Endocrinology & Metabolism Research Institute

Tehran university of Medical Sciences

Bagher Larijani MD Professor of Endocrinology

&Internal medicine President of Endocrinology

&Metabolism Research Institute (EMRI)

2012

Introduction (EMRI )/Research University

Endocrinology & Metabolism Research Institute was established in 1993 as a center affiliated to Tehran University of Medical Sciences.

It was upgraded and recognized as Research Institute since 2010.

Due to vast research activities, the institute upgraded to 3 subgroup institutes and 9 research centers in 2012 by Ministry of Health and Medical Education.

The headquarter of EMRI is located in Dr. Shariati University Hospital.

Director & Chief Scientific Officer

National & International

Advisors

Affiliated Professors

Research Deputy

Executive Secretary

Deputy Director-General

Administration & Human Resource Deputy

Information Technology Management

Public & Professional Training

EMRI Organizational Chart /Head Office

Director of Public & International Affairs

Research Divisions

Evidence Based Medicine

Endocrine Modeling

Medical Ethics

Immunogenetics

Bionanotechnology

Traditional Medicine

Research Divisions and Laboratories directly under supervision of director

Research Laboratories

Bio electrochemistry

Bio nanotechnology

Modeling & Protein Chemistry

Food & Drug Research

Cellular & Molecular

Hormone

Sensors

Innovation

Islamic Fasting

Endocrinology and Metabolism Research Institutes / Research University

Institute of Endocrine Clinical

Sciences

Institute of Endocrine Cellular and

Molecular Sciences

Institute of Endocrine

Population Sciences

Organizational Chart of Institutes

Institute of Endocrine Clinical

Sciences

Institute of Endocrine Cellular and

Molecular Sciences

Institute of Endocrine Population Sciences

Endocrine Research Center

OsteoporosisResearch Center

Diabetes Research Center

Chronic Disease Research Center

Biosensor Research Center

Inborn Metabolic Disorder Research Center

Health Elderly Research Center

NCD Research Center

Obesity & Eating Habits Research Center

GOALS

• Goal 1: Enhancement of research and knowledge production

• Goal 2: Expansion of professional and graduate education

• Goal 3: Promotion of translational medicine by

enhancing communication between clinic and laboratory

The Main Objectives of the Goals are:

• Goal 1– acceleration of knowledge production– Upgrade the quality of research – Improve research productivity – Keep with the ethical and legal standards

• Goal 2– Narrow interdisciplinary gaps in the field – Focus on research based education

• Goal 3– Focus on national priorities – Become technologically self sufficient – Adapt the unifying national framework – Expand internet based research and educational resources

Facts and Strategy of EMRI• During past 18 years, In collaboration with MOH, EMRI as the

highest ranking medical research institute in Iran, has played a key role in:

• Establishing national research networks on Diabetes, Osteoporosis , Aging and Obesity

• Conducting fundamental and practical researches on NCD which 21 centers are involved in the networks.

• Other subjects of strategies includes, improving public awareness, professional education and provision of clinical services with focus on diabetes, osteoporosis, and metabolic diseases.

Memberships

EMRI is Member of 12 international Agencies and NGOs

• The Endocrine Society USA 2002 to present • Society for Endocrinology England 2002 to present• Thalassemia International Federation (TIF) 2002 to present• American Association of Clinical Endocrinology (AACE) 2003 to present• American Diabetes Association (ADA) 2003 to present• International Osteoporosis Foundation (IOF) 2003 to present • International Diabetes Foundation(IDF) 2004 to present • European Association for cancer research(EACR) 2005 to present • Asian Task Force for Organ Trafficking 2007 to present • Asian Bioethics Association (ABA) 2007 to present• International Association of Bioethics (IAB) 2008 to present • European Society for Quality Health Care 2010 to present

Statues of Diabetes in Iran &..

Diabetes increasing all around the world especially in developing countries such as China, India, Pakistan and Iran. (reported by IDF, WHO)

50% of EM people with diabetes will die of cardiovascular diseases. This means that in our region, there are pandemic trends in prevalence of diabetes and associated complications.

