Endocrinology & Metabolism Research Institute
Tehran university of Medical Sciences
Bagher Larijani MD
Professor of Endocrinology
&Internal medicine
President of Endocrinology
&Metabolism Research
Institute (EMRI)
2012
Introduction (EMRI )/Research
University
Endocrinology & Metabolism Research
Institute was established in 1993 as a center
affiliated to Tehran University of Medical
Sciences.
It was upgraded and recognized as Research
Institute since 2010.
Due to vast research activities, the institute
upgraded to 3 subgroup institutes and 9
research centers in 2012 by Ministry of Health
and Medical Education.
The headquarter of EMRI is located in Dr.
Shariati University Hospital.
EMRI Organizational Chart /Head Office
National &
International
Advisors
Director & Chief Scientific
Officer
Affiliated
Professors
Deputy Director-General
Director of Public &
International Affairs
Administration & Human
Resource Deputy
Information Technology
Management
Executive Secretary
Research Deputy
Public & Professional Training
Research Divisions and Laboratories directly under
supervision of director
Research Divisions
Research Laboratories
Endocrine Modeling
Bio electrochemistry
Immunogenetics
Bio nanotechnology
Bionanotechnology
Modeling & Protein
Chemistry
Food & Drug Research
Traditional Medicine
Evidence Based
Medicine
Sensors
Medical Ethics
Cellular & Molecular
Innovation
Hormone
Islamic Fasting
Endocrinology and Metabolism Research
Institutes / Research University
Institute of
Endocrine Clinical
Sciences
Institute of
Endocrine
Population Sciences
Institute of
Endocrine Cellular and
Molecular Sciences
Organizational Chart of Institutes
Institute of
Endocrine Clinical
Sciences
Endocrine
Research Center
Institute of
Endocrine Cellular and
Molecular Sciences
Inborn Metabolic
Disorder Research Center
Diabetes
Research Center
Osteoporosis
Research Center
Obesity & Eating Habits
Research Center
Biosensor Research
Center
Institute of Endocrine
Population Sciences
NCD Research
Center
Health Elderly
Research Center
Chronic Disease
Research Center
GOALS
• Goal 1: Enhancement of research and
knowledge production
• Goal 2: Expansion of professional and
graduate education
• Goal 3: Promotion of translational medicine by
enhancing communication between clinic and
laboratory
The Main Objectives of the Goals
are:
• Goal 1
– acceleration of knowledge production
– Upgrade the quality of research
– Improve research productivity
– Keep with the ethical and legal standards
• Goal 2
– Narrow interdisciplinary gaps in the field
– Focus on research based education
• Goal 3
– Focus on national priorities
– Become technologically self sufficient
– Adapt the unifying national framework
– Expand internet based research and educational resources
Facts and Strategy of EMRI
• During past 18 years, In collaboration with MOH, EMRI as the
highest ranking medical research institute in Iran, has played a key
role in:
• Establishing national research networks on Diabetes,
Osteoporosis , Aging and Obesity
• Conducting fundamental and practical researches on NCD which
21 centers are involved in the networks.
• Other subjects of strategies includes, improving public
awareness, professional education and provision of clinical
services with focus on diabetes, osteoporosis, and metabolic
diseases.
Memberships
EMRI is Member of 12 international Agencies and
NGOs
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The Endocrine Society USA
Society for Endocrinology England
Thalassemia International Federation (TIF)
American Association of Clinical Endocrinology (AACE)
American Diabetes Association (ADA)
International Osteoporosis Foundation (IOF)
International Diabetes Foundation(IDF)
European Association for cancer research(EACR)
Asian Task Force for Organ Trafficking
Asian Bioethics Association (ABA)
International Association of Bioethics (IAB)
European Society for Quality Health Care
2002 to present
2002 to present
2002 to present
2003 to present
2003 to present
2003 to present
2004 to present
2005 to present
2007 to present
2007 to present
2008 to present
2010 to present
Statues of Diabetes in Iran &..
 Diabetes increasing all around the world especially in developing countries
such as China, India, Pakistan and Iran. (reported by IDF, WHO)
 50% of EM people with diabetes will die of cardiovascular diseases. This
means that in our region, there are pandemic trends in prevalence of diabetes
and associated complications.
