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अखिल भारतीय आयुर्विज्ञान संस्थान, नई दिल्ली
All India Institute Of Medical Sciences, New Delhi

Research

Research

S.noName of the Project & Principal InvestigatorDescription of the Project
1 Fetal liver infusion: Further studies on the role of action of fetal liver cells on the regeneration of adult bone marrow: In vitro evaluation Earlier studies conducted in our lab. demonstrated that fetal liver conditioned medium (FLCM) supported the colony growth of normal bone marrow as well as aplastic marrow. This suggested the presence of growth stimulatory cytokines in FLCM. Eliza studies revealed the presence of stem cell factor in 50% of FLCM samples. Subsequent studies revealed that Flt3 and IL-6 were also present in substantial number of FLCM samples.
2 Evaluation of thermal camera to detect early cancer: Collaborative project with Moscow Russian scientists have produced a Camera which measures thermal changes in the body. Thermal changes occurring in superficial parts of body may be indicative of cancer. DST has identified IRCH, AIIMS as one of the centres where this camera could be evaluated to see, if cancer can be detected in its early stages. Two doctor team from IRCH, AIIMS has already visited Moscow and seen this camera. Now IRCH has procured this camera and has initiated the required work.
3 Effect of breathing techniques: Sudarshan Kriya in normal individuals and those with cancer in remission Sudarshan kriya (SK) is a rhythmic breathing process, where 3 rhythms of breath are followed in cyclical fashion. This process has been introduced by H.H. Sri Sri Ravi Shankar. Studies conducted so far have shown that regular practice of Sudershan Kriya (SK) and Pranayam(P) introduces changes in electroencephalogram (EEG) consistent with the achievement of state of relaxed alertness. Fall in blood lactate in those practicing SK & P further confirms that state of relaxation is achieved. Also natural killer (NK) cells and antioxidant defence increases in the body This would raise the possibility that age related diseases may be reduced with these practices. Gene expression profiling revealed that process of scenescence may get delayed and risk of cancer may be less. Patients with breast cancer had fewer side effects to chemotherapy, better quality of life and better immune status.
4 Antioxidant Vitamins in lung cancer: Current therapies for lung cancer are unsatisfactory. Despite using multiple chemotherapy combinations, response rates have been less than 40%; survival less than 10 months and one year survival often less than 40%. In vitro study carried out by us demonstrated increase in apoptosis when antioxidants were added to Carboplatin/Paclitaxel combination. Clinical study also showed improved response rates and longer survival although statistical difference could not be demonstrated.
5 “Common cancers: Perception and determinants of community behavior”. – Terry Fox Project Description:- Under this project 10 focused group discussion (FGD) have been organized with community members, para medical workers, health workers and medical officers. These were organized in four districts of Delhi. Individual interviews with community members, para medical workers, health workers is also conducted in the same district. Interviews with medical officers, senior medical administrative officers and program planners is likely to finish in near future
6 Population screening programme for cancer of cervix, breast and oral cavity to (i) Determine the level of knowledge and skill of health workers in the use of low cost screening techniques for the detection of common cancers in the community (ii) Assess the effectiveness of training of health workers in the use of low cost screening techniques and (iii) Determine the supervisory and monitoring factors in a programme on the use of low cost screening techniques by health workers. Description:- Under this project training program on awareness and cancer screening technique for common cancers i.e cervix, breast and oral cavity is being organized for the medical officers, para medical workers and health workers of CGHS and ESI. So far theoretical and practical training has been provided to 200 personnel. Program is on and target is to cover all personnel of above organization. Screening for cancer cervix is being run in association with various NGO’s.
7 Randomized study comparing upfront surgery followed by chemotherapy versus upfront chemotherapy followed by interval debulking surgery in previously untreated epithelial ovarian cancer stage III C and stage IV (pleural effusion only). Between Oct. 2001 and Aug. 2006, 118 previously untreated patients of Stage IIIC & IV were randomized into two arms; Arm A (n=62) consisted of upfront debulking surgery followed by 6 cycles of Paclitaxel and Carboplatin. Arm B; upfront 3 cycles of chemotherapy followed by interval debulking surgery. Results: Patients in neoadjuvant arm had higher optimum debulking rate (p<0.001) and decreased blood loss. There was good correlation between CAT Scan findings and suboptimal debulking. Quality of life score (QOL) was higher in arm B.
