Friday, May 31, 2019

By Laura Hedli

Associate Professor of Pediatric Infectious Diseases A. Desiree LaBeaud, MD, MS, and her lab exemplify why Stanford Maternal and Child Health Research Institute (MCHRI) is critical to fostering, sustaining, and growing pediatric research. Dr. LaBeaud and her lab members have received 8 MCHRI awards, totaling almost $968,000 in funding.

For Dr. LaBeaud, the contributions of MCHRI extend well beyond salary support. Thanks to MCHRI, she has been able to mentor graduate students, postdoctoral scholars, clinical fellows, and clinical instructors—some are in the Department of Pediatrics, and several others are working on the adult side of infectious diseases under the broader umbrella of Stanford School of Medicine. As a University-wide Institute, MCHRI encourages collaboration across Stanford’s seven schools to improve the health of expectant mothers and children. This transdisciplinary focus is helping to bridge the worlds of adult and pediatric infectious disease, according to Dr. LaBeaud.

“As a PI, all I want to do is foster brilliant people,” says Dr. LaBeaud, adding that traditional grants are typically static and make it hard to give mentees self-motivated research training opportunities. Unrestricted funding from MCHRI allows financial relief for primary investigators like Dr. LaBeaud. Moreover, she says it provides her and her trainees with the “opportunity for new collaborations, innovative problem solving, creative thought, and stretching the envelope a little bit.”

Dr. LaBeaud prefers to let her mentees speak for themselves about their own MCHRI projects, which are many and varied and all relate to international arboviruses—mosquito-borne viruses to be exact. For more on some of their projects, check out the capsules linked below.

Studying arboviral disease in South America, Africa, and the Caribbean

Working globally, Dr. LaBeaud has established field sites in Kenya, Brazil, and, most recently, Grenada, thanks to an MCHRI Pilot New Ideas award of $35,000 in 2017. After an outbreak of Zika virus in Grenada, she wanted to study the effects of in utero Zika virus exposure on child development. Partnering with the Ministry of Health in Grenada and St. George’s University/Windward Islands Research and Education Foundation, Dr. LaBeaud and international collaborators tracked mothers and babies during pregnancy and then postpartum.

Now, with a solid foothold in the Caribbean, the team has secured funding from United States Agency for International Development and the National Institutes of Health (NIH) to conduct follow-up studies on the Grenada cohort. They are working alongside neurodevelopmental psychologists and electroencephalogram (EEG) specialists to study cognitive delays and seizure disorders that may be related to the children’s in utero Zika virus exposure.

As Dr. LaBeaud was establishing a new field site in Grenada, she has been working concurrently in Kenya with support from the MCHRI Bechtel Faculty Scholar Award in Pediatric Translational Medicine; total funding is $500,000 over five years (2015-2020). Up until recently, Dr. LaBeaud had spent her career describing the burden of arboviral disease in Kenya. She was unable to truly intervene to prevent disease. Because of the Faculty Scholar Award, finally, she has been able to design community and school-based educational interventions aimed at disease reduction. The work has had an unexpected effect, too, of bridging Dr. LaBeaud’s service as a pediatrician with her commitment to environmentalism.

Plastics and mosquitoes

Dr. LaBeaud had been working in Kenya for 12 years before she received her Faculty Scholar award. During that time, she and her team used funds from her NIH R01 research project grant to perform vector assessments in order to understand risk for acute dengue and chikungunya disease in Kenyan children. Now, they want to measure changes in mosquito abundance and disease incidence as a result of planned child and community interventions.

The interventions directly involve Kenyan school children, who have been tasked with helping to find and reduce mosquito breeding sites. Dr. LaBeaud used some of her Faculty Scholar funding to support a collaboration with Jenna Forsyth, who graduated in April 2019 from Stanford’s Emmett Interdisciplinary Program in Environment and Resources with her doctorate. Together, they embarked on the initial phase of the intervention project that required educating the kids about all things mosquito. Their innovative curriculum provided information on the mosquito life cycle and the different types of mosquitoes. For instance, the mosquitoes that carry dengue and chikungunya (Aedes aegypti) are active during the day and are distinct from mosquitos that carry malaria; therefore, the primary prevention tool in Africa, insecticide treated bed netting, offers no protection.

In the medical field, we care a lot about the children and their health. But clearly we need to be partnering with sanitation, policy-makers, all sorts of community members at all different levels to really create the changes we want to see.

Once the kids in Kenya learned about mosquito life stages, they were assigned homework—to go out and find the mosquitoes in their communities. It was an easy ask, but the findings weren’t necessarily what the researchers had expected. The kids reported that mosquitoes were breeding in unused containers around residents’ homes and piles of trash, specifically plastic trash.

“It's one of those things where the more you learn, the more you realize that you can't work in silos,” Dr. LaBeaud says. “In the medical field, we care a lot about the children and their health. But clearly we need to be partnering with sanitation, policy-makers, all sorts of community members at all different levels to really create the changes we want to see.”

Wanting to discourage mosquito breeding and reduce plastic waste, Drs. LaBeaud and Forsyth led an effort to plant tree seedlings in the plastic containers the kids collected. Four thousand trees were planted in Kenya as a result.  Another 17,000 containers—over a ton of plastic waste—were buried. In Kenya, recycling isn’t an option as plastics are either buried or burned.

Ultimately, Dr. LaBeaud and her team have been able to prevent infections of dengue and chikungunya and promote cleanup of the environment. Because the project involves an educational intervention, Dr. LaBeaud could not have applied for funding from the NIH unless she classified the project as a clinical trial—which it wasn’t. Support from MCHRI, therefore, has been critical in making a difference in Kenyan communities.

What’s next

The team has secured follow-up funding from the BOVA Network to reduce plastic waste and find ways to repurpose the plastic that already exists. To tackle this problem, Dr. Forsyth, Dr. LaBeaud, and Amy Krystosik, PhD, (a postdoctoral scholar in the LaBeaud lab) decided to take a sort of Silicon Valley disruption approach.

“We thought of creating an entrepreneur incubator where we train and mentor a select number of budding Kenyan entrepreneurs to come up with creative ways to make profits while reusing or repurposing the plastic waste that's currently just sitting around breeding mosquitos,” Dr. Forsyth says. “The great thing about Kenya is that people there are incredibly entrepreneurial.”

A separate Bridge Support Award of $50,000 through MCHRI has also helped to support Dr. LaBeaud’s talented and committed Kenyan teams while she applied for renewal funding for her NIH R01 grant. This funding was able to maintain critical social capital in the country, and keep arboviral surveillance up and running at the Kenyan field sites.

Good news for the LaBeaud lab arrived just recently—the R01 has been renewed. A new arboviral study will be rolling out in Kenya in July 2019.

 “We're improving the health of the planet; we're improving the health of our populations and trying to work towards a better place for all the world's children,” Dr. LaBeaud says. “That's really what drives us.”

Click on a capsule below to read more about other MCHRI-funded awardees.

Laura Hedli is a writer for the Division of Neonatal and Developmental Medicine in the Department of Pediatrics and contributes stories to the Stanford Maternal and Child Health Research Institute.