CENTER FOR
ASTHMA
AND
ENVIRONMENTAL
EXPOSURE
CURRENT PROGRAM DESCRIPTIONS
2000-2001
Jamson Lwebuga-Mukasa, M.D., Ph.D., Director
Elisha Dunn-Georgiou, M.S., Asthma Program Coordinator
Ekatrina Passetchnik, M.D., Laboratory Scientist
Sally Benston, Secretary
Division of Pulmonary, Critical Care & Sleep
Medicine
Department of Medicine
100 High Street
Kaleida Health Buffalo General Division
Buffalo, NY 14203
phone: 716-859-3682/ fax: 716-859-3620
E-mail: jlwebuga@acsu.buffalo.edu
SUMMARY AREAS OF RESEARCH
FOR 2000-2001 ACADEMIC YEAR:
I. CENTER FOR ASTHMA AND ENVIRONMENTAL
EXPOSURE (CA&EE)
CA&EE “linking research to public
policy:”
Long term goal of the Center is to become a
center of excellence in environmental health research - with emphasis on
respiratory health especially disease prevention at a community level. This
will be accomplished through linking research to policy decisions.
Mission of the Center:
Conduct research on asthma and other
respiratory diseased related to environment.
Communicate research findings to communities
(grassroots) and their leaders
Work with communities and their leaders to
implement policies that incorporate research findings
1. Asthma
prevention through implementation of an AsthmaCarePlan Headstart Policy.
CA&EE/Bethel Headstart initiative
CA&EE/Holly Cross Headstart initiatives
2. Asthma
prevention through implementation of an AsthmaCarePlan School Policy.
Buffalo Schools Asthma Alliance
Iroquois Central School District initiative
Niagara Falls School District initiative
3.
Home
interventions to improve Indoor Air Quality – linking public housing
construction and renovation decisions to respiratory health concerns.
EPA Indoor Air Quality Initiative
CA&EE/Fidelis collaborative home-based
pilot for RWJF application
CA&EE/Fidelis/RWJF home-based initiative
4.
Health risks
associated with adverse air quality in urban and rural communities.
Health Effects of Peace Bridge Traffic
pollution on Buffalo’s lower west side residents
Health effects of diesel truck exhaust and
toxic dump emissions on a Cheektowaga/Depew Western New York community
residents.
Investigating potential health effects of
mass silica dust exposure in Cheektowaga/Depew
Health Effects of a coal-fired power plant
emissions on a rural community
II LUNG
BIOLOGY RESEARCH PROGRAM
Mechanisms of lung injury and repair-- silica
lung injury rat model
Role of early apoptosis in triggering
activated type II pneumocyte state
Fibronectin as a pneumocyte switch engine in
silica lung injury model
Activation of type II pneumocyte adhesion
molecules in silica lung injury model
Founded in 1993 by Dr. Jamson Lwebuga-Mukasa, the mission of the
Center for Asthma and Environmental Exposure is to conduct research on asthma
and other diseases impacted by environmental exposure. The Center communicates these research
results to local leaders and communities and works with them to change policy.
Current Projects
School-Based Asthma Policy Program
This program works with elementary schools
and Head Start Centers throughout Western New York to address the increasing
prevalence of asthma among children.
Background
Asthma is a major problem for school children
in Western New York and throughout the United States. There is asthma in every classroom. In any class of 30 children, up to 11 may have asthma. Overall, asthma accounts for over 6 million
days of unnecessary absenteeism per year among school aged children. However, children with asthma can achieve at
the same level as their non-asthmatic peers.
It is therefore important that all school personnel know about asthma so
they can recognize early signs of an asthma attack and educate children with
asthma and their non-asthmatic peers about asthma control and prevention.
This program is currently in place in four
Buffalo Public Schools (#31, #36, #57, and #90), Harry Abate and Niagara
St. Elementary schools in Niagara
Falls, the Iroquois school district and Bethel and Holy Cross Head Start. Intervention in these schools has resulted
in a reduction of between 30-80% in asthma exacerbations among school children
and greater than 70% primary care physician participation. This very successful
program is now ready for implementation in other schools.
Goals
The goals of School-Based Asthma Policy
Program are:
ü To provide a uniform framework for the
management of asthma in participating schools by uniting schools, health care
providers and parents/guardians.
ü To
institute a school policy that all identified asthmatic children needing daily
medication, have at school a health care provider written Asthma Care Plan.
