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In the Lab

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Dr. Paul R.G. Cunningham
Doug Boyd
Crystal Baity
Marion Blackburn
Amy Ellis
Karen Shugart
Mimosa Mallernee Hines
Cliff Hollis
Dawn Robinson
Debbie Creech
Doug Boyd
Susan Cook
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Sensor helps achieve better glucose control

An insulin pump with a sensor can help adults and children with diabetes better manage their blood-sugar levels, according to research conducted at 30 trial sites, including East Carolina University.

The significant decrease in A1C levels observed in the study, called STAR 3, for Sensor-Augmented Pump Therapy for A1C Reduction, occurred without an increase in the rate of hypoglycemia, or low glucose.


Diabetes educator Savanna Martin talks with
patient Joe White during a July clinic visit.

A1C testing is a way to measure blood-glucose levels. In people with poorly controlled diabetes, A1C levels are much higher than in healthy people. The study compared use of the sensor-augmented pump to the traditional method of multiple daily insulin injections.

Dr. Robert Tanenberg, a professor and diabetes specialist at the Brody School of Medicine and a principal investigator of the trial, said the sensor measures tissue glucose levels every five minutes and protects patients from having their blood-sugar levels dropping without them knowing it. That compares to patients who must prick their fingers to measure blood-sugar levels several times a day.

"If you had a sensor, you could probably carry on your life pretty easily," Tanenberg said. "The beauty of the sensor is it monitors blood sugar and shows a trend." Eleven ECU diabetes patients were enrolled in the 18-month study.

Joe White, a probation officer from Pinetops, was one of those patients. He enrolled in the study after a camping trip where he woke in a sweat in the middle of the night then passed out from low blood sugar. Fortunately, his 8-year-old son was camping with him and heard him rummaging for clothes before passing out. He got help, and White was taken to a hospital.



"I wasn't a big fan of the pump," he said. "I was just used to taking injections, and felt I was doing OK with that."

Adult participants saw a 1 percentage point reduction in their A1C levels. Every percentage point drop in A1C blood test results can reduce the risk of complications by 40 percent. Uncontrolled glucose levels in patients with diabetes can lead to short- and long-term complications, including shakiness, confusion, fainting, blindness, kidney failure, limb amputation and, in rare cases, death.

Among children, nearly 44 percent of patients using sensor-augmented insulin pump therapy achieved glucose control targets, compared to 20 percent of patients in the multiple daily injection group.

The study also showed patients on sensor-augmented insulin pump therapy achieved a reduction in mean A1C levels that was four times greater than the multiple daily injection group. The mean A1C decrease was to 7.5 percent in the sensor-augmented pump therapy group, compared to only 8.1 percent in the daily injection group.

Pumps have been used for years by some diabetes patients, but until recently they did not have sensors and required finger-sticks to measure glucose levels. Tanenberg hopes the study results will help convince insurance companies to fund the devices for patients with type 1 diabetes.

Study results were presented June 29 at the American Diabetes Association meeting in Orlando, Fla. The study was sponsored by the medical device maker Medtronic and conducted at sites in the United States and Canada with participation from 485 patients ranging in age from 7 to 70.

Cancer drug enters clinical trials

A potential treatment for many ovarian, breast, cervical and other cancers has entered clinical testing.



The treatment, a collaboration between ImmunoGen and Sanofi-aventis uses an antibody created by Dr. Anne Kellogg, an associate professor of pathology and laboratory medicine at the Brody School of Medicine.

The antibody seeks out and attaches to cancer cells and serves as a delivery vehicle for ImmunoGen's Targeted Antibody Payload technology to attack the cancer cells with a potent cell-killing agent. Once inside, the cell-killing agent activates and kills the tumor cell as it divides. The technology allows the use of precise amounts of powerful cancer-killing drugs while minimizing side-effects.

Kellogg is happy the drug has made it this far and cautiously optimistic about the future.

"You always hope some of the work you do in your research lab will have some positive benefit for people," Kellogg said. "There's still a lot of years in terms of testing in patients."

Project takes on heart disease in 'stroke belt'

A new $10 million grant will help researchers at East Carolina University and the University of North Carolina at Chapel Hill collaborate with health-care practitioners and community leaders in Lenoir County to tackle heart disease, the county's leading cause of death.



The UNC-ECU project aims to better understand the causes of cardiovascular health disparities and test innovative solutions. It is one of 10 Centers for Population Health and Health Disparities funded by a five-year grant from the National Heart, Lung and Blood Institute. The 10 centers are also supported by the National Cancer Institute and the Office of Behavioral and Social Science Research.

