Minutes

Joint Meeting of Temporomandibular Joint and Muscle Disease Interagency Working Group (TMJDIWG)
And
The Working Group of the National Advisory Dental and Craniofacial Research Council (NADCRC)
September 16 - 18, 2007
Bethesda Marriott Suites and The National Institutes of Health

TMJDIWG
Members and Observers: Norman Braveman (NIDCR); Kevin Clark (TMJ Association); Deanne Clare (TMJ Association); Terrie Cowley (TMJ Association)Milton and Renee Glass (JJAMD); John Kusiak (NIDCR); Joan Wilenz (TMJ Association); Lawrence Tabak (NIDCR).

NADCRC Working Group (* designates members of the NADCRC)
Co-chairs: *Cecile A. Feldman (UMDNJ) and John T. Watson (UCSD);
Participants and Presenters: Atul J. Butte (Stanford University); Daniel J.Clauw (University of Michigan); Allen Cowley (Medical College of Wisconsin);  Raymond J. Dingledine (Emory University); *Matthew J. Doyle (Proctor and Gamble); David J. Galas (Institute for Systems Biology); David E. Hill (Dana-Farber Cancer Institute); Janet Kiecolt-Glaser (Ohio State University); *Jon D. Levine (University of California at San Francisco); William Maixner (University of North Carolina – Chapel Hill); Mark A. Milanick (University of Missouri – Columbia); Anne Louise Oaklander (Harvard Medical School); Frank Suits (IMB T.J. Watson Research Center).

The meeting was called to order with a welcome from Dr. Lawrence Tabak, Director, National Institute of Dental and Craniofacial Research at 7 p.m. on September 16 at the Bethesda Marriott Suites in Bethesda, Maryland. A detailed agenda of the meeting is attached to these minutes.

Dr. Braveman explained that the NADCRC recommended that the Institute form a working group of the Council to address certain issues pertinent to the future of research on TMJDs.  Because of the specific nature of the topic discussed as well as its importance to other NIH ICs and to patients, the meeting of the NADCRC working group was opened to members and observers the TMJD Interagency Working Group.  He noted that because this was a meeting of an advisory council working group and therefore under the auspices of the Federal Advisory Council Act, any recommendations coming from the NADCRC working group would first be discussed, possibly modified and approved before any action could be taken on them by the Institute.

Dr.  Tabak gave an update on recent advances in TMJD research including:

• evidence for a genetic component to TMJDs
• recent research identifying a regulatory molecule (DKK-1) and its inducer TNF-alpha as playing key roles in rheumatoid and osteo-arthritis
• the use of cadherin-11 to prevent and reduce arthritis in mouse synovial joints
• a newly discovered BMP-4 and Runx2 pathway linking changes in estrogen levels following ovariectomy with TMJ disorders and osteoarthritis in mice
• an early molecular marker for TMJDs
• evidence for the role of Il-1beta in TMJ pathologic changes, dysfunction and pain
• the use of intra-articular induction of mu-opioid receptors in the mouse TMJ to ameliorate pain and histopathological joint abnormalities
• studies of CNS function in TMJD patients showing cerebral cortical abnormalities during jaw movement
• biomimetic and tissue engineering approaches to building new parts of the TMJ including the condyle
• the use of differentiated human embryonic stems cells to engineer a condyle

Dr. Tabak challenged the group to build upon these emerging advances in TMJD research.

Dr. John Kusiak reminded the group that the goal of the meeting was to provide recommendations around the following points:

• Is there a model of a systems approach that can/should be emulated or would a unique and different approach better serve future research on TMJDs?
  
  
• What are the pros and cons of taking such an approach?
  
  
• In the absence of all necessary expertise existing in a single research area or setting, what options should be explored to develop a cadre of scientists, engineers and scientist clinicians to attack this problem?  

He also provided a key to the organization of the meeting as follows: 

• Three introductory presentations on:
  • The meaning of a systems approach to research  - David Galas
  • A description of TMJDs and the approach being taken by the OPPERA study - William Maixner
  • A review of what is known about TMJD and other comorbid conditions - Daniel Clauw
    
    
• Five presentations on how systems approaches are being used to study other complex diseases
  • Type II Diabetes – Atul Butte
  • Hypertension – Allen Cowley
  • Peripheral Pain Disorders – Anne Louise Oaklander
  • Epilepsy and other brain disorders – Raymond Dingledine
  • Cancer -  David Hill

At the end the working group would be given time to discuss what they’ve heard and to prepare recommendations.

Drs. Feldman and Watson then presented the charge to the working group. They allowed time for each individual, including representatives from the TMJD Interagency Working Group, to provide input about the plan for the meeting and to present what each person saw as his/her top issues requiring the working group’s attention. 

Presentations are listed on the agenda.  Discussion followed each one.  A series of recommendations made by the group were forwarded to the NADCRC for consideration at the open session of the next meeting on January 25 at the NIH.  Recommendations resulting from the discussion by the NADCRC will be posted on the TMJDIWG web site after the Institute has had an opportunity to review and discuss them.