February 19, 2010

Article seeks to spur preterm birth research

Article seeks to spur preterm birth research

Preterm birth should be among our top national research priorities.

That was the underlying message of an article in the Feb. 11 New England Journal of Medicine by Lou Muglia, M.D., vice chair for Research Affairs in the Vanderbilt University School of Medicine's Department of Pediatrics, and Michael Katz, M.D., senior vice president for Research and Global Programs, March of Dimes Foundation.

Lou Muglia, M.D.

Lou Muglia, M.D.

In the review article, entitled “The enigma of spontaneous preterm birth,” Muglia said in order to untangle the mechanisms behind prematurity we first need to understand the mechanisms behind full-term delivery.

“We don't know why children are born prematurely, and we don't know why children are born at the normal time, for that matter. This provides one of the great opportunities for thinking about an important biologic question and having discovery that leads to immediate clinical impact,” Muglia said.

Muglia serves as chair of the five-member Burroughs Wellcome Preterm Birth Initiative Advisory Committee, a group that oversees distribution of $3.5 million in grants for preterm research. He works closely with Katz, who directs a similar research support program at the March of Dimes.
Muglia and Katz hope the article will serve to ignite interest in further research in both the basic science and clinical realms.

“When you spend months and years taking care of the preterm babies and the consequences that follow them for the rest of their life, you appreciate what an enormous public health problem this is. You start to say to yourself, 'Where can I really make a difference?'” Muglia said.

“As the article in the New England Journal proves, no population is immune to preterm birth, and yet so little is known about how to prevent it,” said Jeff Balser, M.D., Ph.D., vice chancellor for Health Affairs and dean of Vanderbilt University School of Medicine. “This is one of the topics that gets right to the heart of the human experience, and Dr. Muglia's work offers hope that we can finally begin to reverse the trend of prematurity.”

Jonathan Gitlin, M.D., James C. Overall Professor and chair of the Department of Pediatrics, calls Muglia a “brilliant thinker” on the topic of preterm birth — an area that is a focus for his department.

“Lou Muglia is at the forefront of research that will discover the causes of premature birth. I have every confidence that he and his colleagues will lead the way to novel therapeutic approaches that will eliminate this devastating problem and forever change the face of pediatrics at Vanderbilt and around the world,” Gitlin said.

In the article, Muglia and Katz laid out the enormous global annual impact of preterm birth: 8 million infants die before their first birthday; in the United States alone, as much as 34 percent of infant deaths are attributable to prematurity, but the cause of premature birth is unknown in about half of cases. It also detailed how unique the physiologic timing of human birth really is, and how much we still need to learn.

“Just as there are genetic contributors for dysregulated blood glucose, appetite regulation, and obesity, the timing of birth has genetic contributors too, but no one has really looked for them and nobody knows how environmental factors change those signals to alter the timing,” Muglia said.

The article reviewed some key areas of research, including social stress and race, infection and inflammation and genetic factors. Vanderbilt projects like the BioVU DNA database bring large-scale genetic studies into the realm of possibility for the first time.

“Vanderbilt is leading the way in this area. Ultimately it would be great to have 50 BioVUs around the country because you could really get a specific cohort in large enough numbers to complete the types of studies that are needed,” Muglia said.

Muglia's own research focuses on genetic studies with evolutionary approaches to describe the mechanisms surrounding the timing of birth.