Ancestry matters . . . even at the cellular level

Welcome to From Florida, a podcast where you’ll learn how minds are connecting, great ideas are colliding and groundbreaking innovations become a reality because of the University of Florida. 

This year, the theme of Black History Month is Black health and wellness, which makes it an ideal time to learn more about the work of Dr. Josephine Allen and Dr. Erika Moore, both materials science engineers at the University of Florida. In this episode of From Florida, they explain why genetic diversity is important to medical research. Produced by Nicci Brown, Brooke Adams and James L. Sullivan. Original music by Daniel Townsend, a doctoral candidate in music composition in the College of the Arts.

Nicci Brown: Welcome to From Florida, where we share stories about the people, research and innovations taking place at the University of Florida. I'm your host, Nicci Brown.

This year, the theme of Black History Month is Black health and wellness, which makes it an ideal time to learn more about the work of today's guests. We know that race is a social construct, but we also know that different diseases impact different populations in different ways. Despite this, the samples used for medical research are often not representative of diverse populations.

That disparity is at the heart of the studies being conducted by Dr. Josephine Allen and Dr. Erika Moore. Dr. Allen is an associate professor and the Genzyme Professor of Materials Science and Engineering. And Dr. Moore is the Rhines Rising Star Larry Hench Assistant Professor of Materials Science and Engineering. Both are faculty members at UF's Herbert Wertheim College of Engineering, and both are African American. Dr. Allen and Dr. Moore, thank you for joining us today.

Erika Moore: Happy to be here.

Josephine Allen: Thanks for having us.

Erika Moore: Thanks for having us.

Nicci Brown: Dr. Allen, I understand your own research has been impacted by the lack of availability of diverse cell samples. Could you tell us a little more about your work, and the impact that this lack of diversity has had on it?

Josephine Allen: Great, yeah, I'd be happy to. So, I work in the area of tissue engineering and regenerative medicine. And, a big amount of our work, a large focus rather, is in the area of biomaterials development. And so, when we're thinking about engineering biomaterials, whether it's going to be a vascular graft or, you know, a construct that can be used to support wound healing or what have you, we really need to think about how we design those materials for the patient that would eventually receive such materials. And so, really, it starts to become looking at the individual, whether it's their sex, male or female, or their ancestry and how those cells that are eventually going to interact with the material may interact differently, depending on those parameters.

Nicci Brown: How did you come to work with Dr. Moore?

Josephine Allen: So, Dr. Moore is a relatively new hire at UF in the Materials Science and Engineering Department. We both work primarily on diseases where there is a health disparity. So, for me, one is cardiovascular disease and, I think, for Dr. Moore here, it's lupus.

Erika Moore: Yes.

Josephine Allen: And so, because of that, we both had this sort of interest in thinking about how our work could translate into different patient populations. And so, that was sort of a nice segue for us to work together on this.

Nicci Brown: When you were going to do your work and you were trying to get these samples, you came across access problems and trying to get these diverse samples, correct?

Josephine Allen: That's correct. That was one of the areas, as we started to look at sex-based differences and how cells respond to biomaterials, we went to commercially available vendors, ones that we'd been using, and many researchers used, for years. What we found is, when we tried to attempt to buy male and female cells, that there really was a lack of diversity in the cell populations that were available to us. So, essentially, we were going to have to use whatever cells we could get for our research, which really wasn't representative of the populations that we think we need some of these innovations.

Nicci Brown: Where do those organizations, those companies, get the cells in the first place? I mean, how does it all work?

Erika Moore: That's a great question. Most of the samples that commercial vendors get are through volunteers. And so, this is a small plug for people to give blood and to donate tissues, whatever they can, because we do use that in our medical assessments, in our assessments that we do with our materials. And so, after they give their donations, basically, depending on the quantity, amount that they donate, some of that can be sold to commercial vendors that then can sell that to different researchers to conduct human based research on.

So, there is a pipeline for us to access these donors. In addition to that commercially available pipeline, we also do clinical trials. So, we can get people to give us blood samples. We do this in the lab, actually, just to get healthy controls or healthy people to give us samples so that way we can also assess their cells and their responses in interactions with our materials that we create.

Nicci Brown: So, it sounds like it's almost a two-way street, in that those vendors need to do more to try and get those diverse samples, but then, also, to the public in general, to be willing to participate in some of these kinds of research and also, as you said, giving blood, that sort of thing.

Erika Moore: Absolutely. There is a huge need for multiple populations of people, all populations of people, to be willing to interface with medical research. And, because of the stigma around medical research, it's hard to get certain populations or people who've had some type of prejudice against participating in medical research. So, that is a huge problem that's being tackled by epidemiologists, geneticists and us, biomedical engineers.

