Center for the Study of Symptom Science, Metabolomics, & Multiple Chronic Conditions

The overarching goal of this P30 award is to address a growing public health concern in this country; the increasing number of individuals living with multiple chronic conditions (MCC) and in particular, Black men and women.  Through the work of its Administrative, Pilot, Enrichment, and Data Science Cores, the “Center for the Study of Symptom Science, Metabolomics and Multiple Chronic Conditions” strengthens the capacity of junior nurse scientist to conduct innovative translational research to reduce symptoms in individuals with MCC, improving public health for generations to come.

Center Aims:

  • Create and manage a Center by providing resources and infrastructure to support cutting-edge research utilizing metabolomics and microbiomic technologies and big data analytics to understand symptom etiology in adult African Americans (AA) with multiple chronic conditions (MCC).
  • Promote the success of junior faculty.
  • Disseminate Center discoveries through publications, summer institutes and conferences.
  • Stimulate discovery of metabolites and metabolic pathways in AAs with MCC, focusing on those that synergize across conditions and associate with severe symptoms of fatigue, depression or anxiety and their cluster, but are less represented in individuals who have minimal symptoms.

Why these aims and why African Americans:

  • African Americans disproportionately suffer MCC
  • Symptoms of fatigue, depression and anxiety often cluster and carry negative consequences for health and well-being
  • Symptom severity in those with even the same MCC varies suggesting mechanisms driving symptoms are not fixed but vary, making them potentially amenable to targeted  intervention

erstand this important health disparity, we will also consider the contribution of various factors including chronic stress, diet, and the gut microbiome.

Administrative Core

The Administrative Core is also home to the Center's robust evaluation plan.  The extensive evaluation plan is designed to assess the extent to which the Center meets its aims.  Administrative Core staff and leadership will also monitor the evaluation process to measure and track Center goals, outputs and outcomes.  Evaluation plans are guided by the NINR Center Director's Logic Model for Sustainability.

External Advisory Committee

The Administrative Core brings together nationally and internationally known experts in the relevant areas of the Center’s scientific focus to provide the necessary infrastructure to oversee Center activities and facilitate and strengthen collaborative, interdisciplinary research and development of junior nurse investigators.  Members of the Center’s External Advisory Committee are highlighted below.

Paula Meek, PhD, RN, FANN, Professor and Interim Assistant Dean for PhD Programs at University of Utah College of Nursing

Dr. Meek is an internationally recognized authority on symptom clusters and pain and fatigue associated with these clusters and symptom self-management.

Margaret Heitkemper, PhD, RN, FANN, Professor and Chair, Biobehavioral Nursing & Health systems, Adjunct Professor of School of Medicine, Division of Gastroenterology, and Co-Director of Center for Innovation in Sleep Self-management, University of Washington Seattle

Dr. Heitkemper is an internationally renowned scholar in the area of irritable bowel syndrome and interaction of stress, sleep, genetics, microbiome, metabolomics, and symptoms.

Shirley Moore, PhD, RN, FANN,  Professor and Associate Dean for Research at Case Western Reserve University Frances Payne Bolton School of Nursing, and Director of the NINR-funded P30 SMART Center II Brain Behavior Connections in Self-Management Science.  Dr. Moore has an extensive track record in the area of self-management.

Internal Advisory Committee

  • Dr. Andrew Miller, Chair, Emory University School of Medicine- Professor
  • Dr. Thomas Ziegler: Emory School of Medicine - Professor
  • Dr. Timothy Read, Emory School of Medicine - Professor
  • Dr. Dean Jones: Emory University, School of Medicine - Professor
  • Dr. Arshed Quyyumi: Emory University, School of Medicine - Professor
  • Dr. Jill Hamilton: Emory University, School of Nursing - Associate Professor
  • Dr. Kenneth W. Hepburn: Emory University, School of Nursing - Professor

Nicole Carlson

Assistant Professor | CNM, PhD, FACNM

Administrator Core Junior Mentor

Elizabeth Corwin | PhD, RN, FAAN (PI)

