National Institute of Arthritis and Musculoskeletal and Skin Diseases

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is one of the institutes and centers that make up the National Institutes of Health, an agency of the United States Department of Health and Human Services (HHS).

NIH is the primary federal agency that conducts and supports basic, clinical and translational medical research. The institute investigates the prevention, diagnosis, causes, treatments and cures (PDCTC) for both common and rare diseases.^[1]

Mission

NIAMS' mission is to support research into arthritis, musculoskeletal and skin diseases PDCTC; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. NIAMS supports and conducts basic, clinical, translational and epidemiologic research and research training at universities and medical centers.^[2]

History

August 1950—An arthritis program was established within the National Institute of Arthritis and Metabolic Diseases under Public Law 81-692.

May 1972—P.L. 92-305 renamed the Institute the National Institute of Arthritis, Metabolism, and Digestive Diseases.

1973—Senator Alan Cranston introduced legislation that would eventually lead to the National Arthritis Act. Companion legislation was introduced in the House by Congressman Paul Rogers.

January 1975—The National Arthritis Act (P.L. 93-640) established the National Commission on Arthritis and Related Musculoskeletal Diseases to study the problem of arthritis and to develop an arthritis plan. The act established the position of Associate Director for arthritis and related musculoskeletal diseases and authorized an interagency arthritis coordinating committee; community demonstration project grants; an arthritis data bank; an information clearinghouse; and comprehensive centers for research, diagnosis, treatment, rehabilitation and education.

April 1976—After a year of study and public hearings, the commission issued a comprehensivtre plan aimed at diminishing the physical, economic and psychosocial effects of arthritis and musculoskeletal diseases. It laid the groundwork for a national program encompassing research, research training, education and patient care.

October 1976—The Arthritis, Diabetes, and Digestive Diseases Amendments of 1976 (P.L. 94-562) established the National Arthritis Advisory Board to review and evaluate the implementation of the Arthritis Plan, prepared in response to the National Arthritis Act (P.L. 93-640).

December 1980—P.L. 96-538 changed the name of the Institute to the National Institute of Arthritis, Diabetes, and Digestive and Kidney Diseases. 1982—HHS conferred bureau status on the Institute, resulting in creation of the Division of Arthritis, Musculoskeletal and Skin Diseases and the appointment of a Division Director.

November 1985—The Health Research Extension Act of 1985, P.L. 99-158, established the National Institute of Arthritis and Musculoskeletal and Skin Diseases to increase research emphasis. The legislation provided for the development of a plan for a national arthritis and musculoskeletal diseases program and established two interagency coordinating committees, one on arthritis and musculoskeletal diseases and one on skin diseases. It also expanded the activities of the National Arthritis Advisory Board to include these diseases.

September 1993—The NIH Revitalization Act of 1993 (P.L. 103-43) directed NIAMS to establish "an information clearinghouse on osteoporosis and related bone disorders to facilitate and enhance knowledge and understanding on the part of health professionals, patients, and the public through the effective dissemination of information."

October 2000—The Children's Health Act of 2000 (P.L. 106-310) directed NIAMS to expand and intensify research programs on juvenile arthritis and related conditions, in coordination with other NIH Institutes and the Arthritis and Musculoskeletal Diseases Interagency Coordinating Committee. The Institute directed to include resources on juvenile arthritis and associated conditions in its clearinghouse.

November 2000—The Lupus Research and Care Amendments of 2000, which passed as part of the Public Health Improvement Act (P.L. 106-505), required NIAMS to expand and intensify research and related activities regarding lupus. Among other provisions, the bill called for information and education programs.

December 2001—The Muscular Dystrophy Community Assistance, Research, and Education Amendments of 2001, or the MD-CARE Act (P.L. 107-84), called on several components of the NIH, including the NIAMS, to enhance research on muscular dystrophy, including establishing Centers of Excellence.

February 2003—The Omnibus Appropriations Act for FY 2003 (P.L. 108-7) directed Office of the Secretary, HHS, to establish a Federal working group on lupus for the purpose of exchanging information and coordinating Federal efforts regarding lupus research and education initiatives. NIAMS led this Federal working group. The group has representatives from all relevant HHS agencies and other Federal departments.

October 2008—The Paul D. Wellstone Muscular Dystrophy Community Assistance, Research, and Education (MD-CARE) Amendments of 2008 (P.L. 110-361) officially named the related Centers of Excellence after the Senator. In addition, the Muscular Dystrophy Coordinating Committee was authorized to give special consideration to enhance the clinical research infrastructure to test emerging therapies.

