UMMS Dean Woolliscroft (center) receiving a token of friendship from the University of São Paulo brought to him by Dr. Edmund Baracat (left) and Dr. Ana Claudia Latrônico (right)
Faculty members in the University of Michigan Medical School (UMMS) have been collaborating with partners in Brazil for more than a decade. Based in large part on the partnerships existing between the Medical School and several educational institutions in Brazil, Former UM President Mary Sue Coleman traveled to Brazil in 2012 with a delegation of researchers and scholars, including several from UMMS, in an effort to formalize these institutional relationships. During her visit, she signed a collaboration agreement with the State of São Paulo Research Foundation (FAPESP), one of the main funding agencies in Brazil, to stimulate collaboration between researchers across the University of Michigan campus and researchers throughout higher education and research institutions in the São Paulo state.
- One of the resulting initiatives was a joint research grant program. Nine grants have been awarded in the first two rounds of proposals, three of which went to UMMS faculty and their Brazilian collaborators. Another UM major partner in Brazil is Rio de Janeiro’s FIOCRUZ, a leading center for health promotion and social development.
- Multidisciplinary research involving FIOCRUZ and UM faculty (including UMMS researchers) has been funded and stimulated both by Global REACH and the Brazil Initiative at the UM Center Latin America and Caribbean Studies (LACS).
Collaborators from Brazil enjoy one of the first snowfalls of winter during the November 2014 UM-Brazil Platform Symposium
Within UMMS, Memoranda of Understanding exist with both the University of São Paulo Medical School (FMUSP), the Institute of Biomedical Sciences at the University of São Paulo (ICB-USP), as well as growing collaborations with USP's Ribeirão Preto Medical and Nursing Schools. FMUSP is widely considered to be the best medical school in Latin America, with a large research capacity and a network of hospital and ambulatory centers serving hundreds of thousands of patients. Recently, an MOU was also signed with the Medical School of Federal University of Bahia (UFBA), an important university from the Northeast region of Brazil.
- As the Brazil Platform has expanded, so has the increased interest of faculty and student from the University of Michigan and the Brazil partner institutions. Currently, more than 40 Global REACH Faculty Associates and Affiliates from 15+ UMMS departments and other UM Schools and Colleges, are engaged in the Brazil Platform.
- More than 20 UMMS students and fellows have visited Brazil as part of educational programs such as M4 clinical electives and the Brazil Winter School.
If you have any inquires or suggestions about Brazil Platform, please contact Elisa DuarteTeixeira at firstname.lastname@example.org.
Research Programs and Collaboration
Adrenal and Other Endocrinological Cancers and Disorders
The adrenal group meeting at the 2014 symposium in Ann Arbor
Brazil has one of the highest concentrations of adrenal cancer in the world with 15 percent more prevalence than anywhere else.
FMUSP is the South American hub of activity in regard to adrenal cancer work, and UM’s Endocrine Oncology Program is an lnternational Destination Program Center of Excellence for the treatment of adrenal cancer.
UMMS and FMUSP programs have collaborated on research studies over the years, and are now working to create combined data registries. Other joint projects include developing mass spectrometry methods to comprehensively examine steroid production and to detect partial blocks in specific steps in cortisol synthesis.
A recent publication by researchers from the two institutions shows that the two common mutations in adrenal cancer are critical for the induction of the disease in humans and in mouse models. It is a powerful example of how international collaboration (which is critical to make progress in the disease) and genomic platforms, together with animal modeling, can shed light on the pathogenesis of rare diseases like adrenal cancer. The work was funded in part by NIH and in part by the Schembechler Adrenal Cancer Research fund.
Collaborators are working on a center grant to continue their pilot work (funded by the National Cancer Institute) on The Cancer Genome Project, a comprehensive, concentrated effort to accelerate the understanding of the molecular basis of cancer through the application of genome analysis technologies. More about this collaboration can be found in presentations from the 2014 Brazil Symposium by investigators Hammer (view here) and Fragoso (view here).
