Interdisciplinary Approach to Endocrinology - PowerPoint Presentation

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Interdisciplinary Approach to Endocrinology

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 پنجمین كنگره بين المللي پزشكيتازه ترين دستاوردهاي پژوهش در دانش پزشكي از پزشكي ملكولي، سلولي و باليني

Bagher Larijani, M.D., F.A.C.E.Professor of EndocrinologyDirector-General, Chief Scientific OfficerEndocrinology and Metabolism Research InstituteTehran University of Medical SciencesSlide3

Interdisciplinary Research

Clinical Medicine

Basic

Sciences

Interdisciplinary

Research

Interdisciplinary research

plays a key role in forging a

link

between basic medical sciences and clinical medicine

3Slide4

Interdisciplinary Research

Promotion of Interdisciplinary Research is priority in different international

strategic plans

4Slide5

Future of Endocrinology: Interdisciplinary Research

Many scientists and physicians believe that

the future of medicine lies in interdisciplinary research.Attempts has been made to promote interdisciplinary research in most prestigious medical schools including Boston University of Medical Sciences

1-Coleman DL,

Spira

A,

Ravid

K. Promoting Interdisciplinary Research in Departments of Medicine: Results from Two Models at Boston University School of Medicine. Trans Am

Clin Climatol Assoc. 2013; 124: 275–282.

5Slide6

Interdisciplinary Research in Iran

Ministry of Health and Medical Education can play a key role in national progress in the fields of

health sciences, technology, and innovation. (1)

1- B. Larijani et al. Iran’s Health Innovation and Science Development Plan by 2025. Iranian Journal of Public Health 2009; 38: 13-16 (supp)6Slide7

Why Interdisciplinary Research? Advances in technology

in the past century began a new era of diagnosis and treatmentThese advances have

failed to offer a curative treatment for many endocrine diseases including diabetes. As a result of the advances, new fields have emerged such as rejuvinative medicine and regenerative medicine. 7Slide8

New drugs for endocrine disorders A specific focus on

clinical pharmacology is crucial if we are to develop new drugs

for endocrine disorders Molecular modeling needs to be in priority to lower the cost of production of new drugsA new approach to Iranian traditional medicine and herbal medicine is necessary to develop new herbal medication based on the traditional approaches

8Slide9

New treatment modalities

Regenerative medicine and stem-cell research need to be in priority if we are to invent new treatment modalities

Research on medical ethics is needed need to overcome ethical, cultural, and religious issues in regards with barriers to new treatment modalities such as stem-cell researchEthical issues need to address dilemmas such as rejuvinative medicine which involves use of hormones in aging normal individuals for restoration of vigor and youth Genetics is needed for gene therapy

9Slide10

New diagnostic methods

In order to invent new diagnostic devices, it is necessary that

analytical chemistry and biosensor technology Genetics and genome mapping is needed for screening high risk individualsInvention of new diagnostic devices similar to ophthalmoscopes, needs close cooperation between

engineering and physics faculties and medial faculties 10Slide11

An Interdisciplinary Approach to Endocrinology

Gene Therapy

Personalized Medicine

New Drugs

Cure for Diabetes

Biosensors for Diagnosis of Diabetes

Approval for stem-cell Research

11Slide12

Diabetes: an example of necessity of

interdisciplinary research

In the field of diagnosis, advance in analytical chemistry, optics, and ultrasonography is necessary Genetics

can be applied for screening and identification of high-risk individualsIslet-cell transplantation and stem-cell research needs to make progress for

treatment

modalities

Progress in

medical ethics

is necessary to address ethical and cultural in order to overcome the barriers to stem-cell research

12Slide13

Timeline of Diabetes-Related Research

There has been

little progress in diabetes-related research since 1923

Polonsky KS. The Past 200 Years in Diabetes. N Engl J Med 2012;367:1332-40.

