From the Scientific and Clinical Directors . . .
We are pleased to bring you the Summer 2008
issue of IRPartners. In this issue, you’ll learn about
the NIAMS Rheumatology Fellowship Program
for physicians pursuing a career in academic
rheumatology medicine. You’ll also learn about
the Institute’s partnership with the Montgomery
County (Maryland) Police Activities League (PAL)
to introduce area children to the basic elements of
research and science education.
In addition, you’ll get an inside look at the NIAMS
Cardozo Community Health Center and our new
laboratories in the NIH Clinical Center. We also
feature IRP staff members who have recently been
honored and a synopsis of IRP research highlights
from the past several months.
We’re excited about a new segment that spotlights a
member of the NIAMS Health Partnership Program.
In this issue, we feature the District of Columbia
Office on Latino Affairs. Lastly, we introduce you to
new health information resources and welcome new
staff members to the NIAMS team.
We hope you enjoy this issue, and we look forward
to sharing future highlights and advances with you.
John O’Shea, M.D.
Intramural Research Program
National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health
Daniel Kastner, M.D., Ph.D.
Intramural Research Program
National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health
NIAMS Rheumatology Fellowship Provides
Rich and Diverse Clinical Experience
In keeping with the NIAMS mission of training basic and clinical scientists to
carry out research in rheumatology, the NIAMS Rheumatology Fellowship
Program provides a
balance of both academic
and practical training for
physicians wishing to
pursue a career in academic
Program participants tend to
be recent graduates of 3-year
internal medicine residency
programs and work as
NIAMS clinical fellows
for 2 or more years. After
2 years, the fellows have
fulfilled the requirements
to become board-certified
in rheumatology, but
many stay on for at least 1
additional year to focus on improving their research skills.
The program is accredited by the Accreditation Council for Graduate Medical
Education and led by Mark Gourley, M.D., Director, Clinical Care and Training.
Dr. Gourley recently served as a staff clinician at NIH’s National Institute of
Environmental Health Sciences (NIEHS), where he worked with a team of
researchers investigating environmental causes of lupus and other autoimmune
diseases. His research interest in lupus began in 1988 when he first joined NIH/NIAMS.
He left NIAMS in 1996 to open the greater Washington, D.C., area’s first
lupus clinic at the Washington Hospital Center.
There are currently four first-year fellows in the NIAMS Rheumatology
Fellowship Program. The fellows gain practical knowledge by completing clinical
rotations in consultative practice, pediatric rheumatology, and community-based
rheumatology practice. This combination provides them the opportunity to
enhance their clinical skills. The fellows also participate in clinical conferences,
core rheumatology lectures, and weekly clinical and basic science journal clubs,
in addition to taking full advantage of the wealth of academic opportunities
available on the NIH campus. Fellows are also encouraged to attend local and
national scientific meetings, which help them acquire
insights into clinical research and scientific investigation.
Under the NIAMS Health Partnership Program, fellows
also work at the NIAMS Community Health Center
(CHC) in the Cardozo/Shaw neighborhood of northwest
Washington, D.C. The CHC was established in 2001 as
a collaborative effort between the local community and
NIAMS to provide area residents access to cutting-edge
specialty care and scientifically based health information,
while offering clinical fellows a unique community-based
learning experience in rheumatic diseases. The CHC also
operates as an extension of the rheumatology research
program at the Institute and allows NIAMS researchers
access to patients most affected by rheumatic diseases.
Dr. John Botson, a first-year fellow, enjoys the opportunity
at the CHC to make a primary diagnosis for his patients
and recommend clinical interventions. Initially trained as
a pharmacist in his home state of Ohio, he then chose to
pursue further training at Ohio State University where
he received his medical degree. Prior to accepting a
fellowship position at NIAMS, Dr. Botson completed a
residency program in internal medicine at Dartmouth-Hitchcock
Medical Center in New Hampshire.
According to Dr. Gourley, “The NIAMS CHC
provides rheumatology fellows a bread and butter
training experience, while at the same time utilizes the
armamentarium of the NIH Clinical Center’s intellectual
expertise, diagnostic capabilities, and state-of-the-art
Besides gaining clinical experience at NIH, fellows
may request clinical electives that are available through
many of NIAMS’ partner institutions in the Washington
metropolitan area, such as Georgetown University, George
Washington University, and Washington Hospital Center.
