DIGESTIVE DISEASE RESEARCH INSTITUTETehran University of Medical Sciences

History• 1974

• Establishment of the department of Gastroenterology and Hepatology of Shariati hospital

• 1994• Establishment of the Digestive Disease Research Center (DDRC)

• 2007• WHO collaborating center for research on gastrointestinal cancers

• 2011• Establishment of the Digestive Disease Research Institute (DDRI)

DDRC• Education

• Medical students• Residents• GI fellows

• 6-8 GI fellows each year• >100 gastroenterologists trained

• Endoscopy training for Internists• Advanced courses for gastroenterologists

• EUS• ERCP• DBE

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DDRC• Patient care

• Routine hospital load• OPD clinic

• Research

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Medical Ethics Committee

Head of the Institute Research

Committee

Executive Committee

Education Deputy Research Deputy Executive Deputy

Proposal Committee

GERD Research Group

IBS Research Group

Celiac Research Group

Achalasia Research Group

IBD Research Group

Stem Cells Research Group

Biobank

Adminstration Unit

Gastro-Intestinal and Hepatic Clinic

Computer Unit

Higher Council of Digestive Diseases Research Institute

Research Center on Autoimmune and motility disorders of the Gastro-

Enterolgy tracts

Chronic Diseases Prevention Research Group

Finance Management Unit

Digital Library

Nutrition Research Group

Pancreatitis Research Group

General and International

Communications Unit

Research Center on digestive and hepatic

cancers

Esophageal and gastric cancers research Group

Colorectal Cancer Research

Group

Hepatic and pancreatitic

Cancers Research Group

Hepatitis C ResearchGroup

Fatty Liver Research Group

Auto-Immune Hepatitis Research

Group

Research Center on Diseases of Liver,

Pancreas, and Biliary Tracts

Hepatitis B Research Group

Research Center on low invasive

surgeries

Colorectal Research Center

CTC Genetic

Epidemiology

Labratory

Proposal Review Committee• Peer-review of proposals considering priorities• Help in improving research proposals• Collaborating with other associations and universities

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Research Council• Final approval of proposals, progress reports, final

reports.• Deciding on budget allocation to various research groups• Approving collaborations, sample transfer, etc.• Major decisions in research subjects

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Collaborating Center for Ethics committee/IRB on Office for

Human Research Protections

(OHRP)

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Collaborations• Many universities and centers in Iran• Collaborating with the 10 best world institutes and

universities• IARC, WHO, NCI/NIH, Cambridge, John Hopkins, Harvard,

Karolinska, Glasco, Leeds, CRUK

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Collaboration with WHO• IARC is the arm of WHO researching on cancer• So our collaboration with WHO has been mainly through

IARC• We have even managed to secure funding from IARC!• Over 20 high-impact papers each year closely related to

problems in Iran, many of which have the potential to change health policies.

• Many training opportunities for our researchers• Have returned to DDRI and help us here or …• Have moved to other research institutes abroad forming further

opportunities for collaboration

Scopus

GI Cancer Research Center• Gastro-Esophageal Malignancy In Northern Iran (GEMINI)

• Case control study• 300 cases of gastric cancer• 600 controls• In collaboration with NCI/NIH/IARC• Numerous studies published and still being published

• Golestan Cohort Study

Collaborations in GEMINI• GEMINI was probably the one research project which

boosted collaborations of DDRI with the world• We currently have collaborations in GEMINI with 10-20

internationally recognized centers and institutes

How to Make Collaborators Interested

• It is not easy to draw attention of international organizations

• Specially in a country so blackened by the media• Guidelines are needed!

