Thank you for participating!

Thank you to all who contributed to the National Heart, Lung, and Blood Institute (NHLBI) Strategic Visioning Forum. Ultimately, over 1,000 ideas were submitted, with more than 42,000 votes. This remarkable response exceeded expectations and provided a wealth of ideas to draw upon as NHLBI moves forward. Please visit the NHLBI Strategic Visioning page to find out more about the NHLBI Strategic Visioning process.


Welcome to the National Heart, Lung, and Blood Institute (NHLBI) Strategic Visioning Forum. The Institute is gathering ideas for the most compelling scientific priorities in the four NHLBI Strategic Goals to address over the next decade.

Goal 3: Advance Translational Research

To expand the NHLBI emphasis on lymphatic research

The critical challenge is to acknowledge the central circulatory role of the lymphatic system and its requisite ability to provide integration of the circulation with the immune system. The NHLBI is challenged to provide programs, resources and education to stimulate and encourage increasing research into the function and the dysfunction of the lymphatics in human health and disease

Submitted by (@rockson)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

The poorly understood, yet vital lymphatic component of the cardiovascular system ensures the internal environment for cellular function. Dysfunction of this system can create regional disturbances (lymphedema, lymphatic vascular malformation, lymphangiectasia), lead to genetic presentations of complex disease, and also contributes to the pathogenesis of coronary disease, congestive heart failure, chronic venous disease, dyslipidemia, cancer metastasis, infection, inflammation, autoimmune disease, diabetes, gastrointestinal malfunction and many other pathologies. Improved and intensified research approaches will help to solve these compelling problems in human health and disease.

Feasibility and challenges of addressing this CQ or CC :

This CC is eminently feasible, inasmuch as compelling research questions have already been identified and the tools and technologies are available to address them. The missing ingredient is funding and sufficient motivation of the investigative community by the NHLBI to step forward and address the problems.

Name of idea submitter and other team members who worked on this idea : Stanley G. Rockson MD

Voting

5 net votes
12 up votes
7 down votes
Active

Goal 3: Advance Translational Research

TREATMENT OF SEPSIS-MULTIPLE ORGAN DYSFUNCTION SYNDROME (MODS) UTILIZING APHERESIS BASED STRATEGIES

Sepsis, a systemic inflammatory response to infection, is the most common cause of death in non-cardiac intensive care units. The incidence and severity of sepsis have increased over the last two decades. With advances in supportive care, sepsis carries a mortality that averages 17%, however, this figure increases to 50 - 80% in Multiple Organ Dysfunction Syndrome (MODS), defined as failure of 3 or more organ systems. ...more »

Submitted by (@zbigniew.m.szczepiorkowski)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Despite many attempts, therapeutic trials using pharmacologic agents to interrupt specific pathways of inflammation and coagulation have been unsuccessful. The failed targeted therapies include the administration of corticosteroids, monoclonal antibodies to TNF, soluble TNF receptor, antithrombin (AT), activated protein C, and tissue factor pathway inhibitor. Because it is non-selective, plasma exchange has the potential to remove deleterious mediators and restore anti-inflammatory/anticoagulant factors consumed in sepsis/MODS. There is evidence that some of the implicated mediators of sepsis can be effectively removed by plasma exchange, eg, TNF alpha and endotoxin. In addition, the normal regulatory molecules consumed during the systemic inflammatory process, such as AT, proteins C and S, and ADAMTS-13 would be replaced, which may influence the pathophysiology of MODS/sepsis. However, the mechanism of action of plasma exchange, whether removal of inflammatory mediators of sepsis or modulation of the later consequences of MODS such as sustained endothelial activation, remains unclear at the present time. Other apheresis based strategies also have been attempted but their results also require confirmation by well-designed clinical trials to answer the question of their value in treatment of sepsis.

Development of apheresis strategies which address the pathophysiology of sepsis and identify responsive patient populations would have a great societal value

Feasibility and challenges of addressing this CQ or CC :

Feasibility: the large number of patients who develop sepsis provides for significant number of potential patients who can be enrolled. More sophisticated methods of enrollment may help as many patients are not capable of providing informed consent. Establishing an apheresis consortium and collaboration with intensive care physicians will be an important step in assuring appropriate accrual of patients. The availability of apheresis devices is likely to be high in the tertiary/quaternary care medical centers where these studies can be performed. Animal models of sepsis are being investigated and are necessary for studies evaluating pathophysiology; though some apheresis strategies can be moved to clinical studies without additional preclinical developments.

 

Challenges: Identification of the patient population which responds optimally to apheresis based strategies is critical to the development of a randomized clinical trial. One study has indicated that it would be the critically ill pediatric population; however, the critically ill adult population is the largest affected group). Given the equipoise of using apheresis based strategies in the treatment of sepsis/MODS, finding patients to randomize is unlikely to be difficult. Other potential challenges include the cost of developing randomized clinical trials using apheresis, competition with other pharmacology based strategies, center bias, and the timing for initiation of the apheresis.

