Institute for Immunity, Transplantation and Infection

The Center for Clinical Immunology at Stanford

C. Garrison Fathman, M.D.

Executive Summary

Immune mediated inflammatory disorders are among the leading causes of illness and disability in the United States affecting nearly 20% of the U.S. population.  Including asthma, rheumatoid arthritis, insulin-dependent diabetes mellitus, systemic lupus erythematosus, psoriasis and multiple sclerosis, these immunologic abnormalities can cause debilitating life-long illnesses and result in serious and protracted morbidity and in insurmountable medical costs.  Progress in the treatment of these and many immune mediated inflammatory disorders depends upon the successful application of cellular, genetic and molecular immunology to clinical medicine.  Stanford scientist physicians are internationally renowned for their fundamental advances in the field of clinical immunology that will allow translation of laboratory discoveries into patient therapies for a broad range of diseases.  Innovative strategies for immunotherapy for autoimmune diseases, bone marrow and stem cell transplantation, and organ transplantation tolerance have been developed and applied at Stanford.  More basic breakthroughs in understanding cell-signaling pathways, lymphocyte biology and immune regulation have also occurred at Stanford. These basic findings linked to the potential clinical application should place Stanford at the forefront of future therapeutic strategies. Developments at Stanford in basic immunology are forecasting new immunotherapeutic approaches to the treatment of diseases like insulin-dependent diabetes mellitus, multiple sclerosis, psoriasis, and rheumatoid arthritis as well as to the transplantation of bone marrow stem cells and solid organ allografts.

The CCIS is an interdepartmental multidisciplinary center within ITI that aims to implement use of approved therapies and to introduce new therapies, preventative approaches, and potential cures to a broad spectrum of diseases.  A new physical facility, the Center for Clinical Sciences Research (CCSR), has been built and serves as an intellectual home for a critical core of scientist physicians who work with clinical investigators, representing a number of different clinical disciplines, in this information exchange.  The CCIS also serves as a training ground for the next generation of clinical investigators who will apply the new concepts of basic immunology to the diagnosis, prevention, treatment and follow up of human disease.  This is accomplished through three CCIS programs.  The Clinical Scholars program supports faculty development by providing salary support to new clinician investigators to allow them to acquire the necessary skills to translate basic scientific discoveries into clinical medicine. Eight MCL Assistant Professors have been funded by CCIS Clinical Scholars awards.  The CCIS postdoctoral fellowship program is intended to support the best and brightest young MD and MD PhD scientist physicians in this newly emerging discipline.  One such postdoctoral fellowship is currently available.  Finally, the CCIS Summer Student program brings bright, highly motivated high school students in touch with the excitement of research in clinical immunology each year.  This program is spearheaded by Dr PJ Utz MD, who will be the next Director of the CCIS.

Background and Rationale

The Nature of the Problem

Immune mediated inflammatory diseases affect nearly 20 percent of Americans.  These conditions, which include juvenile-onset diabetes, rheumatoid arthritis, multiple sclerosis, asthma, systemic lupus erythematosus, and acquired immune deficiency syndrome, lead to chronic debilitation, life-long illness, and premature mortality and result in insurmountable medical costs.  The immune system plays a key role, not only in these diseases, but also in the rejection of transplanted organs and tissues, and in the body’s ability to fight invading cancer cells.

Scientists and clinicians at Stanford have come to the realization that seemingly diverse diseases of the immune system should be managed under a cohesive paradigm -- classified together under their common immune system components rather than managed and treated separately by clinical specialties such as rheumatology, endocrinology, neurology, and oncology.  Ongoing research is no longer disease-specific but is undertaken at the sub-cellular, genetic, and molecular level in order to provide answers to a variety of shared questions.

The Center for Clinical Immunology at Stanford has been established to reflect this new paradigm.  The Center has brought together scientist physicians from diverse disciplines in order to facilitate daily collaboration.  Enhanced opportunities have enabled clinicians and investigators to translate cutting edge basic science into ideas for treatments covering the entire spectrum of diseases of the immune system. 

The Role of Stanford Scientists in Immune Disorders

Stanford is recognized throughout the nation as one of the top centers for research in basic immunology and in treatment of immune-based diseases. Scientist physicians at Stanford have made fundamental discoveries from which new strategies have arisen to treat autoimmune diseases and immune deficiency disorders and to halt the rejection of transplanted organs.  Breakthroughs in understanding cell-signaling pathways, lymphocyte biology, immune system regulation, cell-based communication, gene therapy, and stem cell transplantation forecast further advances in understanding the underlying mechanisms of disease caused by excessive or depressed immune function.  These new insights hold the promise of new modes for prevention, diagnosis, and management of these disorders.

