Research Briefs

Exploring therapeutic interventions for pancreatic cancer

Pancreatic cancer is a devastating disease due to its often-late diagnosis and its unresponsiveness to current therapies. It is estimated that 57,600 new cases were diagnosed in 2020 in the U.S., with a dismal 10 percent five-year survival rate.

For a study published in Current Development of Nutrition, a research team led by CUNY SPH Associate Professor Dr. Ghada Soliman investigated the impact of the mechanistic Target of Rapamycin (mTOR) nutrient-sensitive pathway inhibition, and synergism with the antidiabetic drug, metformin on pancreatic cancer. The results showed that the combined treatment led to reduced pancreatic tumor burden, altered metabolic profile, and is better tolerated than the single-drug administration in an orthotopic pancreatic cancer model.

“Ultimately, this study can help us understand and gain insight into how mTOR controls nutrient metabolism and use such information to develop therapeutic interventions in the treatment of pancreatic diseases, type 2 diabetes, and the associated cardiometabolic complications,” Dr. Soliman says.

Soliman GA, Shukla SK, Etekpo A, Gunda V, Steenson SM, Gautam N, Alnouti Y, Singh PK. The Synergistic Effect of an ATP-Competitive Inhibitor of mTOR and Metformin on Pancreatic Tumor Growth. Curr Dev Nutr. 2020 Aug 10;4(9):nzaa131. doi: 10.1093/cdn/nzaa131. PMID: 32908958; PMCID: PMC7467276.

CUNY SPH researchers outline adapted health communications principles for the Covid-19 pandemic

The Covid-19 pandemic has introduced unique challenges for public health practitioners and health communicators that warrant an expansion of existing health communication principles to take into consideration.

In an article for Public Health Research & Practice, CUNY SPH Distinguished Lecturer Scott C. Ratzan and colleagues outlined a checklist for the implementation of Covid-19 communication strategies to move from the acute phase of the pandemic to the “next normal.”

Ratzan and colleagues identified three general areas of capacity building for health communication during the pandemic: the need for communicators to be proactive and to take preventive actions at times; the importance of planning ahead while also acknowledging the unpredictability of the situation; and the call to focus on people.

“We are trying to advance public health with simple innovations to promote evidence-based approaches to stem the Covid-19 pandemic,” says Ratzan. “While we are pleased to publish and disseminate widely, we implore political leaders and governmental officials to adapt these checklists for a healthier populace and Covid-19 recovery.”

Ratzan SC, Sommariva S, Rauh L. Enhancing global health communication during a crisis: lessons from the COVID-19 pandemic. Public Health Res Pract. 2020;30(2):e3022010.

First Results for COVID-SCORE, a Tool to Evaluate Public Perception of Countries’ Response to the Pandemic

Government response to the Covid-19 pandemic has varied considerably between countries. Although most governments implemented measures such as mobility restrictions, closure of businesses and schools, or shelter-at-home orders, the timing and approach have differed. Compliance with such measures can determine the course of a pandemic and depends on several factors such as trust in government or the clarity of the information that government sources provide.

For a study published in PLOS One, CUNY SPH Senior Scholar Jeffrey Lazarus and colleagues developed the COVID-SCORE questionnaire, an easy and reliable tool to evaluate the public perception of governmental response to the Covid-19 pandemic. According to the first results obtained across 19 countries, the tool can help decision makers improve a country’s response and track trends as the pandemic evolves.

“This tool is easy to implement and can guide researchers and authorities in designing measures to better control the pandemic,” CUNY SPH Dean Ayman El-Mohandes said. In addition, it can be done at different moments to assess the response as the pandemic evolves.

Lazarus JV, Ratzan S, Palayew A, Billari FC, Binagwaho A, et al. (2020) COVID-SCORE: A global survey to assess public perceptions of government responses to COVID-19 (COVID-SCORE-10). PLOS ONE 15(10): e0240011

CUNY ISPH study sheds new light on how ovarian cancer grows and evolves

In a paper published in Cancer Research, Associate Professor Levi Waldron, post-doctoral fellow Ludwig Geistlinger, and colleagues at the Institute for Implementation Science in Population Health (ISPH) at CUNY SPH provided new insights into how ovarian cancer grows and evolves within a person.

The paper is of basic scientific interest for its methodology and insights into the decades-long process of tumorigenesis, and of practical interest for the implications these insights have on the viability of subtype-targeted therapies. More than 20,000 women receive a new diagnosis of ovarian cancer each year in the United States, and approximately 14,000 die each year.

“Understanding how a heterogeneous tumor evolves prior to diagnosis is difficult because we can’t directly observe that evolution,” says Professor Waldron. “But by observing tumors identified at different stages of that evolution, and through detailed investigation of tumor genomics and heterogeneity, we can still learn something about it.”

