Collective Health Equity Research in BME: A Case Study of Sickle Cell Disease

Introduction:: The collaborative effort of dedicated and multidisciplinary basic and translational research centers has been crucial to improving the prevention, detection, and treatment of numerous cancers and cardiovascular diseases. However, many conditions predominantly affecting historically underrepresented and underserved populations do not experience this level of academic investment. A growing number of biomedical engineers recognize their critical role in healthcare equity and are actively expanding the scope of their research programs. The broad experiences and expertise of biomedical engineering departments provide a platform to create dedicated research efforts to address a shared healthcare inequity theme. As a case study of this approach, we will present on the development and progress of collaborative research efforts at the University of Texas at Austin centered around better understanding the pathology and developing effective therapies for sickle cell disease.

Sickle cell disease is a genetic blood disorder that affects millions of people around the world, particularly those of African descent. Despite its high prevalence, there has been a significant lack of scientific research into the disease, leading to a health disparity for those who suffer from it. The following research projects seek to address this disparity through the development of new therapeutic and diagnostic strategies.


Materials and Methods:: Sickle Hematopoietic Stem Cell Transplantation Project

Leads: Dr. Mykel Green, Dr. William Matsui, and Dr. Elizabeth Cosgriff-Hernandez

Hematopoietic stem cell transplantation, which replaces abnormal sickle stem cells with healthy donor stem cells, is currently the only cure for sickle cell disease. In standard practice, stem cell transplantation is highly inefficient, with less than 10% of cells injected into the systemic circulation engrafting in the bone marrow. The risk of graft failure is significantly greater in patients with sickle cell disease than in non-sickle patients due to the pathological manifestations in the bone marrow niche. Cell-releasing hydrogel carriers offer the promise of greater cell retention and viability than that of traditional cell delivery methodologies. Therefore, the goal of this work is to develop an injectable cell-releasing hydrogel carrier to improve hematopoietic stem cell engraftment efficiency in sickle cell disease.


Results, Conclusions, and Discussions:: Sickle Kidney Project

Leads: Dr. Adam Bush and Dr. Alicia Chang
Kidney-related mortality is the third leading cause of death (16.7%) in patients with sickle cell disease, with the median onset of renal failure between 23-40 years of age. Although infants with sickle cell disease show signs of kidney disease, no clinical pediatric strategies are used to slow disease progression. Therefore, the goal of this work is to develop and validate robust MRI and accessible, inexpensive point-of-care ultrasound assays of kidney function and characterize renal pathophysiology in children with sickle cell disease.



Sickle Thrombosis Project

Leads: Dr. Manuel Rausch, Dr. Adam Bush, and Dr. Alicia Chang

Patients with sickle cell disease readily generate venous thrombi (hypercoagulability), which are implicated in severe lung complications such as pulmonary embolism, acute chest syndrome, and pulmonary hypertension. Although much is known of the rheological properties of sickle blood, little is known of the mechanical properties of sickle blood clots that ultimately favor embolism and vaso-occlusion. Therefore, the goal of this work is to characterize the soft tissue structural properties of venous blood clots and use this information as a predictive biomarker of pulmonary complications and to inform future therapies.

Overall, applying the collective research effort and expertise of engineers and clinicians to address the problems of sickle cell disease led to the development of novel collaborations toward innovative solutions that have yet to be addressed for this underserved patient population. Future work will include increasing the number of biomedical engineering faculty in areas such as neuroengineering and partnership with public health practitioners to further expand the scope of research into social determinants of health. Adaptation of this research model by other biomedical engineering institutions will provide cutting-edge clinical, translational, and basic research to populations that have been largely ignored and serve as a positive step toward health equity for all.