Dr. Friedman's early research addressed how parasitic diseases, particularly malaria and schistosomiasis, cause morbidity for pregnant women and children. Our work has focused on mechanisms mediating anemia, undernutrition, growth faltering and neurocognitive impairment. In particular, we have identified anemia of inflammation as a primary cause of schistosomiasis related anemia. This contribution has guided interventions to improve pediatric anemia in this context with a greater focus on co-treating helminthiasis to improve iron uptake and bioavailability. In addition, our studies suggest that pro-inflammatory cytokines contribute to under-nutrition in the context of S. japonicum, due to their cachexia and anorexia inducing effects.

Our current studies seek to quantify the burden of S. japonicum infection during pregnancy and begin to understand the possible mechanisms and best ways to address this. In 2016 we completed a randomized controlled trial in the Philippines to assess the safety and efficacy of praziquantel for the treatment of schistosomiasis during pregnancy. Follow up studies are addressing how schistosomiasis and other helminth infections impact pregnancy and placental health and the longitudinal growth and nutritional status of offspring. In addition, we are examining how pre-natal alcohol exposure interacts with other insults in lesser developed countries to impact placental health as well as birth and infant outcomes. These studies are funded by NIH's NIAID and NIAAA.

Finally, a recently funded NIH/NIAID grant will plan a trial investigating the safety and efficacy of praziquantel in children under age four, for whom the drug is not currently FDA approved. In this dose finding trial, we will evaluate the PK/PD of different doses and examine factors such as impaired gut absorption of therapeutics in children living in lesser developed countries. We will also evaluate the impact of varying doses and frequency of treatment on key nutritional morbidities and mechanisms mediating this.