At least nine types of FABPs, identified by the tissues and organs in which they were first discovered, are known to have numerous roles in lipid metabolism. While they are responsible for important functions in maintaining health, obesity can result in higher levels of these proteins, igniting disease.

“When people are obese, FABPs in different cells and tissues are upregulated, resulting in changes in lipid metabolism and responses,” Li said.

Li’s research focuses the role of FABPs in chronic inflammation, obesity and cancer development. He recently published a proposed mechanism for how increased levels of one of these proteins, FABP4, resulting from higher amounts of fat tissue, .

“Studies from my laboratory demonstrate that FABP family members, especially FABP4 and FABP5, are critical in mediating obesity-associated diseases by regulating immune cell functions,” Li said. “Thus, our studies on FABPs not only uncover the underlying mechanisms by which obesity undermines human health, but also provide new targets for novel immunotherapeutic strategies for clinics.”

Editors of the journal Cell invited Li to create the SnapShot to illustrate the functions of all known FABPs in health and disease with an emphasis on their role in obesity, chronic inflammatory disease and cancer. SnapShots are graphic diagrams designed to serve as quick reference guides for researchers on a specific topic.

“The SnapShot format offers a great deal of opportunity for creativity and can be printed and pinned above lab benches to jog researchers’ memories,” Li said. “While our studies open a window to see the important functions of FABP family members in some disease contexts, a lot of questions remain unexplored in this field. I hope this piece will encourage more young scientists to contribute their talents to combat obesity and obesity-associated diseases.”

Li has been conducting research funded by the for the past five years which led him to the connection between activity of a protein expressed in fatty tissue and an increase in breast cancer development. Li and colleagues shared the theory in an invited forum in , a Cell Press journal, published online last week. The article describes Li’s theory that adipose fatty acid binding protein (FABP4), expressed in fatty tissue, is responsible for fueling breast cancer tumor growth.

“Many types of cancer are related to obesity, not only breast cancer. More than 13 types of cancer are clearly associated with obesity and I think the list will go on and on once we have more data,” Li said. “In our research, we found the fatty acid binding protein family, especially one member, FABP4, plays a very critical role in the association of obesity and cancer, most specifically breast cancer. We theorize that FABP4 is responsible for the underlying molecular mechanism which promotes obesity-associated breast cancer development.”

Adipose tissue in the body produces FABP4 within fat cells, where it processes and distributes water-insoluble long-chain fatty acids. A certain amount of FABP4 enters the bloodstream under normal conditions. However, as a higher volume of fat tissue is accumulated, more FABP4 is secreted into circulation.

“When we get obese, this protein is secreted out much more into the circulatory system,” Li said. “Normally these molecules are inside the cells, but when people are obese, the molecules are outside.”

Li’s theory offers two ways in which FABP4 may stimulate growth in breast cancer tumors.

First, within the cells, FABP4 increases in certain tumor-associated macrophages, which accumulate in tumors to promote tumor growth. Li’s research also revealed that when FABP4 is inhibited, tumor growth is reduced in animal models even though the adipose tissue remained.

Second, when elevated levels of FABP4 circulate outside the fat cells in obesity, the protein promotes breast cancer development through direct interaction with breast cancer cells. In animal research, mammary tumor development and growth were reduced in obese animals in which FABP4 was controlled.

In addition, FABP4 in the bloodstream appears to work in multiple mechanisms to fuel interactions between tumor components and fat cells, thereby promoting cancer development.

Moreover, Li’s research group recently published findings in showing that different types of high-fat diets have different effects on tumor development. High-fat diets of either cocoa butter or fish oil both result in fat-induced obesity. However, the cocoa butter diet results in increased mammary tumor growth, while the fish oil diet does not. This study not only confirms the critical role of FABP4 in obesity-associated cancer, but reveals that not all obesity promotes the development of tumors.

Li and his team believe a better understanding of how FABP4 works both within macrophages and in circulation could provide opportunities to prevent certain breast cancers from progressing. It may also lead to the development of treatment methods that target FABP4 with drugs or specific antibodies.

“Now we are trying to generate some antibodies for this protein, which could be a very effective therapy strategy for obesity-associated cancer,” Li said.

The center is located in the UofL Physicians Outpatient Center, 401 E. Chestnut St., and serves as the clinical arm of the UofL Diabetes and Obesity Center headed by Aruni Bhatnagar, PhD, which focuses on research into prevention of diabetes.