Globally, people with diabetes are 25 times more likely to have a leg amputated than those without the condition.

Somewhere in the world, a leg is lost due to diabetes every 30 seconds.

111. US Dept of Health and Human Services, National Center for Health Statistics, National Vital Statistics Reports

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Population: 75 (2011)Total area: 1.648 million sq

km

•Today about 3.5 million (out of about 75 million) people are suffering from diabetes and its complications in Iran.

•The prevalence of Diabetes increasing in Iran like other developing countries.

Among EMR, diabetes is ranked among the leading

causes of blindness, renal failure and lower limb

amputation

Currently, 52% of the Region’s disease burden is due to

NCD and it is expected that this burden will rise to 60%

by 2020.

The modifiable risk factors smoking, unhealthy diet and

physical inactivity, expressed as diabetes, obesity and

high lipids, are the root causes of the global NCD

epidemic .

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The Prevalence of DM and IGT in Different Areas of Iran (WHO Criteria)

Area Study population

DM prevalence

(%)

IGT prevalence

(%)

Islamshahr (1993) > 30 years 7.4 12.4

Isfahan (1993) > 40 years 7.76 -

Tehran (1994) Rural population > 30 years 7.6 7.5

Tehran (1994) Urban population > 30 years 7.2 8.2

Booshehr (1996) Urban population > 30 year 13.6 15.6

Zanjan (1997) Rural population > 30 years 3.6 -

Yazd (1998) Adult urban population 16.3 13.4

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The prevalence of type 1 DM in

Iran is about 0.6 - 0.8%

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Azizi F. Diabetes Mellitus in the Islamic Republic of Iran, IDF Bulletin 1996

Diabetic Nephropathy

• In diabetic patients, risk of Kidney involvement is 17 times more than normal population

• After 20 - 30 years of DM onset:

– risk of nephropathy in type 1 = 30 – 40 %

– risk of nephropathy in type 2 = 15 – 50 %

• In Iran 20 – 25 % of ESRD is due to DM*

16* Iranian Dialysis Center data

Diabetic Retinopathy in Iran

• Overall prevalence of diabetic retinopathy is

32.4 % of which:

– 17.3 % NPDR

– 15.1 % PDR

17Larijani et al, Prevalence of diabetic retinopathy, MD dissertation No.17628 of TUMS, 1999

Burden of Diabetes Mellitus in Iran

• Disproportionately expensive

• DALY = 306,440 years= 4.72 years per 1000 people

• YLL = 224,000 years among 1,600,000 diabetics in Iran

• A real socioeconomic burden (US $98bil)

18Larigani et al., Iranian J of Diabetes and Lipid disorders,2005; 5:35-48

Diabetic foot• 15% of diabetic patients develop foot ulcer

• 15-20% of these will require amputation

• Up to 50% of DFs are preventable

• In one study in Iran:

– Mean duration hospital admission for DF was 4 weeks

– Amputation rate was 40% in 1995 and decreased to 14% in 2001

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Larijani et al, Iranian Journal of Diabetes and Lipid disorders, 2002

Larijani et al, MJIRC 2006;8(3):21-24

Diabetes care in EM countries is not of uniform standard for a number of

reasons.• Trained diabetes healthcare personnel are limited in

numbers;• Diabetes education and counseling are not readily

available to patients;• Health care models in the industrialized countries are not

applicable due to problems of cost, organization and accessibility.

