Different Cultures, Common Goals

In September a delegation of U-M leaders and researchers traveled to Peking University Health Science Center in Beijing, China, for a symposium celebrating the first anniversary of the schools’ Joint Institute for Translational and Clinical Research.

By Mary Masson

A throng of humanity swarms the front lobby of Peking University’s People’s Hospital in Beijing, China, where neon messages flash at the patients who wait in long lines. Professor Yulan Liu, vice president of the 1,000-plus bed hospital, shrugs at the crowd. This isn’t bad, she says, you should see it in the morning.

There’s one inescapable difference between Beijing and Ann Arbor, Michigan, whether you’re driving the traffic-clogged streets, visiting the tourist attractions or trying to see the doctor about that nagging pain: the amazing volume of people.

In one day, University of Michigan Health System facilities have about 6,411 outpatient visits and 319 emergency room visits. In the Peking University Health Science Center system, those numbers are 32,431 and 1,810. Liu says her younger doctors can see up to 50 patients a day.

That tremendous activity is just one reason why China offers so much potential for researchers at the University of Michigan Medical School and other schools on campus. Through the Joint Institute for Translational and Clinical Research, U-M researchers are tapping into the huge volume of patient samples and participants available for study, along with the expertise of top-ranked Chinese colleagues from the well-respected Peking University Health Science Center.

In the U.S., research studies based on 1,000 patient samples or participants can often have groundbreaking results — and be very expensive. But U-M researchers working with colleagues in the Joint Institute can readily envision sample sizes like 2,000, 3,000 or even 4,000. And for both countries, the researchers will access a completely new cohort of patients with different environmental exposures, nutritional habits and behavioral traits.

With data like that, and the potential for cooperation, officials from both U-M and Peking University have high expectations for the results that will come from this partnership. And that’s where researchers find what they have in common — the goals of preventing, treating and curing disease.

“What this partnership offers is the chance to discover treatments and cures for disease that alone neither of us could accomplish,” says James O. Woolliscroft, M.D. (Residency 1980), dean of the U-M Medical School and Lyle C. Roll Professor of Medicine. “Together we are conducting research that will lead to breakthroughs in pulmonary, cardiovascular and liver diseases. We have established a joint institutional review board for human research subjects. We’ve launched six pilot studies, and we’re building an informatics infrastructure to support sample and research data collection and management. It’s an incredible start for the Joint Institute team.”

In September, Woolliscroft led a delegation of Medical School researchers on a trip to Beijing for a symposium celebrating the one-year anniversary of the Joint Institute. Researchers visited laboratories, made progress on established projects and discussed opportunities for the future.

The delegation included not only multiple Medical School leaders and researchers, but also Dean of the School of Dentistry Peter Polverini, D.D.S., D.M.Sc.; Dean of the School of Public Health Martin Philbert, Ph.D.; Associate Dean for Research and Global Affairs in the School of Nursing Antonia Villarruel, Ph.D.; Executive Director of the William Davidson Institute and Professor in the Stephen M. Ross School of Business Robert Kennedy; and Professor of Biological Chemistry and Associate Dean of the Rackham Graduate School David R. Engelke, Ph.D.

The size and breadth of the U-M delegation made an impression on the Chinese leaders. Yang Ke, executive vice president of Peking University and Peking University Health Science Center, pointed out that U-M’s was the largest delegation they’d ever hosted. During the symposium, Ke stressed that the partnership with U-M is the most successful venture they’ve had with another university, even though it is really just beginning. The platform being built is strong and has the potential to achieve major breakthroughs for the ultimate benefit of mankind, she said.

The weeklong symposium had its share of speeches and gift exchanges and high hopes for the future, but this was not just a ceremonial visit. Researchers from both universities had serious conversations about how to move their projects forward. U-M leaders toured hospitals and collaborated with Chinese researchers on study results.

“For those of us who have had active collaborations, it was great to see how the dialogue and problem solving is smooth and building on itself,” says Joseph C. Kolars, M.D., senior associate dean for education and global initiatives and professor of medicine at the U-M. “When we were first getting started, the trust wasn’t there yet. People weren’t mistrustful, they just didn’t know each other and were clumsy out on the dance floor together. To work collaboratively across the geographic and cultural boundaries requires tenacity and a real commitment to taking down the barriers. And the best part of the symposia for me was seeing this in action.”

For both U-M and Peking University researchers, the symposium also offered a chance to be introduced to the possibilities.

In a typical cab ride in Beijing, there are thrills and chills as drivers careen and zip through the streets populated with overstuffed trucks, loads of bicyclists and tons of cars. But when John Carethers, M.D. (Fellowship 1995), U-M’s chair of the Department of Internal Medicine, took a ride to the People’s Hospital with another gastroenterology researcher, they paid little attention to the drivers’ traffic skills. Within a few minutes, they discovered a mutual interest in markers for colorectal cancer and engaged in a vigorous discussion of their research. That conversation continued as Carethers met with more gastroenterologists inside the hospital.

It was a true exchange of academic ideas, and Carethers offered numerous suggestions to the Chinese researchers for new paths to study or next steps for their research. As the discussion concluded, Yulan Liu, a professor and top hospital executive, told Carethers: “I hope in the future that you will have someone in your lab from our department here.”

Carethers and U-M’s gastroenterology faculty later had a follow-up visit with Liping Duan, a vice president at Peking University in graduate studies and gastroenterology. They are working to establish a Joint Institute Fellowship Program to educate potential junior faculty on not only clinical research, but leadership and management.

