Understanding H. pylori: Meira Epplein
Meira Epplein, PhD, came to epidemiology by a more scenic route than most. She has always been fascinated by China, from Chinese art to culture and modern history. After getting an MA in Chinese Studies, she began working for an Asian research think tank, studying military, political, and security issues surrounding China. Because she frequently went to China’s big cities for work, she also took her vacations there, in the countryside.
“China’s a fascinating country,” she says, “because it’s part developed and part developing. There’s a big divide between city and country. When I was there, it was very easy to see that the people in the countryside could use some very basic improvements and their lives would be so much better.”
To make an impact on the lives of people in rural areas, Dr. Epplein decided to get into public health. She discovered it wasn’t that simple. “I tried to get a job, and no one would give me a job. They said, you have no background in science, you have to go back to school. I already had a master’s degree, I didn’t want to go back to school!”
But go back she did, receiving an MS and a PhD from the University of Washington. Along the way, she took a job as an administrative coordinator at the Fred Hutchinson Cancer Research Center in Seattle, where she worked for cancer epidemiologist John Potter. She organized a conference on Helicobacter pylori in 2002 and became fascinated by the bug.
H. pylori is a bacteria that lives in the stomachs of about half the world’s population. While “we used to think nothing could live in this highly acidic environment, it turns out there’s evidence H. pylori has lived in the stomachs of humans for over 50,000 years.” It is the great causative agent of gastric cancer, one of the most fatal types of cancer, but the curious thing is that not everyone who has it develops the disease. For Epplein, the goal is to understand more about this bug and its relationship with cancer and with humans, particularly in Asia, where there is a high incidence of gastric cancer. “What’s become exciting is trying to understand, maybe from the bug’s point of view, is that it also does good things. It wouldn’t have lasted all this time and become very genetically heterogeneous to survive in all these different stomachs unless there were some good things it did for the host, and vice versa.”
For example, just to live in the stomach, the bacteria must be able to moderate levels of acid. People who harbor H. pylori thus have less likelihood of gastro-esophageal reflux disease. They are also more protected from esophageal adenocarcinoma. Presence of the bug may also be protective for conditions like obesity, allergies, and asthma.
Because not all people who harbor H. pylori develop gastric cancer, there must be cofactors involved, such as different strains of bacteria, bacterial load, and/or—Epplein’s key interest due to her study of Chinese culture—dietary factors. A high intake of salt, for instance, irritates the lining of the stomach and makes it easier for the bacteria to colonize, leading to a higher risk of cancer. “If you change the cofactors so that you can live with your bug, and it does the good things” without causing cancer (which creates an environment terminal to H. pylori as well), then that’s a win for humans and bacteria alike.
Because of her passion for H. pylori and the people it affects, Epplein’s R01 application practically wrote itself. She started in the first year of her K07, “which was too early,” she says, “but I was so excited about the preliminary data, and so excited about the reactions I was getting [to the idea of pinpointing a novel biomarker for gastric cancer risk in China]. I think that when you write with excitement, your readers read with excitement, and everything goes better.”
One of her touchstones during the writing process was Writing the NIH Grant Proposal: A Step-by-Step Guide by William Gerin et al. Although aimed at basic scientists, she found the strategy tips such as using white space, bullet points, and underlining to emphasize key points about impact valuable.
With her award from the National Cancer Institute, Epplein is now searching for a way to identify the population at highest risk of gastric cancer because of the sub-type of H. pylori they have, and then screen them, making it possible to prevent cancer by eradicating the bacteria. “That’s the cool thing about public health,” she says. With the anthropology PhD she originally contemplated, “you try to be an observer—you don’t want to affect their culture—whereas with public health, you do. You want to get in there and change something to make people’s lives better.”