Tuesday, May 6, 2014
“The world’s malnutrition cannot be explained by food insecurity alone,” said Jeff Donowitz, M.D., an infectious diseases fellow in the Department of Pediatrics in the School of Medicine.
For children in the developing world, it’s more complicated than whether they get enough to eat. Malnutrition can also be impacted by unsanitary conditions and poor overall health that interferes with their ability to absorb nutrients.
Their future is further compromised by diseases such as polio and rotavirus. Oral vaccines that are effective in the United States and Europe have a high failure rate in developing countries like Bangladesh. Not yet understood, this failure carries deadly consequences.
Donowitz has hit upon a theory that has won him the support of a two-year fellowship. Donowitz is one of just seven pediatricians in the U.S. selected this year by the Association of Medical School Pediatric Department Chairs for the Pediatric Scientist Development Program.
He hypothesizes that a condition known as small bowel bacterial overgrowth could hold answers to both the malnutrition and the unexplained vaccine failure seen in infants born into the developing world’s impoverished communities.
The small intestine normally contains bacteria. But those with small bowel bacterial overgrowth (SBBO) have abnormally high numbers of our body’s normal bacteria. Living in unsanitary conditions predisposes children to develop SBBO. Those with the syndrome suffer from poor nutrient absorption, and their immune system may also be compromised, since the gastrointestinal tract houses essential components for healthy immune function.
“Your gut’s immune system is the first place to react to an oral vaccine,” Donowitz said. “Could an unhealthy gut be interfering with the vaccines’ effectiveness?”
During his two-year fellowship, Donowitz will work under the mentorship of William Petri, M.D., Ph.D., the highly respected chief of infectious diseases and international health at the University of Virginia. Petri has a track record of mentoring young scientists and receiving funding from the National Institutes of Health and the Bill and Melinda Gates Foundation. He’s also connected to the International Centre for Diarrhoeal Disease Research in Bangladesh that will provide Donowitz a ready-made research network with a more than 50-year history of clinical studies and life-saving treatment.
Nested within Petri’s on-going study, Donowitz’s project will enroll children who have received oral vaccines against polio and rotavirus. He will use a breath test never before tried in Bangladesh to diagnose SBBO and then determine whether the children with SBBO fail the vaccine at a higher rate than children who do not have abnormally high levels of bacteria. Donowitz will also track specific biomarkers over time to gain a better understanding of the possible biomechanics at work.
Because SBBO is treatable with antibiotics, Donowitz’s hypothesis has the potential to improve many aspects of the children’s lives.
Donowitz was 17 when he took his first trip to the developing world to work in a clinic in northern Haiti. Struck by what he described as the unfairness of the poverty he saw, Donowitz determined that he would become a physician and work to benefit those born to the world’s poorest countries.
While an undergraduate, Donowitz majored in anthropology despite being advised toward the basic sciences. He felt “this discipline could teach me about the customs, beliefs and cultures of those people I meant to serve.” That led to a semester living with a family of rural farmers in the Himalayas of
“We ate mostly rice with few fruits or vegetables and got our water from a local river,” Donowitz said. “I contracted giardia, then scurvy. I began to better understand my target population.”
Donowitz traveled to Bangladesh for the first time this winter and will go again in the summer. For two years, he will focus entirely on his research project and will be relieved of all clinical responsibility in the Department of Pediatrics. The support of his fellowship makes that possible.
The Pediatric Scientist Development Program was established in the 1980s in response to a decline in the number of young research-trained pediatricians. The program supplies postdoctoral research training at a critical period in the career development of academic scientists by providing intensive training in research relevant to specialty areas of pediatrics.
The fellowship program is funded by the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, the American Academy of Pediatrics, American Pediatric Society, Sick Kids Foundation in Toronto, the March of Dimes and Paediatric Chairs of Canada. It is coordinated by the Cincinnati Children’s Hospital.
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