October 3, 2006

UCSF Leaders Reflect on Significance of Clinical and Translational Science Institute

Joseph "Mike" McCune

Campus leaders and faculty are excited about the potential for the newly created UCSF Clinical and Translational Science Institute (CTSI) to accelerate the pace at which basic science discoveries can improve human health. The National Institutes of Health (NIH) has awarded UCSF more than $100 million over a period of five years to establish the CTSI, which will integrate and expand existing multidisciplinary clinical research centers, enhance training programs, provide incentives for collaborations between laboratory-based scientists and clinical researchers, and create a virtual home to foster better communication among them. "UCSF is already unique in enjoying world-class excellence across disciplines, departments and schools in an exceptionally collaborative environment," says Eugene Washington, MD, executive vice chancellor and provost. "The CTSI will allow us to leverage our formidable strengths in even more innovative ways to translate research findings for public benefit." Importantly, the UCSF CTSI also will create a new model of clinical research that engages community members, community practitioners and health care organizations in an active partnership with clinical researchers, with a particular emphasis on addressing health disparities. "As a nation, we have made a huge investment in biomedical research over the past several decades," says David Kessler, MD, dean of the UCSF School of Medicine and vice chancellor for medical affairs. "Now, it is time to reap the rewards of that investment. This grant helps us bridge the gaps so that scientific discoveries in labs become practical medical advances for patients." Joseph "Mike" McCune, MD, PhD, principal investigator for the successful NIH grant application, says that despite explosive gains in the understanding of basic science mechanisms of human disease, the meaningful translation of that knowledge to find new and better ways to detect, control, treat and prevent disease in patients has not moved fast enough. "Basic research discoveries can form the foundation for better treatments and prevention of disease, and could potentially have great impact on health care in our society," says McCune, professor of medicine and chief of the Division of Experimental Medicine at UCSF. "To realize this potential, we have to move the research from the lab bench to the patient. This is first done in the controlled situation of our academic medical centers. If findings in patients look good there, the research can then be moved into the community to see if it is also applicable in the real world. This is the process of clinical and translational science, and this is what the CTSI will facilitate." Simply put, McCune says, the "mission of the CTSI is to bring better therapies to more people, more quickly." Specifically, the four goals of the CTSI are to:

Integrate existing training programs to increase the number and quality of programs, and provide trainees from diverse disciplines with the knowledge, skills and motivation to make significant contributions to clinical and translational research;
Improve infrastructure to foster the design and conduct of a diverse spectrum of clinical investigation and translational research;
Enhance career development of people involved in clinical investigation and translational research, and change the academic culture to appropriately reward original, multidisciplinary, collaborative work; and
Create a virtual home for clinical and translational researchers by fostering communication and encouraging collaboration, in part by sharing information using web-based programs and hosting public seminars.

The CTSI is the brainchild of an impressive cadre of more than 200 campus leaders and investigators during a six-month planning process. As such, the CTSI enjoys widespread support across all four schools, the Graduate Division, UCSF Medical Center and the UCSF-affiliated San Francisco Veterans Affairs Medical Center, San Francisco General Hospital Medical Center and the J. David Gladstone Institutes. It also has the support of and will include other area hospitals and institutions, such as the Children's Hospital Oakland Research Institute, the Blood Systems Research Institute of San Francisco and the Kaiser Permanente, Division of Research. "Our commitment to this vision has been established and the values associated with the CTSI have been firmly embraced by all levels of the University," McCune notes. "As a result, the work of the CTSI has already begun." The CTSI will serve as the integrated academic home for research and education in clinical investigation and translational science that involves 13 multidisciplinary programs, each of which is led by senior scientists drawn from all four schools and the Graduate Division. "The goal now is to incorporate translational research into UCSF's very fabric," says Chancellor Mike Bishop, MD, in part "by enlivening a clinical research community to constantly ask, 'What's next ?' of basic researchers." The focus to transform new scientific knowledge into tangible benefits for people is a national priority. Soon after becoming director of the NIH in May 2002, Elias A. Zerhouni, MD, convened a series of meetings to chart a "roadmap" for medical research in the 21st century. Like the CTSI, the NIH Roadmap identifies the most compelling opportunities to improve human health: foster new pathways to discovery, create more multidisciplinary research teams and reorganize the clinical research enterprise. Read more about the NIH Roadmap here.

