CEGIR Mission Statement

Consortium Training Program Supports EGID Researchers of the Future

CEGIR is part of the Rare Diseases Clinical Research Network (RDCRN). A unique part of the RDCRN is a training program that supports investigators that are new to rare disease research. The trainees who participate have access to in-person and web-based opportunities to help them be successful in rare disease research. The trainees are experienced medical professionals who are familiar with eosinophilic gastrointestinal diseases and are working to more deeply focus their research efforts in this area. Here, we are pleased to introduce the five trainees that that have been selected to participate in the training program with CEGIR.

Patricia C. Fulkerson

Patricia C. Fulkerson, MD, PhD

Title: Assistant Professor
Affiliation: Cincinnati Children’s Hospital Medical Center
Year entered into CEGIR training program: 2015
Mentor/s: Dr. Marc Rothenberg, MD, PhD
Biosketch

UCCOM MSTP program 2007, PhD Advisor – Dr. Marc Rothenberg
Cincinnati Children’s Hospital Medical Center: Pediatric Residency and Allergy and Immunology Fellowship

Summary of current CEGIR projects

Dr. Fulkerson currently has two active CEGIR projects. Her first project is to measure eosinophil progenitor levels (cells which will likely become eosinophils) in the blood of those with EoE. Dr. Fulkerson’s findings indicate that that people with active EoE have greater numbers of eosinophil progenitors in their blood compared to those with inactive EoE. She plans to confirm these findings in a second study and to track changes in blood eosinophil progenitor levels in individuals as they go from EoE diagnosis through treatment and food reintroductions.

Dr. Fulkerson’s second project is to try to gain a better understanding of why there is a high rate of EGIDs in individuals that have undergone solid organ transplant and whether the EGID is different in these individuals compared to individuals that have not had a solid organ transplant. “Solid” organs are composed of firm tissue (e.g., liver, pancreas), whereas organs that allow food to pass through are referred to as “hollow” organs (e.g., esophagus, stomach). The findings may provide insight into why EGIDs develop.

Publications as affiliated with CEGIR
  • Morris DW, Stucke EM, Martin LJ, Abonia JP, Mukkada VA, Putnam PE, Rothenberg ME, Fulkerson PC. Eosinophil progenitor levels are increased in patients with active pediatric eosinophilic esophagitis. J Allergy Clin Immunol. 2016 Sep;138(3):915-918.e5. PMCID: PMC5014709
Q&A with Dr. Fulkerson

How has CEGIR participation made a difference in your career, or how do you anticipate it will?
“The CEGIR training award provides opportunities for me to learn from clinicians and clinical investigators at other institutions and for new collaborations to be established.”

How do you feel the patient community benefits from the CEGIR training program?
“Investigators and clinicians working together toward a common goal will result in new knowledge and improved care for patients across the globe as we learn and share our findings and approaches.”

Girish Hiremath

Girish Hiremath, MD

Title: Assistant Professor of Pediatrics
Affiliation: Vanderbilt University Medical Center, Nashville
Year entered into CEGIR training program: 2015
Mentor/s: Evan Dellon, MD MPH; Pablo Abonia, MD
Biosketch

Dr. Hiremath is a board certified pediatric gastroenterologist with a broad background in pediatrics, gastroenterology, global health, and research methods. His emphasis is on providing outstanding clinical care to his patients, and to conduct original translational research addressing some of the most challenging needs of individuals with eosinophilic gastrointestinal disorders, particularly eosinophilic esophagitis.

His clinical-translational eosinophilic esophagitis research focuses on: (1) understanding its epidemiology, (2) applying advanced biomedical technologies to gain novel insights into its pathogenesis and molecular mechanisms, and (3) to discover and to develop innovative non-invasive and/or minimally invasive approaches to diagnose and/or monitor its activity.

Dr. Hiremath's research has been recognized and supported by the National Institutes of Health (NIH) training grant, North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN), American College of Gastroenterology (ACG), American Gastroenterological Association (AGA), and the Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR) training award.

Summary of current CEGIR projects

Dr. Hiremath’s research as a CEGIR trainee focuses on the development of a protocol to validate the online cohort (or group of patients who share specific characteristics) of EGID patients who are enrolled in the CEGIR contact registry. Validating this cohort will likely serve as an important step to use CEGIR contact registry for a variety of patient-oriented research and to disseminate EGID related information.