• PHC structured to deal only with acute and episodic illnesses not designed to provide the optimal array of services to manage a complex, multi-system chronic illness like diabetes

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Recent activities carried out to improve diabetes status

Establishing Diabetes clinics

Establishing Diabetic Foot clinics in most populated

provinces Educational activities at different levels

EMRI affiliated Clinics, Facilities &

Laboratories

Diabetes Metabolic Disease Clinics 1

• Established March 2009 and includes:

  •  Initial Visit Unit   •  Patient Education Unit   •  Diet and Nutrition Unit   •  Diabetic Foot Unit   •  Diagnostic Unit   •  Specialty Clinics Units   •  BMD Unit   •  Diagnostic Laboratory Unit   •  Researcher Unit   •  Cell Therapy Unit

A number of Clinic 1 facilities

Diabetes Metabolic Disease Clinics 2

• Established March 2011, located in Tehran Villa St and includes:

• Patient screening and initial clinical examination unit.• Infection control and prevention unit • Diabetes patient Education Unit • In service training and professional education unit • Nutrition consultancy Unit • Diabetes Rehabilitation Unit • Day care clinic and home care services• Foot care Unit • Diabetes Specialty Health Services Unit • Aging Research Center • Library and Information Unit • Audiovisual unit • Research and Development Unit

Some of Clinic 2 facilities

Establishing Diabetic Foot care Clinics Project

Improvement of 9 diabetic foot care clinics in 7 major high prevalence provinces.

These provinces have about 58% of all diabetics’ populations in Iran

These centers organize training courses to educate: patients, primary health care providers, and professionals.

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EMRI is the project manager and analyzing data gathered from 8 other partners.

Ministry of Health and Medical Education in collaboration with EMRO/ WHO, succeeded to Integrate NCD in PHC and;

Ministry of Health and Medical education allocated budget for establishing / improving existing diabetic clinics in provinces and also for salary of involved personnel.

WDF supported to increase public, patients & professional’s awareness by providing necessary materials and will support with agreed budget in its time line.(grant obtained from WDF)

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Ministry of Health & Medical Education(MOHME)

Tehran University of Medical Sciences (TUMS)

Endocrinology &Metabolism Research Institute (EMRI) Tehran

Tabriz

Boushehr 13.6%

Isfahan 7.76%

Mashhad

Tehran (Three centers)

Shiraz

Yazd 16.3%

rural population over 30 years 7.6 %

Urban population is about 7.2%

EMRI educational activities

• Public Education

• Professional Education

• Preparing 110 books, brochures, pamphlets & CDs distributing all over the country

⁻ Celebration of World Days ⁻ World Diabetes Day (WDD)• Public Awareness Campaigns • Weekly Diabetes Education for patients and their

families

Public Education

Professional Education

• 70 Books &Booklets for Healthcare

Providers

• Preparing National Guidelines; Diabetes Guideline Diabetic Foot Guideline

• This journal since 2008 is available in English as e journal with open –access available full-text.

• IJDLD is a peer reviewed journal, provides a forum for scientific inquiry in the fields of Diabetes , Lipid and Metabolic disorders and Cardiovascular

• Information is available in: http://www.jdmdonline.com/

Workshops & Seminars

• Since establishment, EMRI organized 15 international seminars,workshops and 160 national workshops and seminars.

• Details in three centers of EMRI

As a sample

International Interprofessional Wound Care Course (IIWC) April &NOV 2007

• International Training course on Wound care with special Focus on Foot care with collaboration of University of Toronto Canada was organized.

• 100 professionals ,Nurses and Nurse educators,GPs,Vascular surgeons , Dermatologists and Endocrinologists from Iran and Region participated as trainees.

International Interprofessional Wound Care Course (IIWC) April &NOV 2007

• International Training course on Wound care with special Focus on Foot care with collaboration of University of Toronto Canada was organized.

• 100 professionals ,Nurses and Nurse educators,GPs,Vascular surgeons , Dermatologists and Endocrinologists from Iran and Region participated as trainees.

The 4th International Diabetes Updates Congress 29 Feb to 2 March 2012

EMRI Innovations

• Producing biosensors for monitoring of low level different ingredients,

• Cell transplantation

• ANGIPARS A New Phytotherapeutic Drug for Wound Healing

Invention of a Device for Detection of Sulfonylurea in the Urine

• Sulfonylurea derivatives are a class of antidiabetic drugs used in the management of type 2 diabetes mellitus.

• The first generation of these drugs caused significant and potentially fatal hypoglycemia

• Although new generation of sulfonylurea drugs such as Glipizide, Glimepiride, and Glibenclamide (Glyburide) are currently used as antidiabetic agents, they may also cause severe hypoglycemia.

