Listen: How One NIH Institute is Combating COVID-19 and Health Disparities

Listen: How One NIH Institute is Combating COVID-19 and Health Disparities

Season: 2
| Episode: 17
NIDDK Director Dr. Griffin Rodgers talks COVID-19, disparities in health, and top priorities at the institute.
Dr. Griffin Rodgers, NIDDK Director

With people of minority background and those with obesity and diabetes most at risk for severe cases of COVID-19, the National Institute of Diabetes and Digestive and Kidney Diseases is leading in the research behind why that is. Director Dr. Griffin Rodgers, who contributed to the first effective therapy for sickle cell anemia, updates HealthCast on the institute's work to lessen the effects of COVID-19 on its research community, as well as other top research and data initiatives at the institution.

Podcast
Transcript
Melissa: Welcome to HealthCast, the heartbeat of health IT. I'm your host, Melissa Harris. The National Institutes of Health have been one of the forefront federal organizations working to combat COVID-19, a virus that has challenged this country immensely over the past year plus. The disease has disproportionate mortality and health impacts for certain individuals, especially obese people and those with diabetes, and COVID-19 has also been found to lead to kidney failure. At the same time, the virus has also impacted communities of color and underserved populations disproportionately, a sign that COVID-19 is inflaming underlying issues in public health. I mention all of these because there's one NIH leader who's tackling all of these issues and is here today to illuminate how his Institute is working to combat them. National Institute of Diabetes and Digestive Kidney Diseases Director Dr. Griffin Rodgers is our guest today. Not only will he discuss NIDDK’s work understanding and fighting COVID-19, but also about how NIDDK is working on some cutting-edge projects like rebuilding the kidney. We’ll also see how Dr. Rodgers is getting the institute’s work out there through some pretty strong communications efforts. He even has his own talk show. Alright Dr. Rogers, thank you for joining me today.

Rodgers: Well, it's great to be here today.

Melissa: I wanted to start with some of NIDDK's research priorities. Although NIDDK has a number of research areas that affect hundreds of millions of people globally, which of these areas has been of particular notice, or of recent heightened importance to you? I'd imagine that COVID-19 is top of mind.

Rodgers: Well, thank you Melissa. NIDDK supports and conduct research on some of the most chronic and common and costly and consequential diseases and conditions affecting people in this country. While all of our research areas are important, we've had a heightened sense of awareness of the diseases within our mission that put people at a higher risk of COVID-19 infections, such as obesity, diabetes, kidney diseases. These conditions are also major risk factors for COVID-19 severity. For example, diabetes is associated with a greater than two-fold increased risk of death and other adverse outcomes from COVID-19. And many of the diseases within our portfolio, as well as COVID-19, disproportionately affect people from minority groups and people in lower socioeconomic status groups, which has also increased our focus on the social determinants of health. NIDDK has been and very much continues to be firmly committed to research programs aimed at reducing health disparities and advancing health equity.

Melissa: COVID-19 crosscuts with areas of your institute’s interest. How is your Institute helping to understand, treat, and prevent COVID-19?

Rodgers: Since the beginning of the pandemic, NIH has implemented a rigorous coordinated response against COVID-19 by advancing research on the fundamental knowledge of the disease. Detection and diagnosis, treatment, prevention and health disparities. NIDDK has joined in these efforts in many ways. Here are just a few examples. NIDDK provides support for the rapid acceleration of diagnostics underserved population, abbreviated RADx-UP, a research program launched by NIH to speed up the development of accurate COVID-19 testing and makes this testing accessible to all, including people in underserved areas. Through special funding opportunities, NIDDK is encouraging new research that explores the pathways responsible for poor outcomes and COVID-19 due to conditions like diabetes and kidney disease, as well as research that helps us understand how COVID-19 infection results in damage to organs relevant to NIDDK. Such research could help people who develop post-acute COVID syndrome, often called long-haulers, as well as address the social determinants of health that contribute to the increasing prevalence of metabolic diseases. And many researchers at NIDDK have pivoted their research activities to broadening understanding of SARS COVID-2, ranging from fundamental studies of the virus and potential vaccine targets, to clinical studies of viral detection, organ impact, and possible symptom prevention. For example, NIDDK investigators published findings early in the pandemic showing that simple speech may promote the spread of the virus, even from people were asymptomatic, results that underscore the importance of mask wearing to stem the pandemic.

