Thomas Jansson, MD, PhD, and Theresa Powell, PhD, at work in their
laboratory on the CU Anschutz Medical Campus. Photos by Trevr Merchant.
By Mark Couch
(December 2017) More than 60 investigators from the CU School of
Medicine have joined together to study ways to improve lifelong health
by addressing the health conditions in pregnancy that impact the
developing fetus in the womb.
Called “Building Better Babies,” the
program was created when Thomas Jansson, MD, PhD, and Theresa Powell,
PhD, led an effort to apply for special funding for transformational
research projects on campus made available by the Dean’s Office in 2016.
Though their initiative wasn’t selected for the Dean’s
Transformational Research Funding program, the faculty decided to
continue working together, establishing a network of investigators based
at CU working in an emerging field of study.
“When I was in
medical school many, many years ago, back in Sweden, we were taught that
disease originates from an interaction of two main factors: genes and
lifestyle,” Jansson said. “And that was a paradigm we lived with for a
long time.
“In the last 10 to 20 years, this paradigm has been
revised. We are beginning to understand that in addition to genes and
lifestyle, risk for disease – whether we’re children or adults – is
influenced by what happens during fetal life or early in infancy.”
This concept – called developmental origins of health and disease – is central to the Building Better Babies initiative.
“We
believe it has incredibly important public health consequences and will
change the way we practice medicine,” said Jansson, who is chief of the
Division of Reproductive Sciences and vice chair of research in the
Department of Obstetrics and Gynecology.
“Diabetes, obesity and
other metabolic diseases are critical areas impacted by intrauterine
factors and it may be possible to prevent or at least curb the current
epidemic of these diseases by intervening in early life,” Jansson said.
“Mental health disorders, such as autism and schizophrenia, also have
intrauterine origins and the fact is that we have researchers on this
campus who are intervening in pregnancy to prevent those diseases in
children.
“The development origins of health and disease paradigm
suggests that we must put much more emphasis on prevention of major
childhood and adult diseases not only by modification of lifestyle, but
also by targeted interventions in pregnancy and in infancy. In fact,
spending precious health care dollars in early life is a good business
proposal and an exceptional investment.”
Expanding the map
The
Building Better Babies program is based on this general idea and seeks
to leverage a strength on the Anschutz Medical Campus. Jansson and
Powell knew there were many individual investigators across different
departments in the School of Medicine – and in other schools on the
campus – with their own National Institutes of Health funding in this
area. Why not bring them together?
Thomas Jansson, MD, PhD, and
Theresa Powell, PhD, at work in their laboratory on the CU Anschutz
Medical Campus.
“We
strongly argue that we need to be a center or a program, to do
cutting-edge research, and to inform our colleagues because many in
adult medicine, have no idea about his concept,” said Powell, professor
in the Section of Neonatology, Department of Pediatrics. “Some say,
‘This doesn’t really affect me.’ And we say, ‘Yes it does.’”
As a
result, education of colleagues on campus became a critical mission for
the team leading Building Better Babies. Last spring, they hosted a
daylong conference that assembled researchers on campus, hosted experts
in the field, and included poster presentations from early career
investigators.
Richard Johnston, Jr., MD, professor emeritus of
pediatrics who was the medical director of the March of Dimes when it
began its folic acid awareness campaign in the 1990s, told the
organizers that the symposium was “a major event” for the campus with
the potential for significant impact on perinatal health.
For
Powell and Jansson, the effort is not simply a theoretical premise or
administrative exercise. They also conduct perinatal research that could
lead to lifelong health improvements for the next generation.
“One
of the focus areas of our research is maternal obesity,” Jansson said.
“If you include being overweight as associated with risk, there’s
actually two-thirds of all pregnant women starting pregnancy either
obese or overweight.”
“It’s the most common complication in
pregnancy,” Powell said. “Nothing else – diabetes, preeclampsia,
pre-term birth – come anywhere close to 60 percent of the pregnant
population.”
In particular, Powell and Jansson are interested in
how to address the baby’s risk of metabolic disease later in life when
the mother is obese or develops gestational diabetes.
In their
studies, they are examining the effect of supplementing the obese mother
with adiponectin. Adiponectin is secreted from fat tissue and modulates
multiple metabolic processes. Typically, a lean person has high levels
and an obese person has low levels of this hormone.
“It has been
called the good hormone that everybody wants to have because it
increases your insulin sensitivity and that is a good thing,” said
Jansson.
“In our mouse model of maternal obesity, we see all of
these problems in pregnancy: we get bigger babies, they have too high
glucose, and when they’re three to five months of age, they develop
metabolic disease and cardiovascular disease, as have also been found in
epidemiological studies in humans,” Jansson said.
“Our basic
studies have suggested that adiponectin in the mother is incredibly
important, the fact that it’s low in obese pregnancies impacts both the
mother and her developing baby,” he said. “In our mouse studies we have
supplemented the mother to increase this hormone to levels found in
normal mice and basically we have completely prevented the adverse
effects on placental function, fetal growth and long-term health of the
offspring.”
As Powell and Jansson aim to translate their basic
science results into clinical use, they are also hoping that the
Building Better Babies program promotes working relationships between
faculty members who might not otherwise make connections.
“In the
delivery room when the baby is born, the obstetrician hands that baby
off to the pediatrician,” Powell said. “The two doctors turn to their
respective patients: the pediatrician goes off with the baby and the
obstetrician takes care of the mother.
“And one of the things that Thomas and I are trying to do, and one advantage of having his appointment in obstetrics and mine in
neonatology, is we’re trying to get them talking to each other. In
particular, there are many kinds of interactions to share. We want to
encourage the pediatrician to be looking back into the pregnancy data in
[electronic health records] and the obstetrician to be having a better
understanding the importance of what is happening long-term with that
baby.”