Goal 2: Reduce Human Disease

What is the role of chronic inflammation in lung complications in the HAART era?

With the advent of HAART HIV-infected subjects are living longer. Lung infectious complications so common in the early stages of the HIV epidemic have been replaced by those associated with chronic inflammation (COPD, pulmonary hypertension, lung cancer). Furthermore, this chronic inflammation is likely contributing to premature vascular complications (i.e coronary disease) seen in this population. All of these complications ...more »

Submitted by (@htwig0)

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 the role of chronic inflammation in chronic lung and vascular diseases will impact both the HIV population and our growing U.S. aging population. Approaches to the question could include:

1.. Causes of chronic inflammation

- Antiretroviral drugs, persistent HIV, persistence of other viruses, exogenous retroviral elements, exosomes, other epidemiologic exposures

2. Downstream mechanistic effects of chronic inflammation

- Alterations in gene regulation, alterations in oxidative stress, direct tissue damage

3. Clinical outcomes of chronic inflammation

- Lung – COPD, pulmonary HTN, cancer, interstitial lung disease, asthma.

- Vascular compartment - premature coronary and vascular disease

- Does HIV-infection itself require alterations in treatment modalities for lung disease

- Does HIV infection itself alter the outcome of chronic lung disease?

4. Therapeutic options

- Directed against the cause – i.e. antivirals.

- Immune specific targets against inflammatory mediators

Feasibility and challenges of addressing this CQ or CC :

The critical challenge for this question lies in the fact that complications caused by chronic inflammation such as COPD and coronary disease will by definition take years to develop. Intervention trials will take even longer. This is not like the early HIV epidemic, where complications were primarily infectious and could be seen and addressed quickly. Because of this chronic nature, it will necessary to try and establish cohorts with long term follow-up. Furthermore, it will be critical to have well defined appropriate HIV-uninfected cohorts to compare the HIV-infected population to.

Name of idea submitter and other team members who worked on this idea : Homer L. Twigg III on behalf of the INHALD Consortium

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Goal 2: Reduce Human Disease

Repair and Regenerate the Kidney

Chronic Kidney Disease (CKD) affects millions in the US, and is one of the new diseases on the rise globally. New therapies to slow CKD and to repair and regenerate failing kidneys are drastically needed to reduce health care costs and improve lives.

Submitted by (@ceci00)

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

Details on the impact of addressing this CQ or CC :

New therapies to slow CKD and to repair and regenerate failing kidneys are sorely needed to reduce health care costs and improve lives.

Feasibility and challenges of addressing this CQ or CC :

Our understanding of renal function and risk factors is greater than ever. Our ability to diagnose is technologically advanced. We now need to increase efforts to identify therapeutic targets and develop regenerative approaches to prevent and treat CKD.

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

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Goal 2: Reduce Human Disease

What is the optimal management of coronary artery disease in patients with chronic kidney disease

Patients with chronic kidney disease (CKD) have an extremely high risk of death from cardiovascular cause. The prognosis of patients with chronic kidney disease who also have coronary artery disease is worse than certain cancer. While great strides have been made to create awareness about breast cancer, there is paucity of knowledge about the cardiovascular risk of CKD patients among both physicians and patients. Moreover, ...more »

Submitted by (@sripal.bangalore)

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

Details on the impact of addressing this CQ or CC :

Patients with chronic kidney disease tend to be undertreated (from CV perspective), underrepresented (in clinical trials) and underdiagnosed with less referral for stress testing, even though cardiovascular cause is the leading cause of death in these patients. Patients with chronic kidney disease is a growing cohort and with increase in obesity and diabetes, the prevalence is exploding exponentially. The decision as to what is the best treatment option for patients with coronary artery disease who also have kidney disease- revascularization or medical therapy-is important and can be a paradigm shift in the way we treat such patients

Feasibility and challenges of addressing this CQ or CC :

Randomized clinical trials are urgently needed to answer this question.

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

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9 up votes
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Goal 2: Reduce Human Disease

Postural Orthostatic Tachycardia Syndrome: Mechanisms and Treatments

Examine the mechanisms of POTS and develop effective treatments.

Submitted by (@jeanneearleymcardle)

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

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-10 net votes
1 up votes
11 down votes
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Goal 3: Advance Translational Research

Best Practices for implementation of guidelines in COPD community care

How can guideline recommendations be implemented into community practice in a way that is feasible, usable, relevant, and cost-effective? (examples are use of care management, translation of chronic care model, and EMR based tools)

Submitted by (@swilliams1)

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

Name of idea submitter and other team members who worked on this idea : Stephanie Williams, Community Program Manager, COPD Foundation

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9 net votes
11 up votes
2 down votes
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Goal 2: Reduce Human Disease

Non-Adherence of Patients with Chronic Respiratory Diseases

There are various reasons responsible for patients’ non-adherence. One of them is insufficient or lack of education about medications and equipment required for their treatment.