Melissa: You were talking about before how NIDDK has a number of areas of work around health disparities and ending them. You've committed with NIH Director Dr. Francis Collins to end systemic racism in biomedical research. What work have you done to reach these goals and what further work needs to be done?

Rodgers: Well, NIDDK has been working to advance diversity, equity, and inclusion for several decades. For example, through our many programs that provide training, support, and opportunities to students and new investigators from groups underrepresented in biomedical research. Despite this progress that we've made, we know that there's much more work that remains, and we've committed to redoubling efforts to combat health disparities and increase workplace diversity. We've outlined four major avenues to combat health disparities. One, redoubling our efforts to recruit diverse study cohorts, inclusive of those most affected. Two, in opening doors for young people from underrepresented groups to training, support, and inspiration to pursue research careers. Three, engaging clinical trial participants more broadly in the entire research enterprise, and also supporting research to identify the causes of health disparities, for example, the social determinants of health.

Melissa: Along those lines, what work are you doing to bridge your research to expand accessibility to care, which is a major issue that we're still grappling with these days.

Rodgers: Well as you may be aware, at NIH our role is conducting research, not the provision of care per say, but that said, at NIDDK, one way we address health equity is by funding research that could transform access to evidence-based services, affordable screening for various diseases, and feasible treatment options that align with peoples’ culture and values. This requires strong collaboration with communities, health care systems, and researchers. For example, the NIDDK-supported Apollo study – everything in government is an acronym, so Apollo stand for APOL1 Long-term Kidney Transplant Outcome Network, is exploring how the APOL1 gene variants affect kidney transplantation, with the goal of improving transplant outcome in both kidney donors and recipients. This study team has enlisted a unity advisory committee of African Americans with kidney disease to ensure that the people in those communities most affected by the finding have a key role throughout the research process. NIDDK also supports eight diabetes translation research centers across the country to address health equity and prevention and intervention services, and to foster the next generation of innovative diabetes research. The centers aim to translate research finding into practice to improve the health of people with, and at risk for, diabetes. Those are just two examples.

Melissa: Excellent. I'm sure that a lot of this work takes a lot of effort in communications and outreach to communities and trying to get in touch with the organizations you're trying to impact. So, in that regard, information is power. How’re you using technology and different communication strategies to arm people with the information to look after themselves better and to better reach people generally?

Rodgers: Well, we always strive to reach people where they are and in ways in which they can easily access health information, whether it's through the radio or mobile friendly websites or social media channels or simply calling or emailing us. I host a healthy moments program, which is a weekly radio episode where I provide listeners with reliable science-based healthy lifestyle tips and other important health information. We have over 60 million listeners each week tuning in to us on stations nationwide in areas with the highest rates of conditions, not only NIDDK's mission, but in recent years we partner with our sister institutes here at the NIH to deliver important message. Next month, for example, we’ll be working at having a segment with Dr. Tony Fauci on vaccine hesitancy for those in important populations who have yet to receive their COVID-19 vaccine. People can follow us on Twitter, Facebook, Instagram and YouTube, or subscribe to NIDDK directors update newsletter to find more information. And then finally, our public outreach and health information is extensive and effective, and our mobile website is actually one of the top three websites accessed across the government.
Melissa: I was gonna say, you have a fantastic radio voice, so it's pretty great that you run a radio show.

Rodgers: Thank you. My wife says that I have a face for radio.

Melissa: That’s so funny. So, I also want to piggyback off of the technology aspect. Can you go into the role that health IT plays into determining kidney health outcomes?

Rodgers: Well, increasingly NIDDK is integrating big data tools and analysis to help optimize and accelerate research in our mission areas. For one example is the NIDDK case kidney precision medicine project, which aims to understand human kidney disease by creating an unprecedented database to help uncover, diagnosis, and develop new treatments and cures. This is a very ambitious project and requires a new approach, not just medical records and blood and urine samples, but kidney biopsies, ethically obtained from altruistic research participants with both acute and chronic kidney diseases. These analysis will generate data to find disease pathways and key cells, define disease subgroups, devise individualized treatments, and improve the scientific knowledge base, thereby improving the drug development pipeline, and this is really unprecedented. Ultimately, we envision that this research will find new markers and treatment targets that will make personalized, effective, safe treatment possible for individuals with kidney disease, in a sense, getting the right drug to the right person at the right time.

