Neuroimmune pharmacology as a component of pharmacology in medical school curriculum

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Editorial Manager(tm) for Journal of Neuroimmune Pharmacology Manuscript Draft

Manuscript Number: JNIP292

Title: Inclusion of neuroimmune pharmacology as a component of the pharmacology curriculum for medical school students

Article Type: Invited Review

Keywords: neuroimmune pharmacology; pharmacology curriculum; medical school students Corresponding Author: Dr. Yuh-Fung Chen, Ph.D.

Corresponding Author's Institution: CHINA MEDICAL UNIVERSITY First Author: Yuh-Fung Chen, Ph.D.

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中國醫藥大學

醫學院

藥理學科

Department of Pharmacology

CHINA MEDICAL UNIVERSITY, COLLEGE OF MEDICINE

台中市 40402 北區學士路 91 號 91 Hsueh-Shih Road, Taichung 40421, Taiwan, ROC TEL: +886 4 22053366#2222 FAX: +886 4 22064601 Email: yfchen@mail.cmu.edu.tw ---

Aug 30, 2010

Journal of NeuroImmune Pharmacology Sulie Chang, Ph.D.

Guest Editor for the issue related to NeuroImmune Pharmacology Education

Dear Prof. Sulie Chang:

It is really my greatest honor and also my pleasure to submit the manuscript entitled “Inclusion of neuroimmune pharmacology as a component of pharmacology

curriculum for the medical school students” as a response to the invitation to write a manuscript related to neuroimmune pharmacology education.

I would like to express my appreciation to the Journal of Neuroimmune Pharmacology on the opportunity to submit a manuscript on the topic of

neuroimmune pharmacology in medical student education. This work that is presented is original and is not under consideration to submit elsewhere.

Best Regards,

Yuh-Fung Chen, Ph.D. Associate Professor

Department of Pharmacology China Medical University 91 Hsueh-Shih Road Taichung 40421, Taiwan Tel: +886 4 22053366 ext 2222 Fax: +886 4 22064601 Email: yfchen@mail.cmu.edu.tw Cover Letter

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Abstract

This article introduces the inclusion of neuroimmune pharmacology as a

component of pharmacology curriculum for medical school students.

Pharmacology is part of the scientific foundations of medicine curriculum. The

foundation curriculum to basic medicine would followed by an organ system-base

module. The introductory lectures of neuroimmune pharmacology would be

focused in the immunity and nervous system diseases including (1) the

neuroimmune system in psychiatric disorders, molecular pathogenesis for

schizophrenia and major depression, and the uses of antipsychotic and

antidepressant agents, (2) neurodegenerative disorders such as parkinsonism, and

the treatment, and (3) drugs of abuse and the immune system. With particular

emphasis on the competency of critical thinking, problem solving ability and

enhance the learning interest and effectiveness of medical students, problem based

learning and case study discussions would be applied to the neuroimmune

pharmacology curriculum.

Keywords: neuroimmune pharmacology; pharmacology curriculum; medical

school students

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Title: Inclusion of neuroimmune pharmacology as a component of the pharmacology

curriculum for medical school students

Running Title: Neuroimmune pharmacology for medical students

Author:

Yuh F. Chen

Department of Pharmacology

China Medical University, School of Medicine

91 Hsueh-Shih Road, Taichung 40421, Taiwan

Corresponding Author:

Yuh F. Chen, PhD

Department of Pharmacology

China Medical University

91 Hsueh-Shih Road, Taichung 40421, Taiwan

Phone: +886 4 22053366 ext 2222

Fax: +886 4 22064601

Email: yfchen@mail.cmu.edu.tw

*Manuscript

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Source of Support: This work was supported, in part, by grants from China Medical

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Conflict of Interest Disclosure: The author has neither a financial nor a personal

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This article introduces the inclusion of neuroimmune pharmacology as a component of

pharmacology curriculum for medical school students. Pharmacology is part of the

scientific foundations of medicine curriculum. The foundation curriculum to basic

medicine would followed by an organ system-base module. The introductory lectures of

neuroimmune pharmacology would be focused in the immunity and nervous system

diseases including (1) the neuroimmune system in psychiatric disorders, molecular

pathogenesis for schizophrenia and major depression, and the uses of antipsychotic and

antidepressant agents, (2) neurodegenerative disorders such as parkinsonism, and the

treatment, and (3) drugs of abuse and the immune system. With particular emphasis on

the competency of critical thinking, problem solving ability and enhance the learning

interest and effectiveness of medical students, problem based learning and case study

discussions would be applied to the neuroimmune pharmacology curriculum.

