Goal 2: Reduce Human Disease

Study on key product factors for optimal Bone Marrow Transplantation (BMT) graft function

Hematopoietic progenitor cells (HPC) collected by Apheresis is the most common source used for BMT. How the cells are collected and what kinds of cells are collected can affect BMT graft function. Limited studies have been done to study the key product factors in relationship to optimal graft function.
Questions remain such as the optimal lymphocytes contents for reduced infection post BMT, optimal megakaryocyte precursor... 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

Optimal cell therapy products can lead to reduced post BMT complication and reduced morbidity and mortality.

Feasibility and challenges of addressing this CQ or CC

In vitro, animal studies, clinical samples can be used for key product factors for optimal BMT graft function.
These can be achieved if funding is available, as there are many centers perform allo and auto BMT.
Funding support is critically needed in this area.

Name of idea submitter and other team members who worked on this idea Yanyun Wu on behalf of ASFA

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70 net votes
93 up votes
23 down votes
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Goal 3: Advance Translational Research

The need for funding priorities and emphasis on valve disease and large-animal preclinical studies

Investigators need NHLBI support for programs that transform our approach to heart valve disease to mechanism-based prevention with large-animal preclinical studies through: an NHLBI-sponsored sponsored Heart Valve Network; development of models of genetic and acquired valve disease; a study section devoted to valve disease; and RFAs and RFPs based on Task Force priorities in mitral valve disease.

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

Details on the impact of addressing this CQ or CC

Improved health through mechanism-based prevention in an increasing cause of heart failure. Support for research that can lead directly to clinical applications yet has basic aims.

Feasibility and challenges of addressing this CQ or CC

With NHLBI support, the resources and talented investigators can make this possible.

Name of idea submitter and other team members who worked on this idea Robert A. Levine, MD and member of the Leducq Mitral Network

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

Is “renewal” of R01 grants, competitive or not, justifiable?

Does NIH intend to develop a new milestone-based grant system and introduce accountability with regards to reaching solid metrics and useful, quantifiable research goals and milestones? Does NIH intend to introduce a truly non-conflicted and independent grant review system, similar to the review system and accountability of the FDA, to increase research efficiency? Should the public be informed annually how effective... 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

Increasing the efficiency of NIH and NHLBI-funded research to the level of a private commercial enterprise, such as major drug development companies do, would be in the best interest of the nation. I am concerned that the current R01-type research grant system has limited focus on innovation and significance. In the current peer review system, fresh ideas can face significant competition from “established investigators” who back their grant applications with data generated during previous research cycles or parallel projects. At present, it appears that most NIH R01-type grant funding has been supporting the generation of data, “knowledge”, research papers, or building research teams and careers rather than projects that propose the development of viable, useful, and potentially feasible solutions to unmet medical needs to serve the public. Moreover, some projects seem to perpetually “fail” and thereby get “renewed”, sometimes for decades without interruption (many of these are run by very “successful” or “established” investigators).

Feasibility and challenges of addressing this CQ or CC

The current system would need to be thoroughly revised and reformed, including the peer review system. It could meet significant resistance from “established” career investigators, including those who produced hundreds of papers but not a single useful innovation that benefits those who pay her.

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

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-4 net votes
16 up votes
20 down votes
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Goal 3: Advance Translational Research

Addressing Health Inequities through Nontraditional Partnerships

What non-traditional partnerships can be leveraged to address health inequities?

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

Details on the impact of addressing this CQ or CC

- Broaden reach to underserved populations
- Increase ability to generate evidence based solutions to address health inequities
- Bring expertise and resources to core partner (NIH)
- Enhance ability to identify unanticipated problems and strengthen efforts across all phases of the implementation research agenda

Feasibility and challenges of addressing this CQ or CC

Feasibility:
- Increased emphasis on health and health inequities by non-profit and particularly, for-profit organizations
- Affordable Care Act (ACA) includes both general and explicit provisions that could narrow the health disparities gaps through implementation research.
- Can leverage and build upon current research partnerships that exist between government agencies and health care delivery systems to address questions of major public health importance
- Opportune time to employ implementation research addressing health inequities through non-traditional research partnership with sectors such as education, state and local government, transportation (built environment), penal and re-entry systems (health risks and disparities), ministries of health, and for-profits, foundations, and non-profits with health care focus.

 

Challenges:

 

- Risk of disagreements and friction among partners and management with different priorities

- Synchronization of timing for decision making

- Achieving partners’ concurrence on decisions that provide the most cost effective solutions

- Time needed to establish trust among partners that do not routinely partner to address health inequities

- There are limited resources dedicated to fostering Public Private Partnerships

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

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6 net votes
19 up votes
13 down votes
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Goal 3: Advance Translational Research

Rx for HFpEF

HLBI should make it a priority to develop therapeutic options for the treatment of heart failure with preserved ejection fraction.

