Learn about Children’s of Alabama and the innovative programs, research and advances in pediatric health care being made at one of the No. 1 hospitals for children in the Southeast during the Pediatric Academic Societies (PAS) Meeting in Washington, D.C., April 27 to May 1.
Children’s of Alabama and the University of Alabama at Birmingham (UAB) are proud sponsors of the 2023 PAS Meeting and will have a team in attendance. You can visit us at Booth #536 during the conference, learn from the numerous posters and sessions presented by our faculty and fellows, and keep up with PAS sessions and events through the Children’s of Alabama sponsored app. We will also be hosting a Children’s and UAB Alumni and Friends Reception Saturday, April 29, at the Renaissance Washington, D.C. Downtown. For more information, contact Heather Watts at hwatts@uabmc.edu.
Since 1911, Children’s of Alabama has provided specialized medical care for ill and injured children, offering inpatient, outpatient and primary care throughout central Alabama. Children’s serves patients from every county in Alabama and nearly every state. Children’s is a private, not-for-profit medical center that serves as the teaching hospital for UAB pediatric medicine and surgical divisions.
Children’s of Alabama has launched a new podcast called the Children’s of Alabama PedsCast. It’s focused on research, innovative programs and advances in pediatric health care happening at the hospital and making a significant impact on the lives of patients and families not only in Alabama, but throughout the Southeast. PedsCast, which debuted in September 2022, is a pediatric subspecialist peer-to-peer podcast that features physicians, surgeons, clinical specialists and other experts in the field of pediatrics.
Click here to listen to PedsCast and learn about topics like the Food is Medicine program, led by Children’s nephrologist Daniel Feig, M.D., Ph.D., M.P.H. You can also hear from neonatologist Colm Travers, M.D., about the Golden Week program and how it helps some of the tiniest preterm babies during their first week of life.
PedsCast complements the Inside Pediatrics podcast, which originally launched in November 2017 and now focuses on providing medical information and advice for parents.
Children’s of Alabama Dialysis Director Sahar Fathallah-Shaykh, M.D., and her team developed the Food as Medicine Program in spring 2020. Families who qualify based on income and expenses receive a monthly box of non-perishable supplies for their child, as well as support from a renal dietician in how to use them.
When it comes to kids on dialysis, food really is medicine. “We can provide state-of-the-art dialysis treatment and medications, but if they don’t follow a strict diet, they don’t do well,” said Children’s of Alabama Dialysis Director Sahar Fathallah-Shaykh, M.D. That includes a higher risk of hospital admission, infections and even mortality. Plus, it may make them ineligible for transplant because of poor healing, increased risk of infection and poor outcome.
The strict diets are very low in potassium, salt and phosphorus, with no processed or fast food. “This leaves a majority of our patients with a very difficult-to-obtain diet,” she said, particularly since half have significant food insecurity. “If we can’t meet the basic need of food, we’re not helping them that much.”
Which is why she and her team developed the Food as Medicine program in the spring of 2020. Families who qualify based on income and expenses receive a monthly box of non-perishable supplies for their child, as well as support from a renal dietician in how to use them.
“When we started we were hoping to provide them with fresh ingredients once a week, but then COVID came,” Fathallah-Shaykh said, restricting the ability of families to pick up the food on a weekly basis.
Packages include almond milk, rice, pasta, butter, animal crackers, dried herbs and seasonings, grains, cereals, oils for cooking, canned fruits and unsalted vegetables, canned tuna and chicken, and even snacks such as unsalted pretzels and Rice Krisipies Treats. Once the pandemic ends, “we hope that fresh vegetables will join the mix,” Fathallah-Shaykh said.
The unit typically has about 25 patients on dialysis and about half qualify for the program. They claim their boxes when they come for treatment.