 Globally, people with diabetes are 25 times more likely to have a leg
amputated than those without the condition.
 Somewhere in the world, a leg is lost due to diabetes every 30 seconds.
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US Dept of Health and Human Services, National Center for Health Statistics, National Vital Statistics 11
Reports
Population: 75 (2011)
Total area: 1.648 million sq km
•Today about 3.5 million (out of about 75 million) people are
suffering from diabetes and its complications in Iran.
•The prevalence of Diabetes increasing in Iran like other
developing countries.
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 Among EMR, diabetes is ranked among the leading
causes of blindness, renal failure and lower limb
amputation
 Currently, 52% of the Region’s disease burden is due to
NCD and it is expected that this burden will rise to 60%
by 2020.
 The modifiable risk factors smoking, unhealthy diet and
physical inactivity, expressed as diabetes, obesity and
high lipids, are the root causes of the global NCD
epidemic .
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The Prevalence of DM and IGT in
Different Areas of Iran (WHO Criteria)
Area
Study
population
DM
prevalence
(%)
IGT
prevalence
(%)
Islamshahr (1993)
> 30 years
7.4
12.4
Isfahan (1993)
> 40 years
7.76
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Tehran (1994)
Rural population
> 30 years
7.6
7.5
Tehran (1994)
Urban population
> 30 years
7.2
8.2
13.6
15.6
3.6
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16.3
13.4
Booshehr (1996)
Zanjan (1997)
Yazd (1998)
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Urban population
> 30 year
Rural population
> 30 years
Adult urban
population
The prevalence of type 1
DM in Iran is about 0.6 0.8%
Azizi F. Diabetes Mellitus in the Islamic Republic of Iran, IDF Bulletin 1996
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Diabetic Nephropathy
• In diabetic patients, risk of Kidney involvement is 17
times more than normal population
• After 20 - 30 years of DM onset:
– risk of nephropathy in type 1 = 30 – 40 %
– risk of nephropathy in type 2 = 15 – 50 %
• In Iran 20 – 25 % of ESRD is due to DM*
* Iranian Dialysis Center data
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Diabetic Retinopathy in Iran
• Overall prevalence of diabetic retinopathy is
32.4 % of which:
– 17.3 % NPDR
– 15.1 % PDR
Larijani et al, Prevalence of diabetic retinopathy, MD dissertation No.17628 of TUMS, 1999
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Burden of Diabetes Mellitus in
Iran
• Disproportionately expensive
• DALY = 306,440 years
= 4.72 years per 1000 people
• YLL
= 224,000 years
among 1,600,000 diabetics in Iran
• A real socioeconomic burden (US $98bil)
Larigani et al., Iranian J of Diabetes and Lipid disorders,2005; 5:35-48
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Diabetic foot
• 15% of diabetic patients develop foot ulcer
• 15-20% of these will require amputation
• Up to 50% of DFs are preventable
• In one study in Iran:
– Mean duration hospital admission for DF was
4 weeks
– Amputation rate was 40% in 1995 and
decreased to 14% in 2001
Larijani et al, Iranian Journal of Diabetes and Lipid disorders, 2002
Larijani et al, MJIRC 2006;8(3):21-24
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Diabetes care in EM countries is not of
uniform standard for a number of
reasons.
• Trained diabetes healthcare personnel are limited in
numbers;
• Diabetes education and counseling are not readily
available to patients;
• Health care models in the industrialized countries are not
applicable due to problems of cost, organization and
accessibility.
• PHC structured to deal only with acute and episodic
illnesses not designed to provide the optimal array of
services to manage a complex, multi-system chronic
illness like diabetes
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Recent activities carried out to
improve diabetes status
 Establishing Diabetes clinics
 Establishing Diabetic Foot clinics in most
populated provinces
 Educational activities at different levels
EMRI affiliated
Clinics, Facilities &
Laboratories
Diabetes Metabolic Disease Clinics 1
• Established March 2009 and includes:
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Initial Visit Unit
Patient Education Unit
Diet and Nutrition Unit
Diabetic Foot Unit
Diagnostic Unit
Specialty Clinics Units
BMD Unit
Diagnostic Laboratory Unit
Researcher Unit
Cell Therapy Unit
A number of
Clinic 1 facilities
Diabetes Metabolic Disease Clinics 2
• Established March 2011, located in Tehran Villa St
and includes:
•Patient screening and initial clinical examination unit.