Directors

Programs

NIAMS supports a multidisciplinary program of basic, translational and clinical investigations; epidemiologic research; research centers; and research training for scientists internally and via grants to universities and medical schools. It also supports the dissemination of research results and information through the NIAMS Information Clearinghouse and through the NIH Osteoporosis and Related Bone Diseases National Resource Center.

More than 80 percent of NIAMS funds are awarded via grants and contracts, including some outside the US. Approximately 10 percent of NIAMS’ funding supports research and training activities carried out by NIAMS scientists on its campus in Bethesda, Maryland (including the NIH Clinical Center). Principal investigators lead intramural research projects that involve trainees ranging from high school students to postdoctoral and clinical fellows.

Extramural Research

Most NIAMS funding supports investigators involved in a wide spectrum of basic, clinical, epidemiologic, training, and other programs in universities, medical schools, academic health centers, and small business concerns. The NIAMS Extramural Program's three Divisions—the Division of Extramural Research Activities, the Division of Skin and Rheumatic Diseases, and the Division of Musculoskeletal Diseases—are as follows:

Division of Extramural Research Activities—manages NIAMS' grants, policies and procedures, including grant oversight and contract administration, scientific review and clinical research functions. It serves as the primary liaison for NIAMS with the NIH Office of Extramural Research and with other Institutes that share research interests. It handles scientific integrity and ethical questions in research and manages the NIAMS Council, a congressionally mandated second tier of the NIH peer review system.

Scientific Review Branch—conducts initial peer review of specific research applications. These include applications for Centers, program projects, multi-site clinical trials, scientific meetings and training and career development, as well as applications responding to initiatives published by NIAMS. External peer reviewers selected from the grant community conduct reviews.

Grants Management Branch—works with scientists and institutional research administrators to issue, manage and close out awards. The branch has legal responsibility for the fiscal management of the Institute’s extramural grants and contracts.

Division of Skin and Rheumatic Diseases

Its mission is to promote and support basic, translational and clinical studies of the skin in normal and disease states, leading to PDCTC for rheumatic and related diseases. Research is managed under two main areas:

Arthritis and Rheumatic Diseases—advance clinical biomedical and biopsychosocial PDCTC research for arthritis and rheumatic diseases. This includes work that advances the understanding of the natural history of these disorders, as well as mechanisms of disease susceptibility and development. The programs support research in rheumatoid arthritis; adjuvant and chemically induced inflammatory arthritis; systemic lupus erythematosus; systemic scleroderma; spondyloarthropathies; dermatomyositis and myositis; vasculitis; fibromyalgia; juvenile arthritis and general autoimmunity; gout; Lyme disease; and infection-related arthritis. Research incorporates advances in genetics, genomics, proteomics, microbiomics and imaging related to arthritis and rheumatic diseases.

Skin Biology and Diseases—support a broad portfolio of basic, translational, and clinical research in skin. These efforts include work on its developmental and molecular biology, role of skin as an immune organ and genetics. Areas of particular emphasis include: investigations of stem cells derived from skin; studies related to wound healing and fibrosis; heritable disorders of connective tissue (such as Marfan syndrome); studies related to itch; metabolic studies such as the effects of hormones and the role of enzymes in skin barrier formation; and immunologically-mediated cutaneous disorders, such as atopic dermatitis, contact dermatitis and vasculitis. Research is underway to better understand keratinizing disorders such as psoriasis and ichthyosis; disorders of pigmentation such as vitiligo; and bullous diseases such as pemphigus, pemphigoid, and epidermolysis bullosa. Other studies encompass acne and the physiologic activity of the sebaceous glands, as well as disorders of the hair, such as alopecia areata.

Division of Musculoskeletal Diseases

This group supports PDCTC research on diseases and injuries of the musculoskeletal system and its component tissues: the skeleton, muscles and connective tissues such as tendons and ligaments. Key public health problems addressed by this research include osteoporosis, osteoarthritis, and muscular dystrophy. Research is conducted at every level, from fundamental biology to clinical intervention. Research is managed under three main areas:

Bone Biology and Diseases—supports research to better understand genetic and cellular mechanisms involved in the buildup and breakdown of bone. Research areas include: regulation of bone remodeling; mechanisms of bone formation, bone resorption and mineralization; and effects of hormones, growth factors and cytokines on bone cells. The programs emphasize the application of fundamental knowledge of bone cell biology to the development of drug and gene therapies for bone diseases, especially osteoporosis. This program area supports several large epidemiologic cohorts for the characterization of the natural history of osteoporosis and for the identification of genetic and environmental risk factors that contribute to bone disease.

