Climate Change Contributors to ALS

PI Lisa Satterwhite, Pratt School of Engineering, Civil and Environmental Engineering

Richard Bedlack, School of Medicine, Neurology

Nathaniel Chaney, Pratt School of Engineering, Civil and Environmental Engineering

Zackary Johnson, Nicholas School of the Environment, Marine Science and Conservation

Brian Silliman, Nicholas School of the Environment, Marine Science and Conservation

Ashley Stoop, Albemarle Regional Health Services, Policy, Planning and Preparedness

Ricardo Henao, School of Medicine, Biostatistics and Bioinformatics/Electrical and Computer Engineering

Heileen Hsu-Kim, Pratt School of Engineering, Civil and Environmental Engineering

Lee Ferguson, Pratt School Engineering, Civil and Environmental Engineering/Environmental Sci and Policy

Dana Hunt, Nicholas School of the Environment, Marine Science and Conservation

Henri Gavin, Pratt School of Engineering, Civil and Environmental Engineering

Michael Bergin, Pratt School of Engineering, Civil and Environmental Engineering

Mark Borsuk, Pratt School of Engineering, Civil and Environmental Engineering

Climate Change Contributors to ALS will explore the relationship between climate change and neurological health in a study of amyotrophic lateral sclerosis (ALS, Lou Gehrig’s disease). ALS is a devastating neurodegenerative disease without cure, with the majority of cases idiopathic, or of unknown cause. Geographical clusters of ALS have been linked with cyanobacteria (blue green algae) blooms, a type of harmful algal bloom that releases a strong neurotoxin, beta-methyl-amino-L-alanine (BMAA), that accumulates in air, water and food. BMAA is a homologue of the amino acid serine and is incorporated during protein synthesis, resulting in mis-folded protein tangles which are observed in motor neurons of people with ALS. As the number, sites and intensity of harmful algal blooms potentially increase with climate change due to warming and precipitation extremes (nutrient runoff), our concern is that blooms will negatively impact neurological health to such an extent that we will see increased occurrence of ALS in local human populations.

Our objective is to determine how neurological health is influenced by climate change. We will partner with Albemarle Regional Health Services to study an apparent ALS cluster in the Albemarle Sound region to create a scalable model to test how climate change can drive degradation of human health and how natural ecosystems can mitigate this impact. We will test the general hypothesis that climate-change driven harmful algal blooms (HABs) will lead to decreased neurological health and increased occurrence of ALS and that the natural extent and restoration of NC coastal ecosystems can mitigate these negative impacts on human health.

Aim 1 is a retrospective study to determine the relationship between cyanobacteria blooms (number, size, duration), climate parameters (temperature, precipitation, streamflow discharge) and ALS (prevalence and incidence). We will leverage two decades of satellite remote sensing, historical climate data and ALS case and mortality data over the region to test the hypothesis that climate change-driven effects are associated with both an increased HAB occurrence and the number of ALS deaths. This Aim addresses one challenge in climate health research: the need for a multi-decade longitudinal data acquisition to accurately describe a relationship.

Aim 2 is a prospective study to test the hypothesis that HAB-associated ALS looks different, either clinically or molecularly, compared to ALS that is not HAB-associated. We will collect demographics, disease characteristics and biological samples from people with ALS and their spouses/caregivers living near active blooms compared to those in urban areas without exposure. Biological samples will be used to identify underlying molecular mechanisms in the form of gene expression, epigenetic signatures and metabolites of chemicals and toxins. Differences could strengthen the case for a causal relationship between HABs and ALS, and potentially identify unique ways to diagnose ALS, treat the subset of HAB-associated ALS, and predict ALS disease progression. Additionally, environmental sampling will determine specific organisms and toxins that are associated with ALS.

Aim 3 is a study of how coastal wetland extent (oyster reefs, marshes, swamps) and restoration will mitigate climate change driven HABs and ALS prevalence on the NC coastal plain. Using spatial correlations and modeling we will test the hypothesis that the natural extent of coastal wetland ecosystem and modeled restoration can reduce frequency and incidence of HABs and ALS in the Albemarle Sound region. This aim will develop drone imaging and continuous remote environmental sensing of air and water to lay groundwork for a future project aimed specifically at reducing neurotoxins through large scale ecosystem restoration.

Our study is innovative in applying both ecological and clinical approaches to solve a climate scale problem. Deliverables will be high resolution maps of climate, blooms, and ALS over two decades, blood diagnostics for ALS and cyanobacteria toxin exposure, and wetland restoration models that will describe methodology for removing neurotoxins from the environment through maintaining ecosystem health. We are excited to develop an empowering two-way collaboration with Albemarle Regional Health that will include a patient advisory board, citizen scientists to conduct environmental sampling, and community events that will bring together ALS patients and their families, clinicians and foundations that serve them with the wetland restoration experts who will help them safeguard their environments. We see community engagement as the essential link between discovery and implementation.

We envision this study as the start of a three-decade partnership that will build climate resilience into our land use in rural areas where climate change impact is most severe and where people are least able to combat the negative health effects. This is a now or never moment to work together to build logistics that will empower these communities. We are solution-based optimists, committed to healing our planet and our people.