Children supported with extracorporeal membrane oxygenation (ECMO) are at high risk for fungal infections. These infections are often deadly, but because the ECMO circuit can affect drug levels in the body, the appropriate dosing of antifungal drugs in this population is unknown. Dr. Watt will use an integrative approach to investigate the safest and most effective dose of antifungal drugs in children supported with ECMO. This approach will include: ex vivo studies evaluating antifungal disposition in isolated ECMO circuits;sophisticated physiologically based pharmacokinetic (PBPK) modeling;and model evaluation through clinical trials. The PBPK models developed in this proposal expand on traditional modeling techniques by incorporating the key physiological and physiochemical determinants of these processes, thereby providing a mechanistic understanding of drug disposition and allowing for modification of the model to account for derangements in the system (e.g., decreased renal function, addition of ECMO support). The candidate is a pediatric intensivist with a proven commitment to patient-oriented research, and a desire to develop sophisticated modeling skills. The modeling skills developed from this proposal will facilitate the candidate's long-term career goal to advance public health by integrating physiology and pharmacology into the design and conduct of early-phase trials in critically ill children. The candidate's short-term career goals for the K23 program are to: 1) acquire knowledge and skills in clinical pharmacology, modeling, and simulation;2) develop the professional skills to successfully lead a clinical trial research team;and 3) produce a critical mass of preliminary data and publications to support an R01 grant application and establish a program of independent research in clinical pharmacology. This proposal will capitalize on unique opportunities provided by the Duke ECMO program (4th largest in the world), Duke Clinical Research Institute (DCRI;Benjamin, mentor), and the Eshelman School of Pharmacy at UNC (Brouwer, co-mentor). Concomitant with this proposed research, the candidate will receive advanced training in pharmacokinetic modeling through a PhD program in pharmaceutical sciences and through work with his mentors. The mentorship team assembled is uniquely qualified, and strengths include extensive clinical research experience;internationally recognized thought leadership in trial design, research methods, pharmacology, and modeling;and a successful history of mentorship of junior faculty. At the conclusion of this program, Dr. Watt will be well positioned to be an independent physician-scientist leading a research team.

Public Health Relevance

Fungal infections in children on extracorporeal life support (ECMO) are often fatal, and therapy relies on optimal dosing. Unfortunately, appropriate dosing of antifungal drugs in this population is unknown, because the ECMO machine can substantially alter drug levels in the body. To address this knowledge gap, this proposal will investigate the pharmacokinetics (PK) of antifungal agents frequently given to children on ECMO using novel, sophisticated PK modeling techniques.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Pediatrics Subcommittee (CHHD)
Program Officer
Zajicek, Anne
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Duke University
Other Clinical Sciences
Schools of Medicine
United States
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Watt, Kevin M; Avant, Debbie; Sherwin, Jennifer et al. (2018) Effect of renal function on antihypertensive drug safety and efficacy in children. Pediatr Nephrol 33:139-146
Hornik, Christoph P; Wu, Huali; Edginton, Andrea N et al. (2017) Development of a Pediatric Physiologically-Based Pharmacokinetic Model of Clindamycin Using Opportunistic Pharmacokinetic Data. Clin Pharmacokinet 56:1343-1353
Watt, Kevin M; Cohen-Wolkowiez, Michael; Williams, Duane C et al. (2017) Antifungal Extraction by the Extracorporeal Membrane Oxygenation Circuit. J Extra Corpor Technol 49:150-159
Salerno, Sara N; Edginton, Andrea; Cohen-Wolkowiez, Michael et al. (2017) Development of an Adult Physiologically Based Pharmacokinetic Model of Solithromycin in Plasma and Epithelial Lining Fluid. CPT Pharmacometrics Syst Pharmacol 6:814-822
Smith, Michael J; Gonzalez, Daniel; Goldman, Jennifer L et al. (2017) Pharmacokinetics of Clindamycin in Obese and Nonobese Children. Antimicrob Agents Chemother 61:
Gonzalez, Daniel; Bradley, John S; Blumer, Jeffrey et al. (2017) Dalbavancin Pharmacokinetics and Safety in Children 3 Months to 11 Years of Age. Pediatr Infect Dis J 36:645-653
McMahon, Ann W; Watt, Kevin; Wang, Jian et al. (2016) Stratification, Hypothesis Testing, and Clinical Trial Simulation in Pediatric Drug Development. Ther Innov Regul Sci 2016:
Autmizguine, Julie; Hornik, Christoph P; Benjamin Jr, Daniel K et al. (2016) Pharmacokinetics and Safety of Micafungin in Infants Supported With Extracorporeal Membrane Oxygenation. Pediatr Infect Dis J 35:1204-1210
Sherwin, Jennifer; Heath, Travis; Watt, Kevin (2016) Pharmacokinetics and Dosing of Anti-infective Drugs in Patients on Extracorporeal Membrane Oxygenation: A Review of the Current Literature. Clin Ther 38:1976-94
Watt, Kevin M; Gonzalez, Daniel; Benjamin Jr, Daniel K et al. (2015) Fluconazole population pharmacokinetics and dosing for prevention and treatment of invasive Candidiasis in children supported with extracorporeal membrane oxygenation. Antimicrob Agents Chemother 59:3935-43

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