Muscle Biology and Diseases—support PDCTC research projects in skeletal muscle biology and diseases. They focus on the fundamental biology of muscle development, physiology and muscle imaging. Particular interests include the basic biology of satellite and muscle stem cells, excitation-contraction coupling, muscle metabolism and adaptation of muscle to exercise. The programs address a need for translational research to develop discoveries that enhance treatment and improve management of muscle and musculoskeletal diseases and disorders. Research targets muscular dystrophies, inflammatory myopathies, muscle ion channel diseases, and muscle disorders such as disuse atrophy and age-related loss of muscle mass.

Musculoskeletal Biology and Diseases—understanding the fundamental biology of tissues that constitute the musculoskeletal system, and on applying this knowledge to related disorders. PDCTC Research includes the study of acute and chronic injuries—including carpal tunnel syndrome, repetitive stress injury, and low back pain—and osteoarthritis. The programs support the development of new technologies such as imaging methods. Therapeutic approaches of interest include drugs, nutrition, joint replacement (including biomaterials and implant science), bone and cartilage transplantation and gene therapy. Tissue engineering, regenerative medicine, sports medicine and musculoskeletal fitness are areas of special emphasis.

Intramural Research

Intramural Research Program (IRP) conducts relevant and provides training for investigators who are interested in related research careers. Scientists perform PDCTC clinical studies on rheumatic, autoimmune, inflammatory, joint, skin and muscle diseases. The program operates a Laboratory of Regenerative Medicine and a Laboratory of Oral Connective Tissue Biology. NIAMS scientists explore genetic databases that provide insights into the immune-system defects that underlie rare inflammatory diseases such as ankylosing spondylitis. For example, an intramural investigator’s discovery of an immune system protein led to the identification of therapeutic targets for multiple rheumatic conditions. This led to work facilitated by two Cooperative Research and Development Agreements (CRADAs) between NIH and industry and ultimately U.S. Food and Drug Administration approval of an oral rheumatoid arthritis medication that represents a new class of drugs.

Office of the Scientific Director—program planning, budget and policy formation and resource allocation. The Scientific Director represents NIAMS in NIH-wide intramural policy and program discussions. The Scientific Director serves as the principal advisor to the NIAMS Director concerning ongoing and projected intramural research programs.

Office of the Clinical Director—implements relevant clinical research programs. Through specific programs in translational research, rheumatology fellowship training and health partnerships, the Office establishes cutting-edge therapeutic paradigms, education and in outreach.

Autoimmunity Branch—conducts basic and clinical PDCTC research of autoimmune diseases. Signal transduction pathways that differentiate normal and pathological immune responses are studied in mouse models and human tissue samples and researches targeted immune suppression therapies. The tumor necrosis factor-family of cytokines and their receptors are a current focus, from molecular trafficking and signaling to the study of human diseases.

Cartilage Biology and Orthopaedics Branch—conducts basic and clinical PDCTC research on orthopaedic surgery-relevant musculoskeletal diseases. Current investigations focus on the genetic, cellular, and molecular events involved in the development of heterotopic ossification (HO). Specific attention is paid to progenitor cells obtained from human tissue samples and their trophic and differentiation properties involved in tissue repair and regeneration.

Clinical and Investigative Orthopaedics Surgery Unit—studies the outcomes of many important orthopaedic conditions. The studies are using large clinical databases to investigate rare femur fractures, uncommon hip infections, and novel fracture treatments. The goal is to provide clinical insights into conditions that cannot be examined in traditional clinical studies.

Clinical Trials and Outcomes Branch—studies the health outcomes of patients with rheumatic diseases and orthopaedic conditions. Studies focus on the development and testing of measures of health and disease, identification of predictors of good and poor health outcomes, examination of treatment effectiveness, and investigations of socioeconomic and ethnic disparities in health outcomes.

Community Research and Care Branch—coordinates the NIAMS Community Health Center, a health information resource and medical center that carries out research and provides health services to arthritis, lupus, and other rheumatic disease patients. The Center is located in Silver Spring, MD.

Laboratory of Molecular Immunogenetics (LMI)—studies genetic and molecular regulation of normal and abnormal immune cell processes. LMI includes the Molecular Immunology Section and the Genomics and Immunity Section that study the molecular underpinnings of inflammation regulation in both health and disease.

