NIAID Basic and Clinical Research Training

Allergy and Immunology Training Program

Dean D. Metcalfe, M.D., Program Director
Calman Prussin, M.D., Program Co-Director

Overview

The National Institute of Allergy and Infectious Diseases (NIAID) offers a three-year training program in allergy and immunology. This program, open to physicians who are well-grounded in clinical internal medicine or pediatrics, is designed to provide trainees with the high-quality clinical and laboratory skills that will enable them to pursue careers in academic medicine.

Structure of the Clinical Training Program

The majority of the clinical activities are confined to the first year of training, which includes rotations in the NIH outpatient clinic, on the inpatient ward of the NIH Clinical Center, at the Walter Reed Army Medical Center, and at Children's National Medical Center.

The patients under study have a wide variety of disorders, including asthma and allergic diseases, HIV infections, mast cell disorders, idiopathic eosinophilias, autoimmune diseases and forms of vasculitis, inherited and acquired immunodeficiencies, and disorders of neutrophil and monocyte function. In addition, the residents are the allergy and immunology consultants for the NIH and rotate through the diagnostic immunology laboratory.

The second- and third-year residents spend most of their time engaged in research, although some responsibility for the consultation service and the allergy and immunology clinics is continued. Fellows also receive broad instruction in allergic and immunologic disorders and attend conferences designed to prepare trainees for the allergy and immunology board examination. Residents are fully qualified to take the ABAI examination after two years in the program. The total expected length of stay is three years, although some fellows have remained four to five years for more extensive laboratory training.

Structure of the Research Training Program

The core of the research training program is the two years spent in the laboratory. Trainees work under the direct supervision of one of the M.D. or Ph.D. NIAID senior staff. The research experience is characterized by close daily contact with the preceptor, individual instruction, and continuity during the training period.

The trainee works in the laboratory for about 10% of the time during the first year, 90% of the time in the second year, and almost exclusively in the third year. Trainees have the option, with approval, for a fourth and occasionally a fifth year of training. Allergy and Immunology residents may request to work in any of the laboratories within the intramural NIAID program. Research opportunities involve a wide range of investigations in various aspects of allergy and immunology. These vary from clinical to the most basic aspects of cell and molecular biology. Current trainees pursue research projects in the following areas:

• The biology of the mast cell and basophil
• Pathophysiology of asthma, anaphylaxis, and other allergic disorders
• Effect of cytokines on cellular responses
• Diagnosis of and host responses to infectious agents
• Systemic mastocytosis
• The role of antibody and cellular immune systems in inflammation and autoimmunity
• The function of cellular receptors for immunoglobulin, cytokines, and matrix components
• The basis of mucosal immunity
• Humoral and cellular immunoregulation and immunoregulatory defects
• The biology of polymorphonuclear leukocytes, monocytes, and macrophages
• Vaccine immunology
• Aspects of the pathogenesis of HIV.

Program Faculty and Research Interests

Major Clinical Faculty

• Dr. Dean Metcalfe's interests include both clinical and basic research. In his studies of patients with mast cell disorders, Dr. Metcalfe has characterized the spectrum of diseases associated with mastocytosis, and has developed the currently accepted management programs for this disease. In evolving studies on asthma, emphasis is on pathogenesis. His basic laboratory research focuses on the growth and differentiation of mast cells, employing molecular techniques. His work has led to the current appreciation of the growth factors regulating mast cell differentiation and the multifaceted role of the mast cell in inflammation.
• Dr. Warren Strober performs basic research on cytokines and T-cell regulation and investigates common variable immunoglobulin deficiency.
• Dr. Clifford Lane is the NIAID clinical director. His basic research interest is the immunopathogenesis of AIDS. Dr. Lane's clinical interest is the treatment of HIV.
• Dr. Anthony Fauci is the director of NIAID as well as the chief of the Laboratory of Immunoregulation. His work has focused upon the causes and treatment of AIDS and the regulation of B cells in the immune response.
• Dr. Thomas Fleisher directs the Clinical Immunology Laboratory. His research focuses on laboratory analysis of inherited immunodeficiency.
• Dr. Calman Prussin studies the cytokine biology and cellular immunology of allergic disease with a focus on adverse reactions to vaccines and biologics.

