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Why the ‘wimpy’ Y chromosome hasn’t evolved out of existence

Source: Cell Press
Date: 8/17/2020
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An Opinion paper co-authored by a UNSW scientist – published online this month in the journal Trends in Genetics – outlines a new theory, called the “persistent Y hypothesis”, to explain why the Y chromosome may be more resilient than it first appears. 

Much smaller than its counterpart, the X chromosome, the Y chromosome has shrunken drastically over 200 million years of evolution. Even those who study it have used the word “wimpy” to describe it, and yet it continues to stick around even though sex chromosomes in non-mammalian vertebrates are known to experience quite a bit of evolutionary turnover.

“The Y chromosome is generally thought to be protected from extinction by having important functions in sex determination and sperm production, which, if moved to somewhere else in the genome, would signal its demise,” says co-author Paul Waters, an Associate Professor at the UNSW Sydney. “However, we propose that the future of the Y chromosome is secure because it carries executioner genes that are critical for successful progression of male meiosis–and unlike other genes on the Y, these executioners self-regulate.”

During meiosis, sexually reproducing organisms form haploid gametes (eggs and sperm), each of which contains only one copy of each chromosome. They do this through one round of genome replication followed by two consecutive rounds of cell division. This meiotic process is tightly regulated to avoid infertility and chromosome abnormalities. 

One step of meiosis requires the silencing of both the X and Y chromosomes during a specific window. “Importantly, the Y chromosome bears genes that regulate this process, a feature that has been known for years now,” says co-author Aurora Ruiz-Herrera, a professor at Universitat Autònoma de Barcelona in Spain. “We believe that bearing these genes is what protects the Y chromosome from extinction. The genes that regulate the silencing process, the Zfy genes, are called ‘executioner’ genes. When these genes are turned on at the wrong time and at the wrong place during meiosis, they are toxic and execute the developing sperm cell. They essentially act as their own judge, jury, and executioner, and in doing so, protect the Y from being lost.”

The Y chromosome is present in all but a handful of mammalian species. Important contributions to understanding the Y chromosome have come from looking at the rare mammals that don’t follow the rules–for example, a handful of species of rodents. “I’ve always been a firm believer that the comparison of unusual systems is informative to other systems,” A/Prof. Waters says. “Determining the common prerequisites for rare Y chromosome loss enabled us to build a hypothesis for how Y chromosomes persist in most species.”

The collaboration between Waters and Ruiz-Herrera–based half a world apart–began to bear fruit during the COVID-19 pandemic. “Earlier this year, we put together a grant application to examine aspects of X chromosome silencing during meiosis,” says Waters. “After the shutdown of our labs, we decided to massage our discussions into a review article. We had no idea we would essentially stumble onto such an intuitive mechanism to explain why the mammal Y chromosome has persisted in most species.” Going forward, the researchers plan to take a closer look at how the executioner genes evolved, and how they are regulated from evolutionary and functional perspectives.

“The mammalian Y has been taken as a symbol of masculinity, not only in popular culture but also in the scientific community,” Ruiz-Herrera says. “Despite that, many have projected that, given enough time, it will be eventually lost. However, we propose the Y chromosome can escape this fatal fate. So our male colleagues can breathe easy: the Y will persist!”

Paul Waters is supported by the Australian Research Council. Aurora Ruiz-Herrera is supported by the Spanish Ministry of Science and Innovation.

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COVID-19 patients who experience cytokine storms may make few memory B cells

Source: Cell Press
Date: 8/19/2020
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Newswise — The release of massive amounts of proteins called cytokines can lead to some of the most severe symptoms of COVID-19. When large numbers of immune cells release cytokines, this increases inflammation and creates a feedback loop in which more immune cells are activated and this is sometimes called a cytokine storm. An August 19 study in the journal Cell now suggests that high levels of some cytokines may also prevent people who are infected from developing long-term immunity as affected patients were observed to make very few of the type of B cells needed to develop a durable immune response.

“We’ve seen a lot of studies suggesting that immunity to COVID-19 is not durable because the antibodies decline over time,” says co-senior author Shiv Pillai, a professor at Harvard Medical School and member of the Ragon Institute of Massachusetts General Hospital, MIT, and Harvard. “This study provides a mechanism that explains this lower-quality immune response.”

