Itch Translational Clinical Home at Emory (ITCH-E)

ITCH-E 2019

Our Mission: 

The mission of the Itch Translational Clinical Home at Emory is to create an interdisciplinary team of clinicians, translational researchers, basic researchers, and patients affected by itching in order to better understand mechanisms driving pruritus and to develop improved treatments for patients with itch.

Our Vision: 

The vision of the Itch Translational Clinical Home at Emory (ITCH-E) is to improve the lives of people impacted by itch through research and translating the knowledge gained into clinically meaningful improvements in treatment. 

Itch Measurement Tools: 

The Emory Itch Center has developed several tools to measure itch.  These consist of surveys that allow patients to articulate the severity and impact of their itch.  For more information, please see click  HERE.

About ITCH-E

The origins of ITCH-E can best be traced back to necessity. More than 50 years ago, Emory Dermatology began to be a destination for patients with complex dermatological problems, being the only academic dermatology department in a city undergoing explosive growth in the latter portion of the 20th century. The focus on itch in particular developed as a partnership between Drs. Suephy Chen and Robert Swerlick almost 20 years ago. At that time, our understanding of itch, the epidemiology and impact, the mechanisms driving itch, and effective treatments, were rudimentary at best.  

We noted that while patients might be referred for a wide range of skin issues, those with pruritic components to their skin diseases were over-represented. When we attempted to analyze these patients, in particular regarding the pruritic aspects of their diseases, we found the previous literature relating to etiology, workup, assessment tools, and treatment was sorely lacking.  

Dr. Chen, having recently completed her formal training in outcomes research at Stanford, identified the need to develop validated assessment tools to measure itch in patients and the impact of itch on patient quality of life (QOL). She and Dr. Swerlick also began efforts to structure how information was collected from patients during routine clinical encounters. Subsequently, Dr. Chen also undertook a large study of itch in the Veteran population. 

The product of these efforts has been two fold. First, the VA study efforts have greatly expanded our understanding of the frequency and impact of itch in a large population, further supporting our impressions than treatment of pruritus represents a large unmet need. In particular, itch impact appears to have a disparate impact on African Americans, both in percent of patients affected and the QOL burden. The other product has been the development of a validated itch-specific toll to measure the impact of itch, the Itchy QOL. 

Our efforts at Emory have been accompanied by concurrent efforts at other centers examining the basic science of itch, primarily using animal models and molecular biology to unravel the neurological pathways driving itch. Our efforts focusing on developing tools to measure itch impact in patients and the effect of treatments has served as an essential complement to the basic science work examining mechanisms mediating itch, and each of these elements now serves as the foundation to begin to translate these observations into expanded knowledge that will impact on patients affected by itch.     

Emory Core Faculty Members

Executive Director:     
Robert A. Swerlick, MD

Director:                    
Suephy C. Chen, MD

Managing Director:               
Sarah Chisolm, MD

Director of Translational Research: 
Ron J. Feldman, MD, PhD

Director of Ethnobotanical Research: 
Cassandra L. Quave, PhD

Director of Outcomes Research:
Howa Yeung, MD

Affiliated Faculty Members

Liang Han, PhD
Assistant Professor 
School of Biology 
Georgia Institute of Technology

We use a combination of molecular, cellular, immunohistochemical, electrophysiological, genetic and behavioral approaches to understand the basic mechanisms underlying somatosensation, including pain, itch and mechanical sensations. Somatosensation is initiated by the activation of the primary sensory neurons in dorsal root ganglia and trigeminal ganglia. We have recently discovered the molecular identity of itch-sensing neurons in the peripheral. We are currently investigating how chronic itch associated with cutaneous or systemic disorders is initiated and transmitted.

 

William T. Hu, MD, PhD
Assistant Professor
Department of Neurology
Center for Neurodegenerative Diseases
Emory University School of Medicine

Dr. Hu uses biofluids to understand disease mechanisms and develop clinically meaningful biomarkers.  His laboratory focuses on discovering and validating biomarkers for neurological and non-neurological disorders, and is particularly interested in novel approaches to analyze the balance between pro- and anti-inflammatory pathways.  He is excited about the opportunity to advance the biomarker science of itch because of its serious impact on his family.

