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Cutting-edge cancer research is taking place in a rural part of Maine thanks to an unusual partnership between a group of clinicians at Eastern Maine Medical Clinicians at a community medical center and scientists at a local lab have established a mutually beneficial partnership to accelerate research. Photo: EMMCCenter (EMMC) and scientists at Jackson Laboratory. EMMC is an important specialty care referral center for the region surrounding Brewer, ME, and the Jackson Laboratory Bar Harbor campus is “the epicenter of The Jackson Laboratory’s longstanding biomedical education and training programs.”

Often, there is a gulf between scientific research and clinical care. The researchers who study the causes and possible cures for diseases such as cancer are a step removed from the clinicians who provide care and from the patients who suffer the conditions, even though both types of professionals have the same ultimate goal. The partnership between EMMC and Jackson is bridging that gap and changing the way cancer research is conducted.

How It All Began
The collaboration stemmed from a casual conversation that has grown into what could well be a model for other organizations. Carol Bult, Ph.D., and Kevin Mills, Ph.D., from The Jackson Laboratory visited EMMC in 2011. During that visit, they discussed their current projects with Jens Reuter, MD, and he described his own work. The three were working on different projects, but all had to do with cancer research. Their skill sets and research efforts were complementary to one another.

Following that first conversation, Mills requested blood samples from patients at EMMC with chronic lymphocytic leukemia for a research project. Within two to three months, EMMC was able to send him 100 samples. Having those samples led to a landmark paper, “Attenuating homologous recombination stimulates and AID-induced antileukemic effect,” which was published in The Journal of Experimental Medicine in April 2013.

The usual method for research scientists to obtain blood and tissue samples for research is through tissue banks. Being able to request and receive samples from patients with very specific conditions can speed the pace of research. The fact that Reuter and Mills happened to be working on similar projects initiated a partnership that allows just that.

 “I think he and I got together to collaborate and were the nucleus of the inter-institutional collaboration because we have very complementary interests and skill sets. He was in a clinical institution and I’m a basic scientist, but the questions I ask have translational impacts,” Mills told Laboratory Equipment.  
A collaborative arrangement such as this one can speed up research efforts. Mills said the EMMC contribution of blood samples was critical to the work published in 2013. “We did that as a lead project,” he says, “but then we realized there was a lot of potential to accelerate our translational efforts and apply these discoveries.”

EMMC began regularly collecting tissue samples from patients with particular cancers after surgeries. According to Reuter, EMMC has donated about 360 samples over the last four years. Eventually, EMMC built a dedicated translational research lab, which makes the collaborative work even more productive. The lab is a biorepository where samples can be cryopreserved for future study, as well as a place for “EMMC and community-based researchers to perform translational research.”  

The pros and cons
The fact that this partnership and all it entails came about in an unplanned, organic fashion has both benefits and drawbacks. One of the benefits is that it allows research to happen quickly. However, funding represents a drawback.

Funding research is a problem for many smaller organizations.

“When it comes to funding there seems to be a concentration of larger organizations,” says Reuter. “Traditional research systems like the NIH are clearly written for large, academic institutions. We don’t really fit in there.”

Funding the collaborative work between EMMC and Jackson Lab comes from a variety of sources. The program of tissue collection is mostly funded by Jackson, but various foundations play an important role as well.

“Foundations have been much more flexible,” Reuter told Laboratory Equipment. “The Maine Cancer Foundation has a funding mechanism. They want to make cancer research more efficient and faster, which is what we want. They have revised their grant mechanism and have put in place an infrastructure grant.”

Foundations provide both funding and advice, which is helpful since things have happened so quickly.

In some ways, the biggest problem the program at EMMC is facing is one that may ultimately become a strength: their small size and community-based roots.
“It’s hard to position ourselves,” says Reuter. “Our greatest strength is also partially our weakness.”

One of the reasons that this partnership between a research institution and a community hospital is working so well is that EMMC is well positioned to fill the role of consultant and collaborator.

“With large academic institutions and pharmaceutical companies collaboration, it can be difficult because you run into issues of competition and so forth,” Reuter said.

In their partnership, EMMC provides samples for scientists at Jackson Laboratory to research. Photo: EMMCHowever, that is not a concern at EMMC.

“If we can contribute this one piece, we can catalyze the whole research project,” Reuter explains.

It is defining their role as a community research center and collaborator that can present difficulty, partly because it is not common. Mills agrees and says of the first project, “we turned to each institution to leverage their individual strengths. We applied those strengths to a very specific project.”

Recognizing that success and seeking additional ways to collaborate has opened doors on both sides.
The ultimate goal
The end goal for everyone involved is improved outcomes for patients. The EMMC Cancer Care Center treats patients from throughout the region, and Reuter says that patients seem to be aware of the unusual nature of the partnership with The Jackson Laboratory.

“We keep it general for them, but they do ask questions, and they find the answers very exciting,” he says.

However, there is more work to do. “The loop isn’t completely closed. In order to really give back to the patients we have to show them that together with our partners we will design these very novel therapies that they can participate in and won’t have to travel,” says Reuter. The patients will have the newest therapies available locally, which will benefit everyone involved.

The Translational Research Laboratory at EMMC is currently being expanded, thanks in part to an infrastructure grant from the Maine Cancer Foundation. Several projects are underway, including clinical trials, and very early developing research that involves implanting not only tumors, but also part of the human immune system in mice.

Another exciting project, initiated by Bult, is designed to investigate triple negative breast cancer. Tissue samples are implanted in mice known as avatars, which have been designed to be living hosts of the cancerous tumors. Currently there is no treatment to target triple negative breast cancer, so this project, which is a collaboration between The Jackson Laboratory, EMMC, and the Maine Cancer Foundation, is an important step.

Although other such collaborative relationships do exist, they are still unfortunately rare. The benefit on a personal level for the scientists is that they have more flexibility to pursue the research that is important and interesting to them. At the institutional level, there is less risk in initiating a pilot program, which can serve as a catalyst for future research. Patients can provide tissue samples and so participate directly in the development of treatments.

“Historically these kinds of partnerships have been somewhat difficult to initiate, but I think they represent the path forward in cancer research. We need to have these basic science and clinical partnerships,” said Mills.

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