International Activities—Overview

In support of its mission, NCCAM has established the following goals for its international activities:

Support research to advance understanding of complementary, alternative, traditional and indigenous medical systems through international collaborative studies;
Contribute to the preservation of irreplaceable and valuable traditional/indigenous CAM knowledge and resources; and
Enhance understanding of approaches to integration of safe and effective CAM and non-CAM interventions.

Research

International Centers for Research on CAM/Traditional Medicine (ICRCs)

In support of these goals, NCCAM initiated its International Centers for Research on CAM (ICRC) initiative. The objectives of ICRCs are to:

Establish programs of rigorous, high-quality research on CAM/TM practices in their sites of origin and determine the value of such practices in improving health and well-being;
Support the development of global CAM/TM research capacity;
Facilitate and encourage international research collaborations and exchange; and
Contribute to the preservation of systems of traditional and indigenous knowledge.

This ICRC effort has two phases. The first phase began in October 2003, with the awarding of two-year planning grants to 11 institutions. The goal of these grants was to support the scientific, administrative, and organizational planning efforts required to create an effective international, multidisciplinary research program involving a U.S. institution and one or more non-U.S. partner institutions.

The second phase began in September 2005, when a Request for Applications was released for the larger research center grants, each being 4 years in duration. Recipients of the Phase I planning grants were eligible to apply. Ten applications were received. Three were selected for funding, two by NCCAM and a third by NCI. In 2006 a fourth center was funded by NCI.

ICRCs each will have at least three inter-related, synergistic research projects focused around a central scientific theme. These projects examine fundamental concepts and practices of alternative medical systems that are indigenous to the non-U.S. institution's region. The health issues to be studied must be of relevance to both that particular region's population as well as to other populations around the world.

Functional Bowel Disorders in Chinese Medicine. The goal of this International Center is to continue development of a sustainable international research collaboration that will carry out rigorous, multi-disciplinary research on traditional Chinese medicine (TCM) approaches to functional bowel disorders. Investigators from the Chinese University of Hong Kong (CUHK); the Center for Integrative Medicine at the University of Maryland, Baltimore; the University of Illinois, Chicago; the University of Western Sydney; and Mayo Medical Center will collaborate on three projects centered at CUHK: 1) To evaluate the effects of electro-acupuncture on IBS; 2) To conduct preclinical research on a promising TCM herbal preparation in order to establish the biological potency, safety, adverse effects, and toxicity of a practical, reproducible, quality controlled product; and 3): To carry out a pilot clinical trial evaluating the safety and dose-response of the same herbal formulation in patients with IBS.
The International Center for Indigenous Phytotherapy Studies (TICIPS): HIV/AIDS, Secondary Infections, and Immune Modulation. The goals of the International Center for Indigenous Phytotherapy (i.e., herbal medicine) Studies (TICIPS) are to: Create a collaborative environment of trust, open communication and research; Support scientifically rigorous and ethical studies of African phytotherapies and health care systems; Train scientists to conduct the highest caliber research in complementary and alternative medical practices; Promote conservation of plant biodiversity and protection of indigenous knowledge; Communicate evidence for the safety and efficacy of indigenous phytotherapies and CAM to health care providers and the public; and Advance the health and well-being of the African and American peoples. Consequently, TICIPS will target HIV/AIDS, secondary infections and immune modulation and support several innovative and interrelated research projects focusing upon potentially useful indigenous herbal medicines. These projects are supported by the NCCAM.
International Center of Traditional Chinese Medicine (TCM) for Cancer. This International Center proposes to establish a partnership and cross-cultural exchange through which investigators at M.D. Anderson Cancer Center and Fudan University Cancer Hospital will collaborate to study TCM for cancer in appropriate clinical and laboratory environments. Three aspects of TCM in a cancer setting will be examined: 1) herbal/natural products; 2) acupuncture; and 3) Qigong. These projects are supported by the National Cancer Institute (NCI) and the Fogarty International Center (FIC).
International Center for the Evaluation of East Asian Botanicals for Cancer. The goals of the International Center are to systematically evaluate traditionally used East Asian (Chinese) botanicals for their anti-cancer properties. Objectives include: 1) to establish and maintain a library of authenticated East Asian botanical extracts for scientific evaluation; 2) to create a high-throughput and combinatorial Screening Core to test botanicals individually and in combination for their activity in bioassays relating to cancer; 3) to test extracts and fractions with optimal activity in relevant animal tumor models; and 4) to enhance research capacity at the Chinese University of Hong Kong. These projects are supported by the NCI.