During the first year, these fellows devote most of their
time toward developing clinical competency (skills) in the
practice of rheumatology, under the direct supervision of
NIAMS attending physicians. The fellows select a research
mentor and spend approximately 20 percent of their time
initiating research projects. For instance, Dr. Botson is
currently working 1 day per week in Dr. Richard Siegel’s
lab studying tumor necrosis factor receptor superfamily,
which is involved in the pathogenesis of a number of
In the second year, fellows are more directly involved
in rheumatology and immunology research, with
approximately 80 percent of their time devoted to research
training. An important feature of the research experience
is that fellows maintain close, daily interactions with their
research mentor and receive individualized instruction.
About 20 percent of their time is spent working in clinics
for increased clinical exposure.
Fellows who continue through the third year usually
conduct more focused research study. Fellows who
are interested in advanced training in clinical research
may also apply to participate in the NIH-Duke Training
Program in Clinical Research at this time. Dr. Grant Louie,
a third-year fellow, is currently enrolled in the course. The
courses he is taking include research design, statistical
analysis, health economics, research ethics, and research
management. Dr. Louie completes his coursework
primarily through videoconferences with faculty at
Duke University Medical Center. Dr. Gourley considers
this course a great opportunity for the fellows to receive
a master’s degree in health sciences while receiving
training at NIH. Those with interest in laboratory-based
investigation are able to pursue endeavors in the
laboratory primarily after the first year of training.
Since 2003, 18 fellows have successfully completed
their training at NIAMS. Equipped with the
knowledge and skills gained at NIH, they have
gone on to embark on different career paths in
basic lab research, clinical trial research, academic
rheumatology, and private clinical practice.
NIAMS Partners with
Montgomery County Police Activities League (PAL)
Students from the Montgomery County PAL view protein complexes through an electron microscope
The NIAMS Intramural Research Program
(IRP) recently developed a partnership with
the Montgomery County (Maryland) Police
Activities League (PAL) to work with at-risk
children, age 11 to 16. The arrangement provides
students with an overview of NIH and NIAMS,
while exposing them to the basic elements of research and science education. Program participants
are introduced to research scientists who serve as
positive role models and learn about careers, training
opportunities, and internships that are available.
Under the direction of Career Development Section
Chief Mario Cerritelli, Ph.D., PAL students have
participated in guided tours of several NIAMS stateof-
the-art research facilities and received classroom
instruction and laboratory experience from a host
of scientists, including NIAMS Scientific Director
John O’Shea, M.D.; Richard Siegel, M.D., Ph.D.; and
According to Dr. Cerritelli, “The goal in many of
our outreach efforts is to encourage young students
to pursue careers in the biomedical sciences and to
create a workforce at NIAMS that reflects the rich
diversity of our nation. It was great to see the glow
of excitement in the faces of these children as they
toured NIAMS laboratories, attended a lecture on the
immune system, and constructed 3-D models based
on virus design.”
Community Caring: A Look at
the NIH-Cardozo Program
In 2000, NIAMS, under the leadership of
Dr. Stephen Katz and in an effort to facilitate
research on health disparities in rheumatic
diseases, established a community partnership,
the Health Partnership Program (HPP). The HPP
includes about 68 community partners representing
various sectors of the African American and
Latino communities within Washington, D.C. Its
guiding principles include openness about its
plans and actions, inclusiveness of all constituents
in partnership activities, and responsiveness to
community needs and concerns, as well as those of
NIH. The community is involved in both program
development and the NIH research agenda, and a
core group meets regularly to provide advice about
outreach, research, and education activities, as well
as to review research proposals.
