orthopaedic research program skin biology and diseases. the programs comprising skin biology and diseases support a broad portfolio of basic, translational, and clinical research in skin. these efforts include work on the developmental and molecular biology of skin and skin appendages (such as the hair follicle), the study of skin as an immune organ, and the genetics of skin diseases. areas of particular emphasis include investigations of stem cells found in skin; studies related to wound healing and fibrosis; heritable disorders of connective tissue (such as marfan's syndrome); studies related to itch; metabolic studies of skin, such as the effects of hormones and the role of enzymes in skin barrier formation; and immunologically mediated cutaneous disorders, such as atopic dermatitis, contact dermatitis, and vasculitis. research is underway to better understand keratinizing and inflammatory disorders such as psoriasis and ichthyosis; disorders of pigmentation such as vitiligo; and bullous diseases such as pemphigus, pemphigoid, and epidermolysis bullosa. other studies encompass acne and the physiologic activity of the sebaceous glands, as well as disorders of the hair, such as alopecia areata. the niams also pursues a deeper understanding of the basic biology of skin functions, new approaches for developing artificial skin, and advances in imaging technologies for diagnosis and tracking of skin disease progression. the skin biology and diseases research area encompasses the following individual scientific programs: epidermis, dermis and skin senses program skin immunology and diseases, skin microbiome program skin repair, pigmentation and appendages, vasculature/lymphatic systems program office of extramural operations this office within the der manages the niams grants policies and procedures, including oversight of grants administration, scientific review, and clinical management functions. it serves as the primary liaison for the niams with the nih office of extramural research and with other institutes that share research interests. the office handles scientific integrity and ethical questions in research and manages the niams advisory council, a congressionally mandated second tier of the nih peer review system. the scientific review branch (srb) conducts the initial peer review of specific research applications assigned to the niams. these include applications for centers, program projects, single and multi-site clinical trials, scientific conferences, training and career development awards, as well as applications responding to initiatives published by the niams including contract solicitations. members of the scientific community are selected to serve as peer reviewers. the grants management branch (gmb) works with scientists and institutional research administrators to issue, manage, and close out awards. the branch has legal responsibility for the fiscal management of the institute's extramural grants. the clinical management team (cmt) provides logistical and operational support for the institute's clinical trial activities. the cmt assesses study risk, implementing data and safety monitoring oversight, tracking enrollment progress, and mitigating study related issues for the complete portfolio of niams funded clinical trials and select human subject observational studies with some level of risk. the cmt also implements nih policies pertaining to clinical trials, in addition to being subject matter experts on federal policies for protection of human subjects and fda regulations. intramural research the niams intramural research program (irp) consists of: office of the scientific director, office of the clinical director, autoimmunity branch, clinical trials and outcomes branch, community research and care branch, dermatology branch, laboratory of molecular immunogenetics, laboratory of muscle stem cells and gene regulation, laboratory of oral connective tissue biology, laboratory of skin biology, laboratory of structural biology research, molecular immunology and inflammation branch, office of science and technology, pediatric translational research branch, protein expression laboratory, systemic autoimmunity branch, rheumatology fellowship and training branch, and the career development and outreach branch office of the scientific director the office of the scientific director is responsible for the development of broad decisions concerning program planning, budget and policy formulation, and resource allocation of the intramural program. the scientific director represents the niams in discussions of nih-wide intramural policies and programs and serves as the principal advisor to the director of the niams concerning all ongoing and projected intramural research programs. office of the clinical director the office of the clinical director implements innovative clinical research programs that relate to the broad fields of rheumatologic, musculoskeletal, and skin disorders. through specific programs in clinical research, rheumatology fellowships and advanced training in translational medicine, and health partnerships, the office of the clinical director plays an important role in establishing cutting-edge therapeutic paradigms, in providing medical education in the field of rheumatology, and in reaching out to the community to reduce health care disparities and to improve the understanding of rheumatic and related diseases. the translational genetics and genomics unit in the office of the clinical director focuses on understanding the mechanisms that underlie human inflammatory disease. using an approach that integrates genomics, bioinformatics, and mechanistic investigations, the program aims to identify the causes of genetically complex autoinflammatory diseases, including systemic juvenile idiopathic arthritis and behçet's disease. the clinical trials and outcomes branch conducts research on the health outcomes of patients with rheumatic diseases and orthopaedic conditions. studies focus on the development and testing of measures of health and disease, identification of predictors of good and poor health outcomes, examination of treatment effectiveness, and investigations of socioeconomic and ethnic disparities in health outcomes. the clinical trials and outcomes branch also conducts studies on the outcomes of many important orthopaedic conditions. the studies use large clinical databases to investigate rare femur fractures, uncommon hip infections, and novel fracture treatments, as well as studying rare, genetic bone diseases. the goal is to provide clinical insights into conditions that cannot be examined in traditional clinical studies. the community research and care branch coordinates activities within the niams community health clinic, a health information resource that provides health care services to underserved populations affected by arthritis, lupus, and other rheumatic diseases. the clinic offers patient care with access to specialists, education programs, and referral to clinical investigations for the prevention and treatment of rheumatic diseases. the autoimmunity branch conducts basic and clinical research on the pathophysiology and treatment of autoimmune diseases. signal transduction pathways that differentiate normal and pathological immune responses are studied in mouse models and human tissue samples to gain insights into how these processes drive autoimmune diseases, and how therapies that minimize generalized immune