“One of the really exciting developments from the conference was the awareness among the visiting faculty and scientists about what is being done in China already — and where they could fit in,” says Kolars.

Valerie Castle, M.D. (Fellowship 1990), chair of the U-M Department of Pediatrics and Communicable Diseases, was looking for that place to fit in. Her department does not currently have a research project in the Joint Institute. But after the visit, she’s seeing potential in China, especially for joint research in areas like pediatric kidney diseases, cardiology and neonatology. “I received a greater appreciation for the Joint Institute investment and progress,” Castle says. “It was a terrific opportunity to see firsthand the clinical challenges and accomplishments of the health system in China.”

But for those researchers already engaged in Joint Institute projects, this was a chance to move their projects forward. Projects that have been funded by the Joint Institute for a good portion of the last year include:

• A study into the genetic markers associated with non-alcoholic fatty liver disease, which is led at the U-M by Elizabeth Speliotes, M.D., Ph.D., M.P.H., an assistant professor of gastroenterology, of internal medicine and of computational medicine and bioinformatics.
• Research into the predictors of chronic obstructive pulmonary disease (COPD) and the respiratory microbiome in smokers and non-smokers, led at the U-M by Margaret Gyetko, M.D., professor of internal medicine and senior associate dean for faculty and faculty development.
• A study of the predictors of chronic hepatitis C progression, led at the U-M by Anna Lok, M.D., professor of internal medicine and director of clinical hepatology.
• Research in cardiovascular disease and cholesterol markers, particularly why people with good cholesterol still develop heart disease, led at the U-M by Subramaniam Pennathur, M.D., assistant professor of internal medicine and Eugene Chen, M.D., Ph.D., professor of internal medicine.
• A study of the association of genetic variants with blood pressure and hypertension, led at the U-M by Santhi K. Ganesh, M.D. (Residency 2000), assistant professor of internal medicine.
• Research into the heritability of genes that play a role in myocardial infarction, led at the U-M by Cristen J. Willer, Ph.D., assistant professor of internal medicine.

For Lok, the weeklong symposium provided a chance to meet with her Chinese partners at three sites participating in the study, and spurred her team to make changes to workflow based on the capabilities at those locations. She participated in hands-on training sessions with the research team and worked out a plan for monthly steering committee calls.

“We gained a better understanding of the facilities, workflow and culture at all three sites,” Lok says. “There is tremendous enthusiasm and energy around the project. The visit helped us with team building. We got to know each other better, were able to bond and develop trust and friendship. I came away with more confidence that the project will work, and we can rely on our Peking University colleagues to give it their best effort.”

The friendship was obvious between Gyetko and her lead partner in China, Bei He, M.D., F.C.C.P. He is the vice president of Peking University Third Hospital and Director of its pulmonary division.

As they discussed the project, He and Gyetko nodded enthusiastically.  “I think there is a really, really great future. I do believe we can do more,” He said.

They share a frustration with being unable to help their patients with COPD.

“My dream is we can identify a signature microbiome that is predictive of an unfavorable clinical course and manipulate that microbiome so it is more predictive of a benign case,” Gyetko said. “The power of this study is greater, because we are working in partnership … if we can identify the bacteria that are the bad actors in both populations, we can come to conclusions more quickly.”

To which He added, resoundingly: “Yes!”

U-M Medical School leaders also are dreaming big. During the visit, many U-M delegates visited Pinggu, an area north of Beijing that encompasses an urban city, a more suburban area and a very rural region.

Leaders of the Pinggu hospital showed U-M visitors both their current 900-plus bed hospital and the adjacent 1,200-bed hospital under construction and nearly ready for occupancy. Representatives from the U-M School of Nursing and from the School of Dentistry joined the group to make connections in Pinggu. Speliotes already is working with researchers in this health system.

Conditions are promising for even more partnerships to evolve in Pinggu, says Kolars, adding that the region’s diversity offers great potential for long-term research. Pinggu has a fairly stable population of about 430,000, because people don’t tend to move away frequently, which is beneficial to long-term research.

“One of the big steps forward for us was the visit to Pinggu. This is a terrific health system in a community that could help us understand metabolic disease, cardiovascular, and liver disease much better,” Kolars says. “To have our dean visiting Pinggu with the dean of dentistry and the associate dean for nursing and then chatting on how we could be working together in collaboration with our Chinese colleagues was really exciting.”

 Kolars says he hopes soon to have data from the projects already launched that will demonstrate the power of the partnership and spur even more interest in the Joint Institute.

“Our most important goal in front of us is pursuing the science we set out to do,” he says. “We have pilot projects that we need to fully implement so that we can show the kind of data and results that will be foundational to larger projects. But our goal is to have this as a dynamic platform where U-M and Peking University Health Science Center teachers and researchers can find each other and pursue projects that neither could do alone.”

Some of the U-M delegation ended the symposium with a visit to the Great Wall of China. Like the wall’s uneven steps, steep inclines and unexpected corners, the Joint Institute partnership has its share of challenges. But for both the U-M and its Chinese partners, a climb at the Great Wall is a fitting end to the symposium. Navigating the path laid out by the Joint Institute is much like making the climb at the Great Wall — daunting, but very worth the effort.

View photos from the symposium
Read Mary Masson’s blog coverage of the symposium