This competitive renewal application for a postdoctoral training program in Geographic Medicine and Infectious Diseases at Case Western Reserve University seeks renewal funding for a training program which has had 20 years of uninterrupted support. Thirty-five faculty from eight academic departments participate in the training program. Support is requested for four positions per year, allowing one to two new M.D. postdoctoral fellows to enter the program each year for up to three years of research training support. The program is based on the recognition that diminishing pools of talented and committed physicians threaten to hamper the interactions between clinical and basic scientists, necessary for the application of novel biomedical approaches to infectious diseases research. Training of dedicated physician scientists in the basic biology of infectious diseases remains critical for continued progress in the evolving struggles against human infectious pathogens. This program draws on an expanded pool of candidate trainees from adult and pediatric infectious diseases, and pulmonary medicine fellowship programs at CWRU. The unique features of the training program remain: 1) programmatic areas of research on selected parasitic, bacterial and viral pathogens which are approached using multiple basic disciplines including immunology, biochemistry, molecular biology and epidemiology; 2) international projects and access to well-characterized populations affected by pathogens which are the focus of basic investigations at CWRU; 3) coordinated and structured participation of basic and clinical scientists in training activities. The overall goals of the training program are:

1. To provide rigorous training of promising M.D. postdoctoral fellows in the application of the tools of immunology, molecular biology or biochemistry to the study of parasitic, bacterial and viral diseases.

2. To assume an active role in career development by training and assisting trainees in securing funding either for additional basic postdoctoral training or for faculty development depending on their level of training at entree into the program and development in the training program.

This is a new application for a training program in pulmonary host defenses to microbial pathogens. At Case Western Reserve University (CWRU), research in pulmonary host defenses is remarkably well-developed and perceived to be an institutional strength. Internationally recognized faculty in a number of programmatic areas including tuberculosis (Tuberculosis Research Unit (TBRU)), human immunodeficiency virus-1 (HIV-1) (Center for AIDS Research (CFAR)) and AIDS Clinical Trails Group (ACTG) and Pseudomonas infection (Cystic Fibrosis program) are based at CWRU. Despite the scope of our research activities, however, there currently is no training program that focuses on pulmonary host defenses. The main purpose of the proposed program is to use the existing investigator talent and resources at CWRU to rigorously train physician and Ph.D. scientists to develop productive research careers in this area. The proposed training program will benefit from the highly competitive clinical programs in the Departments of Medicine; and Pediatrics. Yet, as an essential aspect, the research will cut across Departmental and Divisional lines. There are 31 participating faculty in this training program from 5 Departments (Medicine, Pediatrics, Biochemistry, Genetics, and Pathology). Within Medicine and Pediatrics, members from both The Pulmonary and Infectious Diseases Divisions that focus on pulmonary host defenses are involved. Many of the participating faculty have had long-term productive collaborative interactions and have trained a number of successful research and physician scientists in an interdisciplinary manner. Over the past 10 years, research activities at CWRU directly related to pulmonary host defenses to microbial pathogens have increased substantially ($15 million direct costs annually) with diverse research programs in molecular biology, biochemistry, cell biology and immunology. This research training program will be a mechanism to bring together these investigators and programs as never before and will have a major impact on training and future research in pulmonary host defense at CWRU. This application seeks 3 post-doctoral positions in year I and 2 to 3 new trainees per year (M.D. and Ph.D.) in the subsequent years. The critical aspect of this training period will be the 2 years of supervised research experience in the laboratory of a participating faculty member. Considerable didactic work also is provided for the M.D. trainees and is available to the PhD trainees as well, including cell biology and immunology courses. The shrinking of academic subspecialty research training programs brought on by dramatic changes in health care delivery systems forces profoundly different approaches to training physician scientists in programmatic areas. Our proposed training program which emphasizes crossing of Departmental and Divisional barriers is, we believe, necessary for the successful training of the next generation of physician-scientists in the area of pulmonary host defenses.

The AIDS International Training and Research Program at Case Western Reserve University will build upon a broad array of research activities on HIV prevention to train Ugandan scientists and health professionals. The training will be focused on the central scientific theme of HIV prevention, including HIV-1 preventive vaccines and the prevention of common diseases which complicate or promote HIV in developing countries. The training will be offered in both graduate degree and non-degree settings to build the research capacity in Uganda. The graduate degree training will be multidisciplinary and will include training in disciplines such as Epidemiology, Biostatistics, Health Services Research, Anthropology, Immunology, HIV Virology, Biomedical Ethics and Nursing. Non-degree training in the U.S. will cover laboratory techniques and research methodologies best taught in the U.S. setting. The training will be long-term for post-doctorate trainees and short-term for technicians and clinicians. Uganda-based non-degree training will be designed to meet the specific needs in support of HIV/AIDS prevention research for health professionals, technicians, and allied health professionals. To provide continuity of training, a Ugandan research mentor, and former AITRP trainee, will provide structure and help to coordinate research and training activities in Uganda. To encourage independent local research on HIV prevention, build capacity to perform independent research, and disseminate research findings, a society for HIV/AIDS research is proposed. In addition, programs in biomedical ethics and medical informatics cut across the scientific and training themes and will be developed.

Division of Infectious Diseases Research

Division of Infectious Diseases Clinical

Division of Geographic Medicine