VCU news

By Elizabeth Cogar

Scientists, like detectives, excel at connecting dots to find the larger picture.

In the case of Youssef Roman, Pharm.D., Ph.D., an assistant professor at VCU School of Pharmacy’s Department of Pharmacotherapy and Outcomes Science, an observation about the prevalence of gout among people of Filipino heritage led him to explore why that population struggles with such high rates of heart-related death and disease.

The results of his research may help treat people who share genetic backgrounds by using targeted medications and personalized lifestyle recommendations.

While treating Filipinos at his previous position at the University of Hawaii’s School of Medicine, Roman saw a high prevalence of gout, an inflammation of the joints caused by elevated levels of uric acid.

Gout can cause excruciating pain. But more than that, Roman was struck by a connection between gout and cardiovascular disease, the leading cause of death worldwide.

Along with high rates of gout, people of Filipino descent often suffer from cardiovascular diseases — they are twice as likely to die of heart-related problems as the overall U.S. population.

What could cause both problems? Are they related? Roman decided to pursue the questions.

“I discovered that there’s a genetic variation, the ABCG2 gene, that is quite high in Filipinos,” he said. “We know this certain genetic variation predisposes people for developing gout because it is related to a dysfunctional kidney transporter.”

This transporter is responsible for excreting different biochemicals — including uric acid — from the body. When it falters, uric acid builds up.

“The high uric acid level increases inflammation, and that inflammatory state can put you at higher risk for developing cardiovascular risk factors, such as hypertension, atherosclerosis and kidney damage,” Roman said. “Those factors can lead to major cardiovascular events like heart attack, stroke, heart failure.”

To explore the connection between Filipinos and heart health, Roman launched a study at VCU Health in 2021.

The Filipino Heart Health Study, which focuses on studying the effects of genes on heart diseases in the Filipino American community, reflects Roman’s determination to increase minority representation in genetic and genomic research.

Roman, who moved to the United States from his home in Cairo, Egypt, in 2003, said this focus on inclusion is driven by personal experience.

“I know what it's like to be a minority and not be represented,” he said. “So I’ve always had a passion for being a voice for those who don't have a voice. I feel like this has been my calling as a scientist.”

Community engagement will be the key to the study’s success, Roman said. The year-and-a-half-long study, funded by VCU’s C. Kenneth and Dianne Wright Center for Clinical and Translational Research, is built on Filipino participation.

Since 2019, Roman has connected with partners in the Filipino community, building relationships and trust. “When you do community genetic research, you have to be very rooted in the community,” Roman said.

He’s been getting help with that from Drew Armada, a native of the Philippines who is president of the 150-member Filipino American Association of Central Virginia.

The two met at a Filipino cultural festival that Roman attended soon after he joined VCU in 2019. Armada introduced Roman to the Filipino community in Richmond and the Tidewater area, invited him to speak to the association and posted on social media to gain interest and build trust that he hopes will yield more participants.

Myra Hudencial, who was born in the Philippines and is a member of the association, agreed to participate in Roman’s study. “So many Filipinos have heart problems, including my own family,” she said.

Explaining why she joined the study, Hudencial said, “It’s not so much for me but for the entire Filipino population, for our kids.”

Armada agreed. He signed on as a study participant in 2021. “It’s for the next generation,” he said. “Not only for people here but for Filipinos around the world.”

To meet the study’s goals, Roman aims to enroll 300 participants. So far, about 100 have signed on.

Reducing the incidence of heart disease in the Filipino American community is one of the overall goals of the study. While people from Southeast Asia are known to have the highest risk for developing high cholesterol, a major contributor to heart disease and premature death, most genetic and medical research does not focus specifically on Filipinos. Instead, studies include them in a broader Asian group, Roman said.

By looking closely at Filipinos, Roman hopes to determine the root causes — genetics, lifestyle, or the interaction between the two — of their heart disease and optimize management of the disease through early detection and personalized treatment.

For example, if the connections between uric acid, genetic factors and cardiovascular diseases can be teased out, research could help establish if certain medications would be more effective than others in those populations. Likewise, certain foods or nutrients could be recommended or avoided.

While there have been studies looking at how social and psychosocial factors can lead to a higher risk for cardiovascular disease, Roman said he may be the first to study genetics of Filipinos in a community setting.

Colleagues in his field are already taking notice and inviting him to present at events nationwide including the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health; the Gout, Hyperuricemia and Crystal-Associated Disease Network; and the Network of Minority Health Research Investigators.

“This is groundbreaking in terms of going out to the community, enrolling Filipinos, assessing the genetics of cardiovascular disease in Filipinos, and hopefully acting on it by giving it back to the community,” Roman said.