International Scientific Research on CAM Currently Supported by NCCAM

NCCAM, in addition to the ICRC initiative, accepts investigator-initiated grant applications that are based on ideas formulated by the applicant. Researchers may refer to Active Funding Announcements to find grant opportunities that may be appropriate for them. Examples of currently funded international research projects include:

Center for Chinese Herbal Therapy (CHT) for Asthma. In these projects, there will be an in depth evaluation of the therapeutic effects and mechanisms of the herbal formula ASHMI (an asthma herbal medicine intervention composed of 3 herbs) on a well-characterized murine model of allergic asthma. Results of these projects may lead to a novel approach-botanical drug for treating asthma and perhaps other allergic inflammatory disease.
Memorial Sloan-Kettering Cancer Center (MSKCC) Research Center for Botanical Immunomodulators. The Center will pursue systematic investigation of five botanical supplements with previously described immunomodulatory activities (Echinacea, Astragalus, Turmeric, Maitake, and TJ-48 herbal formulation), addressing composition of the botanicals, mechanism of action, development of preclinical models, and translational of clinical application. The aim of these projects is to advance the science and knowledge base of representative botanical immunomodulators, develop model experimental systems for botanical research, and generate evidence-based information to guide their human use.
An International Cooperative Biodiversity Group (ICBG) involved with the study of biodiversity of Vietnam and Laos has an expanded program in Phase II effort. The aims of this ICBG include: 1) biodiversity inventory and conservation at the Cuc Phuong National Park in Vietnam; 2) studies on medicinal plants of Laos; 3) drug discovery from plants of Laos and Vietnam for AIDS, cancer, malaria and tuberculosis therapies; and 4) biomass production and economic development.
Probiotics in Pediatric Diarrhea in Peru. This project proposes to evaluate the relative efficacy of Lactobacillus GG (LGG) and Bifidobacterium bifidum (Bb), two promising probiotic agents, in a randomized double-blinded placebo-controlled trial for the treatment of diarrhea at the community level in Santa Clara, a town in the Peruvian Amazon where chronic malnutrition and childhood diarrhea are highly endemic. The project will allow for a critical and thorough evaluation of the efficacy, practicality, and safety of probiotic organisms in a developing country, where children continue to suffer high burdens of diarrheal diseases and are in need of new and improved approaches to treatment.
Probiotics for Cryptosporidial Diarrhea and Growth Faltering. This study will investigate whether probiotics can improve childrens' immune responses to the Cryptosporidium spp. Infection and reduce the long-term consequences of malnutrition and growth. This study aims to provide insight into a novel alternative approach to alleviate the adverse outcomes of cryptosporidial diarrhea in children as well as potential effects of probiotics on the immune response to this important pathogen.

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Collaboration

Other NIH Centers and Institutes

The many centers and institutes of the NIH often collaborate with one another to advance research activities of shared interest. NCCAM employs this collaborative approach to advance international research in CAM/traditional medicine. At present, NCCAM is a contributing partner in the following collaborative efforts:

International Cooperative Biodiversity Groups (ICBG)
The International Cooperative Biodiversity Groups (ICBG) Program is a unique effort that addresses the interdependent issues of drug discovery, biodiversity conservation, and sustainable economic growth. Efforts to examine the medicinal potential of the earth's plants, animals and microorganisms are urgently needed, since enduring habitat destruction and the resulting diminishment of biodiversity will make it increasingly difficult to do so in the future. Forty to 50 percent of currently used drugs have an origin in natural products. The Fogarty International Center-managed Biodiversity Program is designed to guide natural products drug discovery in such a way that local communities and other source country organizations can derive direct benefits from their diverse biological resources. Benefit-sharing may provide clear incentives for preservation and sustainable use of that biodiversity.
Centrally Co-ordinated Bioethics Education for India
This initiative is designed to: 1) develop a working system for program direction; 2) develop a centrally co-coordinated Bioethics network of faculty among the Indian Council of Medical Research (ICMR) and non-ICMR Institutions to deliver the prepared bioethics curriculum for dissemination of Bioethics Education; 3) develop capacity in Bioethics Education through a Training Program based on the curriculum designed in NIH Planning Grant in the National Task Force I working system mode; and 4) develop a system of evaluation to modify the curriculum on an ongoing basis through feedback.
International Bioethics Education and Career Development Award
This initiative is designed to: 1) improve the quality of international bioethics training by supporting the development of appropriate courses in developing countries; 2) support the advance training of developing country professionals to become bioethicists, involved in the review and/or design of research in their countries; and 3) develop and provide intensive short courses for individuals directly involved in human subjects research ethical review and the conduct of clinical trials in developing countries.
With the Fogarty International Center (FIC) taking the lead, NCCAM and several other NIH centers and institutes support grants to a number of universities in the U.S. and abroad. A list of these is available on the FIC's Web site.

FIC International Research Collaboration (FIRCA)
NCCAM is collaborating with the NIH's Fogarty International Center (FIC) in support of two newly reissued and expanded Program Announcements (PAs) to support research on CAM and traditional medicine. One of these is intended for support of basic biomedical research; the other for research in the behavioral and social sciences. These mechanisms provide funds ($32,000/year direct costs) to foster international research partnerships between NIH-supported U.S. scientists and their collaborators in eligible countries of the developing world.

The FIRCA program's objective is to benefit the research interests of both the U.S. and foreign collaborators while increasing research capacity at the foreign site. U.S. scientists who have an eligible NIH grant may apply. All areas of biomedical and behavioral research supported by NIH are eligible topics for research, except research related to HIV/AIDS or related illnesses.