From Research to Therapy

Although basic investigators and physician scientists in clinical immunology at Stanford University Medical Center have initiated their work in a variety of traditional disciplines, they share a fundamental understanding of the human immune system and a conviction that advances in genetic and molecular biology will provide powerful new therapies and eventual cures for many immune based inflammatory disorders.

Given the nature of the physician scientists’ understanding of the problems at hand, many interesting clinical trials could and should be moving forward.  The Center for Clinical Immunology at Stanford will maximize the potential to expand collaborative research and to bring the results quickly to clinical trial, as well as offering patients access without delay to innovative trials.

From Vision to Reality

The Center for Clinical Immunology at Stanford has raised private funds to support new program development, co-recruitment of outstanding scientists, training of young clinical scholars, postdoctoral fellows and summer students, and construction of state-of-the-art research facilities.  By teaming with pharmaceutical or biotech firms, the Center for Clinical Immunology at Stanford can begin to build bridges between discoveries in basic science and their application to human disease.  The Center offers a milieu in which medical science can apply its finest tools and talents in the quest to solve the problems posed by immune based inflammatory disorders.  The Center promises revolutionary approaches to prevent, treat, and cure these many diverse diseases.

Goals of the Center for Clinical Immunology

The Center for Clinical Immunology at Stanford will link a core of clinical researchers with a diverse group of clinicians and scientists to translate knowledge gained in the laboratory into innovative strategies for the treatment of patients with immunologic disorders.  This cross-disciplinary approach should allow the CCIS to short-circuit delays of the past and enable investigators to fashion discoveries into treatments as quickly as possible.  The CCIS seeks to capitalize further on this link by training a new generation of clinician scientists to explore the common elements of immune diseases and to extend the concepts of basic immunology to their diagnosis and management.

  1. To help recruit faculty whose interests are in clinical immunology, and whose research is aimed at moving immunological discoveries from the bench to clinical trials.
  2. To establish additional Postdoctoral Fellowships; eligible candidates will do a project either in basic research, aimed toward pre-clinical/clinical testing, or in clinical trials; two such fellowships have been established to date.
  3. To establish a seminar series in clinical immunology and an annual Asilomar retreat for clinical immunologists (overlapping with the current Immunology Program scientific retreat).
  4. To support CCIS high school summer students who will spend at least eight weeks studying in a lab oriented toward immune based disease pathophysiology or therapy. 
  5. To explore the development of a new clinical immunology fellowship program with rotations through clinical disciplines not usually found in a single sub-specialty program.  These would include rheumatology, bone marrow and solid organ transplantation, pediatric immunology, immune based neurological disorders, immune based endocrine disorders, immuno-dermatology etc…
  6. To develop and fund young clinical faculty in the area of translational medicine to both understand the pathophysiology as well as the treatment of inflammatory, immune based diseases.

New CCIS Initiatives in Support of these Goals:

Funds for Graduate Student Education

"Introduction to Medicine for Graduate Students in Bioengineering,  Bioinformatics and Biological Sciences:  A two course sequence"

The continued application of basic science, technology and engineering to patient treatment holds great promise for the future of clinical medicine.  However, though the promise of new technologies for medicine has grown, interdisciplinary training in medicine for bioscientists and engineers has not kept pace.

We have begun to develop a didactic and project-based curriculum in human pathophysiology and medicine for graduate students enrolled in Ph.D. programs or post-doctoral fellowships in the basic or engineering sciences. These graduate or post-graduate students are not physicians, but they plan to use their (non-medical) expertise to solve medical or bio-medical problems.  

The first course in this curriculum  is called "Introduction to Medicine" and was developed under the  joint auspices of the Center for Clinical Immunology at Stanford (CCIS) and the Bio-X Program at  Stanford. The course was  designed by Dr. Betsy Mellins from the School of Medicine, working  together with Dr. Decker Walker of the School of Education and  members of the Stanford Learning Laboratory (including then-Director  Larry Leifer of the School of Engineering).  The course focuses on diabetes mellitus and teaches the way that physicians currently understand this disease. Other diseases are discussed in significantly less depth. Lectures are given by over 15 faculty from the School of Medicine with expertise relevant to diabetes. Through this disease-focused approach, students learn a strategy that they can apply to learning about any disease.  The main work in the class is a quarter-long project, carried out by inter-disciplinary teams and focusing on an unsolved problem in diabetes. For more information, see the course website.