ü To educate school personnel about asthma in
school children and the use of Asthma Care Plans in school
ü To educate diagnosed asthmatic children and
their parents/guardians about effective ways of keeping their child’s asthma
under control.
ü To encourage the participation of health care
providers in school-based asthma programs.
Funding
Active: Kaleida Foundation, Fleet Bank, New
York State Department of Health
Pending: National Institute of Health, Head
Start University Partnership Program
Lower West Side/ Peace Bridge Project
This project is designed to assist an
inner-city community address health and environmental justice issues concerning
the neighborhood in a pro-active manner.
Background
Buffalo’s lower west side is a predominately
poor community with high unemployment and poor health outcomes. The community is mainly Hispanic/Latino of
Puerto Rican descent. This zip code
area (14201) has the highest prevalence of asthma in Western New York with
50-60% of all households reporting at least one asthmatic. The Peace Bridge Plaza which handles customs
inspections for approximately 27,000 cars and 7,000 diesel trucks a day enters
into this neighborhood. Residents are
constantly subjected to the effects of diesel exhaust which has been repeatedly
shown to increase respiratory and cardiac disease morbidity and also increase
the likelihood of childhood cancers.
Due to increased trade, the Peace Bridge Authority (PBA) has recently
proposed to expand the Bridge and Plaza.
This would double the amount of cars and trucks in this neighborhood. To
profit from the high volume of traffic, the PBA wishes to build the
bridge/plaza complex right away, without a comprehensive environmental impact
study.
Goals
The goals of the Lower West Side/Peace Bridge
Project are:
ü To investigate whether current levels of
Peace Bridge Plaza traffic are making lower west side community members sick. This will be investigated through community
surveying, collection of biomarker data on diesel exhaust, and personal and
ambient air quality monitoring for diesel exhaust pollutants (SO2,
CO2, Nox, O3, PM10 PM2.5,
and PM < 1 micron).
ü To address the issues of environmental
justice and economic benefit to the lower west side community. Although the government mandates that no one
community shall bear a higher burden of pollution, polluting sources are often
placed in poor, predominately minority neighborhoods which have no means of
fighting back. As of yet, no benefits
for the lower west side neighborhood from the expansion of the Peace Bridge
Plaza have been identified.
ü To work with community members, local
leaders, and regional planners to find an alternative solution to current Plaza
expansion plans.
ü To impact local, regional and national policy
to insure that transport policy decisions are not made separate from public
health policy decisions.
Funding
Active:
University at Buffalo’s Environment and Society Institute. Community surveying and data collection are scheduled to begin in
August 2000.
Pending: NIH Environmental Justice Community
Partnership Grant
Planned: CDC, EPA, NYSDEC
Health Effects of Power Plants and Diesel Exhaust
The purpose of this project is to examine the
relationship between the increasing prevalence of asthma and air pollution from
area and mobile sources.
Background
Two communities in Western New York have been
observed to have asthma admissions rates higher than the regional mean. One of these communities, Buffalo’s lower
west side (zip code 14201) is adjacent to a customs inspection point for
approximately 7,000 diesel trucks per day.
The other community with high asthma admissions rates is a rural county
in eastern Niagara County which is downwind from a coal-burning power
plant. This power plant is an older
facility that was grand-fathered in under the Clean Air Act with plans either
for its closure or remediation. Neither
closure nor remediation has occurred.
Both diesel trucks and coal burning power
plants have been shown to release gases and particulates which contribute to
increased morbidity of respiratory diseases.
In fact, a large fleet of diesel trucks, such as the one passing through
Buffalo’s lower west side produces as much air pollution as medium sized power
plant. Although some epidemiologic data
does exist on the link between air pollution and asthma, there have been no
studies comparing pollution from power plants and diesel exhaust.
Goals
The goals of the Health Effects of Power
Plants and Diesel Exhaust project are:
ü Retrospectively examine hospital admissions
data over the past 10 years in conjunction with air and meteorologic data to
determine pollution related asthma and respiratory disease morbidity for the
two communities.
ü To
determine the prevalence of asthma and other respiratory diseases in the
communities surrounding the pollution sources.
ü To measure ambient air quality for toxic
gases and particulates in the areas surrounding the pollution sources. Currently, no appropriate air monitoring
stations exist in either Buffalo’s lower west side or in the area surrounding
the power plant.
