Unfortunately, Kentucky is a ‘leader’ in chronic diseases and environmentally associated health problems. Kentucky is also a ‘leader’ in low educational attainment and high levels of obesity, smoking and alcohol use. These factors combine to make Kentuckians especially unhealthy. Kentucky sits in the midst of “Coronary Valley” and the “Stroke Belt” with a high prevalence of heart disease, obesity, diabetes, stroke, lung cancer, etc. Louisville and Lexington comprise just 24% of the state’s total population, but nearly 50% of the state’s physicians live in these two metropolitan areas. Thus, much of Kentucky is both rural and medically underserved.
Kentucky is 3rd in the United States in the prevalence of obesity in high school children, 8th in obesity in preschool children, 4th in overweight and obese adults, 7th in obese adults, 7th in hypertension, 6th in diabetes, 5th in adult physical inactivity, and 3rd in the highest poverty rates. All of these problems relating to obesity and heart disease/stroke also have a nutrition component. With Kentucky’s low educational attainment and high poverty levels, a proper diet is much more difficult to maintain. Indeed, Kentucky is a national “leader” in fast food consumption.
The UofL CTSI has designated six overlapping and related areas of emphasis and research excellence: cardiovascular diseases, environmental health, infectious diseases, metabolic diseases, neurosciences, and oncology.
Kentucky is a leader in obesity and cardiovascular diseases and stroke. Kentucky sits in the midst of both Coronary Valley and the Stroke Belt. Thus, these problems have an enormous impact on the health and well-being of Kentuckians. Cardiac care and research is centered in the Division of Cardiovascular Medicine in the Department of Medicine at UofL.
The Cardiothoracic Surgery Department and the Cardiovascular Innovation Institute (CII) develop state-of-the-art cardiovascular devices to improve our patients’ health. There is a long history of cardiac innovations at UofL. The AbioCor artificial heart was developed and tested here. There is a host of clinical trials ongoing at UofL. Basic and translational research is fundamental to the Division and is coordinated through the Institute for Molecular Medicine.
The environment plays a major role in many diseases that are common in Kentucky, such as Black Lung and cardiovascular diseases. The University of Louisville has a long history of addressing these problems. Indeed, one of the sentinel occurrences in environmental health was the discovery in the 1970’s of a cluster of hepatic hemeangiosarcomas among vinyl chloride workers. This discovery led to the promulgation of new OSHA regulations regarding vinyl chloride exposure in the work place and to the development of a tissue and data bank on workers that has continued to the present.
UofL has a long-standing NIH T32 training grant in environmental health that trains pre- and post-doctoral students. UofL is also home to an NIEHS Superfund grant, and one of our investigators, Dr. Matt Cave, has received an NIEHS RIVER grant—a recognition of his groundbreaking research into environmental liver injury. Dr. Aruni Bhatnagar is a leader in the area of environmental cardiology. Our investigators are also looking at the variable effects of environmental exposure on men and women.
In 2018, UofL brought together multiple disparate environmental programs under the umbrella of the Christina Lee Brown Envirome Institute . UofL is home to an NIH-funded COBRE on Diabetes and Obesity, which is housed within the Envirome Institute.
Drugs of abuse (alcohol, opiates, marijuana, methamphetamines, etc.) represent major health challenges to Kentucky. Collateral damage of the opioid crisis is the fact that Kentucky, (predominantly rural Kentucky), now has the highest rate of new Hepatitis C cases in the US and has a major Hepatitis A outbreak. An important goal of the IDeA CTR is to work with our many collaborators, including state government, to try to attenuate the scourge of drug abuse and its complications across the area.
Patient care and research on infectious diseases is centered in the Division of Infectious Diseases, and, for hepatitis, in the Division of Gastroenterology, Hepatology & Nutrition in the Department of Medicine at UofL. The Division of Infectious Diseases is home to a robust infectious diseases research program centered on multiple infectious disease problems. The Department of Microbiology & Immunology has a major focus on infectious diseases, as does the Center for Predictive Medicine. The School of Dentistry’s Oral Health program is important to the UofL infectious diseases effort. A relatively new area of exploration is the effects of the gut microbiome on health. This is especially pertinent to metabolic disorders, as the gut is a major site of metabolism. The UofL School of Dentistry is home to an NIH-funded COBRE studying the microbiome.
Metabolic diseases encompass a host of conditions with which Kentuckians are afflicted, including diabetes, non-alcoholic fatty liver disease, alcoholic organ injury, obesity, etc. This area is highly interconnected with the Cardiovascular and Environmental areas of excellence, and our investigators and health care providers collaborate to give the best treatment to our patients and to find new therapies, new biomarkers and new avenues for exploration for these problems.
Alcohol abuse is a major health problem in Kentucky and alcohol-induced organ injury is a major research focus at UofL. UofL is home to an NIH-funded Alcohol Research Center as well as an NIH-funded Hepatobiology & Toxicology COBRE grant. The gut microbiome is important in alcohol-induced organ injury. UofL is also a participating site in the NIH-funded AlcHepNet consortium of eight centers across the country studying acute alcoholic hepatitis, and UofL is a participating site (Dr. Tom Abell) in the NIH-funded Gastroparesis consortium.
Key to research in metabolic diseases (indeed, all of these areas) are state-of-the-art ‘Omics facilities at UofL. Proteomics efforts are led by Drs. Jon Klein and Mike Merchant. Metabolomics is led by Dr. Xiang Zhang. These investigators use omics technologies to discover new biomarkers and therapeutic targets.
The University of Louisville is home to a very large research and patient care enterprise centered on spinal cord injury. The Kentucky Spinal Cord Injury Research Center was founded through an NIH-funded COBRE grant and continues its important work. Dr. Susan Harkema heads a research team focusing on neurostimulation/locomotion training for spinal cord injury. Dr. Tom Abell is looking at gastroparesis in spinal cord injury patients. Drs. Craig McClain, Shirish Barve and Sri Prakash Mokshagundam are examining metabolic disorders in these patients, showing the interconnections between multiple areas of excellence at UofL.
Kentucky is a leader in the incidence of multiple cancers such as lung cancer. Kentucky’s overall cancer death rate is 17% worse than the national average, and the lung cancer death rate is 45% higher than the national average. At the University of Louisville, cancer care and research are centered in the James Graham Brown Cancer Center, a part of UofL Healthcare. Researchers have discovered important potential therapies for melanomas, lung cancers, and others, and have a robust clinical trials program. The UofL ExCITE program is an NIH REACH program and is headed by one of the Brown Cancer Center investigators, Paula Bates, PhD.
The Brown Cancer Center is also home to a very large tissue repository that provides samples for research. James Graham Brown Cancer Center Biorepository (BCCB) contains plasma, serum, urine and human fresh frozen tissue samples with corresponding clinical information available for researches. Investigators can obtain the material after Utilization Committee approval (IRB approved supporting documents are required). All samples are available from a wide variety of cancers with corresponding normal tissue controls. The BCCB offers prospective and retrospective specimens selection from the existing biobank. For detailed information, contact the BCCB.
The University of Louisville has developed an outstanding Clinical Trials Unit (CTU) that offers “one-stop shopping” for investigators looking to perform clinical research. Concerning contract negotiation to regulatory compliance, financial oversight to trial coordination/nursing care or working with study monitoring procedures, the CTU can help investigators.