Working Groups

Epilepsy Working Group

The investment into new drug research has become the frontrunner in the race of finding cures, yet patients with chronic illnesses vary in their response levels to these medications. Epilepsy’s first line of treatment is typically through medications with the hope of better seizure control and tolerated side effects. However, some patients are unresponsive or respond negatively to anti-epileptic drugs thus having uncontrolled seizures and increased adverse side effects. These patients have intractable epilepsy and seek alternative therapies. Ketogenic Therapy, a nutritional treatment, has been used since the 20's to treat seizures with reported benefits well documented in the literature. However, little has changed with administration of and our understanding of how Ketogenic Therapy works. Use of Ketogenic Therapy has been reported in several other chronic illness populations, particularly neurological illnesses. Patients come to the University of Florida Ketogenic Therapy Research Program to find a better therapy for their epilepsy. KT is a prescribed nutritional treatment that is high fat, low carbohydrate, and adequate protein The University of Florida Ketogenic Therapy Research programs initiates and follows patients on Ketogenic Therapy.

Due to lack of evidence, one of our main objectives is to define and document evidence based procedures to better understand the mechanism of action behind KT while closely monitoring each patient. The relationship between our patient's response to KT and the nutrients they receive continues to progress everyday through our daily tasks such as meal-making, entering anthropometric data and diet recalls, and updating our extensive food database. Our KT Program offers individualized therapy administration, education and support of caregiver(s) by providing a personalized Ketogenic Therapy to pediatric patients diagnosed with intractable epilepsy. We want to focus on the relationship between the metabolome and our patient's dietary regiment to their response to KT to better improve our patient's therapy and health conditions. Focused on relieving the comorbidities that result from anti-epileptic medications (AEDs), our goal is to create a therapy and list of nutritional components needed to treat epileptic patients and help improve their lives.

We hope that through our research and our knowledge on the mechanism of action of KT, we can improve the personalized therapy of our patients while also providing answers to families and health care professionals. In addition, we intend to network with other Keto centers to facilitate synergy in the services of KT and to one day change the medical perspective of treatment for epileptic patients.

Pediatric Malnutrition Working Group

The Malnutrition Working Group collects and analyzes data from pediatric patients diagnosed with intractable epilepsy treated with Ketogenic Therapy, and two subpopulations: adolescents infected with HIV and infants exposed to HIV (E-babies). The goal of the Malnutrition Working Group is to characterize the nutritional status of chronically ill pediatric patient with an emphasis on the relationship of nutrients to phenotype. Different goals accompany each patient population. The goals of the E-baby, HIV positive adolescences, and intractable epilepsy studies are to compare growth parameters of the populations to that of a reference population, and to compare dietary intake of these individuals. Data collected will be used to produce a collective set of parameters to define nutritional status of chronically ill pediatric populations using parameters published in the JPEN articles (Mehta et al., 2013). Our end goal is to better understand the nutritional status of our patient populations so that we can better address nutritional concerns.

Metabolome Working Group

The Metabolome Working Group aims to understand the relationships of the metabolome and input of nutrients in chronic disease and neonatal populations. Metabolomics is the study of small molecules, metabolites, present within living organisms. Metabolites are the products of metabolism that occur inside every living organism. While relatively older scientific fields, like genomics and proteomics, provide substantial information regarding genotype, metabolomics is the closest link to phenotype due the metabolome's direct involvement in physiological interactions and help us understand what is happening in the organism so that we may better treat and care for patients. The Metabolome working group collects blood samples from pediatric epileptic patients receiving Ketogenic Therapy for epilepsy and tissue, blood, and urine samples from neonatal piglets. We want to use the metabolomics information we obtain from patient and piglet population and relate it to other parameters including dietary intake, gut microbiome composition, and response to therapy for chronic disease. We hope that these metabolic snapshots can contribute to our understanding of how to make therapies, specifically nutrition therapies, better for patients.

Microbiome Working Group

Microbiomics is a branch of systems biology dealing with communities of microscopic organisms. In the last few decades, the group of microbes inhabiting the human intestinal tract has become of great interest to medicine. The composition of the microbes in the gut has been linked to pathologies as diverse as obesity and Chrohn's disease, and the Microbiome Working Group is looking at the relationship between the gut microbiome and diet.

The Microbiome Working Group shares goals with the Epilepsy and Piglet Working Groups. The Epilepsy Working Group provides Ketogenic therapy to patients with intractable epilepsy and seeks to understand its effects on them. Ketogenic therapy is diet intervention therapy that often improves intractable epilepsy, and its mechanism is poorly understood. While the Epilepsy Working Group looks at trends of success with the therapy, the Microbiome Working Group analyzes patients' stool to define changes in the gut microbiomes of chronically ill pediatric patients on dietary therapy.

The Microbiome Working Group performs bioinformatics procedures on sequences received from the analyzed samples collected during piglet experiments to generate a list of microbes present in each sample. The samples can then be compared for similarity along several parameters. The compositional change of the microbiome along the intestine, from contents to mucus, and between piglets of different ages or on different diets can be assessed. The intestinal samples can even be compared to stool samples of the same piglet to test the usefulness of the conventional method of study. The gut microbiome interacts with human metabolism in ways that cause or prevent disease, and its composition affects how humans respond to a dietary therapy. The Epilepsy Working Group may identify characteristics leading to the success or failure of Ketogenic therapy, and the Piglet Working Group may show the efficacy and side effects of the therapy in piglets, but a large part of understanding why the therapy works the way it does is understanding how it affects the gut microbiome which alters and augments human metabolism.

Piglet Working Group

The Piglet Working Group performs translational research utilizing a piglet model. Piglets are excellent models for humans due to their similarity in physiology, growth, and development. Our Piglet Neonatal Intensive Care Unit (PNICU) functionally simulates a human NICU. The PNICU gives members of the Piglet Working Group an opportunity to provide optimal care for the piglets as well as collect samples or perform procedures that are too invasive for humans.

Currently, the Piglet Working Group investigates the safety of Ketogenic Therapy (KT) in neonatal piglets. Working Group Members administer KT, as well as a control diet, to piglets over the span of a nine day experiment. Biological samples and clinical observations are collected to determine the growth and overall health of the piglets. Blood, urine, tissues, organs, and stool will be subjected to further analysis to study the effect KT has on the piglet's metabolome and microbiome. We hope to see our work prove that KT is a safe treatment for neonates. The end goal is to see Ketogenic Therapy become a treatment option for neonates in a diseased state.

 

If you have any questions about any of the working groups, please send an e-mail to if-svc-investigators@ifas.ufl.edu, with the WORKING GROUP you are interested in in the subject header.

 

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Dr. Peggy R. Borum
University of Florida
FSHN Department
P. O. Box #110370
Gainesville, FL 32611-0370

409A FSHN Bldg
Newell Drive
UF Campus

prb@ufl.edu
Phone: 352-392-7553
Fax: 352-392-8957

 

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