In early 2015, researchers at the University of Michigan Comprehensive Cancer Center moved closer to uncovering the devastating secrets of adrenal diseases with receipt of a $1.65 million gift from the Hirair and Anna Hovnanian Foundation. The Hovnanian Foundation gift will allow Dr. Gary Hammer and his team to establish the Hirair and Anna Hovnanian Adrenal Cancer Repository and Genomic Database, conduct the world’s most comprehensive genomic and genetic analysis of adrenal cancer, and accelerate the expansion of the adrenal tumor bank. Building a secure database of genetic data and patient data will allow researchers across the globe to access the information; the first step in identifying biomarkers, genetic markers, and genetic syndromes for these tumors.
View a video interview with Dr. Gary Hammer about the importance of the adrenal cancer collaboration with the University of São Paulo.
Gary Hammer, MD, PhD
Millie Schembechler Professor of Adrenal Cancer, Professor of Internal Medicine, Professor of Molecular and Integrative Physiology, Director of Center for Organogenesis and Professor of Cell and Developmental Biology, Medical School
Health Equity and Chronic Disease Management
Members of the health equity and chronic disease management group at the 2014 symposium in Ann Arbor
FMUSP works closely with all primary care centers (Basic Health Units - UBSs) in São Paulo’s low-income neighborhoods of Western Region (Região Oeste). These centers are organized into healthcare teams consisting of 1 doctor, 2 nurses, 2 medical assistants, and 6 community health workers from the served communities.
UM faculty members are working with FMUSP colleagues to develop and test innovative approaches to improve community health worker-led self-management training for patients with chronic disease in Região Oeste.
The Região Oeste project itself is interdisciplinary, bringing together faculty and students from numerous USP departments and schools — including engineering, urban planning, environmental sciences, sociology, economics, and psychology, among others — to conduct interdisciplinary projects to study and improve conditions in the poor urban communities in the Região Oeste.
For the third consecutive year, a group of 3-5 UMMS medical students will spend 6-8 weeks in Brazil during Summer 2016 to work on a project involving Região Oeste. More information about this collaboration was captured in the recent Global REACH Activities Report (view here) and in a presentation made by investigators at the 2014 Brazil Symposium (view here).
Michele Heisler, MD, MPA
Associate Professor of Internal Medicine, Medical School and Associate Professor of Health Behavior and Health Education, School of Public Health; Co-Director, Robert Wood Johnson Foundation Clinical Scholars®, Research Scientist, Center for Clinical Management Research, Ann Arbor VA HSR&D
Spinal Cord Injury
|SCI co-investigator, Dr. Julia Greve (USP), visiting the U-M SCI outpatient clinic to observe patient walking with robotic assistive device|
The incidence and prevalence of spinal cord injury (SCI) in the US and Brazil are among the highest in the world. The cost of caring for someone with SCI continues to exceed that of most disease conditions.
- UMMS and MFUSP researchers are working together to develop a common database to collect information to be used in research to aid clinical care. The collaboration emphasizes the importance of standard datasets to guide clinical treatment and research in SCI. They have translated and completed psychometric studies of the SCI Bowel Function Basic dataset and are currently in the process of completing others for joint use in future clinical validation studies. Testing these datasets adds to the current studies being conducted at the UM SCIMS which focus on examining the influence of bowel and bladder management on complications and quality of life after SCI.
- Comparing data cross culturally is another added benefit of this international collaboration. The Presidents of the International Spinal Cord Society (ISCoS) and the American Spinal Injury Association (ASIA) have approved the project and some initial data were presented at the September 2012 meetings of the International Spinal Cord Society (ISCoS) in London.
- Kidney failure is the number one cause of SCI related mortality. This group is interested in studying the best methods for neurogenic bladder and bowel care in this population.
- The collaborating team is developing a short-term training program on SCI care and research for USP residents and an exchange program for UMMS PM&R residents giving them the opportunity to work with SCI inpatients and outpatients who are clinically and characteristically very different from SCI patients seen in Michigan. More information about this collaboration can be viewed from the Global REACH Activities Report here and a presentation at the 2014 Brazil Symposium here.