•Infection control and prevention unit
•Diabetes patient Education Unit
•In service training and professional education unit
•Nutrition consultancy Unit
•Diabetes Rehabilitation Unit
•Day care clinic and home care services
•Foot care Unit
•Diabetes Specialty Health Services Unit
•Aging Research Center
•Library and Information Unit
•Audiovisual unit
•Research and Development Unit
Some of Clinic 2
facilities
Establishing Diabetic Foot care
Clinics Project
 Improvement of 9 diabetic foot care clinics in 7
major high prevalence provinces.
 These provinces have about 58% of all
diabetics’ populations in Iran
 These centers organize training courses to
educate: patients, primary health care
providers, and professionals.
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 EMRI is the project manager and analyzing data
gathered from 8 other partners.
 Ministry of Health and Medical Education in
collaboration with EMRO/ WHO, succeeded to Integrate
NCD in PHC and;
 Ministry of Health and Medical education
allocated budget for establishing / improving
existing diabetic clinics in provinces and also for
salary of involved personnel.
WDF supported to increase public, patients &
professional’s awareness by providing necessary
materials and will support with agreed budget in its
time line.(grant obtained from WDF)
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Ministry of Health & Medical Education
(MOHME)
Tehran University of Medical Sciences
(TUMS)
Endocrinology &Metabolism Research Institute
(EMRI) Tehran
Tabriz
Boushehr 13.6%
Isfahan 7.76%
Mashhad
Tehran (Three centers)
rural population over 30 years 7.6 %
Urban population is about 7.2%
Shiraz
Yazd 16.3%
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EMRI educational
activities
• Public Education
• Professional Education
Public Education
• Preparing 110 books, brochures, pamphlets &
CDs distributing all over the country
⁻ Celebration of World Days
⁻ World Diabetes Day (WDD)
• Public Awareness Campaigns
• Weekly Diabetes Education for patients and their
families
Professional Education
• 70 Books &Booklets for Healthcare
Providers
• Preparing National Guidelines;
 Diabetes Guideline
 Diabetic Foot Guideline
• This journal since 2008 is available in English
as e journal with open –access available fulltext.
• IJDLD is a peer reviewed journal, provides a
forum for scientific inquiry in the fields of
Diabetes , Lipid and Metabolic disorders and
Cardiovascular
• Information is available in:
http://www.jdmdonline.com/
Workshops & Seminars
• Since establishment, EMRI organized 15
international seminars,workshops and 160
national workshops and seminars.
• Details in three centers of EMRI
As a sample
International Interprofessional Wound
Care Course (IIWC)
April &NOV 2007
• International Training course on Wound care with
special Focus on Foot care with collaboration of
University of Toronto Canada was organized.
• 100 professionals ,Nurses and Nurse
educators,GPs,Vascular surgeons , Dermatologists
and Endocrinologists from Iran and Region
participated as trainees.
International Interprofessional Wound Care Course
(IIWC) April &NOV 2007
• International Training course on Wound care with
special Focus on Foot care with collaboration of
University of Toronto Canada was organized.
• 100 professionals ,Nurses and Nurse
educators,GPs,Vascular surgeons , Dermatologists
and Endocrinologists from Iran and Region
participated as trainees.
The 4th International Diabetes Updates Congress
29 Feb to 2 March 2012
EMRI Innovations
• Producing biosensors for monitoring of
low level different ingredients,
• Cell transplantation
• ANGIPARS A New Phytotherapeutic Drug
for Wound Healing
Invention of a Device for Detection of
Sulfonylurea in the Urine
• Sulfonylurea derivatives are a class of antidiabetic drugs
used in the management of type 2 diabetes mellitus.
• The first generation of these drugs caused significant
and potentially fatal hypoglycemia
• Although new generation of sulfonylurea drugs such as
Glipizide, Glimepiride, and Glibenclamide (Glyburide) are
currently used as antidiabetic agents, they may also
cause severe hypoglycemia.
