Author Interviews, Heart Disease, Stem Cells / 11.05.2016
Small Trial Paves Way for Larger Study of Fat-Derived Stem Cells for Heart Failure
MedicalResearch.com Interview with:
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Dr. Timothy Henry[/caption]
Timothy D. Henry, MD, MSCAI
Director, Division of Cardiology
Cedars-Sinai Heart Institute
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Henry: Heart failure it the #1 cause of morbidity, mortality and cost in the United States today. Patients with Class 3 heart failure, despite optimal medical therapy and device therapy have limited options beyond heart transplantation and left ventricular cyst device.
Transplantation and LVAD are expensive and are challenged by both availability and complications. Therefore, treatment for patients with ongoing symptoms despite medical therapy is an admiral goal. Stem cell therapy appears to be an attractive choice for these patients, in particular patients with ischemic cardiomyopathy.
The ATHENA trial was designed to treat patients with ischemic cardiomyopathy and ongoing ischemia with autologous adipose-derived regenerative cells. Patients would undergo liposuction with onsite processing of their stem cells in 1 ½ - 2 hours, followed by intramyocardial injection of adipose-derived regenerative cells (ADCRs) vs. placebo.
Dr. Timothy Henry[/caption]
Timothy D. Henry, MD, MSCAI
Director, Division of Cardiology
Cedars-Sinai Heart Institute
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Henry: Heart failure it the #1 cause of morbidity, mortality and cost in the United States today. Patients with Class 3 heart failure, despite optimal medical therapy and device therapy have limited options beyond heart transplantation and left ventricular cyst device.
Transplantation and LVAD are expensive and are challenged by both availability and complications. Therefore, treatment for patients with ongoing symptoms despite medical therapy is an admiral goal. Stem cell therapy appears to be an attractive choice for these patients, in particular patients with ischemic cardiomyopathy.
The ATHENA trial was designed to treat patients with ischemic cardiomyopathy and ongoing ischemia with autologous adipose-derived regenerative cells. Patients would undergo liposuction with onsite processing of their stem cells in 1 ½ - 2 hours, followed by intramyocardial injection of adipose-derived regenerative cells (ADCRs) vs. placebo.
Dr. Lynda Harris[/caption]
Lynda Harris PhD
Lecturer in Pharmaceutics
University of Manchester
Manchester Pharmacy School
Maternal and Fetal Health Research Centre
Manchester
MedicalResearch.com: What is the background for this study?
Dr. Harris: Pregnancy complications such as pre-eclampsia and fetal growth restriction remain a problem despite advances in antenatal care, and impact heavily on future health: small size at birth is associated with an increased risk of cardiovascular disease and diabetes in later life. Drugs to improve pregnancy outcome are severely lacking, as pregnant women are considered a high risk cohort by drug companies, who fear expensive lawsuits associated with side effects and teratogenicity. The majority of pregnancy complications are caused by a poorly growing or poorly functioning placenta. A number of potential drugs have been identified that enhance placental function in vitro, and improve fetal growth in animal models; however, there is currently no means of restricting their actions to the placenta, and systemic administration of these drugs to pregnant women is not feasible due to the risk of adverse effects in other tissues. To address this issue, we have identified a series of placental “homing peptides” which we have used to create nanocarriers for targeted delivery of drugs to the placenta.
Dr. Hiten Patel[/caption]
Hiten D. Patel, MD, MPH
Resident, Urological Surgery
James Buchanan Brady Urological Institute
The Johns Hopkins Medical Institutions
Baltimore, Maryland 21287
MedicalResearch.com: What is the background for this study?
Dr. Patel: The study reports results of a systematic review contracted by the Agency for Healthcare Research and Quality based on input from stakeholders. Part of the motivation was due to the American Urological Association's desire to use the results as a basis to update relevant clinical guidelines.
There are four major management options for clinically localized small renal masses diagnosed on imaging including active surveillance, thermal ablation, partial nephrectomy, and radical nephrectomy. The body of research evaluating these management options is broad, but many of the studies performing comparative analyses have limitations. Therefore, the systematic review aimed to evaluate a number of outcomes (e.g. overall survival, cancer specific survival, local recurrence, metastasis, renal function, complications, and perioperative outcomes) based on available comparative studies in the literature.
