I
i
Duke University
Medical Center
Intercom
VOL. 25, NO. 27
JULY 7, 1978
DURHAM, N.C.
Tobacco smoke^ cotton dust targeted
Major lung disease study to examine mineral hazards
Tobacco, cotton and grains will come
under close scrutiny here over the next
few years as scientists attempt to pin
down the causes of certain lung diseases.
Supported by two grants totaling
$873,114 from the National Institute of
Environmental Health Sciences (NIEHS),
the Duke researchers are beginning a
major study of naturally occurring
minerals that stick to crops in the field
and later may lead to lung disease when
inhaled in dust or smoke.
"Our concern is lessening the danger of
exposure to things that we expect people
will be exposed to for some time," said Dr.
William Gutknecht, assistant professor of
chemistry and co-director of the project.
"The goal is not to put down these
products or the industries they support,
but rather to make them safer if possible."
Multidisciplinary effort
The study is a multidisciplinary effort
involving pulmonary physicians,
physiologists, analytic and organic
chemists, pathologists, biochemists and
pediatricians, Gutknecht said.
Eleven Duke scientists will be involved
directly in the research, while others
from Duke, NIEHS and the Research
Triangle Institute will serve as
consultants.
Gutknecht said the project has been
divided into four related parts.
The first will involve patients referred
to Duke and the Durham VA Hospital by
industries that generate dust from such
natural products as clays, coal, tobacco,
cotton and wheat.
After a thorough evaluation on Duke's
Clinical Research Unit, selected patients
will be treated by lung lavage, a process
using a sterile salt solution to wash
hardened secretions and foreign
materials from the airways to improve
breathing.
Material to be evaluated
In the second part of the study,
scientists will evaluate the material
"Our concern is lessening the danger of exposure to things that we
expect people will be exposed to for some time. The goal is not to put
down these products or the industries they support, but rather to
make them safer if possible."
Medical detective work combats illnesses on CRU
By David Williamson
For eight years Betty McDaniel, a 43-
year-old homemaker from Rock Hill,
S.C., suffered from an extremely rare
disease that prevented her body from
using vitamin D.
Her bones became progressively softer,
and nothing her doctors did seemed to
help.
"At home I was getting more and more
crippled every day," she said. "1 thought I
would never walk again, and every bone
in my body hurt. I could break one of
them just by bending over."
Detective work
After being referred to Duke,
McDaniel was admitted to the Clinical
Research Unit (CRU) where some highly
sophisticated medical detective work
began.
Her physician. Dr. Marc K. Drezner,
said he and his colleagues found that a
benign tumor in her hip about the size of a
cantaloupe was secreting a chemical
factor that blocked her vitamin D
metabolism. Drezner, an assistant
professor of medicine who specializes in
endocrinology, called McDaniel's
condition "tumor-induced osteomalacia."
"We felt that we could probably cure
the osteomalacia if we took the tumor
out," he said, "but since giant cell tumors
of bone are notorious for regrowth, that
meant there was an odds-on chance that
her illness would come back."
Two years later,
she feels fine
Drezner said that after extensive tests
and laboratory work, the scientists
pinpointed the chemical stage at which
vitamin D was being affected. They also
found that an experimental drug that is
an activated form of the vitamin could
prevent her painful symptoms should the
tumor grow back later.
Now, almost two years after her
operation, McDaniel said she walks
several miles a day and feels fine. Body
casts and crutches are no longer a part of
her life.
"I was there (at the CRU) six times
altogether, and they did everything they
could to make me comfortable. There's no
way I could have paid for all those
studies," she said.
Not all endings happy
Not all tales of illness and treatment
have happy endings like the one
McDaniel tells. And most medical
scientists would be the first to admit that
they have only begun to understand the
complexities of health and disease.
When breakthroughs do come,
however, many of them will be associated
with the 80 clinical research centers that
the National Institutes of Health
supports through its Division of Research
Resources, according to Dr. Samuel Wells
Jr., professor of surgery and director of
Duke's unit.
"I don't think there is any place in the
federal government where citizens get
more for their tax dollars," Wells said.
"Since 1960, the large majority of clinical
research at Duke has been performed on
the CRU."
Investigators take advances from basic
medical science or experimental animal
research and apply them to patients,
attempting to prevent, treat and
hopefully cure illnesses, he explained.
Two committees
Wells said that any medical center
physician who wants to admit patients to
the unit for research purposes may do so
but first must secure the approval of two
committees.
The Clinical Investigations Committee,
composed of physicians and laymen alike,
determines whether the potential
benefits outweigh the risks to a patient,
whether the individual's rights and
welfare are protected and whether he or
she will be able to understand fully what
will be done.
The Clinical Research Unit Advisory
IConliinifil oil page 21
obtained from the lavages with electron
ind light microscopes and a technique
known as X-ray microanalysis. They
also will evaluate secretions from
experiment.il animals exposed to aerosols
and drugs in an effort to develop practical
animal mtxlels for the lung diseases
humans contract from air pollution.
"One of the goals is (o determine how
useful analysis of lung lavage materials is
in the diagosis of certain illnesses,"
Gutknecht said.
Unique opportunity for study
In the third series of experiments,
chemists will identify inorganic particles
washed from the patients' lungs and
collected from the air where they worked
before getting sick.
The fourth pa rt will Include
biochemical evaluation of materials
secreted by lung disease patients and also
by rats, chickens and rabbits that have
been exposed to mineral pollutants,
"The scientific literature aboimds with
reports of the effects of inorganii
material on the pulmonary system, but
most of these studies have been
performed using autopsy materials and
cell cultures," Gutknecht said.
"The availability of lavage samples
iCoiiHiiHfil on I'liyi'
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NOT lUST COUNTING CALORIES-Sbaron Poiisson, who begins a new job with the National
Institutes of Health m Maryland this month, served as research dietician on the Clinical Research
Unit for the past seven years. Here she demonstrates how food for certain patients must be
weighed on an electronic balance so that exact duplicates of meals can be analyzed for their
mineral content. iPhoto by Jim Wallace)