Lenoir County is on the "buckle" of the "stroke belt," a name given to a region of the southeastern United States recognized by public health authorities for its high incidence of stroke and other forms of cardiovascular disease. The county's hypertension and cardiovascular disease rates are among the highest in the country, and many residents lack access to adequate medical care or opportunities that promote good health.

The project will be based at the UNC Center for Health Promotion and Disease Prevention. The ECU team is led by Dr. Doyle M. Cummings, a pharmacist and professor of family medicine, and Dr. Stephanie Jilcott, assistant professor of public health.



The research will help determine genetic factors associated with cardiovascular disease risk and how clinical and public health communities can more effectively work together to reduce people's risk of heart disease through medication, diet and physical activity. The project will also offer an intensive weight loss intervention for participants who are overweight.

The study will also include a partnership with a non-profit call center adding lifestyle and medication adherence coaching to its focus on jobs, employment and benefits counseling. The project will explore opportunities to create jobs while promoting health, including local food production and distribution systems in Lenoir County.

The project is guided by a community advisory committee, and researchers will work with local decision-makers to implement policy and environmental changes to sustain long-term health improvements. The committee was scheduled to have its first meeting in September. Cummings said local physicians have agreed to work with the group to improve hypertension management in their patients.

Researchers increase external funding

Faculty members at the Brody School of Medicine increased their external funding in fiscal year 2009-2010.

During the 12-month period that ended June 30, research, clinical trials and service contracts brought in slightly more than $25 million, about $1.2 million more than the previous fiscal year.

A total of 182 grants and contracts were funded, down from 195 the previous year, according to figures provided by the school's Office of Research and Graduate Studies.

Nearly 51 percent of the dollars went to service, such as patient care, while the reminder went to basic science investigations, clinical research and clinical trials of devices, medicines and procedures.

Campuswide, ECU totaled nearly $48.7 million in external research dollars from July 1, 2009-June 30 of this year, down from the previous year, according to the ECU Division of Research and Graduate Studies.

Effects of 2008 eastern North Carolina wildfire studied

When Dr. Wayne Cascio stepped outside his home one day in June 2008, he saw smoke and a research opportunity.



Cascio quickly alerted his colleagues at the Environmental Protection Agency: were they interested in an immediate opportunity to evaluate the public health impact of a wildfire in a non-urban area?

They were. So began an ongoing study of the effects of a wildfire that ultimately consumed more than 40,000 acres in Hyde, Washington and Tyrrell counties. Cascio, working with agencies including the EPA and the National Oceanic and Atmospheric Administration, has documented the wildfire's impact on eastern North Carolina and beyond.

The EPA used techniques including geostationary satellite imaging provided by NOAA identified the smoke's location and density and estimated the concentration of particles in the air. ECU and Cascio accessed health information from the N.C. Disease Event Tracking and Epidemiologic Collection Tool, a statewide surveillance system that emerged after the Sept. 11 terrorist attacks.

"With that information, my colleagues at the EPA were able to get data from N.C. DETECT and relate heart and respiratory complaints to these exposures," Cascio said.

They found the wildfire coincided with an increase in health problems — some immediately, as in asthma, and some days later, such as heart failure. They also found that poorer counties tended to be disproportionately affected and that the housing in those counties tended to be older, and therefore, more porous and less likely to be air-conditioned.

"There's a social and environmental justice aspect to this work," Cascio said.

Partnering with University Health Systems of Eastern Carolina, researchers have obtained more detailed information from hospitals and hope to explore matters further.

"Another thing we're interested in looking at is whether individuals who have underlying diseases like diabetes are at greater risk and also to what extent disparities in health care and socioeconomic conditions add to risk. These important public health issues tie in well with the mission of ECU's new Center for Health Disparities Research," Cascio said.

Because the event occurred in a non-urban area, researchers were able to eliminate traffic or industrial pollution as possible causes. "The health effects that we saw are really coming from the smoke," Cascio said.

Cascio and colleagues presented the data at the American Thoracic Society meeting in San Diego early in May, and it's under review for publication.

Study shows racial disparities in lung cancer treatment

A study that looks at newly diagnosed lung cancer patients is one of the first to give reasons why patients don't undergo lung surgery and why surgery occurs less often in blacks.



Researchers found that when blacks had two or more additional medical conditions, they rarely had surgeries, only about four out of 100, whereas white patients in the same situation had surgery just as often as if they didn't have those conditions.

In addition, when black patients did not have a regular source of care, such as a primary care doctor, physicians recommended surgery only one-fifth as often as they did with whites who had no primary care doctor.

The study was composed of patients and physicians at five medical centers in North and South Carolina, including the Leo W. Jenkins Cancer Center at the Brody School of Medicine. It was led by researchers at the University of North Carolina at Chapel Hill and published in the June 16 issue of the Journal of the American Medical Association.