According to Dr. Barbara Mittleman, former NIAMS
director of scientific interchange and current director
of the NIH Office of Science Policy’s public-private
partnership program, the idea for the NIH-Cardozo
relationship came in 2000. The idea of an ongoing
NIH research clinic tied to on-campus research
activities with movement of patients and staff
between locations was quite novel at the time, she
said. Unlike volunteer medical activities in local
clinics, which doctors and fellows often seek out to
keep up and sharpen their skills, staff at NIAMS’
Community Health Center (CHC) conduct official
“The clinic was the result of everyone’s desire to
do the right thing and make it happen,” Mittleman
said, noting that she met biweekly for at least a year
with Clinical Center (CC) department directors to
set things up in a way that served patients, staff,
the Cardozo community, and NIH research needs
all at the same time. In addition, all aspects of
NIAMS—intramural, extramural, and the director’s
office—all worked together. “We had to have an
interdisciplinary, multicultural research team, with
every participant adding their unique talents to the
mix, for this to succeed,” Mittleman said.
A major component of the HPP was the establishment
of the NIAMS’ CHC, an outreach site located within
the Upper Cardozo Health Center, which is operated
by Unity Health Care, Inc., a nonprofit organization
providing health care to uninsured and underinsured
D.C. residents. The CHC provides a venue for
community-based research on clinical aspects of
rheumatic diseases, health education programs, and
training for NIH staff. Located in the historically
African American Cardozo/Shaw neighborhood, the
CHC’s patient population is equally divided between
African Americans and Latinos. “If we only studied
the people showing up at the NIH Clinical Center,
we’d never be able to study health disparities. We had
to go out into the community to get the participants,”
Cardozo’s partners in both the Hispanic and African
American communities embraced the CHC. Jesus
Lopez with the United Planning Organization
said his group has been involved since the clinic
opened. “It offers comprehensive services to benefit
people who suffer from arthritis and other health
conditions. By accepting and including people
from diverse racial and ethnic backgrounds and by
maintaining a high standard of professionalism, the
clinic plays a key role in our community’s success.”
One of the first research protocols conducted with
Cardozo directly benefited its members, as well as
NIH, by increasing both groups’ understanding of the
health behaviors and beliefs of minority patients with
rheumatic disease. Rheumatic conditions are among
the most common health problems in the United States,
and there are marked differences in the incidence,
prevalence, severity, processes of care, and health
outcomes among racial and ethnic groups compared
to white Americans. Although the effects of the disease
may be modifiable by lifestyle changes, such strategies
are often difficult for patients to accomplish and may
be ineffective in minority communities because of
differences in culture and environment and the lack of
culturally sensitive materials and approaches.
Dr. Gwenyth Wallen, chief of the Research and Practice
Development Service, and Dr. Migdalia Rivera-Goba,
CC senior nurse specialist within CC Nursing and
Patient Care Services, conducted a protocol exploring
how health beliefs and behaviors may contribute
to health disparities. The part involving patients is
completed, and they are analyzing the data they
collected, but the Cardozo community invited them to
complete another clinical trial in the future. Wallen and
Rivera-Goba hope to apply what they learned about
what works best within the community by conducting
an intervention study focusing on nutrition, physical
education, and social support.
“It’s all about trust when you’re working in the
community,” Wallen said. “The community told
us, ‘Don’t just come here to gather the information
you want and leave. Come back and feed something
positive back into the community with what you’ve
learned.’” Sometimes the giving back involves
teaching, other times it involves providing access to
health care treatments and medications that wouldn’t
otherwise be available. The result is a win-win for
both sides. “The NIH-Cardozo relationship helps to
improve the health status and quality of life for the
community residents. Researchers receive insights into
a population that otherwise would not have the option
to participate in clinical trials,” Wallen said.
This story was excerpted from an article by Jenny Haliski in the April 2008 issue of NIH’s Clinical Center News.
NIAMS IRP Research in the News
Genes Implicated in Ankylosing Spondylitis
Michael Ward, M.D., and an international team
of researchers recently identified two genes
associated with an increased risk of ankylosing
spondylitis, a disease that causes inflammation of
the tendons and ligaments around the bones and
joints in the spine. Their research, published in
Nature Genetics, used the genome-wide association
approach, which makes it possible to analyze
between 300,000 and 500,000 single nucleotide
polymorphisms (SNPs, or small differences in
DNA that are distributed throughout a person’s
genetic code). An analysis of DNA samples from
1,000 individuals with ankylosing spondylitis and
1,500 healthy controls identified variations in two
genes – ARTS1 and IL238 – that were associated
with an increased risk of the disease.