Necessity for Invention of the Device

• Patients with hypoglycemia can be brought to the emergency ward in an unconscious state

• Currently, there exists no means of detecting sulfonylurea in the urine

• The condition can remain undiagnosed • Therefore, the Endocrinology and Metabolism Research

University planned a project for invention of a device for detection of Sulfonylurea in the urine

The Device for Detection of Sulfonylurea in the Urine

Biosensors in the process of development

Pioglitazone

Terazocin Prazocin Donpezile Memantine Naltroxone

Floxetine

Flurazepam Metformine Granisetron Tramadol Verapamil

Novel Approach In Treatment Of DM

• Oral Insulin

• Gene Therapy

• Immunomodulators

• replacement of functional insulin-producing pancreatic cells, with pancreas , islet-cell transplants or stem cell

Stem Cell

Stem cell is a special kind of cell that has unique capacity

• to renew itself • Differentiate to specialized cell

Stem cell

Stem cellSel

f-ren

ewal

Specialized cell(e.g., white blood cell)

Differentiate

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Kinds of Stem Cell: • Embryonic stem cell

• Fetal stem cell

• Extra embryonic stem cell (umbilical cord stem cell)

• Adult stem cell

• Induced pluripotent stem cells (iPS)

Trials Underway In The World And Iran

• Cardiac disease• Diabetes• Multiple Sclerosis• Muscular Dystrophy• Parkinson’s disease• Spinal cord injury• Stroke

Stem Cell TherapyOur Research

Adult Stem Cells

Adult Tissues

– Adipose tissue (adipose stem cell, ASC)– Bone marrow (hematopoietic stem cell, HSC)– Bone marrow (mesenchymal stem cell, MSC)– Liver (hepatic stem cell)– Nervous tissue (neural stem cell, NSC)– Pancreas

Islet Cell Transplantation in Iran

• The first phase of the project accomplished

• Islet lab equipped and ready to operate

Islets successfully isolated and purified

• Recipients selected, evaluated, and in waiting list for transplantation

• Next phases carried out with collaboration of UBC experts

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First B cell transplantation

carried out Successfully

in September 2010

(UBC Agreement)

ANGIPARSA New Phytotherapeutic Drug for Wound

Healing in Diabetic Foot Ulcer 2008

Achievements

EMRI designated as WHO Collaborating Center for

Research & Education on Management of Osteoporosis and Diabetes from

January 2007and redesignated until 2015

Funding

EMRI has its own budget with long term strategic planning also;

Grants obtained for accepted projects from:

Deputy of research , Ministry of HealthDeputy of Research , Tehran University of Medical

SciencesNational and international agenciesPublic donations

National Research Networks • The EMRI has lunched 4 research networks in order to allow better

collaboration among researchers, clinicians, and policy makers.

• 1. National Diabetes Research Networkhttp://emri.tums.ac.ir/DMnet http://emri.tums.ac.ir/dmfoot

• 2. National Osteoporosis Research Networkhttp://emri.tums.ac.ir/Osteonet

• 3. National Aging Research Network• 4. National Obesity Research Network

• http://emri.tums.ac.ir/en • http://emri.tums.ac.ir/diabetes-en • http://emri.tums.ac.ir/osteo-en • http://emri.tums.ac.ir/ehrc-en • http://emri.tums.ac.ir/dmfoot-en • http://emri.tums.ac.ir/gdm-en • http://emri.tums.ac.ir/stemcell-en • http://emri.tums.ac.ir/lipid-en • http://emri.tums.ac.ir/vclinic-en • http://emri.tums.ac.ir/thyroid-en• http://emri.tums.ac.ir/nutrithon-en • http://emri.tums.ac.ir/mentalhealth-en• http://emri.tums.ac.ir/cp-en

