Gene-environment interactions that contribute to illness severity.
The susceptibility to and severity of many diseases in the ICU are likely subject to gene-environment interactions in which inter-individual variation in disease manifestation is influenced both by host genetic background and environmental exposure. Our overall goal is to use genetic association methods to identify genes that explain inter-individual variation in disease manifestation following environmental exposure. We are using rhinovirus triggered asthma exacerbation as a model because:
rhinovirus-triggered acute asthma exacerbation is a dominant cause of morbidity among children with asthm
there is marked inter-individual variation in the susceptibility to and severity of rhinovirus-triggered asthma exacerbation, ranging from mild symptoms to life-threatening episodes
accumulating evidence suggests that variation in asthma severity is likely influenced by host genetic background. Characterizing the genetic basis of inter-individual variation in the clinical phenotype of rhinovirus infection will provide insights into the biological mechanisms that pre-dispose some children to severe episodes of rhinovirus-triggered asthma exacerbation, and ultimately will improve risk stratification and treatment. Further, we expect that our approach can be used more broadly to study the genetics of severe disease in the intensive care unit.
Point of care ultrasound in the pediatric intensive care unit.
Point of care ultrasound in the critical care setting comprises a set of focused applications utilized to monitor physiological states, guide invasive procedures, and diagnose potentially life-threatening conditions. Accumulating evidence in adults demonstrates point of care ultrasound alters clinical management, improves the safety and efficacy of invasive procedures, and may potentially improve the outcomes of critically ill patients. We are broadly interested in investigating the utility of point of care ultrasound in the pediatric intensive care unit. Current projects include:
using ultrasound to measure anterior thigh muscle thickness as a proxy for muscle mass and nutritional statu
nvestigating ultrasound-based physiological parameters that might predict volume responsiveness
using ultrasound to assess lung recruitment of patients on ECMO. In addition, we are collaborating with a number of other academic centers to investigate how ultrasound-derived data alters the timing and nature of clinical management decisions in the pediatric intensive care unit.
Research Background
David B. Kantor obtained his MD and PhD from the Johns Hopkins University School of Medicine. His PhD work focused on using genetic techniques to identify and characterize genes involved in early brain development. He subsequently completed his internship and residency in Pediatrics at Boston Children’s Hospital, followed by a fellowship in Pediatric Critical Care, also at Boston Children’s Hospital. Dr. Kantor is a past scholar in the Pediatric Critical Care and Trauma Scientist Development K12 Program and is currently funded through a National Heart, Lung, and Blood Institute K23 career development award.
Establishing intensivist-driven ultrasound at the PICU bedside--it's about time*. Su E, Pustavoitau A, Hirshberg EL, Nishisaki A, Conlon T, et al. Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2014; 15(7):649-52. PubMed [journal]PMID: 24977438
Education
Medical School
University of Massachusetts Medical School
2003
Worcester
MA
Internship
University of Colorado Health Sciences
2004
Denver
CO
Residency
University of Colorado Health Sciences
2006
Denver
CO
Fellowship
Boston Children's Hospital
2010
Boston
MA
Publications
Anomalous Left Coronary Artery Arising from the Pulmonary Artery (ALCAPA): The Critically Important Role of Color Flow Doppler in Identifying a Rare Intramural Course. CASE (Phila). 2022 May; 6(3):119-123. View Abstract
Case Report: Comparison of Plasma Metagenomics to Bacterial PCR in a Case of Prosthetic Valve Endocarditis. Front Pediatr. 2020; 8:575674. View Abstract
Online education in a hurry: Delivering pediatric graduate medical education during COVID-19. Prog Pediatr Cardiol. 2021 Mar; 60:101320. View Abstract
Needles in Hay II: Detecting Cardiac Pathology by the Pediatric Chest Pain Standardized Clinical Assessment and Management Plan. Congenit Heart Dis. 2016 Sep; 11(5):396-402. View Abstract
Post-mortem genetic testing in a family with long-QT syndrome and hypertrophic cardiomyopathy. Cardiovasc Pathol. 2014 Mar-Apr; 23(2):107-9. View Abstract
Regional implementation of a pediatric cardiology chest pain guideline using SCAMPs methodology. Pediatrics. 2013 Oct; 132(4):e1010-7. View Abstract
Management of pediatric chest pain using a standardized assessment and management plan. Pediatrics. 2011 Aug; 128(2):239-45. View Abstract
Confirmation of TNIP1 and IL23A as susceptibility loci for psoriatic arthritis. Ann Rheum Dis. 2011 Sep; 70(9):1641-4. View Abstract
Rapid-response extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in children with cardiac disease. Circulation. 2010 Sep 14; 122(11 Suppl):S241-8. View Abstract
Needles in hay: chest pain as the presenting symptom in children with serious underlying cardiac pathology. Congenit Heart Dis. 2010 Jul-Aug; 5(4):366-73. View Abstract
Cytokine gene polymorphisms: association with psoriatic arthritis susceptibility and severity. Arthritis Rheum. 2003 May; 48(5):1408-13. View Abstract