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 2: Reduce Human Disease

Pathobiology of Lung Fibrosis

End organ fibrosis accounts for up to 45% of deaths in developed countries. In particular, lung fibrosis is a devastating disease with poor prognosis. Despite development of two new drugs, their efficacy is still limited, highlighting the need to better understand the pathobiology that accounts for fibrotic disease progression in the presence and absence of acute exacerbation or infectious drivers.

Submitted by (@bmoore)

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

Details on the impact of addressing this CQ or CC :

A better understanding of the pathogenesis of lung fibrosis may uncover new targets for therapy or identify biomarkers of disease progression.

Feasibility and challenges of addressing this CQ or CC :

Approaches should include new and established animal models and experiments utilizing patient-based samples and novel mullti-center clinical trials. Ancillary studies should accompany any clinical trial to provide biologic insight into treatment responses and failures.

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

Voting

19 net votes
30 up votes
11 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 3: Advance Translational Research

Translational Bioinformatics Spanning Multiple Scales of Biologic Complexity to Implement Precision Pulmonary Medicine at the Po

What translational bioinformatics tools could be used in pulmonary medicine to allow multidimensional, multi-scale modeling of clinical and biomolecular data to assist clinical decision-making?

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 :

Deployment of bioinformatics tools to construct multi-dimensional, multi-scale models of pulmonary (mal)functioning from large heterogeneous data sets spanning biological molecules, subcellular compartments, signaling pathways, cells, tissues, organs, organ systems and clinical therapeutics trials to predict actionable precision medicine for clinicians at the point of pulmonary care.

Feasibility and challenges of addressing this CQ or CC :

A variety of existing powerful informatics methods for integrating a vast wealth of clinical and high-dimensional data across DNA to organism compartments to develop multi-scale modeling approaches to improve point-of-care precision medicine. Consistent with a continuous learning healthcare system, precision medicine modeling is recursive, tentative pending better understanding and therefore continuously learning.

Fundamental to implementation of precision medicine is the ability to extract heterogeneous data from basic and clinical research to be integrated systematically into clinical practice in a cohesive and large-scale manner. Deployment of precision medicine models to predict (mal)functioning progression and response the treatment in daily practice relies strongly on the availability of an efficient bioinformatics platform that assists in the translation of basic and clinical science knowledge.

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

Voting

-2 net votes
10 up votes
12 down votes
Active

Goal 4: Develop Workforce and Resources

Using virtual learning technologies for workforce development

How can we harness virtual learning technologies to address the competency development needs of the modern and future biomedical workforce? Virtual learning tools, e.g. immersive learning simulations and serious games, offer tremendous possibilities for creating engaging and compelling learning experiences for biomedical scientists and providing them with opportunities to practice research skills within the context of ...more »

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 :

Virtual learning technologies have been successfully used to promote workforce competency development in a variety of fields including defense, business, and surgery, particularly in areas that require higher-order cognitive skills, such as critical thinking, problem solving, decision making by simulating the real-life situations and conditions under which these skills are developed. We believe that significant improvements can be achieved in the overall preparedness of the biomedical workforce through the use of flexible virtual training and education tools that can help address the critical competency areas that have the most impact on research success. For instance, considering the team-based nature of most biomedical research efforts requiring effective communication and collaboration of experts from different fields, new workforce development approaches must be grounded in team science. Virtual learning environments provide an excellent opportunity to practice effective teamwork skills within the context of realistic scenarios, virtual and live character interactions, and structured reflection/debriefing exercises. Similarly, harnessing the power of virtual learning tools to train up-and-coming biomedical scientists to think through scientific and organizational challenges in a disciplined yet creative way, leveraging evidence from decades of research on decision making, would help accelerate the expertise development process of a new generation of biomedical researchers

Feasibility and challenges of addressing this CQ or CC :

Virtual learning tools represent a powerful mechanism for activating the principles of problem-based learning and experiential learning through anchored instruction, meaningful contextualization, active participation, intrinsic motivation, and continuous assessment. While there is a growing interest in bringing virtual learning tools to the biomedical science domain, this area remains relatively untapped and calls to advance an understanding of how particular types of instructional strategies and virtual learning tools/resources compare in terms of promoting target competencies, behaviors, and research outcomes in real life, i.e. the learning transfer. This remains a challenge considering the lack of funding opportunities available to explore not only the feasibility of bringing these tools to the biomedical sciences domain but also examining the sustaining effects of the novel training and education interventions going forward. We feel that NHLBI is better positioned than ma ny other NIH entities to address this challenge and spearhead the learning innovation efforts for the biomedical research workforce, as it reaches across a very diverse community of biomedical scientists who need to work together effectively and efficiently to solve the most pressing biomedical and healthcare challenges we face today.