He has also recently conducted a study to better understand the unmet needs of EGID patients and caregivers. Analysis of the study data is currently underway with the goal of making recommendations for improved, patient-focused healthcare.

Publications as affiliated with CEGIR

Submitted three abstracts for presentation at Digestive Disease Week 2017. These abstracts are currently under review.

Q&A with Dr. Hiremath

How has CEGIR participation made a difference in your career, or how do you anticipate it will?
“CEGIR participation has allowed me to stay informed and participate in cutting-edge research being carried out in the field of EGIDs. It has allowed me to develop collaborations with EGID specialists and expand my network of mentors.”

How do you feel the patient community benefits from the CEGIR training program?
“The patient community will benefit from having more physicians who are trained in diagnosing and managing EGIDs. For instance, I have developed an EGID clinic in Vanderbilt Children’s Hospital (Nashville) which quickly is becoming recognized as a regional transfer center for EGID patients in the area. The patient community will benefit from wide-array of research being conducted by the trainees.”

Amanda B. Muir

Amanda B. Muir, MD

Title: Assistant Professor of Pediatrics
Affiliation: The Children’s Hospital of Philadelphia
Year entered into CEGIR training program: 2015
Mentor/s: Jonathan Spergel, MD, PhD; Hiro Nakagawa, MD, PhD
Biosketch

My clinical and research goal is to improve the lives of children with eosinophilic esophagitis and prevent the devastating consequences of esophageal fibrosis. Following my training in general pediatrics, my strong foundation in mucosal immunology led to a natural interest in pediatric gastroenterology. During my clinical fellowship year, my interactions with patients and families affected by EoE increased my dedication to increasing the medical community’s understanding of its underlying pathology. One complication, esophageal fibrosis predisposes patients to recurrent food impactions, emergent endoscopy, impaired esophageal motility, and esophageal stricture. I am currently looking for ways to diagnose and treat esophageal fibrosis prior to the onset of these complications.

Summary of current CEGIR projects

Dr. Muir’s project with CEGIR involves utilizing the new EndoFLIP® technology. Dr. Muir’s research will measure the amount of stretch (distensibility) of the esophagus, as it is believed that it may be a marker of early fibrosis in EoE. To measure this, a catheter with a balloon on the end is inserted into the esophagus during routine endoscopy. A sensor at the end of the catheter measures the diameter of the esophagus as well as the amount of pressure in the balloon as it is inflated. Her team plans to utilize the data from the study to establish the pediatric normal values for esophageal distensibility, and then evaluate the distensibility in patients with EoE and determine if it correlates with patient symptoms or with how tissue samples look when analyzed under a microscope.

Publications as affiliated with CEGIR
  1. Merves JF, Whelan KA, Benitez AJ, Muir AB, Furuta GT, Wang ML, Falk GW, Spergel JM and Nakagawa H: ATG7 gene expression as a novel tissue biomarker in Eosinophilic Esophagitis. Am J. Gastroentero 2016 In press. NIHMS#: 749309
  2. Whelan KA, Merves JF, Giroux V, Tanaka K, Guo A, Chandramouleeswaran PM, Chang S, Benitez AJ, Dods K, Que J, Masterson JC, Fernando SD, Godwin BC, Klein-Szanto AJ, Chikwava K, Ruchelli ED, Hamilton KE, Muir AB, Wang ML, Furuta GT, Falk GW, Spergel JM and Nakagawa H: Autophagy mediates epithelial cytoprotection and redox homeostasis in Eosinophilic Esophagitis. Gut.
  3. Muir AB, Benitez AJ, Dods K, Spergel JM, Fillon SA: Microbiome and its impact on gastrointestinal atopy. May 30 2016.
  4. Chandramouleeswaran PM, Shen D, Lee AJ, Benitez A, Dods K, Gambanga F, Wilkins BJ, Merves J, Noah Y, Toltzis S, Yearley JH, Spergel JM, Nakagawa H, Malefyt Rd, Muir AB*, Wang ML*. Preferential Secretion of Thymic Stromal Lymphopoietin (TSLP) by Terminally Differentiated Esophageal Epithelial Cells: Relevance to Eosinophilic Esophagitis (EoE).PLOSone. 2016 Mar 18.
  5. Muir AB, Dods K, Henry SJ, Benitez AJ, Lee D, Whelan KA, DeMarshall M, Hammer DA, Falk G, Wells RG, Spergel JM, Nakagawa H, Wang ML. Eosinophilic esophagitis associated chemical and mechanical microenvironmentshapes esophageal fibroblast behavior. Journal of Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2015 Dec 30.
Q&A with Dr. Muir

How has CEGIR participation made a difference in your career, or how do you anticipate it will?
“CEGIR has given me an opportunity to interact with peers just beginning their careers in EGID research as well as some of the leaders in the field. These connections have offered scientific collaborations as well as assistance with clinical and diagnostic dilemmas.”

