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 4: Develop Workforce and Resources

RO1 funding rate

I would like to suggest the following changes in RO1 funding: (1) Reduce the amount but maintain the duration of each RO1 award to make academic research labs SMALLER but BETTER - This will force PIs pay closer attention to experimental design, to improve the efficiency and accuracy. It may entice more PIs to do more experiments themselves, the best way to reduce errors, maintain consistency and keep in touch with the... more »

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

Feasibility and challenges of addressing this CQ or CC

This is simple math: when the amount of money is reduced but the number of RO1 applications is not, we will see a drop in the RO1 funding rate. This is frustrating, especially when we question the validity of data from some high-profile labs that list 4 or even more RO1 awards in the 'Acknowledgments' of their papers in high-impact journals. By reducing the amount of RO1 award, NIH can fund more (smaller) labs. This may break the monopoly (or at least reduce the impact) of some big labs in key research areas. The increased participation of small labs highly motivated to answer MORE questions with LESS costs will help revitalize the US Biomedical Research Enterprise.

Voting

-8 net votes
23 up votes
31 down votes
Active

Goal 3: Advance Translational Research

Better collaboration with industry

There is a need for better collaboration with industry.

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

Details on the impact of addressing this CQ or CC

Promoting further academic‐industry interactions are likely to yield benefits, which will ultimately lead to improvements in the health of our nation.

Name of idea submitter and other team members who worked on this idea Research Advocacy Committee, American Thoracic Society

Voting

5 net votes
5 up votes
0 down votes
Active

Goal 2: Reduce Human Disease

Precision medicine in non-malignant lung diseases

NIH has a major initiative in Precision Medicine, including whole genome sequencing. In contrast to cancer, mutations with large clinical effects are expected to be uncommon in most non-malignant chronic diseases, such as asthma and COPD. Other data types such as gene expression, biomarkers, and micro RNAs must be combined with clinical and imaging phenotyping to advance Precision medicine in non-malignant lung diseases.... 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 goal is to combine clinical and molecular data to identify subtypes of patients within the major chronic respiratory diseases. Understanding molecular pathways will first lead to more appropriate drug repositioning and eventually novel drug development.

Feasibility and challenges of addressing this CQ or CC

NHLBI has many cohorts of subjects with chronic lung diseases with longitudinal clinical characterization, many with banked biospecimens. It is quite feasible to perform genomic, epigenetic and biomarker assays on these specimens. Based on these results, hypothesis-based targeted profiling can be done in prospective studies.

Voting

12 net votes
15 up votes
3 down votes
Active

Goal 4: Develop Workforce and Resources

Increase participation in HLBS scientific disciplines

What strategies should NHLBI use to pursue students at the K-12 level of their education and also to encourage their scientific interests through the undergraduate and graduate levels?

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

Details on the impact of addressing this CQ or CC

An inspired healthcare related workforce will bring novel ideas and innovations to heart, lung, blood, and sleep (HLBS) related fields of science.

Feasibility and challenges of addressing this CQ or CC

It is definitely feasible to develop or modify programs that will incentivize both students and teachers

Voting

-9 net votes
8 up votes
17 down votes
Active

Goal 3: Advance Translational Research

Develop alternatives for patients for whom routine red cell transfusion is unavailable or impractical

There is a compelling need to advance research to understand the physiology governing the safety and efficacy of hemoglobin-based oxygen therapeutics functioning outside the red cell.

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

Details on the impact of addressing this CQ or CC

Adequate numbers of red blood cells are required to sustain human life. Neurocognitive deficits and mortality in acutely anemic humans increase significantly at a hemoglobin level of below 5 g/dL even in the absence of significant cardiovascular disease. At extremely low hemoglobin levels, alternative treatments (supplemental or hyperbaric oxygen, sedation, muscle paralysis and mechanical ventilation) are of only limited benefit and are not without risk. Several classes of patients cannot be routinely transfused with red blood cells. These classes of patients for whom blood is not an option would include patients who will not accept transfusion for religious or personal reasons, patients who due to multiple prior transfusions have developed red cell antibodies without the option for compatible red cells, and massive trauma patients needing treatment in a remote location. The development of cell-free hemoglobin-based oxygen carriers, stable at room temperature and not requiring cross-matching prior to transfusion as a red cell substitute, has been a sought after goal for several decades, yet to date all attempts have met with failure during clinical trials. There is a compelling need to advance research to understand the physiology governing the safety and efficacy of hemoglobin-based oxygen therapeutics functioning outside the red cell.

