The University of Toronto, Faculty of Medicine and Ruth & Bruce Rappaport Faculty of Medicine at the Technion-Israel Institute of Technology Summer Exchange Research Program 2014 SUPERVISOR APPLICATION FORM If you wish to participate in this program and supervise a medical student from the University of Toronto for a 10-12 week period between June - August of 2013, please complete the below form. Submit this form to apelmane@tx.technion.ac.il by the deadline of January 3, 2014 This information will be sent to a pre-selected medical student at the University of Toronto who will be instructed to contact you or the co-supervisor directly. PART A: SUPERVISOR AND CO-SUPERVISOR CONTACT INFORMATION Name of Supervisor at Technion: Dr. Derek LeRoith Email Address: Derekl@tx.technion.ac.il Telephone: 972-4-8541260 Mailing Address: Diabetes and Metabolism Clinical Research Center of Excellence Clinical Research Institute at Rambam(CRIR) Rambam- Health Care Campus P.O.B 9602. Haifa 31096, Israel Department: Diabetes and Metabolism Clinical Research Center of Excellence Degree (MD, PhD, MD/PhD): MD, PhD Area of Medicine of the Research Project Endocrinology, diabetes (2 keywords): Selected Publications (3 most recent or relevant Ferguson RD, Novosyadlyy R, Fierz Y, Alikhani N, Sun H, Yakar S and to the project the student will be working on): Leroith D. Hyperinsulinemia enhances c-Myc-mediated mammary tumor development and advances metastatic progression to the lung in a mouse model of Type 2 Diabetes. Breast Cancer Res. 2012 Jan 7;14(1):R8. Alikhani N, Ferguson RD, Novosyadlyy R, Gallagher EJ, Scheinman EJ, Yakar S, LeRoith D. Mammary tumor growth and pulmonary metastasis are enhanced in a hyperlipidemic mouse model. Oncogene. 2012 Apr 2. doi: 10.1038/onc.2012.113. [Epub ahead of print]. Gallagher EJ, Alikhani N, Tobin-Hess A, Blank J, Buffin NJ, Zelenko Z, Tennagels N, Werner U, Leroith D. Insulin receptor phosphorylation by endogenous insulin or the insulin analog AspB10 promotes mammary tumor growth independent of the IGF-1 receptor. Diabetes. 2013 Oct;62(10):3553-60. Name of Co-supervisor at UofT: Dr. Email Address: Telephone: 2012 UofT/Technion Summer Exchange Research Program Supervisor Application Form Page 1 of 3 Mailing Address: Department: Degree (MD, PhD, MD/PhD): <or> Check here if you require our support in finding a Co-supervisor for your project 2012 UofT/Technion Summer Exchange Research Program Supervisor Application Form Page 2 of 3 PART B: PROJECT INFORMATION Project Title (this can be modified later, but we would like to have a working title from the start): The relationship between cancer and type 2 diabetes Please provide background information on (1) the project and (2) your program/institution; max 500 words: The goal of the project is to determine the factors involved in enhanced breast cancer development and progression in Type 2 diabetes. Epidemiological studies have shown that the risk of developing breast cancer is significantly increased in patients with Type 2 diabetes, and also that prognosis is worsened in diabetic individuals. The studies will be conducted in the laboratory of Dr LeRoith, Director of the Diabetes Research Center at the Rambam Hospital and Faculty of Medicine at the Technion , Israel Institute of Technology , Haifa Israel. The laboratory space is ~200 sq meters, fully equipped with cell culture hoods, incubators, microscopes and surgical equipment , etc. The animal facilities are in an adjacent building where the LeRoith's lab maintains a variety of knockout and transgenic mouse models, approved by the Ethics committee of the Technion. Student’s roles/responsibilities in bullet form (Please be as specific as possible): The student will learn the molecular mechanisms of the diseases and the relationship between them he will also learn new methods of work with animal models of diabetes and cancer student will work with animal tissue or animals If human subjects are involved, has ethics been Yes No V N/A obtained?* If animal subjects are involved, has ethics been V Yes No N/A obtained?* *Note: Written proof or an email indicating protocol approval may be requested prior to the student’s arrival at Technion Please email this completed form to apelmane@tx.technion.ac.il by January 3, 2014 2012 UofT/Technion Summer Exchange Research Program Supervisor Application Form Page 3 of 3