New Paradigm for the Diagnosis and Treatment of Chronic Pain
The path of diagnosis and treatment for sufferers of chronic pain can be long and arduous. Visits to primary care physicians often lead to referrals to multiple specialists, and a menu of unnecessary and expensive diagnostic procedures, drug treatments, and even surgical solutions. The entire process can be expensive, inefficient, and unfortunately often without a satisfactory outcome for the patient.

The University of Michigan Chronic Pain and Fatigue Research Center is currently working with a major industry partner to create a new paradigm for the diagnosis and treatment of chronic pain.

Using a model developed by the Center, pain is measured on a scale from being due to peripheral damage or inflammation (i.e. peripheral) vs. being due to increased pain amplification because of central nervous system processes (central). Working with industry partners, the Pain team is creating new tools that will allow a primary care physician to measure where a patient’s pain falls on that scale and consequently recommend a personalized course of treatment. Sleep, exercise, and nutrition are among the important elements, and treatment can be tracked by the patients themselves using web-based and social media tools that have been developed in partnership with the U-M College of Engineering.

Our industry partner started with the conviction that it’s possible to change the current paradigm of chronic pain management, while reducing costs and improving patient outcomes. They approached U-M because the our Pain Center is a world leader in thinking creatively about diagnosis and treatment, and could provide a “one-stop-shop” offering novel treatment interventions, research validation, and a working laboratory to test our partner’s theory. The project is particularly attractive to industry because it moves chronic pain treatment from expensive specialized care to primary care, and uses evidence-based medicine to reduce waste and rework while engaging patients in their treatment plans and outcomes.

“This joint collaboration is working to develop a new approach to the diagnosis and treatment of chronic pain,” notes Daniel Clauw, Ph.D. and Director of the U-M Chronic Pain and Fatigue Research Center. “It will benefit both the primary care giver and the patient, with the goal being the personalization of treatment and ultimate positive impact on the patient’s quality of life.”

Story credit: Ann Curtis, UMMS Business Development

A Non-Traditional Approach to Industry Collaboration
There are many ways to build an initial relationship with industry, and sometimes it’s not through the usual sponsored-research channels.  Aileen Huang-Saad, Ph.D. and lecturer in Biomedical Engineering, offers up a case study of how U-M research faculty are pursuing non-traditional approaches to industry collaboration.

Our researchers are often faced with very significant real-world patient problems, but don’t necessarily have the time or tools to explore solutions involving potential new medical devices.  A graduate-level class at the U-M College of Engineering is stepping in to fill this gap. With the support of Stryker Corporation, Dr. Huang-Saad is currently leading a class called “Biomedical Engineering Graduate Innovative Design Team." Her student teams, combined with the added experience and resources of Stryker engineers, will help researchers design and test a wide variety of medical devices or solutions and accelerate the most viable options. It’s a perfect example of how industry collaboration can serve the multiple UMHS missions of research, education, and patient care.

Stryker engineers will act as external guest lecturers for the course, sharing their wealth of experience innovating in the “real world.” And as student teams develop prototypes and preliminary business plans, Stryker staff will participate in the needs assessment and solution generation process. With the company’s support, the class will be able to engage in more sophisticated prototyping efforts, and Stryker will provide guidance and industry perspective at each phase of the design process.  At the end of the course, the company will also potentially help targeted student teams continue to move their technologies forward, through potential licensing opportunities.

“The Stryker partnership is enabling us to accelerate and increase our student teams’ ability to innovate,” explains Dr. Huang-Saad. “This includes finding good problems with the most opportunity that are rooted in clinically based insights, and generating solutions and prototypes through multi-disciplinary teams including the medical school, engineering, and legal.”

Story credit: Ann Curtis, UMMS Business Development

Cell Movement Provides Clues To Aggressive Breast Cancer
Researchers from the University of Michigan Comprehensive Cancer Center have identified a specific molecule that alters how breast cancer cells move. This affects the cells' ability to spread or metastasize to distant parts of the body, the hallmark of deadly, aggressive cancer.

By looking at cells in the lab, in mice and in human tissue, as well as developing a mathematical model to predict cell movement, researchers found that the p38-gamma molecule controlled how quickly and easily a cancer cell moved. When p38-gamma was inactivated, cells flattened out and changed from fast motion to an ineffective movement.

"Normal motion is commonly seen in aggressive cancers, which is why it's very important to understand what the key switches are for this motion," says lead study author Sofia Merajver, M.D., Ph.D., scientific director of the breast oncology program at the U-M Comprehensive Cancer Center.

Results of the study appear online in Cancer Research.

Merajver's previous work found that the cancer gene RhoC promotes aggressive metastasis. In this research, her team followed the pathway back to see what controls the cells to make them so aggressive. They identified the p38 molecule, which has several different types, and found in particular p38-gamma is highly expressed in aggressive breast cancer.

The researchers modified the cells so that they inhibited p38-gamma in cell cultures and discovered the changes in shape and motion. Collaborators in the U-M College of Engineering, Ellen M. Arruda, Krishna Garikipati and their team, then developed a mathematical model to show how these changes would impact cell motion. The model predicted exactly what the researchers observed in the cell cultures.

"This gives us a more complete understanding of how aggressive breast cancer cells move and the influence of p38-gamma in particular on modifying this motion," says Merajver, professor of internal medicine at the U-M Medical School. "Cell movement is very difficult to observe, which is why mathematical modeling in oncology is valuable."

Merajver hopes this model, which can be applied to other cancer types, will improve understanding of how cells move, allowing researchers to plan better experiments to look at this function.

Identifying p38-gamma's role in breast cancer provides a strong target for potential new therapies, the researchers say. They believe it will be possible to develop a drug that targets only p38-gamma without affecting other pathways, which would make it more tolerable for patients.

"We do have targeted therapies in the clinic, but the total burden of disease that they ameliorate is still relatively minimal. The reasons may not necessarily be that they are not good drugs, but simply that we don't understand how they work, because we don't understand the biology in sufficient detail. That's why studies like this are so important in advancing drug development," Merajver says.

Story credit: Margarita Wagerson, UMHS PRMC