The investigators focused on germinal centers–the areas within the lymph nodes and spleens where B cells, the immune cells that produce antibodies, differentiate. Differentiation and changes in antibody genes are required to build immunity to an infectious agent.

“When we looked at the lymph nodes and spleens of patients who died from COVID-19, including some who died very soon after getting the disease, we saw that these germinal center structures had not formed,” says co-senior author Robert Padera, a pathology professor at Harvard. “We decided to determine why that’s the case.”

Because the disease was so new, animal models for studying COVID-19 infection were not yet available at the time they began their study. The researchers instead gained insights from previous studies involving mouse models of other infections that induce cytokine storm syndrome–a malaria model and one of bacterial infection in which germinal centers were lost.

In people with severe COVID-19, one of most abundant cytokines released is called TNF. In the infected mice, TNF appeared to block the formation of germinal centers. In previous cytokine storm models, when the mice were given antibodies to block TNF or had their TNF gene deleted, the germinal centers were able to form. When the researchers studied the lymph nodes of patients who had died of the disease, they found high levels of TNF in these organs. This led them to conclude that TNF may be preventing the germinal centers from forming in people with COVID-19 as well.

“Studies have suggested this lack of germinal centers happens with SARS infections,” Pillai says. “We even think this phenomenon occurs in some patients with Ebola, so it was not surprising to us.”

The researchers also studied blood and lymphoid tissue from people with active infections who were in different stages of COVID-19. They found that although germinal centers were not formed, B cells were still activated and appeared in the blood, which would allow the patients to produce some neutralizing antibodies. “There is an immune response,” Padera says. “It’s just not coming from a germinal center.”

“Without the germinal centers, there is no long-term memory to the antigens,” Pillai adds. He notes that studies of other coronaviruses that cause colds have suggested that someone can get infected with the same coronavirus three or four times in the same year.

The authors say despite their findings, they still believe a successful COVID-19 vaccine can be developed as it should not cause high levels of cytokines to be released.

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‘Bright spot’ during COVID-19: Increased power from solar panels thanks to cleaner air

Source: Cell Press
Date: 6/22/2020
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During the COVID-19 pandemic, one unexpected outcome in cities around the world has been a reduction in air pollution, as people stay home to avoid contracting the coronavirus. Based on data collected in Delhi, India, researchers report that this cleaner air has led to more sunlight reaching solar panels, resulting in the production of more clean energy. The work appears June 19 in the journal Joule.

“Delhi is one of the most polluted cities on the planet,” says first author Ian Marius Peters of Helmholtz-Institut Erlangen-Nürnberg for Renewable Energies in Germany. “Moreover, India enacted a drastic and sudden lockdown at the start of the pandemic. That means that reductions in air pollution happened very suddenly, making them easier to detect.”

Peters and his colleagues had previously done research in different cities, including Delhi, looking at how haze and air pollution impact how much sunlight reaches the ground and the effect of air pollution on the output of solar panels. The photovoltaic (PV) system installation in Delhi used for the earlier work was still in place, and data on the amount of solar radiation reaching the PV installation (called the level of insolation) was available for the time before and during the shutdown.

Insolation is measured with a pyranometer, an instrument that determines the solar radiation flux density from the hemisphere within a given range of wavelengths. Using data from some of their previous studies, the researchers calculated the changes in insolation.

They found that in late March, the amount of sunlight reaching the solar panels in Delhi increased about 8%, compared with data from the same dates from 2017 to 2019. The insolation at noon increased from about 880 W/sqm to about 950 W/sqm. Information on air quality and particulate matter suggested that reduced pollution levels were a major cause for the rise.

“The increase that we saw is equivalent to the difference between what a PV installation in Houston would produce compared with one in Toronto,” Peters says. “I expected to see some difference, but I was surprised by how clearly the effect was visible.”

The researchers say the new data from Delhi, combined with their earlier findings, provide a solid foundation to further study the impact of air pollution on solar resources. They expect to also find increased output of power from solar panels in other areas where air was cleaner due to lockdown measures.

“The pandemic has been a dramatic event in so many ways, and the world will emerge different than how it was before,” Peters says. “We’ve gotten a glimpse of what a world with better air looks like and see that there may be an opportunity to ‘flatten the climate curve.’ I believe solar panels can play an important role, and that going forward having more PV installations could help drive a positive feedback loop that will result in clearer and cleaner skies.”

