Mobilizing cross-disciplinary teams to advance translational research using design thinking methods

Funding agencies are increasingly seeking team-based approaches to tackling complex research questions, but there is a need to mobilize translational teams and create shared visions and strategic action plans long before specific funding opportunities are considered or even released. This is particularly evident for teams who want to pursue large-scale grants, where cross-disciplinary synergy is often required. In response, we created Research Jams, which are engaging yet structured brainstorming sessions that bring together groups for the first time to collectively generate novel research ideas, critically map the future of initiatives, prioritize opportunities and next steps, and build community. Research Jams leveraged various aspects of design thinking, including divergence and convergence, visual thinking, and amplifying diversity. We piloted seven Research Jams for a collective 129 researchers, staff, and partners across 50 University of Michigan units and external organizations. Feedback was overwhelmingly positive, with the vast majority of survey respondents indicating that the sessions were helpful for surfacing shared ideas or visions and that opportunities emerged they would like to pursue. Research Jams were ideal for cross-disciplinary groups who wanted to collaboratively ideate and strategize around complex problems in translational research. Importantly, these models have the potential for implementation with groups in any disciplinary domain who want to spur collaborations to address challenging problems. Our ultimate goal is for Research Jams to be the first intervention within a comprehensive support pathway that extends from early brainstorming all the way to grant submission.

Characterisation of an epigenetically altered CD4(+) CD28(+) Kir(+) T cell subset in autoimmune rheumatic diseases by multiparameter flow cytometry

Objectives

Antigen-specific CD4⁺ T cells epigenetically modified with DNA methylation inhibitors overexpress genes normally suppressed by this mechanism, including CD11a, CD70, CD40L and the KIR gene family. The altered cells become autoreactive, losing restriction for nominal antigen and responding to self-class II major histocompatibility complex (MHC) molecules without added antigen, and are sufficient to cause a lupus-like disease in syngeneic mice. T cells overexpressing the same genes are found in patients with active lupus. Whether these genes are co-overexpressed on the same or different cells is unknown. The goal of this study was to determine whether these genes are overexpressed on the same or different T cells and whether this subset of CD4⁺ T cells is also present in patients with lupus and other rheumatic diseases.

Methods

Multicolour flow cytometry was used to compare CD11a, CD70, CD40L and KIR expression on CD3⁺CD4⁺CD28⁺ T cells to their expression on experimentally demethylated CD3⁺CD4⁺CD28⁺ T cells and CD3⁺CD4⁺CD28⁺ T cells from patients with active lupus and other autoimmune diseases.

Results

Experimentally demethylated CD4⁺ T cells and T cells from patients with active lupus have a CD3⁺CD4⁺CD28⁺CD11a^hiCD70⁺CD40L^hiKIR⁺ subset, and the subset size is proportional to lupus flare severity. A similar subset is found in patients with other rheumatic diseases including rheumatoid arthritis, systemic sclerosis and Sjögren's syndrome but not retroperitoneal fibrosis.

Conclusions

Patients with active autoimmune rheumatic diseases have a previously undescribed CD3⁺CD4⁺CD28⁺CD11a^hiCD70⁺CD40L^hiKIR⁺ T cell subset. This subset may play an important role in flares of lupus and related autoimmune rheumatic diseases, provide a biomarker for disease activity and serve as a novel therapeutic target for the treatment of lupus flares.

The circadian clock in oral health and diseases

Most physiological processes in mammals display circadian rhythms that are driven by the endogenous circadian clock. This clock is comprised of a central component located in the hypothalamic suprachiasmatic nucleus and subordinate clocks in peripheral tissues. Circadian rhythms sustain 24-hour oscillations of a large number of master genes controlling the correct timing and synchronization of diverse physiological and metabolic processes within our bodies. This complex regulatory network provides an important communication link between our brain and several peripheral organs and tissues. At the molecular level, circadian oscillations of gene expression are regulated by a family of transcription factors called "clock genes". Dysregulation of clock gene expression results in diverse human pathological conditions, including autoimmune diseases and cancer. There is increasing evidence that the circadian clock affects tooth development, salivary gland and oral epithelium homeostasis, and saliva production. This review summarizes current knowledge of the roles of clock genes in the formation and maintenance of oral tissues, and discusses potential links between "oral clocks" and diseases such as head and neck cancer and Sjögren's syndrome.