Prof. Craig Anderson[/caption]
Professor Craig Anderson
Professor of Stroke Medicine and Clinical Neuroscience
Sydney Medical School at the University of Sydney
Institute of Neurosciences of Royal Prince Alfred Hospital
MedicalResearch.com: What is the background for this study?
Prof. Anderson: Intravenous use of the clot-busting drug, alteplase (or rtPA), at a dose of 0.9 mg/kg body weight is the only proven medical treatment of acute ischemic stroke. However, a major drawback to the treatment is an increased risk of major bleeding in the brain, or intracerebral hemorrhage (ICH), that occurs in about 5% of cases, and can be fatal. This balance of effectiveness (recovery from disability) and risks (ICH, and bleeding elsewhere and uncommon drug allergic reactions) has led to much of the controversy over the net benefit of the drug. The optimal dose of the drug has never been established, but the Japanese drug safety regulatory authority, has approved a lower dose (0.6mg/kg) on the basis of a small, non-randomized, open study which showed comparable outcomes and lower risk of ICH than historical controls. This ‘east-west’ divide over the approved dose of alteplase has led to much variation in the dose of alteplase used in clinical practice in Asia – according to a doctor’s perceived risk of ICH in individual patients and the affordability of this relatively expensive treatment in low resource settings. Data from the Get-with-the Guidelines Quality Registry in the United States suggests Asian patients are at higher risk of ICH after standard-dose alteplase than non-Asians.
Our research aimed to resolve this uncertainty over the optimal dose of alteplase, as an international, active-comparator, open-label, blinded outcome assessed, clinical trial of low-dose (0.6 mg/kg) versus standard-dose (0.9mg/kg) in 3310 patients recruited from over 100 hospitals in 13 countries between 2012 and 2015.
Dr. Corrine Leach[/caption]
Corinne Leach, MPH, MS, PHD
Strategic Director, Cancer and Aging Research
American Cancer Society, Inc.
Atlanta, GA 30303
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Leach: Using linked data from cancer registries and the Medicare Health Outcomes Survey, we prospectively examined the short-term impact of cancer on the functioning, development of and worsening of age-related health conditions among 921 older adults who developed cancer compared to 4,605 propensity score matched controls. We found that cancer groups demonstrated greater declines in activities of daily living and physical functioning compared to controls with the greatest change for lung cancer patients. Having a cancer diagnosis increased risk for depression but did not increase the odds of developing arthritis in the hand/hip, incontinence (except for prostate cancer), or vision/hearing problems. Having a cancer diagnosis also did not exacerbate the severity of arthritis or foot neuropathy.
Dr. Atul Sharma[/caption]
Atul Sharma MD, MSc(Statistics), FRCPC
Researcher, Children’s Hospital Research Institute of Manitoba; Assistant Professor, Department of Pediatrics and Child Health, University of Manitoba; Senior Consultant, Biostatistics Group, George and Fay Yee Center for Healthcare Innovation
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Sharma: Between 1978 and 2004, a previous comparison of directly measured heights and weights demonstrated an alarming increase in the prevalence of overweight or obesity in Canadian children aged 2-17y, from 23.3% (95% CI = 20.5-26.0) to 34.7% (33.0-36.4) based on the new 2007 WHO criteria.
In Canada, the definitions of overweight and obesity changed with the introduction of the new '2010 WHO Growth Charts for Canada’, Previous definitions were based on Body Mass Index (BMI) percentiles from the 2000 Centers for Disease Control and Prevention (CDC) growth chart’s. In addition to revising the percentile thresholds for diagnosing overweight or obesity, the WHO charts were based on a very different reference population. As a result, the proportion of Canadian children being classified as overweight or obese increased with the introduction of the new WHO charts.
Our current study applied current Canadian definitions of overweight and obesity to a contemporary sample of Canadian children age 3-19y to assess recent trends in the rates of overweight and obesity. By pooling data from the Canadian Community Health Survey (CCHS, cycle 2.2) and the Canadian Health Measures Survey (CHMS, cycles 2 and 3), we were able to study a representative sample of more than 14000 Canadian children from the period 2004-2013. The sample was evenly split between boys and girls and approximately 80% white.