Nicci Brown: What is the impact then down the road of not having this diversity when you are getting your samples? What are the day-to-day kind of impacts that you see?

Erika Moore: Yeah, that's a wonderful question. I think it's highlighted in the NIH, the National Institutes of Health, All of Us campaign. They have this nationwide campaign to actually increase diversity of their samples because when we do our medical based research now, if we don't have representation of entire populations, certain diseases get overlooked or are not studied readily within the populations of impact.

A really good example that Dr. Allen just mentioned, cardiovascular disease development, right? If we're only studying that in one specific, select group of people, well, we're missing out on what's happening in all of these other groups, right? And, sometimes, that fact that we're missing out, creates and propagates health disparity.

Nicci Brown: Could you tell us a little bit more about your research, Dr. Moore?

Erika Moore: Yeah, I'd be happy to. So, I'm here at the University of Florida. Thankfully, Dr. Allen, helped recruit me here, I think about three years ago now. My work really focuses on understanding the immune system and our immune response to materials. And so, if I'm the combination of two worlds, it's material science, and immunology. Specifically, we design new materials to control how the immune system responds upon healing or after injury.

We also use and design biomaterial models to basically recreate small tissues outside of the body, to study different disease development. And so, one that Josie, or Dr. Allen, mentioned before was specifically in reference to lupus. So, we create a biomaterial model of lupus and understanding vascular inflammation in lupus. So, we kind of mix and dabble, but at the center, we are material science whose applied to immunology.

Nicci Brown: We touched upon this a little bit, but I think it's worth going back and just emphasizing. How did it come to be that we have this lack of diversity in medical research samples? It seems that it's a very real need to offset the negative impact of racism and that has undermined the importance ancestry plays in medical research. So, it's a push and pull, I guess, if you will.

Erika Moore: Absolutely. It's a very delicate topic. I think that your question really identifies how hard it is to make progress in understanding ancestral contributions to disease development, but not having those contributions be solely race-based. So, one of the ways that we try to do that, or how we try to probe that, is by specifically having different collaborators and interacting with people and getting lots of advice and help. There are people who have studied this tension that you mentioned for generations. But, how we inherited the state that we're in today is really a reflection of access, you know? So, only certain people had access to study engineering or to study science, or to study medicine.

And so, as we see increased access, increased diversity across STEM, science, technology, engineering and math, we can increase the questions, the diversity of questions that we ask as researchers. And so, right now, I think Dr. Allen and I both feel so grateful, because we've been able to be trained and now we can use our training to ask more innovative questions, applied to populations of interest, specifically, for ourselves.

Nicci Brown: Dr. Allen, as the more senior member of the two of you, have you seen a lot of change in the last five, 10 years? Has it started to accelerate that change that Dr. Moore mentions in terms of people actually working on these issues?

Josephine Allen: Yes, absolutely. As we've seen more diverse researchers enter the research field, the biomedical field, we see that more diverse research questions are being asked and answered. And also, more emphasis on research related to health disparities that affect different populations. So, there is that connection, I think.

Nicci Brown: And, again, going back to the real-life impact, are we talking about things like rejection of materials that might be implanted? Or, how people respond to various treatments? Is that what we're seeing down the line?

Josephine Allen: I think we could be seeing things like that, just how cells and how the body interacts with not just biomaterials, but drug therapeutics and other devices that we're engineering. The different response could potentially lead to different outcomes medically. We've seen that in some instances even now, particularly, for drug treatments that just don't affect male or female in the same way. And then there's, of course, the component related to ancestry.

Erika Moore: Yeah, absolutely. I was just going to add that, we do see that in the clinic now. One disease that I study is systemic lupus erythematosus. People who develop that, you know, there's a disparity in terms of women of African ancestry are more likely to develop it than women of European ancestry, and it's not known why, right? Even disease progression, comorbidities related to cardiovascular disease, we don't know why these differences persist. That's one really real-world example of how a lack of questions around ancestral contributions to disease development leads to differentials in clinical outcomes for people of different ancestry.

Nicci Brown: Now, you both collaborated with another University of Florida professor, Dr. Connie Mulligan who is an anthropologist, on an article that was published by Nature, so, firstly, congratulations on the article. It's a wonderful and highly regarded publication. Dr. Moore, could you tell us more about that collaboration and the article that resulted? And, I guess, what the response was when it came out?

Erika Moore: Absolutely. I am so grateful that you mentioned Dr. Mulligan. She played a pivotal role in helping us frame this article because she is a geneticist and a cultural anthropologist. And so, her work has literally studied the application of ancestry in populations in Florida, specifically. And so, it's great for this audience to hear about some of her work, specifically as it relates to cardiovascular development in Floridians.