Overexpression of X-linked genes in T cells from women with lupus

Women develop lupus more frequently than men and the reason remains incompletely understood. Evidence that men with Klinefelter's Syndrome (XXY) develop lupus at approximately the same rate as women suggests that a second X chromosome contributes. However, since the second X is normally inactivated, how it predisposes to lupus is unclear. DNA methylation contributes to the silencing of one X chromosome in women, and CD4+ T cell DNA demethylation contributes to the development of lupus-like autoimmunity. This suggests that demethylation of genes on the inactive X may predispose women to lupus, and this hypothesis is supported by a report that CD40LG, an immune gene encoded on the X chromosome, demethylates and is overexpressed in T cells from women but not men with lupus. Overexpression of other immune genes on the inactive X may also predispose women to this disease. We therefore compared mRNA and miRNA expression profiles in experimentally demethylated T cells from women and men as well as in T cells from women and men with lupus. T cells from healthy men and women were treated with the DNA methyltransferase inhibitor 5-azacytidine, then X-linked mRNAs were surveyed with oligonucleotide arrays, and X-linked miRNA's surveyed with PCR arrays. CD40LG, CXCR3, OGT, miR-98, let-7f-2*, miR 188-3p, miR-421 and miR-503 were among the genes overexpressed in women relative to men. MiRNA target prediction analyses identified CBL, which downregulates T cell receptor signaling and is decreased in lupus T cells, as a gene targeted by miR-188-3p and miR-98. Transfection with miR-98 and miR-188-3p suppressed CBL expression. The same mRNA and miRNA transcripts were also demethylated and overexpressed in CD4+ T cells from women relative to men with active lupus. Together these results further support a role for X chromosome demethylation in the female predisposition to lupus.

Rhizosphere Bacterial Signalling: A Love Parade Beneath Our Feet

Plant roots support the growth and activities of a wide variety of microorganisms that may have a profound effect on the growth and/or health of plants. Among these microorganisms, a high diversity of bacteria have been identified and categorized as deleterious, beneficial, or neutral with respect to the plant. The beneficial bacteria, termed plant growth-promoting rhizobacteria (PGPR), are widely studied by microbiologists and agronomists because of their potential in plant production. Azospirillum, a genus of versatile PGPR, is able to enhance the plant growth and yield of a wide range of economically important crops in different soils and climatic regions. Plant beneficial effects of Azospirillum have mainly been attributed to the production of phytohormones, nitrate reduction, and nitrogen fixation, which have been subject of extensive research throughout the years. These elaborate studies made Azospirillum one of the best-characterized genera of PGPR. However, the genetic and molecular determinants involved in the initial interaction between Azospirillum and plant roots are not yet fully understood. This review will mainly highlight the current knowledge on Azospirillum plant root interactions, in the context of preceding and ongoing research on the association between plants and plant growth-promoting rhizobacteria.

The public funding of expensive cancer therapies: synthesizing the "3Es"--evidence, economics, and ethics

The cost of new cancer therapies and drugs has risen sharply and somewhat alarmingly in the last five years. In those developed countries where healthcare systems are (primarily) publicly funded, this has caused legitimate concern among government administrators and politicians who must make decisions regarding funding. In the Canadian context, provincial Departments of Health are mandated to provide comprehensive healthcare services to all citizens out of a "fixed pot" of financial resources, which is determined annually as part of the provincial government's overall budget process. In recent years there has been increasing recognition among healthcare decision makers that the approval of funding for multiple new expensive cancer treatments is creating an "opportunity cost" for meeting the other legitimate healthcare needs of provincial citizens. In response to this reality, the Department of Health of the Canadian province of Nova Scotia created a Cancer Systemic Therapy Policy Committee (CSTPC) in 2005. The mandate of this committee is to make recommendations to the Nova Scotia Deputy Minister of Health regarding the public funding of new cancer therapies. In collaboration with consultants from the Dalhousie University Department of Bioethics, the committee developed a comprehensive and inclusive decision-making framework to promote and facilitate decision making that is explicitly informed by evidence, economics, and ethics--the "3Es"--in reaching and making recommendations.

