Feb 28 2013

Say Hello to Research in Action !

Research in ActionThose of us here at Cornerstone are excited to welcome another member of the CHOP family to the blogosphere: the Center for Injury Research and Prevention has launched a new blog! Research in Action will feature news and commentary on the important work being done at the Center for Injury Research and Prevention every day, and will tackle such topics as teen driving, child safety seats, and concussions.

Though it was only launched recently, the Research in Action team has been very active, publishing a number of posts by Center for Injury Research and Prevention investigators. Flaura K. Winston, MD, PhD, scientific director and founder of the Center, wrote a post on the importance of interdisciplinary collaboration in injury prevention research. More recently, Mark Zonfrillo, MD, MSCE, reported on a Pediatrics study of physical disability in children who have suffered traumatic injuries.

The Center’s Suzanne Hill and Nancy Kassam-Adams, PhD, have also contributed posts to the blog, while Patty Huang, MD, a developmental and behavioral pediatrician, will be moderating Research in Action.

The blog is sure to be updated frequently, so don’t forget to subscribe to Research in Action’s feed!

Permanent link to this article: http://www.research.chop.edu/blog/say-hello-to-research-in-action/

Feb 26 2013

Using Next-Generation Sequencing to Understand and Treat Disease

next-generation sequencing

Researchers use next-generation sequencing to gain a deeper understanding of the tumors’ genetics, with the ultimate goal of developing highly targeted therapies.

How time flies! It seems almost impossible that the many events of 2003 are now almost ten years in the past. It’s also hard to believe that the completion of the Human Genome Project, a government-led initiative involving researchers from all around the world, was nearly a decade ago. In addition, the way next-generation sequencing technology has developed in the past decade is almost unbelievable.

The Human Genome Project, for example, cost just under $3 billion and took thirteen years to complete. Nowadays, a person can have their genome sequenced in mere months for several thousand dollars. At CHOP, next-generation gene sequencing technologies are being used all the time to better understand and treat childhood disease.

A recent article in the trade publication Clinical Lab Products examined the development and potential impact of next-generation sequencing technologies. Next-generation sequencing “seems poised to deliver on the potential shift in paradigm that will truly enable precise diagnosis, personalized medicine, and preventive care,” the article says.

The article featured input from CHOP’s Avni Santani, PhD, scientific director of the Molecular Genetics Laboratory. Led by Catherine A. Stolle, PhD, the Molecular Genetics Laboratory provides “DNA-based diagnostic testing for genetic disorders affecting children and adults.”

“In the future, I can see that the application of next-generation sequencing for the diagnosis of genetic diseases in children and adults will find widespread use across clinical genetics labs,” noted Dr. Santani.

A recent example is CHOP’s partnership with Shenzhen, China-based BGI to analyze pediatric brain tumors as part of the Childhood Brain Tumor Tissue Consortium. The researchers use next-generation sequencing to gain a deeper understanding of the tumors’ genetics, with the ultimate goal of developing highly targeted therapies.

“Genetic testing using NGS could be cost-effective, rapid, and comprehensive. Ten years from now, as the technology improves, sequencing the human genome could very well be a routine test,” Dr. Santani said. “The amount of data generated by next-gen sequencing is unprecedented.”

To read more, see the full Clinical Lab Products article. To read more about the Molecular Genetics Laboratory, see the lab’s website.

Permanent link to this article: http://www.research.chop.edu/blog/using-next-generation-sequencing-to-understand-and-treat-disease/

Feb 22 2013

Some Kids With Heart Defects May Experience Abnormal Growth Regulation

heart defectsChildren who are born with complex heart defects like congenital heart disease can often have poor growth. A new study from a pediatric cardiologist and her team at The Children’s Hospital of Philadelphia suggests that that this poor growth may stem from factors beyond deficient nutrition, and may include abnormalities in overall growth regulation.

Meryl S. Cohen, MD, of the Cardiac Center at Children’s Hospital, led a study that looked at the medical records of more than 850 children with congenital heart disease and compared those to more than 7,600 control subjects.

Researchers had previously known that children with congenital heart disease are at an increased risk for poor growth, but this analysis provides a fuller picture of the problem. Investigating the patterns of poor growth in children with the disease gave Dr. Cohen and the other investigators a starting point in guiding them toward more effective treatments.

While looking at the children’s growth patterns, Dr. Cohen and her team noticed that children with congenital heart disease had significant deficits in weight, length and head circumference, compared to others without the disease. The researchers also noted that when caloric intake is insufficient the weight of an infant in the general population is usually affected first, followed later by length and head circumference.