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Studying the Neanderthal DNA found in modern humans using stem cells and organoids

Source: Cell Press
Date: 6/18/2020
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Protocols that allow the transformation of human induced pluripotent stem cell (iPSC) lines into organoids have changed the way scientists can study developmental processes and enable them to decipher the interplay between genes and tissue formation, particularly for organs where primary tissue is not available. Now, investigators are taking this technology and applying it to study the developmental effects of Neanderthal DNA. The findings are reported June 18 in the journal Stem Cell Reports.

“Using iPSC lines to study the functions of archaic human DNA is an untapped but very interesting approach,” says senior author J. Gray Camp of the Max Planck Institute for Evolutionary Anthropology in Germany and the University of Basel in Switzerland. “No one has ever been able to look at the role Neanderthal DNA plays during development.”

Studies have found that about 2% of the genomes of modern humans from outside Africa are composed of Neanderthal DNA. This archaic DNA is a result of mating between the two groups tens of thousands of years ago.

In the new study, the team used resources from the Human Induced Pluripotent Stem Cells Initiative (HipSci), an international consortium that provides data and cell lines for research. Nearly all of the data and cell lines in HipSci are from people of UK and Northern European descent. The researchers analyzed this cell line resource for its Neanderthal DNA content and annotated functional Neanderthal variants for each of the cell lines.

“Some Neanderthal alleles have relatively high frequency in this population,” Camp explains. “Because of that, this iPSC resource contains certain genes that are homozygous for Neanderthal alleles, including genes associated with skin and hair color that are highly prevalent in Europeans.”

Camp’s team used five cell lines to generate brain organoids and generated single-cell RNA sequencing data to analyze their cell composition. They showed that this transcriptomic data could be used to track Neanderthal-derived RNA across developmental processes. “This is a proof-of-principal study showing that you can use these resources to study the activity of Neanderthal DNA in a developmental process,” Camp says. “The real challenge will be scaling up the number of lines in one experiment, but this is already starting to be possible.”

Camp notes that this research could be expanded to study other ancient human populations, including Denisovans, which have genes that are present primarily in Oceanian populations. His team also plans to continue studying Neanderthal alleles using HipSci and other resources. “Organoids can be used to study a number of different developmental processes and phenotypes controlled by Neanderthal DNA, including the intestinal tract and digestion, cognition and neural function, and the immune response to pathogens,” he concludes.

The researchers have generated a web browser with this information to make the data easily accessible for future research.

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Team shares blueprint for adapting academic research center to SARS-CoV-2 testing lab

Source: Cell Press
Date: 5/12/2020
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During the COVID-19 pandemic, as demand for SARS-CoV2 diagnostic testing has far outweighed the supply, academic research scientists have begun converting their labs to testing facilities. In a paper published May 10 in Med, a team of investigators from Boston University School of Medicine and Boston Medical Center (BMC) outline how they adapted their lab to test patient samples for SARS-CoV2, and they provide a blueprint for other labs that want to do the same thing.

“As with other basic biology labs across the country, we were forced to shutter operations due to the pandemic,” says senior author George Murphy, an Associate Professor of Medicine in the Division of Hematology and Oncology. “We saw that our friends and colleagues at Boston Medical Center were going into battle on the front lines of this pandemic, but that they were having to wait seven to 10 days for results from state and commercial laboratory facilities. This was unacceptable to us, and we decided we needed to take action.”

Murphy is normally co-director of the Boston University and Boston Medical Center (BMC) Center for Regenerative Medicine (CReM) and focuses on stem cell research. As stem cell and molecular biologists, he and the members of the lab had extensive experience developing and running the type of quantitative, real-time reverse transcriptase polymerase chain reaction (qRT-PCR) assay that was needed to detect the presence of viral RNA in patient samples.

The bigger challenge was adapting their lab to the strict policies required to run a Clinical Laboratory Improvement Amendments (CLIA)-certified, College of American Pathologists (CAP)-accredited diagnostic lab. The team requested and received emergency permission from the FDA to repurpose the lab, and they began operating in less than a week. As of April 20, 2020, they had already tested more than 3,000 samples, with a sample turnaround time that’s under 24 hours. Nearly 45% of those tests were positive, a large number due in part to the high-risk population served by BMC, the largest safety net hospital in New England.