Necessity for Invention of the Device
• Patients with hypoglycemia can be brought to the
emergency ward in an unconscious state
• Currently, there exists no means of detecting
sulfonylurea in the urine
• The condition can remain undiagnosed
• Therefore, the Endocrinology and Metabolism Research
University planned a project for invention of a device for
detection of Sulfonylurea in the urine
The Device for Detection of Sulfonylurea in
the Urine
Biosensors in the process of
development
 Pioglitazone
 Floxetine
 Terazocin
 Flurazepam
 Prazocin
 Metformine
 Donpezile
 Granisetron
 Memantine
 Tramadol
 Naltroxone
 Verapamil
Novel Approach In Treatment Of
DM
• Oral Insulin
• Gene Therapy
• Immunomodulators
• replacement of functional
insulin-producing
pancreatic cells, with
pancreas , islet-cell
transplants or stem cell
Stem Cell
Stem
cell
Stem cell is a special kind of cell that
has unique capacity
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to renew itself
• Differentiate to specialized cell
Stem cell
Specialized cell
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(e.g., white blood cell)
Kinds of Stem Cell:
• Embryonic stem cell
• Fetal stem cell
• Extra embryonic stem cell (umbilical cord
stem cell)
• Adult stem cell
• Induced pluripotent stem cells (iPS)
Trials Underway In The
World And Iran
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Cardiac disease
Diabetes
Multiple Sclerosis
Muscular Dystrophy
Parkinson’s disease
Spinal cord injury
Stroke
Stem Cell Therapy
Our Research
Fetal
stem cell
• Pluripotent
Adult
stem cell
• Multipotent
• Sources: fetus
• Sources: Adult Tissues
Adult Stem Cells
Adult Tissues
– Adipose tissue (adipose stem cell, ASC)
– Bone marrow (hematopoietic stem cell, HSC)
– Bone marrow (mesenchymal stem cell, MSC)
– Liver (hepatic stem cell)
– Nervous tissue (neural stem cell, NSC)
– Pancreas
Islet Cell Transplantation in Iran
• The first phase of the project accomplished
• Islet lab equipped and ready to operate
Islets successfully isolated and purified
• Recipients selected, evaluated, and in waiting list for
transplantation
• Next phases carried out with collaboration of UBC
experts
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First B cell transplantation
carried out Successfully
in September 2010
(UBC Agreement)
ANGIPARS
A New Phytotherapeutic Drug for Wound
Healing in Diabetic Foot Ulcer 2008
Achievements
EMRI designated as WHO Collaborating
Center for
Research & Education on Management of
Osteoporosis and Diabetes from
January 2007
and redesignated until 2015
Funding
EMRI has its own budget with long term strategic planning
also;
Grants obtained for accepted projects from:
 Deputy of research , Ministry of Health
 Deputy of Research , Tehran University of Medical
Sciences
 National and international agencies
 Public donations
National Research Networks
• The EMRI has lunched 4 research networks in order to allow better
collaboration among researchers, clinicians, and policy makers.