Melissa: Going off the role of health IT as well, can you go into how health technologies play a critical role in clinical trials and population health management?

Rodgers: Well, technology advances are making it possible for us to address fundamental questions about health once impossible to tackle, you know, refractory. For example, these tools allow us to sift vast quantities of data and samples from thousands of participants in our Environmental Determinants of Diabetes of the Young Study, better known by the acronym TEDDY. This approach will allow us to identify even fairly subtle environmental and biological factors that distinguish children at high risk who go on to develop type one diabetes from those who also at risk but who do not go on to develop so that, one day, we may be able to prevent many cases of type one diabetes in this matter. In addition, a project that we have called the accelerating medicine partnership in type 2 diabetes, or AMP type 2B, is an open resource that allows researchers to access data and perform analysis on genetic variations contributing to diabetes with the goal of identifying potential therapeutic targets and disease precursors. The program created what's called a type 2 diabetes knowledge portal by building a database of DNA sequences, functional genomic and epigenomic and clinical data, from type 2 diabetes studies with cardiac and renal complications data from hundreds of thousands of people, not only in the US, but around the world, and these, this project, this knowledge portal is already providing a lot of return on our investment.

Melissa: You were touching upon the role of data a little bit there, and it can be pretty key for many emerging areas and health, like personalized medicine. How are you starting to look at genetic versus environmental data and health factors to personalize both preventative medicine for better health outcomes and then to treat health conditions?

Rodgers: Well the NIH launched the precision medicine initiative with the long term goal of identifying personalized, maximally effective treatments based upon individual variabilities in genes, environment, and lifestyle that, to that end, the NIH All of Us program is gathering data from at least 1,000,000 volunteers who will reflect our nation's rich diversity. Now one aspect that excites us about the All of Us and other big data tools is their potential to provide novel insights about diabetes on an unprecedented scale, for example, to learn why some people develop diabetes complications or respond to various treatments while others do not. As well, a very recently added component of All of Us is the nutrition for precision health program, which will explore how people respond to different diets by studying the interactions between diet, genes, protein, the microbiome, metabolism, and other factors, and high-quality nutrition studies such as this one will help individuals and their health care providers create healthy, precise, and effective diet plans. We know that people respond quite differently to different types of diets that we hear a lot about, and what this program envisions is taking people's genes, their metabolism, their environment and other factors into consideration, and under control feeding experiments, determining which of those eating plans is best for them.

Melissa: Lastly, what is coming down in your pipeline next at NIDDK? What are some of your moon-shot initiatives and what do you think is generally in store for the future?

Rodgers: Well, we have, you know, a number of initiatives that are ongoing, all related to and taking advantage of this concept of precision health. I’ve focused on a few of them related to diabetes, for example the TEDDY study, the type 2 diabetes efforts, all of which will be addressing personalized components and making sure that we can either prevent the disease or better treat the disease on a more individualized fashion. I talk a little bit about the kidney precision medicine program where we're actually redefining the nature of certain diseases and reclassifying them, which we think will provide new avenues for potential therapies in this regard, more precision-based personalized therapy. One area that I didn't talk about, which really is a, I would consider it to be a moon-shot, is our efforts in rebuilding the kidney. You know that there are 37 million Americans who have elements of chronic kidney disease, and a good number of them, several hundred thousand, develop in-stage kidney disease requiring either dialysis or a kidney transplant in order to remain alive. What this rebuilding the kidney effort is all about is using the tools of regenerative medicine to allow that kidney, albeit nonfunctional, to serve as a shell, in a sense, or a structure under which we can begin a little at a time to redifferentiate some of the remaining cells to ultimately rebuild a functioning kidney, thereby alleviating the need for dialysis or for transplantation in this group. And then finally, in our GI division, therapies more targeted at inflammatory bowel diseases like ulcerated colitis, Crohn's disease, or efforts to regenerate aspects of the liver that have been damaged by a variety of environmental insults. All of these sort of fall under that category of regenerative medicine and we're very excited about these efforts as well. And so this is what the future holds, and with ongoing research by very talented investigators, we think that the future really looks quite bright.

Melissa: Certainly. As someone who, you know, has had a couple of people in my life who have had severe kidney issues, I really appreciate the work that you and your Institute are doing, so thank you so much for joining me today.

Rodgers: Thanks again for having me, and I hope that your listeners enjoy the segment as much as I have.