCH

Randomized controlled/clinical trial

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Kessler Foundation strategy-based training to enhance memory (KF-STEM):Study protocol for a single-site double-blind randomized clinical trial in multiple sclerosis

Academic medical centers are linked to better health outcomes at neighboring hospitals, researchers find

Patients treated at non-teaching hospitals had lower mortality in markets with academic medical centers

Peer-Reviewed Publication

BETH ISRAEL DEACONESS MEDICAL CENTER

BOSTON – An academic medical center (AMC), sometimes called a teaching hospital, is a hospital that is integrated with a medical school and that serves as the principal site for the education of medical students and trainees. Many studies provide evidence that AMCs in general have better patient outcomes than non-teaching or community hospitals. However, how the presence of AMCs may affect their neighboring community hospitals has been unknown.  

A new study led by researcher-clinicians at Beth Israel Deaconess Medical Center (BIDMC) suggests that the presence of academic medical centers within a healthcare market is linked to better outcomes for patients treated at nearby community hospitals. Findings published in JAMA Network Open show that receiving care at a non-AMC hospital in a market with AMC presence was associated with lower mortality and a greater number of healthy days at home. These associations were greatest in markets with the highest AMC presence, indicating that AMCs may have a positive impact on outcomes for patients treated at neighboring non-teaching hospitals. 

“To our knowledge, this is the first study to systematically examine the potential indirect clinical benefits of receiving healthcare at a non-teaching hospital with greater proximity to one or more AMCs across a wide range of conditions,” said lead author Laura G. Burke, MD, MPH, an emergency medicine physician at BIDMC. “Identifying strategies by which AMCs may enhance care for patients in the entire region has the potential to improve health outcomes for underserved populations.”   

In their retrospective cohort study of older Medicare beneficiaries who received care from U.S. acute care hospitals from 2015 to 2017, Burke and colleagues looked at more than 22 million total hospitalizations. Nearly 19 million of these, or nearly 84 percent, were at non-teaching hospitals. They calculated mortality within 30 and 90 days of an inpatient stay. They also calculated patients’ healthy days at home during the follow-up period, defined as the number of days during which the patient was not at an inpatient or long-term facility, outpatient emergency department or deceased. 

Next, the team created four healthcare market categories. In a market with no AMC presence, zero patients who were admitted to a hospital were admitted to an AMC. In a market with low AMC presence, up to 20 percent of patients admitted the hospital went to an AMC. In moderate AMC regions, AMCs managed 20-35 percent of cases; and in high AMC markets, more than 35 percent of hospitalized patients were admitted to AMCs.  

Burke and colleagues saw stark disparities in the demographic characteristics of the overall populations residing in the four markets, with those with no AMC presence having the lowest median income, lowest mean population, highest mean poverty rate, and highest proportion of white residents. Before accounting for the negative impact poverty and other regional characteristics can have on health, the scientists saw significant association with lower mortality for treatment in markets with high and low AMC presence compared to markets with no AMC presence.  

However, when Burke and colleagues adjusted their model for patient characteristics and demographic factors, the association strengthened. Patients hospitalized at non-AMCs had lower 30- and 90-day mortality and more healthy days at home at 30 and 90 days when they received care in markets with greater AMC presence.  

By contrast the team found no relationship between market-level AMC presence and outcomes for patients treated at the AMC themselves; that is, the presence of more AMCs in a given market did not impact outcomes for patients of AMCs.   

“Taken together these results suggest a spillover effect of AMC's on outcomes for neighboring community hospitals and that the benefits of AMC for the broader community may be greater than is traditionally recognized,” said Burke, who is also an instructor in the department of Health Policy and Management at Harvard T. H. Chan School of Public Health. 

Burke and colleagues speculate that AMCs may have a positive impact on neighboring community hospitals in a few different ways. Given that physicians tend to practice in close geographic proximity to where they trained, it is possible that the presence of an AMC may lead to a more robust physician supply. Indeed, Burke and colleagues’ analysis revealed that markets with the greatest AMC presence have more nurses and physicians per capita. 