Azospirillum brasilense produces the auxin-like phenylacetic acid by using the key enzyme for indole-3-acetic acid biosynthesis

An antimicrobial compound was isolated from Azospirillum brasilense culture extracts by high-performance liquid chromatography and further identified by gas chromatography-mass spectrometry as the auxin-like molecule, phenylacetic acid (PAA). PAA synthesis was found to be mediated by the indole-3-pyruvate decarboxylase, previously identified as a key enzyme in indole-3-acetic acid (IAA) production in A. brasilense. In minimal growth medium, PAA biosynthesis by A. brasilense was only observed in the presence of phenylalanine (or precursors thereof). This observation suggests deamination of phenylalanine, decarboxylation of phenylpyruvate, and subsequent oxidation of phenylacetaldehyde as the most likely pathway for PAA synthesis. Expression analysis revealed that transcription of the ipdC gene is upregulated by PAA, as was previously described for IAA and synthetic auxins, indicating a positive feedback regulation. The synthesis of PAA by A. brasilense is discussed in relation to previously reported biocontrol properties of A. brasilense.

Effects of cilostazol in patients with Raynaud's syndrome

Raynaud's syndrome (RS), which is characterized by recurrent episodes of vasospasm with exposure to cold, may occur alone (primary RS) or in association with connective tissue diseases or other underlying conditions (secondary RS). We investigated the effect of cilostazol on vessel wall responses in RS. Patients were diagnosed (primary or secondary RS associated with connective tissue diseases) and randomized to placebo or cilostazol 100 mg twice daily for 6 weeks in a double-blind manner. Brachial artery vasoreactivity, laser Doppler fluxmetry, and cold pressor testing (CPT) were performed at study initiation and completion. Symptoms were assessed using standardized questionnaires. Forty subjects completed the study (19 with primary RS and 21 with secondary RS). Cilostazol significantly increased the mean brachial artery diameter at 6 weeks (primary RS, p = 0.006; secondary RS, p = 0.06). There was no change in median flow-mediated dilation (FMD) with cilostazol in primary RS (25th, 75th percentiles) (4.06% [2.5, 6.1] to -0.77% [-2.4, 3.4] or secondary RS (2.2% [0.05, 6.3] to 2.95% [1.7, 7.4]). There were no changes in nitroglycerin-mediated dilation or microvascular flow indexes in either cohort. In patients with primary RS, cilostazol treatment yielded a positive change in the slope of brachial responsiveness to CPT (increase of 0.32 mm/min; p = 0.002 vs placebo). Cilostazol treatment remained significantly associated with increased brachial artery diameter when controlling for baseline values (p = 0.018). Cilostazol increased conduit vessel diameter in patients with primary and secondary RS, with a favorable impact on conduit vessel responsiveness to cold in patients with primary RS without affecting microvascular flow or symptoms.

Increased asymmetric dimethylarginine and endothelin 1 levels in secondary Raynaud's phenomenon: implications for vascular dysfunction and progression of disease

OBJECTIVE

To compare microvascular and macrovascular functions in a cohort of patients with primary and secondary Raynaud's phenomenon (RP) who were matched for demographic, risk factor, and severity profiles.

METHODS

Forty patients with primary or secondary RP matched for vascular risk factors and severity scores underwent testing of endothelial function and cold pressor responsiveness of the brachial artery. Microvascular perfusion of the digital vasculature was assessed using laser Doppler fluxmetry in response to reactive hyperemia. Plasma was assayed for endothelin 1 (ET-1), asymmetric dimethylarginine (ADMA), intercellular adhesion molecule 1, vascular cell adhesion molecule 1 (VCAM-1), and monocyte chemoattractant protein 1 (MCP-1).

RESULTS

Patients with RP had abnormal vasoconstrictor responses to cold pressor tests (CPT) that were similar in primary and secondary RP. There were no differences in median flow-mediated and nitroglycerin-mediated dilation or CPT of the brachial artery in the 2 populations. Patients with secondary RP were characterized by abnormalities in microvascular responses to reactive hyperemia, with a reduction in area under the curve adjusted for baseline perfusion, but not in time to peak response or peak perfusion ratio. Plasma ET-1, ADMA, VCAM-1, and MCP-1 levels were significantly elevated in secondary RP compared with primary RP. There was a significant negative correlation between ET-1 and ADMA values and measures of microvascular perfusion but not macrovascular endothelial function.

