Why is it harder for kids in low- and middle-income countries to grow as well as kids in wealthy countries? Food security, or access to good nutrition, remains a major challenge. The issue is not just food supply but poor sanitation - a problem exacerbated by local infrastructure and cultural mores.
Sean Moore, MD, a doctor at Cincinnati Children's Hospital Medical Center, remembers reading about a man who was visiting a wealthy household in India. A dog had urinated on the kitchen floor. The chef said to the man, "You're just going to have to leave it there because there is no one around to clean it up."
The man cleaned it up himself. But when he did, the chef made him leave the kitchen, saying that it wasn't acceptable for him to be there anymore, because only "untouchables" can deal with bodily waste.
The story illustrates a problem in many parts of the developing world. Despite access to healthy diets, many children remain malnourished, leaving them far short of where they should be in height and weight.
Dr. Moore, a pediatric gastroenterologist, hopes to find solutions to this problem through a $1 million Phase II grant from Grand Challenges Explorations, an initiative of the Bill & Melinda Gates Foundation. Dr. Moore and colleagues will develop a mouse model of environmental enteropathy - "the single most important barrier to achieving healthy growth and development in children around the world," says Dr. Moore.
"Environmental enteropathy refers to damage to the gut's lining seen in people who live in environments where fecal contamination of water and food is all too common and children can't reach their growth potential - even when they have enough food," says Dr. Moore.
Beyond impairing children's growth, environmental enteropathy may also negatively impact children's responses to life-saving vaccines. The rotavirus vaccine that was developed at Cincinnati Children's protects 98 percent of children in the United States who get the vaccine. But in the poorest countries, it only protects about half of those who get vaccinated. Could it be that the vaccine works differently in intestines damaged by environmental enteropathy than it does in the intestines of children in the United States?
"We'll be developing a mouse whose intestines look like the intestines of children with environmental enteropathy, says Dr. Moore. "This will help us understand what's happening in these children's intestines and ultimately lead to better designed nutritional interventions and vaccines."
Dr. Moore also hopes to determine the extent to which ingestion of fecal material provokes intestinal inflammation in this mouse model and the link between intestinal stem cell damage and its effect on the gut.
"If it is confirmed that dysregulation of intestinal stem cells is the central pathway of gut injury in environmental enteropathy, we might have a new therapeutic target and a highly plausible explanation for why environmental enteropathy persists or recurs following antimicrobial therapy, nutritional interventions or even moving to high-sanitation environments," says Dr. Moore.
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