Contents - Winter 2008

Wellness Begins Before Birth: Discovering the Origins of Disease

By Mari-Louise Rowley

How does it happen that one newborn enjoys a happy and healthy future and another does not?

That nagging question has led Dr. Alan Rosenberg, a University of Saskatchewan pediatric rheumatologist, to study the complex interplay of genetics, environment and lifestyle to determine the earliest origins of disease and the key to health later in life.

His own observations over 25 years as a researcher-clinician together with growing medical evidence suggest that most diseases have their origins during childhood or even before birth.

Rosenberg leads a national team of health scientists in this quest for the early origins of disease. The goal of their work is the holy grail of medicine—to improve diagnosis, treatment and prevention.

“There is no way that we will be able to sustain an affordable, high quality health care system if we don’t begin to understand the multiple influences early in life that result in disease later,” Rosenberg says.

Dr. Alan Rosenberg. Photo courtesy Dr. Alan Rosenberg.

As director of the U of S Pediatric Rheumatic Disease Research Laboratory, Rosenberg studies and treats various forms of arthritis and related rheumatic diseases in Saskatchewan youth and children.

He notes there have been remarkable advances in childhood disease treatment and prevention over the course of his career. Despite these advances, however, chronic diseases are increasing at an alarming rate.

For instance, in Canada, the prevalence of asthma in children and youth has increased six-fold in 20 years. In the past 10 years, obesity rates have doubled. Arthritis now affects 20 per cent of Saskatchewan residents, and the incidence of diabetes in the province has increased 24 per cent in the past 20 years.

For Rosenberg, the health and well-being of the expectant mother is crucial to understanding the early causes of disease, and to preventing these disease conditions later in life. For example, a mother who is obese is more likely to have a child who will become obese and develop obesity-related diseases later on.

During pregnancy, the prenatal environment inside the mother’s womb is susceptible to intrauterine inflammation, which can be caused by infection, psychological or physical stress, environmental pollutants and other factors.

Rosenberg and colleagues believe that exposure to inflammation before birth could predispose a child to develop chronic inflammation-mediated diseases later in life. These include conditions associated with prematurity, autism, high blood pressure, coronary artery disease, allergies, arthritis and diabetes. His group will study possible links between intrauterine inflammation and future disease.

Studying how genetic, lifestyle and environmental factors interact to cause disease is a daunting task, requiring time, money and patience. As with any chronic disease, there is no quick fix.

“The reason that the earliest origins of disease haven’t been studied in such a comprehensive way before is because it is expensive and difficult to do,” says Rosenberg.

“It requires a commitment from political and administrative leaders to invest in pediatric research and care—an investment that will improve the health and well-being of children now and adults in the future. This vision of the future must extend beyond the next fiscal year or election campaign.”

This type of research also requires a wide range of multidisciplinary expertise. Rosenberg’s team includes physicians, nurses, psychologists, physiotherapists, kinesiologists, nutritionists, molecular and cell biologists, epidemiologists, statisticians and geneticists.

The group received $1.1 million in funding from the Canadian Institutes of Health Research, the Canadian Arthritis Network and The Arthritis Society to study the relationship between genetics, environment and lifestyle in juvenile idiopathic arthritis, a painful and debilitating childhood disease.

“We are very fortunate to have Dr. Rosenberg in Saskatchewan, both for his contributions to research relating to the causal factors of arthritis and for his passionate care and treatment of children with the disease as a pediatric rheumatologist,” says Patti Kelm, Executive Director of The Arthritis Society’s Saskatchewan division.

In addition, the team has received funding to investigate the effects of prenatal inflammatory events and the development of future disease.

“This funding will allow us to begin the first phase of our study—to design protocols, enroll patients and collect biological samples,” says Rosenberg. By demonstrating the ability to formulate such a complex research program, he hopes to attract additional funding for genetic studies and further phases of the project.

For Rosenberg, the key to solving the health care crisis requires a deep commitment to the health, well-being and future of our children.

“The path to innovative therapies and preventative strategies must be guided by the long-term needs of our children and of our communities,” he says.

“To achieve the high standards of health we desire for all our citizens and to ensure long-term sustainability of our health care system, we must invest more aggressively in pediatric health care and research.

The MS–Vitamin D Connection

Multiple sclerosis (MS) is a devastating disease that appears later in life, but could very well have its origins in the womb.

Saskatchewan has one of the highest incidences of MS in the world, as the disease is more prevalent at higher latitudes where the amount of vitamin D available from sunshine exposure is lowest.

Dr. Rosenberg notes there is also a strong correlation between the incidence of MS and birth month. Babies conceived in the winter have the highest risk of developing MS in adulthood, since the first trimester occurs when a mother is exposed to less sunlight and therefore most likely to be lacking in vitamin D.

Rosenberg and his team plan more extensive studies of the role vitamin D plays in the origins of disease.