Adjunct Faculty

• Dr. Bryan Martin, Allergy-Immunology Training Program Director, Walter Reed Army Medical Center
• Dr. Michael Sly, Chief, Section of Allergy and Immunology, Children's National Medical Center
• Dr. Melody Carter, pediatric asthma, pediatric mastocytosis, NIAID
• Dr. Hirsh Komarow, pediatric allergic diseases, NIAID

Examples of Papers Authored by Program Faculty

Luccioli S, Brody DT, Hasan S, Kojima D, Noben-Trauth N, Keane-Myers A, Prussin C, Metcalfe DD. IgE+ Kit- I-A/I-E- myeloid cells are the initial source of IL-4 following antigen challenge in a mouse model of allergic pulmonary inflammation. J. Allergy Clin. Immunol. 2002. 110:117-124.

Yavuz AS, Lipsky PE, Yavuz S, Metcalfe DD, Akin C. Evidence for the involvement of a hematopoietic stem cell in systemic mastocytosis from single cell analysis of mutations in the c-kit gene. Blood. 2002. 100:661-665.

Basta M, Van Goor F, Luccioli S, Billings E, Vortmeyer A, Baranyi L, Szebeni J, Alving CR, Carroll MC, Stoljilkovic SS, Metcalfe DD. F (ab)12-mediated neutralization of proinflammatory-effects of C3a and C5a anaphylatoxins: A novel effector function of immunoglobulins that could extend their therapeutic potential. Nature Medicine. 2003. 9:431-438.

Kirshenbaum AS, Akin C, Wu Y, Rottem M, Goff JP, Beaven MA, Rao VK, Metcalfe DD. Characterization of novel stem cell factor responsive human mast cell lines LAD1 and 2 established from a patient with mast cell sarcoma/leukemia; activation following aggregation of FceRI or Fcg RI. Leukemia Res. 2003. 27:677-682.

Foster B, Metcalfe DD, Prussin C. Human dendritic cell 1 and dendritic cell 2 subsets express FcepsilonRI: Correlation with serum IgE and allergic asthma. J. Allergy Clin. Immunol. 2003. 112:1132-1138.

Prussin C, Griffith DT, Boesel KM, Lin H, Foster B, Casale TB. Omalizumab treatment downregulates dendritic cell FcepsilonRI expression. J. Allergy Clin. Immunol. 2003. 112:1147-1154.

Program Graduates

The following is a list of fellows who have recently trained in the Allergy and Immunology Program, including their current status:

• Cem Akin, Assistant Professor, Univ. of Michigan
• Soheil Chegini, Assistant Professor, Penn State College of Medicine
• John McDyer, Assistant Professor, Johns Hopkins Asthma and Allergy Center
• Jack Ragheb, Tenure-Track Scientist, NEI, NIH
• Robert Seder, Tenured Research Scientist, Vaccine Research Center, NIH.

Application Information

The Allergy and Immunology Training Program is fully accredited by the Accreditation Council for Graduate Medical Education. Residents are approved for two years of full credit and may sit for the Board of Allergy and Immunology. There are two to four positions available per year, and candidates should apply for the program in the fall 18 months prior to entry in July via the ERAS system. The training program application deadline in ERAS is January 31st. Applicants must be on track to complete an ACGME-approved residency in internal medicine or pediatrics at the time they enter the program. Interviews are held between November and March.

Applications must contain:

1. MyERAS application
2. Three (3) letters of recommendation
3. Personal statement
4. Medical school transcript
5. Medical student performance evaluation /Dean's letter
6. USMLE or COMLEX transcript
7. ECFMG status report (for international medical graduates only)

For further information the applicant may contact:

Dean D. Metcalfe, M.D.
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Building 10, Room 11C205
10 Center Drive, MSC 1881
Bethesda, MD 20892-1881
Inquiries: (301) 496-3951
Fax: (301) 480-8384
E-mail: dmetcalfe@niaid.nih.gov

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