Shown are Drs. Fabiana Faleiros (left) and Denise Tate
Dr. Fabiana Faleiros, a faculty member at the School of Nursing at the University of Ribeirao Preto, São Paulo, Brazil spent approximately three months during Winter 2015 with researchers at the University of Michigan SCI Model System (SCIMS) to develop common methods of assessing bladder and bowel problems after spinal cord injury. During her stay, she worked with Dr. Denise Tate, Co-Director of SCIMS, Marty Forchheimer, Senior Research Associate, and others on the translation of international datasets from English to Brazilian Portuguese. The team of collaborators will be comparing data from persons with SCI in Michigan and São Paulo, Brazil, with respect to methods of management, medical complications, and the impact of these on quality of life. The group is also planning joint presentations on the validation of these datasets at national and international meetings in the near future.
Denise Tate, PhD, ABBP, FACRM
Professor of Physical Medicine & Rehabilitation, Medical School; Associate Chair for Research and Director, Model Spinal Cord Injury (SCI); Director, Advanced Rehabilitation Research Program
Dr. Sally Camper is shown with Brazilian colleagues at the 2014 symposium in Ann Arbor
Collaborations have existed for a number of years with shared publications and presentations, and UMMS faculty have taught short-duration courses at USP attended by students and faculty.
- Dr. Luciani Carvalho (USP) and Dr. Sally Camper (UMMS) have a collaboration aimed at identifying stem cell markers in pituitary gland using mouse models. Another USP researcher is using zebrafish to study the effect of environmental toxins on fertility.
- Camper also collaborates with Carvalho’s colleagues Dr. Mendonca and Dr. Arnhold. Mendonca is internationally known for her work in disorders of sexual development, while Arnhold is an expert in short stature.
- São Paulo used to be the only site in Brazil that could treat patients with growth hormones, so they have a large cohort they are following from childhood through adulthood. Carvalho, Arnhold, and colleagues identify mutations in patients with short stature and growth hormone deficiency, Camper’s lab advises and assists with developing the functional tests when needed.
- Plans are in the works to do SNP typing and exome sequencing on patients who have growth hormone deficiency, but have no mutations in known genes. More updates about this collaboration can be viewed from a presentation at the the 2014 Brazil Symposium here.
Sally Camper, PhD
James V. Neel Collegiate Professor of Human Genetics; Chair, Department of Human Genetics; Professor of Human Genetics and Professor of Internal Medicine, Medical School
|Brains from mice infected with an encephalitic virus (bottom row) show disruption of the blood-brain barrier (green dye permeability) that is not seen in control uninfected mice (top).|
Neuropathogenesis of Oropouche Virus
Oropouche virus (OROV) is second only to dengue in causing febrile illnesses in Brazil. Infection can be quite debilitating, although the virus does not cause death. OROV is currently rated as a BSL-3 (Biosafety Level 3) virus, 4 being the most dangerous. UMMS does have a BSL-3 facility, but one of the aims of this collaboration is to petition to reduce OROV's rating to BSL-2 to faciliate additional research.
The arthropod vector of OROV is primarily biting midges (Culicoides paraensis). Deforestation and global climate change impact the potential for expansion of the range of the vector and increase of the disease in South and North America.
Two forms of the OROV disease exist, a classic febrile form and one that progresses to aseptic meningitis in approximately 5% of patients seeking medical care. Nearly 60% of patients have a recurrence of clinical signs 1-2 weeks after their initial disappearance. There is a gap in knowledge about the cells or organs in which OROV replicates and in how it causes relapses and meningitis. Currently, there are no treatments or vaccines.
The long-term goal of this project is to improve therapy for people with arboviral disease by understanding how viral gene products interact with the host to cause disease. Toward that goal, this team seeks to determine how OROV infects the central nervous system (CNS) using and further developing mouse models in which there is severe CNS involvement. Read more about this project from a page in the Global Reach Activities Report (view here).