“For about a month or so, we were the only game in town,” Murphy notes. “Results from samples that were sent out to large commercial labs were taking up to a week, but even a wait-time of 24 hours delays the ability to make decisions about whether or not someone needs to be isolated and whether precious PPE [personal protective equipment] should be used.”

The team developed a test that could be done with technologies and reagents that are likely to remain available. The test was also designed with the ability to use different reagents at each step of the process. “Our ‘home-brew’ assay is extremely flexible, allowing us to slot in various reagents at multiple points and eliminating potential supply-chain issues,” Murphy says.

He doesn’t expect the need for testing to decline any time soon. “Although we have gotten through the early stages of this pandemic, which involved the testing of critically ill and symptomatic patients during a time of acute need, everyone is going to soon need to transition into asymptomatic and surveillance testing. It may be extremely difficult for large commercial labs to contend with the enormous number of samples this will entail,” Murphy says. “We decided to share what we did so that other institutions can implement their own in-house testing.”

The team is also looking at expanding to other kinds of assays, including saliva-based tests.

Murphy credits his colleagues and coauthors, including laboratorian Chris Andry, pathologist Nancy Miller and bioinformaticist Taylor Matte, for putting together this testing program so quickly. “We think it’s important for the public to see something positive in these very challenging times,” he concludes. “This project was a wonderful example of collaboration and teamwork in which scientists, clinicians, diagnostic laboratory technicians, and administrators came together to solve a seemingly insurmountable problem.”

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Bioethicist calls out unproven and unlicensed ‘stem cell treatments’ for COVID-19

Source: Cell Press
Date: 5/7/2020
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As the COVID-19 pandemic enters its third month, businesses in the United States are marketing unlicensed and unproven stem-cell-based “therapies” and exosome products that claim to prevent or treat the disease. In Cell Stem Cell on May 5, bioethicist Leigh Turner describes how these companies are “seizing the pandemic as an opportunity to profit from hope and desperation.”

“I’m concerned that individuals purchasing these supposed ‘therapies’ for COVID-19 will be scammed,” says Turner (@LeighGTurner), an associate professor at the University of Minnesota Center for Bioethics. “I’m also worried that they’ll be injured as a result of being given products that haven’t been adequately tested, or that they’ll forgo measures like social distancing because they’ve paid for a product that they think will protect them from being infected or getting sick.”

Many stem cell clinics have a history of selling unproven and unlicensed interventions for injuries and illnesses ranging from Alzheimer’s disease to pulmonary disorders to spinal cord injuries. Since the COVID-19 pandemic began, some have added claims about “immune-boosting” therapies for treating COVID-19 and acute respiratory distress syndrome (ARDS) caused by infection with SARS CoV-2. These companies advertise stem cell interventions and exosome products derived from such sources as umbilical cords and amniotic fluid. Turner says uncritical news media accounts have compounded some of these claims by reporting on preliminary evidence and case studies.

Yet rigorous clinical trials on these stem cell products have not yet been done. “Randomized controlled trials are needed to establish whether particular stem cell products are safe and efficacious in the treatment of COVID-19-related ARDS,” he explains.

Turner has studied the US direct-to-consumer marketplace for stem cell clinics for nearly a decade. “These businesses have a long history of claiming to treat diseases and injuries for which evidence-based therapies do not yet exist,” he says. To find out what these businesses were promoting, he did Google searches on a variety of terms related to stem cell treatments, COVID-19, and ARDS. He also searched YouTube for promotional videos made by these clinics.

“I found more examples of businesses peddling stem cell products for COVID-19 than I had space to describe in detail,” he notes. “I wasn’t surprised at how quickly some of these companies began making these claims. For them, the COVID-19 pandemic is an opportunity to generate a new revenue stream.”

In the paper, Turner also discusses the role of medical organizations, noting that while most are doing a good job of criticizing deceptive advertising, some have been promoting these interventions despite the lack of scientific evidence supporting their use.

“I want members of the public to know that some companies are trying to take advantage of them by selling supposed treatments that aren’t backed by credible evidence,” Turner concludes. “I’m also hoping that this paper will catch the attention of regulatory bodies like the Food and Drug Administration (FDA) and the Federal Trade Commission (FTC), as well as state medical boards and state attorney general offices. The FDA and FTC have issued letters to some businesses, but additional regulatory action is needed.”