Administrative Core Mentor

Drenna Waldrop-Valverde, PhD, Center Evaluator

Pilot Core Studies

Sandra Dunbar, PhD, RN, FAAN, FAHA, FPCNA
Pilot Core Director

The Pilot Core generates and supports pilot investigators and studies addressing symptoms in multiple chronic conditions (MCC). Although MCCs are increasing in adults, little is known about the complex and synergizing metabolites and metabolic pathways underlying symptoms, thus symptom management interventions are under-developed. The overall Center proposes to advance the understanding of symptoms to address the gaps in knowledge that will lead to more precise symptom-reducing interventions. The Pilot Administrative Core will generate research on the specific and distressing symptoms of fatigue, depression and anxiety in Black adults living with a chronic condition and hypertension (HTN), a chronic condition that significantly contributes to MCC and health disparities. Pilot studies will examine individual, biological, and behavioral factors related to the symptoms and symptom clusters, and examine metabolites and metabolic pathways associated with these symptoms. As the Center's scientific framework is tested and refined, metabolic pathways may be uncovered that may contribute to future intervention work. The Pilot Administrative Core will function as an incubator for interdisciplinary research based on the Center's scientific framework of symptoms and clusters and metabolites derived from high resolution metabolomics in Black adults with MCC and will expand the number and quality of pilot research projects.   Approaches include recruitment of future pilot applications, rigorous scientific reviews, monitoring of pilot progress, interdisciplinary mentoring of pilot investigators, and harmonization of methods including common data elements and innovative data analysis.

The initial active pilot projects address populations with HTN and either obesity or HIV infections. Through the discoveries of the Center, we envision future extension of the framework to support sustained inquiry on symptom and symptom clusters within MCC including HTN and other chronic conditions in Black adults. These studies will contribute essential knowledge to ultimately improve quality of life in MCC and position Center investigators to conduct future inquiry with innovative and precision approaches.

Erin Ferranti, PhD, MPH, RN, FAHA
Pilot Cor Junior Mentor


Glenna Brewster, PhD, MA, MS

Pilot # 1

Metabolic Pathways to Fatigue, Depression, or Anxiety in Black Family Caregivers with Obesity and Hypertension. Glenna Brewster, Project Lead

Planned Start Date: 08/14/2018

Planned Completion Date: 08/13/2020

Family caregivers of persons living with dementia (PLWD) provide an important service both to their care recipients and to society. However, this role can become a chronic stressor and increase their risk for many negative outcomes including obesity and hypertension. Black adults, the second largest group of caregivers of PWLD in the nation, have the highest rates of obesity and hypertension compared to adults of other races/ethnicities. With the population of PLWD, and by extension their caregivers, projected to triple by 2050, Black caregivers of PLWD with multiple chronic conditions (MCC), including obesity and hypertension, are emerging as a high-risk group. In the context of chronic stress, obesity and hypertension may work together to produce or worsen the symptoms of fatigue, depression, and anxiety in this high-risk caregiving population. However, the underlying mechanisms by which these MCCs connect to produce or worsen the symptoms of fatigue, depression, and anxiety in PLWD caregivers who have obesity with and without hypertension are still not known. Since certain by-products and the pathways resulting in these by-products are known to be activated by obesity and hypertension, and known to associate with the symptoms of fatigue, depression, and anxiety, the following specific aims will be addressed in this prospectively matched, cohort study: In Black family caregivers (N=30) of PLWD who have obesity or obesity plus hypertension  1) using high-resolution mass spectrometry a) examine the associations between the circulating by-products and the by-product profiles that associate with the seriousness of each symptom of fatigue, depression, or anxiety, and b) compare the circulating by-products and the by-product profiles that associate with symptom seriousness in family caregivers with obesity versus caregivers with obesity plus hypertension at baseline and 3 months. 2) Examine the relationships among demographic, clinical, psychosocial and behavioral covariates, circulating by-products and the by-product profiles, levels of symptoms of fatigue, depression, or anxiety, symptom synergy, and outcomes of health related quality of life at baseline and 3 months.