In addition, those children who required surgery for their condition much more likely to be below the 3rd percentile in weight, length and head circumference during early infancy, and their growth by age 3 did not catch up with that of their healthy peers, according to the study.

“The fact that all three parameters changed simultaneously rather than sequentially supports the idea that impaired growth in children with heart disease is affected at least in part by factors unrelated to nutrition,” said Dr. Cohen.

Further studies should investigate the possible roles of growth hormones and other physiologic factors that affect growth regulation in children with CHD, Dr. Cohen added.

More information about the study is available on the CHOP Research Institute’s website.

Permanent link to this article: http://www.research.chop.edu/blog/some-kids-with-heart-defects-may-experience-abnormal-growth-regulation/

Feb 19 2013

Study Finds Link Between Genes and Lifespan

lifespan

Dr. Hakonarson, director of the Center for Applied Genomics at Children’s Hospital, led the study, which is the first to look at copy variation numbers in children that may be linked with human lifespan.

Several gene variants can influence a person’s potential lifespan by either raising the probability of developing a disease or by providing protection from disease, according to new research from The Children’s Hospital of Philadelphia. Hakon Hakonarson, MD, PhD, director of the Center for Applied Genomics at Children’s Hospital, led the study, which is the first to look at copy number variants in children that may be linked with human lifespan.

Copy number variations, often referred to as CNVs, are losses or gains in DNA sequence. Although usually rare, CNVs can play a critical role in raising or lowering a person’s risk of disease.

Dr. Hakonarson and his team examined the rates of CNVs in more than 7,300 children aged 18 or younger from the CHOP network, and compared them to 2,701 Icelandic subjects 67 years of age or older. The research team replicated the study in sample involving several thousand more children and older adults. At the end of their analysis they identified seven CNVs — three of which were caused by deletions in a DNA sequence and the other four by duplications in the sequence.

Interestingly, the specific genes impacted by the copy number variations are involved in an important biological mechanism called alternative splicing — modifications inside a gene that result in a protein different from what would otherwise come from that gene.

“Possibly in a more global way than previously thought, some of these CNVs may have favorable effects, whereas others are bad for you and predispose you to diseases,” said Dr. Hakonarson.

More research is needed, and Dr. Hakonarson said that the duplicated CNVs he and his team found may represent novel targets implicated in short lifespan. Eventually, he added, if CNVs are incorporated into early clinical screening tests, their presence could be prognostic markers indicating which patients should take individualized preventive health measures.

More information on this study is available on the Research Institute’s web site.

Permanent link to this article: http://www.research.chop.edu/blog/chop-study-finds-link-between-genes-and-lifespan/

Feb 15 2013

Searching for the Signs of Autism in Infants

One out of 88 children in the United States has been diagnosed as having an autism spectrum disorder. There is no cure and relatively few treatments that work well for everyone on the autism spectrum. But research, including ground-breaking studies on infants, is making great strides to better understanding autism spectrum disorders.

Investigators at the Center for Autism Research at The Children’s Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine lead innovative teams investigating what causes autism spectrum disorders and possible ways of treating it.

One of the studies conducted by UPenn and the Center for Autism Research involves exploring the early signs of autism. Check out this video from the University of Pennsylvania about the study, called the Infant Brain Imaging Study:

Permanent link to this article: http://www.research.chop.edu/blog/searching-for-the-signs-of-autism-in-infantsvideo/

Feb 14 2013

Unlocking the Secrets of Mitochondria

mitochondria

Mitochondria are key suppliers of the energy needed for the multiple functions of our cells.

A team led by CHOP’s Marni J. Falk, MD, has expanded next-generation gene tools designed to sequence nuclear DNA to analyze a separate source of DNA — that found within mitochondria. Mitochondria are key suppliers of the energy needed for the multiple functions of our cells. Mitochondria contain their own DNA, and play a pivotal role in human health and disease.

“A first step in developing treatments for a disease is to understand its precise cause,” said Dr. Falk, director of the Mitochondrial-Genetic Disease Clinic. “We have developed a one-step, off-the-shelf tool that analyzes both nuclear and mitochondrial DNA to help evaluate the genetic cause of suspected mitochondrial disease.”

In addition to her role at CHOP, Dr. Falk is also chair of the United Mitochondrial Disease Foundation’s Scientific and Medical Advisory Board.

To create their test— which they call the “1:1000 Mito-Plus Whole-Exome” kit — the researchers adapted an existing sequencing kit from Agilent Technologies, expanding it to encompass the mitochondrial genome.