From 1923 when insulin was discovered, there has been little progress in treatment of diabetes

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Milestones in the Treatment of Diabetes

Discovery of Insulin

Progress

in

Pancreas

transplantation

Advances in Stem-cell research

Polonsky

KS. The Past 200 Years in Diabetes. N

Engl

J Med 2012;367:1332-40

.

?

14Slide15

The Global Burden of Diabetes (IDF Official Report)

366 million

people have diabetes in 2011; by 2030 this will have risen to 552 million80% of people with diabetes live in low- and middle-income countries

The greatest number of people with diabetes are between 40 to 59 years of age

The majority of Iranian Population is forecast to be in this range in 2025

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Why Diabetes is a Future Concern in Iran?

The population of Iran is projected to

grow older in 2025.

B.

Larijani et al. Iran’s Health

Innivation

and Science Development Plan by 2025.

Iranina

Journal of Public Health 2009; 38: 13-16 (supp)

16Slide17

Burden of Diabetes in Iran

Level 3 Tree Map of All Causes of DALYs In 2010

Diabetes

is a major cause of DALYs in Iran

DALYs

= Disability Adjusted Life Years

(The sum of years of potential life lost due to premature

mortality and the years of productive life lost due to disability.)

17Slide18

The change in the leading causes of DALYs from 1990 to 2010 in Iran

http://

www.healthmetricsandevaluation.org

/gbd/country-profiles

In the past two decades, the

burden of diabetes has significantly increased in Iran

18Slide19

Ranking of leading age-standardized rates of disability-adjusted life years (DALYs) (relative to comparator countries in 2010)

Diabetes ranked 9

th

in Iran in ranking of DALYs in 2010

http://

www.healthmetricsandevaluation.org

/

gbd

/country-profiles

19Slide20

Interdisciplinary Approach to Endocrinology

( Diagnosis and Treatment)

Technological advances in the field of screening and diagnosis of Diabetes Application of Analytical Chemistry (Biosensors) .Employment of genetics to spot high risk individuals New treatment options: Whole

pancreas transplantation Pancreatic islet transplantation Regenerative medicine (Stem-cell therapy)Gene therapy Personalized medicine

New drugs developed with the use of

molecular modeling

Traditional medicine

20Slide21

Biosensors in Endocrinology

Advantages of biosensors for clinical use: Detect small amounts

Fast response Cost-effectiveOnline monitoringPortable

Biosensors can effectively detect very small amounts of biologically active substances 21Slide22

Detection of Glucose in Saliva

Glucose measurement in saliva

and tears with the use of biosensors

Jonathan C. Claussen, Anurag Kumar, David B. Jaroch, M. Haseeb Khawaja, Allison B. Hibbard, D. Marshall Porterfield, Timothy S. Fisher.

Nanostructuring

Platinum

Nanoparticles

on Multilayered

Graphene Petal Nanosheets for Electrochemical Biosensing. Advanced Functional Materials, 2012;

DOI: 10.1002/adfm.20120055122Slide23

Invention of a Biosensor-Based Device for Measurement of Glucose in Saliva by

EMRI Scientists

Glucose measurement in saliva can provide a pain-free alternative for estimation of the blood sugar As glucose concentrations are extremely low in saliva, a very sensitive technique is requiredResearchers of the

EMRI have invented a portable device for measurement of glucose concentrations in saliva in a joint project.

The device invented by EMRI scientists (joint project).

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Diagnosis, Screening and Monitoring Diabetes

1776:

Saccharometers for detection of glucose in urine

Currently:

Glucometers for detection of glucose in blood

Near future

:

EMRI Developed device for detection of glucose in saliva will be commercially available

Future:

Smartphone screens will detect glucose in saliva (Spit-on-Phone)

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EMRI Joint Invention was Broadcasted via MedGadget

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Biosensor-Based Device for Detection of Sulfonylurea in the Urine

Patients with hypoglycemia

can be brought to the emergency ward in coma: the cause?EMRI sciences have invented a biosensor-based device which is capable of detecting sulfonylurea in the urine