Burton PR et al. Association scan of 14,500
nonsynonymous SNPs in four diseases identifies
autoimmunity variants. Nature Genetics. 2007;
New Test for Joint Infection Could Spare Some
Patients an Unnecessary Procedure
Rocky Tuan, Ph.D., chief of the NIAMS Cartilage
Biology and Orthopaedics Branch, and his
colleagues recently identified a potential
diagnostic test that could help surgeons confirm
or rule out the presence of infection-causing
bacteria in prosthetic joints that require surgical
revision. The test, described in the Journal of Bone
and Joint Surgery, could spare a subgroup of people
who need the surgery a time-consuming and
costly treatment for infection, while helping to
ensure that people who need the procedure get it.
Tuan and his team used a process called reverse
transcription polymerase chain reaction (RT-PCR)
to directly quantify viable bacterial mRNA in
synovial fluid samples. The test, which is currently
being evaluated using clinical samples, would help
physicians identify or rule out infection before
proceeding with joint revision surgery.
Birmingham P et al. Simulated joint infection
assessment by rapid detection of live bacteria with
real-time reverse transcription polymerase chain
reaction. Journal of Bone and Joint Surgery. American
Volume. 2008; 90(3): 602-608.
Cellular Defect Identified in Job’s Syndrome
IRP scientific director John O’Shea, M.D., and a
team of investigators from the National Institute of
Allergy and Infectious Diseases (NIAID) have made
an important discovery regarding Job’s syndrome,
which helps to explain why people with this rare
immunodeficiency condition suffer from recurrent
outbreaks of abscesses. Their finding, reported
in Nature, was the result of a collaborative effort
between the NIAMS Molecular Immunology and
Inflammation Branch and the Human Immunology
Section of the NIAID Vaccine Research Center.
O’Shea and his colleagues found that people with
Job’s syndrome are unable to produce TH17 helper
cells, which fight infection by producing a protein
called interleukin-17. The discovery builds on
previous NIH work that found that people with
Job’s syndrome have defects in STAT3 (signal
transducer and activator of transcription 3), a gene
responsible for the differentiation of TH17 cells.
Milner JD et al. Impaired TH17 cell differentiation
in subjects with autosomal dominant hyper-IgE
syndrome. Nature. 2008; 452: 773-776.
Discovery Sheds Light on Muscle Physiology
Investigators from the NIAMS Laboratory of
Muscle Stem Cells and Gene Regulation, led by
Vittorio Sartorelli, M.D., have gained valuable
insights regarding the process of gene expression
in skeletal muscle. Their discovery centers around
MyoD, a master regulatory gene that controls the
expression of other genes that directly impact skeletal
muscle. Sartorelli and his colleagues found that
the occurrence of a natural chemical modification
of the MyoD protein at different stages of muscle
development influences its effect on gene expression.
This discovery may ultimately help to explain the
occurrence of certain muscle defects and result in
the development of therapeutic strategies to enhance
muscle function and repair.
Di Padova M et al. MyoD acetylation influences
temporal patterns of skeletal muscle gene expression.
Journal of Biological Chemistry. 2007. 282(52):
Scientists Identify New Pathway Related to
Researchers from the NIAMS Molecular
Immunology and Inflammation Branch, led
by John O’Shea, M.D., and an international
team of investigators used a mouse model to
identify the pathway by which interleukin-10
(IL-10) is produced. (IL-10 is a cytokine with
immunosuppressive properties, so stimulating its
production could help to moderate inflammatory
responses.) Their findings were reported in Nature
Immunology. O’Shea and his team demonstrated
that IL-27 and IL-6 induced T helper type 1
and type 2 cells, as well as T helper cells that
produce IL-17, to secrete IL-10. Understanding
of this pathway should shed further light on
the mechanisms involved in the development of
autoimmune disease and may ultimately result
in new treatment approaches. The work was a
collaborative effort between NIAMS, the University
of Pennsylvania, Ludwig Institute for Cancer
Research (Australia), and Amgen, Inc.
Stumhofer JS et al. Interleukins 27 and 6 induce
STAT3-mediated T cell production of interleukin 10.