CONCLUSION

Secondary RP is characterized by elevations in plasma ET-1 and ADMA levels that may contribute to alterations in cutaneous microvascular function.

Antiphospholipid antibodies and incidence of venous thrombosis in a cohort of patients with systemic lupus erythematosus

OBJECTIVE

To study the relationship between antiphospholipid antibodies (aPL) and the incidence of venous thrombosis (VT) among patients with systemic lupus erythematosus (SLE).

METHODS

The study population consisted of 678 patients with SLE enrolled in the Hopkins Lupus Cohort. Medical records were reviewed to identify the occurrence of VT prior to cohort entry. During cohort participation, VT was diagnosed by ultrasound or venography. Lupus anticoagulant [LAC, Russell viper venom time (RVVT) assay] and anticardiolipin (aCL, polyclonal assay) status of each subject was determined on a quarterly basis. The Kaplan-Meier approach was used to estimate probability of having a VT over time since SLE diagnosis. The association between the most recently measured values of LAC and aCL on the subsequent risk of VT was estimated using Cox proportional hazards models.

RESULTS

Counting only first occurrences, the rate of VT was 5.1 cases per 1000 person-years. Of those with a mean RVVT greater than 37 s during followup, an estimated 42% will develop a VT within 20 years of SLE diagnosis [95% confidence interval (CI) 21% to 63%, p < 0.0001 compared to those with lower RVVT]. The immediate risk (hazard) of deep venous thrombosis increased 34% with each 5 second prolongation of the RVVT test, based on the most recent assessment of RVVT, controlling for gender and cholesterol [p = 0.0022, 95% CI 11% to 61%]. Of those with a mean polyclonal aCL greater than 2.3 units, 34% developed a VT within 20 years of SLE diagnosis (95% CI 11% to 57%, p = 0.0097 compared to those with lower aCL). The immediate risk (hazard) of deep venous thrombosis was not significantly associated with the most recent assessment of aCL.

CONCLUSION

This large prospective study indicates that patients with SLE are at substantial risk for VT over time. Both the presence of a LAC and of polyclonal aCL are associated with the risk of VT, but LAC is a better predictor of risk than is aCL.

The apoptotic ligands TRAIL, TWEAK, and Fas ligand mediate monocyte death induced by autologous lupus T cells

Individuals with systemic lupus erythematosus show evidence of a significant increase in monocyte apoptosis. This process is mediated, at least in part, by an autoreactive T cell subset that kills autologous monocytes in the absence of nominal Ag. We have investigated the apoptotic pathways involved in this T cell-mediated process. Expression of the apoptotic ligands TRAIL, TNF-like weak inducer of apoptosis (TWEAK), and Fas ligand on lupus T cells was determined, and the role of these molecules in the monocyte apoptotic response was examined. We report that these apoptotic ligands mediate the autologous monocyte death induced by lupus T cells and that this cytotoxicity is associated with increased expression of these molecules on activated T cells, rather than with an increased susceptibility of lupus monocytes to apoptosis induced by these ligands. These results define novel mechanisms that contribute to increased monocyte apoptosis characterizing patients with lupus. We propose that this mechanism could provide a source of potentially antigenic material for the autoimmune response and interfere with normal clearing mechanisms.

Cloning and characterisation of the Azospirillum brasilense glnD gene and analysis of a glnD mutant

Nitrogen regulation in bacteria involves the capacity to sense the availability of fixed nitrogen and to translate a signal indicating nitrogen deficiency or nitrogen excess into a cellular response. One of the key enzymes in this complex regulation process, the uridylyltransferase/uridylyl-removing (UTase) enzyme, encoded by the glnD gene, was characterised in the diazotroph Azospirillum brasilense, which promotes plant growth. The glnD gene product is responsible for the uridylylation of both P(II)-like nitrogen regulatory proteins, P(II) and P(Z), depending on the nitrogen status of the cell. The nitrogen-regulated activity of the main ammonium-assimilating enzyme, glutamine synthetase, is not altered in a glnD-Tn 5-B30 insertion mutant. UTase influences processes that are regulated by the NtrB-NtrC two-component histidine protein kinase system, such as ammonium uptake and nitrate assimilation. Moreover, the glnD gene product is indispensable for the activation of nitrogen fixation. Transcription of glnD is up-regulated under nitrogen-fixing conditions. This regulation is only partially dependent on the global nitrogen regulation (Ntr) system.

