The OHSU-PSU School of Public Health recently established the Center for Infectious Disease Studies , led by Kevin Winthrop, M.D., M.P.H., an epidemiologist and infectious disease expert.
The Center specializes in evaluations of infectious disease, in individual patients and the population as a whole. The Center’s experts are national leaders in two rare diseases that predominantly affect the lungs – nontuberculous mycobacterial, or NTM disease, and bronchiectasis. About 100,000 people in the U.S. have pulmonary NTM disease, and 200,000 have bronchiectasis.
NTM can cause a chronic infection that may lead to progressive lung disease. Bronchiectasis is an inflammatory lung disease in which the walls of the bronchi, the airways into the lungs, are widened, causing collection of mucus and recurring infections of the airways.
The Center’s researchers also study rheumatologic disease and drug safety, along with pharmacoepidemiology – or research into the use and effectiveness of drugs in large numbers of people.
The Center’s leaders have a special expertise in the study of NTM infection. NTM are naturally-occurring organisms found in water and soil. An NTM lung infection can occur when a person inhales the bacteria from his or her normal environment. Many people never become ill after NTM infection, but others – including the elderly, some younger women and those with existing lung diseases – can develop significant lung problems.
Patients with more severe NTM disease – including those who undergo the 18 to 24 months of a multi-drug treatment used to combat it – can experience significant impacts on their quality of life. And unlike its well-studied “cousin” – Mycobacterium tuberculosis, which causes tuberculosis – much remains unknown about NTM. That complicates both the clinical care of patients and the design of clinical trials to learn more about how the disease can be treated.
Since 2006, Winthrop has led a variety of projects exploring the natural history, burden and treatment of NTM and, more recently, bronchiectasis. (People with NTM infection also often have bronchiectasis.) The Center is one of the founding U.S. research sites in the COPD Foundation’s Bronchiectasis and NTM Research Registry, which was established to help medical centers with expertise on bronchiectasis and NTM work together on research.
The Center places a strong emphasis on the patient-centered aspects of these diseases, and also has partnered with two patient advocacy organizations – NTM Info & Research and the COPD Foundation – on several projects studying the effectiveness of treatments for patients.
In partnership with the Oregon Health Authority, the Center has completed several special projects that helped establish statewide measurements of infection in Oregon during 2005 and 2006. The projects also explored outcomes in a sample of a large number of patients with pulmonary NTM. The Center also did additional work that generated the first estimates of the incidence of pulmonary NTM from 2007 through 2012.
Center leaders continue to work to identify new cases of pulmonary NTM, including through monitoring of laboratory results and a regional network of pulmonary and infectious disease clinics that refers patients to OHSU or the Center for clinical care and for research studies.
The Center founded the NTM Research Consortium , established in 2014 by a group of researchers working to improve NTM patient care and outcomes. Since its inception, the consortium has met annually to further define its mission and vision and prioritize research questions that are important to patients and clinical stakeholders. The consortium includes frequent collaborators Dr. Charles Daley (National Jewish Health), Dr. David Griffith (University of Texas Health Science Center Northeast), and Dr. Kenneth Olivier (National Institutes of Health).
The Pacific Northwest NTM Biobank was established in 2013 to set up a human specimen and clinical data repository from patients confirmed through laboratory results to have NTM. The biobank and repository are supported by the Oregon Clinical and Translational Research Institute, the American Lung Association and most recently a grant from the American Thoracic Society Foundation/American Lung Association of the Mountain Pacific. The biobank has enrolled more than 400 patients and is continuing to enroll.
Center researchers are using the NTM biobank to explore specific questions about NTM, including:
Why NTM progresses in some patients is unknown and largely unexplored. Today, physicians cannot predict which patients will suffer disease progression or would benefit from antibiotic therapy. In collaboration with David Lewinsohn, M.D, Ph.D., a tuberculosis immunologist at OHSU, Center researchers are conducting pilot studies using biobank samples to evaluate immune responses in patients with NTM disease. We are specifically interested in predictors of disease development after infection and predictors of treatment response.
Center researchers are evaluating the health-related quality of life in NTM patients. Patients and doctors have reported that improvement in symptoms and ability to function is an important outcome of treatment for NTM patients. In a prior Center research project, patients identified health-related quality of life as the most important outcome that current and future research should measure.
The Center is collaborating with Alexandra Quittner, Ph.D., a professor of psychology at the University of Miami, to validate measures developed for bronchiectasis and NTM. In addition, our research is examining whether quality of life measurements can be used to measure how well NTM treatment is working.
Center researchers are working with a patient advisory panel, the COPD Foundation, NTM Info & Research and researchers at other institutions on a comparative effectiveness study sponsored by the Patient-Centered Outcomes Research Institute, a nonprofit institute. We are evaluating the benefits and harms of the most common therapies prescribed for bronchiectasis. To do that, we are using data on a large group of bronchiectasis patients from the Centers for Medicare and Medicaid Services.
The Center’s staff includes an epidemiologist, a program director, four study coordinators, three program managers and an analyst.
Kevin Winthrop, M.D., M.P.H. – is principal investigator and director of the Center for Infectious Disease Studies. Dr. Winthrop is a professor of public health at the School of Public Health and an associate professor of infectious diseases and ophthalmology at the OHSU School of Medicine. He is a former infectious disease epidemiologist with the Division of Tuberculosis Elimination at the U.S. Centers for Disease Control and Prevention. More information on his clinical care can be found here: http://www.ohsu.edu/xd/education/schools/school-of-medicine/departments/clinical-departments/medicine/divisions/infectious-diseases/faculty/kevin-winthrop.cfm
Sabina Blizzard, B.A. – earned her bachelor’s degree in biology at Lewis & Clark College, and is working towards her MPH at the OHSU-PSU School of Public Health. She is a study coordinator working on clinical trials for treating NTM chest infections.