Keywords: neuroimmune pharmacology; pharmacology curriculum; medical school

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Neuroscience, immunology, and pharmacology are broad disciplines and foundation to

basic medicine curriculum for medical school students to enter the medical field.

Foundation curriculum first guides students to know the structure, development and

functions of normal human organs (curriculum integrates anatomy, histology,

embryology and physiology) therefore medical students are familiar with the human body

in health condition. Then, human diseases caused by a variety of biological pathogens,

transmission routes (combined microbiology, virology and parasitology), and the body’s

immune system to produce defense against external pathogens (immunology) would be

introduced to students. Following is the pathology caused by pathogens and pathogenic

mechanism (pathology) and how the basic concepts of drug therapy (pharmacology), and

so on. Hence, enable students to understand health and pathological comparison of the

circumstances with their professional knowledge and abilities of clinical manifestations

of these diseases together to apply to the future diagnosis, treatment and prevention of

diseases. In addition to traditional lecturing methods, clinical case study and

problem-based learning would be included in the curriculum in order to accelerate students’ acquire their ability of active learning and competencies of professional knowledge. These foundations are required for the medical students to deep understand

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the molecular and cellular biology of basic medicine. Take for example, neuroscience

introduces neurobiology, neurophysiology, neurogenesis, neuropathology,

neurodevelopment, and neuroimaging, which is a foundation discipline to medical

students regarding to the nervous system. Immunology mainly introduces the immunity

and the self-defense system, such as innate immunity, adaptive immunity, humoral

immunity, immunodeficiency, autoimmune disease, allergy, immunomodulation,

oncology, rheumatology, and HIV/AIDS etc. This discipline is an essential foundation for

immunopharmacology. Pharmacology mainly introduces the pharmacodynamic and

pharmacokinetics of clinical used agents, regarding to their action mechanism and

untoward effects. All these three disciplines must first be understood as a single entity,

when they converged and integrated together formed the multidiscipline of neuroimmune

pharmacology. It is required another level of insight and seeking to better define the

epidermiology, prevention, and treatment of immune disorders of the nervous systems

( Ikezu and Gendelman, 2008).

Typically, foundations to basic medicine curriculum of medical school students takes

place during the second year of medical school in Taiwan, and would occur over a period

of 8 months (Table 1). The foundation curriculum to basic medicine would followed by

an organ system-based module curriculum that would last at least for 8 months of study

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concurrently studying core subjects such as, anatomy, embryology, histology, physiology,

pharmacology, pathology, clinical medicine and medical imaging. Clinical case studies

and problem-based learning would be integrated into both the foundation curriculum to

basic medicine and organ system-based curriculum, including the neuroimmune

pharmacology sub-module. In this instructional model, both teaching faculties of basic

medicine and clinical medicine would interface with each other to present the appropriate

topical module materials in order to accomplish unit horizontal integration and to provide

students the learning effectiveness.

The pharmacology course of medical students during the foundation to basic

medicine curriculum would be divided into two parts (Table 3). In the first part, the

fundamental concepts of pharmacodynamics, pharmacokinetics, and agents that act to

affect autonomic and central nervous systems would be discussed. In the second part,

agents act to circulatory system, endocrine system and chemotherapeutic agents would be

addressed. Subsequent lectures would address immunopharmacology which is focused on

immuno-suppressive and immuno-regulatory agents. The foundation of these lectures is

based on the concepts from the immune system. These conceptual lectures in

immunopharmacology would serve as a foundation for neuroimmune pharmacology

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Description of the inclusion of neuroimmune pharmacology in the pharmacology

course

In order to introduce the field of neuroimmune pharmacology to medical students, a

course sub-module formulated in a lecture format is designed to provide medical students

with a basic knowledge of neuroimmune pharmacology as a sub-discipline of

pharmacology course. Base on the concepts introduced in the immune system and

immunopharmacology, this sub-discipline would be focused in the immunity and nervous

system diseases. The contents would include (1) the neuroimmune system in psychiatric

disorders, molecular pathogenesis for schizophrenia and major depression, and the uses

of antipsychotic and antidepressant agents, (2) neurodegenerative disorders such as

parkinsonism, and the treatment, (3) Drugs of abuses. With particular emphasis on the

competency to use critical thinking, problem solving ability and enhance the learning

interest and effectiveness of medical students, PBL and case study discussions would be

applied to this module.

