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What is the role of respect, as seen through a bioethics lens, in research partnerships, whether between a clinical researcher and the subjects in a randomized controlled trial, a PI and the population of focus in a community-based study, or among the participants in a translational science collaborative? What leadership style best fosters the interdependence critical to the success of research partnerships? In what ways can power sharing improve the quality of the science of prevention and its results?

These were just some of the bioethical values explored at a recent workshop, cohosted by CCTS and the Tuskegee University National Center for Bioethics in Research and Health Care. CCTS members from several partner institutions, including Auburn, Tuskegee, and UAB, participated. The daylong interactive event featured an ethical opinion poll, an exercise highlighting the dynamics of “us-them” categorizing, a test in ethical decision making, and many lively discussions.

The Bioethics workshop is held annually—visit the CCTS events page to learn about all of our upcoming events.

Dr. Surya Bhatt is one of four recent CCTS KL2 awardees, who says he heard about the research opportunity through the Division of Pulmonary, Allergy and Critical Care Medicine where he works. “Three different people sent me an email about it in one day, because they thought I’d be a good candidate,” he recalls.

“I wasn’t getting the full time I needed to do research, and this was a timely opportunity to have my time fully protected.” Surya Bhatt, MD, Assistant Professor, UAB Division of Pulmonary, Allergy and Critical Care Medicine Medical Director, Pulmonary Function and Exercise Physiology Lab

The title of his research project is, “Diastolic Dysfunction and Pauci-inflammatory Acute Exacerbations of Chronic Obstructive Pulmonary Disease.” His goal is to try and phenotype acute exacerbations of chronic obstructive pulmonary disease, or COPD. While the majority of exacerbations are thought to be caused by viral or bacterial infections, up to one-third are from an unknown cause.

“All are treated with steroids or antibiotics, which is often not very successful,” Bhatt says. Bhatt says some of the exacerbations may be related to cardiac issues, as approximately 40 percent of stable COPD patients have impaired relaxation of the heart. “We have shown previously that if you have an irregular heartbeat, you’re more likely to have an exacerbation of COPD,” he says. “We put these things together and said, maybe the exacerbations are due to cardiac dysfunction.”

As possible evidence of this, Bhatt says, if COPD exacerbations arise only from the lung, there should be inflammation in the lungs and blood; however it has been shown that there is no lung inflammation in about 20 percent of these patients.

Bhatt and his research team are recruiting patients during acute exacerbations to look for systemic and pulmonary inflammation via blood draw and exhaled breath condensate analyses. In addition they conduct echocardiography to assess diastolic dysfunction of the heart and lung ultrasound to look for fluid in the lungs. Ideally, they would study patients both in the stable phase and during a subsequent exacerbation, but because that is not feasible, they are repeating the studies 35 days post-exacerbation to compare with findings during acute exacerbations.

“We’ve found so far that patients who have low inflammatory status during exacerbation have a considerably higher rate of cardiac dysfunction,” Bhatt says. “This has two potential implications: We could try and modulate these patients’ diastolic dysfunction; or we could treat them differently from the usual prednisone and antibiotic therapy, such by using beta blockers or diuretics, for example.”

Bhatt suggests that alternative treatments to antibiotics and steroids might avoid the side effects those drugs can cause, including muscle weakness, high glucose levels,  and reduced immunity causing susceptibility to infections. “While considerable efforts have been made toward phenotyping stable COPD, this is one of the first studies attempting to phenotype acute exacerbations.”

He will use a portion of the time dedicated to this research to learn about cardiac magnetic resonance imaging (MRI) with Dr. Thomas Denney at Auburn University, part of the CCTS Partner Network. Bhatt says he also hopes to complete a Master of Science in Public Health degree in Clinical and Translational Science. He is mentored by Dr. Edwin Blalock and Dr. Mark Dransfield, both leading investigators in COPD research. 

Ceren Yarar-Fisher, PT, PhD, Assistant Professor Department of Physical Medicine and Rehabilitation UAB School of MedicineCeren Yarar-Fisher, PT, PhD, Assistant Professor in the Department of Physical Medicine and Rehabilitation at UAB, is one of four current CCTS KL2 Awardees. Yarar-Fisher learned about the program via the CCTS’ Training Academy, specifically Director Ryan Outman.  She had been considering an award application, she said, and this one caught her eye.

“The application was very easy to follow, and Ryan was very helpful,” she says. “It was well explained in the materials provided, and fairly straightforward.”

Yarar-Fisher is a physical therapist—in training who completed her PhD and postdoctoral work on spinal cord injury and secondary health complications. Her career goal, she says, is to use nutrition and early rehabilitation interventions to improve neuro-recovery and metabolic health in people with spinal cord injury. Her CCTS KL2 grant is aimed at acute care in the form of a nutritional intervention to improve neuro-recovery in spinal cord injured patients. The title of her project is, “Utilizing a ketogenic diet to improve neuro-recovery following spinal cord injury.”

“To date, no pharmacologic therapy has demonstrated significant improvement effects in the neurological or functional recovery in spinal cord injury patients”, Yarar-Fisher says. “Changing a diet to a more neuro-protective one during acute care of SCI can be implemented anywhere in the world at low cost and without major regulatory hurdles. Proposed nutrition intervention in animal models has shown promise. This would be groundbreaking if it worked in humans because it’s very easy to do in clinics.”

The idea is to feed patients high-fat, or “ketogenic” diets (KD), the KD is a high-fat, low carbohydrate diet designed to mimic the metabolic and biochemical changes seen during calorie restriction. Ketone bodies have been shown to exert their neuro-protective effects via preventing oxidative damage; attenuating neuroinflammation and glutamate excitotoxicity; and inhibiting apoptosis in the brain and spinal cord. The diets have been used in children with epilepsy who are resistant to prescription treatments for years, Yarar-Fisher says.

“No one has thought about using these diets in spinal cord injuries,” she says. “Our goal in this study will not be to change how these patients are are already being treated, but to add this diet to support those approaches.”

Yarar-Fisher is working with a big research team including trauma surgeons, physical medicine and rehabilitation physicians, scientists, and dieticians. Betty Darnell, Director of the CCTS’ Bionutrition Unit, will design and implement the diets. “UAB Bionutrition Unit will provide all of the food for the study and transfer it to the hospital. The patients will be on the diet for eight weeks,” Yarar-Fisher explains.

This KL2 grant will assist Yarar-Fisher with her salary support over its duration, as well as provide what she calls “stellar” training that includes a sabbatical at Duke University’s Department of Nutrition Sciences. In addition she will work with UAB’s Dr. Barbara Gower to study metabolism, Dr. Amie McLain to study neuro-recovery and with the CCTS’ Dr. Robert Oster for biostatistics training.