“It is immensely gratifying to see the science of diabetes prevention being implemented to improve the public’s health,” Bhatnagar said. “It is through programs such as this that we will turn the tide in the fight against the epidemic of type 2 diabetes.”

In addition to the CDC recognition, the UofL Physicians Diabetes and Obesity Center, in a partnership with ULP Department of Medicine, is recognized by the American Diabetes Association for Quality Diabetes Self-Management ����ֱ�� and Support.

The ULP Diabetes and Obesity Center was created in part from support by KentuckyOne Health to provide preventive care and education and to promote research in diabetes and obesity. The Center is directed by Sri Prakash Mokshagundam, MD.

“Once you have diabetes, you can’t get rid of it, but if you have prediabetes, which is higher than normal blood sugar levels, or if you are at risk for developing diabetes, you can prevent it with lifestyle changes,” Mokshagundam said. “Diabetes also can be effectively managed with physician-directed care.

“We want people to know they have the power to change their outcome.”

The program is directed by Registered Dietitian and Certified Diabetes Educator Beth Ackerman, who cited UofL’s own employee wellness program, Get Healthy Now, in earning the recognition.

“This recognition was made possible through collaboration with UofL Get Healthy Now and its director, Patricia Benson, assistant vice president for health, wellness and disease management,” Ackerman said. “We currently offer the program to UofL employees who are covered by the university’s health plan, and will begin offering it to other patients in January.”

The UofL Physicians Diabetes and Obesity Center works to:

• Elevate the health status of our community by raising awareness of the risks for diabetes and heart disease;
• Facilitate prevention and management programs;
• Be a resource to our patients and community health care providers; and��
• Support researchers in their efforts to fight the growing epidemic of diabetes and obesity.

The Diabetes and Obesity Center at UofL Physicians offers diabetes self-management education and support if a patient is newly diagnosed or has had diabetes for many years. The center’s diabetes educators assess each patient’s needs and help them individually or to enroll in an education class to meet those needs. Classes cover:

• Diabetes Prevention
• Diabetes Self-Management��
• Pregnancy Planning
• Diabetes Medications
• Diabetes and Technology
• Medical Nutrition Therapy
• Weight Management
• Monitored Activity Options

More than 84 million Americans – one in three adults��– now have prediabetes. Of those 84 million, nine out of 10 of them don’t know they have it. Without intervention, many people with prediabetes could develop type 2 diabetes within five years.

In Kentucky, diabetes and prediabetes are at epidemic levels, according to the American Diabetes Association. More than 531,000 people in Kentucky, or 14.5 percent of the adult population, have diabetes. Of these, an estimated 108,000 have diabetes but don’t know it, greatly increasing their health risk. In addition, 1.168 million people in Kentucky – 35.5 percent of the adult population – have prediabetes with blood glucose levels higher than normal but not yet high enough to be diagnosed as diabetes. Every year an estimated 27,000 people in Kentucky are diagnosed with diabetes.

During an interview on “UofL Today with Mark Hebert,” Lennon said he expected to find obese employees costing their companies much more for health care and, in return, being penalized with lower salaries. Instead, Lennon says, he was surprised to find overweight workers aren’t seeing the doctor significantly more than their thinner colleagues and their earnings are similar.

“What I found was a very small wage offset,” Lennon said.

But, Lennon says the United States’ employer-based health insurance does, rightly or wrongly, discriminate against job applicants who are obese, smoke or have health problems.

“If they (companies) have two people who can do the same job it incentivizes them to try and cherry pick the worker who is going to add less to the medical spending and add less to the health insurance costs,” Lennon said. “Economists are very interested in this.”��

Listen to the full interview:��

“More than 90 million adults in the United States are obese and more than 30 million adults suffer from diabetes. Our faculty, staff and students work every day to understand the causes and impacts of both so that we can develop the next generation of preventions, cures and treatments,” said UofL President Neeli Bendapudi, PhD. “This group of dynamic researchers now is looking at how our environment, in the broadest sense of the word, plays a role. This understanding has the potential to change not just people in Louisville, but literally the world. This is some of what makes UofL a great place to learn, work and invest.”

Aruni Bhatnagar, PhD, director of the UofL Diabetes and Obesity Center and the recently created Envirome Institute, which houses the Diabetes and Obesity Center, earned a competitive renewal grant that provides funding for essential core programs for all researchers in the center. Additionally, the center grant helps set the director of the research with an emphasis on metabolic and inflammatory mechanisms leading to diabetes, obesity and insulin resistance; stem cell biology; and environmental determinants of cardiometabolic disease. This marks the second successful five-year renewal that Bhatnagar has earned.

