Showing 15 ideas for tag "vascular"

Goal 2: Reduce Human Disease

Lipid apheresis as adjunct therapy in peripheral vascular disease

What is the roll of inflammation and how does lipid apheresis alter inflammation in peripheral vascular disease when added to standard therapy and/or when used alone? Does lipid apheresis result in long-term improvement with reduced morbidity, mortality, and expense compared to standard therapy?

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

Details on the impact of addressing this CQ or CC

The prevalence of peripheral vascular disease (PVD) in the United States is estimated to be 5.9%, affecting up to 20% of adults over the age of 65. Therapy for PVD is vascular surgical intervention for limb ischemia; combined with medical therapy and anti-platelet agents but morbidity and mortality remains high. Low density lipoprotein cholesterol (LDL-c) is associated with increased risk for development and progression of PVD. Preliminary studies of the use of lipid apheresis have demonstrated improvement in symptoms and a variety of laboratory measures with decreased morbidity when added to standard therapy. The mechanism of this treatment may go beyond reducing LDL-c as the columns also affect levels of inflammatory cytokines, alter blood rheology, and affect other lipids.

Feasibility and challenges of addressing this CQ or CC

Currently two lipid apheresis devices have been cleared by the Food and Drug Administration and are in use in the United States. The presence of cleared devices, the large number of affected patients, and availability of testing for lipoproteins, fibrinogen, CRP, PAI-1, IL-6, IL-17, IL-1, IL-10, INF-γ, VEGF, PGI2, IGF-I and rheology factors make the enrollment and evaluation of patients into a clinical trial examining the use of this treatment of PVD feasible. Challenges for the performance of a clinical trial would include the limited number of centers offering lipid apheresis, the chronic nature and length of time needed to perform lipid apheresis, and the expense of the lipid apheresis devices and disposables.

Name of idea submitter and other team members who worked on this idea Bruce Sachais on behalf of ASFA

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96 net votes
116 up votes
20 down votes
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Goal 2: Reduce Human Disease

Vascular Origins of Cognitive Decline

A comprehensive research plan is needed to identify the vascular causes of cognitive decline, to develop early treatment options, and most ideally, develop effective measures to maintain cognitive function.

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

Details on the impact of addressing this CQ or CC

Reduction in the number of elderly with cognitive impairment would not only increase quality of life but would reduce health care costs. Research is indicating that the pathologic decline in cognitive function is complex and may involve multiple pathways of cardiovascular and metabolic origin.

Feasibility and challenges of addressing this CQ or CC

Addressing this issue requires research on vascular biology, tools for brain imaging and measurements of cognitive decline, all of which are advancing in development and implementation. The 2013 BRAIN Initiative includes $100 million in commitments from 5 federal agencies, including $46 million from NIH in grant awards focusing on new tools and techniques.
The frequently observed cognitive decline with aging can occur in a mild state or can progress to forms of dementia that are devastating to individuals and families and require a functioning and affordable support system for the affected individual. The vascular origin of this decline is only beginning to be understood. With increasing numbers of the US population surviving to their 80s and 90s, healthy cognition is critical for these elderly to be able to live independent functioning lives. .

As always commitment of funds is required as well as identifying appropriate research populations and efficient study designs.

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

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30 net votes
51 up votes
21 down votes
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Goal 2: Reduce Human Disease

what endogenous anti-inflammatory mechanisms can improve vascular diseases

the role of pro-inflammatory mechanisms of vascular disease are well characterized, but we know little about potentially protective endogenous anti-inflammatory mechanisms.

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 will identify new therapy or targets of therapy to improve our understanding of most vascular disease and lead to improved human health.

Feasibility and challenges of addressing this CQ or CC

this is quite feasible; if we know so many pro-inflammatory mechanisms which for years we have tried to reduce or prevent, we can just as easily identify endogenous anti-inflammatory mechanisms that we can identify and enhance.

