By Sean R. Moore, MD, MS
Q: In 2018, why is pediatric global health research important to the United States?
A: We live in interesting times. Never before has there been greater recognition of the degree to which the health of all people and nations is interconnected, e.g., Zika, Ebola, and other emerging infectious diseases. Yet, as Americans wrestle with the costs and complexities of our own healthcare system, its commitments to leadership in global health are being questioned at the highest levels..
Q: How does your laboratory’s work tie in to this research?
A: I am a pediatric gastroenterologist whose work as a physician-scientist provides me the privilege to care for children with digestive diseases and also labor upstream on scientific discoveries to transform that care. Over the past two decades, I have partnered with leaders in the field of diarrheal diseases in Virginia, Brazil, Pakistan, and elsewhere to understand and reverse break the “vicious cycle” of childhood gut infections and undernutrition in developing countries. This work spans laboratory studies of intestinal stem cells, bacteria, and viruses; translational studies with mouse models of disease; and pediatric cohort studies and randomized control trials. The sweet spot in our work is when we connect the dots between patients, diseases, and research discoveries at home and abroad.
Q: Does global health research benefit Virginia children directly?
A: Yes. Perhaps the most striking historical example of how global health research has benefited Virginia children is a treatment used by almost every pediatrician and parent: oral rehydration therapy (ORT). Prior to the advent of ORT, intravenous fluid therapy was the first line treatment for treatment of dehydration from diarrhea. Fundamental laboratory observations that glucose enhances intestinal absorption of sodium and water formed the scientific basis for the discovery of ORT. Captain Phillips of the US Army in 1964 first successfully tried oral glucose saline on two cholera patients in Manila. Subsequently, U.S. and international partners working in Dhaka and Calcutta contributed to the development of modern oral rehydration salt (ORS) solution. Presently, ORS is first line therapy for diarrhea-related dehydration everywhere in the world and has saved the lives of millions of children.
Q: What will you study next?
A: In partnership with the Bill & Melinda Gates Foundation and pediatric colleagues at the Aga Khan University in Pakistan, my UVa colleague Dr. Sana Syed and I are now studying children with repeated infections of the intestines who fail to grow despite access to good nutrition and medical therapies like ORT and antibiotics. Comprehensive evaluations for children who fail to respond to nutritional interventions will include an upper gastrointestinal endoscopy to diagnose underlying illnesses and provide tissue and fluids to analyze using cutting edge approaches to assess gut gene transcription, the metabolome, and microbiome.
Similar approaches are being used by my GI colleagues to study digestive diseases in U.S. children, most notably inflammatory bowel disease and short gut syndrome, chronic diseases associated with significant disability and healthcare costs in the U.S. Despite access to the best care in the world and the best medicines, many Virginia children with these conditions will not meet their full growth potential. Not so different, perhaps, from the children we study in Pakistan. Although the growth and diseases of children in the developing world, at times, seems far away from the concerns of Virginians, the promise of global health research remains cures and improved therapies, like ORT, for the benefit of all.
Q: For you, what is the most meaningful part of your work with global health research?
A: Teaming up with amazing colleagues in the developing world and here at the University of Virginia to apply cutting edge scientific tools to tackle neglected childhood diseases of poverty. All with the dream that some day soon children everywhere will have the opportunity to grow to lead healthy, productive lives. We love involving students and trainees in our projects and invite you to drop by our website to learn more: https://med.virginia.edu/sean-moore-lab/
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