And specifically, through her navigation and guidance, we wanted to frame the article for a large impact or population. And so, that's why we specifically selected Nature Reviews, because we wanted to get people thinking about it. It's a thought-provoking piece, right? How do we consider ancestry as we design our material systems, and as we try to undergo bioengineering? And so, that's why we birthed the project with Connie, or Dr. Mulligan, because we thought, together, with our voices, with our background, all of the people who published on the article are women. We're all in science and the majority of us are actually women of color. And, so, we wanted to say, from our perspective, from our history building these systems, how can we make an impact? We thought Nature was a great way to make that statement, to induce thoughts for people.

Nicci Brown: When did it come out? The article.

Erika Moore: The article came out in December 2021. And so, the outpouring from our communities, our collective communities, was so positive specifically, at UF and then also within Florida, nationally, even internationally, because a lot of science communication occurs independent of realm, independent of time zone. And so, we saw people from Brazil, we saw people from Europe, we saw people all over the world reading this article and responding in kind to say, "How do we consider ancestry," right? So, the purpose of asking the question was successful.

Nicci Brown: Dr. Allen, how do you see things evolving now that you're getting that kind of response from people all over the world?

Josephine Allen: Yes. With the response being generally so positive and really just highlighting this need, I think it opens the doors for people to start to ask these questions and really, within the same context of the work that they're already doing, just to kind of add as another variable in their study's ancestry and patient-specific demographics, and sort of thinking how to apply different research more broadly, to broad population. I think the response has been positive, and I think it has the potential to change the field, at least we hope.

Erika Moore: Absolutely.

Nicci Brown: As we mentioned at the start of our time together, the theme of Black History Month 2022, is Black health and wellness. How do you view the progress that's being made in this area? And Dr. Allen, perhaps we can start with you, and then hear from Dr. Moore.

Josephine Allen: You know, if I take a step back, I'd like to see more progress, right? I mean, there is some progress, but we can always do more. The health disparities exist. They have existed for decades, generations. And even in our current crisis of COVID, we see that there are some differences in the way different populations are affected. So, while I think there is some progress being made, I would like to see more and I think that a paper, like the one that we published, and others that we've worked on, essentially open the door, I think, for the field to say, "Hey, let's ask broader questions about our work and see how we can make it apply to broader populations."

Erika Moore: Yeah, absolutely. I think of the Martin Luther King, Jr. quote, about the arc of justice, right? It might be long, but it always comes back. And so, I do think that there's the ability for us, in these conversations, to try to bring us back to asking questions about who's being impacted in the research, in the science that we study? How do we consider different populations? And, with that, we can kind of achieve the promise of encouraging more people to get involved in STEM, encouraging more innovative questions to be asked, and, hopefully answering some of those questions. So, it's encouraging and we do need more progress.

Nicci Brown: And a message, I guess, to people who are not, perhaps, researchers, members of the general public, who might be listening-

Erika Moore: Absolutely.

Nicci Brown: ... and have those very understandable concerns about participating in research. Maybe, if you could tell us a little more about why they shouldn't be as concerned? What are the protocols that are in place, now, if there are any things that you can share with them?

Erika Moore: Absolutely. I think that hesitancy around medicine is very well understood and is very appropriate. I don't want to come across as if we're judging or condemning anyone because we're certainly not, you know? There is history around why certain populations might be more hesitant to engage in medical research. So, my only piece of advice is to become curious about what's out there, to read primary literature articles.

You know, there's a lot of articles that are not vetted, that do not have any type of peer review. So, there are articles also published in Nature, in Science, that are rigorously peer reviewed. And so, beginning to understand those conversations. Beginning to understand those statements made in the peer-reviewed articles, educating yourselves and taking your time with it. There is no rush, right? We want to help all populations, but if we design the best material in the world and no one wants to use it, we've truly failed, right? And so, the conversation around vulnerability and hesitancy needs to take place and that can occur, hopefully, beginning with education and openness.

Nicci Brown: And, perhaps, also with people like Dr. Connie Mulligan-

Erika Moore: Absolutely.

Nicci Brown: ... who can help in her work, as well.

Josephine Allen: Absolutely.

Erika Moore: Yep, definitely.

Nicci Brown: Dr. Allen and Dr. Moore, thank you so much for your time today. It's very much appreciated.

Erika Moore: Thank you so much for having us.

Josephine Allen: Thank you.

Erika Moore: It's been a pleasure.

Josephine Allen: It's been wonderful. Thank you

Nicci Brown: Listeners, thank you for joining us for another episode of From Florida. I'm your host, Nicci Brown, and I hope you'll join us next week.