Name of idea submitter and other team members who worked on this idea : Zbigniew M. Szczepiorkowski; Joseph Kiss, Ed Wong on behalf of ASFA

Voting

97 net votes
115 up votes
18 down votes
Active

Goal 2: Reduce Human Disease

Impact of intrauterine environment on obesity

How does maternal obesity before or during pregnancy affect the intrauterine environment and increase the risk of overweight/obesity in the offspring?

How does maternal dietary intake during pregnancy impact weight in the offspring?

What types of interventions are most effective for preventing excessive gestational weight gain among high risk groups?

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Developing effective interventions during pregnancy can help reduce the risk of obesity in the offspring and mother.

Feasibility and challenges of addressing this CQ or CC :

Addressing how the intrauterine environment impacts obesity is feasible because there is already existing preliminary data that shows pregnancy can have an impact on obesity in offspring. More work needs to be done to better understand the mechanism and how best to intervene.

There is emerging evidence that the intrauterine environment can have an impact on obesity.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

Voting

33 net votes
66 up votes
33 down votes
Active

Goal 2: Reduce Human Disease

Macrovascular disease in Type 1 and Type 2 diabetes mellitus

Do the etiology and vascular pathology of macrovascular disease differ in Type 1 and Type 2 diabetes?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Large scale impact on the rethinking of the paradigm of diagnosis, delay (prevention) and potential treatment of CVD due to the high prevalence of Type 2 diabetes and the not so low prevalence of Type 1 diabetes in the nation.

Feasibility and challenges of addressing this CQ or CC :

Given the number of patients with Type 2 diabetes who undergo CABG, and the potentially increasing number of Type 1 diabetes patients who live longer and undergo diagnostic testing for CAD, the potential sources of human coronary artery tissue is expected to be sufficient to perform some initial case-control or Type 1 vs Type studies. In addition to coronary arteries, other large arteries could be studied (e.g. cerebral [autopsies], carotid, aortic, femoral, popliteal, dorsalis pedis].

Small post-mortem studies have demonstrated that the atherosclerotic plaque in patients with Type 1 diabetes mellitus is more vulnerable to rupture than the plaque in patients with Type 2 diabetes mellitus. In addition, it has been suggested that CAC score or number of plaques is not as important as the composition of the plaque in predicting cardiovascular events in patients with Type 1 diabetes, since the plaque is more unstable in Type 1 than in Type 2 diabetes mellitus. Thus, some researchers have questioned whether CAC is a good biomarker of CAD in Type 1 diabetes mellitus.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

Voting

4 net votes
14 up votes
10 down votes
Active

Goal 2: Reduce Human Disease

Transfusion strategies in pediatric and neonatal populations

What are the optimal strategies for transfusion of blood products in pediatric and neonatal population?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Blood is the most prescribed drug in the PICU, and 95% of all neonates are transfused during their stay in the NICU. Currently, there are no evidence-based guidelines for the optimal hemoglobin levels or platelet counts for these populations. There is a balance that must be achieved between hemostasis and thrombosis for this vulnerable population.

Feasibility and challenges of addressing this CQ or CC :

Clinical trials have begun to assess the optimal hemoglobin levels in neonates, but there are no trial to asses the optimal platelet count. Neonatologists, pediatric intensivists, and transfusion medicine physicians are beginning to come together to work on solutions to these problems.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

Voting

39 net votes
52 up votes
13 down votes
Active

Goal 3: Advance Translational Research

Regenerative Medicine 2.0 in Heart and Lung Research - Back to the Drawing Board

Stem cell therapies have been quite successful in hematologic disease but the outcomes of clinical studies using stem cells for cardiopulmonary disease have been rather modest. Explanations for this discrepancy such as the fact that our blood has a high rate of physiologic, endogenous turnover and regeneration whereas these processes occur at far lower rates in the heart and lung. Furthermore, hematopoietic stem cells ...more »

Submitted by (@jalees)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Some barriers to successfully implementing cardiopulmonary regeneration include the complex heterogeneous nature of the heart and lung.

 

Hematopoietic stem cells can give rise to all hematopoietic cells but the heart and lung appear to contain numerous pools of distinct regenerative stem and progenitor cells, many of which only regenerate a limited cell type in the respective organ. The approach of injecting one stem cell type that worked so well for hematopoietic stem cells is unlikely to work in the heart and lung.

 

We therefore need new approaches which combine multiple regenerative cell types and pathways in order to successfully repair and regenerate heart and lung tissues. These cell types will likely also require specific matrix cues since there are numerous, heterogeneous microenvironments in the heart and lung.

 

If we rethink our current approaches to regenerating the heart and lung and we use combined approaches in which multiple cell types and microevironments are concomitantly regenerated (ideally by large scale collaborations between laboratories), we are much more likely to achieve success.

 

This will represent a departure from the often practiced "Hey, let us inject our favorite cell" approach that worked so well in hematologic disease but these novel, combined approaches targeting multiple endogenous and/or exogenous regenerative cells could fundamentally change our ability to treat heart and lung disease.