Teaching, learning objectives and goals for the neuroimmune pharmacology

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Upon completion of the pharmacology course sub-module, the medical students would be

able to (1) describe the immune system in the central nervous system and neuro-immune

interaction, (2) apply the knowledge of pathologic process, pharmacokinetics, and

pharmacodynamics to guide safe and effective treatments in psychiatric disorders,

neurodegenerative disorders and abuse of drugs, (3) develop competency to apply basic

principles to clinical care and lifelong learning in medical practice.

Principles of the course performance assessment

The course performance assessment is described in Table 4. It summarizes the outcome

and performance assigned to instructional course of neuroimmune pharmacology:

1. Instructional methods

Classroom lectures supplemented with multimedia such as animations, and molecular

models. Teaching materials would be on the web a week ahead of each lecture.

2. Lecture would be presented as a sub-module of the pharmacology course during the

organ system-based curriculum.

3. Clinical case study and problem-based learning would be focused on the clinical

correlation with immunity and nervous system diseases.

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1. Ikezu T ,Gendelamn HE: Neuroimmune Pharmacology, Springer Science + Business

Media, LLC, 2008.

2. Katzung BG, Masters SB, Trevor AJ: Basic and Clinical Pharmacology, McGraw Hill

Lange, 2009

Lecture syllabus for neuroimmune pharmacology included in the pharmacology

curriculum (Ikezu T ,Gendelamn HE; 2008)

Lecture 32  The neuroimmune system in psychiatric disorders, molecular pathogenesis

for schizophrenia and major depression, and the uses of antipsychotic and antidepressant

agents

Introduce the students how the hypothalamic-pituitary-adrenal axis, the CNS and the

immune system are integrated and regulated each other’s activity. There are many

neurotransmitters and nureohormones that act through the CNS on the immune system to

regulate the immune response. Give a brief overview of how the neuroimmune system

plays a role in psychotic illnesses such as depression and schizophrenia and the action

mechanisms of antipsychotic agents, antidepressants would be introduced in this lecture.

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Parkinson’s disease is the second most frequent neurodegenerative disorder of the aging

brain. Most ascending dopaminergic pathways are affected as revealed from autopsy

investigation. Studies performed in autopsy tissues from patients afflicted with

parkinsonism have led to the conclusion that inflammation is a generic phenomenon that

arises from neuronal death. In this lecture, the role of inflammation in parkinsonism, and

agents used in Parkinson disease would be discussed

.

Lecture 34  Drugs of abuse and the immune system

There is indisputable evidence of natural physiological connections between the neural

and immune systems. Many evidences supporting the link of opioids and cannabinoids

and their effects on immune responses. In this lecture, effects of drugs of abuse on the

production of cytokines and chemokines and effects of drugs of abuse on infection would

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Ikezu T, Gendelman HE: (2008) Neuroimmune Pharmacology. Springer Science +

Business Media, LLC., New York

Katzung BG, Masters SB, Trevor AJ: (2009) Basic and Clinical Pharmacology, McGraw

Hill Lange, 2009

Lowery RC (2005) Teaching and learning with interactive student response systems: c

comparison of commercial products in the higher-education market. The annual

meeting of the Southwestern Social Science Association and its affiliates, March 23 -

26, 2005 at New Orleans, LA.

Slain D, Abate M, Hodges BM, Stamatakis MK, Wolak S (2004) An interactive response

system to promote active learning in the doctor of pharmacy curriculum. Am J Pharm

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Table 1 Foundation to basic medicine curriculum of medical school*

Module Topical areas

1 Introduction to biochemistry, amino acids, structure of proteins and carbohydrate, metabolism of carbohydrate, lipids, DNA, RNA, gene expression, signal transduction and second messenger pathways

2 Introduction to embryology, gametogenesis, embryonic development, introduction to histology, epithelium tissue, connective tissue 3 Introduction to physiology, homeostasis and transmembrane transport, excitable tissues and membrane potential

4 Introduction to immunology, innate immunity, adaptive immune responses, immune system in health and disease 5 Basic concepts of bacteriology, basic concepts of virology

6 Introduction to parasitology, the amoeba protozoa, lumen protozoa, the blood and tissue protozoa, trematodes, cestodes, nematodes, arthropods

7 Introduction to pharmacology, pharmacodynamics, pharmacokinetics, drug receptors, pharmacogenetics 8 Introduction to pathology

9 Introduction to clinical medicine and medical imaging

* Foundation curriculum includes anatomy, embryology, histology, physiology, microbiology, parasitology, pharmacology, pathology, clinical medicine and medical imaging.