ü Utilize geographic mapping (GIS) to create a
visual image of disease clusters surrounding the pollution sources. This mapping will show any gradients that
exist in disease prevalence and/or gases or particulates surrounding the power
plant and Peace Bridge Plaza.
Funding
Pending:
New York State Energy Research and Development Agency for funding of
this project to begin in Fall 2000.
Mining and Community
This project explores the health and
environmental impacts of stone quarry mining and nearby toxic dumps on
communities in Western New York.
Background
The Cheektowaga/Depew community residing in
zip codes 14043 and 14227 is bordered by a stone quarry mine containing
limestone and quartz. There are also several toxic dumps near the community.
Research has demonstrated that the mining of quartz releases silica, a known
carcinogen and immune modifier. In
addition to the possible release of silica, the mine employs blasting methods
to release limestone from the ground.
This blasting contributes to noise pollution in the area in addition to
shaking of residents houses. The volume
of limestone produced by the mine requires transport of goods by diesel
trucks. Daily, a high number of diesel
trucks pass through the neighborhoods bordering the quarry. Diesel exhaust is a major source of air
pollution, especially ambient particulate air pollution. Particulate matter (PM) has been associated
with increased cardiopulmonary morbidity and mortality. Residents of this community have complained
of a high rate of respiratory disease and other diseases, dusty home
environments, strong smells of hydrogen sulfide and diesel exhaust. Also
reported are high rates of thyroid disease and cancer.
Currently, the mine has proposed expansion of
its operation. This expansion would not
only use more land in the neighborhood but would also increase mining production
and increase truck traffic through that area.
Goals
The goals of the Mining and Community Project
are:
ü To determine prevalence of respiratory
disease, cancers, autoimmune diseases and reproductive problems among residents
living in the neighborhood bordering the mine.
ü To collect data on ambient air quality
through monitoring of air pollution from diesel truck traffic and mining.
ü To collect data on off-site levels of silica
and hydrogen sulfide in the community surrounding the mine.
ü To utilize GIS mapping to create a visual
image of this community’s disease burden in relation to the mine’s location.
ü To perform cost analysis for disease
morbidity expenditure in the community adjacent to the mine.
ü To work with community members, local
leaders, mining officials and regional planners to develop alternative plans to
the current expansion intentions of the stone quarry.
Funding
Active:
The Center for Asthma and Environmental Exposure is currently
working with the Depew/Cheektowaga
Taxpayers Association to complete the
neighborhood survey. Assistance
in air, silica and water sampling has been
obtained from the University of Rochester.
Pending: EPA, CDC, NYSDEC
Lung Biology Research Program
This program focuses on the cellular and
molecular mechanisms of lung injury and repair, and roles of extracellular
matrix and adhesion molecules using the silica lung injury model in rats.
Background
Silica is a ubiquitous fibrogenic agent,
capable of inducing fibroblast proliferation and excess collagen production,
causing lung fibrosis or silicosis It
has also been shown to cause lung tumors in rats and has recently been
classified as a known human carcinogen.
Silica enters the body as inhaled free silica dust into the airways and
alveolar space of the lung. People most at risk for silica-induced injury are
those who work in professions that produce free silica such as construction,
sandblasting, or mining.
Epidemiological studies such as the one performed by Amandus et al., in
1991, have established clear links between occupation, silicosis, and elevated
incidence of lung cancer.
We have demonstrated via an animal model of
silica-induced lung epithelial cell apoptosis that the in vivo treatment
of rat alveolar epithelial cells with crystalline silica results in an
apoptotic effect that increases from day zero to three, then decreases but
remains present through and likely beyond day twenty-one. There have been several silica-apoptosis
studies that target the neutrophil, granulomatous cells, and PMN’s and many
more that concentrate on the macrophage.
To our knowledge, however, this is the first study to focus on silica’s
apoptotic effect on the alveolar epithelial cell.
Goals
The current research goals of the Lung
Biology Research Program are:
ü To confirm that positive cells in the TUNEL
assay, are type II epithelial cells. This will be done by double labeling
antibodies to pneumocin and surfactant apoprotein which are type II pneumocyte
markers.
