Meira Epplein

Overview:

Meira Epplein is a cancer epidemiologist interested in modifiable risk factors in under-served populations, with a focus on the association of infection and cancer.  She became Co-Leader of Cancer Control and Population Sciences at Duke Cancer Institute and Associate Professor of Population Health Sciences in the Duke University Medical Center in May of 2017.  Previously, she was a tenured faculty member at Vanderbilt University Medical Center, after two years as a post-doctoral fellow with the Multiethnic Cohort Study at the University of Hawaii.  Prior to earning her PhD in epidemiology from the University of Washington, she completed an MA in international studies, and spent five years as a program officer for the Asian research think tank, the National Bureau of Asian Research.

Dr. Epplein’s research program has centered around the bacteria Helicobacter pylori, a spiral, gram-negative bacterium that infects approximately 50% of the world’s population, and is the leading carcinogenic infectious agent according to the International Agency for Research on Cancer.  Her research seeks to understand the heterogeneity of H. pylori, to determine the most toxigenic forms of the bacteria so to identify the highest risk populations which can then be targeted for antibiotic therapy, which has been shown to be effective for risk reduction. At the same time, she is committed to furthering our understanding of the co-factors involved in both H. pylori-associated disease risk and benefit, as the bacteria has inhabited the stomachs of humans for over 100,000 years, and so very likely also confers certain biological advantages to its hosts.

As Principal Investigator, she has obtained three large NIH-funded grants to further explore the epidemiology of H. pylori heterogeneity: a 5-year career development award (K07) from NCI that focuses on infection, inflammation, and cancer; a 5-year R01 from NCI to develop an H. pylori blood biomarker for gastric cancer risk in East Asia; and a 4-year R01, again funded by NCI, to further investigate, in a large consortium of prospective cohorts across the United States, the novel preliminary finding of H. pylori protein-specific antibodies and the risk of colorectal cancer. She also serves as a Co-Investigator and lead gastric cancer and H. pylori researcher for the Southern Community Cohort Study (SCCS). In addition to serving as a standing member of the study section NCI Subcommittee J (Career Development Awards), she is an editorial board member of the journal Cancer Epidemiology, Biomarkers & Prevention, and is co-chair of the 2017 American Society of Preventive Oncology Annual Meeting Program Committee. 

Area of expertise: Epidemiology

Positions:

Associate Professor in Population Health Sciences

Population Health Sciences
School of Medicine

Associate Professor in Medicine

Medicine, Medical Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.A. 1997

University of Washington

M.S. 2005

University of Washington

Ph.D. 2007

University of Washington

Grants:

Helicobacter pylori protein-specific and colorectal cancer risk

Administered By
Duke Cancer Institute
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Publications:

Differences in antibody levels to H. pylori virulence factors VacA and CagA among African Americans and whites in the Southeast USA.

PURPOSE: Helicobacter pylori (H. pylori) is the leading cause of gastric cancer. High antibody levels to H. pylori virulence factors Vacuolating cytotoxin A (VacA) and Cytotoxin-associated gene A (CagA) have been suggested as gastric cancer risk markers. In the USA, H. pylori sero-prevalence is twofold higher in African Americans compared to whites. We sought to assess whether African Americans also exhibit higher antibody levels to VacA and CagA. METHODS: Antibody responses to H. pylori proteins were measured by multiplex serology in 686 African Americans and whites of the Southern Community Cohort Study. Among VacA- and CagA-seropositives, we analyzed the association of race with antibody level using logistic regression models to produce odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Sero-positive African Americans had significantly higher mean antibody levels to both VacA and CagA, which resulted in increased odds for the highest quartile of antibody levels compared to sero-positive whites (VacA, OR: 6.08; 95% CI 3.41, 10.86; CagA, OR: 3.77; 95% CI 1.61, 8.84). CONCLUSION: Our findings support future studies to assess the association of differential antibody responses by race with risk of gastric cancer in the USA, which could then aid in developing targeted H. pylori eradication strategies.
Authors
Butt, J; Blot, WJ; Shrubsole, MJ; Waterboer, T; Pawlita, M; Epplein, M
MLA Citation
Butt, Julia, et al. “Differences in antibody levels to H. pylori virulence factors VacA and CagA among African Americans and whites in the Southeast USA.Cancer Causes Control, vol. 31, no. 6, June 2020, pp. 601–06. Pubmed, doi:10.1007/s10552-020-01295-z.
URI
https://scholars.duke.edu/individual/pub1436746
PMID
32222845
Source
pubmed
Published In
Cancer Causes Control
Volume
31
Published Date
Start Page
601
End Page
606
DOI
10.1007/s10552-020-01295-z

Helicobacter Pylori-mediated carcinogenesis

© 2019 Elsevier Inc. All rights reserved. Helicobacter pylori is the most successful bacterial pathogen worldwide, coevolving with humans for millennia and currently infecting over 50% of the global populous. It is a Gram-negative, spiral-shaped organism that can evade the immune response for the lifetime of its host. The identification of H. pylori as an etiological agent of gastric adenocarcinoma led to its classification as a class I carcinogen. Improved hygiene and targeted eradication with antibiotic therapy have been efficacious in reducing the incidence of gastric cancer, but the opportunity remains to further reduce the burden of H. pylori-associated disease through testing and treatment of high-risk populations.
Authors
Varga, MG; Epplein, M
MLA Citation
Varga, M. G., and M. Epplein. “Helicobacter Pylori-mediated carcinogenesis.” Encyclopedia of Cancer, 2018, pp. 187–97. Scopus, doi:10.1016/B978-0-12-801238-3.65172-3.
URI
https://scholars.duke.edu/individual/pub1432429
Source
scopus
Published Date
Start Page
187
End Page
197
DOI
10.1016/B978-0-12-801238-3.65172-3