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

Details on the impact of addressing this CQ or CC

Heart failure with reduced ejection fraction (HFrEF), formerly called systolic heart failure, is the classical form of heart failure that is characterized by defective ventricular contraction. The most common variant of heart failure is heart failure with preserved ejection fraction (HFpEF), formerly called diastolic heart failure, characterized by resistance to ventricular filling. The prevalence of HFpEF has been rising steadily over the past two decades at a rate of increase of 1% per year, while the prevalence of HFrEF which has remained stationary. The most common causes of HFpEF are ischemia, obesity, hypertension, diabetes and ageing. Since the population is increasingly obese, hypertensive, diabetic and ageing, the incidence of HFpEF will be the dominant heart failure phenotype over the next decade. The clinical management of HFpEF is complicated by lack of therapeutic options that provide survival benefit. Therapies of proven benefit in HFrEF have repeatedly been shown to add little if any benefit in HFpEF. The prognosis of HFpEF is about the same as HFrEF, with 5-year mortality ranging from 54% to 65%.

Feasibility and challenges of addressing this CQ or CC

Recent developments in our understanding of the molecular mechanisms of myofilament regulation and assays can be used to develop lead compounds for treating HFpEF.

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

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1 net vote
13 up votes
12 down votes
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Goal 2: Reduce Human Disease

Shift from NHLBI guided research to individual investigator initiative

NHLBI directed research should be abandoned and switched to investigator initiated research. I respectfully suggest read the following assay by Brown and Goldstein, Science 2012; 338: 1033-1034

The best way to run the science sponsored by the NIH (or NHLBI) is not to guide it (analogy to running science from ivory tower) but let the investigators decide what is worth pursuing. Get rid of NHLBI-directed research initiative... more »

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 AJ Marian

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47 net votes
63 up votes
16 down votes
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Goal 2: Reduce Human Disease

Why is the heart resistant to cancer?

Cancer of the heart is almost unheard of, whereas most other organs can develop cancer. Why is this?

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 could understand why cancer does not develop in the heart, this might help to develop strategies to protect other organs from doing so.

Feasibility and challenges of addressing this CQ or CC

To my knowledge, no one has looked at this problem, because cardiologists and oncologists train in different fields. With molecular profiling, iPS technology, and animal models, this question can be addressed.

Name of idea submitter and other team members who worked on this idea Henry Chang, M.D.

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-1 net votes
11 up votes
12 down votes
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Goal 1: Promote Human Health

ROLE OF HEALTH DISPARITIES IN SLEEP AND CIRCADIAN HEALTH—ENVIRONMENT

Self-report data indicate that insufficient sleep is more common in minority populations. This seems to be related to socioeconomic status. There is a need to move this beyond self-report and obtain objective measures in the relevant populations. Moreover, the basis of this difference needs to be established. What aspect of the environment leads to these differences, e.g., noise, stress related to sense of vulnerability,... 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

Self-report indicates that sleep duration is lower in minority populations. This seems to be related to socioeconomic groups. To address this issue requires understanding the basis of this and developing appropriate interventions.

The impact of this is as follows:

a. Implementing new technology based on mobile approaches to assess sleep duration in subjects in different socioeconomic groups.
b. Developing a comprehensive approach to understanding and evaluating environmental influences in sleep and circadian rhythm.
c. Designing and testing intervention to increase sleep duration in disadvantaged populations.
d. Improving the sleep health of minority populations.

Feasibility and challenges of addressing this CQ or CC

There is rapidly developing new mobile technology to assess sleep duration and other phenotypes in individuals living in their normal lives. There are a number of studies currently being conducted that could be leveraged to address this question. There are also developing approaches to assess environmental influences on sleep and circadian rhythm such as noise, light exposure, etc. Thus, this question could be addressed in the near future.

Name of idea submitter and other team members who worked on this idea Sleep Research Society

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122 net votes
173 up votes
51 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?

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

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4 net votes
14 up votes
10 down votes
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Goal 2: Reduce Human Disease

Image Repository

There is a need to digitize, remove identifiers, and archive, and catalog physical images, and to promote their use in clinical investigations.

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

Details on the impact of addressing this CQ or CC

Enable leveraging existing resources and possible re-purposing of existing resources to address a wide variety of research questions.

This is a cross-study, cross-NHLBI, and even cross-NIH or beyond, need.