Dr. Eurico Arruda (left) and Dr. Kathy Spindler in Dr. Arruda's laboratory, University of São Paulo Medical School at Ribeirão Preto, FMRP
Dr. Spindler and her Brazilian collaborator, Dr. Eurico de Arruda Neto from the Cell Biology and Virology Research Center at the University of São Paulo Medical School at Ribeirão Preto (FMRP), have known each other through scientific meetings since 2008. In 2012, Dr. Arruda was on the PhD committee of Luiza Antunes de Castro Jorge, who is now a post-doc in Dr. Spindler’s lab with a “Science Without Borders” scholarship. View a presentation by Dr. Castro Jorge here.
Katherine Spindler, PhD
Professor of Microbiology and Immunology, Medical School
Reproductive Endocrinology and Technology
(left-right) Dr. Tim Johnson (UMMS) and Drs. Edmund Baracat and José Otávio Auler (FMUSP)
|FMUSP faculty visit the UM Center for Reproductive Medicine include (left-right) Drs. Gustavo Maciel, Edmund Baracat, and Jose Maria Soares, Jr.|
- The UMMS-FMUSP collaboration in reproductive endocrinology and technology dates back more than a decade and provided an important foundation for the creation of the Brazil Platform at Global REACH. For several years, UMMS Professor of Obstetrics & Gynecology (OBGYN), Dr. Gary Smith, served as off-site scientific director of the Huntington Centers for Reproductive Medicine of Brazil – a large in-vitro fertilization (IVF) clinic performing over 3,000 cycles per year. The collaborative teams completed phase I and II clinical trials, implemented state-of-the-art infertility treatment and fertility preservation technologies, and improved fertility healthcare. They also published 10 collaborative peer-reviewed papers, participated in more than 20 national and international meetings, and exchanged more than 10 physicians, fellows and students from 2004 to 2013.
- To build on this earlier reproductive sciences work, UMMS OBGYN Professor, Dr. Senait Fisseha, visited the University of São Paulo in February 2015 and met with FMUSP leadership from the Department of Gynecology and the International Relations Commission Office (CRInt). During her visit, she extended an invitation to Dr. Edmund Baracat, FMUSP Full Professor of Gynecology and President of the Undergraduate Medical Education Commission, and faculty members, Drs. José Maria Soares Jr. and Gustavo Arantes Rosa Maciel, to visit UMMS in the Summer of 2015.
- During their visit, Dr. Baracat participated in several activities including a meeting with UMMS Chair of Obstetrics & Gynecology, Dr. Tim Johnson, with whom he developed a plan for strengthening the partnership among the two institutions by focusing on four main areas of mutual interest: PCOS, tumors (especially leiomyoma and breast/ovarian cancers), family planning, and human reproduction, including fertility preservation and premature ovarian failure.
The former Director of the IVF/Andrology and Endocrine laboratories at the UM Center for Reproductive Medicine travelled to São Paulo in November 2015 to conduct a program evaluation for standardizing protocols, and to learn from FMUSP experiences in fertility preservation in cancer patients. A follow up visit is being planned for October, 2016.
Timothy RB Johnson, MD
Bates Professor of the Diseases of Women and Children and Chair of Obstetrics and Gynecology; Arthur F. Thurnau Professor, Professor of Women's Studies; and Research Professor, Center for Human Growth and Development
(left-right) Drs. César Briceño (UMMS), and Drs. Remo Susanna and Mirko Babic (FMUSP)
In early 2014, UMMS faculty members Drs. César Briceño and M. Bernadete Ayres began initial communications with Brazilian partners in the UMMS-Brazil Platform to explore potential OVS collaborations. FMUSP ophthalmology faculty and leadership were very enthusiastic about hosting an exploratory visit aimed at discussing the exchange of residents and potential scientific collaborations. Dr. Briceño’s trip to São Paulo in October 2014 and the November 2014 UM-Brazil symposium in Ann Arbor provided concentrated opportunities for discussion and marked the beginning of a promising collaboration.