Additional courses that will extend this curriculum to allow extended project work and greater exposure to other disease areas are being considered for development.

Funds for CCIS Faculty Clinical Scholars

A Fund for CCIS Faculty Clinical Scholars has been created with an initial $250,000 donation from a local businessman supplemented by an additional $100,000 gift from a "friend of the CCIS".  The CCIS has also secured a $200,000 pledge from a local family to be added to this fund.  This fund is being held at the Community Foundation, Silicon Valley.  These funds as well as their investment income have been used to help support the salary of eight young clinical immunology MCL faculty at Stanford. Each of these CCIS funded clinician scientists receives $50,000 yearly for three years, in partial support of their salary in order to allow them sufficient time to develop appropriate scientific knowledge in clinical immunology to compete for extramural funds at the end of their three-year funding cycle.

Current and potential recipients of these funds, new Medical Center Line clinical immunology faculty, are in a difficult position since most federal grants go to laboratory-based researchers with established programs.  Since there are no current support mechanisms to pay for their training, the young physician scientists may struggle while trying to pursue clinical research, publish manuscripts, teach students and house staff, as well as see patients to establish their reputations as physician scientists.

The candidates must be MCL faculty members at the Assistant Professor level.  These grants are available for a three-year period and are in the amount of $50,000 per year.  A committee of the CCIS faculty reviews the candidates’ applications and selects the candidate (or candidates if funds increase) to support. The requirements are listed below:

These applications must be received no later than April 15, of the funding year; the awards will be made for the next academic year, payment to commence on September 1.

Funds for CCIS Postdoctoral Fellowships

With an initial gift of $100,000 in 2001, we have begun a new initiative to fund CCIS post-doctoral fellows. The initial Fellowship (funded by the Yu-Bechmann Foundation) was established in March, 2001 by Albert Yu and Mary Bechmann. The successful applicant for this fellowship will demonstrate potential for innovative research using genomics in application to studies in cancer diagnosis, pathophysiology, or treatment.  Special consideration will be given to the research proposal that offers the greatest promise of delivering actionable findings in the near term using the most advanced techniques and information resulting from the mapping of the human genome.

The Weiland Family Fellowship is an award of $50,000 per year designed to support two years of research in a Stanford CCIS laboratory undertaken by a recent M.D., Ph.D. or M.D./PhD. graduate.  In addition to a salary of $40,000 per year, the Fellowship includes funds for a personal computer in the first year. The remaining funds will be used for laboratory support including networking and security costs, journal subscriptions and societal memberships, as well as travel for the awardee. 

An additional CCIS postdoctoral fellowship has been recently announced, the Reinhart Family Fellowship, following an initial gift of $50,000, with the expectation of subsequent years funding.  The requirements for the applicants for this fellowship encompass any area of clinical immunology.  Selection of successful candidates will be by the CCIS Steering Committee.

Two additional CCIS fellowships of $75 each were established in 2002 following an education grant from Centocor.

Funds for CCIS Summer Student Award

In December 1998, a Fund was created following an initial $100,000 donation from a local family.  This fund has been increased by additional donations.  The CCIS Summer Program started with 10 high school summer students interested in biology who for support for an 8-week summer program consisting of lab research, lectures by selected faculty, and a modest clinical exposure under the leadership of PJ Utz MD and has increased to over twenty students in the recent graduating class.  A $1,500 stipend is awarded to each selected student.  The students who are selected perform research in clinical immunology in a laboratory of their choice from the CCIS faculty list and project descriptions on the CCIS web page.

For more information contact:

C. Garrison Fathman, M.D.
Chief, Division of Immunology and Rheumatology
Director, Center for Clinical Immunology at Stanford (CCIS)

CCSR Building, Room 2225
269 Campus Drive West
Stanford. CA 94305-5166
Tel: (650) 723-7887
cfathman at cmgm dot stanford dot edu [cfathman cmgm.stanford.edu]

Paul J. Utz, M.D.
Division of Immunology and Rheumatology
Co-Director, Center for Clinical Immunology at Stanford (CCIS)

CCSR Building, Room 2215-A
269 Campus Drive West
Stanford. CA 94305-5166
Tel: (650) 724-5421
Email: pjutz at stanford dot edu [pjutz]

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