- We've been fortunate enough to receive competitive
funding from the National Heart Lung and Blood Institute,
NHLBI in a number of networks.
The first has been the Severe Asthma Research Program,
which is now been renewed and it's in its 11th year
and will go on for another six years.
This program is a little bit of a misnomer because
when anyone says, again the Severe Asthma Research Program
or SARP as I will call it, they think that we're only
evaluating and characterizing and investigating
severe asthma but the comparison group for severe asthma
are individuals, not normal individuals
but individuals with mild disease.
So within this program in the first 10 years
across initially eight sites and now in the last four
years four sites, we've characterized about 1,400
individuals in a population that has a large number
of severe asthmatic individuals.
Probably the largest group of severe asthmatics that
have been seen anywhere in the world.
And within that we've been developing insights
into the characteristics of more severe asthma,
why individuals develop more severe asthma
and have progressive disease.
Understanding specific penotypes
and using this data I think to better develop
personalize and individualize therapeutic approaches
by understanding the characteristics of the disease.
The second network is the principal investigator
Steve Peters, this is the NHLBI Asthma Clinical
Research Network, again we've been part of the
prior grant and this was recently renewed
and is now called Asthma Net.
Each of the sites in the Asthma Net have both
a adult site and a pediatric pulmonary site.
Our pediatric pulmonary site is primarily at Emery
with Anne Fitzpatrick.
And the purpose of this network in many ways is to do
studies on understanding therapeutic indications or new
therapies that most pharmaceutical companies will not do.
We led a very important study from the site with
Steve Peters and I in which we looked at a medication
Tiotropium, an anticholinergic that's primarily
used in treating patients with COPD and showed that
this medication was very effective in asthma
as an add on therapy to inhale Corticosteroids.
As effective as long acting Beta agonists
and both of these medications were more effective
then just increasing the dose of inhaled Corticosteroids.
And this paper was published in the
New England Journal last year.
The third network is a new NIH network,
it's called SPIROMICS, and it's really involved
in understanding the molecular and longitudinal and
genetic characteristics that lead to COPD and progression.
And again like SARP this is now a longitudinal study
over three years, we're one of six sites across the
country that was funded in this network
and we're well into now establishing the cohort
which will be followed over the next three years
at Wake and hopefully longer if there's additional funding.
So these networks are very critical to understanding
what we now call translational medicine and characteristics
of both asthma and COPD.
Additional networks that we're involved in we've
been in one of the three lung sites in the 13 site
Stampede Network, which was to look at genome wide
association studies in heart, lung and blood diseases.
10 of the sites were either heart, one on blood,
and three sites were across the country lung disease.
One at the University of Souther California,
a pediatric site and one Hopkins looking at ethnic
diversity in asthma, and our site really was emphasizing
characteristics that lead to progression
and severity of asthma.
The second of these sub networks that we're involved
as we're a sub site to the Pharmacogenetic Network
grant that's at Harvard with Scott Weiss,
where we're looking at the Pharmacogenetics of asthma,
especially related to Beta agonist therapy
and inhale Corticosteroid therapy, the two mainstays
of treatment in asthma and other obstructive lung diseases.
What's my future vision for where all of this is going
is a number of aspects and some off this is gonna
be transferable to other respiratory diseases.
In asthma we've already defined better ways to understand
in disease phenotype, heterogeneity, what causes
disease progression from mild to severe.
Part of SPIROMICS network is to do the same in
patients with COPD, where we're evaluating a group
of individuals with mild disease, smokers without COPD
and individuals with vary severe COPD,
and looking at their disease progression,
their biologic mechanisms, trying to look at biomarkers
that predict disease progression and try to look at
structural corallites by doing imagining using CT scanning.
So the future will be better approaches that I think can
be brought down to real clinical skills that can be used
to both, for better diagnosis, better treatment and more
individualized or personalized therapies.