Traumatic smoke inhalation, cognition and health disparities

Anita Randolph, Ph.D., wants to improve the quality of life for veterans after active duty.

Anita Randolph, Ph.D., wants to improve the quality of life for veterans after active duty. As a doctoral student, she made a major discovery about brain damage in people who’ve suffered third-degree burns and smoke inhalation injury. Now, as a new postdoc in the labs of Damien Fair, PA-C, Ph.D., and William Hoffman, M.D., Ph.D., she focuses on addiction. Her work is supported by the postdoctoral Fellowship for Diversity and Inclusion in Research program.

What are you working on and why is it important?

Randolph demonstrated that cognitive damage after traumatic smoke inhalation injury is not caused by shock from the trauma itself but that smoke inhalation causes profound pathological changes in the brain. The paper was published in May 2019 in Shock, the journal of the International Federation of Shock Societies.

As the granddaughter of a Vietnam veteran and daughter of a disabled Persian Gulf veteran, I see the extreme need for new ways to improve quality of life for people after active duty. Not only is there a lack of accessibility to quality care and support, there is a need for new knowledge about the neurological disorders that affect this diverse population, including mental health and drug addiction.

My goal is to identify changes in the brain networks of drug-dependent individuals so we can individualize treatment approaches to drug addiction. I use MRI and PET imaging to identify neural predictors of relapse and response to treatment.

What’s been your most exciting discovery?

My most exciting discovery actually led to a change in the way patients are treated.

Image above: Randolph traveled on a medical mission throughout Africa in the summer of 2018.I looked at the ways large third-degree skin burns and smoke inhalation affect the central nervous system. This is a neglected field of study but is particularly important because new therapies for these traumas mean a lot more people are surviving these types of injuries.

People who survive major burns and smoke inhalation may experience progressive cognitive deficits. Understanding how and why this happens can make it possible to treat these patients more effectively.

Before my research, it was thought that cognitive changes were caused by shock from the trauma itself or from the anesthesia used to sedate the trauma patient.

I demonstrated, for the first time, that smoke inhalation, alone or in combination with third-degree skin burn injury, produces substantial bleeding and profound pathological changes in the brain that are not caused by lack of oxygen, hypoxia. Major burns and smoke inhalation result in dilated and congested blood vessels, neurovascular hemorrhaging, ruptured blood vessels, and neutrophil infiltration in the frontal cortex, basal ganglia, amygdala, hippocampus, pons, cerebellum, and pituitary gland following.

This is important to the field because it demonstrated that neurological decline experienced by these patients is not secondary to shock and sedation, but could be caused by damage to the blood-brain barrier.

These findings changed standards of care in the field — leading to the inclusion of neurological examinations in the standard evaluation for these patients.

What is your day-to-day life as a researcher look like?

Working with veterans

Randolph’s professional goals include a strong outreach component. She conducts outreach projects throughout the greater Portland area and abroad in countries such as Ghana, Tanzania, and South Africa (Courtesy Randolph)

A typical day in the lab begins with me recruiting subjects. After recruiting and screening, I administer cognitive tests to evaluate impulsive behavior, attention and working memory deficits, and cognitive flexibility.

Then begins the imaging part of the research — that includes several sessions with each participant. I use functional magnetic resonance imaging (fMRI), including resting state functional connectivity fMRI, to assess neurological differences between alcohol and methamphetamine-dependent individuals versus control subjects. Next, I’ll turn to processing and analyzing my imaging data through state-of-the-art data analysis pipelines.

Other overlooked populations

For the engagement part of my work, I serve with Dr. Binyam Nardos as co-director of Youth Engaged in Science (YES!) outreach program at OHSU. We promote science in middle schools and high schools by sharing research with teachers, mental health practitioners and the community. The primary aim of YES! is to tackle the health and educational disparities that disproportionately impact communities of color and other underrepresented minority communities.

YES! programs include bringing graduate students and postdocs to schools and fairs and bringing middle- and high-school students to OHSU. YES! also provides research internships to high school and undergraduate students.

In the Lab

The In the Lab series looks at the people who help make OHSU such a vibrant research institution. In each post, researchers and clinician-scientists describe their current work and life as researchers.