Similarly, formal and informal affiliations between AMCs and non-AMCs within the same market may encourage diffusion of knowledge, innovation as well as sharing of best practices and even clinicians who work at multiple sites. Perhaps most obviously, patients admitted to community hospitals in regions with greater AMC availability may be more likely to be transferred to a teaching hospital should their conditions warrant tertiary care. 

“This study extends prior work examining the role of AMCs in driving acute care outcomes,” said Burke, who is also an assistant professor of emergency medicine at Harvard Medical School. “The findings are consistent with other studies demonstrating geographic disparities in healthcare access, and highlights the degree to which rural regions have less access to AMC services. The presence of AMCs may enhance care for patients in rural and remote locations and further research may identify strategies that have the potential to improve health outcomes for underserved populations and widen the reach of the nation's academic healthcare institutions.” 

Co-authors included Ryan C. Burke, PhD, MPH of BIDMC; E. John Orav, PhD, of Brigham and Women’s Hospital; Jose Figueroa, MD, MPH and Ciara E. Duggan of Harvard T.H. Chan School of Public Health; and Ashish K. Jha, MD, MPH of Brown University School of Public Health.  

This work was supported by a grant from the Association of American Medical Colleges and the National Institutes of Health (R56AG075017). Burke reported serving as a consultant for the Emergency Medicine Policy Institute outside the submitted work.  Figueroa reported receiving grants from Commonwealth Fund, National Institute on Aging, Episcopal Health Foundation and Arnold Ventures foundation outside the submitted work. This manuscript was written prior to Jha’s government service. The views and opinions expressed are those of the authors and are not made on behalf of the federal government.  
 

About Beth Israel Deaconess Medical Center 

Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School and consistently ranks as a national leader among independent hospitals in National Institutes of Health funding. BIDMC is the official hospital of the Boston Red Sox. 

Beth Israel Deaconess Medical Center is a part of Beth Israel Lahey Health, a health care system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, more than 4,800 physicians and 36,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education. 

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JOURNAL

JAMA Network Open

DOI

10.1001/jamanetworkopen.2022.54559 

ARTICLE TITLE

Association of Academic Medical Center Presence With Clinical Outcomes at Neighboring Community Hospitals Among Medicare Beneficiaries

ARTICLE PUBLICATION DATE

1-Feb-2023

Pro-cannabis social media linked to youths’ intentions to use

Peer-Reviewed Publication

WASHINGTON STATE UNIVERSITY

PULLMAN, Wash. – Despite laws against advertising cannabis to teens, young people reported in surveys that they still see a lot of positive cannabis messages through social media posts. 

Washington State University researchers found these messages were also connected to the teens’ intentions to use cannabis, and for college students, with their actual use. Anti-cannabis messages also had an effect in lessening use-intentions, but young people saw less of those types of messages.

“Youth, in particular, have really grown up bombarded with cannabis information compared to previous generations,” said Jessica Willoughby, first author on the study published in the journal Health Communication and an associate professor in WSU’s Murrow College of Communication. “We found that they were seeing more positive messages about using cannabis and a lot less about the risks.”

For this study, the researchers surveyed 350 teens and 966 college students from across Washington state, where recreational marijuana has been legal since 2012.

The state does have regulations aimed at preventing advertising cannabis to minors, such as prohibiting the use of cartoons or youth-oriented celebrities. This does not prevent individuals from posting about cannabis on social media, however.

Of the study participants, the vast majority, over 80%, reported seeing pro-cannabis messages on social media, such as posts about being high or claims that marijuana is harmless. The pro-cannabis messages most often encountered were those from celebrities or lyrics in songs.

“Parents might not understand that if their kid is using a social media site—whether it’s Twitter, YouTube, Instagram, Facebook or Snapchat —they are going to see cannabis messages. That's just the reality,” said co-author Stacey Hust, a professor at WSU’s Murrow College of Communication. “This means we need to be getting training into schools at much younger ages. At the very least middle school and high school health classes need to talk about cannabis and how it can be harmful to the developing brain.”