suppression can best be developed for these diseases. the branch focuses on the tnf-family of cytokines and their receptors, from basic investigation of the trafficking and signaling by these molecules to the study of human diseases involving tnf-family cytokines and their receptors. the branch also studies intracellular signaling and how this leads to immune-mediated disease. individuals with known or currently undiagnosed rare genetic syndromes are evaluated by genetic and biochemical investigations. the dermatology branch investigates fundamental and clinical aspects of neoplastic and inflammatory skin disease as well as normal skin function, while also providing all dermatology patient care at the nih clinical center. the branch includes research focused on clinical and translational research in rare disease populations, including new clinical syndromes and trials of new therapies, and houses three sections devoted to cutaneous research areas. the branch studies signaling pathways that regulate development and maintenance of normal skin, and the changes in these signals that occur during the formation of skin cancer. one area of focus is skin sensory neuroendocrine cells, merkel cells, and the pathogenesis and treatment of merkel cell carcinoma (mcc). an important area of research for the branch includes investigation of the skin microbiome in health and disease. the branch also aims to extend knowledge of interactions of immune cells in skin and skin appendage niches, combining mouse genetics, bioinformatics, immunology and cell biology. closely related is the laboratory of skin biology, which conducts research on the regulation of epidermal differentiation, skin barrier formation, and inflammatory responses associated with barrier dysfunction. a major focus is basic investigation of ectodermal appendage development and the study of human ectodermal dysplasias. the laboratory of molecular immunogenetics conducts research on b lymphocytes focusing on the regulation of gene expression and chromatin organization in normal cells and in the setting of cancer. the laboratory of muscle stem cells and gene regulation investigates the cellular and molecular mechanisms that regulate differentiation and regeneration of skeletal muscle in physiological and pathological conditions. the ultimate goal of these studies is to provide a conceptual, as well as practical, framework for the diagnosis and treatment of human diseases affecting skeletal muscle. the lab also focuses on dissecting the composition of ribonucleoproteins involved in cellular rna transport and control of rna stability, and inflammatory and autoimmune human muscle disease as well as the basic biology of skeletal muscle regeneration. the laboratory of oral connective tissue biology studies the molecular biology of dental-oral-craniofacial development, with a focus on the teeth, gums, and related jaw structure. the aim of these studies is to understand cells and signals influencing tooth, bone, and periodontal ligament development in order to identify improved regenerative strategies. the laboratory of structural biology research conducts research into the structural basis of the assembly and functioning of macromolecules and their complexes (such as viruses and cytoskeletal proteins), and the mechanisms and proteins that control their assembly. these studies make extensive use of cryoelectron microscopy and three-dimensional image processing in studies of virus infection and replication; renewal of the epidermis, with maintenance of barrier function; prionogenesis (structural transitions of infectious proteins called prions); and intracellular protein quality control by energy-dependent proteases. the molecular immunology and inflammation branch conducts basic and clinical investigations of the molecular mechanisms underlying immune and inflammatory responses in rheumatic and autoimmune diseases. a major focus is the study of receptor-mediated signal transduction and how these processes link to the regulation of genes involved in inflammatory responses. the office of science and technology encompasses an infrastructure of research and support facilities designed to enhance the research capabilities of all irp scientists. in addition, staff members advise the scientific director, laboratory and branch chiefs, and other key officials on collaborative and cooperative activities, training programs, and proper use of laboratory animals. staff members also negotiate and facilitate scientific collaborations that involve trans-institute and trans-nih initiatives and agreements. the office includes the following: the flow cytometry section provides state-of-the-art multiparameter analytic and cell sorting capabilities for irp investigators. the laboratory animal care and use section supports all irp branches and laboratories that utilize animal models in their research initiatives. the light imaging section offers irp scientists access to light imaging equipment and expertise in light microscopy techniques. the biodata mining and discovery section assists with computational and bioinformatics approaches to support niams intramural research. the translational immunology section provides niams investigators with services, consultative advice, and in-depth instructions in a variety of immunologic methods to interpret immunoassays. the pediatric translational research branch conducts basic, translational, and clinical research to dissect the pathways involved in the pathogenesis of immune-mediated inflammatory diseases. the mechanisms by which specific gene mutations and polymorphisms predispose to inflammation, and how they contribute to unique phenotypic manifestations of individual diseases, are being investigated using a variety of approaches. the protein expression laboratory plans and conducts research on the expression, purification, and structural characterization of human immunodeficiency virus (hiv) and hiv-related proteins. laboratory scientists also collaborate with nih intramural researchers studying the structure and function of hiv and hiv-related proteins. the lab serves as a support and resource group for the expression and purification of these proteins. the systemic autoimmunity branch focuses on unraveling the fundamental mechanisms that lead to the development and perpetuation of systemic autoimmune disorders, particularly systemic lupus erythematosus (sle) and rheumatoid arthritis (ra), and their associated organ damage. by identifying the mechanisms of tissue damage in sle and ra, the branch is exploring whether specific pharmacologic interventions that block identified pathways can mitigate complications in these and other immune disorders. the vasculitis translational research program based in the systemic autoimmunity branch develops clinical and translational research initiatives across many types of systemic vasculitis. the program's key objectives include comprehensive clinical evaluation of patients with known or suspected vasculitis, assessment of vascular inflammation through imaging studies, discovery of novel biomarkers through genomic profiling, and clinical trials of novel therapeutics. the program works closely with the nih clinical center and has established an ongoing collaboration with the international nih-funded vasculitis clinical research consortium. the rheumatology fellowship and training branch is dedicated to the clinical and research training of physicians