For more information about the study or to participate, contact Project Coordinator baderinwa.offutt@emory.edu

Jessica Wells, PhD, RN

Pilot #2

Metabolic Pathways to Fatigue, Depression, and Anxiety in Black Adults with HIV and Hypertension.
Jessica Wells, Project Lead

Planned Start Date: 08/14/2018

Planned Completion Date: 08/13/2020

The purpose of this pilot project is to examine mechanistic pathways of symptoms (the how and why symptoms develop), symptom severity (how serious your symptoms are), and symptom synergy (how symptoms exacerbate one another) in a sample of Black adults with a diagnosis of HIV or with a diagnosis of HIV and hypertension (HTN).  The presence of multiple chronic conditions (MCC) is an emerging public health problem for HIV-infected individuals, where Black adults are both more likely to be HIV-infected and more likely to present with MCC such as HIV and HTN. Chronic inflammation caused by HTN and HIV may contribute to common symptoms reported in HIV-infected individuals such as fatigue, depression, and anxiety. Yet, the underlying metabolites (your body’s byproducts) and pathways associated with these symptoms and symptom severity in the presence of HIV and HTN, are still unknown. Thus, this study will examine the metabolites (your body’s byproducts) and metabolic pathways in individuals with a diagnosis of HIV or with both HIV and HTN using high resolution metabolomics and define the symptom severity and symptom mechanisms that may exist in synergy. The specific aims of the proposed study are: 1) examine the associations of circulating metabolites and metabolic profiles with the severity of each symptom of fatigue, depression, and anxiety, and 1b) compare the circulating metabolites and metabolic pathways that associate with symptom severity in participants with HIV versus participants with HIV plus HTN at baseline and 3 months; 2) examine the relationships among demographic, clinical, psychosocial and behavioral covariates, metabolites and metabolic pathways, severity levels of symptoms of fatigue, depression, and anxiety, symptom synergy and outcomes of heath related quality of life at baseline and 3 months. As an exploratory aim, we will explore the contribution of the gut microbiome (you’re body’s natural bacteria) (dominant species, ratios of species) and microbiome-associated metabolites and metabolic pathways as potential covariates associated with self-report of severity of each symptom of fatigue, depression, and anxiety at baseline and 3 months. Understanding the mechanisms of symptoms in individuals with MCC will allow for targeted interventions that clinicians can provide to help reduce the personal burden of individuals living with MCC and its associated symptoms.

For more information about the study or to participate, contact Project Coordinator:

robert.m.knott@emory.edu

Pilot # 3

Metabolomic Pathways to Fatigue, Depression, Anxiety, and Dyspnea in Black Adults with Heart Failure and Hypertension.

Brittany Butts Nurse Scientist, Project Lead

Heart failure is the only cardiovascular disease increasing in prevalence; over 6.5 million Americans are living with HF. Black adults have the highest risk of developing HF, with an earlier HF onset, more severe left ventricular (LV) dysfunction, and more advanced disease severity, all leading to a higher HF morbidity.  Hypertension (HTN) is the etiology in >50% of Black adults with HF, and represents the strongest risk factor for HF. The prevalence of HTN among Black adults in the US is among the highest in the world.  Although Black adults have the highest death rate for heart failure, they are consistently underrepresented in clinical trials.  Considering the greater HF burden among Black adults, further work is needed to discover effective therapeutic targets for this higher-risk population.  This pilot study will examine the specific and distressing symptoms of fatigue, depression, anxiety, and dyspnea in Black adults living with HF and HTN, focusing on how individual, biological, and behavioral factors relate to symptoms and symptom clusters and how metabolites and metabolic pathways are associated with these symptoms.  The specific aims of this study are:  1. examine the associations among the circulating metabolites and metabolic profiles with the severity of each of the symptoms of fatigue, depression, or anxiety, and compare the circulating metabolites and metabolic pathways that associate with symptom severity in participants with HF versus participants with that HF plus HTN at baseline and 3 months; 2. identify the relationships among demographic, clinical, psychosocial and behavioral covariates (e.g., sex as a biological variable, body mass index, stress, SES, diet, smoking, medications, comorbidities, disease severity), metabolites and metabolic pathways, severity levels of symptoms of fatigue, depression, or anxiety, symptom synergy and heath related quality of life at baseline and 3 months. In addition, an exploratory aim will explore the contribution of the gut microbiome and microbiome-associated metabolites and metabolic pathways as potential covariates associated with self-report of severity of symptoms of fatigue, depression, and anxiety at baseline and 3 months.  This study will advance our understanding of symptoms to address the gaps in knowledge that will lead to more precise symptom-reducing interventions in HF.  The findings from this study will inform future work to improve outcomes in Black adults with HF, and hopefully work towards lessening the disparities in morbidity and mortality experienced by this population.

