DREAM CAMPAIGN SUPPORTS 11 RESEARCH FUNDING PRIORITIES
Duke Dream Campaign Podcast
iPEGASUS
Andy Shaw, MD
Hello I’m Elizabeth Perez and welcome to the Duke Dream Campaign Podcast.
We are here with anesthesiologist and researcher, Dr. Andy Shaw who is best known for his revolutionary work with iPEGASUS, a study that collaborates data from institutions around the world. Dr. Shaw’s research interests center around the genetics of perioperative medicine, particularly the role of genetic variation in the response to cardiothoracic surgery, and in postoperative acute renal failure. Three of his research endeavors, including iPEGASUS are part of the 11 funding priorities of the Duke DREAM Campaign. Today we will be discussing his study, iPEGASUS. Dr. Shaw, thank you for taking the time to talk with us today
Tell me about this study.
iPEGASUS stands for International Perioperative Genetics and Safety Outcomes Study. This is an extension of a study that has been running at Duke for the past 5 years in which we aim to study how an individual’s genetic make-up affects their response to surgery. We have recently extended this study to countries in other parts of the world because we recognize that there is benefit in this type of thinking for patients all around the world. The essential thrust behind the idea is to collect a large number of samples from a large number of patients from all round the world and then to look at the way patterns in individual’s gene sequences predict and describe the way that those individuals respond to surgical intervention.
So why study genetics around the world? Is there evidence to suggest that patients from different racial backgrounds will have different surgical outcomes because of their genes? Is it possible for people from different backgrounds to heal differently?
Many things affect the way a patient responds to a surgical intervention. We have reason to believe that a person’s genetic make up partially determines how someone responds to surgery. Although it is important to put this into perspective, this is just one aspect of a very complex mix of factors that will affect an individual’s outcome. The important thing that we have observed is that people from different racial subtypes respond differently to surgical interventions and particularly in the form of different types of complications. Our research will try and measure those effects so that we can compensate and plan for it before an individual’s operation.
If over 25,000 patients will be participating in the study, that’s a lot of data. What specific data points are you interested in?
We have sites in England, United States, Canada, Australia, Singapore, China, Chile, South America as well as 2 sites in South Africa. It is not enough to collect just a few samples from a few patients because there is so much genetic diversity. In order to get a good handle on that, you have to collect thousands of samples from thousands of patients and of course no one institution can do that on their own. So what we have managed to do is amass a very large number of samples with an accompanying data set that will allow us to explore the way genetic sequence variation affects the response to surgery. We are interested in specific data points like heart, kidney injury after surgery, pain particularly after lung surgery, stroke and delirium and long-term cognitive decline which has been a main thrust of our group’s research efforts over the last five to ten years.
How will you manage to organize and interpret this huge amount of information so that it is meaningful?
It can rapidly get out of hand if you try to collect 25,000 patients worth of data and put it all in one big database. That is why it is important to tie in centers like Duke’s Institute for Genomic Science and Policy (IGSP) which allows us to tap into the incredible statistical and data management resources that we have here at Duke. This way we can make sure that the data collected is analyzed in a meaningful and appropriate way. We have a specially designed database, which is served through the web and was specially designed to manage the iPEGASUS project, that is scalable up to hundreds of sites if necessary. Currently though, funding limits us to the ten sites that we’ve arranged to take part at the moment.
In what ways does this information have the potential to impact patient care?
iPEGASUS will change perioperative medicine by individualizing patients’ treatment and the response to the treatments that they receive. We know that in general it is a good idea to replace valves that do not work, but we do not always know precisely the exact type of valve to use in the exact type of patient. We know how to put someone to sleep to have that operation but do not know whether the way we do that will affect their risk of a post operative outcome. We know that there are certain ways of taking a lung cancer out of someone’s chest but we do not know the right combination of drugs to give them while they are asleep that will be able to reduce the risk of chronic pain after that operation. Over the course of the next decade or two, the greatest impact we will have is to individualize patient care such that the only unexplained variable is the unexpected finding that you come across during the operation.
How will you share and implement your discoveries in nations with less-developed healthcare options than the U.S.?
We feel it is important to translate scientific discoveries all around the world, not just to limit them to those societies that are able to pay for them. We have deliberately gone to centers in all parts of the world so that they can be involved. Perhaps the best example of this two-way exchange of information is the African sites who are enrolling patients in iPEGASUS using the study database as a way to track their trainee, surgeon and anesthesiologist case load. In other words, every time they do a case, they enroll the patient in the iPEGASUS database and they can then access that data in real time right from their hospital in Johannesburg even though it is stored on a server at Duke - they can use that to both describe and improve their own practice. That is something that they would not be able to do if they were not involved in iPEGASUS.
Thank you for listening to the Duke Dream Campaign podcast. Special thanks Tom Freeland and to our producer, Cindy Cho. For more information about this research project or how you help this featured research project come through fruition, please visit us at http://dreamcampaign.duhs.duke.edu or call (919) 681-2849.
To learn more about our 11 funding priorities please click on the images above.
If you are interested in becoming a donor to the Duke Dream Campaign, please contact Elizabeth Perez at 919-681-2849.