Filling the Knowledge Vacuum

In my 30 years as a physician and researcher, one of the most important lessons I've learned is that the best work is never done in a vacuum. When I worked on the pediatric wards and intensive care units, we relied on nurses, intensivists, respiratory therapists, immunologists, cardiologists, surgeons, and many others to make sure that we delivered the best possible care to each patient. The human body is so intricate and elaborate that it takes teamwork among specialists at many levels to address complex health problems.

I've taken those learnings with me in my research career, and I appreciate more than ever the importance of an interdisciplinary, collaborative approach to solving difficult health issues. I lead the Global Alliance to Prevent Prematurity and Stillbirth, an initiative of Seattle Children's, and we have spent much of the last year soliciting and reviewing proposals from researchers all over the world for the Preventing Preterm Birth initiative (PPB), a Grand Challenge in Global Health. In our request for proposals, we stressed the fact that preterm birth is a complex syndrome that has many pathways, and we wanted investigators from a range of disciplines to bring their unique expertise to the field. We were thrilled to receive 320 applications from researchers in 50 countries.

Proposals focused on the many different factors that can contribute to preterm birth, including environment, nutrition, inflammation, infection, microbiota, and more. A team of experts from a variety of fields reviewed the proposals for scientific merit and the potential for translating knowledge into interventions that will prevent preterm birth. We have announced the funded projects today, and feel confident that we have shaped a portfolio that spans a broad research spectrum, from bench science to field research in low- and middle-income countries. We anticipate that many of the findings will contribute to preventing the burden of preterm birth in low- and middle-resource settings, and will be relevant to developed countries as well.

As the second-leading cause of death for children under 5 around the world, preterm birth is a critical issue that has suffered from a lack of coordinated research efforts. Many current research projects are not part of a larger enterprise and therefore fail to gain the momentum required to have a significant impact. The PPB helps fill the knowledge vacuum and is a critical step toward a harmonized research pipeline, which can help uncover new interventions and potentially save millions of lives.

Here are the projects that have been selected for funding, and which will work together toward making every birth a healthy birth:

• Dr. David Aronoff of the University of Michigan will be focusing on group B Streptococcus (GBS), which is a leading cause of preterm birth and stillbirth worldwide. Dr. Aronoff and his team will be researching GBS strains to identify potential targets for vaccine and drug development.

• Dr. Margaret Hostetter from Cincinnati Children's Hospital Medical Center and her co-investigators will be focusing on Candida spp. in pregnant women and how it relates to preterm birth. Their goal is to understand the apparent effectiveness of vaginal antifungal therapy in preventing preterm birth.

• Dr. Kevin Kain of the University Health Network in Toronto will be studying the effects of malaria and inflammation during pregnancy, which is known to increase the risk of preterm birth and stillbirth. This project will focus on pinpointing biomarkers to identify at-risk pregnancies as well as developing intervention programs for infected women.

• Dr. Sam Mesiano from Case Western Reserve University School of Medicine will be working to improve the use of progestin-based therapies in pregnant women to prevent preterm birth. The long-term goal of this project is to develop an inexpensive oral therapy that will reduce the prevalence of preterm birth worldwide.

• Dr. David Olson from the University of Alberta will be working to better understand how infections can cause preterm birth. He and his team will seek to discover the earliest triggers of preterm birth and develop new therapeutics to prolong pregnancy.