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New approach allows blind, sighted to “see” shapes

Source: Cell Press
Date: 5/15/2020
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For most adults who lose their vision, blindness results from damage to the eyes or optic nerve while the brain remains intact. For decades, researchers have proposed developing a device that could restore sight by bypassing damaged eyes and delivering visual information from a camera directly to the brain. In study published in the journal Cell, researchers from Baylor College of Medicine report that they are one step closer to this goal.

They describe an approach in which implanted electrodes are stimulated in a dynamic sequence, essentially “tracing” shapes on the surface of the visual cortex that participants were able to “see.”

“When we used electrical stimulation to dynamically trace letters directly on patients’ brains, they were able to ‘see’ the intended letter shapes and could correctly identify different letters,” said Dr. Daniel Yoshor, professor and chair of neurosurgery and senior author on the paper. “They described seeing glowing spots or lines forming the letters, like skywriting.”

Previous attempts to stimulate the visual cortex have been less successful. Earlier methods treated each electrode like a pixel in a visual display, stimulating many of them at the same time. Participants could detect spots of light but found it hard to discern visual objects or forms. “Rather than trying to build shapes from multiple spots of light, we traced outlines,” said Dr. Michael Beauchamp, professor and in neurosurgery, director of the Core for Advanced MRI and first author on the paper. “Our inspiration for this was the idea of tracing a letter in the palm of someone’s hand.”

The investigators tested the approach in four sighted people who had electrodes implanted in their brains to monitor epilepsy and two blind people who had electrodes implanted over their visual cortex as part of a study of a visual cortical prosthetic device. Stimulation of multiple electrodes in sequences produced perceptions of shapes that subjects were able to correctly identify as specific letters.

The approach, the researchers say, demonstrates that it could be possible for blind people to regain the ability to detect and recognize visual forms by using technology that inputs visual information directly into the brain, should they wish to. The researchers note, however, that several obstacles must be overcome before this technology could be implemented in clinical practice.

“The primary visual cortex, where the electrodes were implanted, contains half a billion neurons. In this study we stimulated only a small fraction of these neurons with a handful of electrodes,” Beauchamp said. “An important next step will be to work with neuroengineers to develop electrode arrays with thousands of electrodes, allowing us to stimulate more precisely. Together with new hardware, improved stimulation algorithms will help realize the dream of delivering useful visual information to blind people.

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Researchers restore injured man’s sense of touch using brain-computer interface technology

Source: Cell Press
Date: 4/23/2020
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While we might often take our sense of touch for granted, for researchers developing technologies to restore limb function in people paralyzed due to spinal cord injury or disease, re-establishing the sense of touch is an essential part of the process. And on April 23 in the journal Cell, a team of researchers at Battelle and the Ohio State University Wexner Medical Center report that they have been able to restore sensation to the hand of a research participant with a severe spinal cord injury using a brain-computer interface (BCI) system. The technology harnesses neural signals that are so miniscule they can’t be perceived and enhances them via artificial sensory feedback sent back to the participant, resulting in greatly enriched motor function.

“We’re taking subperceptual touch events and boosting them into conscious perception,” says first author Patrick Ganzer, a principal research scientist at Battelle. “When we did this, we saw several functional improvements. It was a big eureka moment when we first restored the participant’s sense of touch.”

The participant in this study is Ian Burkhart, a 28-year-old man who suffered a spinal cord injury during a diving accident in 2010. Since 2014, Burkhart has been working with investigators on a project called NeuroLife that aims to restore function to his right arm. The device they have developed works through a system of electrodes on his skin and a small computer chip implanted in his motor cortex. This setup, which uses wires to route movement signals from the brain to the muscles, bypassing his spinal cord injury, gives Burkhart enough control over his arm and hand to lift a coffee mug, swipe a credit card, and play Guitar Hero.

“Until now, at times Ian has felt like his hand was foreign due to lack of sensory feedback,” Ganzer says. “He also has trouble with controlling his hand unless he is watching his movements closely. This requires a lot of concentration and makes simple multitasking like drinking a soda while watching TV almost impossible.”

The investigators found that although Burkhart had almost no sensation in his hand, when they stimulated his skin, a neural signal — so small it was his brain was unable to perceive it — was still getting to his brain. Ganzer explains that even in people like Burkhart who have what is considered a “clinically complete” spinal cord injury, there are almost always a few wisps of nerve fiber that remain intact. The Cell paper explains how they were able to boost these signals to the level where the brain would respond.