• 1. National Diabetes Research Network
http://emri.tums.ac.ir/DMnet
http://emri.tums.ac.ir/dmfoot
• 2. National Osteoporosis Research Network
http://emri.tums.ac.ir/Osteonet
• 3. National Aging Research Network
• 4. National Obesity Research Network
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http://emri.tums.ac.ir/en
http://emri.tums.ac.ir/diabetes-en
http://emri.tums.ac.ir/osteo-en
http://emri.tums.ac.ir/ehrc-en
http://emri.tums.ac.ir/dmfoot-en
http://emri.tums.ac.ir/gdm-en
http://emri.tums.ac.ir/stemcell-en
http://emri.tums.ac.ir/lipid-en
http://emri.tums.ac.ir/vclinic-en
http://emri.tums.ac.ir/thyroid-en
http://emri.tums.ac.ir/nutrithon-en
http://emri.tums.ac.ir/mentalhealth-en
http://emri.tums.ac.ir/cp-en
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http://emri.tums.ac.ir/obesity-en
http://emri.tums.ac.ir/modeling-en
http://emri.tums.ac.ir/genetics-en
http://emri.tums.ac.ir/tm-en
http://emri.tums.ac.ir/ebm-en
http://emri.tums.ac.ir/nea-en
http://emri.tums.ac.ir/pdl-en
http://emri.tums.ac.ir/me-en
http://emri.tums.ac.ir/bionano-en
http://emri.tums.ac.ir/fasting-en
http://emri.tums.ac.ir/biosensor-en
http://emri.tums.ac.ir/it-en
http://emri.tums.ac.ir/dmclinic-en
http://emri.tums.ac.ir/dmclinic2-en
Faculty ,Researchers and other staffs
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Faculty members
Researchers
Fellows in endocrine
PhD by research student
Supporting and administration staff
National advisors
International advisors
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Published articles and papers
During 16 years, EMRI has presented 800 articles and
abstracts, of which 775 have been published in
international medical journals such as New England
Journal and Lancet
•Citations (provided by Thompson Reuters up to
November 2012)
•The number of published articles: 861
•Total number of citations: 5042
•Average citation per paper: 5.75
•H Index: 33
•Highly Cited Paper: 12
EMRI published and citations
( ISI web of Science)
Tehran University of Medical Sciences
Papers & Citations
Iran is in place 24 in endocrinology among the countries
in the world during recent decade
EMRI is in place 63 among the other
Endocrinology Centers
in the world during last decade
Iranian Endocrinologist in the world during recent decade
Domestic (Iranian universities and centers)
453
National projects
21
International Projects
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In collaboration with WHO
7
Grants and internal projects
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Ongoing projects (2010-2012)
187
Partners
• Undersecretary for Research and Technology (Ministry of Health
& Medical Education)
• Mashhad University of Medical Sciences
• Shiraz University of Medical Sciences
• Esfahan University of Medical Sciences
• Tabriz University of Medical Sciences
• Bushehr University of Medical Sciences
• Yazd University of Medical Sciences
Agreements and projects
So far 73 contracts and agreements accomplished
• 7 NCD projects in cooperation with WHO
• GDM, in cooperation with UNFPA
• Thalassemia complications, in cooperation with TIF
• Osteoporosis activities, in cooperation with IOF
• Educational activities with IDF
Agreements…
• University of Alberta (Canada), Laboratory of Experimental
Surgery , consultation services on establishment of clinical
Islet Transplant Program.
• University of British Colombia (Canada)
• University of Tennessee (USA)
• National Academy of Sciences of Belarus
• University of Toronto Canada
• University of North Dakota, Division of Endocrinology
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Prof. A. Kitabchi (USA)
Prof. Adeli (Canada)
Prof. P. Bonjour (Switzerland)
Prof. Ghahhari (UBC,Canada)
Dr.Ziliang AO (UBC,Canada)
Dr. L. Jovanovich (USA)
Dr. J. Lakey (Canada)
Prof. A. McClung (USA)
Dr. Wajih Rizvi (USA)
Visiting Ministry of Health from EMRI
Obtaining Grants and Awards
• 16 National and International grants and awards
obtained such as;
• IOF Education Award 2005
• WDF Foot care award 2009
• Eminent Scientist of the year 2005 from ASIA
International Research Promotion Council.
• WHO Prize for the Control of Diabetes in the Eastern
Mediterranean 2010
Best Medical Research Center 2005, Razi Festival
Best Medical Research Center 2009, 2010 Razi
Festival
Recent WHO Prize obtained
• WHO Prize for the Control
of Cancer, Cardiovascular
Disease and Diabetes in
the Eastern
Mediterranean 2010
Obtained directly by
Dr.Larijani
EMRI Ranks First amongst Iranian Research
Centers 2011
 The Institute got the
top ranking in the score
used for ranking Medical
Institutes for the eighth
running years.
EMRI as research University is going to expand
Research activities through enhancing;
• Research Infrastructure
• Data base for multidisciplinary research
projects on Diabetes ,Lipid Disorders ,
Obesity and Osteoporosis
• Expanding International Collaborations.
• We welcome the co-operation and support of
our peers in the region and in the world.
Thank you
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