Diabetes, Endocrinology, Metabolism

The landscape of diabetes is at a tipping point, with a significant increase in the number of patients to epidemic proportions, outstripping the pace of scientific discovery and the development of therapies and preventions. In response to this challenge, leaders in the Division of Endocrinology, Diabetes and Metabolism have developed a first class and distinctive program for the care of patients with diabetes.

CAMPUS-WIDE INITIATIVES
Our priorities being patient care as well as breakthroughs in clinical and basic research, making an impact on Diabetes by developing new avenues for the treatment, prevention, and cure. The basic research effort focuses on major research interest areas of islet biology, autoimmune diabetes, type 2 diabetes and diabetes complications. This group includes investigators with an interest in islet cell biology, regeneration, autoimmunity, and physiology or pathophysiology relevant to Type 1 and 2 diabetes. The interest in pancreatic islet biology has continued to grow with the recruitment of new faculty. These efforts complement existing strengths in Diabetes research across campus. The current group includes the laboratories of Alejandro Caicedo and Ernesto Bernal-Mizrachi, chief of the Division who recently was recruited to the Miller School of Medicine as Chief of the Division. DRI faculty members with appointment in our Division Drs. Pugliese, Pastori and Mendez complement these research efforts. The long-term goal of this joint research effort is the goal of having patients with diabetes free of daily insulin injections to control glucose levels. The current work is focused on understanding how human islets orchestrate a hormonal response that contributes to glucose homeostasis and how the pancreatic islet fails in diabetes. These studies are also aimed to finding new avenues to preserve insulin-producing cells and discover novel approaches to treat diabetes. The use of powerful and novel techniques in genetically modified mice, in vitro studies, and examination of human pancreatic slices in vivo and human islets transplanted in the mouse eye provides unique innovative tools. This complementary and diverse approach offers an ideal model to make groundbreaking discoveries that could be translated into clinical therapies. These research efforts complement the current work on immunology and islet transplantation performed at the Diabetes Research Institute and are supported by state of the art cores at the Institute.

CLINICAL BREAKTHROUGHS
The basic research effort is complemented by a strong clinical care and clinical research components. Drs. Marks, Skyler and Goldberg currently carry out major clinical research studies on the natural history of type 1 diabetes and type 2 diabetes. These studies are complemented by clinical research on diverse aspects of adipocyte tissue in the heart disease by Dr. Iacobellis. Our outstanding team of diabetologist including Drs. Solano, Miranda, Bernal-Mizrachi, Vendrame, Iacobellis, Baidal, Goldberg, Skyler and Marks complemented with Allison Wick and a solid group of diabetes educators and dietitians provide world-class diabetes management. This effort will be expanded and complemented by the development of the University of Miami Comprehensive Diabetes Center (UMCDC). This center will enhance clinical capabilities and diabetes research resulting in a regionally differentiated program. The vision for the Comprehensive Diabetes Center of the University of Miami is to become the local and regional leader in personalized medicine approach to the clinical care and accelerate new treatments as well as training future leaders in diabetes. This will be achieved by an integrated multidisciplinary approach to complex patients with diabetes as well as community involvement and prevention of diabetes and its complications.
This Diabetes program is embedded within the rich environment in other areas of endocrinology including thyroid, adrenal and pituitary disease. All these activities are developed within a highly collegial, and interdisciplinary group and excellent core resources for biomedical research. The combination of the research and clinical program is expected to have a major impact in our community and enhance our reputation nationally and internationally.

FIRST DIABETES SUMMIT
As part of this ongoing effort in expanding our diabetes research enterprise, the Division of Endocrinology held the first Diabetes summit in April 2016. The goal of the Summit was to develop tools and strategies to support innovative research and enhance diabetes research at the University of Miami by identifying critical needs, foster collaborations and integrate and coordinate efforts. The Summit included over 50 faculty members involved in different areas of diabetes research and different disciplines across the University. Current efforts are ongoing to develop a plan based on the information gained at this Summit.

The goals for this summit were as follows:

The long-term goal of this program is to develop tools and strategies to support innovative research and enhance diabetes research at the University of Miami.
o Identifying critical needs
o Foster collaborations and establish/expand partnerships between the diabetes research community (Basic scientist/clinical research). Promote the translation from bench to bedside
o Integrate and coordinate efforts across different disciplines
o Develop an inventory of resources, animal models, bioinformatics tools, current cohorts and expertise in different areas of diabetes research across the University
o Create mechanisms to stimulate innovative research and scholarship by launching a seed funding to multi-unit, faculty-led teams.

Future Target
o Diabetes Research Center grant (P30)
o Diabetes Training grant (T32)
o Obesity research Center
o Fetal Programming Center

Strategies
Support basic research aimed at understanding the genetic, biochemical, molecular, environmental, and behavioral mechanisms underlying diabetes and obesity.
Create a seamless organization to accelerate drug discovery efforts from gene discovery to clinical trials, including Biomedical Engineering, Public Health and Pharmacy.
Expand abilities to perform “big data” analytics and bioinformatics.
Create “Longitudinal Diabetes” cohorts to assess lifelong trajectories for diabetes from prenatal status to the oldest old.
Develop population health models for prevention and treatment of diabetes.
Develop models to standardize care approaches and implementation of research into practice.

The agenda for this event can be accessed here.

The group continues to facilitate group interactions, with focus on research and education, with the vision to submit “large initiative” grants. Multiple faculty members across the university were identified as being involved in Diabetes related research. These come from 14 departments across campuses. The Diabetes research community is grouped into the following Research Areas:

a. Diabetes Complications: Cardiac Complications, Neuropathy/wound healing, Outcomes Research, Nephropathy
b. T1D related research basic research (Immunology)
c. Islet Biology; Bioengineering
d. Clinical research in diabetes (different areas)
e. Epigenetics/Fetal Programming
f. Outcomes research

Working groups in the different areas are formed to catalyze synergism based on faculty expertise. The group is also working toward a T32 application.

For more information on this initiative, please contact Dr. Ernesto Bernal-Mizrachi, Division Chief, Endocrinology, Metabolism and Diabetes.