The study participants also reported seeing some anti-cannabis messages, such as that cannabis can cause harm or that smoking it is gross or for losers, but they saw these types of messages less often than pro-cannabis ones.

The youth, both teens and college students, who reported seeing higher levels of positive messages were more likely to indicate an intention to use cannabis. The college students were also asked about actual use and there was a positive connection between exposure to pro-cannabis posts and use for that group.

The good news is that seeing the anti-cannabis messages had some effect, although indirectly. Among the youth who already held beliefs that cannabis use could cause negative outcomes, such as damaging their brain or doing worse in school, seeing anti-cannabis messages appeared to lower their intentions to use.

The researchers said this finding indicates a good area for parents and counselors to target.

“Prevention efforts can have an impact,” said Willoughby. “Since youth are seeing more of that positive cannabis content, it's worthwhile to put out more content highlighting the risks, especially to the young people like them.”

This study received partial funding through Washington state’s initiative measure 502 which taxes production processing and wholesale retail sales of marijuana.  

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DOI

10.1080/10410236.2022.2162707 

ARTICLE TITLE

Exposure to Pro and Anti-Cannabis Social Media Messages and Teens’ and College Students’ Intentions to Use Cannabis

Medical cannabis for chronic pain may help patients on long-term opioid treatment reduce dosages

Peer-Reviewed Publication

CUNY GRADUATE SCHOOL OF PUBLIC HEALTH AND HEALTH POLICY

New York, NY | January 30, 2023 — A new study from New York State and CUNY researchers suggests that receiving medical cannabis for thirty days or more may help patients on long-term opioid treatment to lower their dose over time.

The study, published today in the Journal of the American Medical Association (JAMA) Network Open, found an association between receiving medical cannabis for chronic pain for a longer duration and a reduction in prescription opioid dosages among patients on long-term opioid therapy. Patients who were on higher baseline dosages of prescription opioids when they started receiving medical cannabis experienced larger reductions in opioid dosages.  

These findings leverage existing population-level data to contribute robust evidence for clinicians regarding the potential clinical benefits of medical cannabis in reducing the opioid burden for long-term opioid therapy patients, and possibly reducing their risk for use of illicit substances and overdose. The findings could further inform policies in other jurisdictions, where medical cannabis is not yet legalized.

Researchers from the CUNY Graduate School of Public Health and Health Policy (CUNY SPH), the New York State Department of Health, and the New York State Office of Cannabis Management used a combination of two large state databases to analyze data from eight thousand adult New Yorkers during 2017-2019. They evaluated prescription opioid dosages of participants during the 12 months prior to receipt of medical cannabis and up to eight months later. For each month of the study, the researchers compared the average daily morphine milligram equivalent (MME) for those who received medical cannabis for more than 30 days vs. those who received 30 days or less. The following results were observed eight months after patients started receiving medical cannabis:

• Among patients with the lowest MME (less than 50 MME), the average daily MME at the end of the follow-up period for patients with longer medical cannabis duration was reduced 48% from baseline. In contrast, there was a 4% reduction from baseline for patients with shorter medical cannabis duration. This resulted in a total MME net reduction of -14.53 (range, -17.45 to -11.61) over eight months for patients receiving medical cannabis for a longer duration.
• Among patients with a baseline MME of 50 to 89, the average daily MME at the end of the follow-up period for patients with longer medical cannabis duration showed a 47% reduction from baseline versus 9% reduction for patients with a shorter medical cannabis duration. This resulted in a total MME net reduction of -29.49 (range, -35.94 to -23.04) over eight months for patients receiving medical cannabis for a longer duration.
• For adults with a baseline MME at 90 or greater, by the end of the follow-up period, the daily MME for patients with longer medical cannabis duration, there was a 51% reduction from baseline versus 14% reduction for patients with shorter medical cannabis duration. This resulted in the largest MME net reduction of -69.81 (range, -87.09 to -52.53) over eight months for patients receiving longer medical cannabis duration.