For more information or to enroll as a participant contact

brittany.butts@emory.edu

Pilot # 4

TBD. TBN Nurse Scientist, Project Lead

Pilot #4 Solicitation began in fall/winter 2019. An announcement will be made Fall 2020

Pilot # 5

TBD. TBN Nurse Scientist, Project Lead

Stay connected with the Center for details on the process and requirements for Pilot Project #5.

Pilots

TBD. TBN Nurse Scientist, Researcher, Project Lead

The Center is excited about the opportunity to partner and support emerging research incorporating Metabolomics and experiences of patients with Multiple Chromic Conditions.    Please feel free to reach out to us if you feel your research would create synergy with the Projects and aims of the Center.  Continue to check back for new resources, events and opportunities to partner or participate with the Center in the future.

Stay connected with the Center for details on the process and requirements for Pilot Projects 4 and 5. The Center is excited about the opportunity to partner and support emerging research incorporating Metabolomics and experiences of patients with Multiple Chromic Conditions.  Please feel free to reach out to us if you feel your research would create synergy with the Projects and Aims of the Center. Continue to check back for new resources, events and opportunities to partner or participate with the Center in the future.

Administrative Supplements

Supplement #1

Oral Health, Inflammation, and the Risk of Mild Cognitive Impairment among Cancer Caregivers (OHICC).

Irene Yang Nurse Scientist, Project Lead

Irene Yang | PhD, MSN, RN (Lead Co-I)

Alzheimer’s disease is devastating on many levels, for individuals, their families, and beyond. People who care for persons with advanced illness, like cancer, are at increased risk for Alzheimer’s disease. This increased risk is thought to be related to various factors like stress, certain behaviors, and physiologic factors. Some caregivers are at even higher risk. Black, older adults, for example, have additional risk related to racial disparities and chronic conditions.

Mild cognitive impairment (MCI) describes a condition where individuals demonstrate subtle signs of cognitive decline, greater than expected for their age, but not yet meeting the criteria for Alzheimer’s disease. Because individuals with MCI are at greater risk for developing Alzheimer’s disease, it is a suitable target for preventive efforts.

There is a growing awareness of the associations among poor oral health, the oral microbiome, and the risk of Alzheimer’s disease, especially with regard to inflammation, which is a theoretical hypothesis for Alzheimer’s disease. Yet, virtually no attention has been placed on the oral health of caregivers of persons with advanced illness, who are not only at risk for compromised oral health due to their advancing years, but also at increased risk for MCI.

Therefore, this study will recruit older Black caregivers of advanced cancer patients to describe and examine relationships between their oral health, oral microbiome, inflammation, stress, and symptoms of MCI. This study is important because it will provide evidence that may contribute to the development of oral health screening efforts and preventive interventions for people at risk for MCI.

For more information or to enroll as a participant contact taqiyya.alford@emory.edu

Supplement #2

Metabolites and Metabolic Pathways Associated with Symptoms Among African-Americans with Systemic Lupus Erythematosus:Auto-Immune Metabolomics Study (AIMS).