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

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10 net votes
18 up votes
8 down votes
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Goal 2: Reduce Human Disease

Understanding the Role of the Vasculature in Dementia

Dementia is traditionally grouped into vascular dementia, Alzheimer's dementia, Parkinson's dementia and other causes of dementia. Vascular dementia is generally thought to be a consequence of strokes but there are some recent studies indicating that even Alzheimer's dementia may have a vascular underpinning. Vascular permeability is increased in the early stages of Alzheimer's disease and it is possible that similar... more »

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

Details on the impact of addressing this CQ or CC

The NHLBI could fund programs which enable vascular biologists to collaborate with neuroscientists and neurologists in order to understand whether the vasculature has a causal role in the progression of dementia.

 

 

Can interventions that improve vascular function prevent the progression of dementia? Instead of using broad interventions such as statins which affect numerous signaling pathways, vascular biologists could target selected aspects of vascular health such as improving vascular barrier function and vascular regeneration.

If these interventions that have been shown to be efficacious in other vascular beds outside of the brain are also effective in the brain, then important new therapies could be developed for dementia which is likely to become one of the leading cause of death in the next decades.

Feasibility and challenges of addressing this CQ or CC

A key challenge for targeting the brain vasculature will be the blood-brain barrier. Understanding the role of the blood-brain barrier in dementia will be a prerequisite to developing novel vasculature-directed therapies.

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

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9 net votes
13 up votes
4 down votes
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Goal 2: Reduce Human Disease

Vascular biology and the pathophysiology of sepsis

Unravel the cellular & molecular mechanisms related to the vascular biology of sepsis and related cardiovascular collapse. The goal is to develop a new scientific framework for the prevention of sepsis related morbidity and mortality by applying novel approaches to discover new targets for biomarkers and therapy by promoting multidisciplinary research required for scientific cross-talk between complementary research disciplines... more »

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 of Critical Care Medicine Executive Committee/Council

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4 net votes
8 up votes
4 down votes
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Goal 2: Reduce Human Disease

How gene mutations contribute to defects in vascular development

How do gene mutations in endoglin and alk 1 create arteriovenous malformations leading to disease. Alk 1 and endoglin are receptors in TGFB/BMP family signaling. TGFB/BMP have roles in vascular development, remodeling and maintenance in vascular integrity. Understanding the downstream effect will lead to advancements in reducing genetic diseases such as HHT as well as vascular malformations in general

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 Marianne Clancy MPA, Chris Hughes PhD

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

National network to study the pathobiology of sepsis

Sepsis is the leading cause of death in hospitalized patients, the 3rd leading cause of death in all people in the US, the most common condition leading to widespread vascular collapse, among the most common causes of respiratory failure, and a frequent cause of acute cardiac dysfunction.

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 a national network to address important aspects of sepsis (causes and consequences of cardiac dysfunction, molecular determinants of respiratory failure) and serve as a trials group for testing novel interventions for new discoveries.

Name of idea submitter and other team members who worked on this idea Society of Critical Care Medicine Executive Committee/Council

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2 net votes
4 up votes
2 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 net votes
2 up votes
0 down votes
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Goal 2: Reduce Human Disease

Pulmonary Vascular Diseases

Does treatment with spironolactone improve outcomes in patients with pulmonary arterial hypertension (and/or pulmonary hypertension associated with diffuse parenchymal lung disease or COPD)?

Spironolactone has been shown beneficial in CHF and many of the same mechanisms are at plan in RV failure from pulmonary hypertension.

Again, no clear evidence whether this is a useful treatment or not, and no evidence to guide... more »

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

Feasibility and challenges of addressing this CQ or CC

This is a view of problems in the field.
Pulmonary Hypertension Clinical Research: Current Problems and Possibilities
Current studies limited to the short term, with soft outcomes.
No mechanistic studies embedded in trials.
Control of phenotype is weak.
Small n: lumping of cohorts.
No factorial of advanced design.
No biological samples obtained for study.
Failure to study basic management issues.