Submitted by (@vlady.rozenbaum)

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

Details on the impact of addressing this CQ or CC :

There is a critical need to develop uniform guidelines and handouts addressing the confusion over the proper use of medications (particularly inhalers) and equipment (i.e. oxygen). Improper use leads to diminished or no benefit, frustration, and, ultimately, even to a patient's decision to stop the treatment.

Feasibility and challenges of addressing this CQ or CC :

This is an issue that has been universally acknowledged for a number of years. With the help of patient focus groups, convened at the NHLBI, national pulmonological conferences, or at local venues around the country, appropriate materials can be created to benefit patients and reduce a huge burden on nation's economy due to decreased productivity and increase in hospital admissions.

Name of idea submitter and other team members who worked on this idea : COPD-ALERT

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20 up votes
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Goal 2: Reduce Human Disease

Systems biology and pathobiology

What are systems-based approaches to better define disease endotypes and develop more effective therapies, especially in multiple chronic conditions?

Submitted by (@nhlbiforumadministrator1)

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

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

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11 net votes
19 up votes
8 down votes
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Goal 2: Reduce Human Disease

Lung exacerbations and disease progression

What is the relationship between exacerbations and progression of chronic lung diseases?

Submitted by (@nhlbiforumadministrator)

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

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

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5 net votes
11 up votes
6 down votes
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Goal 3: Advance Translational Research

Coordination of COPD care when comorbidities are present

How should providers coordinate management strategies and treatment goals in patients with COPD and other co-existing chronic diseases?

Submitted by (@jsullivan)

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

Name of idea submitter and other team members who worked on this idea : Janice Cotton, COPD Foundation State Captain for IL, PPRN Governing Board Member

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12 up votes
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Goal 2: Reduce Human Disease

Lack of Collaboration Across NIH Institutes

There are many significant questions in CVD prevention that cross the disciplines represented by the different institutes. For example, the obesity epidemic, poor nutrition, and physical inactivity are relevant to CVD, neurological disease, diabetes, and cancer. Tobacco use is directly relevant to cancer and CVD. Social determinants and disparities affect multiple diseases and outcomes. Reducing obesity will require interventions ...more »

Submitted by (@stephen.fortmann)

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

Details on the impact of addressing this CQ or CC :

Two or more collaborating NIH Institutes could afford to fund creative projects that neither institute can afford alone.

Feasibility and challenges of addressing this CQ or CC :

NIH Institutes have a long history of isolation from one another. This has undoubtedly suppressed creativity and interdisciplinary research. It is inherently bureaucratic and reflects poorly on science. As an outsider I can only speculate about how to address this issue, but it would be well worth some attention at the highest levels.

Name of idea submitter and other team members who worked on this idea : Stephen P. Fortmann

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7 up votes
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Goal 2: Reduce Human Disease

Systems Approaches to "Phenosimilar" Diseases

There are diverse diseases that share similar features. For example, many chronic airways diseases (chronic aspiration, ciliary dyskinesia, some COPD) "phenocopy" cystic fibrosis in terms of infectious agents, mucus clearance problems, progressive loss of lung function, etc. Use multiplatform "omics" approaches and Big Data bioinformatics to identify common nodes for therapeutic targeting. Other examples: emphysema and ...more »

Submitted by (@jhagood)

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

Details on the impact of addressing this CQ or CC :

may be able to target multiple diseases with new or repurposed therapies. Might narrow down the broad array of potential "high value" targets to study.

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Goal 2: Reduce Human Disease

Identification and validation of surrogate endpoints for long-term morbidity in Sickle Cell Disease

Research in sickle cell disease (SCD) has mostly focused on preventing or treating acute medical events, such as vaso-occlusive pain, acute chest syndrome, and, in pediatric patients, acute strokes. Chronic SCD complications such as chronic kidney disease or pulmonary hypertension, develop over decades, thus are poor choices for clinical trial endpoints. There is a great need to develop surrogate endpoints that predict ...more »

Submitted by (@hulbertm)

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

Details on the impact of addressing this CQ or CC :

Longitudinal cohorts of SCD patients, spanning childhood and adulthood, with biobanking DNA, plasma, and serum, and standardized clinical and imaging assessments will allow identification predictors of negative clinical outcomes. An NHLBI-funded national SCD clinical registry with biobanking will be necessary to validate any surrogate endpoints.

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

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13 net votes
16 up votes
3 down votes
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