Dr. Serena Nik Zainal[/caption]
Serena Nik-Zainal MD PhD
Wellcome Beit Fellow & Honorary Consultant in Clinical Genetics
CDF Group Leader
Wellcome Trust Sanger Institute
United Kingdom
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Nik-Zainal: We have used the massive improvement in speed of "sequencing" (reading the human genetic material) in order to obtain comprehensive whole genome maps of 560 human breast cancer patients. This is the largest whole genome sequencing study of a single cancer type in the world. We wanted to forensically search these cancers, find all the important genes that drive breast cancer, find all the important mutation patterns that tell us something about why breast cells turn into cancer cells and then to pull it altogether for each patient. We wanted to be able to "profile" each cancer patient, to see if we could further our understanding of personal cancer genomes.
In all, we had 556 female and four male patients, and they were sought from all over the world – USA, Europe and Asia.
Dr. Robert Keefe[/caption]
Professor Robert H. Keefe PhD, LMSW, ACSW
School of Social Work, University at Buffalo
State University of New York, Buffalo, New York
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Keefe: The study focuses on recommendations mothers of color, who have histories of postpartum depression, would make to service providers that they believe would improve service effectiveness. The study is timely inasmuch as the Patient Protection and Affordable Care Act mandates ongoing research to better understand and address differences in treatment needs among mothers from racial and ethnic groups and to develop culturally competent, evidence-based treatment approaches.
We were concerned that the research on postpartum depression relies heavily on White mothers, who have access to care, ongoing relationships with service providers, are married or otherwise coupled, and from middle-class backgrounds. While the limited research on mothers of color notes their rates of postpartum depression are markedly higher than White mothers, it does little to address how their treatment needs differ from White mothers.
We undertook this study to get recommendations from the mothers and discovered that many of the issues that inhibit the mothers from accessing services are the very issues that lead mothers to have postpartum depression. For example, many of the mothers report because they have poor-paying jobs, no health benefits, and limited transportation, they are unable to keep appointments despite wanting to do what is best for their newborn babies. Furthermore, because they missed appointments, the service provider would terminate the mother from a service the mother needs, or worse contact Child Protective Services to report the mother for neglect. The mothers were not at all neglectful. They were all invested in their child’s wellbeing; but various life problems kept mounting up so that they and their babies were not receiving ongoing care.
Consequently, the recommendations these mothers make have little to do with psychotherapy. In fact, most of the mothers reported they had no time to be depressed and that psychotherapy was a luxury they could not afford. Instead, the mothers wanted service systems in place that would allow them to receive the care they need so that they and their new-born babies could live happy and health lives.
Dr. Alexander Turchin[/caption]
Alexander Turchin, MD, MS
Associate Physician, Brigham and Women's Hospital
Associate Professor of Medicine, Harvard Medical School
Brigham and Women's Hospital
Department of Medicine
Endocrinology
Boston, MA 02115
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Turchin: It is known that fewer women than men at high risk for cardiovascular disease are treated with statins.
However, the reasons for this sex disparity are not fully understood.
Our study identified 4 factors that accounted for over 90% of the difference in statin therapy between women and men with coronary artery disease:
Dr. Anna Pease[/caption]
Dr Anna Pease
Senior Research Associate
University of Bristol
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Pease: We tried to gather evidence of whether there was an association between swaddling for sleep and SIDS. This was a review, not a new original study, but it is the first time these data have been brought together to try to quantify any risk between swaddling and SIDS. We only found 4 studies and they were quite different making it difficult to pool the results. We did find, however, that the risk of SIDS when placing infants on their side or front for sleep increased when infants were swaddled.
Dr. Jean Philippe Chaput[/caption]
Jean-Philippe Chaput, Ph.D.