Name of idea submitter and other team members who worked on this idea : Anya Andrews, Ph.D., PMP, Director of Research Initiatives, Associate Professor of Medicine, University of Central Florida College of Medicine

Voting

2 net votes
5 up votes
3 down votes
Active

Goal 2: Reduce Human Disease

Addressing the population-level determinants of CVD

Atherosclerotic CVD is an epidemic disease that is determined primarily by the social and physical environments acting in part through risk factor distributions. To date most preventive efforts have been in the clinical setting, using medications for risk factors. As useful as this is, a much better solution is to deal with the behavioral contributors to risk and their social determinants, including strong destructive ...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 :

Atherosclerotic disease is largely preventable through behavior: physical activity, nutrition, absence of tobacco use. Achieving ideal risk factor levels would virtually eliminate ischemic CVD, even in genetically-susceptible individuals. The decline in CVD mortality has been in large part due to declines in risk factor levels. The current epidemic of obesity threatens to reverse these gains. It is a critical challenge to develop ways to counter the negative social and economic forces that prevent improvements in risk behaviors

Feasibility and challenges of addressing this CQ or CC :

The short-term nature of NHLBI research has limited its ability to address this overwhelming part of the CVD problem. This is the challenge. NHLBI needs new mechanisms and perhaps partnerships to discover ways to address these population-level issues. Research on how to build community coalitions to address public health policy and educational approaches to CVD prevention will require new funding mechanisms perhaps analogous to funding individual investigators rather than individual grants.

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

Voting

7 net votes
22 up votes
15 down votes
Active

Goal 3: Advance Translational Research

Should Allogeneic stem cell transplantation be considered as an upfront treatment in high risk double hit DLBCL?

Double-hit lymphomas (DHL’s) are high-grade B-cell lymphomas characterized by chromosomal rearrangements of MYC gene with BCL2 and less commonly, BCL6.Large analysis of patients with de novo DLBCL have shown that conventional chemotherapy does not improve the survival of DHL Aggressive upfront chemotherapy followed by autologous stem cell transplantation (ASCT) has become a standard treatment in eligible patients. Retrospective ...more »

Submitted by (@shahram.mori.md)

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

Details on the impact of addressing this CQ or CC :

There are currently no recommendations regarding upfront allogeneic stem cell transplantation of high-risk DHL patients in CR. Harnessing graft versus lymphoma activity may be a potential strategy to improve responses in such patients

Feasibility and challenges of addressing this CQ or CC :

The challenge of this question is the definition of DHL. FISH is commonly used to characterize DHL’s but may miss a significant portion of patients with aggressive disease. Including the cohort DLBCL patients identified by IHC expands the number of patients. Majority of patients with DHL are older but the ability to perform reduced-intensity and haploidentical -transplants will increase the number of eligible patients. The use of post-transplant therapies is needed to keep the lymphoma in check while graft versus lymphoma responses take effect.

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

Voting

2 net votes
3 up votes
1 down votes
Active

Goal 1: Promote Human Health

Cardiac Gene Networks

What is the level of intra-tissue variation of cardiac development gene regulatory networks at single cell resolution?

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

Voting

2 net votes
16 up votes
14 down votes
Active

Goal 4: Develop Workforce and Resources

Redefining success to include scientific careers other than research

How do we redefine success to include scientific careers other than research (e.g., careers in teaching, industry, government) and provide opportunities for exposure to alternative careers?

Submitted by (@nhlbiforumadministrator1)

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

Feasibility and challenges of addressing this CQ or CC :

Challenges:

• Redefining success

• Encouraging team based research by rewarding it and redefining success to include it

• Training programs in alternative careers in science, particularly industry

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

Voting

8 net votes
20 up votes
12 down votes
Active

Goal 2: Reduce Human Disease

COPD care

What is the standard of care for stable COPD and acute exacerbation of COPD that should constitute the reference base for clinical trials?

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

Voting

11 net votes
23 up votes
12 down votes
Active

Goal 1: Promote Human Health

Promoting health through simultaneous prevention of obesity and eating disorders

How to best promote healthy weight while also not stigmatizing obesity and creating risk for eating disorders (i.e., weight concern and body dissatisfaction) in youth. How to tackle both without contributing in unwitting way to development of either.

