PICTURE: Drs. Ryan Harris, Xiaoling Wang, Neal Weintraub. View of David Stepp and Anna-Gay Nelson More
Photo credit: Kim Ratliff, University of Augusta
Cardiovascular disease and cancer, the two leading causes of death in the country, have similarities like obesity and chronic inflammation, as well as a disproportionate impact on black Americans. A new American Heart Association-funded center at the Medical College of Georgia is working to better understand the bi-directional dynamics and intervene when, for example, cancer treatment itself leads to heart problems.
MCG, the state’s public medical school, is one of four centers nationwide funded with $ 11 million by the AHA Strategically Focused Research Network, which addresses disparities in cardio-oncology, which includes Boston University School of Medicine, the Medical College of Wisconsin, and the University of Pennsylvania.
As part of the concerted new initiative, MCG conducts population, clinical and basic science research projects such as: For example, monitoring patients with newly diagnosed prostate and breast cancer to look for early indicators that their cancer treatment is affecting their heart and how factors such as social inequality and obesity may predispose some people with cardiovascular disease to cancer says Dr. Neal Weintraub, director of the MCG cardiology department, co-director of the Vascular Biology Center and director of the new AHA-funded center.
“Above all, we are trying to understand the causes of the two conditions, how the crossing occurs and where we can possibly intervene and prevent,” says Weintraub. “Once we understand the causes and, above all, the differences, this can lead to individualized approaches. Personalized medicine is kind of a buzzword, but it’s essentially about that. ”
The new MCG center, funded with a $ 2.84 million grant from the AHA’s new strategically focused research network, will also attract three postdoctoral researchers specializing in cardio-oncology for up to two years with a focus on underrepresented minorities support, with the ultimate goal of ensuring that the next generation of scientists focus on these important health interfaces, says Weintraub.
The postdoctoral training will focus on cardiovascular physiology, cancer biology and statistical analysis under the direction of Dr. David Stepp, vascular biologist and director of the vascular biology graduate program at VBC, and director of education for the new center.
In partnership with Paine College, a historically black college and MCG’s neighbor, the center will also offer a research internship for Paine MCG students, allowing students to work directly with MCG clinics, academics, and postdocs that are diverse Aspects of the two-way relationship between the two common conditions, says Dr. Anna-Gay Nelson, Faculty Chemist and Chemistry Advisor at Paine and Head of Training for the Center.
Many of their students have parents or other family members affected by cancer, heart disease, and / or obesity, Nelson says, and many are also first-generation college students.
“We’re moving from the side of the affected people to stepping to the top and being part of the research,” she says, while Paine students take a front-row seat and a role in research into biological and environmental factors who put them and their families at increased risk. “Now we’re trying to be one step ahead,” says Nelson.
“We want to be there to support and help these students,” says Weintraub. “We hope that through this opportunity you will see what your ambitious goals can be,” he says. “Why not say: I can become a doctor-scientist.”
The MCG Center examines likely factors that contribute to increased risk, such as socioeconomic disparities that impede healthy lifestyle habits such as eating fresh fruits and vegetables, regular physical activity and health care, and promote obesity, worsen high blood pressure and related inflammation and cardiovascular disease and cancer and the aggravating consequences of both can accelerate vascular aging.
“We know that there are many risk factors between cardiovascular disease and cancer, but after you get cancer, mortality and morbidity increase in African American and obese people,” says Dr. Ryan Harris, clinical exercise and vascular physiologist at MCG’s Georgia Prevention Institute and lead investigator for the center’s clinical science project.
Harris examines newly diagnosed breast or prostate cancer patients in collaboration with Dr. Zach Klaassen, urological oncologist, and Dr. Priyanka Raval, hematologist and oncologist specializing in breast cancer, at both the MCG and Georgia Cancer Centers. Harris’ lab runs complex tests – such as measuring arterial rigidity and skeletal muscles – at regular intervals over 12 months to assess the cardiovascular effects of cancer treatment and the stress of a cancer diagnosis.
“We’re studying how vascular aging, inflammation, and stress affect the time after a cancer diagnosis,” says Harris. They want to better understand why blacks have a greater impact on the cardiovascular system and how obesity after a cancer diagnosis affects vascular aging over time, he says of the unique studies that both adult black and white patients are following.
“These projects within the clinical population will allow us to understand where to put these risk factors or these vascular health outcomes in an attempt to reduce the post-cancer burden,” says Harris.
The success of cancer treatment over the past decade is really driving cardio-oncology forward, Cardiologist Weintraub adds, as more patients live with cancer and doctors work to correct the effects of treatment as well, including an increased risk of cardiovascular disease. Diseases.
“As a cardiologist you constantly see that people are struggling with it,” says Weintraub. But you’re also seeing great treatment options for both cancer and cardiovascular disease, optimistic that more can be done, he says, illustrating the need to pursue the new center’s tripartite mission.
The MCG center team plans to work with other SFRN cardio-oncology centers to test new cancer therapies they have identified to reduce cardiovascular effects in mice lacking DARC, or Duffy’s antigen receptor for chemokine, a receptor on red blood cells, which appears to protect against malaria but when it is mutated, as it does in around 70% of blacks, it can increase the risk of problems such as obesity and inflammation.
As part of their basic scientific research at the new center, Weintraub and his colleagues will also investigate their early evidence that the common DARC mutation in blacks affects their susceptibility to cancer and cardiovascular disease. In fact, their DARC knockout mouse has similar indicators of predisposition, such as higher levels of chronic inflammation. They hypothesize that obesity and socioeconomic disparities, along with the loss of DARC from the mutation, lead to increased obesity and inflammation in blacks and an increased risk of cancer and cardiovascular disease.
The DARC mutation likely affects the effectiveness and toxicity of cancer treatment in these people, says Weintraub. “Patients survive because our therapies are so much better in so many ways. It is therefore now even more important to prevent cardiovascular disease or to be able to identify and treat it at an early stage, ”he says.
One of its many long-term goals is to build a cardio-oncology telemedicine network that will enable doctors investigating the unfortunate synergies to easily make doctors and patients accessible, especially in underserved areas.
The center’s population science project is called Reverse Cardio-Oncology because it studies whether social inequalities and health inequalities that exacerbate obesity also put black and white people with cardiovascular disease at higher risk of cancer. And whether a reduced DARC expression and an associated higher inflammation can predict which black people with cardiovascular diseases will also get cancer.
Co-lead investigators for these studies are Dr. Xiaoling Wang, genetic epidemiologist at the GPI, and Dr. Avirup Guha, who completed his specialist training at the MCG and AU Medical Center and is now a cardio-oncologist at the Seidman Cancer Center University Hospital in. is Cleveland and Case Western Reserve University School of Medicine.
Large databases like the NHANES-Medicare cohort are used to analyze these population health issues and to gain insight into whether people with cardiovascular disease are also at increased risk of cancer, not necessarily because of their cardiovascular treatment, but because of general risk factors for both conditions, says Wang.
The MCG team will share relevant material from its diverse activities with the other new cardiac oncology centers, such as novel mouse models such as the DARC knockout, human plasma / blood samples and population science databases.