Assistant Professor of Pediatrics, University of Ottawa
Research Scientist, Healthy Active Living and Obesity Research Group
Children’s Hospital of Eastern Ontario Research Institute
Ontario, Canada
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Chaput: Folklore has associated behaviors of animals and humans, and even werewolves, to moon phases of the lunar cycle. However, the empirical evidence that the moon exerts an influence on behaviors is weak and very limited. In order to verify if the full moon is associated with sleep and physical activity of children (and possibly debunk this myth), we used a 12-country study involving 5,812 participants and providing 33,710 24-hour accelerometer recordings of sleep and activity behaviors. Overall, we observed that sleep duration was 5 minutes (1%) shorter at full moon compared to new moon, while activity behaviors were not significantly associated with the lunar cycle in this global sample of children drawn from all inhabited continents. However, the magnitude of this effect on sleep duration is unlikely to be clinically significant from a public health standpoint and people should stop worrying about the full moon.
Dr. E. Scott Sills[/caption]
Dr. Scott Sills MD, PhD
Medical Director at the Center for Advanced Genetics
an IVF program based in Carlsbad, California
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Sills: Often regarded as a miracle procedure by many infertile couples, in vitro fertilization (IVF) can be financially difficult for those without insurance coverage for the treatment. This prohibitive cost leads many would-be parents who pursue IVF to transfer multiple embryos at once, to increase their chances of getting a baby and minimize the need for additional attempts.
This new study now reports that the economic impact of IVF deserves a closer look. As corresponding author E. Scott Sills, MD PhD noted, rates of cesarean-section deliveries, premature births, and low birth weight of babies are all greater with two or more embryos transferred to the mother at once, compared to a lower risk, single-embryo pregnancy.
The data derived from a comprehensive analysis of all IVF cases in Vermont (UVM) and was recently published in the journal Applied Health Economics & Health Policy. It is believed to be the first effort to calculate the difference in infant hospital costs based on the number of embryos transferred. Sills and his team had access to UVM Medical Center records of patients who conceived through IVF and delivered at least 20 weeks into their pregnancies between 2007 and 2011.
Dr. Julie Shakib[/caption]
Julie H. Shakib, DO, MS, MPH
Assistant Professor of Pediatrics | University of Utah
Medical Director | Well Baby and Intermediate Nursery
Salt Lake City
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Shakib: Immunization against influenza in the first six months of life is ineffective due to an immature immune response. Passive protection via maternal immunization offers an alternative but only a few studies have evaluated the efficacy of this immunization strategy. We found that in infants born to women immunized against influenza during pregnancy, the risk of laboratory-confirmed influenza and influenza-related hospitalization were reduced by 70% and 81% in their first 6 months of life, respectively.This large study provides more evidence that when women are immunized against influenza during pregnancy, their infants are much less likely to be diagnosed with influenza in their first 6 months.
Wenpeng You[/caption]
Wenpeng You, PhD student
Biological Anthropology and Comparative Anatomy Research Unit
University of Adelaide | School of Medicine
Adelaide, Australia
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Dr. Maciej Henneberg[/caption]
Maciej Henneberg, PhD, DSc, FAIBiol
Wood Jones Professor of Anthropological and Comparative Anatomy
University of Adelaide School of Medicine;
Institute for Evolutionary Medicine, University of Zurich
Editor in Chief, Journal of Comparative Human Biology HOMO
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Type 1 diabetes disease has very strong genetic background. Prevalence of type 1 diabetes has been increasing globally. Previous studies focusing on regional genetics and environmental factors cannot fully explain this phenomenon. Due to insufficient medical knowledge up until early 20th century, people with type 1 diabetes disease would most commonly die during their teens or early 20s. Therefore, they did not have the opportunity to pass on their genes providing background for the development of type 1 diabetes to their next generations. Since discovery and introduction of insulin to modern medicine in early 1920s, more and more type 1 diabetes patients have been able to survive their reproduction cycle (up until and past 50 years of age). This has made more and more genes related to type 1 diabetes to accumulate in human populations.
We applied the Biological State Index which measures a probability to pass genes on to the next generation at population level. We found that the rapid increase in type 1 diabetes over the last few decades was correlated with increases of the Biological State Index and its proxy, human life expectancy, especially in more developed world in which natural selection has been relaxed most. This correlation was found after statistically excluding differences in countries income, levels of urbanization, sugar consumption and obesity prevalence.
Dr. Charu Kaushic[/caption]
Charu Kaushic. PhD.