Submitted by (@tantillo)

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

Details on the impact of addressing this CQ or CC :

Studies show that diets do not lead to sustained health benefits for the majority of people and several studies indicate that dieting is actually a consistent predictor of future weight gain. Repeated cycles of losing and gaining weight are linked to heart disease, stroke, diabetes and altered immune function. Children and adolescents are especially vulnerable to the impact of dieting. Several long-term research studies show that girls and boys who use unhealthy weight control practices (including dieting) in early teen years are more likely to become overweight five years later, even if they started out at normal weight. These studies also show that early teen boys and girls who use unhealthy weight control practices are at greater risk for binge eating, use of severe weight control practices ( vomiting, diet pills, laxatives and water pills), and eating disorders compared with adolescents not using weight-control behaviors.

 

Since our culture tends to create weight bias and obesity stigmatization, it is not surprising to see our children become increasingly fearful of becoming “fat.” Weight concern can be experienced by underweight, average weight and overweight children and teens. Studies have shown that body dissatisfaction, especially weight concern (for early teen boys and girls), can lead to overweight, binge eating, severe weight control practices, and eating disorders. Weight teasing by family members and peers can also increase the risk for eating disorders.

Feasibility and challenges of addressing this CQ or CC :

Challenges include creating teams of researchers who will collaborate across the two fields. I believe if we could create such teams we could

move both fields ahead with regard to prevention and a focus on health (behaviors that are health promoting), not BMI (a number) or an emphasis on intake.

 

The key to both health problems involves the ecology in which youth are located b/c this ecology influences body image, intake, activity, self regulation and self care.

Name of idea submitter and other team members who worked on this idea : Mary Tantillo PhD PMHCNS-BC FAED

Voting

62 net votes
116 up votes
54 down votes
Active

Goal 2: Reduce Human Disease

What do we know about Heart Failure with Preserved Ejection Fraction (HFpEF)

Mortality is similar between HFpEF and HFrEF but we have currently no viable therapeutic option for HFpEF. There have been many large trials, but they all failed. Our basic understanding of the disease is very limited which contributed to failures of many prior trials and wasting $$$. We know very little about the pathophysiology of the disease . It is time to get back to the basic science and use our new tools (e.g. ...more »

Submitted by (@rezanezafat)

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

Details on the impact of addressing this CQ or CC :

Better therapy for HFpEF is an unmet clinical needs which will impact millions of patients

Voting

6 net votes
17 up votes
11 down votes
Active

Goal 2: Reduce Human Disease

Bicuspid aortic valve is not a “one size fits all” condition. Variations exist within families and the population generally.

Clinical disease manifestations in individuals and families where bicuspid aortic valve is present may best be described as a spectrum, with considerable variability in presentation. Patients and families would benefit from an individualized approach, which does include familial medical history, but couples that information with current best understanding of BAV, considering both variations and risks.

Submitted by (@bavtad)

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

Details on the impact of addressing this CQ or CC :

This variability of aortic disease expression (aorta and valve), while amenable to trend analysis, does not lend itself well to a “one size fits all” approach to care. Some individuals and families display other characteristics in their body suggestive of additional complexity. Brain aneurysms are also mentioned in the literature in the presence of BAV.

 

Braverman’s article, “Guidelines for management of bicuspid aortic valve aneurysms: what’s the clinician to do?” highlights the variation in guidelines regarding elective aneurysm surgery in BAV patients, discusses why “one size fits all” is not appropriate, and supports the importance of an individualized approach.

 

Individuals and families face some degree of distress, most particularly those stricken by the serious injury or death of a loved one, and anguish over their future. Some, told surgery was many years away, or that they were fixed for life, have lived to discover those well intentioned words were far from accurate. Others, diagnosed with BAV, have lost their lives.

 

Individualized care, rather than general statements meant to reassure a large and varied population, is important in order to live confidently and proactively continue with follow up. An approach to care that does not use “always” and “never” thinking, and that avoids predictions interpreted as fact, will do a great deal to instill confidence and engagement in BAV individuals and families, who make life decisions based on what they are told.

Feasibility and challenges of addressing this CQ or CC :

This is an intelligent population that is well suited to grasp the issues and participate in decision making. Patients and families desire to be told accurately what is and is not known, to be assessed individually, and to have greater understanding of the implications for blood relatives. They desire to have an informed voice in their treatment decisions, including the timing of elective surgery based on surgical risk versus the risk of living with the disease

Name of idea submitter and other team members who worked on this idea : Arlys Velebir, Bicuspid Aortic Foundation

Voting

-4 net votes
10 up votes
14 down votes
Active