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

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2 net votes
2 up votes
0 down votes
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Goal 2: Reduce Human Disease

Pulmonary Vascular Diseases

Does anticoagulation with warfarin improve outcomes (time to clinical worsening, qualtiy of life, exercise capacity) in patients with pulmonary arterial hypertension treated with current oral/inhaled therapies? There are substantial "unknowns" and practice variation in anticoagulation in PAH. Resource utilization is also a factor here. We may either be helping patients (or hurting them with side effects) by using anticoagulation.... more »

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 view of problems in the field.
Pulmonary Hypertension Clinical Research: Current Problems and Possibilities
Current studies limited to the short term, with soft outcomes.
No mechanistic studies embedded in trials.
Control of phenotype is weak.
Small n: lumping of cohorts.
No factorial of advanced design.
No biological samples obtained for study.
Failure to study basic management issues.

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

Voting

2 net votes
2 up votes
0 down votes
Active

Goal 2: Reduce Human Disease

Pulmonary Vascular Diseases

Does "goal-targeted" therapy (with adjustments/additional therapy, if certain "goals" are not achieved) improve quality of life, functional status, and survival in patients with pulmonary arterial hypertension? Trials of therapies for hepatopulmonary syndrome.

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

Feasibility and challenges of addressing this CQ or CC

This is a view of problems in the field.
Pulmonary Hypertension Clinical Research: Current Problems and Possibilities
Current studies limited to the short term, with soft outcomes.
No mechanistic studies embedded in trials.
Control of phenotype is weak.
Small n: lumping of cohorts.
No factorial of advanced design.
No biological samples obtained for study.
Failure to study basic management issues.

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

Voting

2 net votes
2 up votes
0 down votes
Active

Goal 2: Reduce Human Disease

Pulmonary Vascular Diseases

Does pulmonary rehabilitation or regular exercise improve outcomes in patients with PVD?

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 view of problems in the field.
Pulmonary Hypertension Clinical Research: Current Problems and Possibilities
Current studies limited to the short term, with soft outcomes.
No mechanistic studies embedded in trials.
Control of phenotype is weak.
Small n: lumping of cohorts.
No factorial of advanced design.
No biological samples obtained for study.
Failure to study basic management issues.

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

Voting

1 net vote
1 up votes
0 down votes
Active

Goal 2: Reduce Human Disease

Novel methods to diagnose and treat microvascular ischemia

Microvascular ischemia is common, particularly in the setting of critical illness. We need better ways to evaluate, diagnose and treat these conditions, whether they relate to microvascular myocardial ischemia, as a primary diagnosis of complication of other acute illness, or non-myocardial ischemia during the course of surgery, injury, infection or acute illness.

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

Details on the impact of addressing this CQ or CC

Development of effective diagnostics would lead to improved treatments for myocardial and non-myocardial microvascular ischemia, and also advance understanding to extend the advance beyond this setting.

Name of idea submitter and other team members who worked on this idea Society of Critical Care Medicine Executive Committee/Council

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0 net votes
2 up votes
2 down votes
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Goal 2: Reduce Human Disease

Improve vascular healing and extend long term benefit of interventions

How can we develop new approaches to improve vascular healing and extend the long term benefits of vascular interventions for more patients?

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

Details on the impact of addressing this CQ or CC

­The response to vascular injury, whether it be catheter interventions, bypass surgery, or chronic implants, is a reactive process characterized by inflammation, cell proliferation, and fibrosis leading to failure. Better understanding of the mechanisms of vessel remodeling, and restoring homeostasis, is needed to improve prediction, develop and translate new treatments. This remains the leading scientific problem in vascular medicine and surgery. New approaches such as proteomics, lipidomics, molecular imaging offer new opportunities in this realm.

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

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0 net votes
1 up votes
1 down votes
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