DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
Fiscal Year 2019 Budget Request
Statement for the Record
Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies
Gary H. Gibbons, M.D.
Director, National Heart, Lung, and Blood Institute
Mr. Chairman and Members of the Committee: I am pleased to present the President’s Fiscal Year (FY) 2019 budget request for the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH).
This year, the NHLBI commemorates its 70th anniversary and a legacy of achievements across the broad spectrum of research – including basic science, epidemiology studies, implementation research, training, and landmark clinical trials – that have helped people all over the world live longer, healthier lives. Moving forward, the Institute remains committed to leveraging scientific opportunities and working in partnership with the public and private sector to prevent and treat heart, lung, blood, and sleep disorders.
The NHLBI’s continued investments in fundamental discovery science provide the foundation for tomorrow’s medical breakthroughs. This includes the NHLBI’s support for research on the circadian rhythm (the body’s daily internal clock), how it is regulated, and its relationship to the risk of chronic disease. Well known to cardiologists, blood pressure rises and falls on a daily rhythm, reaching its peak in the early morning – which is also when the risk for heart attacks and other cardiovascular events is greatest. Moreover, disruption of circadian rhythms has been shown to contribute to obesity, diabetes, and other conditions that can increase the risk of heart, lung, blood, and sleep disorders. Recent discoveries from basic research – including work on fruit flies recognized with the 2017 Nobel Prize in Medicine – have revealed new insights on the genetic and molecular pathways underlying circadian rhythms that are opening new doors to prevention and treatment.
To leverage these discoveries, the NHLBI has partnered with the National Institute of Diabetes and Digestive and Kidney Diseases on a program to better understand how circadian-dependent mechanisms contribute to obesity and to the risk of heart and lung disorders linked to obesity. Such research may help identify novel therapies that act on the circadian rhythm to prevent or manage these disorders. As researchers learn more about the basic pathways underlying circadian function, they may also gain new insights into treating sleep disorders such as sleep apnea.
The goal of precision medicine is to give health care providers the tools to better predict health and preempt chronic disease, and to tailor treatment strategies to a patient’s unique characteristics. To accomplish this, the NHLBI’s Trans-Omics for Precision Medicine (TOPMed) program is integrating clinical, genomic, and other data from diverse cohort studies, including the NHLBI’s long-standing Framingham Heart Study and Jackson Heart Study, which continue to help us understand who is vulnerable to chronic diseases and why. To date, TOPMed has generated whole-genome sequences from 120,000 individuals in these studies, which we expect will identify new genetic risk factors for disease and new molecular targets for therapy.
Data from TOPMed will be included in a pilot of the new NIH Data Commons, a public-private partnership to bring research findings into a cloud-computing environment to enhance data sharing. This effort will give researchers access to data from hundreds of studies, creating new opportunities for collaborative research, innovation, and discovery.
Despite declines in overall death rates from cardiovascular disease (CVD), many populations in the United States, whether defined by race, gender, geography, or other factors, continue to experience a high burden of CVD and other chronic diseases. Increasingly, it is clear that place matters. Where people live, work, and play affects their susceptibility to disease and their health outcomes.
A 2017 study of more than 3,000 counties found a high burden of CVD throughout the U.S. heartland, from Kentucky to Oklahoma, with mortality rates in the highest-burden counties up to four times higher than in the lowest-burden counties. New CDC data also shows that rural Americans face a higher burden of chronic obstructive pulmonary disease (COPD) than urban Americans and are dying from it at higher rates. Many communities face economic, cultural, and geographic barriers to disease awareness, prevention, and treatment, reflected in a high burden of CVD risk factors such as high blood pressure, smoking, low physical activity, and high-calorie diets.
These data help inform efforts to reduce health disparities through implementation research. For example, a recent NHLBI-funded study shows the power of using non-traditional settings to adapt and implement health care interventions for high-risk communities. In the study, blood pressure screenings and pharmacist referrals at barbershops helped reduce high blood pressure among African American men in the Los Angeles area. In alignment with the comprehensive federal COPD National Action Plan, other research seeks to improve COPD care in medically underserved areas. One recent study found that a set of simple affordable diagnostic tools can help primary care providers identify patients with COPD and follow up with appropriate treatment.
The NHLBI is expanding its implementation research programs. The STIMULATE initiative seeks investigator-initiated proposals to overcome barriers to implementation of proven interventions, and DECIPHeR will create opportunities to integrate intervention trials into the NHLBI’s long-running observational studies of minority populations.