The subperceptual touch signals were artificially sent back to Burkhart using haptic feedback. Common examples of haptic feedback are the vibration from a mobile phone or game controller that lets the user feel that something is working. The new system allows the subperceptual touch signals coming from Burkhart’s skin to travel back to his brain through artificial haptic feedback that he can perceive.

The advances in the BCI system led to three important improvements. They enable Burkhart to reliably detect something by touch alone: in the future, this may be used to find and pick up an object without being able to see it. The system also is the first BCI that allows for restoration of movement and touch at once, and this ability to experience enhanced touch during movement gives him a greater sense of control and lets him to do things more quickly. Finally, these improvements allow the BCI system to sense how much pressure to use when handling an object or picking something up — for example, using a light touch when picking up a fragile object like a Styrofoam cup but a firmer grip when picking up something heavy.

The investigators’ long-term goal is to develop a BCI system that works as well in the home as it does in the laboratory. They are working on creating a next-generation sleeve containing the required electrodes and sensors that could be easily put on and taken off. They also aim to develop a system that can be controlled with a tablet rather than a computer, making it smaller and more portable.

“It has been amazing to see the possibilities of sensory information coming from a device that was originally created to only allow me to control my hand in a one-way direction,” Burkhart says.

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Clinic Screens High-Risk Patients to Reduce Incidence of Anal Cancer

Source: Brigham and Women's Hospital
Date: 5/30/2023
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Screening guidelines for cervical cancer have been recognized for decades. But for other cancers linked to human papillomavirus (HPV), including anal cancer, cancer screening guidelines are not well-developed.

Since 2020, a unique Brigham and Women’s Hospital clinic has offered high-resolution anoscopy (HRA) to screen for anal dysplasia in people at increased risk of anal cancer due to HPV infection, HIV status, and other factors. The clinic aims to reduce the incidence of anal cancer in high-risk populations.

“The value of treating anal dysplasia to prevent anal cancer for the highest-risk patient population has now been established and is still being studied for lower-risk groups,” says colorectal surgeon James Yoo, MD, one of the two founders of the HRA clinic. “The field is still evolving, and more data are needed to determine the best practices. But this is clearly an area where we can make an impact in cancer prevention, especially for patients at higher risk.”

“As an infectious disease doctor, I’m obviously interested in the different diseases and complications that affect HIV patients,” says Jennifer A. Johnson, MD, a clinician-educator and the clinic’s other co-founder. “We know that people with HIV are one of the highest-risk groups for the development of anal dysplasia and anal cancer, making this an important population to focus on.”

A Collaborative Approach to Patient Care

Results from the phase 3 Anal Cancer–HSIL Outcomes Research (ANCHOR) trial, published in The New England Journal of Medicine in June 2022, demonstrated for the first time that treatment for anal high-grade squamous intraepithelial lesions reduced the progression to anal cancer when compared with active monitoring. Drs. Yoo and Johnson note that this study’s findings help illustrate the value of the Brigham’s HRA clinic.

“HRA requires special equipment that’s not commonly available as well as special training to learn how to perform the procedure and to know what to look for,” Dr. Yoo says. “In terms of what our clinic can offer, it’s relatively special.”

In addition to Drs. Yoo and Johnson, colorectal surgeon Ronald Bleday, MD, also participates in the clinic.

The clinic’s collaborative approach produces significant benefits for patients. Follow-up care may consist of a range of actions depending on what is found during the HRA exam. These include annual anal Pap smears, HRA exams offered on an annual or semiannual basis, ablation of dysplastic lesions, and more extensive surgical procedures.

HRA Offered as Simple Office Procedure

When a patient is referred to the clinic, they can have their HRA exam performed on their first visit. This makes scheduling less burdensome.

“The HRA procedure is very similar to a cervical colposcopy,” Dr. Johnson notes. “It requires no anesthesia beyond sometimes a local anesthetic. It is minimally invasive, doesn’t require any specific preparation on the patient’s part, and doesn’t affect their activities for the rest of the day.”

Beyond those with HIV, patients taking immune-suppressing drugs to treat autoimmune diseases may also be at increased risk of developing lesions caused by HPV. The leaders of the HRA clinic provide consultations to physicians both inside and outside the Brigham to help them identify which patients may benefit from enrollment in the clinic’s programs. The clinic also provides opportunities to counsel patients on topics like HPV vaccination.

