Immune Thrombocytopenia and Low-Level Mercury Exposure

描述（由申请人提供）： 博士Segal正在寻求这个指导患者导向奖，以研究美国免疫性血小板减少性紫癜（ITP）的表皮学，进行一项横断面研究，检查汞与ITP患者相关自身抗体的关系，并开始建立一个ITP患者队列进行纵向研究。这些活动将有助于她成为一名独立的临床研究人员。 在美国，关于ITP流行病学的信息很少。 自身免疫性疾病总体上是医疗保健系统的一个未被充分认识的负担，ITP可能是一个重要的贡献者，因为受影响的患者需要定期住院治疗，手术干预，并且通常需要终身药物治疗。 Segal博士将使用两个大型国家数据库，全国住院患者样本和全国医院门诊医疗调查，调查疾病的患病率，性别和性别分布，共病疾病和ITP患者的资源消耗。 慢性ITP的病因，发生在成人，仍然不确定，但可能涉及一个易感基因型患者的环境触发。为此，Segal博士将收集横断面数据，旨在调查汞在慢性ITP患者中的作用。她将测量血液和趾甲汞浓度和与低水平汞暴露相关的自身抗体，以及抗血小板糖蛋白抗体。 预计汞相关自身抗体患者的血小板特异性抗体患病率较高。未来的研究将旨在调查这些患者的免疫基因型，这些患者对汞的自身免疫效应表现出易感性，这可能会为这部分受影响的患者提出新的治疗方法。 最后，西格尔博士将试点建立一个ITP患者队列进行纵向研究。这将促进与其他机构的研究人员的合作，他们可能有兴趣在队列研究中招募ITP患者。 博士Segal拥有强大的临床和研究培训，并在血液相关主题的临床研究（包括抗凝和自体血液使用的流行病学）方面拥有早期记录。由一位经验丰富的流行病学家、一位具有丰富重金属经验的环境科学家和一位具有血小板疾病专业知识的血液学家/病理学家提供指导，将为Segal博士成功完成研究提供必要的支持。

DESCRIPTION (provided by applicant): Dr. Segal is seeking this Mentored Patient-Oriented Award to study the epiderniology of immune thrombocytopenic purpura (ITP) in the United States, to conduct a cross-sectional study examining mercury's association with relevant autoantibodies in patients with ITP, and to initiate the establishment of a cohort of patients with ITP for longitudinal study. These activities will contribute to her becoming an independent clinical researcher. There is scant information on the epidemiology of ITP in the United States. Autoimmune diseases, collectively, are an under-recognized burden on the health care system and ITP may be a substantial contributor, as affected patients require periodic inpatient care, surgical interventions, and often life-long medical therapy. Dr. Segal will use two large national databases, the Nationwide Inpatient Sample and the Nationwide Hospital Ambulatory Medical Care Survey, to investigate the prevalence of disease, sex and gender distribution, comorbid illnesses, and consumption of resources by patients with ITP. The etiology of chronic ITP, as occurs in adults, remains uncertain, but may involve an environmental trigger in patients with a susceptible genotype. To this end, Dr. Segal will collect cross-sectional data aimed at investigating the role of mercury in patients with chronic ITP. She will measure blood and toenail mercury concentrations and autoantibodies which have been associated with low-level mercury exposure, as well as anti-platelet glycoprotein antibodies. It is expected that patients with mercury-associated autoantibodies will have a high prevalence of platelet-specific antibodies. Future research will be aimed at investigating the immunogenotypes of these patients who demonstrate susceptibility to the autoimmune effects of mercury, which may suggest new therapies for this subset of affected patients. Finally, Dr. Segal will pilot the establishment of a cohort of patients with ITP for longitudinal study. This will facilitate collaboration with researchers at other institutions who may be interested in enrolling patients with ITP in cohort studies. Dr. Segal has strong clinical and research training and an early track record in clinical research in blood-related topics including anticoagulation and the epidemiology of autologous blood use. The mentoring by a skilled epidemiologist, an environmental scientist with extensive heavy metal experience, and a hematologist/pathologist with expertise in platelet disorders, will provide Dr. Segal with the necessary support for successful completion