When Don Coulter enrolled in medical school after working four years on an investments team at Charles Schwab, he couldn’t have envisioned that on-the-job lessons in customer service, budgeting, and team building would one day pay dividends in building a pediatric cancer research program. Throughout medical training, his sights were set on serving patients in the clinic. Then, in 2013, the parents of a young neuroblastoma patient refused to accept Nebraska’s unmet needs for cutting-edge pediatric cancer research, especially when they lived in a state with pediatric cancer rates repeatedly among the top 10 in the US. They wondered what it would take to develop “our own cancer Dream Team.” One hard reality they encountered is the treacherous path to NIH funding for MD-trained investigators who haven’t logged conventional research fellowships or established deep publication records. These conversations triggered Dr. Coulter’s business problem solving skills, and he took on leadership in the cause of building something new, through state support. Harnessing the energy of committed patient families and community advocates and making repeated testimonies legislative committees in Lincoln led to passage of a bill to allocate $1.8 million for establishment of a pediatric cancer research infrastructure at UNMC.
In 2014, the team’s Year 1 report back to the Legislature showed a strong enough return on investment to pave the way to approval of yearly $1.8 million allocations toward Nebraska’s pediatric cancer research in perpetuity. Ongoing objectives of this unparalleled state investment include:
- Conduct deeper epidemiologic studies into the dimensions, causes, and healthcare implications of pediatric cancer in Nebraska.
- Foster translational studies to propel child-compatible cancer drug candidates toward human trials.
- Enrich research opportunities and resources available to local clinicians and lab scientists.
Dr. Coulter discovered that “there was a way I can use my business background as a collaborative guy, rather than rather than somebody who's running all the research, so that's where I developed this Pediatric Cancer Research Group (PCRG).” As Director, he has overseen the distribution of seed grants to support 36 projects in basic science, translational science, and epidemiology. The state dollars have been leveraged with matching philanthropic gifts and spurred progress in the acquisition of NIH funding. PCRG investigators’ NIH proposals have earned increasingly competitive scores, with two R21 grants awarded to date.
The author affiliations listed on a 2018 paper in Cancer Epidemiology reflect the type of interdisciplinary, regional collaboration that Dr. Coulter wants to nurture: Public Health, Epidemiology, and Pediatric Hematology/Oncology units at UNMC; Nebraska Department of Health and Human Services; and the Department of Geography and Geology at the University of Nebraska-Omaha. This team analyzed incidences of several pediatric cancer categories, state-wide and by county, between 1990 and 2013, tapping into the Nebraska Cancer Registry and Geographic Information System (GIS) mapping. Over that near-quarter century, adjusted incidence rates of overall pediatric cancer was 173.3 per million in Nebraska, versus 167.3 per million in the US overall. Nebraska’s disparities in lymphoma and CNS tumor incidence increased in the last years of the study, 2008-2013. Counties with incidence rates exceeding the statewide rate by ≥10% are concentrated in rural areas located 1-7 hours driving distance from treatment centers in Omaha. In light of the results, PCRG initiatives are exploring etiological links to environmental factors, such as contamination of the Ogallala Aquifer. They are also pursuing strategies for greater engagement of rural pediatric patients using telemedicine and decentralized care that could lighten families’ burdens of travel and time away from school and work.
On the translational research front, new on-campus collaboration possibilities for PCRG opened up when Dr. Don Durden and his NIH-funded computational chemistry research group moved to UNMC and Children’s Hospital in 2018. Dr. Coulter and colleagues in PCRG look forward to seeing promising compounds and knowledge that emerge from their preclinical investigations incorporated in the Dr. Durden’s vision to deliver personalized precision medicine. High-volume in vitro and animal testing capacities of the Durden Lab offer possibilities of greatly accelerated progress toward testing novel compounds in humans.
One of Dr. Coulter’s specialties is listening to fellow researchers who may work in different spheres, spotting opportunities for synergy, and helping them kindle their own collaborations. In one example, he was listening to Dr. Sidharth Mahapatra, a PhD researcher and pediatric intensive care unit doctor, present data on a silencing messenger RNA with profound effects in medulloblastoma. Intrigued at the therapeutic possibilities if it could be delivered in patients with nanoscale carriers, Coulter’s thoughts turned to Dr. Joseph Vetro, a PhD scientist in the College of Pharmacy. “That's what Joe does, is he makes these cholesterol esters that are sort of able to package whatever inhibitor you have and then can deliver it in a very, very efficient way to the tumor. So, it was very easy for me to call the two of them together and say, ‘We should have a meeting, the three of us.’ The three of us sit down have a cup of coffee. I say, ‘Sid, this is Joe. Joe this is Sid. This is this is what he does, and this is what he does.’ Then I step back and watch the electricity and that's super fun.”
Dr. Coulter feels a strong commitment to fostering clinicians’ engagement in academic research, borne from the recognition that individuals who have full-time service loads in the clinic and may not have lengthy formalized training in research often feel excluded from conventional NIH-driven funding paths. “The Pediatric Cancer Research group is going to continue operating as a model as to how you can use public-private partnership to drive research to get to the point where you could consider getting NIH grants. If you're a clinician and you don't think that you could ever really be a researcher at the bench doing basic science work or you could ever be a translational scientist, (we say) ‘Absolutely no problem – what you could do is you could partner with the PhDs who are working in those labs and you could tell them what the clinical problems are and help them to identify how they could use their skill-set to address those clinical problems.’”
The formation of CHRI, another driver of cross-institutional and cross-disciplinary research with research opportunities for clinicians, is right in sync with Dr. Coulter’s passions: “We have a lot of expertise here that we don't necessarily all know about, which I think the CHRI is eventually going to help people understand. A lot of these experts are available on campus and the key is getting them together in a room and talking through ‘what would this project look like?’ I think there are people who look at the CHRI and think, ‘Oh, that is great – that's going to help people who are doing research.’ And on the flip side of the coin, I think the CHRI is for everybody. I think CHRI takes that wide global view of accepting these clinicians and helping them identify places where they can plug in with a PhD or somebody who's doing something in the lab. I think the clinicians might find that not only do they have time for that… it might change the way that you practice in more efficient ways when you identify and research a problem and understand how better to address it.”
August 6, 2019