The salCAB operon of Azospirillum irakense, required for growth on salicin, is repressed by SalR, a transcriptional regulator that belongs to the Lacl/GalR family

The salAB genes of Azospirillum irakense KBC1, which encode two aryl-beta-glucosidases, are required for growth on salicin. In the 4-kb region upstream of the salAB genes, two additional genes, salC and salR, were identified. SalC shows characteristics of the outer membrane receptors in the FepA/FhuA family. The salC AB genes are transcribed as a polycistronic mRNA. The salR gene encodes a protein homologous to the LacI/GalR family of transcriptional repressors. Expression of the sal operon, measured by means of a salC-gusA translational fusion in A. irkense KBC1, requires the presence of aryl-beta-glucosides such as arbutin and salicin. Expression is markedly enhanced when a simple carbon source, like glucose, cellobiose or malate, is added to the medium. In a salR mutant, expression of the salC-gusA fusion does not require an aryl-beta-glucoside inducer. Expression of a salR-gusA fusion is constitutive. The product of arbutin hydrolysis (hydroquinone) partly inhibits the expression of a salC-gusA fusion in arbutin- or salicin-containing minimal medium. This effect is independent of SalR. Salicylalcohol, the hydrolysis product of salicin, also partly inhibits salC expression in a SalR-independent fashion, but only in salicin-containing minimal medium.

Clostridium botulinum types A, B, C1, and E produce proteins with or without hemagglutinating activity: do they share common amino acid sequences and genes?

Clostridium botulinum produce the antigenically distinct 150 kD neurotoxin serotypes (e.g., A, B, C1, and E) and simultaneously proteins, A Hn+, B Hn+, C Hn+, and E Hn-, that have high, low, and no hemagglutinating activity. A Hn+ and B Hn+ are serologically cross-reactive. A Hn+, B Hn+, and C Hn+ found as large aggregates (900-220 kD) can be dissociated on SDS-PAGE into multiple subunits, the smallest for A Hn+, B Hn+ is 17 kD and 27 kD for C Hn+. The 116 kD E Hn- does not aggregate. We determined the sequences of 10-33 amino terminal residues of the 17, 21.5, 35, and 57 kD subunits of A Hn+ and B Hn+. Each of these subunits have unique sequences, indicating that the larger units studies are not homomers or heteromers of smaller units. The subunits of A Hn+ and B Hn+ of comparable size have striking sequence identity (e.g., 21.5 kD subunits from the two are identical and 57 kD subunits have 80% identity). In vitro proteolysis of 116 kD E Hn- with different proteases did not impart hemagglutinating activity to the fragments. The 116 kD E Hn- and one of its proteolytic fragments (87 kD) were partially sequenced. Sixty-two base pairs downstream from the termination codon of the cloned 33 kD subunit of C Hn+, there is an initiation codon followed by an open reading frame for at least 34 amino acid residues (Tsuzuki et al., 1990). The derived amino acid sequence of this open reading frame, we found, has 73-84% sequence identity with those of the 17 kD subunits of A Hn+ and B Hn+ and significant identity with the N-terminal of E Hn-. These highly conserved sequences show existence of genetic linkage among the Hn+ and Hn- proteins.

Drug regulation--the Canadian approach

The legislative authority and framework for the regulatory control of drugs in Canada is outlined. The layered approach of the regulatory system is described, including the premarket review mechanism, postmarketing monitoring, and other requirements for specific drug categories. Changes in the Canadian regulatory approach to provide timely and effective drug evaluation are discussed, particularly increased international collaboration, regulatory accommodation for AIDS drugs, rationalized policies for traditional medicines, and the concept of risk/benefit analysis.