Feasibility and challenges of addressing this CQ or CC

Multiple physiologic insults and adverse events seen with earlier modified hemoglobins, compared to banked red blood cells, have been described and are now better, but not completely, understood. Advances in hemoglobin modification could allow for successful use in a variety of clinical scenarios with life-saving results. Additional clinical indications could be investigated and established, such as identification of clinical situations where additional oxygen delivery could modulate the effects of chronic ischemic conditions. In addition, the hemoglobin molecule could be modified to deliver additional therapeutic benefit.

Name of idea submitter and other team members who worked on this idea Office of Blood Research and Review, CBER, FDA

Voting

8 net votes
13 up votes
5 down votes
Active

Goal 4: Develop Workforce and Resources

Stop changing the biosketch

Recent changes in the biosketch do nothing to help us reviewers, and put a burden on submitters to change and learn new formats. I see no reason for this at all, the previous iteration was fine and gave all information needed.

 

Nothing more need be said.

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

Details on the impact of addressing this CQ or CC

Reduce researcher time in preparing grant submissions.

Reduce administrative time from NIH staff implementing and communicating changes. Only downside is the company that produced a 64 page primer on the new format would be out of luck. So this tells the story, it takes a 64 page primer to help someone make a minor change in the bio that reviewers (speaking for myself) find neutral.

Feasibility and challenges of addressing this CQ or CC

Reduces wasted time and resources. Use that money to fund some science!

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

Voting

70 net votes
81 up votes
11 down votes
Active

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

Voting

0 net votes
1 up votes
1 down votes
Active

Goal 3: Advance Translational Research

Tissue engineered constructs for vascular disease

Can we develop improved, clinically effective tissue engineered constructs for vascular 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

We need a better alternative to coronary and lower extremity bypass surgery for patients lacking adequate vein.

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

Voting

1 net vote
2 up votes
1 down votes
Active

Goal 2: Reduce Human Disease

Outcomes of heterogeneous responses to tiotropium

Tiotropium is widely used for COPD, but patients report highly variable responses to this medication. A clinical trial of severe COPD subjects could address both short-term (bronchodilator effect) and intermediate-term (COPD exacerbations) outcomes of this heterogeneous response by examining radiologic (chest CT), clinical (Six Minute Walk, Spirometry), and pharmacogenetic (GWAS) influences on this heterogeneous response.... 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 American Thoracic Society member

Voting

2 net votes
2 up votes
0 down votes
Active

Goal 2: Reduce Human Disease

PUFA Toxicity

Our diets contain 20 times more omega-6 fatty acids than the diets of humans before agriculture, industrial solvent extraction of seed oils and hydrogenation. These acids including linoleic and arachidonic acids are precursors to eicosanoids that mediate inflammation and blood clotting and the amount in our diet has been shown to correlate with negative health outcomes. Should NHLBI fund more research into the effects... 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

Federal regulations could limit the amount of omega-6 fatty acids in foods and significantly reduce the incidence of atherosclerosis, strokes, heart attacks, asthma and autoimmune disease.