NCCAM is interested in funding FIRCA awards relevant to NCCAM's mission and which focus on the science underlying highly promising traditional medicine (TM) and complementary and alternative medicine (CAM) health practices. Through the use of these two mechanisms, NCCAM hopes to increase collaborative efforts between NIH-funded researchers, and investigators in eligible countries who are knowledgeable about indigenous, traditional medicine practices. These may include basic, translational, or early clinical research aimed at determining whether these practices are beneficial to health problems both at the overseas site where research is proposed, and in other global settings as well.

Please visit the FIC/FIRCA Web site for more details.

International CAM/TM Organizations

World Health Organization Collaborating Centers for Traditional Medicine
NCCAM continues to serve as a member organization of the WHO Collaborating Centers for Traditional Medicine. In its role as a WHO collaborating center, NCCAM: 1) promotes research and research training in CAM; 2) expands communication and information exchange about CAM through electronic and other means; and 3) engages in international collaborative efforts, and provides consultation relative to CAM research and research training, upon request, to other WHO Centers.
NCCAM–China Research Collaboration
On April 19, 2006, NCCAM Director Stephen E. Straus, M.D. signed a "Letter of Intent (LOI) on International Collaboration in Complementary, Alternative, and Traditional Medicine Research" with three of the principal Chinese Government agencies most involved in the study of traditional Chinese medicine. These include the Ministry of Science and Technology, the China Academy of Chinese Medical Sciences, and the State Administration of Traditional Chinese Medicine.
The focal point of the LOI is an agreement to work together to advance the scientific discipline of complementary and alternative medicine and traditional medicine (CAM/TM) research through approaches intended to foster and stimulate additional scientific exchange and collaboration between individual scientists and research institutions in both countries. The effort will help NCCAM advance its international objectives, as defined in its Strategic Plan, to: 1) increase global capacity for CAM/TM research; 2) facilitate greater sharing among investigators and institutions of scientific knowledge and resources; and 3) create more opportunities for researchers from the U.S. and abroad to partner on specific studies.
- More background »
- Letter of Intent »
HHS–China Memorandum of Understanding
On June 16, 2008, HHS Secretary Mike Leavitt signed a memorandum of understanding with Chinese Vice Minister of Health Wang Guoqiang to foster collaboration between scientists in both countries in research on traditional Chinese medicine (TCM) and to further scientific research on TCM.
The signing marked the opening of a two-day TCM Research Roundtable at NIH, which included a delegation from the Chinese State Administration on TCM, academics from U.S. universities, and scientists and researchers from NIH, the Indian Health Services, and the Food and Drug Administration.
- Memorandum of Understanding » (192 kB PDF)

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Research Training

International Postdoctoral Fellowships

NCCAM supports an International Postdoctoral Fellowship program which provides a means for foreign independent scientists (non-U.S. citizens, non-U.S. permanent residents) to do collaborative research with a U.S. scientist on alternative medical systems, or components of such systems. The duration of support is 1 to 3 years at a U.S. institution, followed by 2 years at the applicant's institution in his/her home country. (The program announcement, released on January 6, 2003, describes this program online.) Through this program, NCCAM is funding International Postdoctoral Fellows who come to the U.S. to conduct research at U.S. research centers, and then return to their home country to continue their research. Note: The F05 International Fellowship mechanism is currently under review and is closed to new applicants at this time.

Research topics currently being studied through these fellowships include:

Gene-expression profile in berberine (a constituent of a Chinese herb)-treated human cancer cells. By analyzing the expression profile of nearly 40,000 genes, the research expects to identify a set of target genes that may function as intracellular mediators of berberine's anti-cancer action. In the long-term, this will hopefully shed light on the possible use of berberine and its derivatives as effective chemotherapy and/or chemopreventive agents in human cancer.
Mechanisms of action of plant products used in TCM in animal models of arthritis. These study results would help in establishing a reliable scientific basis for use of some of these TCM products in autoimmune arthritis, and in developing better therapeutic approaches for patients with rheumatoid arthritis.
Pharmakinetic and pharmacodynamic interactions between indinavir, a HIV protease inhibitor, and American ginseng, commonly used by HIV-infected patients. The investigator hypothesizes that ginseng may reduce indinavir levels, and may reverse indinavir-induced insulin resistance.
The role of a reputed anti-tumor Chinese herbal formula, ZYD88, testing the hypothesis that it induces apoptosis in prostate cancer cells in a xenograft animal model with prostate LNCaP tumor. Dose response and time-course analyses of ZYD88 action will also be performed. These studies will facilitate our understanding of the efficiency and mechanisms of Chinese herbal medicine in cancer therapy.
FMRI of Autonomic Regulation with Acupuncture. Acupuncture modulation of the autonomic nervous system will be investigated by multi-modal techniques combining functional MRI with physiological monitoring. After validation, these studies will explore the central network for acupuncture ANS modulation and potential laterality in acupoint response.
Transcription Activation-Based Herb-Drug Interactions. The objective of this project is to elucidate the molecular basis for herb-drug interactions, and to develop molecular-based technologies to predict such interactions. Results may reveal molecular details involving the activation of the pregnane X receptor (PXR) by Chinese herbal extracts and model compounds hyperforin and guggulsterone.

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