Illinois Medicine

Translational Medicine Leaders Recently recruited department heads spearhead translational research Rohit Varma: Patricia W. Finn: John Hickner: Mary D. Stephenson: For Rohit Varma, MD, MPH, head of ophthalmology and visual sciences, translational research has provided methods to assess the risk factors of developing blinding eye diseases, the impact those diseases have, and the issue of access and barriers to care. When it comes to risk factors, "There is a very straightforward translational component," says Varma, principal investigator on three NIH-funded, community-based studies to examine prevalence of and socioeconomic burdens caused by vision impairment. "We look at the factors that cause disease that are modifiable." Diabetic eye disease, for example, is strongly related to levels of hemoglobin a1c, while cataracts are closely associated with cigarette smoking. Examining the impacts of people's vision loss on everyday activities like driving or watching television also has an obvious translational aspect, says Varma, who is associate dean for strategic planning. "The amount of change in vision is directly associated with the difficulty in performing these tasks," he says. "If you can reduce vision loss, you can improve the person's ability to perform them." Perhaps even clearer are the effects of barriers to care, says Varma, whose research focuses primarily on epidemiology in minority and disadvantaged populations. "If you can potentially reduce the barriers and have greater access to care, you can reduce the potential for losing your vision and going blind," he says. Department of medicine head Patricia W. Finn, MD, is excited that the College of Medicine has taken such a proactive stance in encouraging translational research. "The basic scientist working on the bench has a lot to offer the clinician," she says. "It's possible that those analyses and discoveries can lead to a better treatment, or at the very least a better understanding [of disease]." With a clinical and research focus on immune mediated pulmonary diseases, including transplantation, lung injury and asthma, Finn sees her work drawing from these connections in a number of ways. In treating asthma, for example, translational research can lead to not only new drug discovery but also greater analyses of immune system responses that trigger attacks. "It requires a discussion about, 'How do you avoid those triggers?' " she says. As the most common cause for mortality among those admitted to an intensive care unit, lung injury is ripe for exploration through translational research, says Finn, an NIH-funded researcher who is also Earl M. Bane Professor of Medicine. "Who goes on to have lung injury? Why does that happen?" she says. "These are questions that are incredibly exciting and have to do with how you identify the data and intervene." Transplantation is another area where translational research could provide answers, Finn believes. "Why do certain populations have better outcomes? Is it due to immune response, related to the microbes that live on you?" she asks. "There are so many unanswered questions and so many ways to analyze the data." Department head and professor of family clinical medicine John Hickner, MD, MPH, figures his specialty takes the final step in bringing translational research to the front lines of care at the bedside. "How do we take the work of specialists and apply it to the runof-the-mill patient who walks into the clinic?" he says. "That's where we tend to get interested and focused … at the far end of translation." The application of translational research to patient safety, particularly regarding safe use of medication, has been Hickner's own focus. "In primary care, we've studied errors and how to do something about that in physicians' offices, not hospitals," he says. "A lot of my, quote, 'research' has really been supporting others and supporting networks of doctors working together to improve care." Hickner has started four such networks to bring research into practice, in addition to being the founding director of the American Academy of Family Physicians. He's also worked on general health systems improvement, mostly focused on medication management, "reducing the costs of care and hopefully improving efficiency," he says. "There's a widespread belief that we do 30 percent to 40 percent more tests and procedures than are really needed to improve outcomes." Given the underserved nature of the patient population at the University of Illinois Hospital & Health Sciences System, Hickner says it's important to apply the lessons of such translational research to that profile. "Our work is going to focus on pragmatic issues: management of common illnesses, appropriate testing, appropriate use of medication, and frankly, whatever else is of interest to our researchers." An internationally renowned expert in recurrent pregnancy loss and head of the college's department of obstetrics and gynecology, Mary D. Stephenson, MD, conducts randomized, controlled trials to assess treatments and optimal drug dosing strategies. "Studying pharmacokinetics of medications in pregnancy is paramount because absorption, bioavailability and elimination of medications change in the first, second and third trimesters," she says. "It's extremely important to determine whether there is a significant benefit to taking medication during pregnancy." Often, recurrent pregnancy loss patients are prescribed multiple medications," Stephenson says. "But what is the net effect of multiple medications?" She adds, "Such translational research, from bench to bedside, impacts patient care; with recurrent pregnancy loss, this means improving the likelihood of having a successful pregnancy outcome." For example, Stephenson was co-investigator of a multicenter trial in which women were injected with "white blood cells" from their reproductive partners. "This treatment had been given for over a decade, despite little evidence to support doing so," she says. "The trial showed that this treatment was not effective; in fact, there were more miscarriages." Stephenson is presently focusing her research on genetic factors associated with recurrent pregnancy loss. "Looking to the future, couples with a history of recurrent pregnancy loss may be screened for miscarriage genes," she says. "If identified, there may be a role for preimplantation genetic testing to select embryos which are not affected, which should lead to a high likelihood of success." Clearer Vision 24 | Spr i n g 2 013 Breathing Easier Safer Patients Saving Pregnancies

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