September 28, 2016 by
Kelly Cowan, M.D., Assistant Professor of Pediatrics at The Robert Larner College of Medicine at The University of Vermont and Pediatric Pulmonologist at the University of Vermont Children's Hospital. (Photo: LCOM Design & Photography)
ECHO program to investigate exposures from conception through early childhood
On September 21, 2016, the National Institutes of Health announced $157 million in awards in fiscal year 2016 to launch a seven-year initiative called Environmental influences on Child Health Outcomes (ECHO). The ECHO program will investigate how exposure to a range of environmental factors in early development — from conception through early childhood — influences the health of children and adolescents.
Kelly Cowan, M.D., a pediatric pulmonologist at the University of Vermont Children’s Hospital and assistant professor of pediatrics at The Robert Larner, M.D. College of Medicine at The University of Vermont, received a $1.84 million four-year grant as part of this program. The funding will establish UVM as an IDeA States Pediatric Clinical Trials Network (ISPCTN) site – one of seven programmatic components of the ECHO initiative. The Vermont program is called IMproving Pediatric Access to Clinical Trials in Vermont – or IMPACT VT. (See list of additional ISPCTN awardees.)
Experiences during sensitive developmental windows, including around the time of conception, later in pregnancy, and during infancy and early childhood, can have long-lasting effects on the health of children. These experiences encompass a broad range of exposures, from air pollution and chemicals in our neighborhoods, to societal factors such as stress, to individual behaviors like sleep and diet. They may act through any number of biological processes, for example changes in the expression of genes or development of the immune system.
The ECHO program awards will build the infrastructure and capacity to support multiple, synergistic longitudinal studies that extend and expand existing cohort studies of mothers and their children. ECHO research will focus on factors that may influence health outcomes around the time of birth as well as into later childhood and adolescence, including upper and lower airway health and development, obesity, and brain and nervous system development. A critical component of ECHO will be to use the NIH-funded Institutional Development Awards (IDeA) program to build state-of-the art pediatric clinical research networks in rural and medically underserved areas, so that children from these communities can participate in clinical trials.
“We are excited and honored that the University of Vermont has become an ISPCTN site for this program,” says Cowan.
The goal of the ISPCTN is to provide medically underserved and rural populations with access to state-of-the art clinical trials, apply findings from relevant pediatric cohort studies to children in IDeA state locations, and build pediatric research capacity at a national level that will benefit children and families living in a rural state.
“I look forward to building our pediatric clinical trials research infrastructure in ways that will improve the health of the children and families served by the University of Vermont,” Cowan says.
In addition to the clinical sites for the ISPCTN, the ECHO infrastructure includes the following programmatic components:
ECHO will fund existing pediatric cohorts with a goal of enrolling more than 50,000 children from diverse racial, geographic and socioeconomic backgrounds to become part of the ECHO consortium. These cohort studies will analyze existing data as well as follow the children over time to address the early environmental origins of at least one of ECHO’s health outcome areas. Each cohort will participate with the others to combine data that are collected in a standardized way across the consortium. See the list of awardees.
The ECHO Coordinating Center will be the central site responsible for organizing and managing activities and logistics for all collaborative components of the initiative, including oversight and coordination of the multi-cohort study design, evaluation of progress, and tissue sample storage. The coordinating center will develop standard operating procedures for how each cohort collects core elements, including demographics, typical early health and development data, genetic influences, environmental exposures and patient reported outcomes. The ECHO Coordinating Center will include an Opportunities and Infrastructure Fund to support pilot projects, encourage junior investigators, and introduce new tools and technologies in the context of the ECHO program. See the list of awardees.
Data Analysis Center:
The ECHO Data Analysis Center will be responsible for managing all existing and new data from ECHO pediatric cohorts. The center will develop and apply new analytic methods for combining and analyzing existing and new longitudinal data from participating cohorts collectively, and will conduct sophisticated multi-level analyses on pooled consortium data to pinpoint potential causes of child health outcomes over time. See the list of awardees.
Children’s Health and Exposure Analysis Resource (CHEAR) Core:
The ECHO CHEAR Core will serve as a consortium resource for laboratory and statistical analyses of personal environmental exposures in existing and future collections of biological samples. It will build off the existing CHEAR resource. See the list of awardees.
Patient Reported Outcomes Core:
Researchers in the ECHO Patient Reported Outcomes (PRO) Core will capture the voices and experiences of children and their families who are participating in the pediatric cohort consortium. The PRO Core is responsible for maintaining and providing PRO information for consortium researchers, assisting researchers with incorporating PROs into their study designs and coordinating methods for updating, validating and administering PRO information in studies. See the list of awardees.
Data Coordinating and Operations Center for the IDeA States Pediatric Clinical Trials Network:
The center will be the central site within the ISPCTN that provides data coordination, technical instruction, data standards, quality control and assurance and operational coordination for IDeA States pediatric clinical trials. It also will serve as the ISPCTN liaison with other ECHO entities. See the list of awardees.
Learn more about the ECHO program components and the awardees for each component.
About the National Institutes of Health (NIH)
NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
(This article was adapted from a press release produced by the NIH News Media Branch.)