EMRI invented biosensor-based device for detection of sulfonylurea in the urine

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News of the EMRI Invention

MegGadget broadcasted the news of the invention

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Curative treatment for Diabetes:

Whole Pancreas Transplantation

Pancreas transplantation was first used for the treatment of diabetes in humans

in 1966.In 2006, approximately 1400 procedures were recorded. This method is proved to be effective in controlling diabetes, especially unstable diabetes.

www.ustransplant.org (Accessed 7/6/09)

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Islet Transplantation VS Pancreas Transplantation

Islet

Transplantation Whole Pancreas Transplantation

Simple procedure

Major surgery

Abundant sources

Limited

sources

Mortality <1% in the first year

Mortality increases 10% each year

Various alternatives

(encapsulation)

Need for lifelong

immune

suppression

Indicated before DM complications

Is more suitable after complications

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Pancreatic Islet-cell Transplantation

30Slide31

Islet Transplantation Timeline in Iran

2002:

A scientific visit to University of Alberta Clinical Islet Transplant Program 2005: EMRC-TUMS established a fund to build GMP facility for pancreatic islet processing2007: Joint collaboration with IKE Barber human Islet transplantation laboratory-

UBC, Vancouver, Canada was formedDrawing up SOPs and work instructions for each step was designedCapital equipment and instruments

were purchased

First islet isolation

was performed in the facility

Cont’

Larijani B et al. Establishing a

cGMP pancreatic islet processing facility: the first experience in Iran. Cell Tissue Bank 2012; 13(4):569-75 31Slide32

News of the Foundation of the Facility

Larijani B et al. Establishing a

cGMP pancreatic islet processing facility: the first experience in Iran. Cell Tissue Bank 2012; 13(4):569-75

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In 2010:

- GMP facility was set up and experimental isolation of human pancreatic islets (process validation) was carried out

- Clinical islet transplantation was preformed in 2 patients

Larijani B et al. Establishing a cGMP pancreatic islet processing facility: the first experience in Iran. Cell Tissue Bank 2012; 13(4):569-75 33Slide34

Published Successful Examples of

stem-cell therapy in

type 1 diabetes

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EMRI Experience

:

Studies Methods And Protocols

Intervention Human fetal liver-derived Hematopoietic stem cells Cells certificates are prepared for each patient IV injected within 20-30 min.

Follow-up

Patient were visited followed up

(1w-2w-4w-8w-12w…)after cell therapy.

Laboratory test

(CBC, HbA1C, FBS, LFT, TG, cholesterol, U/A, C-peptide, surface markers, immunoglobulins.

Ghodsi M, Heshmat R, Amoli M, Keshtkar A, Arjmand B, Aghayan H, Hosseini P, Sharifi

A M, Larijani B. The Effect of Fetal Liver-Derived Cell Suspension Allotransplantation on Patients with Diabetes: First Year of Follow-up. Acta Medica Iranica 2012; 50(8): 541-54635Slide36

Fetal Stem Cell Transplantation

(The First Study)

Ghodsi M, Heshmat R,

Amoli M, Keshtkar A, Arjmand B, Aghayan H, Hosseini P, Sharifi A M, Larijani B. The Effect of Fetal Liver-Derived Cell Suspension Allotransplantation on Patients with Diabetes: First Year of Follow-up. Acta Medica Iranica 2012; 50(8): 541-546

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Safety Study

3 Years After Cell Transplant

Purpose

Results

Evaluation for complications of diabetes or any other life-threatening complication

No life-threatening complications

or malignancy

No significant difference between case and control in micro and macro vascular complications

Evaluation of Fetal Cell Transplantation Safety in Treatment of Diabetes : a three-year follow-up

Current Status : Submitted at “ Stem Cell Research and Therapy “

37Slide38

Fetal Stem Cell Therapy

The Second Study

Ghodsi M, Heshmat R,

Amoli M, Keshtkar A, Arjmand B, Aghayan H, Hosseini P, Sharifi A M, Larijani B. The Effect of Fetal Liver-Derived Cell Suspension Allotransplantation on Patients with Diabetes: First Year of Follow-up. Acta Medica Iranica 2012; 50(8): 541-546