In April 2015, the Kellogg Eye Center (KEC) hosted two lecturers from FMUSP: Dr. Remo Susanna, Chair of Ophthalmology, and Dr. Mirko Babic, a specialist in glaucoma. Their talks highlighted the high volume of patients and major research endeavors at FMUSP, including a focus on a water-drinking test used as an effective surrogate for measurement of peak intraocular pressures and as a reliable predictor of patients who are at high risk of vision loss from glaucoma. Dr. Susanna also met with the KEC telemedicine group, led by Dr. Maria A. Woodward, and is especially excited about the ongoing joint Kellogg-FMUSP research protocol involving the use of smart phone photographs in the diagnosis of eyelid lesions. A 3D printed portable slit lamp developed by Dr. Woodward’s team will be tested at FMUSP later this year. Also in April, Dr. Paul Lee, Director of KEC, traveled to Brazil to tour FMUSP ophthalmology facilities and to meet with leadership of the International Relations Commission Office (CRInt).
Additional collaborative activities in 2015 included a one-month observership at KEC for the first FMUSP exchange resident, Dr. Amanda Viel Sanchez, to help develop the UMMS-FMUSP collaboration on telemedicine; and a July visit by FMUSP Dean, Dr. José Otávio Auler Jr., and CRInt Director, Dr. Aluísio Segurado. In December 2015, Dr. Briceño will host a symposium at FMUSP focusing on Oculoplastics, as part of their annual ophthalmology congress – the second-largest yearly ophthalmology meeting in South America. Other KEC faculty will join him for the meeting and then he will travel to Rondônia to visit the ICB-5 branch of the University of São Paulo Institute of Biomedical Sciences (ICB), to plan for the UM-ICB multidisciplinary group visits to the Amazon Region starting Summer 2016.
Collaborations between UMMS and USP date back more than 10 years. Many high-level publications have resulted from these collaborations.
This partnership has resulted in many visiting scholars from Brazil, including three postdocs and four PhD students. Two of the postdocs now hold faculty appointments and remain collaborators; one is at São Paulo State University, one at the Federal University of Rio de Janeiro.
Dr. Peters-Golden is a formal collaborator on grants held in Brazil by Professor Jancar and former trainee Professor Medeiros (Araraquarnra).
During a visit in the fall of 2011, Peters-Golden met with Dr. Carlos Carvalho, Professor of Internal Medicine and Director of Pneumonology, and his department. Based on their discussion, there is mutual interest to further explore possible opportunities for research collaboration and exchange of trainees at the fellowship level (i.e., individuals who have completed MD and internal medicine residency, and are in subspecialty training in Pulmonary and Critical Care Medicine).
Marc Peters-Golden, MD
Professor of Internal Medicine, Medical School, Pulmonary & Critical Care Medicine
The UMich-FIOCRUZ Collaboration is a joint project involving researchers of the University of Michigan and Rio de Janeiro’s Oswaldo Cruz Foundation, FIOCRUZ. The program, which is part of the University of Michigan's Presidential Initiative launched in 2012, is managed by Bebete Martins, Brazil Initiative Program Manager at the Latin American and Caribbean Studies Center (LACS).
The collaboration brings together researchers from both institutions working in the areas of health status, determinants, outcomes, interventions, and histories to engage in substantive and medium-range projects. The research methods are interdisciplinary, including quantitative and qualitative approaches (implementation studies, survey data collection, ethnography, archival research, and more).
On the Michigan side, the interdisciplinary faculty group includes researchers based in the SPH, UMMS, SNRE, LS&A, and ISR. This five-year research collaboration was consolidated at a research symposium held August 7-9, 2013, at the FIOCRUZ campus, in Rio de Janeiro, Brazil. A summary report of the symposium can be downloaded here (PDF). Click these links to learn more about their joint projects from presentations at the 2014 Brazil Symposium: History of Cardiology (view here); Milk Banks (view here and here); and the Brazilian Longitudinal Study of Adult Health - ELSA-Brazil (view here and here). In 2015, U-M-Fiocruz researchers participate in several academic exchanges, continued to work on research collaborations, and organized a mini-course on the history of eugenics and genetics at Fiocruz (view here); and a major interdisciplinary conference on race, health, and discrimination in Brazil (view here).
For more information, please contact Bebete Martins at email@example.com.