Name of idea submitter and other team members who worked on this idea : Jalees Rehman

Voting

7 net votes
11 up votes
4 down votes
Active

Goal 3: Advance Translational Research

NHLBI Cohort Populations for T4 Implementation Research

How best can NHLBI observational cohorts be utilized to study observational T4 Implementation Research among both general and vulnerable US populations?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

• Would help identify key factor associated with successful implementation that could be studied in interventional T4 implementation research

• Result would refine implementation strategies and health and social policy aimed to reduce heart, lung, blood, sleep diseases and conditions

• Builds on excellent established platform of research with high quality outcomes in well characterized study populations over long term follow-up.

Feasibility and challenges of addressing this CQ or CC :

• Big data is developing methods to link large data sets from national, state, and community level surveys – surveys that can define exposures to various policies and interventions in place, time, and population.

• A family of high quality cohorts are available for ancillary observation studies

• Collection of community level and more broad policy level exposures is feasible through data already collected and through potentially new data collection.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

Voting

-4 net votes
11 up votes
15 down votes
Active

Goal 2: Reduce Human Disease

International collaboration for genetic and metabolic research on specific human population

During recent years, clinical research including well-organized randomized clinical trials in developed countries generated large database and human biological sample banks. These are valuable resources for human disease research. Mechanisms to encourage and facilitate international collaboration for genetic and metabolic research using database and human biological samples from specific human disease population of international ...more »

Submitted by (@hongw0)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Name of idea submitter and other team members who worked on this idea : Hong Wang, Xiaofeng Yang

Voting

4 net votes
4 up votes
0 down votes
Active

Goal 4: Develop Workforce and Resources

Enhancement of the Medical Home and Medical Community with the use of EMS providers

Traditionally the Health Care model has meant that patients come to HCF for their care. Hospitals are increasingly overcrowded and also not always the best place to be due to the risk for nosocomial infections. Utilizing existing community resources to enhance the health both acute and chronic deserves exploration at the national level. Training paramedics to do chronic disease monitoring as well as as remotely work with ...more »

Submitted by (@dayam0)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

If we can train paramedics to go beyond simply responding to acute emergencies and add in chronic disease monitoring as well as management at home of common simple conditions, population health can be enhanced and costs reduced.

Feasibility and challenges of addressing this CQ or CC :

Pilot projects are needed. Need to work to reimburse these visits and address barriers that will occur due to concerns from others that already consider home health their territory like nurses. Would require some telemedicine support and development.

Name of idea submitter and other team members who worked on this idea : Mohamud Daya

Voting

3 net votes
4 up votes
1 down votes
Active

Goal 4: Develop Workforce and Resources

Promoting collaborations to advance research

Insufficient funding and resources hamper scientific progress. Providing funding opportunities that require collaborations across multiple institutions would encourage open and collaborative research while promoting advances in research due to complementary expertise, sharing of resources, combining scientific efforts, etc.

Submitted by (@feghalib)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

It would enhance research, accelerate the pace of discoveries, create collegial and collaborative environments across institutions and research groups. It would also promote team science and foster junior investigators who will learn the advantages of collaborating and functioning as a team.

Feasibility and challenges of addressing this CQ or CC :

It would require funding opportunities with availability of funds being contingent on collaborations across a certain number of institutions/centers having complementary resources, expertise, & research teams.

Name of idea submitter and other team members who worked on this idea : CFB

Voting

36 net votes
44 up votes
8 down votes
Active

Goal 2: Reduce Human Disease

Ischemia-independent mechanisms contributing to infarct size

What are the mechanisms of ischemia-independent mechanisms contributing to the infarct size in patients with acute myocardial infarction? Infarct size is the single most important prognostic factor for short- and long-term outcomes. The success in reperfusion strategies have shown that prompt reperfusion leads to a reduction in infarct size, and to improved outcomes. Despite effective reperfusion, however, a secondary ...more »

Submitted by (@aabbate)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Addressing this compelling question may lead to:

1) Improved therapy and outcomes for acute myocardial infarction

2) Reduction of acute morbidity/mortality following reperfusion

3) Prevention of heart failure

Feasibility and challenges of addressing this CQ or CC :

The progresses in basic science/signaling, preclinical models, imaging techniques, and invasive monitoring now provide the ideal setting to complete this research in a preclinical model or pilot exploratory clinical trials.

Name of idea submitter and other team members who worked on this idea : Antonio Abbate

Voting

-2 net votes
6 up votes
8 down votes
Active

Goal 2: Reduce Human Disease

Enhanced Pain Research in Sickle Cell Disease

There is a need for more enhanced pain research in order to help improve sickle cell disease patient outcomes and quality of life.

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Pain is the most common clinical manifestation of sickle cell disease (SCD) and accounts for a large proportion of emergency department visits and hospitalizations. Due to its impact on the patients’ quality of life, there is a need for more basic and clinical research studies focused on understanding the mechanisms of different pain syndromes as well as the role of neurotransmitters and inflammation in acute and chronic SCD pain. Also, comparative effectiveness studies in the management of chronic pain will be crucial in helping to improve the patients’ overall quality of life.

Name of idea submitter and other team members who worked on this idea : Alice Kuaban on behalf of the American Society of Hematology (ASH)

Voting

39 net votes
58 up votes
19 down votes
Active