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Mesenchymal Stem-Cell Therapy

(EMRI Experience)

39Slide40

Molecular Modeling in Endocrinology

Models are : Representations containing the essential structure

or some object in the real worldBuilt after simplification of the object or eventModels are not “real” and have their limitations but could be “useful”Advantages of application of molecular Modeling in MedicineReducing the cost of production of new medication

Minimizing the need for clinical trials Obviating the need for animal studies in some cases

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Molecular modeling: Modeling or mimicking

the behavior of molecules. It includes three branches:

Mathematical modelingMolecular Modeling Cells/organs/animals as disease modelsMolecular Modeling

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Clinical Genetics:

Follow up of a family with insulinoma and hyperparathyroidism

Patients present with insulinoma and

hyperparathyroidism

pancreatic mass and liver metastasis in abdominal CT and

parathyroid multifocal adenoma or hyperplasia in

MIBI

scan

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Clinical Genetics: (Follow up a whole family with

MEN1 Syndrome)

43Slide44

Traditional Iranian Medicine

Iranian Traditional Medicine (TIM) is entirely based on practical experience and observations

passed down from generation to generation.Iranian Traditional Medicine can be defined as knowledge and practices used in diagnosis, prevention and elimination of diseases in Persia from ancient times to present (1).H Rezaeizadeh1

, M Alizadeh1, M Naseri2, MR Shams Ardakani. The Traditional Iranian Medicine Point of View on Health and Disease. Iranian J Publ Health 2009; 38(1):169-172

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Origin of Traditional Iranian Medicine

Roots back to 8000 B.C. (1)Is a branch if not the root of the so called Arabic-

Unani Medicine as quoted by Cyril Elgood, the English medical historian. (1)It is even claimed that Persians taught the Greeks the elements of that system of medicine, which has been known ever since as Greek medicine (2,3)

1- H Rezaeizadeh1, M Alizadeh1, M Naseri2, MR Shams Ardakani. The Traditional Iranian Medicine Point of View on Health andDisease. Iranian J

Publ

Health 2009; 38(1):169-172

2-

Elgood

C (1992). Iran Medical History and the Regions of Eastern Caliphate, translated by Baher F. Amir Kabir Publications,Tehran, pp.: 22, 37.

3- Elgood C (1979). A Medical History of Persia and the Eastern Caliphate from the Earliest Times to the Year A.D. APAPhilo Press, Amsterdam.46Slide47

Avicenna and Diabetes

Avicenna (980–1037) provided a detailed account on diabetes mellitus in The Canon of Medicine: (1,2)

Abnormal appetiteCollapse of sexual functionsSweet taste of diabetic urinePrimary and secondary diabetesDiabetic gangrene Treatment of diabetes using a mixture of lupine, trigonella (fenugreek), and zedoary seed, which produces a considerable reduction in the excretion of sugar, a treatment which is still prescribed in modern times.Avicenna also described diabetes

insipidus very precisely for the first time, though it was much later that Thomas Willis differentiated it from diabetes mellitus in a chapter of his book Pharmaceutice rationalis (1674). (1,2)

1- History of Diabetes

. (

n.d

.). In

Wikipedia

. Retrieved October 21, 2013 from http://en.wikipedia.org/wiki/ History_of_diabetes

2- Siva L, Mythili , Kumar PS, Rani

J. Diabetes and Iron Metabolism. International Journal of Science Innovations and Discoveries 2012; 2 (2): 62-73

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EMRI Traditional Medicine Research Group

This research group was established in 2008The main objectives of this group are to:

Expand the existing knowledge on Traditional Iranian Medicine (specifically herbal medicine) through systematic reviews Integrate applicable elements of Traditional Iranian Medicine into current practice of Endocrinology Discouraging harmful and ineffective practices of Traditional Iranian Medicine The TIM group of EMRI has so far published:44 Articles on diabetes 15 Articles on hyperlipidemia 12 Articles on obesity 2 Article on

hyperprolactinemia 15 Articles on antioxidants

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Angipars: a milestone in Interdisciplinary Research at EMRI

One of the most important objectives of the traditional medicine research group of the EMRI is to evaluate efficacy and safety of different and introduce novel drugs to the market.