Petra Haberzettl, PhD, assistant professor of medicine, and Bradford Hill, PhD, associate professor of medicine, received funding to examine the effects of air pollution on stem cell health.

Jason Hellman, PhD, assistant professor of medicine, received funding to explore how exercise can reduce inflammation. His previous work has shown previously uncovered new mechanisms of sustained inflammation in atherosclerotic lesions in diet-induced obesity.

Matt Nystoriak, PhD, assistant professor of medicine, received support to study how the molecule carnosine can be activated in protecting humans against airborne particulate matter.

Timothy O’Toole, PhD, assistant professor of medicine, earned a competitive renewal grant to gain a better understanding of how diabetic conditions and pollutant exposure affects small pieces of genetic materials that line blood vessels.

Some services require that participants meet certain criteria; staff in the booth can provide information.

Daily services

University of Louisville health care providers will be on-site in the Health Horizons Pavilion at the Kentucky State Fair, and three programs will be offering services each day:

• Mammogram screenings: Providers affiliated with the UofL James Graham Brown Cancer Center and Kentucky Cancer Program will provide mammograms. All screenings will take place in the privacy of the Horses and Hope Cancer Screening Van. Mammogram screenings will be billed to insurance, so participants should have their health insurance verification and photo identification handy. Yearly mammograms are covered by Medicare and most private insurance providers for women over 40. Special discounted rates are available to those without insurance.
• Vascular screenings, including carotid artery screen and ankle brachial index, will be provided daily at the fair, Aug. 17-27. A carotid artery screen is ideal for anyone with dizziness, ringing in the ears or anyone with a family history of carotid artery disease. It also is indicated for smokers and people with high blood pressure, high cholesterol or diabetes or for anyone who is over the age of 50. The test is administered by a registered technologist and uses ultrasound technology.��
• ����ֱ��, prevention and survivorship information from the Kentucky Cancer Program: The Kentucky Cancer Program is a statewide cancer prevention and control program, bringing together local organizations, providers and other partners in planning, implementing and evaluating cancer prevention and control efforts. The KCP staff and volunteers will be on-site providing information and giveaways to fair-goers with the goal of reducing cancer incidence and cancer death in Kentucky.

Women’s health

Staff from UofL Hospital’s��Center for Women & Infants��and��UofL Physicians-Ob/Gyn & Women’s Health��will be on hand at the fair to help women of all ages. The Center for Women & Infants specializes in both high-risk obstetrics and general maternity services and gives expectant families their choice of care from board-certified obstetricians and certified nurse midwives who practice with UofL Physicians-Ob/Gyn & Women’s Health.

At the fair, staff will be on hand to discuss urogynecology with providers from the Female Pelvic Medicine & Reconstructive Surgery practices, fertility specialists in reproductive endocrinology and infertility, the certified nurse midwifery program, family planning services, and our newest offering – Centering Prenatal Care.��

Emergency care, training

The UofL Hospital Level I Trauma Center and the Burn Unit will also both provide a variety of services at the fair.

The��Trauma Center��is the region’s only Level I trauma unit. Staff will train fair-goers to “Stop the Bleed” on Aug. 18. This innovative program uses a lifelike replica of the human thigh – complete with faux blood – to train participants in handling bleeds from wounds at the scene where they occur. On Aug. 22, the Trauma Center will participate in Senior Day at the Fair, and feature a walk-through demonstration to help older adults identify potential hazards, help prevent falls and improve balance. The Trauma Center staff will return on Aug. 26, with more trauma prevention activities.

The UofL��Burn Unit��is the region’s only dedicated adult burn unit and will provide safety information and activities for the entire family. Burn Unit personnel will be at the fair on Aug. 23.

Senior Day

Senior Day at the Fair will feature two programs that will only be available to fair-goers on that date, Tuesday, Aug. 22:

• UofL Hospital Pharmacists��will share information of interest to older adults, including diabetes, vaccinations, pharmacy services at UofL facilities and more. They also will be available to answer questions one-on-one with fair-goers about their medications and treatments.
• UofL Hospital Volunteers��will be at the fair to provide information on how fair-goers can serve others as a hospital volunteer. A wide array of service opportunities are available each year, from greeting guests to clerical service and more.

