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Department of Medicine

Department of Medicine

  Division of Pulmonary, Allergy and Critical Care Medicine



Faculty Profile: ALISON MORRIS, MD, MS

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Dr. Alison Morris' Research

 

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The type of studies performed by Dr. Morris' group include large cohort epidemiologic studies of lung disease and respiratory symptoms, translational studies in which physiologic and molecular techniques are applied to patient populations, and collaborations with co-investigators utilizing non-human primate models of disease.  Dr. Morris’ research interests focus in several overlapping areas:

1.  HIV-associated lung disease:  We are currently evaluating the types of pulmonary complications that occur in HIV-infected subjects in the era of effective combination antiretroviral therapy.  We are conducting these studies in 2 large cohorts (the Multicenter AIDS Cohort and the Women’s Interagency Health Study) which include over 5000 HIV-infected and HIV-negative subjects. 

2.  HIV-associated emphysema:  Studies early in the AIDS epidemic demonstrated that HIV-infected subjects have accelerated emphysema.  It is unknown whether this finding persists in the current era and what the causes are.  We are studying 600 HIV-infected and HIV-negative subjects at 3 centers to determine if emphysema is more severe and progresses more quickly in those with HIV infection and to determine causes of emphysema in this population.

As part of the HIV studies, we are one of the sites in the Lung HIV study group (www.lunghiv.com).   Lung HIV is a collaborative multi-site study sponsored by the National Heart, Lung, and Blood Institute (NHLBI) to examine a broad range of separate yet overlapping pulmonary topics. Eight Clinical Centers and a Data Coordinating Center have been tasked with creating a collection of datasets and biological specimens for use during the study period and in future investigations. The program is structured to facilitate both the development of these shared resources and the completion of the individual projects. 

3.  Role of Pneumocystis in COPD:  Our group has proposed the novel hypothesis that low levels of Pneumocystis in the lungs of both HIV-infected and non-HIV-infected subjects are associated with development and/or progression of COPD.  We have discovered that HIV-infected smokers have a higher prevalence of colonization with Pneumocystis and that colonization is associated with airway obstruction.  Our collaborator in immunology, Dr. Karen Norris, has developed a non-human primate model of HIV immunosuppression and Pneumocystis colonization.  Current studies in this model include an assessment of clinical consequences of persistent colonization with Pneumocystis and the elucidation of the pathogenesis of inflammation-mediated lung injury.  We have also found that Pneumocystis colonization is an independent predictor of more severe COPD in non-HIV-infected subjects.  We are currently exploring the role of Pneumocystis in progression of COPD as well as characterizing the COPD phenotype associated with colonization.  The ultimate goal of these projects is to determine if antibiotic treatment of Pneumocystis colonization could improve COPD. 

Figure 1

Figure 2

Lung tissue from subjects with equivalent smoking histories but varying degrees of obstruction was analyzed for presence of Pneumocystis.  As the GOLD stage increased (airway obstruction got more severe), the prevalence of Pneumocystis colonization also increased.

Low antibody levels to Pneumocystis is associated with increased airway obstruction in non-HIV-infected subjects with COPD, suggesting increased susceptibility to colonization. 

   

Figure 3


Data from the Multicenter AIDS Cohort study demonstrates that non-infectious complications such as obstructive lung disease are increased in HIV-infected subjects in the current era of effective combination antiretroviral therapy.