Table

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Table 2 Organ system-based curriculum of medical students Module Organ system Topics#

1 Musculoskeletal system Anatomy and Embryology, Histology, Physiology, Pharmacology, Pathology, Clinical medicine, Medical Imaging

2 Circulatory system Anatomy and Embryology, Histology, Physiology, Pharmacology, Pathology, Clinical medicine 3 Lung respiratory Anatomy and Embryology, Histology, Physiology, Pharmacology, Pathology, Clinical medicine,

Medical Imaging

4 Nervous system Anatomy and Embryology, Neuroanatomy, Histology, Physiology, Pharmacology, Pathology, Clinical medicine, Medical Imaging

5 Digestion and Nutrition System

Anatomy and Embryology, Histology, Physiology, Pharmacology, Pathology, Clinical medicine

6 Renal urinary system Anatomy and Embryology, Histology, Physiology, Pharmacology, Pathology, Clinical medicine 7 Growth and development

and male and female reproductive systems

Anatomy and Embryology, Neuroanatomy, Histology, Physiology, Pharmacology, Pathology, Medical Imaging, Clinical medicine

8 Endocrinology and Metabolism System

Histology, Physiology, Pharmacology, Pathology, Clinical medicine

9 Blood oncology system Pharmacology, Pathology, Clinical medicine 10 Gross Anatomy Lab Anatomy and Embryology, Neuroanatomy # suggested order of topic discussion

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Table 3 Pharmacology course lecture schedule

Part I Part II

Lecture 1  Introduction to pharmacology

Lecture 2  Drug Receptors & pharmacodynamics

Lecture 17 Regulation of blood pressure by the autonomic nervous system

Lecture 3  Pharmacokinetics: rational dosing & the time course of drug action Lecture 18  Antihypertensive drugs Lecture 4  Drug biotransformation

Lecture 5  Development and regulation of drugs

Lecture 19  Diuretics: Drugs that increase the excretion of water and electrolytes

Lecture 6  Introduction to autonomic pharmacology Lecture 20  Antiarrhythmic drugs Lecture 7  Drugs affecting the parasympathetic nervous system and autonomic

ganglia

Lecture 21  Drugs to treat heart failure

Lecture 8  Drugs affecting the sympathetic nervous system Lecture 22  Vasodilators and nitric oxide synthase Lecture 9  Introduction to the pharmacology of drugs that act on the central

nervous system

Lecture 23  Lipid-lowering drugs and atherosclerosis, drugs to treat blood disorders

Lecture 10  Sedative-Hypnotic drugs, The alcohols

Lecture 24  Mechanisms of action of antineoplastic drugs, clinical effects of antineoplastic drugs

Lecture 11  General anesthetics, Lecture 25~27  Drugs that kill invading organisms Local anesthetics Lecture 28~29  Drugs affecting endocrine systems

Lecture 12  Skeletal muscle relaxants Lecture 30  Gene therapy and emerging molecular therapies Lecture 13  Treatment of seizure disorders Lecture 31  Immunopharmacology

Lecture 14  Opioid analgesics & antagonists Lecture 32~34  NeuroImmune Pharmacology Sub-Module Lecture 15  Nonsteroidal anti-inflammatory drugs Review II

Lecture 16  Disease-modifying antirheumatic drugs, Drugs used in gout

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Table 4 Principles of the module performance assessment

Evaluation description Evaluation type

Lecture topics Written examination

Interactive Response System (IRS) ISR systems appear to provide several benefits that can facilitate active learning in the classroom setting, such as improve student learning, improve teaching effectiveness and reduce the paperwork and faculty labor. All students have the capability of answering every question anonymously. In addition, instructors can immediately assess student comprehension of concepts and address any misconceptions or areas of confusion. (Slain et al. 2004; R. Lowery 2005)

Problem-based learning/ small group discussion Evaluated by group peers based one individual’s performance of problem-discussion and presentation

Case study Oral presentation

Laboratory Experimental competency skills and written examination