Laura Kimble Nurse Scientist, Project Lead

Laura P. Kimble, PhD, RN, FNP-C, FAAN, Principal Investigator

Systemic lupus erythematosus (SLE) is a chronic, life threatening disease affecting the immune system. African Americans with SLE have higher death and disability compared to Caucasians including multiple symptoms that negatively affect quality of life. Additionally, AA with SLE have increased risk for cardiovascular disease.

The purpose of this prospective cohort study is to explore metabolic pathways and associated factors underlying symptoms in Black adult men and women with SLE and/or SLE with hypertension. An exploratory aim will address how the microbiome may impact symptom expression. The main symptoms to be investigated in the study include fatigue, depression, anxiety, and pain.

Male and female African American patients, who read and speak English, ages 30 to 64 years with a diagnosis of SLE, documented in the electronic medical record, with and without HTN will be recruited in SLE clinics at Emory Clinic and Grady Memorial Hospital. Individuals with a history of uncontrolled major mental disorder will not be eligible.

Following written informed consent, subjects will complete a battery of symptom questionnaires and will experience venipuncture by research staff to collect 45 ml. of blood for metabolomic analysis. Additionally, subjects will provide two self-collected rectal swabs for DNA sequencing and microbial analysis. Symptom questionnaires, blood sampling, and rectal swab collection will be repeated at the next clinic visit 3 months after the baseline data collection.

This pilot project is conducted within the framework of the SON P30 Center for the Study of Symptom Science, Metabolomics, and Multiple Chronic Conditions and all biologic data will be processed and analyzed within the SON clinical laboratory. All subjects will receive a $35 Amazon gift card following completion of the first data collection visit and a $25 Amazon gift card at the final data collection visit.

For more information or to enroll as a participant contact lkimble@emory.edu

Enrichment Core


Marcia Holstad, PhD, FNP-BC, FAANP, FAAN, Enrichment Core Director

The overall goal of the Enrichment Program (EP) is to support interdisciplinary and collaborative educational and experiential activities that complement and/or enhance the development and research skills of current and future nurse scientists. The Enrichment Program will support the aims of the Center by promoting professional development and scientific enrichment related to the science themes of the Center. Its activities will include both mentoring (in collaboration with the Pilot Administrative Core) and content/knowledge expansion and dissemination.

Irene Yang, PhD, FNP-BC, FAANP, FAAN,

Enrichment Core Junior Mentor

Past Events Enrichment Core

Recruitment of Elderly African Americans into Research Studies: Lessons Learned

Dr. Jill Hamilton

P30 Best Practices for Research Project Management Workshop

Panel: Graham, Laszlo, Nash, Plotsky, Henry

Suggested Reading/Training:

https://trialinnovationnetwork.org/elements/network-events/?category=all

https://learn.nursing.jhu.edu/face-to-face/courses/research-coordinator/index.html

Team Science Toolkit: https://www.teamsciencetoolkit.cancer.gov/Public/Home.aspx

The 17 Indisputable Laws of Teamwork by John C Maxwell

Introduction to Metabolomics & Use As A Translation Tool to Explore Mechanisms in Labor Dysfunction

Presenter: Nicole Carlson
Authorship:  Guidelines and Planning

Presenter/Facilitator: Bonnie Jennings

Foundations of Collaboration: Using Improvisational Skills

Facilitator: Allison Gilmore

Motivational Interviewing: Communication Skills for Mentees

Facilitator: Marcia Holstad
The Oral Microbiome: A Stepping Off Point for Investigating the Oral-Systemic Connection

Presenter: Irene Yang

Nursing Omics Journal Club Session
Discussant: Jennifer Frediani
Article: “Metabolomic characterization of human model of liver rejection identifies aberrancies linked to Cyclooxygenase (COX) and nitric oxide synthase (NOS)”
Skill NJ et al. Annals of Transplantation 2019;24: 341‐49.
Phenotyping for Cardiovascular Disease

Presenter:  Dr. Arshed Quyyami

Upcoming Events Enrichment Core

P30 Pilot Investigators Research Roundtable
Metabolomics for Nursing Research: Lessons Learned
March 3, 2020
Panel:  P30 Pilot Investigators

Inaugural Summer Institute on Symptoms and Omics (SISO)

Two days dedicated to stimulating new ideas and providing resources for nurse scientists who are interested in incorporating omics methods into their programs of research.
June 4-5, 2020
Miller Ward Alumni House

SON Omics Journal Club (Ongoing)
Journal Club meets twice during the Spring and Fall semesters
Please e-mail
SMCCenter@emory.edu  for details on upcoming sessions.