"This study found meaningful reductions among patients receiving medical cannabis for longer duration,” said lead author Dr. Trang Nguyen of the Department of Health. “Patients’ daily opioid dosages were reduced by 47%-51% of the baseline dosages after eight months. In contrast, patients receiving medical cannabis for a shorter duration reduced their initial dosages by just 4%-14%."

“These findings have important implications for clinicians and policy makers,” said co-author Dr. Danielle Greene of CUNY SPH. “They provide evidence for another tool to be used in response to the opioid epidemic. Changes in attitudes and policies toward opioid prescribing over the past decade have left some patients dependent on long-term high dosage prescriptions but fewer providers willing to write these prescriptions. Previous research has shown that abrupt disruption in opioid prescriptions among patients on high dosages and long-term opioid therapy can lead to patients’ use of illicit drugs, overdose, and self-harm. Our study suggests a more humane option for achieving lower prescription dosages and potentially reducing those risks. Equitable implementation of these findings will require addressing disparities in both access to medical cannabis due to high cost and the high rate of patients receiving long-term opioid therapy in Medicaid and other programs.”

“Since the inception of the Medical Cannabis Program in New York State, we’ve heard anecdotal evidence from patients, caregivers and health care providers suggesting that medical cannabis can reduce the amount of opioids patients take to manage pain – and now we have the study demonstrating a statistically significant reduction for those patients who were on medical cannabis for a longer duration,” said co-author Nicole Quackenbush of the NYS Office of Cannabis Management. “Research is critical to further our knowledge of the potential risks and benefits of cannabis and the OCM will be continuing efforts to promote cannabis knowledge and research in New York State.”  

Nguyen T, Li Y, Greene D, Stancliff S, Quackenbush N. Changes in Prescribed Opioid Dosages Among Patients Receiving Medical Cannabis for Chronic Pain, New York State, 2017-2019. JAMA Netw Open. 2023;6(1):e2254573. doi:10.1001/jamanetworkopen.2022.54573

For media inquiries, contact:
Ariana Costakes
Communications Editorial Manager
ariana.costakes@sph.cuny.edu 

About CUNY SPH

The CUNY Graduate School of Public Health and Health Policy (CUNY SPH) is committed to promoting and sustaining healthier populations in New York City and around the world through excellence in education, research and service in public health and by advocating for sound policy and practice to advance social justice and improve health outcomes for all. sph.cuny.edu

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JOURNAL

JAMA Network Open

DOI

10.1001/jamanetworkopen.2022.54573 

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Changes in Prescribed Opioid Dosages Among Patients Receiving Medical Cannabis for Chronic Pain, New York State, 2017-2019

ARTICLE PUBLICATION DATE

30-Jan-2023

Smart contact lens that diagnoses and treats glaucoma

Peer-Reviewed Publication

POHANG UNIVERSITY OF SCIENCE & TECHNOLOGY (POSTECH)

 

IMAGE: SCHEMATIC ILLUSTRATION OF A THERANOSTIC SMART CONTACT LENS FOR GLAUCOMA TREATMENT. view more 

CREDIT: POSTECH

Glaucoma is a common ocular disease in which the optic nerve malfunctions due to the increased intraocular pressure (IOP) caused by drainage canal blocking in the eye. This condition narrows the peripheral vision and can lead to vision loss in severe cases. Glaucoma patients have to manage IOP levels for their life-time. Automatic monitoring and control of the IOP in these patients would significantly improve their quality of life.

 

Recently, a research team at POSTECH has developed a smart contact lens by combining an IOP sensor and a flexible drug delivery system to manage IOP measurement and medication administration.

 

A POSTECH research  team led by Professor Sei Kwang Hahn and Dr. Tae Yeon Kim (Department of Materials Science and Engineering) has  developed a wireless theranostic smart contact lens for monitoring and control of intraocular pressure in glaucoma. Their findings were recently published in Nature Communications.