Feasibility and challenges of addressing this CQ or CC

Digitized imaging data files are enormous. Advances in data storage, with corresponding decreases in cost, have enabled storage of these files. For some types of images, data format standards have also arisen.
Many studies have collected data using a wide variety of imaging technologies. While the extracted data have been utilized in analyses and incorporated into shared data resources, additional research could be done on the original images.

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

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

Reducing Disparities

NHLBI should continue to support prospective cohort studies, projects, and investigators that evaluate longitudinal outcomes in minority populations where longitudinal data are scarce and difficult to obtain. The resources generated remain invaluable and can be used to conduct crosscutting translational research (i.e. the Jackson Heart Study, Strong Heart Study, and others).

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

Voting

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

Targeting Preclinical Diastolic Dysfunction to Prevent Heart Failure

Heart failure (HF) affects over 5 million American adults, and projected estimates show growth of this epidemic by 25% over the next 15 years as the population of the United States continues to age. Heart failure with preserved EF (HFpEF) encompasses 50% of all heart failure cases. Preclinical diastolic dysfunction (PDD) is defined as normal systolic function, moderate or severe diastolic dysfunction determined by Doppler... 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

There is currently no FDA approved therapy for HFpEF and yet HFpEF makes up 50% of all HF population. The prevalence of PDD (ACC/AHA Stage B HF) is abt 28% of the general population and these patients do not have symptoms of HF. Understanding the pathophysiology of PDD may leady to the development of therapeutic strategies to prevent the development of HFpEF. This would decrease the burden of HF impact public health and be cost-effective, similar to the use of vaccine to prevent infectious diseases.

Feasibility and challenges of addressing this CQ or CC

With echocardiography, we are able to identify PDD patients before they develop symptomatic HF. Hence with research funding, we can better characterize preclinical diastolic dysfunction, and to discover further targets for this entity to prevent development of HFpEF

Name of idea submitter and other team members who worked on this idea Horng H Chen

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1 net vote
2 up votes
1 down votes
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Goal 1: Promote Human Health

Updating level C evidence in Clinical Guidelines

Clinical Guidelines depends on good science. Despite this, only 11% of guidelines that reported level of evidence in 2009, had level of evidence A while 48% had level C. Studies have shown that recommendations based on Level of Evidence C (or their equivalence) are significantly less reliable and may be downgraded, reversed or omitted when better evidence is available.
I propose a comprehensive review of ACC/AHA... 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

Upgrading the level of evidence that recommendations are based on in clinical guidelines, will potentially improve outcomes, reduce unnecessary risk and reduce cost of all aspects of cardiovascular care.

Feasibility and challenges of addressing this CQ or CC

There are three phases:

  1. Review the current published clinical guidelines (and Appropriate Use Criteria) for recommendations relying on level of evidence of C- Very feasible.
  2. Ranking impact of clinical recommendations that only have level of evidence C- Quite feasible, but will need to set up a protocol and review committee.
  3. Designing and funding high priority studies: Feasible- especially if done under the umbrella of the NHLBI. The challenges will be to set up good studies that supply enough data to be useful in making recommendations based on Level of evidence A in the Guidelines.

Name of idea submitter and other team members who worked on this idea Gilead Lancaster, MD, Associate Clinical Professor of Medicine, Yale University School of Medicine

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3 net votes
3 up votes
0 down votes
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Goal 3: Advance Translational Research

Heart Valve Engineering from Basic Science to Translation

Heart valve disease is third cardiac condition in the U.S.affecting 2.5% of adult population. There are multiple questions with regard to heart valve engineering from basic science to translation. Many unknowns exist related to calcification and its potential mechanisms in transcatheter heart valve (THV), for example, due to stent crimping that can critically affect the valve durability. This is particularly important... 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 self-regenerating heart valves; Does stent-crimping damage prone the valve's leaflet to premature calcification in transcatheter heart valves? what are the basic biological elements and pathways that result in valve calcification? how can we translate the basic science related to heart valve biology into clinically viable technologies that improve patients condition?

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

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5 net votes
15 up votes
10 down votes
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Goal 3: Advance Translational Research

Neglect of Valuable Heart Health Data

Routine bypass surgery generates left ventricle pressure and volumetric flow data which can be modeled by estimated parameters capable of determining a heart health index. This capability is also available online for the surgeon's

guidance and is applicable to any heart chamber.

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

Details on the impact of addressing this CQ or CC

A comprehensive heart health state would be established

Feasibility and challenges of addressing this CQ or CC

The theory has been proven multiple times, intellectual and political inertia are the roadblocks.

Name of idea submitter and other team members who worked on this idea William ONeill, Jeffery Shuhiaber

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-6 net votes
4 up votes
10 down votes
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