Fulbright Scholar Integrates Brain Therapeutics, Culture to Treat Huntington's Disease

Introducing herself with the traditional Māori greeting, Fulbright Scholar Dr. Melanie Cheung (Ngāti Rangitihi, Te Arawa) shows that her feet are planted firmly in the world of her Indigenous people of New Zealand. It is this commitment to exploring both Indigenous and Western scientific paradigms that brought Cheung to NIH in November to present her research findings on a neurodegenerative illness that is affecting her people: Huntington's disease.

During a special lecture, Cheung painted a beautiful picture of the rich culture, mythology and distinctive crafts of the approximately 600,000 people in New Zealand identifying as Māori. But, she revealed that Western-centered approaches are currently failing Indigenous people when it comes to Huntington's disease, a progressive brain disorder that, according to Cheung, is 10 times more prevalent in the Māori people than any other population in the world. The familial disease involves changes in personality, movement and thinking and inevitably ends in death. With no cure, Māori families have been watching the disease destroy their loved ones' ability to feel, think and move.

"What's very interesting with this disease is it's in families," she said. "We have big families. That has to do with our culture. My tribal elders wanted us to do research in a Tikanga Māori type of way - using ceremonies to acknowledge spirit. We believe there's continuity between the physical and spiritual worlds, that there is no separation between the two. The work I'm doing is really about making a Māori-responsive, brain plasticity-based training program to treat Huntington's disease."

Based in San Francisco at the Brain Plasticity Institute, Posit Science, Cheung is proving to be a leader in the science of health disparities since her research is about integrating biomedical science and cultural aspects: exploring both Indigenous and Western scientific paradigms to help people with neurodegenerative diseases. Integrating brain plasticity-based therapeutics and culturally-responsive methods to treat Huntington's disease, her work joins experimental neuroscience, bioethics, tikanga (ceremony/customary practice) and Mātauranga Māori (Māori traditional knowledge).

"Respect is the most important thing and knowing cultural practices is important," she said. "Māori have a process of welcoming strangers with ceremony, then they become family. I recognized that I needed to do the same ceremony with the post-mortem human brain tissue that I was growing primary cell cultures from.

When a person and their family gives the gift of their brain, Cheung honors that gift through ceremony, which is about acknowledging the relationships that extend out of that brain.

"The brain has come from a person, a human being who belongs to a family and community," she explained. "I acknowledge their passing. I ask that their family is comforted in their grief. I acknowledge the gift that they have given our research. Then I welcome the brain to its new home in our laboratory, and welcome a new function to the cells that may help us to understand more about the disease."

Over the past seven years, she and her research team have worked closely with a large Māori family that has Huntington's disease. Her current research projects include:

• Developing and testing a novel brain plasticity-based training program for Huntington's disease;
• Developing a model of mutually beneficial partnership between Māori families and biomedical scientists and clinicians;
• Researching clinical and translational aspects of Huntington's disease; and
• Teaching Indigenous students as part of the Mahina Project, a biomedical and behavioral health training program. It is an NIH-funded T37 Minority Health and Health Disparities International Research Training Program conducted through the Indigenous Wellness Research Institute at the University of Washington.

In her research, Cheung, who received a Doctorate in Pharmacology from the University of Auckland, believes integrating clinical excellence, cutting edge science and cultural-responsiveness is equally important. Knowing that neuroplasticity-based therapeutics have the potential to change the ways doctors and researchers treat brain diseases, she said that Indigenous research methods, which incorporate spirituality, ethics and community, also have the potential to provide innovation and inspiration in the laboratory and clinic.

"Building relationship with Indigenous communities takes a long time," she said. "We worked with a large Maori Huntington's family for six years before we even contemplated starting a science project with them. Our research has both [short- and long-term] goals. Short-term is about developing practical clinical solutions for them—right here, right now. Whereas, long-term is about the science, developing the treatments that probably won't benefit them, but it may benefit their children or their grandchildren. This gives them hope."

Cheung's special NIH lecture was hosted by the National Institute on Minority Health and Health Disparities, the National Institute of Neurological Disorders and Stroke, and the Fogarty International Center. Fulbright's Outreach Lecturing Fund allows Fulbright Visiting Scholars, like Cheung, to travel across the country to share their specific research interests, speak on the history and culture of their home countries and exchange ideas with U.S. students, faculty and community organizations.

Cheung's other research projects have included using Indigenous values and practices in scientific practice, with specific focus on developing culturally respectful laboratory practices for working with human tissue. This research was featured in a 2007 issue of Science and Australia Broadcasting Corporation's award winning "All in the Mind" radio show in 2008. Cheung has also coordinated the award-winning Tuakana (pronounced "two-uh-ca-na") Biology Tutorial Program at the University of Auckland, which is celebrating its 25th year. It is the most successful Māori STEM program to date.