2011 - Two Awards

(1) "Assessing the cost effectiveness of different interventions for clinically significant diabetic macular edema"

David Hutton, PhD, John G Searle Assistant Professor of Health Management and Policy; Assistant Professor of Health Management and Policy, School of Public Health; and Assistant Professor of Industrial Operations, College of Engineering
Joshua Stein, MD, MS, Assistant Professor, Department of Ophthalmology

ABSTRACT:

Clinically significant diabetic macular edema (CSME) is a major source of visual impairment in the United States and worldwide. The standard first-line treatment for CSME has been focal argon laser trabeculoplasty (FALP). Recently, investigators have identified several novel treatments for CSME including injections of anti- vascular endothelial growth factor (anti-VEGF) agents and injections of corticosteroids. While there is some evidence that these newer interventions can improve best-corrected visual acuity in patients with CSME, these interventions carry increased risk of ocular and systemic side effects, may be more costly and often require frequent repeat injections before the patient experiences stabilization or improvement in vision.

The purpose of this project is two-fold. First, we wish to capture utilization patterns of these newer interventions for the management of CSME among enrollees in a large national U.S. managed care network over the past decade. In addition, we hope to capture rates of ocular and systemic side effects associated with these interventions and the need for subsequent repeat or alternative interventions for CSME. Second, we plan to perform a cost-effectiveness analysis to determine whether these newer interventions for CSME are more cost effective than FALP and to identify which intervention or group of interventions confers the greatest value. The findings of these analyses will have important implications for patient care as well as in helping guide health policy-makers as to how to allocate limited healthcare resources for this common sight-threatening condition.

(2) “ Targeting killer and regulatory B lymphocyte function in IDDM”

Steven K. Lundy, PhD, Research Assistant Professor, Department of Internal Medicine
Massimo T. Pietropaolo, MD, Professor of Internal Medicine, Division of Metabolism, Endocrinology & Diabetes; Professor of Pediatrics and Communicable Diseases, and Professor of Microbiology and Immunology

ABSTRACT:

Immune suppression is a critical process that balances inflammation and prevents unwanted immune reactions such as the autoimmune responses in type 1 diabetes (T1D). Autoreactive T lymphocytes mediate destruction of the insulin-producing    cells of the pancreatic islets. However, the factors that control the development and maintenance of pathogenic T cells in T1D are poorly understood. We hypothesize that a population of antigen presenting cells that should actively suppress autoreactive T cell development and survival is functionally deficient in T1D. These multi-potent suppressor B (MPS-B) cells are a newly recognized subset of lymphocytes that constitutively express several immune regulatory molecules, and are suspected to play both direct and indirect roles in suppressing pathogenic T cells to prevent autoimmunity. The first aim will be to compare MPS-B cell phenotypic and functional properties in NOD and control mice. This arm of the study will focus on expression of FasL,TRAIL, granzyme B, PD-L1, PD-L2, TGF functional properties of control and NOD MPS-B cells will be compared in culture with purified T cells. The second aim will utilize a novel method of expanding MPS-B cells to facilitate an adoptive transfer study in NOD-scid mice. The focus will be on the direct and indirect effects of increasing MPS-B cell activity in vivo on T and NKT cell activation and diabetes pathogenesis. This project will improve our understanding of the function of MPS-B cells in T1D, and is expected to identify new targets for research and treatment.