Turning Point

For UCSF, the CTSI represents a major turning point in the history of the health sciences university. While UCSF laboratory-based scientists and clinical researchers already work together on novel therapies for patients at its three NIH-funded General Clinical Research Centers, as well as many other sites such as the UCSF Comprehensive Cancer Center, the CTSI will provide the infrastructure to unite, expand and institutionalize translational research at UCSF and throughout the community. As a result, the CTSI will fundamentally transform the University by creating new opportunities for multidisciplinary research and training, campus leaders say. "Beyond the obvious benefits of translational research bringing a synergy to diverse disciplines -- with the aim of new treatments, new cures and new diagnostic methods -- we decided to envisage the CTSI application as a vehicle for the schools of dentistry, medicine, nursing and pharmacy and the Graduate Division to begin working together in an entirely new way," says Charles Bertolami, DDS, DMedSci, dean of the UCSF School of Dentistry. "This will be the model for the future. It's an historic transition for us." Mary Anne Koda-Kimble, PharmD, dean of the UCSF School of Pharmacy, describes the grant as "transformative. It will help us pull together and expand upon the strengths of faculty across all schools and campuses. What's more, the translation of our knowledge to the direct benefit of the public goes right to the core of our mission. We clearly have the vast expertise, the institutional mindset and vision required for this grant to succeed. Its ultimate value to the public will surely far exceed the tremendous face value of the grant award itself. And in the end, that's what counts most." Although the concept of the UCSF CTSI is relatively new, the University has laid the foundation to take translational research to the next level in recent years, McCune says. Funding from the NIH, for example, has supported a number of very successful training programs, ranging from the Medical Scientist Training Program for MD-PhD students to the NIH Roadmap-funded Training in Clinical Research Program and Masters in Clinical Research Program. In addition, the Howard Hughes Medical Institute, the Doris Duke Charitable Foundation and Burroughs Wellcome Fund have committed resources to the training of physician-scientists. Biotechnology and pharmaceutical companies and private donors also have targeted funds to translational research and the infrastructure needed to support it. Kathleen Dracup, RN, FNP, DNSc, dean of the UCSF School of Nursing, says that ultimately patients will benefit from the heightened emphasis on multidisciplinary training spurred by the CTSI. "Training in the health professions has traditionally occurred in silos," she says. "Students from different disciplines must learn early in their training how to communicate effectively in a team, yet these skills are often ignored or relegated to a low priority. Research shows that patients' lives depend on good communication among different professionals. The CTSI provides the structure to change this tradition." Executive Vice Chancellor and Provost Washington, has convened a series of boards made up of researchers and clinicians from many disciplines and from each of the four schools to evaluate and make recommendations to improve key functions necessary for clinical and translational science to flourish. "The CTSI is designed to interact with and to integrate these parts into a cohesive whole," McCune says. "In many ways, it is not so much a thing as it is a process, one aimed at allowing basic science discoveries to be applied to the health care of the community as efficiently and as wisely as possible."

Hurdles Ahead

Despite recent progress in clinical and translational research at UCSF, much needs to be done. These challenges were acknowledged by UCSF faculty in the NIH grant application. "Particularly in an institution as large as UCSF, composed as it is of many physically and intellectually distinct islands of excellence, substantial hurdles confront clinical and translational research," the application says. "There is a need to train more clinician-scientists in various fields of translational research and clinical investigation; to remove barriers that hinder cross-disciplinary interactions; to create systems that facilitate the design and implementation of research in patients and vulnerable communities; and to bridge the chasm that currently exists between academic medical centers and the broader community. "For trained clinician-scientists to deliver significant contributions, we must build environments in which their careers can advance and they can thrive. It is also critical to create and sustain a sense of community or home among clinical and translational scientists, so they can most effectively collaborate across and within disciplines." One way to encourage and support those who want to pursue translational research is to integrate training programs, so that clinically trained investigators gain familiarity with basic science disciplines and methodologies and, conversely, that basic scientists gain exposure to the skills and steps in clinical investigation. Another way is to change the criteria by which faculty are reviewed for academic promotion. The traditional academic promotion processes focus on competition and individual achievement. For example, a principal investigator can publish as a first author and receive most of the credit for a research finding that may have only been possible through a multidisciplinary team effort. The CTSI can help pave the way for a new approach to recognize valuable contributions to research performed by large teams. "These issues are complex and they are not unique to UCSF," the application authors write. "In seeking solutions, we hope those that prove to work for us will be found useful elsewhere, and we look to learn from other, similar academic institutions. UCSF has vast potential for contributing to clinical investigation and translational research, and we believe that the CTSI will provide the impetus to realize that potential fully. Five years from now, we envision an environment for clinical and translational research at UCSF that is markedly better than that which exists today."

Turning Point

Hurdles Ahead

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