In May, hundreds of UCI faculty, staff and students celebrated UCI’s annual Pathway to Cures: Translational Science Day at the Cove @ UCI, hosted by UCI’s Institute for Clinical and Translational Science, a local centerpiece funded by the National Institutes of Health and under the Clinical and Translational Sciences Award program. ICTS is dedicated to advancing scientific discoveries and medical breakthroughs.
The full day event featured impactful and thought-provoking presentations, think tanks, and oral and poster presentations that focused on the concept of clinical translational science as well as addressed electronic health records (EHR), a large pain point in healthcare. Enrique Lavernia, provost and executive vice chancellor, Ph.D., provided opening remarks touting UCI’s research and the UCI ICTS.
“Moving from basic science to pathways that lead to cures is really something we are proud of and are investing in because we think it’s important for us as a campus,” said Lavernia. “Having an impact on the community is one of the strategic objectives of our strategic plan. We are proud to be the host of one of 60 NIH-funded centers of clinical translational science.”
Lavernia highlighted just a few of ICTS’ accomplishments, such as hosting 16,213 visits for clinical research producing 1,159 publications. He noted that gaining ICTS affiliated scholars, which account for over 50 percent of NIH grants and the increasing grant connectivity, as an important goal for the campus.
“On the education front, 345 UCI undergraduates took the ICTS 190 series in translational research, so we are building the pipeline–something that is very important,” said Lavernia. “I would also like to announce and celebrate the number of clinical trials, an average 12-15, $31 million a year, last year, they went up to $70 million.”
Keynote speaker Edward Shortliffe, professor of biomedical informatics and senior advisor to the dean in the college of health solutions at Arizona State University, M.D., Ph.D., began his discussion with a broad scope to trace the evolution of clinical translational science. He discussed electronic health record (EHR) and informatics’ role in the evolution of clinical translational science.
“We are back in a stage of evolving process,” said Dr. Shortliffe. “We know what the problems are, we know what needs to get fixed, but we’re dealing with a political and economic system that creates challenges for us to make those fixes.”
Dr. Shortliffe discussed that needing an EHR system is not the issue at hand, as the focus should be on the research needed with regards to clinician usability and patient interface, as well as the sharing of information.
“Yes, there are limitations to our current systems, including EHRs… but the trajectory is clearer,” said Dr. Shortliffe. “We have to deal with some of the non-scientific barriers for improvement, but have faith and be part of the process.”
Think Tank Sessions
Later in the morning, the first Think Tank session, “The SEPSIS Challenge: Opportunities of Applying Emerging Computer Technologies for Better Patient Outcomes,” developed in partnership with Beckman Coulter, identified the technology gaps that could enhance the day-to-day effectiveness of clinical care in sepsis detection.
According to the presentation, sepsis is a life-threatening illness with a high mortality rate and is one of the leading causes of death in the intensive care unit. It accounts for 20 percent of all ICU admissions and is reported in 750,000 cases per year in the United States.
Panel speaker Michael Samoszuk, chief medical officer, Beckman-Coulter Diagnostics and Life Science, M.D., discussed the current unmet needs for early detection, diagnosis confirmation and monitoring treatment responses as potentially being treated through artificial intelligence.
“Sepsis often accompanies very serious illness types, but sometimes will just occur out of the blue,” said Dr. Samouzuk. “It has a huge cost, it actually exceeds colon cancer, breast cancer, AIDS, and congestive heart failure combined.”
Among a panel of featured speakers, Shruti Gohil, associated medical director epidemiology and infection prevention at UCI, M.D., Ph.D., highlighted challenges for clinicians and researchers, which are the diagnostic odyssey in identifying patients who have sepsis and lab test turnaround times. As a $600 million market, she labeled sepsis as a “prime target” for AI.
“Machine algorithms can be super helpful,” Dr. Gohil. “We’re already finding that amongst about 300,000 patients that we have studied retrospectively, 40 percent of them receive a big antibiotic when actually 1.2 percent of those people need it.”
The second Think Tank session, “Are Physicians Obsolete in the Age of Artificial Intelligence?” featured three panelists who shared their opinions on the hot button topic.
“Doctoring is fundamentally a human interaction,” said Douglas Bell, M.D., Ph.D., Ronald Reagan UCLA Medical Center. “Ultimately patients want to have a person in the driver’s seat.”
Dr. Bell described that, despite the fact that some may be untrusting of medical doctors, patients need an authority figure during the medical journey. AI could one day have better predictions than a medical doctor, but he emphasized the need for a person to interpret the results.
Paul Fu, M.D., MPH, clinical informatics director, Harbor-UCLA Medical Center, discussed his opposing view. Dr. Fu compared the evolution of the doctor over time with the current status of several support staff within the medical community, as well as computers, stating the idea of a physician as “obsolete.”
“I think proceduralists will be the first physicians to really go away,” said Dr. Fu. “I needed a really good gastroenterologist to do my endoscopy before. Now, I’m just going to swallow a pill and take some pictures while it’s on its way down.”
According to Dr. Fu, due to the human brain’s wear limitations, computers will outpace human performance.
