The Duke Department of Medicine (DOM) recently honored the commitment of a few Duke centers and institutes that continue to drive the University’s mantra to honor its “outrageous ambitions,” as articulated by former Duke President and U.S. Senator Terry Sanford when he highlighted Duke medical community’s brilliant reputation and focus on excellence in his 1984 final annual address to faculty.
Good ideas tend to remain evergreen— universally and continually relevant, said Dr. Steve Taylor, professor in the Division of Infectious Diseases and moderator of the Duke Centennial event panel discussion with the department’s strategic research partners on Driving Duke’s “Outrageous Ambitions” through Biomedical Research.
Dr. Taylor led a lively discussion about how these institutions, led by DOM faculty, provide a strong support platform for research at Duke; support that may not have otherwise been available.
Panelists included Dr. Adrian Hernandez, executive director, Duke Clinical Research Institute (DCRI), Dr. Susanna Naggie, director, Duke Clinical and Translational Sciences Institute (CTSI), Chris Newgard, PhD, director, Duke Molecular Physiology Institute (DMPI), and Dr. Svati Shah, director, Duke Precision Genomics Collaboratory.
Duke Clinical Research Institute (DCRI)
Known for conducting groundbreaking multinational clinical trials, managing major national patient registries, and performing landmark outcomes research, DCRI is the world’s largest academic clinical research organization, housing eight primary therapeutic areas and a workforce of about 1,000 team members.
The institute has led the way in shaping the future of clinical research, creating a legacy of innovation and impact in the process.
DCRI’s original “outrageous ambitious,” Dr. Hernandez said, came in 1993 upon completion of the first international trial (GUSTO-I), the largest comparative thrombolytic trial in history at the time with over 40,000 patients. Prior to GUSTO, led by Principle Investigator Dr. Robert Califf, commissioner of the U.S. Food and Drug Administration, the largest study in the country involved hundreds of patients. GUSTO-1 was replicated to multiple studies, effectively launching DCRI in the process in 1996.
"There was a problem and an outrageous ambition to solve it in a way that had not been done before and that started the emergence of DCRI,” Dr. Hernandez said. “Going forward now almost 30 years from the formal founding of DCRI in 1996, that is often what we are aiming to do is try to address problems that people have not been able to solve before. We have this ambition to get research everywhere for everyone at once and creating the tools to do so."
DCRI operates 300 to 400 projects each year, runs the largest healthy aging clinical trial called Preventable, and works continually to foster ideas from across the Duke community and specifically, in the DOM.
Duke Molecular Physiology Institute (DMPI)
DMPI bridges basic sciences and clinical departments with mechanistic research that relates to clinically relevant problems through the omics sciences: genomics, proteomics, and metabolomics.
“I use this word retro-translate from the biomarker to the underlying mechanism because that's ere we're going to find new disease intervention points and I think we've done that,” said Dr. Newgard. “It has been very exciting and the partnership with Medicine today is absolutely essential to what we do."
Founded in 2013 by consolidating the Sarah W. Stedman Nutrition and Metabolism Center, the Center for Human Genetics, and clinical translational investigators, one of DMPI’s strongest principles is having the “will and skill” to interpret complex molecular profiles in a physiological context, and to use such profiles to design experiments that unveil novel biological and disease mechanisms in tractable cellular and animal model systems.
Through such new mechanistic understanding, the goal is to define novel methods for disease detection and targets for disease intervention that can be tested in human studies.
DMPI today has a faculty of 45, divided almost equally in terms of MDs and PhDs, and 220 total people, all located in one modern research facility. The collaborative cross-pollination within the institute and its partners has proven invaluable.
“I think that’s extremely healthy, and I don't see it very much going around the country where you have that unification of the technology core labs, the basic labs, and the translational labs all in one facility,” Dr. Newgard said. “That's what we offer.”
Duke Clinical and Translational Sciences Institute (CTSI)
CTSI is a center for innovation and testing novel, high-risk ideas that supports and funds translational research with a key focus on thinking about how that translational science happens.
“It's research on how you do research,” said Dr. Naggie, who stepped into the director’s role in May 2023. “It’s about identifying the roadblocks and the challenges that help to rapidly move discoveries into clinical care discoveries into impact.”
A major area of focus for CTSI is supporting first-time researchers, community engagement and partnerships. It’s Recruitment Innovation Center works directly with research teams to think through ways to recruit and retain people in their research protocols, a free and heavily-utilized resource. Another Community Engagement and Equity Research consulting group works with researchers to organize community or research events, or to develop a community advisory council to assist with research protocols.
Such was the case with OneDukeGen, a precision medicine study led by Principal Investigator Dr. Svati Shah, associate dean of genomics. The study is recruiting over 100,000 consented Duke patients to participate in pivotal research that advances healthcare through cutting- edge research and collaboration to unravel the connections between genetics, health, and disease.
CTSI and DOM team members were also critical in securing a recent $29.5 million Bloomberg philanthropic grant to establish an early college for high school students interested in pursuing health care careers. A CTSI workforce development team created the curriculum and training for students while DOM faculty members led the evaluation program for the Bloomberg application.
“By bridging the gap between scientific discovery and clinical practice, we are poised to usher in a new era of healthcare delivery,” Dr. Naggie said. “This effort will fuel scientific discovery and facilitate insights that can potentially revolutionize our understanding of disease. Together, we are charting a path towards a healthier and more informed future.”
Duke Precision Genomics Collaboratory
Countering DMPI’s focus on retro-translation, the Duke Precision Genomics Collaboratory’s “outrageous ambition” is forward translation, said Dr. Shah, who is leading the process of collecting samples and doing genetic sequencing on 150,000 Duke patients.
Over the last two decades, genomics has become a commonplace tool in science and patient care. The Collaboratory was created to bring the medical community from across the School of Medicine together in one place around genomics, continue to fuel basic science discovery and bring these discoveries to patients and do that forward translation.
The Precision Genomics Collaboratory has spent the past six years building out its structure to become a contemporary, cloud-based, on-premise compute for the huge need to address not just the genetics and genomics across AI but processes that bring together diverse groups to solve patient-related problems.
One piece of that was to build a population-based genetics cohort, an offshoot of which is the Center for Precision Health, an operational administrative and scientific home that partners with the CTSI on conducting community participatory research.
“We have an incredible interface between discovery and patient care,” Dr. Shah said. “The literal physical co-location as well as the passion of the people we have here. We have made significant impact and I think we're at a critical time where we can continue to be a real differentiator amongst academic organizations because of that very strong interface.”
Learn more about each Duke Center and Institute at https://medschool.duke.edu/academic-departments-centers-and-institutes#CI