Title: Integrated Clilnical and Research Systems for Diabetic Foot Wound Care
Description: Diabetes is a common, complex, and costly disease affecting 9.4% (30.3 millions) of Americans. It remains the 7th leading cause of death in the United States, contributing to over 250,000 deaths annually. Diabetic foot ulcers (DFU) are the most frequently recognized complication in diabetics with an incidence of 6% in the diabetic global population, 6% among Medicare diabetic beneficiaries, 5% among diabetic U.S. veterans and a lifetime incidence of foot ulcers between 19% and 34% in diabetics. The natural history of a diabetes-related foot ulcer is devastating. More than half of ulcers become infected and approximately 20% of moderate or severe diabetic foot infections lead to amputation. Mortality after diabetes-related amputations is greater than 70% at 5 years for all patients with diabetes, which is 2.5 times higher than in diabetic patients without a foot ulcer. This proposal is designed to establish a clinical research unit (CRU) at the University of Pittsburgh Medical Center that integrates high quality care delivery seamlessly with outstanding clinical research. The CRU will then be a participating site in the NIH consortium studying biomarkers for diabetic foot ulcer healing. Our central hypothesis is that we can address the major challenges of diabetic foot ulcer clinical research through the seamless integration of wound center clinical operations with research operations. Our specific aims are: Aim 1: Establish a unified recruiting and retention system integrated with the clinical operations of our wound care service line, and linked to our EPIC scheduling system and electronic medical record (EMR). Aim 2: Establish integrated research quality systems, linked to highly standardized clinical pathways, and supported by a wound Informatics and Data Core connecting our 8 wound care centers.
Description: Drs. Glorioso and Cohen will share a two-year ACGT grant to support a study to develop a cancer vaccine for melanoma. Their research builds on previously successful results using a tumor-targeted, actively replicating herpes virus to infiltrate cancers and stimulate an immune system assault. Dr. Glorioso calls the methodology a “heat-seeking missile that targets metastatic cancer for destruction.” The treatment doesn’t stop there. Once the cancer is eliminated, the vaccine inserts an immunity barrier to protect against recurrence. Melanoma is among the most deadly cancers and this treatment offers new hope.
Title: Three-dimensional organoid models to study breast cancer progression
Description: Approximately 20% of breast cancers detected through mammography are pre-invasive Ductal Carcinoma in situ (DCIS). If left untreated, approximately 20-50% of DCIS will progress to more deadly Invasive Ductal Carcinoma (IDC). No prognostic biomarkers can reliably predict the risk of progression from DCIS to IDC. Similar genomic profiles of matched pre-invasive DCIS and IDC suggests that the progression is not driven by genetic aberrations in DCIS cells, but microenvironmental factors, such as hypoxia and metabolic stress prevalent in DCIS, may drive the transition. We need innovative models to investigate how to halt steps of DCIS progression to invasive phenotypes and subsequent metastasis from the primary site. This proposal directly addresses this unmet need by developing a novel three-dimensional in vitro organoid model that recapitulates key hallmarks of DCIS to IDC progression: tumor-size induced hypoxia and metabolic stress, tumor heterogeneity and spontaneous emergence of migratory phenotype in the same parent cells without any additional stimulus. A tangible advantage of the proposed organoid models is the ability to precisely and reproducibly study how the hypoxic microenvironment induces tumor migration in real time and in isolation from non-tumor cells present in vivo, providing unique opportunity to define tumor-intrinsic mechanisms of DCIS to IDC progression. Our preliminary observations lead to central hypothesis that tumor size-induced hypoxia establishes a “hypoxic secretome”, which initiates the migratory phenotype; the hypoxic secretome then cooperate with intracellular signaling networks to independently maintain cell migration. We propose three independent but inter-related aims to link hypoxic secretome with the initiation, maintenance and spatial distribution of migratory phenotypes. Aim 1 will engineer size-controlled DCIS organoids (150-600 µm) with controlled hypoxic microenvironments to identify and examine how hypoxic secretome initiates migratory phenotype. We will combine experimental organoid models with time-lapse imaging and computational approaches to study organoid migration. Aim 2 will demonstrate that migratory cells can re-establish the secretome and maintain migratory phenotype independent of hypoxia. We will reconstruct an intracellular signaling network activated by the hypoxic secretome using microarray data. We will verify these gene expression signatures in sorted migratory and non-migratory cells, and validate them using secretome inhibition studies. Aim 3 will investigate, for the first time, the spatial distribution and origin of the migratory phenotype. We will use CRISPR-based gene knock-in (FP-labeling), automated image analyses, and a deep-learning algorithm to track and visualize the emergence of migratory phenotypes from the hypoxic core outward to the periphery or from the migratory front. The successful development of this 3D organoid model and completion of the proposed work will provide answers to two fundamental questions in the progression of invasive breast cancer: 1) What causes some DCIS cells to become migratory and develop into invasive tumors? 2) How and where does the migratory phenotype (IDC) emerge? The mechanistic understanding gained from these studies will improve diagnosis, lead to the development of treatment strategies to arrest invasion at the pre-malignant stage, and thus prevent patient overtreatment. It is straightforward to generalize our system to other tumor types, development of tumor/stromal co-culture, and drug screening.
Title: A New Molecular Mechanism to Bioengineering a Liver
Description: Hepatocyte transplantation has many potential applications. Extensive animal experiments have shown that hepatocytes transplanted in the liver or at ectopic sites survive, function, and actively participate in the regenerative process. However, our understanding of hepatocyte engraftment and their remarkable proliferative and regenerative potential is limited, even if primary hepatocyte transplantation is at the doorstep of applications in the treatment of inherited and acquired human diseases. We previously made a serendipitous observation that normal hepatocytes transplanted in the peritoneal cavity of an animal with lethal liver disease migrate into the lymphatic system and engineer ectopic liver-like organoids that rescue an animal model from a fatal metabolic disorder. How hepatocytes enter the lymphatics and what molecular mechanism is responsible for the generation of ectopic mass is not known. We hypothesized that hepatocytes must borrow some of the molecular mechanism lymphocytes use to migrate into the lymphatics. Our interest will be to study ectopic cell transplantation and our central objective of our application is to translate a highly interesting observation, the generation of ectopic liver, to a potential clinical application for patients with liver diseases.
Description: The facility at 2124 Penn Ave. in Pittsburgh’s Strip District includes office and laboratory space where biotechnology companies can collaborate. In addition to the physical space, the LifeX platform brings together experts with proven track records of building new pharmaceuticals, medical devices, molecular diagnostics and population-health solutions to support entrepreneurs with deep industry knowledge. LifeX’s initial cohort of companies will focus on unmet health needs related to cancer, Alzheimer’s disease, multidrug-resistant bacterial infections, obesity and diabetes and rare genetic diseases.
Description: Researchers plan to spend the first few years of the grant improving or adding to existing standards, particularly related to cushion load-bearing performance, cushion durability, caster durability, and wheel rolling resistance, and the remaining few years applying those standards to different products. Ultimately, the researchers envision their work being used in several ways, including helping funding sources make reimbursement decisions, and clinicians, providers, and users make product decisions.
Description: The researchers will compare spinal manipulation and supported self-management to usual medical care, which includes prescription medications for the care of acute lower back pain in adult patients at increased risk of becoming chronic.