The program has been funded, in part, by the Children’s Table fundraiser, a food event and fundraiser to raise awareness about the importance of dietary choices in the health of children and management of pediatric disease. In past years, participants enjoyed tasting plates, signature cocktails, beer, wine and dessert from some of the top chefs in the state. The event has raised more than $100,000 over the past three years to support families’ nutritional needs.
Now the team is trying to figure out how to keep the program going given the COVID-19 pandemic and the challenge it presents for in-person events.
“Without that funding,” Fathallah-Shaykh said, “these children may die if we don’t help them with their basic dietary needs. It’s really that serious.”
The issue is simple: there are simply not enough hearts for all the children who need them. So 17% of all children who need a heart transplant die while waiting; this translates to 20% to 25% of infants.[1]
The University of Alabama at Birmingham (UAB) and Children’s of
Alabama aim to change those dismal statistics with one of the most
revolutionary approaches since the first heart was transplanted from one human
to another in 1967 – xenotransplantation.
Thanks to a $19.5 million grant from biotechnology magnate United
Therapeutics Corporation, UAB and Children’s have launched one of the top
programs in the world dedicated to developing genetically modified solid organs
from pig models for transplantation.
The idea isn’t
new. Pig tissue has been used to replace heart valves for years, said cardiothoracic
surgeon David Cleveland, M.D., MBA, who leads the program at Children’s. The
greatest challenge with solid organs, he said, is overcoming immunological and
physiological barriers.
If they can do that, “We believe that there’s huge potential to
improve the lives of children,” he said.
Supporting
Evidence
Earlier this year, Cleveland presented preliminary results from a
study showing little reactivity in an infant’s blood to cells from a
triple-knockout (TKO) pig. The pig had been genetically modified to delete the
three major antigens that react with natural human anti-pig antibodies. Even
those human cells that did react demonstrated a very mild reaction.
“We found that very promising,” Cleveland said.
Another area of interest is producing immune tolerance by
transplanting porcine thymus tissue to “re-educate” the immune system to accept
the pig heart, said cardiac intensivist Leslie
Rhodes, M.D. The idea comes from the fact that children can develop an immune
system via a human thymus transplant. “We wonder if we could we train their
immune system to be tolerant to the pig thymus transplant,” she said.
Infants are the ideal starting place, Cleveland said, not only because they have the highest wait list mortality of any other demographic waiting for a solid organ transplant, but because their immune systems are still naïve. Indeed, they do not develop antibodies to pig glycans during at least the first three months of life, Cleveland and his team wrote in a recent journal article, providing a “window of opportunity” for the transplant.[2]
The next step is a transplant in a non-human primate. “The FDA
won’t even consider it until we can prove consistent survival in a non-human
primate,” Rhodes said. They hope to perform their first transplant later this
year.
Societal Concerns Addressed
The team is also aware of the societal issues around
xenotransplantation. To address that, they surveyed the families of patients on
the transplant list and the nurses and physicians who will care for these
children.
”I was surprised by how positive they were,” Cleveland said. “I
thought there would be more pushback than there was.” Still, he said, “I think there
has to be major education,” once xenotransplantation becomes a reality. “The
idea of replacing a heart with a pig heart will take some people a little time
to get over.”
He’s confident it will happen, though. “UAB is going to be one of
the centers in the world with the potential to make this happen,” he said. “We
have children living in our ICU because there’s not enough cardiac function; they
are having their birthdays here. It totally changes entire families to have a
child in the hospital forever. There has to be another way.“
[1] Dipchand AI. Current state of pediatric cardiac transplantation. Ann Cardiothorac Surg. 2018;7(1):31–55. doi:10.21037/acs.2018.01.07
[2] Cleveland D, Adam Banks C, Hara H, Carlo WF, Mauchley DC, Cooper DKC. The Case for Cardiac Xenotransplantation in Neonates: Is Now the Time to Reconsider Xenotransplantation for Hypoplastic Left Heart Syndrome? Pediatr Cardiol. 2019;40(2):437-444.