“These visits provide a good opportunity to make sure we’re paying attention to any concerns the patients have about minimizing their cancer risks,” Dr. Johnson says.

“We have a pipeline of patients who come to us because their providers are aware of the need to screen for anal dysplasia,” Dr. Yoo adds. “One of our continuing roles is to educate other doctors about which patients they should send to us for evaluation.”

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Embedding Diabetes Care in the Latino Community

Source: Brigham and Women's Hospital
Date: 5/24/2023
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Brigham and Women’s Hospital has adopted a new approach to providing diabetes care for Latino (LatinX) and Hispanic patients that involves embedding diabetes specialists in community clinics and offering culturally appropriate services to help patients control their disease and related complications.

The new model for care is spearheaded by A. Enrique Caballero, MD, director of Latino Diabetes Health in the Division of Endocrinology, Diabetes and Hypertension. His work developing comprehensive models of diabetes care for the Latino/Hispanic community has earned widespread recognition since he founded the Latino Diabetes Initiative at the Harvard-affiliated Joslin Diabetes Center (JDC) in 2002. Recently, for example, he received the American Diabetes Association’s Outstanding Educator in Diabetes Award for his work with the Latino population and his leading role in professional education.

“Despite meaningful advances in diabetes care, we are falling short in helping many patients achieve treatment targets,” Dr. Caballero says. “This burden is particularly taxing among Latino and Hispanic populations and leads to increased risk of complications and comorbidities.”

Delivering Diabetes Care Closer to Home

Dr. Caballero transitioned from the JDC to the Brigham in 2018 and decided to establish his practice at the Brigham’s Southern Jamaica Plain Health Center, which is in a culturally diverse neighborhood with many Spanish speakers. There, he sees patients during routine appointments with their Brigham primary care providers and supplies targeted education, outreach services, and research opportunities that would otherwise be difficult or impossible for patients to access.

His presence in the clinic gives Dr. Caballero the opportunity to guide the clinic’s primary care providers on how to better assess and treat patients with diabetes. It also supports a multidisciplinary, collaborative approach that allows him to stay closer to patients’ other health needs and improve the management of chronic diseases like diabetes.

“Ninety percent of diabetes care is delivered by primary care providers, and many health systems require patients to travel to a main campus for specialty care,” Dr. Caballero says. “The Brigham has made a commitment to reducing health disparities among underserved populations by bringing that care closer to home and involving the entire care team, including primary care providers, nurses, dieticians, social workers, educators, pharmacists, and population health specialists.”

Care at Dr. Caballero’s clinic also feels closer to home for Latino patients because all providers on staff are fluent Spanish speakers. Furthermore, Dr. Caballero conducts all his patient encounters in Spanish, which leads to enhanced provider-patient concordance, better engagement, more authentic conversations, and more productive interactions. Patient education materials are linguistically and culturally appropriate to help patients better understand and comply with treatment and lifestyle recommendations.

Patient Management Plans Consider Social Determinants of Health

To further reduce diabetes care inequalities in the Latino community, Dr. Caballero’s initiative combines the latest evidence-based strategies for diabetes care with a focus on social determinants of health (SDOH). He says this area has been long neglected in diabetes care.

“Traditionally, the physician’s role has been to make a diagnosis, recommend a treatment, and send the patient along their way,” Dr. Caballero says. “We are moving beyond that approach by talking with patients about the financial, societal, cultural, emotional, and family support factors that influence their behavior so we can be more effective in helping them reach their treatment goals.”

For example, while healthier eating is a first-line recommendation for diabetes patients, many underserved patients are food insecure and struggle to afford or access healthy food (especially if they live in a food desert, where residents have limited access to affordable, nutritious food providers). A doctor’s recommendation to exercise more may be unattainable for those who can’t afford a gym membership or find welcoming fitness facilities. Compliance with medication protocols may prove difficult for patients who lack adequate insurance coverage.

To address these SDOH issues, members of the clinic’s multidisciplinary team talk to patients about free and reduced-cost nutrition, exercise, and medication assistance programs.

“While the science of caring for diabetes patients with new technologies and new medications continues to move forward, it is not the whole solution,” Dr. Caballero says. “We also need to focus on the art of caring for diabetes patients by addressing their social, cultural, emotional, and economic concerns. Everyone at the Brigham is committed to working against health disparities and doing the best possible job of acknowledging these social determinants of health.”