 

The IOP sensors currently available for glaucoma patients do not have the function to administer the appropriate amount of drug in response to the IOP levels.

 

The smart contact lens developed by the research team has an IOP sensor that uses hollow nanowires made of gold. It is integrated with a flexible drug delivery system, wireless power and communication system, and an application-specific integrated circuit chip for both monitoring and control of IOP in glaucoma. Notably, the IOP sensor has exhibited high sensitivity to ocular strain, excellent chemical stability, and biocompatibility. Furthermore, the flexible drug delivery system can provide the on-demand delivery of timolol for IOP control.

 

The researchers successfully demonstrated that the theranostic smart contact lens enabled the IOP measurement in real-time and the appropriate amount of drug release to match the degree of IOP in rabbits with glaucoma.

 

The new smart contact lens is expected to make possible a personalized glaucoma treatment with maximum efficacy and minimal side effects. In addition, the feedback system would be applicable to various wearable devices other than smart contact lenses as well.

 

Professor Hahn who led this study commented, "We hope the early commercialization of the newly developed theranostic smart contact lens for diagnosing and treating glaucoma intraocular pressure to provide glaucoma patients’ compliance.”

 

This study was supported by the Basic Science Research Program, the Korea Medical Device Development Fund grant, BRIDGE Research Program, and Bio & Medical Technology Development Program of the National Research Foundation (NRF) funded by the Ministry of Science and ICT, Korea.

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JOURNAL

Nature Communications

DOI

10.1038/s41467-022-34597-8 

ARTICLE TITLE

Wireless theranostic smart contact lens for monitoring and control of intraocular pressure in glaucoma

Save the Nautilus! Three new species described from the Coral Sea and South Pacific

Peer-Reviewed Publication

PENSOFT PUBLISHERS

 

IMAGE: NAUTILUS SAMOAENSIS view more 

CREDIT: BARORD ET AL.

Nautiloids were once quite plentiful throughout the oceans, based upon the fossil record. Today, they are represented by just a handful of species, including the newly described Nautilus vitiensis of Fiji, Nautilus samoaensis of American Samoa, and Nautilus vanuatuensis of Vanuatu. These descriptions highlight the concept of allopatric speciation, or biogeographic isolation, where populations are geographically separated from other populations, resulting in a barrier to gene flow. Over time, these populations may eventually evolve into distinct species.

But what does it take to be able to collect the evidence needed to determine if three different populations of nautiluses are, in fact, three different species?

“For me, this is the best/worst part of the overall process, because nautilus fishing is not easy,” explains Dr Gregory Barord, marine biology instructor at Central Campus and conservation biologist at the conservation organization Save the Nautilus. “For our team, it starts with building large, steel traps that are about a meter cubed. Then, we wrap the steel frame (ouch), with chicken wire (ouch) mesh (ouch), create an entry hole (ouch), attach it to a surface buoy with about 300 meters of fishing line, and bait it with (ouch) raw meat, usually chicken!”

“Trap construction may take place on a nice beach or a bit inland in the rain or in a warm warehouse. Wherever it takes place, you will have some memories, I mean little scars, on your hands from working with the chicken wire. Looking down at my hands right now, I can remember where I was by looking at each of those scars… worth it!”

Tossing the traps into the sea at dusk is the easy part, Dr Barord says. Load them on the boat, find the right depth, and tip them over the side of the boat. “The hard part is retrieving the traps the next day, after about 12 hours of the raw chicken scent moving through the currents. There are a number of methods we’ve used to pull the traps up, from mechanical winches, hand-powered winches, float systems, boat pulls, and of course, just pulling with one hand at a time. Invariably, something happens in each location where we are just pulling the trap up from 300 meters one meter at a time, which takes a good half hour at least. But, at least you are getting a VERY good work-out. Eventually, you see the trap and these white little orbs in it and you know you’ve caught some nautiluses and the pulling is almost done, for now.”

