Showing 6 ideas for tag "aneurysm"

Goal 2: Reduce Human Disease

Detection of rupture prone small aortic aneurysms

Critical challenges in the assessment of aortic aneurysms are: (1) Availability of reliable animal models that simulate the human pathology, (2) Availability of molecular imaging resources – identification of biomarkers, development of targeted imaging probes and pre-clinical imaging methods, and plasma markers that predict whether an aneurysm is prone to rupture or dissection, (3) Bringing together a wide array of multi-disciplinary... more »

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

Details on the impact of addressing this CQ or CC

Developing clinically viable methods to detect rupture prone aneurysms can lead to better methods of diagnosis and intervention and avoid preventable fatalities

Feasibility and challenges of addressing this CQ or CC

Several other disease areas including oncological that had similar gap was filled by NIH (NCI) and the challenges were overcome in less than 10 years. The scientific expertise to fill the gap exists, however they work in silos, which need to be brought together to fulfil this gap and is achievable in less than 10 years
Assessment of aortic aneurysms that are prone to rupture or dissection has been an elusive target. Current clinical practice measures the aortic diameter and fails to relate to the pathophysiology and biomechanical properties of the aneurysm in deciding preventive surgery. Critical gap exists in the diagnosis of aneurysm especially with small aneurysms (3 - 5 cm in diameter) that are rupture prone. Based on autopsy about 10 percent of individuals with small abdominal aneurysms had undergone fatal rupture, while 40 percent with diameters of 7-10 cm had intact aneurysm and died from other causes. International Registry of Aortic Dissection found that 40% of thoracic aneurysms dissected at diameters smaller than 5 cm.

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

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Goal 3: Advance Translational Research

Molecular determinants of vascular wall development and aneurysm formation that can be used as markers for early diagnosis

To increase the potential of translating basic research discoveries into the clinic, there is a need to discover molecular biomarkers that confer risk for aneurysms and vascular dissections. The creation of a nation-wide biorepository of well-defined tissue and plasma samples along with research utilizing these tissue samples employing state-of-the art proteomics, genomics and development of appropriate mouse models will... more »

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 challenge is the coordination of all components of the Project (i.e. development of a national biorepository along with coordination of proteomics and genomics analysis as well as proof of concept in animal models).

Feasibility and challenges of addressing this CQ or CC

This process is not feasible via the R01 funding mechanisms. The feasibility of addressing this critical challenge is excellent provided adequate resources are provided.

Name of idea submitter and other team members who worked on this idea Dudley Strickland and Selen Catania Muratoglu

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5 net votes
7 up votes
2 down votes
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Goal 3: Advance Translational Research

How can we determine a patient’s risk of a life-threatening aortic dissection?

Even though science and technology has advanced, many of the advancements have not met the critical challenge of making significant changes in patient therapies for improved outcomes and thus have not been able to break through the translational barrier. In today’s world, risk of aortic dissection is still based purely on a crude size measurement. It is true that evidence indicates that aortic root aneurysm above 4.5... more »

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

Details on the impact of addressing this CQ or CC

We need tools to assess vascular function and morphology to determine the weakness and/or strength of the aorta. We need biomarkers and predicators of outcomes for aneurysms and acute aortic dissection. We also need to understand the actual physical limitation of the aorta and where there may actual be physical barriers which cannot be overcome by drug therapies.

Utilizing singe gene disorders like Marfan syndrome can help to develop the tools needed to access not only risk but can provide candidate pathways that can contribute to more complex, common and polygenetic disorders and moving research to the preclinical and clinical stage to prioritize therapeutic targets in many related and common diseases..

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

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6 up votes
2 down votes
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Goal 2: Reduce Human Disease

Controversies exist regarding the treatment of the thoracic aorta in those with bicuspid aortic valve

Controversies exist regarding the treatment of the thoracic aorta in those with bicuspid aortic valve (BAV), in particular: 1) conflicting views regarding criteria for elective surgery, particularly aneurysm size 2) extent of thoracic aortic aneurysm repair.

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

Details on the impact of addressing this CQ or CC

This is a population that may approach 6 million Americans, without inclusion of their trileaflet aortic valve blood relatives. The controversy generally revolves around when to intervene surgically to prevent an aortic catastrophe, and how much of the ascending aorta should be removed (will any residual ascending aorta enlarge over time, and if so, what risk does this represent versus another aortic surgery later?).

Compounding this is the recognition in the literature of significant percentages of aortic dissection at sizes occurring below the guidelines for elective surgery. Patients do not realize that sometimes they are told to wait for elective surgery based on a size difference roughly as small as the thickness of a nickel (approximately 2 mm) or a dime (just over 1 mm).

The implications of this uncertainty in their treatment are staggering, particularly in light of the potential consequences for the most vulnerable individual, which include sudden death. Even those who survive an aortic emergency, with a chronically damaged aorta, face a very different future from that of someone with a non-emergent aortic repair with no residual aortic injury. Surgical uncertainty regarding the aorta should also consider valve surgeries needed by some individuals, and the total number of surgeries an individual may ultimately face.

Many with BAV are vibrant and active, if they avoid premature injury or death. Their disability or loss robs society of their many gifts.

Feasibility and challenges of addressing this CQ or CC

The medical literature reflects varying information and findings, perhaps due in part to the spectrum of expression across this large population, and the characterization of relatively small numbers of individuals under varied scenarios. Some may be carefully followed and receive medical treatment for blood pressure. Others may not receive those benefits, some being diagnosed only in emergency settings. Greater consistency in knowledge and treatment would benefit individuals and families. Advancements are very feasible within a five to ten year period and could greatly benefit the future of those undergoing surgery.

In the interim, patients are empowered when they understand these controversies: the known data regarding aortic size and dissection, and the considerations around the extent of aortic removal, and are fully engaged in elective surgery decisions.

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

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Goal 2: Reduce Human Disease

Medical therapy to reduce aneurysm progression

How to develop effective medical therapies to reduce aneurysm progression - currently only surgical intervention is effective.

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 Society for Vascular Surgery

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2 net votes
3 up votes
1 down votes
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Goal 2: Reduce Human Disease

Cause of disparity in prevalence and progression of various vascular disorders

What are the causative factors underlying the disparity in prevalence and progression of various vascular disorders (PAD, CVD, aneurysm) across populations?

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

Details on the impact of addressing this CQ or CC

­Genetic, epigenetic, biochemical, nutritional, environmental, and psychosocial factors should be characterized.

Name of idea submitter and other team members who worked on this idea Society for Vascular Surgery

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2 up votes
0 down votes
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