8 Alpha interferon vs low dose Thalidomide as maintenance therapy following autologous stem cell transplant in patients with multiple myeloma: A randomized study To reduce the risk of relapse, after autolo stem cell transplant we are performing a prospective ,study in which patients are randomized to receive either IFN- a 3 mU SC thrice a week for => one year or low dose thalidomide, 50 mg daily for =>one year. Between October 2002 and June 2004, 17 patients have been entered into the study (IFN- a - 8, thalidomide- 9). Therapy was started within 12 weeks of transplant. Patients are being followed regularly for any toxicity to above therapy and relapse. In one patient randomized to IFN-a arm , treatment could not be started due to low counts >3 months post transplant. In another patient IFN-a had to be stopped after 12 weeks due to intolerance. The major side effects to thalidomide were- constipation, drowsiness and mild neuropathy and skin rash in one patient. In IFN arm, - flu like symptoms were seen in almost all patients within first 2 to 6 weeks, followed by myelosuppression (grade I-II). All 17 patients continue to be alive till date.
9 Concomitant chemoradiation protocol for advanced and or unresectable squanous cell carcinoma of oropharynx and nasopharynx The head and neck cancers constitute 5% of all cancers worldwide and 15% of all cancers in developing countries. Most of these patients present in advanced stages. There are areas in the head and neck region e.g. Nasopharynx and Oropharynx where surgery is not technically feasible or it is difficult and these cancers are treated with radical or palliative radiotherapy which is often supplemented with chemotherapy. A number of trials including meta analyses are available in the literature giving conflicting results whether addition of chemotherapy definitely adds to the improvement in survival or not. There is lack of published literature from India in this particular field. In the proposed study we, plan to study the safety and efficacy of chemoradiation (concomitant using single agent cispaltin) in unresectable squamous cell carcinoma of oropharynx and nasopharynx and to compare it with radical radiotherapy in a randomized fashion.
10 Efficacy and Adverse effects of Thalidomide and Prednisone in Hormone refractory prostate cancer Prostate cancer is an important and increasing public health problem. In India incidence of prostate cancer is 4.5/ 1,00,000. However, it is the 3rd commonest cancer in males in Delhi. During the course of disease once the cancer becomes androgen independent or refractory there are limited options available. Angiogenesis has been identified as a key pathophysiological process that is important in growth, local invasiveness and metastasis of malignant tumors. Therefore, anti-angiogenic therapy represents one of the promising new approaches to anticancer therapy. Thalidomide is one such drug available in oral formulation and have limited side effects except teratogenecity. In this trial 50 hormone refractory metastatic prostate cancer patients will be recruited.
11 Gemcitabine, and Oxaliplatin in advanced/Unrespectable Adenocarcinoma of Gall Bladder: A phase II study Gall bladder cancer is one of the commonest cancer in females in this part of country. Majority of these patients present in advanced and unresectable stage. Currently these patients of unresectable/ metastatic gall bladder cancer are treated with palliative RT, chemotherapy or just with analgesics. There are some initial reports about efficacy of Gemcitabine, and Oxaliplatin in these patients. The drugs are also available in India. As majority of our patients present with advanced stage it will be meaningful to test combination of Gemcitabine and Oxaliplatin as first line therapy in advanced/ unresectable adenocarcinoma of gall bladder.
12 In vitro expansion and establishment of human fetal liver hematopoietic stem cell line. Fetal liver is the predominant site of hematopoiesis during mid gestation. Fetal liver infusion has been used to treat certain disorders like aplastic anemia (AA), acute myeloid leukemia (AML) and immunodeficiency syndrome., In previous study we have demonstrated the presence of putative growth factors (cytokines), such as stem cell factor (SLF), IL-6 and fms – like tyrosine kinase – (FLt-3) in fetal liver conditioned media. In the present project we plan to isolate fetal liver hematopoietic stem cells (FLHSC) expand these cells under in vitro culture condition and establish transformed and non-transformed cell lines.
