Research: Laser Detection of Cardiovascular Complications

Researcher and second-year medical student, Laurent Sundheimer ses laser to detect diabetes-related vascular changes. Findings from this UC Irvine laser technology study may hold the key to an effective non-invasive outpatient tool for screening and monitoring those at risk for cardio-vascular complications. We had a chance to speak with Lauren about here research and how the public can volunteer for the study..

How would you describe your research project?

LS: Metabolic Syndrome is a highly prevalent condition that is comprised of several major clustering factors that increase the risk for developing cardiovascular compications  For the purposes of this study, metabolic syndrome is classified as type II diabetes combined with at least two additional diagnoses: abdominal obesity, high blood pressure, and/or high cholesterol.  However, even if a patient has diabetes alone, then he/she is still at risk for developing cardiovascular complications as insulin resistance on its own is associated with vascular changes.  These disturbances can be seen down to the level of the microvasculature.  Further, these vascular disturbances also lead to nerve damage and neuropathy.  Diabetic peripheral neuropathy is a condition brought on by prolonged exposure to high blood glucose.  Interestingly, neuropathy can also modulate vascular reactivity and hence alter circulation.  Thus, it is important to monitor microvascular changes in patients to assess their disease progression and cardiovascular risks.  We hope, that by using the Diffuse Optical Spectroscopy (DOS) technology developed here at UCI, we can measure the varying degrees of microvascular changes in patients.  We would ultimately like to use this as a tool to screen for changes in patients predisposed to the development of diabetes, metabolic syndrome, or cardiovascular disease.  This would be beneficial both as a means to evaluate progression towards a given disease state as well as the advancement of that disease.

What is the main purpose of this research project?
                                                                                       
LS: Microvascular disturbances include abnormalities in arteriolar reactivity, capillary recruitment, permeability, and blood flow.  These changes are evident in both metabolic syndrome and diabetic patients.  There are varying degrees of these disruptions, and the defects in small vessel structure and function can be observed very early in life and early in disease.  Therefore, screening for early signs of microvascular changes in patients is of clinical importance in diseased patients as well as at-risk patients.  Despite this importance, there are, however, no established, non-invasive, accurate, and easy ways to measure these changes at clinics.  A tool that would allow clinicians to non-invasively measure changes in the microvasculature (for example, by quantifying the change in concentrations of deoxyhemoglobin and oxyhemoglobin in the microvasculature in response to metabolic stress) in an outpatient clinic, could allow for earlier detection and long-term monitoring of patients. 

How and why was this project initiated?

LS: This research project, in collaboration with partners at the Beckman Laser Institute, aims to evaluate the hypothesis that the novel DOS technology can be used to non-invasively measure changes in the microvasculature of patients.  DOS is a technique that measures the optical absorption and scattering properties of near-infrared light in tissues such as muscle in order to quantify the absolute concentration of oxygenated and deoxygenated hemoglobin, water, and lipids.  It provides quantitative and functional information on the microvasculature related to tissue perfusion, metabolic changes, and indicators of tissue damage.  It is very sensitive and has already shown promise in the field of breast cancer.  As such, we seek to evaluate the potential of DOS as a means to measure the microvascular changes in metabolic syndrome and diabetic patients in order to assess cardiovascular disease risk.

When do you expect this research project to be completed?

This pilot study is just beginning and there is no specific completion date at his time. Presently, we are enrolling people to participate (see four categories of participants listed below).

How might this research affect diabetes control and eradication?

LS: Complications due to diabetes are important contributors to the morbidity and mortality associated with the disease.  This research is important because it would allow for some of the potential complications to be detected earlier, thereby allowing more time for treatment.  Also, the detection of existing vascular changes can be used to study the progression/regression/etc. to monitor the cardiovascular complications.

Recent studies suggest that patients with type II diabetes are at increased risk of cardiovascular problems, and that this risk equals that of patients with established atherosclerotic disease.  This, combined with the fact that the rate of diabetes diagnoses is on the rise, highlights the importance of monitoring the cardiovascular changes in diabetics.  This research aims to do just that and is aimed toward managing and preventing unnecessary complications.

What motivated you to get involved in diabetes research?

LS: Before entering medical school, I worked as a clinical research coordinator for a local endocrinologist at his private practice and research center. I was involved in various clinical trials for diabetes, neuropathy, cholesterol, blood pressure, obesity, etc.  My work with these patients, and experience in observing how common and connected these conditions are, drove me to continue to seek understanding of the disease states and hopefully help with their treatment.

Research and helping others are two things I am very passionate about, so it just seemed natural for me to seek out a research project wherein my efforts could be put toward helping many.  This, combined with my past research experience and innate intrigue with signaling in the body, made diabetes research a perfect fit.  From a logical standpoint, I knew that I wanted to take my knowledge to help others, but also to help myself as a future physician in my treatment of others.  Diabetic patients are seen by all sorts of physicians in all sorts of specialties and at all ages.  Knowing this, I want to be sure that I can fully understand and appreciate the disease that is diabetes; and what better way than to truly learn about it than to work with patients, researching it and its treatments.

Do you have any direct connection to diabetes ?

Personally, the diabetes research is important for my understanding of the disease pathology, so that I can better serve and treat patients in the future.  It also has personal significance because my family has a history of diabetes.  My great grandmother was a diabetic in the days before they had insulin and the effective treatments that they now have today.  She had multiple amputations, poor glycemic control, and poor health overall.  If I can, in my own small way, work to improve the treatment and state of health of diabetics, so that these traumas do not have to occur today, then I will be content knowing that I have made a difference.

Why do you believe that it is important to conduct diabetes research?

With so many new diagnoses of diabetes and the large number of diabetics unaware of their condition, diabetes is a major, and global, health problem and I believe it is very important to conduct diabetes research because the disease is so far reaching.  Furthermore, because of the large number of complications due to the disease, I also think it is important to study these complications.  Until a cure is found, the more that can be understood about what brings about these complications and what can be done to monitor and prevent them from occurring, I think, the better.

Research Study Participation

Please tell us about the type of participants you are recruiting for this research project.

For now, we are recruiting patients in four categories:
 (1) Type II Diabetic and Metabolic Syndrome patients
(2) Non-diabetic relatives of the patients listed in (1) – subjects genetically predisposed to the disease
(3) Long-term Type I Diabetic patients with history of diabetic peripheral neuropathy
(4) “Normal” age, sex, ethnic background matched control subjects] and observe significant changes between the research patients and the “normal,” control subjects. 
Once studies show that DOS is a useful tool for our purposes, then additional, more specific studies will be initiated.

Those interested in participating in this research study should contact Lauren by e-mail at lsundhei@uci.edu or by phone at (949) -292-0915

\\