Guidelines for Attracting Collaborators

• Search for something of mutual interest for you and the international community.• Cancers• Cardiovascular mortality and it’s prevention

• Choose a subject in which you have an advantage• High rate of ESCC in north Iran than most of the world• Referral center for Achalasea with over 800 samples• Very good infrastructure for population based rural studies

Guidelines for Attracting Collaborators

• Search the literature to find centers/authors most interested in this subject with most publications

• Identify authors with highest interest and key persons• Contact them

• Emails• In person in meetings/congress/…• Through colleagues working in the same centers/city

• Iranians abroad• Previous collaborators

Start the Collaboration• Invite them to Iran (congress, seminar, meeting, …)

• Their view to Iran will suddenly change• You can discuss the basics of collaboration without distrations• Sometimes a PhD student can be assigned at the same time

• Good proposal• It helps a lot if you can send a sharp PhD student to the

collaborating center to work on the mutual project.• Much better communication• Training opportunity

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The Golestan Cohort Study (GCS)• A cohort of 50,000 subjects, above 40 y/o started on

2005, now 9 Years old. A great deal of data collected including:• Detailed 30-page questionnaire (including FFQ)• Frozen samples of serum, whole blood, nails and hair.• Yearly follow-up of subjects

• The cohort was originally designed to study ESCC, but many other studies are also on-going within this cohort.

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Sub-Cohorts of GCS• Hepatitis B cohort

• Approx. 5,000 subjects• All HBs Ag positives subjects of GCS (3500) and their positive

family members (1500)• Ultrasound and Fibroscan available for those living in Gonbad

(400)

• Hepatitis C cohort• 350 subjects• Ultrasound and Fibroscan available

• NAFLD …

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Sub-Studies of GCS• Re-measurement

• 20-25% of the GCS subjects were revisited after 5 Years and data/samples collected

• PolyIran project• Interventional study• Aims at reducing cardiovascular mortality

• PolyIran-Liver project• Focusing on liver disease

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The PolyIran Study• We observed that during the first 5 Years of GCS, the

mortality from cancer was less than 20% whereas the mortality of CVD was over 50%

• We started a CVD-prevention trial with a combination pill we call “PolyPill”

• We have randomized all re-measurement subjects above 50 (8,500) to receive either polypill or minimal care

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PolyPill• ASA: 81 mg• Atorvastatin: 20 mg• Hydrochlorthiazide: 12.5 mg• Enalapril: 5 mg or Valsartan: 80 mg

Given daily for 5 years

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The PolyIran-Liver Study• 1,500 of the PolyIran subjects live in the city of Gonbad

where better facilities are available.• These subjects undergo some liver work-up too; we call

them the PolyIran-Liver group• Ultrasound• Fibroscan• IMT, visceral fat measurement, MRI

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Future and On-Going Activities• Identifying high risk groups for gastric and esophageal

cancer• Preventive measures• Providing guidelines for early detection

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Ardabil (prevalent gastric cancer)• Ten years ago, we performed1000 endoscopies on

randomly selected volunteer subjects over 45 years of age

• Chromoendoscopy (lugol staining) was carried out on all subjects and suspicious lesions were biopsied

• In addition, biopsies were obtained from 10 predetermined sites in the stomach

• Histology, blood, urine, nail, and hair samples plus an extensive questionnaire is available

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Ardabil (prevalent gastric cancer)• We have identified over 900 of these subjects • 34 cases of cancer have been documented• We will compare initial data of subjects with progressed or

new precancerous lesions with controls• We hope to find markers in their initial data (pathology,

blood, questionnaire, …) which helps us identify high risk subjects

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Gonbad (prevalent esophageal cancer)

• We have already identified a few risk factors during our studies in Gonbad

• In the case control study (GEMINI), we compared 300 cases of esophageal cancer with 600 controls

• In the cohort (GCS), we have followed 50,000 subjects and so far over 50 have developed esophageal cancers

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Gonbad (prevalent esophageal cancer)

• During these studies we have already identified 7 risk factors

• We will use these factors to create a model for prediction of esophageal cancer

• High-risk subjects can then be screened by endoscopy

GE Cancer Screening Project (GESP)

• Finding an efficient screening method for esophageal Ca• Most screening protocols are not really cost-effective• Endoscopy for all is definitely not an option• Evaluating serologic tests, sponge cytology, …

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