Feasibility and challenges of addressing this CQ or CC

Evidence already exists but should be confirmed in large scale studies

Name of idea submitter and other team members who worked on this idea James Shoemaker MD PhD

Voting

-4 net votes
9 up votes
13 down votes
Active

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 »

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

Voting

1 net vote
19 up votes
18 down votes
Active

Goal 2: Reduce Human Disease

Development of Optimally Hemostatic, Systemically Safe, Platelet Mimetics or Substitutes

What are the knowledge and technological gaps in production, evaluation and clinical translation of donor-independent platelets for transfusions? Specific questions include: a) How can stem or progenitor cells be expanded to maximize platelet production?; b) What are the hemostatically relevant design and function requirements and evaluation metrics for ideal/optimal “biologic” and “synthetic” platelets? c) What preclinical... 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

Platelets produced from induced pluripotent stem or progenitor (megakaryocyte) cells (biologic production), as well as, manufactured from engineered biomaterials (synthetic production) could address clinical needs of supply issues and transfusion related function and safety concerns. However, there are key knowledge and technology gaps in both approaches, and in corresponding qualitative and quantitative correlation of the platelet products with hemostatic efficacy and safety. One important step is increasing both stem and progenitor cell expansion in culture. A parallel step is to develop synthetic platelet mimetics using biomaterials engineering. Finally, the hemostatic efficacy and safety of the products need to be established in clinically relevant models and patients.

Feasibility and challenges of addressing this CQ or CC

The above questions can be addressed by establishing high throughput screens for compounds that expand CD34 or CD41 cells or trigger platelet release and ploidy, developing culture methods using 3D scaffolds to mimic bone marrow perivascular niche, using proteomics or RNA-sequencing to reveal molecules critical for terminal megakaryocyte maturation and platelet formation. Large-scale bioreactors can be adapted to test molecules, triggers and conditions for amplifying platelet production. For synthetic platelet mimics, the benefits of integrating natural platelet’s physico-mechanical properties with its hemostatic biochemical properties on synthetic biomaterial platforms, can be studied in vitro. Scaled-up particle fabrication technologies with control over particle geometries and surface chemistries, can be adapted for manufacturing synthetic platelets. Large-scale production of platelets through biologic and synthetic routes would enable studies in animal models with clinically relevant bleeding disorders, to correlate design and dosage with hemostatic function and safety. Subsequently, clinical studies can be carried out in Phase 1 for safety analysis in dose escalation and in vivo kinetics (recovery and survival for biologic, degradation and clearance for synthetic). Phase II studies can evaluate bleeding incidence, transfusion requirements and thrombotic events in a controlled population of thrombocytopenic patients under-doing chemotherapy or stem cell transplantation.

Name of idea submitter and other team members who worked on this idea NHLBI 2015 State of the Science in Transfusion Medicine

Voting

20 net votes
38 up votes
18 down votes
Active

Goal 2: Reduce Human Disease

Childhood Interstitial Lung Disease

What is the relationship of ChILD disorders to more common childhood respiratory diseases?

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

Details on the impact of addressing this CQ or CC

For example, what is the role of surfactant-related sequence variants in chronic lung disease of prematurity? Cystic fibrosis? Severe bronchiolitis? Refractory asthma?

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 3: Advance Translational Research

The "Metagenome"

How could we best understand the interplay within the metagenome (the nuclear (nDNA), mitochondrial (mtDNA), and microbiome DNA), and between the metagenome and environment as a cause for individual variability, including susceptibility to disease and therapeutics? Could the genomic “chimerism” possibly be related to reported sex differences in HLBS diseases?
• Most factors needed for mitochondria are encoded by nDNA.... 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

Would allow understanding the basis for complex individual variations beyond the current focus on the nuclear genome

Feasibility and challenges of addressing this CQ or CC

Feasible in 10 years.
For example, the issue of “chimerism” between mtDNA and nDNA is intriguing: every cell, male or female, contains mtDNA and mitochondria of female (maternal) origin. Mitochondria are cell’s main energy engine, essential in all cells with high energy expenditure, such as myocytes, but mitochondria are also emerging as a major source of pathogenic reactive oxygen species in connection with a variety of heart, lung, blood, sleep diseases.

 

High complexity requires researchers working across discipline boundaries, big data science, modeling

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

Voting

-25 net votes
9 up votes
34 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 »

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