A surprising outcome of the research is a dismissal of the idea of discrete transcriptome subtypes for this cancer, and replacement by a model of continuous tumor development that includes mixtures of subclones, accumulation of mutations, infiltration of immune and stromal cells in proportions correlated with tumor stage and tissue of origin, and evolution between properties previously associated with discrete subtypes.

Geistlinger L, Oh S, Ramos M, Schiffer L, LaRue RS, Henzler CM, Munro SA, Daughters C, Nelson AC, Winterhoff BJ, Chang Z, Talukdar S, Shetty M, Mullany SA, Morgan M, Parmigiani G, Birrer MJ, Qin L, Riester M, Starr TK, and Waldron L. Multi-omic analysis of subtype evolution and heterogeneity in high-grade serous ovarian carcinoma. Cancer Res October 15 2020 (80) (20) 4335-4345; DOI: 10.1158/0008-5472.CAN-20-0521

Study disputes notion that people of color have “flawed” beliefs about pregnancy

Black and Latinx individuals are often the focus of efforts to “correct” perceived flawed beliefs about pregnancy in order to increase contraceptive use and reduce unintended pregnancies. In a study published in the journal Ethnicity and Disease, Assistant Professor Meredith Manze and Associate Professor Diana Romero sought to revisit the association between race, ethnicity, and beliefs about pregnancy.

The researchers administered a web-based survey to 2,099 heterosexual men and women aged 21-44 years and analyzed a subset who were not currently pregnant to examine the association between race/ethnicity and beliefs about avoiding pregnancy: whether it can be prevented, that it is determined by fate/God or that it “just happens.”

Bivariate analyses revealed that, compared with Whites, those who identified as Black/African American or Latinx were significantly more likely to believe that pregnancy was determined by fate/God, or a natural process, and less likely to report that it can be avoided. In the first regression model, these differences persisted. However, in the second model, being Black/African American or Latinx was not significantly associated with beliefs about avoiding pregnancy.
Latinx individuals do not hold strongly different beliefs than Whites,” says Manze. “Our findings suggest reconsideration of public health research that problematizes ‘unintended pregnancy’ and focuses on racial and ethnic minority group identity.”

Manze MG, Romero DR. Revisiting the Association between Race, Ethnicity, and Beliefs about Pregnancy. Ethn Dis. 2020;30(4):525-532; doi:10.18865/ed.30.4.525

Statins’ unique effectiveness in preventing heart disease

Statins, a class of drugs that lowers the level of cholesterol in the blood by reducing the production of cholesterol by the liver, are the first line of defense in preventing and treating cardiovascular disease. Statins appear to be more effective than other drugs targeting cholesterol at preventing death and possibly are more effective in men than women, but the reasons for any such differences are unclear.

In a study published in the journal eLife, CUNY SPH Professor Mary Schooling and team used Mendelian randomization, an observational study design that avoids confounding by taking advantage of the random allocation of genetic material at conception, to mimic the effects of statins.

Consistent with a long-standing hypothesis, the findings suggest that statins, unlike other major lipid modifiers such as PCSK9 inhibitors and ezetimibe, partially operate via testosterone in men specifically. This additional property of statins contributes to their overall superiority, because testosterone affects cardiovascular disease and to differences by sex, because testosterone levels are higher in men than women.

“Identifying why statins are uniquely effective provides new avenues for preventing cardiovascular disease, the leading cause of death in the United States,” says Professor Schooling.

Schooling CM, Zhao JV, Au Yeung SL, Leung GM. Investigating pleiotropic effects of statins on ischemic heart disease in the UK Biobank using Mendelian randomisation. Elife. 2020 Aug 25;9:e58567. doi: 10.7554/eLife.58567. PMID: 32838838; PMCID: PMC7449694.

Reckoning with the role of race and ethnicity in health research

In a paper published in the New England Journal of Medicine, a team of researchers led by Distinguished Professor Luisa N. Borrell contend that, while we know that race/ethnicity is correlated with genetic ancestry, which captures information about the likelihood of having genetic variants for many diseases, we must not fail to recognize that race/ethnicity also captures social exposures not captured by genetic ancestry.

“Race and ethnicity represent the biological embodiment of discrimination, socioeconomic position, access to healthcare, environmental exposures, and genetic variation, all of which are important for clinical decisions and outcomes,” Borrell explains.

The authors advise that researchers and clinicians should carefully weigh whether the inclusion of race and ethnicity is evidence-based and results in improved and fairer decisions for clinical outcomes. Race/ethnicity should continue to be used in clinical and biomedical research until a better biological predictor or social risk score emerges, they say.

“The removal of race and ethnicity in medicine and biomedical research will likely increase or even create new health inequities, which we aim to address and ultimately eliminate in our society,” Borrell added.

