The candidate is a pediatric gastroenterologist with strong training in patient-oriented research methodology, and a proven commitment to applying these methods to the study of the inflammatory bowel diseases (IBDs), including Crohn's disease (CD) and ulcerative colitis (UC). The candidate's long-term-career goal is to be an independently funded physician scientist, combining both traditional and genetic epidemiological methods to identify modifiable risk factors in genetically susceptible populations. The candidate's short-term career goals are 1) to acquire the necessary background in genetics, genetic epidemiology, pharmacoepidemiology, and research ethics in order to conduct studies of gene-environment interactions in pediatric IBD, 2) to develop the professional skills needed to successfully lead multidisciplinary research teams, and 3) to produce the critical mass of preliminary data and publications to be credible as the PI of an R01. The proposed research plan, career development activities, mentorship team, and institutional environment are all uniquely suited to assist the applicant in achieving these goals. Our overarching hypothesis is that CD risk is determined by complex interactions between 1) """"""""early-life"""""""" exposures that impact the development of gut microbiota, 2) """"""""disease-precipitating"""""""" exposures that may alter the microbiota, and 3) susceptibility genes which limit bacterial killing and allow persistent stimulation of an abnormal immune response. In this proposal, the PI will test the specific hypothesis that early-life exposure to antibiotics, which may disrupt the development of the microbiota, is a risk factor for CD, particularly in genetically susceptible individuals.
In Aim 1, the PI will conduct a retrospective birth cohort study including approximately 900,000 children born in Denmark between 1995 and 2007. Population-based prescription registries, patient registries, pathology databases, and other administrative data maintained by the Danish government will be used to measure the primary exposure, potential confounders, and outcomes of interest.
In Aim 2, the PI will establish the feasibility of a population-based case control study that combines traditional epidemiological methods with the additional collection of genetic data in order to assess gene-environment interactions. To support the candidate's career development, he will pursue advanced coursework and independent study in the areas of genetic epidemiology, pharmacoepidemiology, biostatistics, and research ethics. The mentorship team, which includes internationally-recognized, independently-funded investigators with expertise in gastrointestinal epidemiology (Sandler), genetic epidemiology (Millikan), IBD pathogenesis (Sartor), epidemiology methods (Sorensen), and research ethics (Dressler) will guide Dr. Kappelman's research and career development. The research environment including the UNC Translational and Clinical Sciences Institute and Center for Gastrointestinal Biology and Disease at UNC and the Department of Clinical Epidemiology at the University of Aarhus will provide a productive, collegial, and collaborative atmosphere in which to pursue the above research and training goals.

Public Health Relevance

Nearly 600 thousand Americans are affected by Crohn's disease (CD), a chronic, idiopathic, inflammatory bowel disease (IBD) that results in substantial morbidity including frequent hospitalization and surgery, missed work and school, and reductions in quality of life. The goal of this and subsequent research is to identify potentially modifiable risk factors in susceptible individuals. This could lead to strategies for disease prevention.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Clinical Investigator Award (CIA) (K08)
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Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Podskalny, Judith M,
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University of North Carolina Chapel Hill
Schools of Medicine
Chapel Hill
United States
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Geisz, Matthew; Ha, Christina; Kappelman, Michael D et al. (2016) Medication Utilization and the Impact of Continued Corticosteroid Use on Patient-reported Outcomes in Older Patients with Inflammatory Bowel Disease. Inflamm Bowel Dis 22:1435-41
Weaver, Kimberly N; Kappelman, Michael D; Sandler, Robert S et al. (2016) Variation in Care of Inflammatory Bowel Diseases Patients in Crohn's and Colitis Foundation of America Partners: Role of Gastroenterologist Practice Setting in Disease Outcomes and Quality Process Measures. Inflamm Bowel Dis 22:2672-2677
Long, Millie D; Kappelman, Michael D; Martin, Christopher F et al. (2016) Role of Nonsteroidal Anti-Inflammatory Drugs in Exacerbations of Inflammatory Bowel Disease. J Clin Gastroenterol 50:152-6
Abdalla, Maisa I; Sandler, Robert S; Kappelman, Michael D et al. (2016) The Impact of Ostomy on Quality of Life and Functional Status of Crohn's Disease Patients. Inflamm Bowel Dis 22:2658-2664
Jensen, Elizabeth T; Martin, Christopher F; Kappelman, Michael D et al. (2016) Prevalence of Eosinophilic Gastritis, Gastroenteritis, and Colitis: Estimates From a National Administrative Database. J Pediatr Gastroenterol Nutr 62:36-42
Dotson, Jennifer L; Bricker, Josh B; Kappelman, Michael D et al. (2015) Assessment of Sex Differences for Treatment, Procedures, Complications, and Associated Conditions Among Adolescents Hospitalized with Crohn's Disease. Inflamm Bowel Dis 21:2619-24
Dotson, Jennifer L; Kappelman, Michael D; Chisolm, Deena J et al. (2015) Racial disparities in readmission, complications, and procedures in children with Crohn's disease. Inflamm Bowel Dis 21:801-8
Dotson, Jennifer L; Crandall, Wallace V; Zhang, Peixin et al. (2015) Feasibility and validity of the pediatric ulcerative colitis activity index in routine clinical practice. J Pediatr Gastroenterol Nutr 60:200-4
Long, Millie D; Cadigan, R Jean; Cook, Suzanne F et al. (2015) Perceptions of patients with inflammatory bowel diseases on biobanking. Inflamm Bowel Dis 21:132-8
Dellon, Evan S; Jensen, Elizabeth T; Martin, Christopher F et al. (2014) Prevalence of eosinophilic esophagitis in the United States. Clin Gastroenterol Hepatol 12:589-96.e1

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