The next step is probably Dr Barord’s favorite: “One of us jumps in the water and free dives about 5 meters to carefully (ouch, that chicken wire) reach for the nautiluses in the trap and bring them to the surface. You are face to face with these uniquely, misunderstood organisms who seem like this is just another day for them. For me, this is exhilarating!”

Once on the boat, they are placed in chilled seawater and from then on, the data collection happens fast. “With the living organism in hand, you can start to glean even more of the differences between the species, examining the hood ornaments, or lack thereof,” Dr Barord explains. After some photos, measurements, and non-lethal tissue samples, the nautiluses are released and burped.

“Maybe nautilus burping is my favorite part,” he adds. To do this, the researchers either dive with SCUBA or free dive with the nautiluses, and ensure there are no air bubbles trapped in the shell that may cause them to be positively buoyant. “Imagine, you have one nautilus in each hand and you start swimming down, your feet and the nautilus tentacles pointed toward the surface. At a sufficient depth, you release them and observe their buoyancy. As the nautiluses compose themselves and jet back down to their nektobenthic habitat 300 meters below, you realize you may never see that individual nautilus again, and that nautilus may never see another human, well, maybe they will…”

For him, the impetus for a publication in the scientific journal ZooKeys describing the three new species is rooted in nautilus conservation efforts. Over the last 20 years, he has studied nautiluses from many angles and for over 10 years now, has worked with an international team to address nautilus conservation issues.

“For many nautiluses, probably millions, they were caught in much the same way that our team collected nautiluses,” he points out. “However, their first meeting with humans was their last as they were pulled from the trap, ripped from their protective shell, and tossed back in the ocean, used as bait, or, rarely, consumed. The shell is the attractive piece for shell traders and the living body has no value. It is like shark finning in that sense.”

As a direct result of these unregulated fisheries, populations of nautiluses have crashed, some have reportedly gone extinct, and international and country level legislation and regulations has been enacted.

Currently, there are no known fisheries in Fiji, American Samoa, or Vanuatu so the risk of these populations decreasing from fisheries is low, at the moment. Now, what is the risk to these same populations from ocean acidification, increased sedimentation, eutrophication, warming seas, and over-fishing of other species connected to the ecosystem nautiluses reside in?

“Right now, we simply do not know,” says Dr Barord. “Our conservation efforts started with simply counting how many nautiluses were left in different areas across the Indo-Pacific, then recording them in their natural habitat, then tracking their migrations, and now describing new species. There are still many questions to address regarding where they lay eggs, what they eat, and how they behave.”

All nautiluses have long been grouped together when describing their natural history, but as we continue to uncover the nautilus story, it is increasingly obvious that each population of nautiluses is different, as exemplified by these three new species descriptions.

“This is certainly an exciting time for nautilus research, as we uncover more and more information about the secret life of nautiluses,” Dr Barord says in conclusion.

“I just hope that this is also an exciting time for nautiluses as well, and they continue doing their nautilus thing as they have done for millions of years.”

Nautilus vanuatuensis

Nautilus vitiensis

Lateral view of Nautilus samoaensis

 

Lateral view of Nautilus vanuatuensis

Lateral view of Nautilus vitiensis

A nautilus trap in the water with nautiluses in it.

CREDIT

Gregory Barord

Research article:

Barord GJ, Combosch DJ, Giribet G, Landman N, Lemer S, Veloso J, Ward PD (2023) Three new species of Nautilus Linnaeus, 1758 (Mollusca, Cephalopoda) from the Coral Sea and South Pacific. ZooKeys 1143: 51-69. https://doi.org/10.3897/zookeys.1143.84427

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JOURNAL

ZooKeys

DOI

10.3897/zookeys.1143.84427 

ARTICLE TITLE

Three new species of Nautilus Linnaeus, 1758 (Mollusca, Cephalopoda) from the Coral Sea and South Pacific

ARTICLE PUBLICATIO

Shining a light on the biological origins of PTSD

A Tufts-led team finds a brain marker that indicates vulnerability to developing post-traumatic stress disorder

Peer-Reviewed Publication

TUFTS UNIVERSITY

By Taylor McNeil, Tufts Now

Understanding one’s susceptibility to developing post-traumatic stress disorder (PTSD) is important. If you knew you were at risk, for example, you might steer clear of jobs that carry more likelihood of high stress and potential trauma or seek treatment as soon as you experienced a potentially triggering event.

