NEI’s Research Partnerships Around the World & Vision Loss Prevention Activities

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NEIs Research Partnerships Around the World & Vision Loss Prevention Activities. World Sight Day 2012: From Vision Research to Vision Loss prevention October 11, 2012. John Prakash, PhD, MBA Associate Director, International Programs National Eye Institute- National Institutes of Health - PowerPoint PPT Presentation

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  • NEIs Research Partnerships Around the World & Vision Loss Prevention Activities

    John Prakash, PhD, MBAAssociate Director, International ProgramsNational Eye Institute- National Institutes of HealthTel: (301) 496-2234; Fax:301-496-9970Email: prakashg@mail.nih.gov

    Department of Health and Human ServicesWorld Sight Day 2012: From Vision Research to Vision Loss preventionOctober 11, 2012

  • 1. Goals of the NEI International Program 2. Research Partnerships Around the World Intramural CollaborationsExtramural Collaborations

    3. Sample Case Studies Trachoma Corneal ulcer Brain neuroplasticity

    Contents

  • NIH MISSION STATEMENTAn agency of the United States Department of Health and Human Services, the NIH conducts and supports medical research to uncover new knowledge that will improve the health of all Americans and the human condition throughout the world.

  • High-throughput technologies in genomics and nanotechnologyDeveloping diagnostics, preventative strategies and therapeutic tools through publicprivate partnershipsReining in the costs of health care with comparative-effectiveness research and personalized medicineExpanding research into diseases affecting the developing worldIncreasing budgets and investing in training & peer review to achieve a predictable funding trajectory

  • to conduct and support research, training, and other programs with respect to blinding eye diseases, visual disorders, mechanisms of visual function, preservation of sight, and specific health problems and needs of the blind.NEI Missionhttp://www.nei.nih.gov/

  • Office of International Programs-Global HealthGood Eye Research Anywhere is Good Eye Research Everywhere

  • Broad Functions

    Coordinate and support collaborative international research programs that focus on selected eye diseases of substantial health importance to the US and other countries

    Maintain a knowledge base of the Institute's research programs and policies in coordination with the National Institutes of Health - Fogarty International Center (FIC)

    Identify relevant programs of other federal domestic agencies, bilateral research agencies, multilateral research organizations, and volunteer agencies involved in international health activities

    Advise the NEI Director on program relationships and opportunities for collaborationOffice of International Programs-Global Health

  • Three Goals for NEI International Programs

    Goal I: Coordination

    Address the daily needs of the international business and actively participate in the NIH and the USG wide programs that may affect vision research and training

    Goal II: Research Collaboration

    Foster a sustainable international research environment, expand collaborations in the countries across the globe that are interested in the advancement of vision research, and support international partnerships providing scientific value to the NEI-NIH programs

    Goal III:Training

    Develop human capital in the US to support the future needs in the areas of vision research and training, support mentoring activities for the next generation of scientists and professionals interested in global health and vision research

    Goals

  • 1. Goals of the NEI International Program 2. Research Partnerships Around the World Intramural CollaborationsExtramural Collaborations

    3. Sample Case Studies Trachoma Corneal Ulcer Brain neuroplasticity

    Contents

  • Summary of the Latest International Collaborative Activities at NEI-intramural

    >50 international collaborations, projects, affiliations, CRADAs, and other engagements on all 6 continents

    40% collaborative engagements are in Asia, 35% in Europe and 25% in other countries

    23 Major International Initiatives over past 2 years

    6 Recent Achievements in Global Health Activities

    10 International Partnerships & Collaborations

    5 Current Memberships on Global Health Committees/Working Groups

    Currently training 66 international scientists and fellows

    18 scientists trained in the past two years have gone back (to their native countries)

    *

  • Major International Initiatives over Past Two years*

  • Summary of New International Partnerships & Collaborations

    US-NIH & UK-NIHR Collaboration with NEI, UCL and University of Bristol - UNITE

    CRADA with Genomatix in Munich, GERMANY, to develop meta-analysis tools for omic data to identify novel biomarkers and to develop therapies for retinal and macular diseases

    CRADA with Zhongshan Ophthalmic Center, Sun Yat-sen University, China

    Indo-US Joint Working Group

    Various ARVO international group participation and support

    Lowy Institution, Sydney, Australia. Participation in design & conduct of a natural history study & clinical trial