 

Zhexing Wen, PhD
Assistant Professor
Department of Psychiatry and Behavorial Sciences
Department of Cell Biology
Emory University School of Medicine

The research of Dr. Zhexing Wen’s laboratory centers on understanding the molecular mechanisms underlying neurological and psychiatric disorders such as schizophrenia, major depression and autism spectrum disorder. In particular, we are interested in using patient-derived induced-pluripotent stem cells (iPSCs) to elucidate the biological functions of causal/risk genetic and environmental (such as stress, itch, and virus infection) factors in neurological and psychiatric disorders, identify pathological developmental processes that may contribute to the etiology of these complex diseases, and translate such knowledge into therapeutic targets for developing novel treatments. To achieve these goals, our research employs a combination of cutting edge technologies, including human non-integrated iPSCs generation, genome editing, specific cell type differentiation, brain-region-specific 3-D organoids generation, as well as molecular biology, biochemistry, molecular/cellular imaging, electrophysiology, deep sequencing and bioinformatics, and high-throughput screening. It is our hope that our studies will bring novel mechanistic insight into these disorders and provide new therapeutic strategies for these devastating diseases that affect millions of people worldwide.

 

 

 

Research

Basic Science Research

The Quave Lab is composed of an interdisciplinary team of scientists who are passionate about translational science geared towards the improvement of human health. The research lab takes the ethnobotanical approach to drug discovery. Their research has developed a novel drug discovery platform based on botanical extracts used in traditional medicine for infectious and inflammatory disease. Dr. Quave and her lab focus on the discovery of new molecules for the treatment of bacterial and fungal infections, including those responsible for chronic itch (atopic dermatitis (eczema), candida infections, seborrheic dermatitis, and jock itch to name a few). Dr. Quave’s research has resulted in three patents for botanical inhibitors of microbial virulence, pathogenesis and growth. She is excited about the potential applications of these innovations for the management of itch.

The Han Lab uses a combination of molecular, cellular, immunohistochemical, electrophysiological, genetic and behavioral approaches to understand how the nervous system receives, transmits and interprets various stimuli to induce physiological and behavioral responses. Dr. Han and her laboratory are particularly interested in the basic mechanisms underlying somatosensation, including pain, itch and mechanical sensations. Somatosensation is initiated by the activation of the primary sensory neurons in dorsal root ganglia and trigeminal ganglia. They have discovered the molecular identity of itch-sensing neurons in the peripheral and provided novel insights into the mechanisms of itch sensation. The Han Lab is currently investigating how chronic itch associated with cutaneous or systemic disorders is initiated and transmitted.

The Hu Lab uses biofluids to understand disease mechanisms and develop clinically meaningful biomarkers. Dr. Hu and his laboratory focus on discovering and validating biomarkers for neurological and non-neurological disorders, and is particularly interested in novel approaches to analyze the balance between pro- and anti-inflammatory pathways.  Dr. Hu is excited about the opportunity to advance the biomarker science of itch because of its serious impact on his family.

The Wen Lab centers on understanding the molecular mechanisms underlying neurological and psychiatric disorders such as schizophrenia, major depression and autism spectrum disorder. In particular, they are interested in using patient-derived induced-pluripotent stem cells (iPSCs) to elucidate the biological functions of causal/risk genetic and environmental (such as stress, itch, and virus infection) factors in neurological and psychiatric disorders, identify pathological developmental processes that may contribute to the etiology of these complex diseases, and translate such knowledge into therapeutic targets for developing novel treatments. To achieve these goals, their research employs a combination of cutting edge technologies, including human non-integrated iPSCs generation, genome editing, specific cell type differentiation, brain-region-specific 3-D organoids generation, as well as molecular biology, biochemistry, molecular/cellular imaging, electrophysiology, deep sequencing and bioinformatics, and high-throughput screening. It is the hope of the Wen Lab that their studies will bring novel mechanistic insight into these disorders and provide new therapeutic strategies for these devastating diseases that affect millions of people worldwide.

Translational Science Research

Comparing impact and mechanism of Itching in Bullous Pemphigoid (BP) and Atopic Dermatitis (AD) Patients
PI: Ron Feldman, MD, PhD
Co-Investigators: Sarah Chisolm,MD;  Suephy Chen, MD, MS; and  Liang Han,
Funding: Pfizer
We will compare known pruritus biomarker levels between AD and BP during both active disease and remission, and to analyze the extent to which pruritus severity and quality of life correlate with changes in biomarkers. Our hypothesis is that biomarker changes will be similar between AD and BP. We will correlate the biomarker findings to the clinical characterization of pruritus (ItchyQoL and ItchyQuant).

