Thursday, May 24, 2012

A dream come true: working at Mass General's Food Allergy Center

Qian Yuan, MD, PhD

Qian Yuan, MD, PhD

Dr. Yuan is having the time of his life at the Food Allergy Center at Massachusetts General Hospital. When asked about his job, he smiles and says, “I have the best job because I get to visit and treat patients, as well as contribute to exciting research to make their lives better.”

He attended medical school in China before leaving his native country in 1989 for New Zealand, where he completed his doctorate in immunology­. After moving to the United States in 1993, Dr. Yuan went to Brigham and Women’s Hospital in Boston to do research in immunology with K. Frank Austen, MD, and Joshua A Boyce, MD, and subsequently to Mass General with Andrew D. Luster, MD, PhD. During his research, Dr. Yuan became interested in Eosinophilic Esophagitis (EE or EoE), an inflammatory condition of the esophagus that can cause problems with feeding, weight gain and daily living. Although it is currently unknown what causes EoE, it appears to be related to food allergies. After his three-year pediatric residency, Dr. Yuan completed a gastrointestinal fellowship at MassGeneral Hospital for Children and began his career at Mass General working with Wayne Shreffler, MD, PhD, a nationally recognized expert in food allergy.

The Food Allergy Center includes basic, translational and clinical researchers and clinicians who meet regularly to guide EoE research at Mass General. The group includes a wide range of clinicians and researchers working closely together: Dr. Yuan, Jyoti P. Ramakrishna, MBBS (Pediatric Gastroenterology) and Aubrey J Katz, MD (Clinical Director, Pediatric Gastroenterology), Paul E. Hesterberg, MD, Shuba Rajashri Iyengar, MD, MPH, Perdita Permaul, MD, and Jolan E. Walter, MD, PhD, (Pediatric Allergy/Immunology), Aidan Angelo Long, MD (Clinical Director, Allergy Associates), Gary Tearney, MD, PhD (Pathology), Bryan Hurley, PhD (Mucosal Immunology) and others.

Because of the lack of information, EoE is a mysterious disease that can be frustrating to treat. Dr. Yuan often will explain to parents that their child has a food allergy, but he cannot identify the food. New EoE patients evaluated at the Food Allergy Center usually have selected food allergy testing, including Immunoglobin E (IgE)/blood tests, skin prick tests and sometimes, skin patch tests.

With so many unknowns around EoE, the doctors at the Food Allergy Center appreciate feedback from parents about their concerns regarding treatment. At a recent evening event focused on EoE, the doctors learned that—aside from a cure—parents’ most immediate wish is to eliminate invasive endoscopies that are used to diagnose the disease. Knowing these concerns helps doctors be better caregivers and researchers. Working with the Department of Pathology, the Food Allergy Center is currently exploring ways to perform endoscopies with less invasive devices, as well as studying how to prevent repeated procedures.

Current EoE research projects

  1. Comparison of outcomes following various elimination diets: EoE patients seen at the Food Allergy Center are followed over time to understand outcomes of dietary modification, as well as the reintroduction of specific foods (e.g. forms of cooked versus fresh milk).
  2. Biomarkers: A biomarker study involving Dr. Katz and Dr. Yuan aimed at identifying non-invasive biological markers from the blood, saliva or urine in patients with EoE who are undergoing dietary changes. Identifying predictive biomarkers will eventually enable researchers to follow EoE disease activity or inflammation without repeated invasive endoscopies.
  3. Investigation of early risk factors in children with EoE. Marcella Rodano, MD, a clinical fellow of pediatric gastroenterology, initiated this project, under supervision by Dr. Yuan and Dr. Shreffler to research early risk factors that may trigger EoE.
  4. Noninvasive endoscopic devices: In collaboration with Gary Tearney, MD, PhD, in the Department of Pathology, investigation of a non-invasive endoscopic device to evaluate the esophagus of EoE patients.
  5. Therapeutic targets: In collaboration with Bryan Hurley, PhD, investigation of basic mechanisms of eosinophilic inflammation in vitro to identify pathways that might be therapeutic targets in the future.

Much of the research at Mass General Food Allergy Center is in need of funding, especially research gathering preliminary data. Collecting this data allows researchers to have a base with which to apply for National Institutes of Health grants as well as to obtain private and foundation support.

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