Dr. Brian Cox Awarded Grant from Preeclampsia Foundation
The Department of Physiology’s Dr. Brian Cox has been awarded a 2022 Peter Joseph Pappas Research Grant from the Preeclampsia Foundation for his project “Subtyping and clustering of preeclampsia, a personalized medicine approach to improve prediction.” Named for the infant son of preeclampsia survivor Lauren Pappas and her husband Clement, the Peter Joseph Pappas Research Grants program awards grants totaling up to $200,000 each year.
Dr. Cox took some time over Zoom to tell us more about this exciting project. The conversation has been edited for length and clarity.
What is preeclampsia?
Preeclampsia is a disease of pregnancy. It causes hypertension in pregnancy which can be extremely severe and lead to other problems, such as kidney damage, heart failure and stroke. If we don’t treat it early enough, it becomes what’s called eclampsia, which is generally fatal. In developed countries we have a lot more prenatal care available and we can catch the preeclampsia. There’s some debate around whether we “treat” it or not, but the “treatment” is generally to deliver the baby and often preterm, which can create other problems. Unfortunately not all types of preeclampsia improve once you get the baby and the placenta out.
Why is it important to study today?
In spite of decent outcomes in developed countries, people still get sick. The disease is one of the one of the highest reasons for hospitalization of women and accounts for something around a third of all Neonatal Intensive Care admissions. Outside of developed countries, in places where there is no prenatal care, preeclampsia is a leading cause of death for pregnant people and fetuses.
The other problem is that it affects some groups of people disproportionately. In the United States, for example, pregnant people of African American descent have higher rates of death and neonatal death than non-African American pregnant people. So this may be in part due to a disparity in delivery and distribution of healthcare to that population. And it could also be that that preeclampsia in an African American person is not the same as in a Caucasian or South Asian person, for example. The difference could be influenced by genetic, socioeconomic factors, or dietary and lifestyle factors, but these things are not yet well known.
How will your project help us learn more?
One of the aims of the Preeclampsia Foundation has been to create patient data sets on preeclampsia. It's community driven, people consent to have their clinical record sent to the foundation, and they abstract information into a database in part based on researchers’ interests. Most of what they’ve got in the database so far is information on the pregant people – weight, age, blood pressure, etc. Part of my project is to focus now on the fetal data part of the chart so we can think about the interplay between what's happening to the fetus and what's happening to the pregnant person.
I also have some Commonwealth data collected and the Preeclampsia Foundation’s data set is largely American, so that gives me two different locations, different demographics of people to try to compare. The more we can figure out why some patients do well, some patients do poorly, why some babies are growth restricted, why some are not…if we can understand those things, then maybe that's what gets us towards treatments.
Another thing that I'm trying to do with this grant is to take patient demographic information – not just clinical factors, but their ethnicity, socio-demographic score, whether they live urban or rural, etc. – and try to disentangle what some of those environmental influences are that affect the rate of preeclampsia.
What does receiving this grant from the Preeclampsia Foundation mean to you?
I’ll use this grant to hire a new person for my lab who has more of a background in statistics and blend that with my developmental biology background and hopefully find some synergy there. It’s a way to get some interdisciplinary work happening and expand the type of big data work we’ve been doing more of in Physiology.
The other thing is that when I work with the Preeclampsia Foundation to abstract the data I need, that data becomes available for other researchers too. It creates a continuing and expanding resource for other people, so it’s not just something that’s mine alone. That keeps with the sort of community spirit of what the Foundation is trying to do. The more researchers tap into these resources and use them, the larger we can make them.