Daniella Meeker, clinical research informatics director, University of Southern California, Ph.D., agreed with Dr. Fu’s view and predicted that AI may replace certain aspects of the medical community.
“We’ve seen some amazing things with machine learning and AI with respect to how we can differentiate imaging,” said Meeker. “When we’re looking at machine learning problems, are we training them with the right information?”
She questioned machine learning’s objective process towards the right answer and also asked if the answer is oriented towards cost-effectiveness in the age of value-based care.
“Part of the way we could advance towards a better partnership between the physician and the computer might be taking into account more of these things that are in the gray area and understanding when the clinical judgement and human interactions are going to be more informative at managing that uncertainty versus a deterministic answer,” said Meeker.
More than 70 poster presentations from UCI students, faculty and researchers were showcased just outside of the Cove’s prototyping lab. Of the posters, five were selected for oral presentations, which were held in Launch Bay.
UCI undergrad Taylor Capretz gave the first presentation: “Can coconut water consumption potentially prevent kidney stones?”
Capretz highlighted low levels of urinary citrate as a risk factor for kidney stones. She said citrate inhibits the process of calcium formation, and patients are then diagnosed with hypocitraturia, or a citrate excretion of less than 320 milligrams per day. The most common treatment for patients with hypocitraturia is potassium citrate, which Capretz mentioned increases urinary citrate levels to prevent stone formation.
“Adherence to the supplement is poor given the frequency to take the medications—up to two-to-three times daily, and the overall cost of approximately $180 per month,” said Capretz.
The team concluded that coconut water revealed a significant increase in urinary potassium and chloride. The audience asked the team about specific brands of coconut water or similarly products that are reputed for hydration.
Joanna Bisquera-Cacpal, M.D., neonatal fellow at UCI Medical Center, gave the second presentation, “Autologous vs. Allogeneic Mesenchymal Stem Cells in Neonatal Bronchopulmonary Dysplasia,” which focused on human preterm umbilical cord mesenchymal stem cells (MSC), or stem cells that develop into tissues of the lymphatic and circulatory systems. She hypothesized that if preterm MSCs are harvested from the umbilical cords of non-bronchopulmonary dysplasia (BPD), then infants will have superior biological efficacy compared to MSC’s harvested from BPD infants, which proves as a potential stem cell-based therapy for neonatal lung disease.
BPD is a chronic lung disease that affects mostly premature newborns and infants, according to the American Lung Association. Most infants recover, but some may have long-term breathing difficulty.
Following the previous, “Determination of LOXL-1 and Fibulin-5 Levels in the Vaginal Secretions of Women With and Without Pelvic Organ Prolapse,” was presented by Bobby Garcia, M.D., UCI Department of Obstetrics and Gynecology. The team wants to develop a non-invasive tool to measure LOXL-1, or the lysyl oxidase enzyme, and the Fibulin-5 protein in vagina secretions to determine women who may or may not experience pelvic organ prolapse. According to the team’s abstract, POP is defined as the descent of the vaginal walls, apex of the vagina or uterus–a potentially devastating condition that affects up to 50 percent of women.
“In this small pilot, we were able to develop a novel non-invasive method to detect LOX1 and Fibulin-5 in vaginal sections of women with and without POP,” said Dr. Garcia.
The team concluded that the data supports a trend towards a positive correlation between prolapse stage and Fibulin-5 concentration and also a negative correlation between prolapse stage and LOXL-1 concentration.
Nima Khoshab, M.Sc., discussed “Tissue-engineered 3D Ear Cartilage Construct,” which focuses on co-culturing chondrocytes, or health cartilage cells, with adipose derived stem cells (ADSCs) to increase chondrocyte proliferation and to introduce new acellularized adipose matrix (AAM) as cell scaffold.
The team concluded with an observed improvement in chondrogenesis, or the generation of cartilage, by co-culturing chondrocytes with ADSCs, with the new AAM providing a good framework for cellular growth.
Lastly, Arul Subramanian, Ph.D., presented “Developing a translational approach to treat tendon injuries using insights from zebrafish,” which focuses on a scaffolding protein that maintains configuration of attachments between tendons and muscles in animals. The team’s work presents new ways to treat sports injuries, heart attacks and other musculoskeletal disorders, such as muscular dystrophy.
Their study identified a novel protein, TSP4 as an essential scaffold for formation and maintenance of tendon matrix assembly. They found that TSP4 is essential for proper muscle attachment and maturation.
10th Annual Awards Dinner
The day-long event concluded with a cocktail reception at the Cove and the 10th Annual Awards Dinner—“People who Make a Difference in Human Health,” where several UCI faculty were honored for making a remarkable difference in human health at UCI and the community.
Clinical Translational Scientist Career Achievement Award:
Bruce Tromberg, Ph.D., UCI School of Engineering
Junior Investigator of the Year:
An Do, M.D., UCI Irvine Health
Distinguished Faculty Mentor Award Recipient:
Alan Widgerow, MBBCh (M.D.), MMed (MHS), FCS, FACS
Industry-University Partnership Award:
Fiona Adair, Ph.D., Beckman Coulter & Abe Lee, Ph.D., UCI Biomedical Engineering Department