While the NHLBI supports implementation research programs in sickle cell disease (SCD) that are helping develop and test approaches to improve patient outcomes, fundamental discoveries in stem cell biology and genomics are converging toward a cure. SCD is a genetic blood disorder that affects 100,000 Americans and millions worldwide. It is caused by a genetic mutation that causes the body’s red blood cells to take on a sickled shape and obstruct blood flow, leading to severe frequent pain, organ damage, and other debilitating effects.
More than 50 percent of adults with SCD have significant pain more than three days per week, and about 40 percent take opioid pain medications daily. The NHLBI supports research to investigate mechanisms of pain in SCD and the potential for non-opioid treatments. This research will assist in addressing the Nation’s devastating opioid epidemic, by helping ensure that individuals with SCD and other types of chronic pain can acquire effective relief without over-reliance on opioids.
In addition to managing pain and other complications of SCD, it is possible to cure SCD with a bone marrow transplant. However, this procedure requires that the patient have a healthy, immunologically matched marrow donor, which is not an option for most patients.
Advances in gene-editing technologies, such as CRISPR, are offering new hope for a cure that works for all patients. By using the patient’s own bone marrow stem cells, researchers can replace the faulty SCD gene or edit the misspelled gene and transplant the corrected cells back into the patient, without the risk of immune rejection. NHLBI intramural scientists are leading cutting-edge research and clinical trials in this area.
Curing this disease within the decade is not something the NIH can do alone. The NHLBI Cure Sickle Cell initiative is bringing together patients, patient advocacy groups, health care providers, academic researchers, and industry to accelerate development of a widely available SCD cure.
Medical breakthroughs and improvements in public health that once seemed impossible are now within reach due in large part to the NHLBI’s seven decades of investing in excellent science. The Institute remains committed to funding investigator-initiated discovery science, training and building a talented diverse scientific workforce to help address an array of research needs, forming new strategic partnerships, and promoting the implementation of evidence-based care. Through these multi-pronged efforts, the NHLBI will continue to stimulate the scientific advances needed to further reduce suffering from heart, lung, blood, and sleep disorders.
Director, National Heart, Lung, and Blood Institute
Gary H. Gibbons, M.D., is director of the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH), where he oversees the third largest institute at the NIH, with an annual budget of more than $3 billion and a staff of about 900 federal employees. The NHLBI provides global leadership for research, training, and education programs to promote the prevention and treatment of heart, lung, and blood diseases and enhance the health of all individuals so that they can live longer and more fulfilling lives.
Since being named director of the NHLBI, Dr. Gibbons has enhanced the NHLBI investment in fundamental discovery science, steadily increasing the payline and number of awards for established and early stage investigators. His commitment to nurturing the next generation of scientists is manifest in expanded funding for career development and loan repayment awards, as well as initiatives to facilitate the transition to independent research awards.
Dr. Gibbons provides leadership to advance several NIH initiatives, and has made many scientific contributions in the fields of vascular biology, genomic medicine, and the pathogenesis of vascular diseases. His research focuses on investigating the relationships between clinical phenotypes, behavior, molecular interactions, and social determinants on gene expression and their contribution to cardiovascular disease. Dr. Gibbons has received several patents for innovations derived from his research in the fields of vascular biology and the pathogenesis of vascular diseases.
Dr. Gibbons earned his undergraduate degree from Princeton University in New Jersey, and graduated magna cum laude from Harvard Medical School in Boston. He completed his residency and cardiology fellowship at the Harvard-affiliated Brigham and Women's Hospital. Dr. Gibbons was a member of the faculty at Stanford University in California from 1990-1996, and at Harvard Medical School from 1996-1999. He joined the Morehouse School of Medicine in Atlanta in 1999, where he served as the founding director of the Cardiovascular Research Institute, chairperson of the Department of Physiology, and professor of physiology and medicine. While at Morehouse, Dr. Gibbons served as a member of the National Heart, Lung, and Blood Advisory Council from 2009-2012.
Throughout his career, Dr. Gibbons has received numerous honors, including election to the Institute of Medicine of the National Academies of Sciences; selection as a Robert Wood Johnson Foundation Minority Faculty Development Awardee; selection as a Pew Foundation Biomedical Scholar; and recognition as an Established Investigator of the American Heart Association.