"African-Americans have a poorer outcome in lung cancer because they get less treatment," said Dr. Paul Walker, a study co-author and director of the thoracic oncology clinic at the Leo W. Jenkins Cancer Center. "If and when they get the same treatment as Caucasians, the outcome is the same."

The study analyzes data from 386 lung cancer patients. The results show that 66 percent of white patients had surgery, compared to 55 percent of black patients.

The results suggest there may be thousands of black patients with lung cancer in the United States who should be getting surgery but aren't, researchers said. The differences in care go beyond what can be explained by differences between blacks and whites in health insurance, education and income, they said.

To correct this disparity, researchers said, physicians should look at cases where black patients have been steered away from surgery. In such cases, doctors should push for second opinions or other fail-safe mechanisms. Researchers also recommended improvements in electronic medical records to better track patients and their treatments.

Better care management, communication and patient education are also important, researchers said.

In addition to researchers at UNC and ECU, physicians from Charlotte and Charleston, S.C., also participated. The study was funded by the American Cancer Society.

Researchers plan to further analyze their data to see if differences exist across institutions based upon the makeup of each institution's lung cancer programs. They also plan an intervention study to focus on changing physicians' medical sense and perspectives of African-Americans in lung cancer treatment, Walker said.

Microbe research receives grant

Dr. Jeffrey Smith is furthering his study of a gastrointestinal microbe thanks to a new five-year, $1.6 million grant.



Smith, professor and chair of the Department of Microbiology and Immunology at the Brody School of Medicine, received the grant from the National Institutes of Health. He's working with Bacteroides fragilis to understand how the microbe, which is part of the normal flora of the human digestive system, withstands the body's immune system. Doing so could lead to a better understanding of how opportunistic infections occur in the body.

Bacteroides species are generally beneficial, helping to break down complex molecules and supply vitamins, though B. fragilis sometimes can cause infections following appendicitis, diverticulitis, or other trauma to the gut. Smith has studied the microbe since he arrived at ECU in 1987.

Smith's research could also benefit the Human Microbiome Project, a NIH program to characterize the entire human microbiota – the microbes inhabiting an organ or body part – and its role in human health and disease. These microbes outnumber the human cells by more than 10 to 1 but we have very little understanding of their biology or how they interact with the human body.

Recent technological advances allow analysis of the DNA of microbe communities, leading to an understanding of how communities interact with each other. This will ultimately provide insight into how the immune system discriminates between the good and bad microbes and help answer questions from why do doctors see more children with asthma today to how have MRSA infections become so common.
Smith, Charles_teeth-c57.tif

Grant to aid cancer research at ECU

An East Carolina University scientist has received a $45,000 grant from Triad Golfers Against Cancer.



The grant will help Dr. Li Yang, an assistant professor in the Department of Internal Medicine at the Brody School of Medicine, further his research into the interaction between tumors and their microenvironments, identify therapeutic targets and develop small molecules to modulate tumor microenvironment interaction for combination cancer therapy. Yang's research focuses on prostate cancer and melanoma, but is adaptable to other cancers.

Yang's project involves collaboration with Dr. Gordon Ibeanu at N.C. Central University

Triad Golfers Against Cancer awarded $219,000 in grants this year to the four medical schools in North Carolina. Golfers Against Cancer, founded in 1997, is a national charitable organization.

Professor receives national research award

Dr. William Meggs, a professor of emergency medicine and chief of toxicology at the Brody School of Medicine, has received the Research Award from the American College of Medical Toxicology for contributions to toxicology research.



Over the past three decades, Meggs has shown innovation and creativity in medical toxicology and related areas of study. These range from the use of the drug heparin to treat anaphylactoid shock to ways to delay onset of toxicity from snakebites. Perhaps his greatest impact has been his research into the problem of irritant sensitivity, which can cause inflammation similar to asthma and other conditions.

Meggs also was the first researcher to report that chronic exposure to low levels of an organophosphate insecticide could induce obesity.

Meggs is also author of "The Inflammation Cure," a book that combines scientific writings regarding fundamental processes that produce inflammation in diseases with lifestyle modifications to reduce harmful inflammatory processes in the body.

Meggs accepted the award from Dr. Erica Liebelt, president of ACMT, at the group's March meeting in Scottsdale, Ariz.

He has been on the ECU faculty since 1988.

Medical students showcase research

researchday_350pMedical student Hannah Fuhr poses for Dr. Emmanuel Zervos, professor of surgery, during Medical Student Research Day, held Aug. 16.

The program allows rising second-year medical students to spend eight weeks during the summer performing research under faculty direction. This year, 19 students made 20 poster presentations.