Jefferson Investigates: COVID and Platelets, Training for Inclusive Care and Benefits of Safe, Green Spaces

COVID Infection Causes a Big Change in Platelets

When you scrape or cut your skin, your body forms a clot at the wound site. Key players in blood clotting are tiny cells called platelets, which are unusual in that they don’t have nuclei. That means they don’t carry their own genome, or their own instructions in the form of DNA for making proteins. However, platelets do carry proteins and RNA molecules.

The best-known RNA — messenger RNA or mRNA — serves as an intermediary between DNA and proteins; however, researchers have characterized multiple other classes of RNA with very diverse roles. “As sequencing technology became easier to apply and cheaper, more types of RNAs that are short in length (“small RNAs”), were found in many different cells and tissues,” says Isidore Rigoutsos, PhD, Richard W. Hevner Professor of Computational Medicine at Thomas Jefferson University.

MicroRNAs (miRNAs), the first and most well-characterized class of small RNAs, were discovered 30 years ago, and have been shown to regulate numerous biological pathways. But as researchers discover more players, the picture becomes more complex.

In a new study, Rigoutsos’ team made an unexpected discovery about the small RNAs found in platelets. They found that the most abundant small RNAs in the platelets of healthy people are fragments from a curious RNA species called Y RNAs. “The Y RNA fragments are the biggest player among the small RNAs in platelets, outpacing even miRNAs,” Rigoutsos says.

In contrast, the team also found that in the platelets of people infected with COVID the Y RNA fragments are greatly depleted and replaced by miRNAs. “With COVID, the difference in the small RNA composition of platelets is like day and night,” he says. “It begs the question: What do the Y RNA fragments do in platelets, both in health and disease?” No one knows for sure at the moment, he says, though he suspects they may play system-wide roles, including in cancers or other diseases.

The findings are compelling, but it’s not yet clear what they mean. That’s because the knowledge base for the small RNA types the team discovered in platelets — how they are made and end up in platelets, how they are trafficked and function at their destination — is nascent. Rigoutsos, along with his collaborator Paul Bray, formerly at Jefferson and now at the University of Utah, hope to explore these questions in future work. Y RNA fragments and miRNAs are but two of several classes of small RNAs that are actively being researched by Thomas Jefferson University's Computational Medicine Center, of which Rigoutsos is the director.

By Jill Adams

Educating Physicians on Caring for Sexual and Gender Minorities

Many people who identify as sexual and gender minorities (SGM) experience discomfort and discrimination in healthcare settings. For example, transgender and non-binary patients with a cervix have reported delaying cervical cancer screenings due to gender dysphoria, and same-sex couples have reported facing discrimination in end-of-life care. Despite the major health implications this poses to the queer community, many physicians do not receive proper training to provide quality care to SGM patients. To address this, oncologist Ana Maria Lopez, MD, worked on a team that created and tested the Together-Equitable-Accessible-Meaningful (TEAM) training program to help educate cancer teams across the country in providing competent cancer care for sexual and gender minorities.

Healthcare providers spent approximately a year participating with the TEAM training, learning topics around inclusive care ranging from the determinants of inequity to institutional strategies for creating equitable care. Many of the solutions are as simple as respecting people’s preferred pronouns and not assuming patient’s sexual orientation. “I see part of my job as a physician is to ease suffering. When patients say it is painful to be misnamed, then it is my job to fix that, and make sure that person is called by their preferred name in our office. When people tell you something hurts, we need to pay attention.”

While this training can help fill the gap in resources for physicians, more research is necessary to properly understand the barriers to inclusive care for SGM patients and the impact those barriers have on the health of the queer community. The TEAM Training research group is pushing for more innovation in the field by creating a new tool in their own evaluation. Assessing competence based on what matters to patients is critical to quality care delivery. From Dr. Lopez’ perspective, “we know that we've succeeded when people are just comfortable.”

By Makhari Dysart

Parks Narrow Health Disparities — But Only if Visitors Feel Safe

As spaces to relax, exercise and socialize, parks offer clear benefits to those who live nearby — so much so that they’ve been hailed as a way to reduce racial disparities in health. Findings from a new study, however, indicate that not all parks have this equalizing effect.

According to an analysis of survey data collected from the Philadelphia metro area by Jefferson researchers, if people don’t feel safe in their neighborhood park, they don’t appear to experience the same boost to their health, as measured by a reduced risk of high blood pressure. The potentially detrimental effects associated with feeling unsafe appeared most strikingly among Black respondents, the researchers report in the journal Preventing Chronic Disease.

“Preventing high blood pressure means preventing premature death,” says study researcher Stephanie Kjelstrom, a PhD student in Population Health at Thomas Jefferson University.

Excess body weight and a lack of exercise are among the risk factors for high blood pressure or hypertension, she explains. High blood pressure, in turn, increases the likelihood of cardiovascular disease, including heart disease, which is the leading cause of death in the U.S.

The burden is not evenly distributed. Black Americans suffer from higher rates of hypertension than whites and Hispanics, according to the U.S. Centers for Disease Control.

To investigate the connection between perceived safety and high blood pressure, as well as how it breaks down along racial lines, Kjelstrom and her colleagues used data collected in the 2018 Southeastern Pennsylvania Household Health Survey, which asked residents whether they had access to a park. And for those who did, if they felt safe there. Not surprisingly, both white and Black respondents with nearby parks were less likely to have high blood pressure than their counterparts without.

Black respondents living near unsafe parks, however, were by far the most likely to report having high blood pressure. The likelihood they had this condition outpaced everyone else’s risk, including that of Black respondents with no access to greenspaces at all. While the reason for this disparity isn’t clear, Kjelstrom suggests several possible explanations: the legacy of neglect through the lack of financial investment in historically Black neighborhoods, higher rates of poverty and the accumulated stress Black people experience because of racism.

“We want to emphasize that when you put a park in a neighborhood, you also have to take into account other factors, such as crime rates, walkability and lighting,” she says. “And if people aren’t visiting a park that’s already there, policy makers or city planners should consider making it feel safer.”

By Wynne Parry