Barbara Van Der Pol, an epidemiologist at the IU School of Medicine, and David Nelson, a molecular biologist at IU Bloomington, have been named co-investigators on a four-year, $7 million grant from the National Institutes of Health’s Human Microbiome Project. The project is one of only eight nationwide selected to receive funding from this NIH project. J. Dennis Fortenberry, M.D., professor of pediatrics at the IU School of Medicine and an expert on sexually transmitted diseases, serves as the principal investigator on the project.
“This project will play a key step in the NIH’s larger mission to identify and understand all the microbes in the human body,” Fortenberry said. “Although our bodies contain trillions of these microorganisms, surprisingly little is known about their role in human health and disease, especially as related to men’s sexual health.”
The study, which combines anonymous patient information from healthy young men as well as patients at an STI/STD clinic in Indianapolis with high-tech molecular analysis, aims to uncover the physical and behavioral causes behind some very painful urethral infections. Early support for the project was provided by the Indiana CTSI, a statewide collaboration between IU, Purdue and Notre Dame universities, as well as public and private partners, that facilities the transformation of promising laboratory research into new patient treatments in Indiana.
“This is actually the main cause of male health care visits to HMOs and other federal care institutions,” Van Der Pol said, citing a 2001 study from the Massachusetts Department of Public Health in which nearly 70 percent of first-time clinical visits by men were related to urethritis, a disease characterized by inflammation of the urethra, pain during urination, pain during sex or burning and itching. The federal government spends millions each year trying to improve the control of STDs.
“What’s really interesting — or maybe sad and disturbing — is that less than one in five of the urethritis cases from the 2001 study could be effectively diagnosed and treated,” Van Der Pol said. Undiagnosed cases are referred to as “idiopathic urethritis,” which may be triggered by parasites, viruses or bacterial infections, such as gonorrhea and chlamydia. The least understood of these stem from bacteria that cannot be grown in a lab — making it difficult for scientists to conduct testing.
“This is where collaboration becomes essential,” said Van Der Pol, whose work with the Bell Flower Clinic, a sexual health clinic operated by the Marion County Department of Public Health STD Control Program, put her in contact with male patients who could contribute live samples to the project. Nelson then oversaw advanced laboratory analysis. The Department of Biology at IU Bloomington is in the College of Arts and Sciences.
“We correlate information from patients, including demographics, sexual history and the impact of urogenital discomfort on daily living, with diagnostic data, such as cell counts, inflammation levels and infection type,” Nelson said. “Then we drill down to the molecular level.”
The goal? To pinpoint the precise microbial communities behind these “idiopathic” infections. Early findings have been eye-opening, said Van Der Pol, including infected men who lack a bacteria known to serve a protective function in women — and it may turn out in men as well. The analysis also discovered others carrying a bacteria more commonly associated with women suffering from complications in pregnancy, including miscarriages. Both findings suggest the study also may have an impact on women’s health research.
New insights are also being made into the effectiveness of current clinical practices, including evidence that painful swab tests, which involve physically probing the male urethra, are not required to collect viable clinical samples. This is significant since using urine testing as a less invasive alternative will allow researchers to collect bacteria samples from a larger patient community. Every man who has ever experienced an unpleasant visit to a urologist should also be interested in this finding, Nelson said.
Van Der Pol added that the study’s unique combination of expertise in molecular biology and public health policy is not only resulting in new insights into previously unexplored bacteria, but may also help predict behaviors most likely to cause urethritis, including the role of same- versus opposite-sex couplings or the type of sexual activity in which they’re engaged.
The next step will be to develop practical sexual behavior recommendations for at-risk populations using this new data, she said, empowering patients to improve their sexual health — as well as avoid future clinical visits.
About the Indiana Clinical and Translational Sciences Institute
The Indiana Clinical and Translational Sciences Institute is a statewide collaboration of Indiana University, Purdue University and the University of Notre Dame, as well as public and private partnerships. It facilitates the translation of scientific discoveries in the lab into clinical trials and new patient treatments in Indiana and beyond. Indiana CTSI was established in 2008 with a $25 million Clinical and Translational Science Award from the National Center for Research Resources of the National Institutes of Health, together with nearly $60 million from the state, the three member universities, and public and private donors. The Indiana CTSI is a member of a national network of 55 CTSA-funded organizations across the United States.