Professor
OHTN Applied HIV Research Chair
Department of Pathology and Mol. Medicine
McMaster Immunology Research Center,
McMaster University
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Kaushic: Female sex hormones, estradiol and progesterone have been shown to regulate immune responses in many experimental and clinical studies. We and others have shown previously that these hormones also regulate susceptibility to and outcome of sexually transmitted infections (STIs), including Chlamydia, HSV-2, SIV and HIV-1. Most studies show that progesterone generally increases susceptibility while estradiol generally confers protection against STIs. This has recently gained much more widespread attention because of the controversy surrounding use of injectable hormonal contraceptives in geographical areas where there is high prevalence of HIV-1. The most frequently used injectable contraceptive uses a progestin-based formulation which has been correlated with 2-fold increase in HIV acquisition and transmission in epidemiological studies. Oral contraceptives that contain a combination of estradiol and progesterone do not show similar correlation with increased infection. This is currently a very important women’s health issue, which is being carefully monitored by many public health agencies, including WHO. Many researchers are focusing efforts in understanding how sex hormones can increase or decrease susceptibility of women to STIs.
We have published in this area for more than a decade, including a series of papers showing that in a mouse model, the outcome of genital herpes (HSV-2) infection can depend on which hormone we treat the mice with. A few years ago, we showed for the first time that mice that received an HSV-2 vaccine under the influence of estradiol were much better protected and showed less disease pathology (Bhavanam et al, Vaccine 2008). These results were reproduced a year later by another group, using an actual HSV-2 vaccine formulation. Since then, we have been working to understand at a cellular level, the underlying mechanism of estradiol-mediated enhanced protection. In this PLOS Pathogens paper, we report for the first time a cellular mechanism by which estradiol was seen to enhance immune protection against HSV-2 infection in mice.
The main findings are that estradiol primes dendritic cells in the vaginal tract to induce enhanced anti-viral T cell responses. Dendritic cells are key immune cells that decide what type of immune responses will be mounted against an infection. Under the influence of estradiol, the dendritic cells in the vaginal tract of mice induced Th17 cells which in turn helped enhance anti-viral T cell responses (Th1), resulting in better protection against genital HSV-2. This regulation of anti-viral immunity was seen only in the reproductive tract.
Dr. Riyaz Bashir[/caption]
Riyaz Bashir MD, FACC, RVT
Professor of Medicine
Director, Vascular and Endovascular Medicine
Department of Medicine
Division of Cardiovascular Diseases
Temple University Hospital
Philadelphia, PA 19140
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Bashir: The use of compression stockings in the prevention of post thrombotic syndrome following an episode of deep vein thrombosis is common in clinical practice. However, the evidence to suggest its efficacy has been put into question by the recent publication of the SOX trial. Since this was the largest randomized controlled trial to date addressing this issue, it has led to clinicians questioning whether compression stockings should be used at all in these patients.
The main finding of this meta-analysis was that in patients with deep venous thrombosis, use of elastic compression stockings does not significantly reduce the development of post thrombotic syndrome. However the current body of evidence is limited and we believe at present it is too early to give up on the use of this therapy, which may benefit many subgroups of patients.
Dr. Martha Rumore[/caption]
Martha M. Rumore, PharmD, JD, MS, LLM, FAPhA
Associate Professor, Social, Behavioral & Administrative Pharmacy
Touro College of Pharmacy
New York, NY 10027
& Of Counsel Sorell, Lenna, & Schmidt, LLP
MedicalResearch.com: What is the background for this study?
Dr. Rumore: The management of lipid therapy is only one component that affects overall cardiovascular outcomes.This study is one of the first to look at the benefits of dose titration versus intensity-based statin therapy. To evaluate whether patients titrated on statin therapy using ATPIII algorithm with an LDL goal of <100mg/dL also met the 2013 ACC/AHA Guideline for Management of Blood Cholesterol goal of ≥40% LDL reduction from baseline compared to inpatients initiated on high-moderate intensity statin (HIS). Other objectives included comparison of algorithms to lower LDL ≥40%, final dose, adverse drug events (ADEs), clinic visits to goal, and cardiovascular event occurrence.
MedicalResearch.com: What are the main findings?
