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the early days, James recalls, immunology researchers focused on aspects of the innate immune system such as macrophages, and the structure and function of antibody molecules. When the role of T cells and B cells came to light, interest shifted to the biological workings of the adaptive immune system and how it programs its weaponry. With the recent discovery of the card15 gene mutation, which appears to increase a persons risk of developing Crohns disease, research interest has shifted back to the innate immune system. Researchers hypothesize that its possible that some cells may be deficient in sensing bacteria, which might result in an exaggerated inflammatory response.

This is typical of how things recycle in science, says James, whose current mission as Director of DDN is to oversee research to better understand the perplexing biological mechanisms behind complex diseases of the gastrointestinal system, knowledge that would make new diagnostics and treatments possible.

Despite incremental discoveries, the mechanism behind Crohns disease, an inflammatory disease of the small bowel, remains something of a mystery. Crohns afflicts an estimated 400,000 to 600,000 Americans. We still have a lot to learn, says James. One important recent advance was the discovery that tumor necrosis factor (TNF) is an inflammatory cytokine. This finding led to the development of infliximab, an anti-TNF monoclonal antibody, which has been effective in relieving symptoms in two-thirds of patients. This is an example of the kind of bench to bedside progress we would hope to bring to other digestive diseases, James adds.

IBD comprises two of the complex digestive diseases needing more effective diagnostic tests and interventions. The average person goes many years before being diagnosed, says James. In Crohns and ulcerative colitis, our long-term goal is to figure out whos at risk early enough to modify environmental risk factors and to intervene before complications and morbidity become an issue.

Celiac disease is another chronic inflammatory disease with interesting research potential, James points out. In this case, medical science knows a bit more: the body reacts to environmental triggers — proteins in wheat, rye and barley. We also know theres a genetic link, he adds. The question is: How do the controlling genes interact with the protein triggers to cause disease?

Celiac disease is easily treated by eliminating these foods from the diet, James notes, but it remains widely underdiagnosed because symptoms are difficult to recognize and a biopsy is necessary to confirm diagnosis. Celiac is a good research model, he says, because once we know more about how genes and the environment conspire, we may be able to apply that information to other complex diseases. If we can develop better diagnostic tests, it will be possible to prevent complications and morbidity at low cost.

Digestive diseases such as IBD, esophageal reflux, celiac disease, and chronic liver diseases, such as hepatitis B and C, all cause chronic inflammation and are associated with an increased risk of cancer. Right now, Dr. James says, were collaborating with NCI in studying Barretts Esophagus as a precursor to esophageal cancer. We also are cooperating with the NIAID in hepatitis C studies.

In motility disorders such as gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS), there are great opportunities for advances through neuroscience, James says, particularly in understanding the complex activities that connect the brain to the nerves in the gut. This has become an exciting new area for patient-based research, he says, as new tools such as brain imaging techniques have become available.

lins

judge will hear the matter on June 20.

Lohan's spokeswoman had no comment Tuesday.

The starlet, who grew up in Merrick and Cold Spring Harbor, is no stranger to car accidents. She had three in 2005 and one in 2007. She is also being sued for the August 3, 2005 accident, in which the plaintiffs, Eddie Pamilton and Ilex Harris, claim she struck their vehicle.

Her last accident, on May of this year, prompted her arrest for DWI. The Beverly Hills Department arrested her and claims they found a substanced which was tentatively identified as cocaine. Lohan entered a medical rehab clinic two days later.

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