Borrell LN, Elhawary JR, Fuentes-Afflick E, Witonsky J, Bhakta N, Wu AHB, Bibbins-Domingo K, Rodríguez-Santana JR, Lenoir MA, Gavin JR, Kittles RA, Zaitlen NA, Wilkes DS, Powe NR, Elad Ziv E, and Burchard EG. Race and Genetic Ancestry—A time for reckoning with racism. N Engl J Med. January 6, 2021, Vol 384 (1): DOI: 10.1056/NEJMms2029562

Study suggests waiting for a more effective vaccine means more hospitalizations

While the Pfizer/BioNTech and Moderna Covid-19 vaccines were around 90 percent efficacious in clinical trials, it is not known how effective these vaccines will be once they are rolled out into the general population.

In a study published in the American Journal of Preventive Medicine, Professor Bruce Y. Lee and his colleagues at Public Health Informatics, Computational, Operations Research (PHICOR) developed a computational model that simulated the entire U.S. population, the spread of Covid-19, subsequent outcomes of infection (e.g., symptoms, hospitalizations), the associated costs along the way, and vaccines with different efficacies and vaccination timings.

The model suggests that waiting for a vaccine with a higher efficacy would result in additional cases, hospitalizations, and costs over the course of the pandemic.
“This tells us that there are few situations in which it is worth passing on the first vaccine available to you in favor of a vaccine that becomes available later on, even if that vaccine has a substantially higher efficacy,” Lee says. “Results could help with the vaccine rollout and answer questions such as: is it better to administer a single dose to cover more people rather than the full 2-dose regimen to fewer people?”

Bartsch SM, O’Shea KJ, Wedlock PT, Strych U, Ferguson MC, Bottazzi ME, Randall SL, Siegmund SS, Cox SN, Hotez PJ, Lee BY. The Benefits of Vaccinating With the First Available COVID-19 Coronavirus Vaccine, American Journal of Preventive Medicine, 2021, ISSN 0749-3797

Transmission of Covid-19 in NYC schools is low, but classroom conditions can be improved

As fall 2020 began, schools around the U.S. reopened for in-person learning, having shuttered in the spring as the Covid-19 outbreak surged. But by September, the weekly average began to rise again, only a few days before students were slated to return to in-person learning on October 1.

To estimate the risk of SARS-CoV-2 transmission among students and teachers in New York City public schools, the largest school system in the U.S., a CUNY SPH team led by Assistant Professor Brian Pavilonis assessed 101 classrooms in 19 NYC schools using a modified Wells-Riley equation under steady-state conditions and varying exposure scenarios. They then used multivariable linear regression with GEE to identify school and classroom factors that impact transmission risk.

The researchers found the mean probability of transmission to be generally low, but it varied by scenario. Transmission rates were higher during the heating season and in newer buildings and lower in schools with mechanical ventilation. Surprisingly, schools located in older buildings and lower-income neighborhoods had lower transmission probabilities, likely due to the greater outdoor airflow associated with older, draftier buildings.
Despite the generally low risk of school-based transmission found in this study, Pavilonis and team warned that that risk would increase given the rising prevalence of SARS-CoV-2 at the time.

“Outdoor airflow rates, a key for limiting indoor transmission, were generally high in the classrooms surveyed in the study,” Pavilonis said. “In order to continue to safely implement in-person instruction, schools should try to keep windows open as much as possible, maintain physical distancing, and students and teacher should wear masks at all times.”

Pavilonis BA, Ierardi M, Levine L, Mirer F, Kelvin EA. Estimating aerosol transmission risk of SARS-CoV-2 in New York City public schools during reopening, Environmental Research, Volume 195, 2021, 110805, ISSN 0013-9351.

Report: The Impact of the Covid-19 Pandemic on CUNY Students

A survey of the approximately 274,000 CUNY students published in the Journal of Urban Health found that the Covid-19 pandemic had taken a toll on their mental health and financial security.

The population-representative survey, conducted by a team of CUNY SPH faculty in collaboration with researchers at Healthy CUNY, found that more than half of CUNY students (54%) reported experiencing depression and/or anxiety in April 2020, at the height of the first wave of the Covid-19 pandemic. They also found high levels of financial instability and noted that food insecurity and housing worries were strong predictors of anxiety/depression in multivariable models.

“We found concerning levels of financial instability in our student body, with clear effects on CUNY students’ mental health and well-being,” said Associate Professor Heidi Jones. “Further, over a quarter of CUNY students reported anticipating graduating later than originally planned because of the pandemic. CUNY is known to be an important ‘equalizer’ in terms of the upward social mobility of many of its graduates, and increased time to graduation or drop-out could exacerbate existing inequities.”

Fifty percent of CUNY students reported often or sometimes worrying about running out of food before being able to afford more, and 27% reported often or sometimes skipping a meal because they could not afford food. These estimates are considerably higher than reported in an earlier Healthy CUNY survey in 2018.

Jones HE, Manze M, Ngo V, Lamberson P, Freudenberg N. The impact of the COVID-19 pandemic on college students’ health and financial stability in New York City: Findings from a population-based sample of City University of New York (CUNY) students. Journal of Urban Health. 2021.