Nature Immunology. 2007; 8(12): 1363-1371.
NIAMS Labs Open with
On March 28, the NIAMS Intramural Research
Program held a ribbon-cutting ceremony and
open house to introduce the new home of four
laboratories within the Molecular Immunology
Present at the ribbon-cutting ceremony (from l.), Gilbane senior project engineer Earl Gilliam; NIAMS scientific director Dr. John O’Shea; ORF research space coordinator Cyrena Simons; and NIAMS director Dr. Stephen Katz
and Inflammation Branch and the Autoimmunity
Branch. The new state-of-the-art facilities, located
on the 13th floor of NIH’s Building 10, will allow
researchers within the groups of Dr. John O’Shea, Dr.
Juan Rivera, Dr. Richard Siegel, and Dr. Rafael Casellas
to conduct cutting-edge research in an environment
that promotes interaction and collaboration.
Kastner Recognized as NIH
Daniel L. Kastner, M.D., Ph.D., clinical
director and chief of the NIAMS Genetics
and Genomics Branch, IRP, has been
awarded the position
of NIH Distinguished
Investigator. The honorific
current NIH senior
investigators for their
career achievements and
impact on the scientific
field. It is reserved for
tenured intramural senior
investigators at the highest
level of accomplishment—the
top 2 or 3 percent of all senior investigators at
NIH. Congratulations, Dr. Kastner!
Scott Heading to Chapel Hill
Congratulations to NIAMS postbaccalaureate
fellow Eric Scott on his recent admission to the
biological and biomedical sciences graduate
program of the University
of North Carolina (UNC)
at Chapel Hill. Scott
grew up in rural North
Carolina with his parents
and two brothers. Following
high school, he served 6
years in the U.S. Air Force
and later graduated from
the University of North
Carolina at Pembroke with
a biology degree. According
to Scott, “I am the first
of my family to have
received a baccalaureate degree.” He is grateful for
his experience in the NIAMS Molecular Inflammation
Section. Best wishes to Eric and his family!
NIAMS HPP Spotlight: DC
Office on Latino Affairs
The District of Columbia Mayor’s Office on Latino
Affairs (OLA) was established in 1976 to work
with the Council of the District of Columbia,
government agencies, community-based organizations,
and businesses to ensure that, among many other
benefits, “a full range of health services” are available
to all Latino residents living in the nation’s capital.
Honoring this maxim and along with NIAMS’ best
interest to address health disparities in rheumatic
diseases, OLA joined NIAMS in February 2000 as a
partner in the Health Partnership Program (HPP),
a community-based research initiative that made
possible the establishment of the Community Health
Center in Washington, D.C.
As a partner, OLA continues to provide NIAMS
with insight into the Latino community’s needs and
concerns about health care and research. They also
share resources to help the HPP operate effectively
in the metro area. “NIAMS is a great information
resource for our community that is not otherwise easily
accessible,” remarks Kathy Ruffner, senior community
outreach specialist at OLA. “NIAMS also provides
a wonderful opportunity for networking between
nonprofit agencies through the annual Community
Partnership meetings at the Cardozo Clinic. It is a great
venue to get a clear picture of the initiatives that are
targeting the Latino community.” OLA’s sponsorship
of numerous community events throughout the year
offers NIAMS a wonderful opportunity to disseminate
health information and clinical studies recruitment
materials in both English and Spanish.
To learn more about the DC Office on Latino Affairs,
please visit http://ola.dc.gov
The Institute has set up the NIAMS Community Health
Center to help doctors and scientists understand the causes
of rheumatic diseases and why many of these diseases
occur more often and more severely in certain minority
With this information, we can find better ways to treat and
prevent these diseases. There are no experimental treatments
or medications being used at the Community Health Center.
For information, please call 202–673–0000.
NIAMS Introduces Easy-to-Read Health Information CD-ROM
NIAMS has developed a new CD-ROM for
clinicians and individuals seeking easy-to-read
information on musculoskeletal,
rheumatic, and skin diseases. The CD contains print-friendly
copies of select NIAMS publications in
English, Spanish, and Chinese.