13 An invitro study of antiproliferative and apoptotic effects of gefitinib on lung cancer cell lines. Lung cancer is the leading cause of cancer death across the globe. Nearly 60% of people diagnosed with lung cancer die within one year and >75% within 2 years of their diagnosis. Recent data from the combination of newer agents plus platinum has shown a modest increase in survival for patients with advanced lung cancer. We plan to examine the effects of gefitinib alone and in combination with various chemotherapeutic drugs on the cell cycle. Cytotoxicity and apoptosis in lung cancer cell line.
14 Antioxidant as adjunct to chemotherapy of lung cancer: in vitro study. In this study, we want to see the effects of antioxidants (Vitamin C, E & beta-carotene) in conjunction with standard chemotherapeutic agents in a number of lung cancer cell lines. As earlier in our study we have demonstrated that a mixture of antioxidants significantly enhance the apoptotic effect of chemotherapeutic agents paclitaxel and carboplatin on human lung cancer cell line.
15 Resistance to Imatinib Phositive Indian leukemia patients: Molecular mechanism. Imatinib mesylate is a tyrosine kinase inhibitor that has now become the standard drug therapy for chronic myeloid leukemia in all phases of disease. But a cohort of patients either do not achieve a significant level of response or looses their best response.. In this project we aim to study what are the changes occurring at molecular level that are responsible for this type of resistance to Imatinib.
16 Expansion of adult human bone marrow and cord blood stem cells for reconstituting marrow and for reprogramming into hepatocytes. With discovery of transdifferentiation ability of hematopoietic stem cells, cellular therapy is expected to become relatively simpler and versatile. Patient’s own born marrow cells can be utilized for the therapy avoiding immune rejection. It would be exciting to explore the possibility of candidates stem cell expansion, then ex vivo reprogramming them to partially different target cells and transporting into the hose (nude mice in our project). Beside bone marrow, cord blood is an excellent candidate for adult stem cells having primitive phenotype (CD 34+, CD38-, HLA-DR); has the potential for ex vivo expansion and cell therapy. In this project we target both cord blood and born marrow as a source of multipotent adult progenitor cells (MAPC). Characterization of MAPC, its ex vivo expansion and differentiation into hepatocytes will provide possible insight for transdifferentiation. In vivo experiments using nude mice will provide evidence of stem cell potential for homing engraftment and differentiation into hepatocytes
17 Treatment and characterization of acute lymphoblastic leukemia in children, adolescents and young adults Enrolling patients of ALL <25 years age for diagnosis, immunophenotyping, treatment protocol and to study their biology using molecular markers.
18 G-CSF mobilized peripheral blood progenitor cell transplantation(allogeneic or autologous: A multicentric study. Role of G-CSF in mobilization of stem cell in both autologous and allogeneic stem cell setting. So far 8 patients have been recruited. Initial results confirm the role of G-CSF (grastim) in mobilization of CD34 +ve cells.
19 Randomized comparison of ABVD with EVAP in newly diagnosed cases of Hodgkin’s lymphoma-protocol p-0402 Most of Hodgkin’s Lymphoma (Disease) patients require combination chemotherapy. The available chemotherapy regimens include doxorubicin (adriamycin), bleomycin, vinblastine, decarbazine (ABVD) which is considered gold standard; COPP< MOPP-ABV etc. Whereas, the ABVD is one of the most effective combination majority of our patients find it difficult to afford. Alkylating based regimen like MOPP and COPP are usually associated with sterility in significant number of cases together with risk of secondary leukemia (malignancy). Hence, there is a need for a new regimen which may be as effective as ABVD, devoid of late side effects of alkylators and yet cheaper. Earlier we have shown effectiveness of etoposide, vinblastine, adriamycin, and prednisolone (EVA). Therefore, we plan to compare effectiveness of EVAP vis a vis ABVD in a prospective randomized fashion in newly diagnosed cases of Hodgkin’s lymphoma. Study was started in September 2004 and we are likely to complete accrual of 100 by October 2006.
20 Role of arsenic trioxide with ascorbic acid in treatment of multiple myeloma – a pilot study. A Phase II study of role of arsenic trioxide with ascorbic acid in treatment of relapsed/refractory multiple myeloma is underway, a total of eight patients have been recruited and their evaluation is underway. A total 20 patients are intended for recruitment.

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