Risk assessment of drugs

The value of risk-benefit analysis for drugs is outlined with emphasis on its special qualities compared with decisions on environmental agents, occupational risks and other societal risks. Consideration is given to the issue of risk perception and examples given of risk assessment in practice in Canada for Bendectin, isotretinoin, bovine somatropin (somatotrophin) and oral contraceptives. The changes in regulatory approaches for AIDS drugs are noted. It is suggested that an understanding of the risk-benefit balance should be incorporated into the drug evaluation process, perhaps eventually by the use of quality-of-life measures.

The classification of chemical carcinogens

Various approaches to classification of chemical carcinogens developed by international and national agencies are described. Special features of each classification scheme with their strengths and weaknesses and their usefulness in regulation are discussed. Some recent examples of regulatory decisions on chemical hazards in Canada are presented, illustrating the many factors that need to be considered for risk assessment, in addition to merely categorizing carcinogens.

Characterization of botulinum type A neurotoxin gene: delineation of the N-terminal encoding region

A 456 basepair HindIII fragment that encoded a portion of the type A botulinum neurotoxin gene was cloned into Escherichia coli using a plasmid vector. DNA sequence analysis revealed that this botulinum DNA insert encoded an open reading frame of 35 amino acid residues of which 34 corresponded to the N-terminal residues of botulinum neurotoxin type A.

Making decisions from numbers

Regulatory agencies require numbers to provide health protection. The manner in which these numbers are derived from animal experiments and human epidemiology is considered together with the limitations and inadequacies of these numbers. Some recent examples of risk assessment in Canada are given including asbestos, drinking water, and indoor air quality. The value of these numbers in providing a measure of the hazard in a wider perspective is stressed, although they can never be the sole determinant of public policy.

The weight of evidence: regulatory toxicology in Canada

The legislative application of regulatory toxicology in Canada is reviewed, together with the sources of experimental evidence used for action. Examples are given of the critical toxicological information that led to a regulatory decision. Risk numbers have only been used to a limited extent in Canada. Some possibilities for future research are offered.

Risk estimation for environmental chemicals as a basis for decision making

An account is given of the manner in which regulatory decisions for a number of environmental chemicals have been made in Canada. The sources of evidence for such decisions are reviewed and applied to tris(2,3-dibromopropyl)phosphate, drinking water contaminants, polychlorinated biphenyls, lead, dioxins, and urea-formaldehyde foam insulation. Finally, the societal implications of too mechanistic an approach to risk estimations are considered.

Environmental health risk management in Canada

The legislative basis of the federal Canadian government's control of toxic chemicals is described and examples are given of the practical application, ranging from recommendations to a ban on the sale of the product. The ordered sequence of risk assessment and the application of risk estimation techniques are considered. It is clear that the ultimate political decision is not amenable to simplistic scientific analysis, although risk analysis is valuable in defining, rather than solving, the problem.

Environmental monitoring and the development of health standards

The relationship of environmental monitoring to health protection control measures is described and the monitoring programs divided into those that measure targets and those that measure factors. The models are illustrated by descriptions of Canadian programs on the monitoring of chemicals in the media-food, drinking water, and air-and the factor monitoring of a physical agent, radiation. With lead it has proved possible to combine all the monitoring data from the principal sources of human exposure and derive the received dose. Finally, the manner in which some risk acceptability decisions are developed from risk estimations of chemical and radiation is described.

Influence of starch source on sporulation and enterotoxin production by Clostridium perfringens type A

Of 16 different starch preparations tested, Clostridium perfringes NCTC 8798 yielded maximum sporulation and enterotoxin formation when ICN-soluble starch was included in Duncan and Strong sporulation medium. In general soluble starches were better than potato, corn, or arrowroot starch with regard to these two parameters.

Determination of Heavy Metals in Wines by Atomic Absorption Spectrophotometry

The effect of alcohol and sugar concentration on the atomic absorption analysis of copper, zinc, nickel, chromium, lead, cadmium, and cobalt has been investigated. Sugar reduced the sensitivity of analysis but could be compensated for by using the method of additions. Interference from alcohol was avoided by introducing an evaporation stage, and the concentration of the above cations was determined by direct aspiration in 24 native and imported wines.