Dr. Rumore: 981 patients were included- 43% were titrated and 57% achieved LDL<100; 38% achieved both LDL <100mg/dL and LDL ≥40% reduction; 58% received HIS and 53% achieved LDL <100; 43% achieved both LDL <100mg/dL and LDL ≥40% reduction.
Initiating patients on High Intensity statins was not more effective than dose titration in achieving <100mg/dL and ≥40% LDL reduction;X2=0.006,N=159,p=0.938. A 50% LDL reduction in patients that also achieved an LDL <100 was 54% and 48%, in titration and HIS groups, respectively; X2=0.611,N=159,p=0.434. The titration group required an average of 4.3 clinic visits to achieve goal, compared to 3.1 visits for HIS; p=0.309; 95% CI(-1.36,1.06).
Dr. T. Jared Bunch[/caption]
T. Jared Bunch, MD
Director of Heart Rhythm Research
Medical Director for Heart Rhythm Services
Intermountain Healthcare System
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Bunch: Approximately 6 years ago we found that patients with atrial fibrillation experienced higher rates of all forms of dementia, including Alzheimers disease. At the time we started to ask the questions of why this association existed. We know that atrial fibrillation patients experience higher rates of stroke. These patients are placed on blood thinners, most commonly warfarin, to lower risk of stroke which at the same time expose that patient to a higher risk of intracranial bleeding. One possibility to explain the association was that perhaps dementia in the manifestation of many small clots or bleeds in the brain that in total lead to cognitive decline. If this is the case, then the efficacy and use of anticoagulation is very important in atrial fibrillation patients.
We conducted additional studies that showed this to be the case. In patients with no history of dementia, managed long-term with warfarin anticoagulation, those that had levels that were frequently too higher or too low that resulted in poor times in therapeutic range, experienced significantly higher rates of dementia. The risk was highest in younger atrial fibrillation patients that were less than 80 years of age. We then found that in atrial fibrillation patients that were frequently over anticoagulated and also use an antiplatelet agent, aspirin or plavix, the dementia rates nearly doubled. At this point we raised the question if atrial fibrillation increased the risk beyond anticoagulation, or does anticoagulation efficacy drive most of the risk. This question formed the background of the current study.
Robert Bonacci[/caption]
Robert Bonacci MPH, MD Candidate’16
University of Pennsylvania School of Medicine
MedicalResearch.com: What is the background for this study?
Response: During the mid-2000’s, the HIV incidence rate stubbornly persisted around 50,000 infections per year. Responding to this trend, President Obama released the first comprehensive US National HIV/AIDS Strategy (NHAS) in 2010. The NHAS hoped to spur a more coordinated national response and set ambitious targets for reducing HIV incidence (25 percent) and the transmission rate (30 percent), among other goals, by 2015.
To evaluate whether the U.S. achieved the NHAS goals by 2015, we used mathematical models drawing on data from the U.S. Centers for Disease Control and Prevention (CDC) on HIV prevalence and mortality for 2007 to 2012, and our own previously published incidence estimates from 2008-2012. Changes seen from 2010 through 2012 were extrapolated for the time period 2013 through 2015.
Dr. Melissa Stockwell[/caption]
Melissa Stockwell, MD, MPH, FAAP
Florence Irving Associate Professor of Pediatrics and
Population and Family Health
Columbia University - College of Physicians & Surgeons and
Mailman School of Public Health
Medical Director, New York-Presbyterian Hospital Immunization Registry (EzVac)
Co-Director, Primary Care Clinician Research Fellowship in Community Health
New York, NY 10032
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Stockwell: Fragmentation of immunization records place children at risk for underimmunization and overimmunization. Nearly all 50 states, 5 cities, and the District of Columbia operate an immunization information system, which is a system that collects and centralizes immunization data for children and adolescents from immunization providers at a regional or state level. More than 75% of US office-based physicians have adopted an electronic health record (EHR), but until recently, clinicians wanting to access patient immunization information in an IIS generally had to manually look up the patient data on a state or local IIS website, that data was not available to them within their own EHR. In this study, we demonstrated that exchange of immunization information between an immunization information system (IIS) and an EHR at point of care had a significant impact on up-to-date rates, overimmunization, and immunization record completeness for low-income, urban children and adolescents.