Educational Exchanges and Engagement
The exchange of medical students, residents, and fellows between the Brazil Platform partner institutions has been enhanced by the establishment of MOUs and increased cross-national visits of Platform faculty. Since 2012, UMMS has hosted Brazilian medical students who were competitively selected from partner universities in Brazil to participate in clinical observerships under the Special Pathway for International Medical Students (SPIMS) program, overseen by Dr. Maya Hammoud. UMMS and FMUSP departments are beginning to send and host residents from various medical areas for short-period, mentored observerships, and several Brazilian post-docs and fellows (most fully-funded by Brazilian agencies) come to work within UMMS research laboratories.
FMUSP, UMMS, and other international medical students enjoy lunch at Global REACH in January 2015
For the third year in a row, 3-5 UM medical students will go to Brazil in Summer 2016 on a 2-month Faculty-led Trip. These trips are funded by Global REACH and led by a Global REACH Faculty Associate who mentor the students on ongoing joint projects between UMMS and FMUSP faculty. Students accepted for these trips participate in a Portuguese language course at UM offered in the Fall and Winter semesters preceeding their trip and designed specifically to assist them with medical Portuguese and conversation. In addition, the creation of an Online Medical Portuguese course in partnership with FMUSP is underway.
Many of these educational exchanges can be found in the annual Global REACH Activities Reports in the final section of this webpage.
Shown above are participants in the Winter 2014 Portuguese for Spanish-Speaking Health Professionals pilot course. From left to right: Dr. Bernando Rodrigues, MD, PhD (Brazilian fellow at Movement Disorders), Stephanie Chalifour*, Pooja Agrawal*, Elizabeth Kaselitz, LLMSW (Clinical Research Project Manager at the U-M Division of General Medicine), Marlon Bohorquez*, Thaisa Barbosa**, Leonardo Lima**, Simanjit Mand*, and Miguel Rovira*
Some of their collaborative research programs are highlighted on this page as are many of the educational and research initiatives that have taken place over the past few years. Events such as the August 2013 FIOCRUZ Symposium (held in Brazil), and the March 2014 Brazil Meet and Greet and the November 2014 UM-Brazil Platform Symposium (see below), which were held in Ann Arbor, have provided additional opportunities for multi-partner engagement and to showcase many of the institutional collaborations.
Brazil Platform Symposium: November 12-13, 2014
The event aimed to advance the establishment of formal programs for the exchange of medical students, residents and scholars in basic and clinical sciences, and to plan joint educational activities, such as bi-institutional courses and webinars.
Co-sponsors: Global REACH and the Brazil Initiative at the Center for Latin American and Caribbean Studies
View program here (PDF).
Note: The material presented in these PDF files has been made available to the public for personal viewing purposes only. Any alternative use of the material requires permission from the author. Should you wish to request permission for a particular file, please submit the title of the presentation along with the purpose of your request and your contact information to firstname.lastname@example.org.
Presentations are listed according to order in the program.
Wednesday, November 12, 2014
Thursday, November 13, 2014
Brazil Platform Highlights by Fiscal Year
- September 2015: To read a post by Portuguese Communicator at Michigan News, Fernanda Pires, about the collaborations we have with Brazil, including the Winter School mentioned below, click here (in Portuguese).
Summer 2015: FMUSP hosts its first Winter Medical School with more than 50 student participants from around the world. Three UMMS students were among those participants. Read more here.
December 2014: University of Michigan News Services features Milk Bank project. Read more here.
October 2013: Dr. Kate Stanley, UM neonatologist, goes to Belo Horizonte to participate in a Milk Bank International Meeting , as part of the UMich-FIOCRUZ Collaboration (more information, In Portuguese, here: http://www.youblisher.com/p/749759-rBLH-Comunica-N-171-Boletim-da-Rede-de-Bancos-de-Leite-Humano/)
September 2012: President Mary Sue Coleman traveled to Brazil with a delegation of U-M faculty and staff. A pre-trip interview with Dr. Heisler and Dr. Sueann Caufield (another member of the delegation) can be seen here. An article that appeared in the Detroit Free Press on January 14, 2013 can be found here.
An Estate Gift supporting Community Health Training Programs in Brazil was captured in the 2012-13 Global Activities Report. View here.
FY2011-2012 Global REACH Activities Report: platform highlights.