    Retina Institute, Japan, Serving on the Scientific Advisory Board

    Pierre and Marie Curie University, Paris, France: Collaborations with several scientists

    Cell Cure Neurosciences, Israel. Serving as a board member for the Medical Advisory Board

    Singapore Eye Research Institute. Serving as a member of the Scientific Advisory Panel

    *

  • International Scientists in DIR(As reported in June 2012)

    *

  • NEI Extramural ProgramsFunded NEI Grants International ProgramsArgentinaPrimary Open Angle GlaucomaAustraliaNuclear CataractCanadaRetinal Stem CellsChinaGenetics of Age-related Macular Deg.DenmarkDiabetic RetinopathyEthiopiaTrachomaFranceRetinal Pigment Epithelial/Stem CellsGermanyAdvanced Imaging for Eye DiseasesGhanaGlaucoma Genetic Risk FactorsIndiaCornea Ulcers TrialProject PrakashIsraelPhototransductionItalyOxidative Damage to TM-GlaucomaJapanMacular DegenerationSwitzerlandNanofabrication technology/T cellsUK Various Eye Disorders Supports 26 grants and 36 foreign sites in 15 countries

  • 1. Goals of the NEI International Program 2. Research Partnerships Around the World Intramural CollaborationsExtramural Collaborations

    3. Sample Case Studies Trachoma Corneal Ulcer Brain neuroplasticity

    Contents

  • US Public Health Service officers examining migrants at Ellis Islandslide (modified) courtesy of Prof. Hugh TaylorCivilian Populations Crowded Slums of Industrial Revolution

  • Avoidable Blindness: Trachoma affects 11 Million People Worldwidephotos courtesy of Emily West, STAR Study TeamChlamydia trachomatis bacterial infection

  • STAR TRIAL - Eye Research Leads the Way: Single-dose Antibiotic Reduces Recurrence of In-turned Eyelashes after SurgerySTAR Study - Surgery for Trichiasis, Antibiotics for Recurrence. An NEI-funded clinical trial partnered with ORBIS International. in Archives of Ophthalmology, March 2006photo courtesy of Emily West, STAR Study Team

  • slide (modified) courtesy of Prof. Hugh TaylorBiannual Treatment of Azithromycin is Effective145 million doses to date

  • Trachoma Vaccine ?A new vaccine tested in monkeys shows promise against the disease. If successful in humans, it could be a very helpful tool within the global strategy

    NIAID, NIH-funded research

    J. Exp. Med. 2011;208(11):2217-23.

  • Treatment Topical Corticosteroids Found To Heal Severe Bacterial Corneal UlcersResearchers found significant vision improvementone and a half to two lines of improvement on an eye chartby using corticosteroid therapy on patients with severe ulcers.

    Steroids for Corneal Ulcers Trial (SCUT) - Arch Ophthalmol:130, Feb 2012UCSF and the Aravind Eye Care System, in Madurai, India500 participants with culture-positive bacterial corneal ulcer from US & IndiaRandomized placebo-controlled trial from September 2006-February 2010Half of the patients received 1% topical prednisolone sodium phosphate treatment and the other half received placebos. No difference in overall group, but a difference in severe ulcers subgroupNEI-supported International Research

  • PROJECT PRAKASH

  • Project Prakash-Video

  • The NEIs New World

    Questions/Comments?

    **************C. trachomatis is spread by interpersonal contact and by flies. In the study, six cynomolgus macaques received three doses each of the vaccine in eyedrops over the course of a few months, while six others werent vaccinated. One month after the last vaccine dose, all 12 monkeys were given eyedrops containing a highly virulent strain of C. trachomatis and were then monitored weekly.The unvaccinated monkeys showed moderate to severe eye disease for two to four months.In contrast, three of the vaccinated monkeys demonstrated strong immunity to the bacterium, remaining free of eye disease. The other three had partial immunity, characterized by significantly less infection immediately after exposure compared with the unvaccinated controls which also made them less likely to spread the microbe.Just one vaccinated monkey still showed signs of infection six weeks later. After 14 weeks of observation, monkeys with any lingering infection were treated with antibiotics to cure them. To make the vaccine, the scientists deleted a key component of C. trachomatis, a ring of DNA called a plasmid that was suspected to play a role in the disease. The eye damage caused by trachoma results less from the microbe itself than from the immune systems response to it. The infection triggers a hyper-reaction of inflammation of the eyelid, Caldwell says, which swells and eventually can turn inward. Over time, the eye lashes scratch the cornea, leading to scarring and blindness.The plasmid encodes a protein whose function is unknown, so exactly how the vaccine works is unclear. Caldwell suspects the plasmid is driving a very strong innate immune response that, in a sense, becomes the pathology for the infection. Removing the plasmid might allow a more specific immune reaction against the microbe with fewer harmful effects, he says.The researchers are working on that puzzle. The team is also testing the vaccine in more monkeys and is seeking regulatory approval to test it in people, Caldwell says.