How do you feel the patient community benefits from the CEGIR training program?
“CEGIR has brought the EGID community together. Researchers and clinicians are able to talk on a weekly basis, whereas before we primarily only interfaced during conferences. We can discuss patients' issues and think critically about clinical trends. We can take these observations and then ask research questions and design studies that can take place nationwide.”

Robbie Pesek

Robbie Pesek, MD

Title: Assistant Professor of Allergy and Immunology
Affiliation: Arkansas Children’s Hospital & University of Arkansas for Medical Sciences
Year entered into CEGIR training program: 2015
Mentor/s: Evan Dellon, MD, MPH
Biosketch

Dr. Pesek completed his medical school in 2004 and Pediatric residency training in 2008 at Arkansas Children’s Hospital and the University of Arkansas for Medical Sciences in Little Rock, Arkansas. He then completed a fellowship in Allergy/Immunology at the University of South Florida in Tampa, Florida. He returned to Arkansas in 2011 as an Assistant Professor of Pediatrics and Allergy/Immunology. He is currently the medical director of the Allergy and Eosinophilic Gastrointestinal Disorders Clinics at Arkansas Children’s Hospital.

Summary of current CEGIR projects

Dr. Pesek’s current research project is to characterize the demographics, medical history, and clinical presentations of patients with eosinophilic gastritis (EG), eosinophilic gastroenteritis (EGE), and eosinophilic colitis (EC) as well as analyze the pathology information obtained during endoscopy that was used to make these diagnoses. He will also evaluate the treatments utilized by participating physicians. His aim is to better understand how often these particular disorders occur as well as how they are diagnosed and treated.

Q&A with Dr. Pesek

How has CEGIR participation made a difference in your career, or how do you anticipate it will?
“The CEGIR training program has made me a better clinician for my patients. It has allowed me to have a better understanding of the ongoing research in the field but also allows me to connect with clinicians across the country. Through involvement with patient advocacy, I have gained a better understanding of the challenges that patients and families face when they are diagnosed with an EGID.”

How do you feel the patient community benefits from the CEGIR training program?
“CEGIR has allowed patients and families direct access to clinicians and researchers. They also have direct input into study development as well as access to results, something that is not seen in many areas.”

Joshua Wechsler

Joshua Wechsler, MD

Title: Assistant Professor in Pediatrics
Affiliation: Ann & Robert H. Lurie Children’s Hospital of Chicago
Year entered into CEGIR training program: 2016
Mentor/s: Barry K. Wershil, MD; Bruce Bochner, MD; Ikuo Hirano, MD; Paul Bryce, PhD
Biosketch

Dr. Wechsler is a pediatric gastroenterologist whose long-term clinical and research goal is to improve outcomes for children with EoE through translational studies that address the role of mast cells. During fellowship, Dr. Wechsler developed a research interest in the role of mast cells, and their mediator, histamine, in gastrointestinal mucosal inflammation, in the laboratory of Paul Bryce, PhD. This led to a natural interest in allergic immunity and EoE, which along with interactions with patients and families, led to a passion to improve outcomes. Dr. Wechsler’s research focuses on dissecting the clinical and cellular implications of mast cell activation in EoE.

Summary of current CEGIR projects

Dr. Wechsler’s project with CEGIR involves examining the role of mast cells in EoE. Mast cells are immune cells that reside in tissue and are increased and activated in EoE, causing inflammation that leads to chronic symptoms and fibrosis. This work will assess the clinical characteristics of these cells, the specific effects of their activation.

Q&A with Dr. Wechsler

How has CEGIR participation made a difference in your career, or how do you anticipate it will?
“CEGIR has created a unique environment for my career development with interactions between junior investigators and leading clinical and basic science investigators.”

How do you feel the patient community benefits from the CEGIR training program?
“CEGIR brings together leading experts in eosinophil disease and patient advocacy groups from around the country that are all working toward a common goal – to define outcome metrics and identify key research questions that are critical to broadly improving care.”