ü To
use keratin antibodies which though less specific will distinguish epithelial
cells from macrophages in a mixed cell population. In these experiments the
isolated cells will be permeabilized prior to being subjected to Fluorescent
activated cell sorting or scanning (FACS Scanning). Therefore we repeat the experiment,
working with isolated type II cells. We are also going to use double labeling
of the cells in order to define our study and concentrate it on type II lung
epithelial cells.
Funding
Active: Troup Fund, Kaleida Health
Planned: NIH
The Center For Asthma and Environmental
Exposure and The Lung Biology Research Program offer research opportunities for
pulmonary fellows, residents, graduate and undergraduate students, and area
high school students. Below are participants during the 1999 -2000.
Social and Preventive Medicine Residents
John Almeida, M.D., 1998-1999.
Digna Almeida, M.D., 1999-2000
Lisa Santoro, M.D., 2000-
Vacina Menen, M.D., Ph.D, 2000-.
Graduate student:
Matt Sergent, M.S., Roswell Park Cancer
Research Institute
Environmental Hygienist
Denis Ray, Empire State College (SUNY)
ECC Associate Diploma, Environmental Hygiene
Summer Students(2000):
Samuel Semwangu, Williamsville School
District
Kasalina Nabakooza, Williamsville School
District
Publications 1995-2000:
1.
Kumar NM, Sigurdson
SL, Sheppard D, Lwebuga-Mukasa JS. (1995). Differential modulation of integrin receptors and extracellular
matrix laminin by transforming growth factor β1 in rat alveolar
epithelial cells. Expt Cell Res; 221:385-394.
2. Gibson KF, Aguayo SM, Flowers JC, Ford JG,
Jackson JH, Lwebuga-Mukasa JS, Roman J, Samet JM, Thomas Jr., AV, Young
RC, Ram JS and Hurd SS. (1995). Respiratory disease disproportionately
affecting minorities. Chest;
108:1380-1392.
3.
Nair MPN, Kumar
NM, Monaco G, Tang Y, Lwebuga-Mukasa JS, Schwartz SA.(1996). Alcohol
inhibits lipopolysaccharide (LPS)-induced tumor necrosis factor alpha
(TNFα) gene expression by peripheral blood mononuclear cells as measured
by RT-PCR in situ hybridization.
Clin Diag Lab Immunol 3: 392-398.
4.
Mensah EA,
Kumar NM, Nielsen L, Lwebuga-Mukasa JS.
(1996). Distribution of alveolar
type II cells in neonatal and adult rat lung revealed by RT-PCR-In-situ.
Am J Physiol 271 (Lung Cell & Mol Physiol 15): L178 -L185.
5.
Moxey-Mims MM,
Nielsen L, Noble B, Lwebuga-Mukasa
JS. (1996). Monocyte
chemoattractant protein-1 in chronic proliferative immune complex
nephritis. Clin Immunol Immunopath
80:123-128.
6.
Kumar NM,
Rabadi NH, Sigurdson LS, Schünemann HJ, Lwebuga-Mukasa JS. (1996). Induction of interleukin-1 and interleukin-8
mRNAs and proteins by TGFβ1 in rat lung alveolar epithelial
cells. J Cellular Physiol 169: 186-199.
7.
El-Solh A,
Kumar NM, Nair MPN, Schwartz SA, Lwebuga-Mukasa JS. 1997. An RGD
containing peptide from HIV-1 Tat-(65-80) modulates protooncogene expression in
human bronchoalveolar carcinoma cell line, A549. Immunol Invest 26(3): 351-370.
8.
Abul-Khoudoud
MR, Lwebuga-Mukasa JS. 1997. Primary lung cancer in a seventeen year
old, twenty-seven-week pregnant woman. Chest 112: 159S.
9.
Schünemann HJ,
Dillon D, Nielsen LC, Lwebuga-Mukasa JS. (1998). Modulation of laminin integrin receptors in
the postnatal and adult rat lung.
Differentiation, 63: 181-191.
10.
Sigurdson SL
and Lwebuga-Mukasa JS. 1998. Adhesive characteristics of type II
pneumocyte subpopulations from saline-and silica-treated rats. Exp Lung Res,
24: 307-320.
11.
Hicks W, Hall L
III, Sigurdson SL, Stewart C, Hard R, Winston J, Lwebuga-Mukasa J.
(1998). Isolation and characterization of basal cells from human upper
respiratory epithelium. Exp Cell Res, 237: 357-363.
12.
Hicks W, Jr.