Also on Senior Day, the UofL booth will provide mammogram screenings, vascular screenings, colon cancer screenings, blood pressure checks, stroke assessments, women’s health information and a walk-through demonstration for older adults to help them avoid falls.

Specialty screenings

Several specialty services will be provided by UofL staff at the fair:

• UofL Physicians-Pediatrics��will be at the fair Aug. 19, offering vision and blood pressure screenings and a child safety demonstration.��
• UofL Physicians-Diabetes & Obesity Center��will be at the fair Aug. 23, providing screenings for prediabetes and diabetes. The screening requires a finger stick and the participant does not have to be fasting.
• UofL Hospital Infection Control��will be at the fair Aug. 24, with information on the importance of hand hygiene in preventing the spread of disease. The staff also will show fair-goers the benefits of getting annual flu vaccinations and provide information on when antibiotics should be used and when they should not.
• Carbon monoxide screening��will be available during the final four days of the fair, Aug. 24 through Aug 27. The carbon monoxide breath test shows the amount of carbon monoxide in the lungs and blood in an indirect, non-invasive manner. Breath carbon monoxide also is an indicator of the levels of approximately 7,000 toxic substances present in cigarette smoke, 69 of which are known to cause cancer. Participants will blow into a small handheld device for several seconds.

Cancer screenings and more��

Staff with UofL’s James Graham Brown Cancer Center, the Kentucky Cancer Program and the UofL School of Dentistry will be on hand to provide information, screenings and more. In addition to the aforementioned mammogram and vascular screenings:

• Head and neck cancer screenings: Provided Aug. 19 and 20, Aug. 22, Aug. 26 and Aug. 27, the UofL School of Dentistry and the Kentucky Cancer Program will observe the 25^th��anniversary of their collaboration in providing head and neck assessments at the fair. Dental students and faculty have conducted more than 3,800 screenings since the collaboration began. This oral head and neck exam is painless and quick, and open to everyone. Participants wearing dentures will be asked to remove them during the 10-minute exam.
• Prostate cancer screenings: Provided Aug. 19 and Aug. 20. Prostate screenings are recommended for men with average risk starting at age 50. African-American men and anyone with a brother, father or son who had prostate cancer before age 65 should begin getting screened for prostate cancer at age 45. Testing will involve a prostate specific antigen (PSA) blood test that involves taking a small amount of blood. A digital rectal exam also will be performed in the privacy of the Horses and Hope Cancer Screening Van to feel for any lumps, bumps or other abnormalities. The results of the PSA will be mailed about two weeks after the fair ends. The entire testing process takes approximately 20 minutes.
• Colon cancer screenings: Provided Aug. 21 through Aug. 27. Colon cancer screenings with FIT kits are available to anyone over 50 who has not had a colonoscopy within the past 10 years or a stool test in the past year. A free take-home kit will be available for men and women 50 and older and to younger participants who are cancer survivors or have a history of cancer in close relatives. The participant will complete stool collection at home and then mail it to UofL Hospital in special packaging provided.
• Cancer resources and Reiki demonstration from the M. Krista Loyd Resource Center��at the Brown Cancer Center: Provided Aug. 24. The Krista Loyd Center provides a peaceful environment for patients with cancer to learn, relax and heal emotionally. One service provided is the Japanese technique of Reiki for stress reduction and healing promotion. Personnel from the Loyd Center will demonstrate the technique.
• Stroke risk assessments and blood pressure screening:��Provided Aug. 22 and Aug. 26. The UofL Hospital Comprehensive Stroke Center was the first certified stroke center in Kentucky. Staff will provide free stroke risk assessment and blood pressure checks to fair-goers.

The study, published this month in the , included 193 third-and-fourth-grade students at three Texas elementary schools throughout��a two-year period. Children in the control classrooms sat at traditional desks, while those in the test group learned at what the study calls “stand-biased desks,” equipped with a footrest and stool. These desks, designed and researched by Texas A&M co-investigators on this study, are meant to encourage longer standing periods since students can occasionally sit on a stool and prop their feet on a footrest underneath the desk to relieve back tension and leg fatigue.

In the study, 62 children remained in the test group for two years, 82 students were in the test group one year and the control group one year, and 49 students were in the control group both years. At the initiation of the study, researchers recorded the students’ height, weight, gender, birth date, and age to calculate their BMI, BMI percentile and BMI category – normal or underweight, overweight or obese. The same information was collected at the end of the second year.

