Juan Carlos Cardet, MD, a native Puerto Rican, is no stranger to the struggles of treating asthma. Cardet, his mother and his sister all have asthma, a trend that is all too common in Puerto Rico. The island has one of the highest asthma prevalence rates in the world, but scientists do not yet know why this is.
After graduating from medical school in Puerto Rico and finishing his residency in Internal Medicine in Connecticut, Cardet moved to Boston to complete his fellowship in allergy and immunology at BWH. Now the assistant director of the BWH Asthma Research Center, he has quickly become involved in several key research initiatives working to better understand asthma.
“The resources at BWH are fantastic. Here, if you have an idea or if you’re just willing to do the work, opportunities are thrown at you. That’s really powerful,” Cardet said.
There is still a lot of research needed to better understand asthma, according to Cardet. Although several medication options exist, many of these treatments are not helpful for a large percentage of patients with asthma. Scientists also do not fully understand the stark differences in asthma prevalence among ethnic groups. According to the Environmental Protection Agency, Puerto Rican children are 3.2 times more likely to have asthma than non-Hispanic white children.
Cardet’s frustration with this disparity motivated him to pursue research. His interest in asthma was originally more clinical in focus, but Cardet quickly became concerned with the limitations in current care.
“BWH’s great research focus encouraged me to question why we do the things that we do in asthma treatment,” Cardet said. “I wanted to investigate what can be done to understand this disease differently.”
Cardet hopes to better understand the biological mechanisms behind asthma in order to create more precise and long-lasting treatments. He collaborates with one of his fellowship mentors, Jessica Savage, MD, MHS, to study the potential relationship between asthma and the human gut microbiome (the community of microorganisms living in humans). Previous studies have found a link between the presence of certain bacterial metabolites and a decreased risk for certain cancers, cardiovascular disease and osteoporosis, but nobody had looked to see if a similar pattern existed for asthma.
Cardet and Savage used data from the National Health and Nutrition Examination Survey (NHANES) to see if enterolactone – a metabolic product derived from foods like flax and sesame seeds – was related to asthma symptoms. They found that patients with a higher concentration of enterolactone in their urine had a lower chance of having asthma symptoms in the past year. With these promising results in mind, Cardet and Savage are now working with Elliot Israel, MD, to see if enterolactone concentration is related to asthma severity as well.
Cardet is also collaborating with Israel to test the effectiveness of Alendronate – a drug intended to treat osteoporosis – in minimizing the drop in lung function during an asthma attack. This is called bronchoprotection. Typical asthma medications like Albuterol and Salmeterol, known as beta-2-agonists, are designed to relax airway muscles, making it easier to breathe during an asthma attack. They also provide bronchoprotection when a patient encounters asthma triggers in the future, but this protection is weakened by regular use of these medications. Cardet’s clinical trial tests whether Alendronate could prevent this loss of bronchoprotection. This could be a convenient and economically feasible way to protect lung function in severe asthmatics.
Even though Cardet spends a majority of his time working in labs and conducting research, he still sees patients once a week at Brigham and Women’s Faulkner Hospital.
Cardet said he wouldn’t have his career any other way. “I’m still a clinician at heart – I was just bitten by the research bug. Seeing patients reframes your research questions and gives you a sense of urgency for what’s important,” said Cardet.