Sigurdson L, Gabalski E, Hard R, Hall L, Gardella J, Powers C, Kumar N, Lwebuga-Mukasa
J. (1999). Cartilage downregulates growth factor expression in tracheal
epithelium. Arch Otol Head & Neck Surgery , 125: 1239-1243.
13.
Lwebuga-Mukasa,
JS, Dunn-Georgiou E. (2000).
The prevalence of asthma in elementary school children in western New York. (In
Press, J. Urban Health).
14.
Lwebuga-Mukasa,
JS, Pszonak R. (2000).
Patterns of asthma hospitalization in Western New York. (In Press, J. Asthma
38 (2): in March 2001).
15.
Lwebuga-Mukasa
JS, Wojcik R, O’Shea RO, Dunn-Georgiou E, Johnson C.
(2000). Home Environmental factors Associated with asthma prevalence in two
Buffalo inner-city neighborhoods. (In Press, J of Health Care for Poor and
Under-Served)
16.
Lwebuga-Mukasa,
JS , Dunn-Georgiou, E.
(2000). Health Implications of Peace
Bridge Plaza Complex: Traffic Related Pollution Effects on an American
Community at a U.S. - Canada Gateway. (In Press, J of Air and Waste Managt.
Assoc).
17.
Almeida J, Lwebuga-Mukasa,
JS. (2000). Geographic variations in asthma mortality in Erie and Niagara
counties western New York, (Submitted, J. Public Health)
18.
Almeida J, Lwebuga-Mukasa,
JS. (2000). Patterns of pediatric asthma hospitalizations in Erie and
Niagara counties, Western New York, 1991-1996.
(Submitted, J. Public Health).
Books/Book Chapters and Educational
Monographs:
1.
Lwebuga-Mukasa
JS. (1998). Mechanisms of Lung Injury and Repair. In "Internal
Medicine." Jay H. Stein, Editor; 5th
Edition, Mosby-Year Book, Inc., St. Louis, MO.
2.
Lwebuga-Mukasa
JS. (1998).
Isolation of type II alveolar epithelial cells pneumocytes. In “Methods in Pulmonary Research.” pp 387-400; Eds. S. Uhlig and A.E. Taylor,
Birkhäuser Verlag AG, Basel, Switzerland, 1998.
3.
Lwebuga-Mukasa,
JS. 1997. Asthma, I Can
Control It: An Asthma Workbook I. Waterfront Press, Buffalo, NY.* pp 26
4.
Lwebuga-Mukasa,
JS. 1997. Asthma, I Can
Control It: An Asthma Workbook II. Waterfront Press, Buffalo, NY.* pp 31
5.
Lwebuga-Mukasa,
JS. 1998. Controlling Your
Child’s Home Environment: An Asthma
Workbook. Waterfront Press, Buffalo, NY. pp 18
6.
Lwebuga-Mukasa,
JS. 1998. Controlling Your
Home Environment: An Asthma Workbook. Waterfront Press, Buffalo, NY. pp 18
7.
Lwebuga-Mukasa,
JS. 1998. Asthma, I Can Control It: An Asthma Workbook
I. 2nd Edition, Waterfront
Press, Buffalo, NY.* pp 26
8.
Lwebuga-Mukasa,
JS. 1998.Asthma, I Can
Control It: An Asthma Workbook II., 2nd Edition, Waterfront Press, Buffalo, NY.* pp 31
9.
Lwebuga-Mukasa
JS. 1998. A Model School
Asthma Policy: Buffalo Schools Asthma Alliance (BSAA). (In
Press)* pp 13
*Spanish translations published in 1998.
10. Lwebuga-Mukasa JS. 1999.
Pocket-size asthma Care Action Plan. A pocket reference for school personnel
and patients.
11. Lwebuga-Mukasa JS. 1999. Managing Asthma
in School. An action folder for school personnel.
Communication of Research Findings to
Community by CA&EE Staff in past 12 months:
Testimony at Public Hearings in past 12
months: 4 times
Reference made of research findings in
Buffalo News in target areas: 6
times
TV (all channels) and Radio: 6 times – Peace Bridge & Stone
Quarry
Buffalo News Editorial: 1 time – Stony
Quarry
Letters to Editor: 1 time
Featured Article Related to Project
(ArtVoice): 1 time
Presentations to community groups: 6 times
Radio only (WNED): 1 time – regarding
Ozone advisory.