Easy-to-Read Health Information on Bones, Muscles, Joints,
and Skin in English, Spanish, and Chinese contains health
information on a variety of topics, including:
- back pain, osteoarthritis, osteoporosis, and scoliosis
- rheumatoid arthritis, fibromyalgia, and scleroderma
- acne, psoriasis, and rosacea.
The CD-ROM also contains links to NIAMS and
NIH resources as well as to voluntary nonprofit
The CD is available at no charge. To order by phone
or inquire about bulk orders for health forums
or fairs, please contact the NIAMS Information
Clearinghouse at 877–22–NIAMS (226–4267) or
Need an NIH Speaker?
The NIH Speakers Bureau
is a service that lists NIH
researchers, clinicians, and
other professionals who
are available to speak to
school groups and other
local and national organizations. Speakers have
expertise in such areas as arthritis, osteoporosis,
autoimmunity, and several dozen other topics
covered by NIH. To find out more about this
service, sponsored by NIH ’s Office of Science
Education, visit its Web site at
NIAMS Welcomes New
NIAMS welcomes new staff members to the Health
Partnership Program and Cardozo Community
Health Center (CHC):
Isabel Ochoa joined NIAMS this year as a nurse assistant in the NIAMS Cardozo Community Health Center.
Ochoa wears many hats at the CHC. Her
duties include being medical assistant,
phlebotomist, and patient liaison for those patients who
have specialty appointments. She also assists NIAMS
fellows with Spanish translations as needed. Ochoa
came to the United States from El Salvador and has been
working with the Hispanic/Latino community since 1985.
Her most recent experience was working at the Spanish
Catholic Center’s Catholic Community Services in the
Washington, D.C., metro area where she worked for 19
years as a medical assistant.
Sara Rosario Wilson recently joined NIAMS as a writer-editor in the Office of Communications and Public Liaison.
Wilson comes to NIAMS after 7 years
at the National Institute on Drug Abuse
(NIDA) where she served as deputy press officer
and lead staffer for Spanish-language translations.
She began her career at NIH as an intern through the
Hispanic Association of Colleges and Universities.
She received her bachelor’s degree in public
communication from the University of Puerto Rico.
As a native Spanish speaker, Wilson will help manage
NIAMS’ Spanish-language publications, coordinate
the national and local exhibit program, and assist with
activities related to the Health Partnership Program
and the Multicultural Communications Initiative
among other projects.
Questions To Consider Before Joining a Study
- What is the purpose of the study?
- What is required of me?
- Will the study benefit me or others?
- Are there risks? If so, what are they and what are the chances that they will occur?
- What discomforts are involved?
- How long will the study last?
- What will happen if I decide to leave the study?
NIAMS Has Free Health
NIAMS has free health information (some
in Spanish) available to the public,
health professionals, and organizations.
Information is available on arthritis, lupus, and other
rheumatic diseases, skin disorders, joint problems,
and musculoskeletal diseases.
Contact NIAMS at 1–877–22–NIAMS (free call),
TTY: 301–565–2966. Check our Web site at
www.niams.nih.gov. Many of our publications can be
printed directly from our site.
Free information on osteoporosis, Paget’s disease
of bone, osteogenesis imperfecta, primary
hyperparathyroidism, and other metabolic bone
diseases and disorders is also available from the
NIH Osteoporosis and Related Bone Diseases ~
National Resource Center (NIH ORBD~NRC).
Contact the NIH ORBD~NRC at 1–800–624–BONE,
TTY: 202–466–4315, or at www.niams.nih.gov/Health_Info/bone.
Office of Science Policy, Planning and Communications
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
National Institutes of Health
Building 31/Room 4C02
31 Center Drive, MSC 2350,
Bethesda, MD 20892-2350
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Toll free: 877-22-NIAMS (877-226-4267)
Stephen I. Katz, M.D., Ph.D., Director
John O’Shea, M.D., Scientific Director
Daniel Kastner, M.D., Ph.D., Clinical Director
Janet S. Austin, Ph.D., OCPL Director
Marcia Vital, M.S., Editor
Trish Reynolds, R.N., M.S., Associate Editor
Mimi Lising, M.P.H., Ping Wang, M.D., Sara Rosario Wilson