Laboratory of Muscle Stem Cells and Gene Regulation—investigates the cellular and molecular mechanisms that regulate differentiation and regeneration of skeletal muscle. The ultimate goal of these studies is to provide a practical conceptual PDCTC framework.

Laboratory of Oral Connective Tissue Biology—studies the molecular biology of dental-oral-craniofacial development, with a focus on teeth, gums and jaws. The aim of these studies is to understand cells and signals influencing tooth, bone, and periodontal ligament development.

Laboratory of Skin Biology—studies the regulation of epidermal differentiation, skin barrier formation, and inflammatory responses associated with barrier dysfunction. A major focus is basic investigation of ectodermal appendage development and the study of human ectodermal dysplasias.

Laboratory of Stem Cell Biology—studies cell fate and tissue development. It examines various types of stem cells to generate neurological disease models, to discover and test drugs, and to develop replacement therapies for neurodegenerative diseases and disorders.

Laboratory of Structural Biology Research—studies the structural basis of the assembly and functioning of macromolecules and their complexes (such as viruses and cytoskeletal proteins), and the mechanisms and proteins that control their assembly. These studies make extensive use of cryoelectron microscopy and three-dimensional image processing in studies of virus infection and replication; renewal of the epidermis, with maintenance of barrier function; prionogenesis (structural transitions of infectious proteins called prions); and intracellular protein quality control by energy-dependent proteases.

Molecular Immunology and Inflammation Branch—conducts basic and clinical investigations of the molecular mechanisms underlying immune and inflammatory responses in rheumatic and autoimmune diseases. A major focus is the study of receptor-mediated signal transduction and how these processes link to the regulation of genes involved in inflammatory responses.

Office of Science and Technology—provides research and support infrastructure to support IRP scientists. Staff members advise the Scientific Director, Laboratory and Branch Chiefs and other key officials on collaborative and cooperative activities, training programs and proper use of laboratory animals. Staff members also negotiate and facilitate scientific collaborations that involve trans-institute and trans-NIH initiatives and agreements. The Office includes the following:

• Flow Cytometry Section—provides state-of-the-art multiparameter analytic and sorting capabilities for IRP investigators.
• Laboratory Animal Care and Use Section—supports all IRP branches and laboratories that study animals.
• Light Imaging Section—offers IRP scientists access to state-of-the-art light imaging equipment and expertise in light imaging techniques.
• Biodata Mining and Discovery Section—assists with computational and bioinformatics approaches to NIAMS' intramural research.
• Translational Immunology Section—provides NIAMS investigators with services, consultative advice and in-depth instructions in immunologic methods to interpret immunoassays.

Pediatric Translational Research Branch—conducts basic, translational, and clinical PDCTC research in immune-mediated inflammatory diseases. The mechanisms by which specific mutations and genetic polymorphisms predispose to inflammation and how they contribute to unique phenotypic manifestations of individual diseases.

Protein Expression Laboratory—studies the expression, purification and structural characterization of human immunodeficiency virus (HIV) and HIV-related proteins. Laboratory scientists collaborate with NIH intramural researchers studying the structure and function of HIV and HIV-related proteins. The lab serves as a support and resource group for the expression and purification of these proteins.

Systemic Autoimmunity Branch—studies the fundamental mechanisms that lead to the development and perpetuation of systemic autoimmune disorders, particularly systemic lupus erythematosus and rheumatoid arthritis and their associated organ damage. By identifying the mechanisms of tissue damage, the Branch explores specific drugs that can block identified pathways can mitigate complications.

Rheumatology Fellowship and Training Branch—provides clinical and research training of physicians wishing to pursue careers in biomedical or translational research. The fellowship program runs two years with extensions available for advanced research training. The program is accredited by the Accreditation Council for Graduate Medical Education (ACGME) and graduates are eligible to sit for the certifying examination.

Career Development and Outreach Branch—advises the Scientific Director, Lab and Branch Chiefs and other IRP officials on current and potential training programs; coordinates resources available for NIAMS fellows and their sponsors; and works in partnership with existing NIAMS and NIH components to ensure that NIAMS continues to attract the highest caliber of trainees. In addition, it leads career outreach activities, administers the summer internship program and supports the annual Intramural Retreat.

References

1. ↑ "Arthritis, Musculoskeletal and Skin Diseases Home Page". nih.gov. 
2. ↑ "IRP Mission". nih.gov. 

External links

• Official website
• Bill Summary & Status 99th Congress (1985 - 1986) H.R.2409 All Information
• National Institutes of Health home page