While individual mitochondrial diseases are very rare, hundreds of causes of mitochondrial diseases are known. Some originate in mutations in DNA specific to the mitochondria, while many other mitochondrial diseases are based in nuclear DNA genes that affect mitochondrial function. The role of mitochondria in human disease has only been recognized since the 1980s, and is based on the pioneering research by CHOP’s own Douglas C. Wallace, PhD. However, many mitochondrial diseases remain poorly understood.

One complicating factor is heteroplasmy — a mixture of mutated and normal mitochondrial genomes within the same cells or tissues. In contrast to conventional gene sequencing, which can detect only heteroplasmic mutations that reach levels of at least 30 to 50 percent, Dr. Falk’s kit has the sensitivity to detect mitochondrial genome mutations present at levels as low as 8 percent.

The availability of the new test could help to shorten the “diagnostic odyssey” experienced by patients and families seeking the cause of debilitating and puzzling symptoms, said Dr. Falk. “Many families travel from one specialist to another for years, searching for the cause of their rare disease,” she said.

Specific treatments are not always available, but identifying their disease cause may be the first step toward discovering treatments, Dr. Falk noted.

To learn more about Dr. Falk’s research, see the full press release.

Permanent link to this article: http://www.research.chop.edu/blog/unlocking-the-secrets-of-mitochondria/

Feb 12 2013

The Human Genome — Yep, There’s an App for That!

human genome

The app has been consistently ranked as a top 10 “What’s Hot” medical app on iTunes.

It’s been nearly a decade since scientists completed the Human Genome Project — a scientific marvel that, in its essence, provided the blueprint for the genetic make-up of humans.

A team in the Center for Biomedical Informatics (CBMi) at The Children’s Hospital of Philadelphia Research Institute took all of the information generated from the project and developed a free iPad® app so users can quickly and efficiently navigate the vast information on the human genome.

The app, called Genome Wowser, allows users to traverse the entire human genome — just like planning a travel route on Google Maps. Since its launch, the app has been consistently ranked as a top 10 “What’s Hot” medical app on iTunes, downloaded approximately 7,800 times, with 30,000 app updates by researchers around the world for new versions.

And on Feb. 1, Genetic Engineering & Biotechnology News named Genome Wowser one of the Best Science Apps available.

The app can find a searched-for gene on one of the 23 human chromosomes, displaying an interactive image of its precise location among the genome’s 3 billion base pairs. Genome Wowser can also tell users about a gene’s known or suspected biological functions, identified mutations and variants of each gene, or learn how a gene’s functions are modified when chemicals attach or separate from exposed sections of DNA.

“With this app, researchers can now access genomic data from anywhere with minimal effort, and they can immediately explore the genome visually by using the intuitive screen touches and gestures that have made the iPad® platform so powerful,” says CBMi director Peter White, PhD.

Want to know more about Genome Wowser? Check out the story in our most recent Research Annual Report, or visit the app’s official Facebook page.

Permanent link to this article: http://www.research.chop.edu/blog/the-human-genome-yep-theres-an-app-for-that/

Feb 07 2013

The Cornerstone of Personalized Medicine

personalized medicine

Personalized medicine: it’s all about you.

The idea of “personalized” medicine isn’t just about a one-on-one encounter with a doctor, the use of sophisticated mobile applications, or heightened access to healthcare providers, medical records, and services. Personalized medicine also extends into the depths of who each of us are at our essence — to our individual genetic makeup.

Why does this matter? Because now, more than ever before, rapid technological advances and scientific breakthroughs mean we know more about how genes may point to a predisposition for developing certain diseases. By understanding the cause of a disease, rather than focusing solely on its symptoms, we have far greater opportunities to try to delay the onset of a disease — or prevent it altogether.

Understanding our genetic makeup also sheds light on why a medicine may work well in one person but be ineffective in someone else with the same condition. Armed with this information, doctors can tailor treatments to those that carry the greatest chance of success based on a patient’s genetic predisposition.

A relatively new field of study, personalized medicine rocketed onto the scene after the completion of the Human Genome Project in 2003, the ambitious multi-billion-dollar federal initiative that analyzed 3 billion chemical base pairs involved in DNA and provided the genetic makeup of humans.

“On its surface, the concept of personalized medicine may seem complicated and perhaps a bit futuristic, but it’s far more science than science fiction,” says Philip R. Johnson, MD, chief scientific officer at the CHOP Research Institute. “It’s here now, and it is expanding what scientists understand about disease and changing the ways we care for patients.