    Embargoed for Release Monday, October 10, 2011 9 a.m. EDT Contact: Ken Pekoc 301-402-1663 Experimental vaccine protects monkeys from blinding trachomaNIH-developed vaccine based on live, attenuated Chlamydia bacteriaAn attenuated, or weakened, strain of Chlamydia trachomatis bacteria can be used as a vaccine to prevent or reduce the severity of trachoma, the worlds leading cause of infectious blindness, suggest findings from a National Institutes of Health study in monkeys. "This work is an important milestone in the development of a trachoma vaccine," noted Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID) at NIH. "If this approach demonstrates continued success, the implications could be enormous for the tens of millions of people affected by trachoma, a neglected disease of poverty primarily seen in Asia and sub-Saharan Africa."In their study, published in The Journal of Experimental Medicine online, scientists from NIAID, led by Harlan Caldwell, Ph.D., describe how they tested their vaccine concept in a series of experiments. First they infected six cynomolgus macaques with the strain of C. trachomatis that they had weakened by removing a small piece of DNA. The scientists observed that the monkeys spontaneously cleared the infection within 14 days with no or minimal signs of ocular disease. The animals then were exposed twice more to the weakened strain at four- and eight-week intervals, but the animals still showed no signs of trachoma despite being infected.According to Dr. Caldwell, this finding is particularly significant because repeated C. trachomatis infections typically lead to more severe eye disease in people. The infected animals did not develop eye disease, and they all mounted robust immune responses.The same six macaques then were exposed to a highly virulent strain of C. trachomatis as were six other macaques in a control group that had not been vaccinated. Three of the macaques in the vaccine group showed no signs of infection or disease, and the three others showed greatly reduced infection compared with monkeys in the control group. All six macaques in the control group became infected and displayed moderate to severe eye disease that persisted for between two and four months.Macaques are used in trachoma studies because their immune responses closely predict those of humans. The animals in the study were treated with antibiotics after completion of the experiments, and all recovered completely. The NIAID researchers are currently exploring how they can move their vaccine into human clinical trials.If left untreated, prolonged trachoma infection can cause a person's eyelids to fold inward, so that the eyelashes rub the eyeball and scar the cornea. This can result in impaired vision and sometimes blindness. Trachoma is treatable with antibiotics, although in many parts of the world people have limited access to treatment. Currently, there is no vaccine for trachoma. Trachoma experts estimate that approximately 1.3 million people are blind from trachoma, 1.8 million people have low vision as a result of the disease, and an estimated 40 million people have active trachoma. Trachoma is most often spread through direct personal contact, shared towels and other cloths, and flies that have come in contact with the eyes or nose of an infected person.Chlamydia diseases include sexually transmitted infections, which can result in pelvic inflammatory disease that can cause infertility in women, as well as trachoma. According to the NIAID researchers, findings from this study also could lead to the development of a vaccine against sexually transmitted Chlamydia infections. The Centers for Disease Control and Prevention received more than 1.2 million reports of Chlamydia infections in 2009. NIAID conducts and supports research at NIH, throughout the United States, and worldwide to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.NIH...Turning Discovery Into Health

    From Science News:I think this is promising, to finally see some results in vaccine development, says physician Danny Haddad, director of the International Trachoma Initiative, a nongovernmental organization based in Decatur, Ga., who was not involved in the study. Haddad cautions that it could still take many years before a vaccine reaches the public, but allows that it could be a very helpful tool within the global strategy against trachoma. That approach now centers on improving hygiene, dosing whole villages with antibiotics, and providing eye surgery as needed (SN: 2/23/08, p. 116).

    ***

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