• http://emri.tums.ac.ir/obesity-en• http://emri.tums.ac.ir/modeling-en • http://emri.tums.ac.ir/genetics-en • http://emri.tums.ac.ir/tm-en • http://emri.tums.ac.ir/ebm-en • http://emri.tums.ac.ir/nea-en • http://emri.tums.ac.ir/pdl-en • http://emri.tums.ac.ir/me-en • http://emri.tums.ac.ir/bionano-en• http://emri.tums.ac.ir/fasting-en • http://emri.tums.ac.ir/biosensor-en • http://emri.tums.ac.ir/it-en • http://emri.tums.ac.ir/dmclinic-en • http://emri.tums.ac.ir/dmclinic2-en

Faculty ,Researchers and other staffs

• Faculty members 25• Researchers 75• Fellows in endocrine 6• PhD by research student 11• Supporting and administration staff 20• National advisors 6• International advisors 6

Published articles and papers

During 16 years, EMRI has presented 800 articles and

abstracts, of which 775 have been published in

international medical journals such as New England

Journal and Lancet•Citations (provided by Thompson Reuters up to November 2012) •The number of published articles: 861•Total number of citations: 5042•Average citation per paper: 5.75•H Index: 33•Highly Cited Paper: 12

EMRI published and citations( ISI web of Science)

Tehran University of Medical Sciences Papers & Citations

Iran is in place 24 in endocrinology among the countries in the world during recent decade

EMRI is in place 63 among the other Endocrinology Centers

in the world during last decade

Iranian Endocrinologist in the world during recent decade

Domestic (Iranian universities and centers) 453

National projects 21

International Projects 44

In collaboration with WHO 7

Grants and internal projects 48

Ongoing projects (2010-2012) 187

Partners

• Undersecretary for Research and Technology (Ministry of

Health & Medical Education)

• Mashhad University of Medical Sciences

• Shiraz University of Medical Sciences

• Esfahan University of Medical Sciences

• Tabriz University of Medical Sciences

• Bushehr University of Medical Sciences

• Yazd University of Medical Sciences

Agreements and projects

So far 73 contracts and agreements accomplished

• 7 NCD projects in cooperation with WHO

• GDM, in cooperation with UNFPA

• Thalassemia complications, in cooperation with TIF

• Osteoporosis activities, in cooperation with IOF

• Educational activities with IDF

Agreements…

• University of Alberta (Canada), Laboratory of Experimental Surgery , consultation services on establishment of clinical Islet Transplant Program.

• University of British Colombia (Canada)

• University of Tennessee (USA)

• National Academy of Sciences of Belarus

• University of Toronto Canada • University of North Dakota, Division of Endocrinology

• Prof. A. Kitabchi (USA)• Prof. Adeli (Canada)• Prof. P. Bonjour (Switzerland)• Prof. Ghahhari (UBC,Canada)• Dr.Ziliang AO (UBC,Canada)• Dr. L. Jovanovich (USA)• Dr. J. Lakey (Canada)• Prof. A. McClung (USA)• Dr. Wajih Rizvi (USA)

Visiting Ministry of Health from EMRI

Obtaining Grants and AwardsObtaining Grants and Awards

• 16 National and International grants and awards obtained such as;

• IOF Education Award 2005 • WDF Foot care award 2009• Eminent Scientist of the year 2005 from ASIA

International Research Promotion Council.• WHO Prize for the Control of Diabetes in the Eastern

Mediterranean 2010

Best Medical Research Center 2005, Razi Festival

Best Medical Research Center 2009, 2010 Razi Festival

Recent WHO Prize obtained

• WHO Prize for the Control of Cancer, Cardiovascular Disease and Diabetes in the Eastern Mediterranean 2010 Obtained directly by Dr.Larijani

EMRI Ranks First amongst Iranian Research Centers 2011

The Institute got the top ranking in the score used for ranking Medical Institutes for the eighth running years.

EMRI as research University is going to expand Research activities through enhancing;

• Research Infrastructure • Data base for multidisciplinary research

projects on Diabetes ,Lipid Disorders , Obesity and Osteoporosis

• Expanding International Collaborations.• We welcome the co-operation and support of

our peers in the region and in the world.

77Thank you