And, as in many areas of investigation, research conducted within the Centers of Emphasis at The Children’s Hospital of Philadelphia Research Institute serves as the cornerstone of this new foundation in personalized healthcare.

Learn more about personalized medicine and work at CHOP Research by taking a look at our recent Research Annual Report.

Permanent link to this article: http://www.research.chop.edu/blog/the-cornerstone-of-personalized-medicine/

Feb 04 2013

Parents Magazine Names CHOP Top Pediatric Hospital

parents magazine

We are proud to announce that The Children’s Hospital of Philadelphia has been named the nation’s overall best pediatric hospital by Parents magazine in its exclusive list of the 10 Best Children’s Hospitals.

The Children’s Hospital of Philadelphia also ranked in the top 3 in all 6 medical specialties included in the survey. Parents magazine also ranked Children’s Hospital’s Cancer Center and emergency medicine first; the Cardiac Center tied for first; neonatology ranked second and orthopedics and pulmonology ranked third.

Parents magazine’s list of the 10 Best Children’s Hospitals provides the most comprehensive family-focused and data-driven comparison of pediatric facilities. In compiling the list, Parents focused on key areas including treatment success, groundbreaking research and family-friendly facilities.

The hospitals on the list were ranked by Parents magazine editors, with input from a team of medical advisors, based on their responses to detailed questions in the following areas: survival rates for childhood cancer, pediatric heart disease, and other critical conditions; experience in performing certain complex procedures; depth of the research program; safeguards to prevent medical errors; staffing ratios and quality; community outreach; and services that address the emotional needs of families of patients. All surveyed hospitals are members of the National Association of Children’s Hospitals and Related Institutions.

“We are honored by this recognition, particularly as it comes from a source so many families trust for advice about their children’s wellbeing,” said Steven M. Altschuler, MD, chief executive officer of The Children’ Hospital of Philadelphia.

“Accomplishments like this one are a testament to our staff, whose commitment to every child and family in our care is extraordinary. To be ranked #1 in the nation affirms our mission and reminds us of our continued and profound responsibility to advance pediatric health,” Dr. Altschuler said.

The “10 Best Hospitals” list will appear in the March 2013 issue of Parents magazine, which will be available on newsstands nationwide on February 12. The list will also be online at www.parents.com.

For more information on the hospital and the six ranked specialty areas, please visit the Children’s Hospital website.

Permanent link to this article: http://www.research.chop.edu/blog/parents-magazine-names-chop-top-pediatric-hospital/

Feb 01 2013

Longer CPR Saves Lives in Children and Adults

CPR

The conventional thinking has been that CPR is futile after 20 minutes, but these results challenge that, said Dr. Berg.

Two recently published studies show that extending cardiopulmonary resuscitation (CPR) longer than previously thought useful saves lives in children and adults. The research teams analyzed the impact of duration of CPR in patients who suffered cardiac arrest while hospitalized.

“These findings about the duration of CPR are game-changing, and we hope these results will rapidly affect hospital practice,” said Robert A. Berg, MD, chief of Critical Care Medicine at Children’s Hospital. Dr. Berg is also chair of the Scientific Advisory Board of the American Heart Association’s Get With Guidelines-Resuscitation program (GWTG-R), a national registry that tracks and analyzes the resuscitation of patients after in-hospital cardiac arrests.

The investigators reported data from the GWTG-Resuscitation registry of CPR outcomes in thousands of North American hospital patients in two landmark studies, one of which was focused on children.

In the pediatric study, to which Dr. Berg contributed as a co-author, the researchers analyzed the hospital records of 3,419 children in the U.S. and Canada from 2000 through 2009. They found that among children who suffered in-hospital cardiac arrest, more children than expected survived after prolonged CPR. Of those children who survived prolonged CPR — which is defined as lasting longer than 35 minutes — over 60 percent had good neurologic outcomes.

The pediatric results parallel those found in the second GWTG-R investigation, which examined 64,000 adult patients with in-hospital cardiac arrests between 2000 and 2008. Dr. Berg also was also a co-author of that study.

The conventional thinking has been that CPR is futile after 20 minutes, but these results challenge that, said Dr. Berg.

“Taken together, the adult and pediatric results present a clear and hopeful message: persisting longer with CPR can offer better results than previously believed possible,” concluded Dr. Berg.

To read more about the CPR studies, see the full press release.

Permanent link to this article: http://www.research.chop.edu/blog/longer-cpr-saves-lives-in-children-and-adults/

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