After adjusting for grade, race/ethnicity and gender, Wendel and her colleagues found a 5.24-percent decrease in BMI percentile in the group that used stand-biased desks for two consecutive years relative to the group that used standard desks both years. There was no significant difference between the group that used standing desks for two consecutive years and students that used the desks for only one year of the study.

“School-age children spend most of their waking hours during the week at school. Changing classrooms to stand-biased environments has the potential to affect millions of children by interrupting sedentary behavior, and this can be done simply, at a low cost, and without disrupting classroom instruction,” Wendel said.

National data from 2012 shows 16.9 percent of children ages 2-19 are obese, and another 14.9 percent are overweight. Wendel says as a growing body of evidence shows that prolonged sitting greatly increases a person’s risk for obesity, metabolic issues and chronic disease, a change in philosophy to incorporate standing desks in the classroom could have a major impact on public health.

Areas receiving grants are pediatric cardiac regenerative medicine, pediatric surgery research, the Kosair Charities Pediatric Clinical Trials Unit, the UofL Autism Center at Kosair Charities, the Child and Adolescent Health Research Design and Support Unit, and the Kosair Children’s Hospital Research Institute.

“Research is vital to advancing the care we, as partners, can provide to children,” said Steven T. Hester, MD, MBA, system senior vice president and chief medical officer, Norton Healthcare. “The pediatric specialists at the University of Louisville are doing work that can help us provide even better care and, hopefully, cures.”

“We appreciate the funding provided by Norton Healthcare to further our work in understanding and ultimately curing diseases and conditions that affect children,” said Gregory C. Postel, MD, interim executive vice president for health affairs, University of Louisville. “At UofL, we have set an ambitious yet achievable agenda in pediatric research that will advance medical knowledge and provide novel and innovative treatments for the children of Kentuckiana and beyond.”

“We see firsthand the benefits that research provides to children,” said Thomas D. Kmetz, division president, Women’s and Children’s Services and Kosair Children’s Hospital. “Supporting this research agenda is incredibly important not just to children, but also in continuing to attract additional pediatric specialists to Louisville.”

The $1.25 million provides one year of funding to the six research areas:

• $100,000 for pediatric cardiac regenerative medicine, led by Bradley B. Keller, MD, for research focusing on identifying the biomechanical origins of congenital heart disease and the development of implantable engineered cardiac tissues for repair and restoration using patient-derived human pluripotent stem cells. The goal of these studies is to repair and regenerate damaged heart muscle as an alternative to cardiac transplantation.
• $100,000 for the pediatric surgery research lab, led by Mary E. Fallat, MD, to support research in surgical techniques and outcomes, trauma practices and necrotizing enterocolitis, a disease that affects mostly the intestine of premature infants where the wall of the intestine is invaded by bacteria that cause local infection and inflammation that can ultimately destroy the bowel wall. Research in this area directly impacts the care children and neonates receive when they need surgical services.
• $100,000 for the Kosair Charities Pediatric Clinical Research Unit, led by Janice E. Sullivan, MD, to support the unit’s medication, quality improvement and device clinical trials. The goal of this unit is to improve health care provided to children through development of new or improved treatment practices and evaluation and approval of medical devices or medications for children.
• $250,000 for the UofL Autism Center at Kosair Charities led by Gregory N. Barnes, MD, PhD, to support the Precision Medicine Initiative in Autism Spectrum Disorders. The goal of this study is to use a child’s DNA to develop individualized treatment approaches to better restore the function of neural circuits in the brain, thereby improving behavior and cognitive skills.
• $300,000 for the Child and Adolescent Health Research Design and Support Unit led by Charles R. Woods Jr., MD, to support research projects around overprescribing of psychiatric medications and antimicrobial agents in children, as well as improving data availability to frontline state workers in the foster care system. The goal of this research unit is to improve the effectiveness, quality, safety and delivery of health care and prevention/health promotion services to children.
• $400,000 for the Kosair Children’s Hospital Research Institute led by Lu Cai, MD, PhD, for support in research programs in the areas of diabetes- and obesity-related multi-organ diseases, including cardiovascular diseases, pulmonary diseases, neurobiological and carcinogenic susceptibility, molecular and cellular mechanisms and potential interventions. The focus of the institute is on basic and translational research, bringing these programs forward as quickly as possible from the laboratory bench to the patient’s bedside.

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