Outcomes Research & Epidemiology Research 

Chronic pruritus (CP), or itch that lasts for more than 6 weeks, is a very common symptom that can be extremely debilitating.  Our group has found that patients affected by CP may be willing to give up 13% of their lives to not itch.  Because of the impact of CP, our ITCH-E group is interested in outcome research, implementation research, health services research, and epidemiology in chronic pruritus.

The following are active areas of investigation:
  1. The Study of Kids Itch Severity and Quality of Life (SKIS)
    PI: Suephy Chen and James Roberts (GA Tech)
    Funding: NIH U01
    Aim:  Validate self-reported itch specific outcome measures in children.  We are validating an itch severity index as well as an itch-specific quality of life measure.  These measures are adapted from the adult ItchyQoL and ItchyQuant.
  2. Integration of Standard Pruritus Outcome Measures (ISPOM) in Electronic Medical Records 
    PI: Robert Swerlick
    Funding: none
    Aim: Incorporate the ItchyQoL and ItchyQuant along with other standard outcome measures in the clinical workflow such that it can be capture in the EeMR in a structured format without disrupting workflow.
  3. Comparing impact and mechanism of Itching in Bullous Pemphigoid (BP) and Atopic Dermatitis (AD) patients
    PI: Ron Feldman 
    Co-I's: Sarah Chisolm, Suephy Chen, Liang Han (GA Tech)
    Funding: Pfizer
    Aim: Examine whether there are similarities or significant differences in specific pruritus characteristics and quality of life impact in patients with both AD and BP.  We will also compare known pruritus biomarker levels between AD and BP during both active disease and remission, and to analyze the extent to which pruritus severity and QoL correlate with changes in biomarkers. 
  4. Racial Disparities in Chronic Pruritus
    PI: Suephy Chen
    Co-I: Glenda Wrenn (Morehouse), Sarah Chisolm, Seema Kini, Cassandra Quave, Robert Swerlick
    Funding: none
    Aim: To further characterize the racial disparity in the quality of life impact of patients affected by chronic pruritus, even after adjusting for severity, as found in pilot data.

Clinical Trials

For a list of the current clinical trials being conducted within the Department of Dermatology, please click HERE.

Measurement Tools

The Emory Itch Center has developed several tools to measure itch.  These consist of surveys that allow patients to articulate the severity and impact of their itch.  To use these instruments, please contact Dr. Suephy Chen (schen2@emory.edu) and Raj Guddneppanavar (rajsekhar.guddneppanavar@emory.edu).

  1. ItchyQoL is a 22 item survey that asks about the functional (activities), emotional, and symptomatic impact of itch in adults.  It has been translated into Azerbaijan, Chinese, Czech, US and Canadian English, Canadian French, French, German, Hungarian, Japanese, Polish, Spanish, and Turkish.  Pediatric versions are being developed. For more information on this measurement tool, please click HERE
  2. ItchyQuant is a cartoon annotated numeric rating scale that allows patients to rate the severity of their itch with a number.  Similar to other numeric rating scales, the cartoons allow for meaning to be assigned to the numbers.  This approach may be helpful in patients who have cognitive difficulties, such as children, the elderly, and those where English is a second language.  Thus far, the ItchyQuant has been validated in cognitively intact adults. For more information on this measurement tool, please click HERE.

Giving to ITCH-E

We are currently under construction-please come back soon for additional information. 

Information for Patients

The clinicians that participate in the ITCH-E are also members of Emory Healthcare (EHC).  In order to help as many patients who are suffering from pruritus, we will provide consultation while partnering with community physicians who can assume primary responsibility for ongoing care. In this way, we believe that we can engage patients at multiple levels, all to their benefit and to the benefit of the Center.

If you are interested in being seen in a one-time consultation, please fill out the attached questionnaire and follow the associated directions regarding forwarding your previous medical records and fax (secure) to 404-712-4920.  When the packet is complete (both questionnaire and outside records are received) it will be reviewed and we will contact you regarding an appointment.