Invention

of Angipars ™ which is a new herbal-based treatment option for treatment of diabetic food by EMRI in 2007 can be considered as a perfect example of

the result of research on the efficacy and safety of a herbal medicine and introducing it to the pharmaceutical market

49Slide50

Scholarly articles published on Angipars

50Slide51

Citations to EMRI published articles in the field of Traditional and Herbal Medicine

51Slide52

An Interdisciplinary Approach to Endocrinology

Gene Therapy

Personalized Medicine

New Drugs

Cure for Diabetes

Biosensors for Diagnosis of Diabetes

Approval for stem-cell Research

52Slide53

EMRI Research Organizational Chart

53Slide54

EMRI Research Groups

Currently, apart form 9 EMRI Research Centers,

8 Affiliated Research Groups actively involved in research activities of the Institute, some of them are to be promoted to Research Center

status. These Research Groups are: Islamic Fasting Research GroupEvidence-based Medicine

Research Groups

Immunogenetics

Research Group

Bionanotechnology

Research Group

Traditional Medicine Research Group Medical Ethics Research Group Molecular Modeling Research Group Innovation Research

Group

54Slide55

Source:

EMRI research activities

EMRI publications

has significantly increased since its establishment and

citations to the articles

show a remarkable rise

55Slide56

Ranking of Iran in endocrinology science-production

During the past decade, Iran ranked 23

rd

with 1.62% of the scientific production in endocrinology

56

Source:Slide57

Ranking of world endocrinology authors

During the past decade, Director of the EMRI ranked 3

rd

amongst the world endocrinology authors

57

Source:Slide58

TUMS position in endocrinology science-production

During the past decade, TUMS ranked 23

rd

amongst world universities in terms of endocrinology science-production

58

Source:Slide59

Ranking of

universities of Iran in endocrinology science-production

During the past decade, TUMS ranked 1

st

amongst universities of Iran in endocrinology science production

59

Source:Slide60

EMRI Supplement Issue for IJPH

Published in 2014

60

Advance

s in Interdisciplinary Endocrinology:

A Supplementary Issue Slide61

Interdisciplinary Advances in Endocrinology

Advances in Interdisciplinary Endocrinology: A supplementary issue

of the Iranian Journal of Public HealthA comprehensive textbook project in Interdisciplinary Endocrinology published as a Supplement Issue

Future plans for the Textbook 61Slide62

Future of Interdisciplinary Endocrinology (Special Issue)

EMRI has successfully initiated a special issue in collaboration with International Journal of Endocrinology:

Future of Interdisciplinary Endocrinology

(impact factor: 1.515)

62Slide63

New horizons in Diabetology (Special Issue)

EMRI has successfully initiated a collaborative publication with Journal of Diabetes Research:

New Horizons in Diabetology

(

impact factor: 3.536

)

63Slide64

Conclusions

Significant advances has been made in Iran during the past decade:

In 1392 (AH) Iran ranked 17th in the world in terms of total number of published scholarly articles 38% of the articles were in the field of medicine

25% of highly cited articles were on medicineHowever, we are lagging behind in terms of production of health-related

technologies

,

new drugs

, and

applied medical sciences 64Slide65

Conclusions, cont’ If we are to overcome this

gap in knowledge production in Iran, we need to promote interdisciplinary researc

h in all branches of medicine. We used endocrinology as an example of how interdisciplinary research can result in production of applied knowledge and national scientific achievements. We believe that other branches of medicine should take a similar approach if we are to overcome the gap.

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