Auto-antibodies to p53 and the Subsequent Development of Colorectal Cancer in a United States Prospective Cohort Consortium

Authors
Butt, J; Blot, WJ; Visvanathan, K; Le Marchand, L; Chen, Y; Sesso, HD; Wassertheil-Smoller, S; Ho, GYF; Tinker, LE; Potter, JD; Song, M; Berndt, S; Waterboer, T; Pawlita, M; Epplein, M
MLA Citation
Butt, J., et al. “Auto-antibodies to p53 and the Subsequent Development of Colorectal Cancer in a United States Prospective Cohort Consortium.” Cancer Epidemiology Biomarkers & Prevention, vol. 29, no. 3, American Association for Cancer Research (AACR), 2020, pp. 690.1-690. Crossref, doi:10.1158/1055-9965.epi-20-0050.
URI
https://scholars.duke.edu/individual/pub1436977
Source
crossref
Published In
Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology
Volume
29
Published Date
Start Page
690.1
End Page
690
DOI
10.1158/1055-9965.epi-20-0050

Performance of multiplex serology in discriminating active vs past Helicobacter pylori infection in a primarily African American population in the southeastern United States.

PURPOSE: To feasibly analyze associations of Helicobacter pylori (H. pylori) with disease in large cohort studies, assays are needed to assess H. pylori prevalence in existing biospecimens. However, serology has traditionally been unable to distinguish active from past infection. We sought to determine the sensitivity of seropositivity to H. pylori proteins to detect active infection. METHODS: We measured antibody responses to 13 H. pylori proteins using multiplex serology in serum samples of a training (n = 78) and validation set (n = 49) collected concurrently from patients undergoing urea breath test (UBT). To determine sensitivity of seropositivity to H. pylori proteins for active infection, a cutoff was applied to achieve 90% specificity. Antibody levels were retested in a subset of participants (n = 16) 6 months after baseline. RESULTS: With a specificity of 91%, seropositivity to H. pylori proteins VacA, GroEl, HcpC, and HP1564 ascertained active infection from 100% to 75% sensitivity. Positivity to a combination of these proteins (≥2 out of the 4) resulted in specificity of 90% and sensitivity of 100%. The validation set replicated results from the training set. Among those participants with successful H. pylori eradication after baseline, antibody levels decreased significantly for VacA, HcpC, and HP1564 when assessed 6 months later. CONCLUSION: Utilizing the cutoffs for seropositivity established through comparison with UBT, seropositivity to ≥2 of the H. pylori proteins VacA, GroEl, HcpC, and HP1564 determines active H. pylori infection at high specificity and sensitivity and may approximate the prevalence of active H. pylori infection in large cohorts.
Authors
Butt, J; Blot, WJ; Shrubsole, MJ; Varga, MG; Hendrix, LH; Crankshaw, S; Waterboer, T; Pawlita, M; Epplein, M
MLA Citation
URI
https://scholars.duke.edu/individual/pub1421640
PMID
31746104
Source
pubmed
Published In
Helicobacter
Volume
25
Published Date
Start Page
e12671
DOI
10.1111/hel.12671

The U-shaped association between body mass index and gastric cancer risk in the Helicobacter pylori Biomarker Cohort Consortium: A nested case-control study from eight East Asian cohort studies.

The association between body mass index (BMI) and noncardia gastric cancer (NCGC) risk remains controversial. The purpose of our study was to examine the association of BMI with NCGC risk with consideration of Helicobacter pylori (HP) biomarkers. This international nested case-control study, composed of 1,591 incident NCGC cases and 1,953 matched controls, was established from eight cohorts in China, Japan and Korea, where the majority of NCGCs are diagnosed worldwide. HP antibody biomarkers were measured in blood collected at cohort enrollment by multiplex serology. The NCGC risk according to baseline BMI was estimated using logistic regression to produce odds ratios (ORs) and 95% confidence intervals (CIs). We found a U-shaped association between BMI category and NCGC risk. Compared to those with reference BMI (22.6-25.0 kg/m2 ), those with lower and higher BMI had an increased NCGC risk (BMI <18.5 kg/m2 , OR = 1.56, 95% CI = 1.04-2.34; BMI >27.5 kg/m2 , OR = 1.48, 95% CI = 1.15-1.91; adjusted for age, sex and smoking). The U-shaped association was persistent among subjects with HP infection and high-risk biomarkers (HP+ CagA+: BMI <18.5 kg/m2 , OR = 1.60, 95% CI = 1.00-2.55; BMI >27.5 kg/m2 , OR = 1.59, 95% CI = 1.21-2.11; and Omp+ HP0305+: BMI <18.5 kg/m2 , OR = 1.88, 95% CI = 1.04-3.42; BMI >27.5 kg/m2 , OR = 1.70, 95% CI = 1.20-2.42, respectively). Our study provides evidence of significantly increased NCGC risk among individuals with low or high BMI, including in subjects with high-risk HP biomarkers (HP+ CagA+, Omp+ HP0305+) in the high-risk area of East Asia.
Authors
Jang, J; Wang, T; Cai, H; Ye, F; Murphy, G; Shimazu, T; Taylor, PR; Qiao, Y-L; Yoo, K-Y; Jee, SH; Kim, J; Chen, S-C; Abnet, CC; Tsugane, S; Zheng, W; Shu, X-O; Pawlita, M; Park, SK; Epplein, M
URI
https://scholars.duke.edu/individual/pub1421518
PMID
31745972
Source
pubmed
Published In
Int J Cancer
Published Date
DOI
10.1002/ijc.32790