Now a research team has found a marker that indicates vulnerability to the disorder. They discovered that heightened activation in one particular brain region in response to seeing surprised and neutral facial expressions appears to be tied to developing PTSD.

A number of symptoms define PTSD, but the researchers were particularly interested in hypervigilance—“always feeling that you need to monitor your environment for potential threats,” says Cecilia Hinojosa, AG21, who was first author on the research paper in the Journal of Psychiatric Research and is now a postdoctoral researcher at Emory University, focusing on PTSD in women.

Previous research had found that hypervigilance may lead people with PTSD to respond with fear to signals that are ambiguous or not clearly threatening—for example, hearing a firecracker might trigger fears of gunshots.

The team, led by Tufts researchers, studied male identical twin pairs using fMRI studies of brain activation. By studying identical twins, who share the same genes, the researchers could show which traits are familial and which are not.

In a set of 12 identical twin pairs one twin had experienced trauma and developed PTSD, while the other was not trauma-exposed. A set of 15 identical twin pairs were used as a control group. One member of that twin set had experienced trauma but not developed PTSD, and the other was not exposed to trauma.

While reactions of people with PTSD to trauma-related imagery have been studied, no one had previously examined their responses to ambiguous imagery while doing brain activation scans. The research team focused on two brain mechanisms.

Mechanisms of PTSD

The first was heightened activation of the amygdala, a part of the brain that is involved in processing fear-related stimuli, resulting in the fight, flight, or freeze response.

“Every time we experience something that could be potentially threatening in our environment, the amygdala starts a chain of reaction of responses in the brain,” says Hinojosa, who as a graduate student worked on the study with Lisa Shin, a Tufts professor of psychology and an expert on PTSD.

The second mechanism is activation of the medial frontal gyrus, a part of the prefrontal cortex involved in inhibiting the amygdala’s response to things that are in fact not threatening.

The study, which involved researchers from Tufts, MGH, Duke, and the National Institutes of Health, sought to find out whether people have preexisting brain activation patterns that make them more susceptible to PTSD, or if they acquire that activation pattern because they have PTSD.

While the researchers were expecting the men who had PTSD to show greater activation of the amygdala when observing faces with surprised looks, they hadn’t expected that the participants would have the same response to neutral facial expressions. Tellingly, the same was true in the participants’ trauma-unexposed twins who didn’t have PTSD.

On the other hand, the group who had experienced trauma but not been diagnosed with PTSD did not show the same heightened amygdala response to either the surprised or neutral faces.

These findings may mean that that individuals who have greater amygdala activation before experiencing trauma may be more vulnerable to developing PTSD, Hinojosa notes.

The findings may also imply that if a person shows preexisting vulnerability to developing PTSD—through heightened amygdala activation—and experiences a traumatic event, “we could potentially provide them with treatments as soon as they experience that trauma to hopefully prevent the development of PTSD symptoms,” Hinojosa says.

A final takeaway from the study is that the decreased reactivity in the medial frontal gyrus, which tamps down an excessive fear response, occurred only in the group with PTSD. This suggests that the lowered response in the prefrontal cortex “is an acquired characteristic of PTSD,” says Hinojosa, who earned a Ph.D. in experimental psychology.

She pointed to studies of non-human animals, which suggest that chronic stress or traumatic events are neurotoxic. Stress and trauma “could be harming this region of the brain, so it doesn’t work as well,” she says.

For next steps, Hinojosa says, the study would need to be replicated with larger sample sizes and expand beyond the male-only subjects in the current study.

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JOURNAL

Journal of Psychiatric Research

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Exaggerated amygdala activation to ambiguous facial expressions is a familial vulnerability factor for posttraumatic stress disorder