Amanda Brunton, M.P.H. – is a study coordinator supporting the safety and effectiveness of the Varicella Zoster vaccine study and clinical trials for treating NTM chest infections. She has a BS in biology from the University of Nevada, Reno, and an MPH from OHSU, specializing in epidemiology and biostatistics.
Joseph Clock, B.A. – earned a bachelor’s degree in public health at Portland State University. He is a study coordinator working on clinical trials for treating NTM chest infections and the safety and effectiveness of the Varicella Zoster vaccine study.
Emily Henkle, Ph.D., M.P.H. –is an epidemiologist and principal investigator/co-principal investigator on several grants focusing on the natural history of NTM infection and the Center’s research supported by the Patient-Centered Outcomes Research Institute, or PCORI. She also runs the Center’s population-health biobank.
Erin Hernandez, B.A. – is a program manager working on the population-health biobank for individuals with NTM and the Center’s participation in the national Bronchiectasis Research Registry. She earned her bachelor’s degree in politics and environmental studies at Whitman College, and is pursuing her MPH at the OHSU-PSU School of Public Health.
Jennifer Ku, M.P.H. – is a program manager working on the safety and effectiveness of the Varicella Zoster vaccine study and the population-health biobank for individuals with NTM. She has a bachelor’s degree in Neuroscience from the University of Michigan, and an MPH from OHSU, specializing in epidemiology and biostatistics.
Sarah Siegel, M.P.H. – is a Ph.D. student in epidemiology in the OHSU-PSU School of Public Health. When she graduates, she will take on the formal title of program director for the Center of Infectious Disease Studies, and will oversee all of the Center’s clinical trials as well as epidemiological evaluations of infections in immunosuppressed populations. Sarah earned her BS in materials science and engineering at Cornell University, and her MPH at OHSU, specializing in epidemiology and biostatistics.
Peter Sullivan, B.A. – has a bachelor’s degree in biochemistry from Oberlin College. He is a study coordinator working on clinical trials for treating NTM chest infections, and the population-health biobank for individuals with NTM.
Megan Wardrop, M.S. – is the program manager for the PCORI-funded Bronchiectasis Research project, and coordinating center manager for the Clofazimine/NTM treatment trial. She has a BA in psychology and French from Bowdoin College, and a master’s degree in counseling psychology from Northeastern University.
Benjamin Chan, M.S. – is a biostatistician associated with the School of Public Health’s Biostatistics & Design Program. He supports analysis of large administrative databases, as well as clinical trial design and analysis. Ben earned his BA in statistics at the University of California, Berkeley, and Master’s degrees in biostatistics and teaching from The University of Washington and Concordia University, respectively.
Gregory Ranches, M.D. – is a sub-investigator working on the Center’s clinical trials on lung disease. His research involves the epidemiology of NTM, specifically the identification of risk factors for progressive pulmonary NTM infection. He earned his bachelor’s degree in biological sciences from the University of California Irvine, and his MD degree at the Sydney Kimmel Medical College in Philadelphia, Penn. He completed his internal medicine and chief residency at Scripps Health in San Diego, Calif., and began his Pulmonary and Critical Care Medicine fellowship at OHSU in 2015.
Luke Strnad, M.D. – is an assistant professor of medicine in the Division of Infectious Diseases. He is an investigator with the Center, focusing on clinical trial involving therapy for NTM chest infections. He is a clinician educator within the School of Medicine and specializes in mycobacterial disease and staphylococcus aureus infections. He completed his medical school at Loma Linda University School of Medicine, his internal medicine residency and chief residency at the Beth Israel Deaconess Department of Medicine, and his infectious disease fellowship training at the University of California San Francisco before joining the OHSU infectious diseases faculty in 2016. In addition to his clinical and educational work within the department of medicine, Luke is the co-director of the infectious disease fellowship program’s HIV curriculum, a member of the OHSU Educators’ Collaborative, and a member of the IDSA/ESCMID staphylococcus aureus bacteremia guideline writing committee.More information on his clinical care can be found here.
Industry-sponsored. Jeffrey Curtis and Kevin Winthrop are co-principal investigators. Using a large database (Medicare) to estimate the baseline comorbidities within a standing cohort of patients with psoriasis. Quantify the background incidence of key events and outcomes of interest and to evaluate the association of event incidence with various comorbidities, drug exposures, and other patient factors.
Industry-sponsored. Jeffrey Curtis and Kevin Winthrop are co-principal investigators. Analyze the prevalence of the ankylosing spondylitis-associated co-morbidities and disease manifestations in large cohorts of ankylosing spondylitis patients identified from three administrative databases. Compare the incidence of disease-associated events including malignancy and hospitalized infection in patients starting TNF inhibitors with those treated with non-steroidal anti-inflammatory drugs and non-biologic disease modifying anti-rheumatic drugs.
Psoriasis-related morbidity and mortality, unfunded. Sarah Siegel is the PI with Kevin Winthrop as mentor. Evaluate the association between treatment type and psoriasis-related morbidity and mortality among Medicare beneficiaries, taking into account disease severity. Medicare beneficiaries will be linked to the national Corrona Registry and the OHSU-based Center for Psoriasis and Psoriatic Arthritis registry. This study will combine clinical data and population health data to fill critical knowledge gaps related to adverse outcomes and mortality.