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t m c » p u l s e | o c t o b e r 2 0 1 6 14 14 while the spokes represent various activities occurring within Baylor, MD Anderson and UTHealth. With financial and technological support from the three partic- ipating institutions, researchers involved in the program have made significant scientific discoveries. Gerard Karsenty, M.D., Ph.D., identified gene RUNX2 as the main protein respon- sible for bone formation. Benoit de Crombrugghe, M.D., discovered that osteoblasts—the cells that make bone—derive from the same lineage as chondrocytes—the cells found in cartilage. And Lee pinpointed CRTAP as the gene responsible for modulating bone collagen and then identified how mutations within it cause osteogenesis imperfecta. "When we bring all of the patients and all of the institutions together as part of the program," Lee said, "we are now actually elucidating at a very refined level the function of all the things that control bone health. That's been the enormous achievement." Hecht added: "We all have expertise in different areas. By putting us together, we are stronger as a group than we are individually." A little earthquake Andersson Dyke's spine follows an S-shaped curve that limits the space in her chest and weakens her lungs. Without her walker or wheelchair, she can only amble around a short distance before she runs out of breath and her bones begin to ache. At a young age, she endured an extensive surgery in which doctors placed metal rods in her arms and legs to splint her long bones. But her bones still break. They've broken "up to a 100" times in Andersson's 15 years, her mother said, though it's hard to keep track because of how frequently it happens. "The Texas Medical Center has the thing that other cities don't have: It's that we're all together," Gagel said. "That's our strength. We don't need to build strong collabo- rations within the insti- tutions. We already have them. We just need to work together." But it wasn't easy. MD Anderson and Baylor each have a wealth of proprietary information, so the legal agreement to work together in one specialized program meant sharing research, technology and finances. This was new territory for both institutions. They essentially had to agree to a pre-nup. After a year-long legal tug of war and a sizeable endowment from Lawrence, the bone disease program made its official debut in 2002. As the program grew, Lawrence brought The University of Texas Health Science Center at Houston (UTHealth) into the fold in 2014. "Putting the three of them together is like having 10 institutions," Lawrence said. "I see there's lots of collabora- tion between all of them now, and I think it will accelerate the technology and the success in solving a lot of these bone diseases." Lauded as the first cross-institutional, multidisciplinary effort of the Texas Medical Center, the program is co-directed by Gagel, Lee, and UTHealth cartilage disorders expert Jacqueline T. Hecht, Ph.D. Its mission: to research and treat a kaleidoscope of "silent killers," including osteoporosis, brittle bone disease, craniofacial disorders and the spread of cancer to the skeleton. The program has been "a real paradigm for collaboration," Lee said. "It builds on the strength of all these institutions and puts a legal agreement to get everyone to work together. It was kind of like getting married at some level." The program operates like the hub of a wheel, Lee explained, Philanthropist Berdon Lawrence at his South Texas ranch. His personal experience with severe osteoporosis led to the Rolanette and Berdon Lawrence Bone Disease Program of Texas.