Data Science

Vicki Hertzberg, PhD, FASA, Data Science Core Director

The Data Science Core provides expertise in the analysis of metabolomics and microbiome data, of particular relevance to the aims of the pilot studies proposed.  In addition, the core works with pilot investigators as they prepare manuscripts and presentation, providing assistance with interpretation and visualization of results. With respect to data management, the Core works with pilot project investigators to develop projects within Emory’s REDCap and LabKey systems for managing the clinical, questionnaire, and biological data. The Core also implements Quality Control and Quality Assurance procedures for data collection and management.  The Core has implemented reproducible workflows for metabolomic and microbiome analyses using R, R Markdown, Git, and GitHub, which also assures version control. The Core will also support resource sharing, uploading data to the Emory Dataverse as well as creation of an NCBI BioProject.

The Data Science Core:

  • supports sequencing of high throughput data whose analyses by nature are highly complex and cannot be processed using standard software or statistical analyses.
  • provides consultation and training opportunities for junior faculty and others, both within and outside of the NHWSN and Emory, to gain expertise in the handling and analysis of large data sets.
  • is vital to ensuring data collected are correctly maintained and rigorously analyzed, thereby increasing the dissemination of our findings and the impact of our Center.

The Data Science Core also provide educational activities to address the analytic needs of investigators in the Center.  The Data Science Core hosts investigator trainings and educational events throughout the year.  See examples past of trainings and offerings below:

“Introduction to Data Management for Nursing Research”, Winter 2019, hands-on workshop series designed for Center affiliated and school-wide junior faculty.

With so many advances in data collection, it is essential to have effective data management skills. In this course, students will learn skills necessary to design appropriate data collection strategies, navigate relational databases, and develop long-term data storage and sharing mechanisms. Each attendee will receive a data management workbook manual, access to data management resources, and a certificate of achievement.

“Key Concepts on Microbiome Research”, August 20-21, 2019, Emory SON, workshop covered best practices and key concepts for microbiome research.

Suggested Readings discussed during the session:

  1. Gut Microbiota in the First 2 Years of Life and the Association with Body Mass Index at Age 12 in a Norwegian Birth Cohort. Maggie A. Stanislawski, Dana Dabelea, Brandie D. Wagner, Nina Iszatt, Cecilie Dahl, Marci K. Sontag, Rob Knight, Catherine A. Lozupone, Merete Eggesbø
  2. An obesity-associated gut microbiome with increased capacity for energy harvest. Peter J. Turnbaugh, Ruth E. Ley, Michael A. Mahowald, Vincent Magrini, Elaine R. Mardis & Jeffrey I. Gordon
  3. Characterizing the Subgingival Microbiome of Pregnant African American Women. Yang, I., Knight, A. K., Dunlop, A. L., & Corwin, E. J.
  4. Bioconductor Workflow for Microbiome Data Analysis: from raw reads to community analyses Ben J. Callahan, Kris Sankaran, Julia A. Fukuyama, Paul J. McMurdie

Leadership

Mi-Kyung Song

Center Director

Mi-Kyung Song, PhD, RN, FAAN


Kate A. Yeager PhD, RN, FAAN

Center Associate Director

Kate A. Yeager PhD, RN, FAAN

Get Involved/Contact

Contact us

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Address

17 Executive Park Drive NE, Suite 650 Atlanta, GA 30329-222

Office hours

8 a.m. - 4:30 p.m. ET

Contact information

Office: 404.778.4067
Fax: 404.778.4778
Email: enpdc@emory.edu