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NIAID conducts and supports research that strives to understand, treat, and ultimately prevent the myriad infectious, immunologic, and allergic diseases that threaten millions of human lives.
The National Institute of Allergy and Infectious Diseases (NIAID) is the component of the National Institutes of Health (NIH) charged with conducting and supporting research on diseases of the immune system and infectious diseases. With a FY 2000 budget of more than $1.8 billion, NIAID is the third largest institute at NIH. During the past 15 years, three factors have prompted NIAID to grow significantly. First, the emergence of HIV/AIDS in the early 1980s shattered the notion that successful new vaccines and therapies had brought an end to infectious diseases. Second, results from basic research are now driving new approaches to solving clinical and public health problems. Third, is the realization that infectious diseases will continue to emerge unpredictably and at times explosively.
Today, there are more research avenues to invest in and opportunities to capitalize on than there were even 5 years ago. Consequently, planning has become a more critical element of the Institute's day-to-day operation. The need to prioritize opportunities to maximize potential advances is among the primary motivations driving our strategic plan. This plan also stems from the 1998 Institute of Medicine (IOM) Report, Scientific Opportunities and Public Health Needs: Improving Priority Setting at the National Institutes of Health, which recommended that the NIH Director receive a forward-looking strategic plan, developed with public input, from each Institute and Center (IC). Because unforeseeable circumstances may shift the Institute's priorities, the plan is necessarily a dynamic document that will require reexamination over time.
NIAID's stewardship of this mission is driven by two convictions: strong commitment to basic research and the understanding that the fields of immunology, microbiology, and infectious disease are related and complementary. Although the plan framework centers on four cornerstones - immune-mediated diseases (and immune tolerance), AIDS, emerging infectious diseases, and vaccines - considerable synergy exists within that framework.
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NIAID planning and priority setting occurs in a larger programmatic and resource allocation context. This context includes areas of emphasis determined by Congress, the Department, and NIH; a highly refined peer review process; the annual congressional appropriation; and other factors. Within that setting, NIAID supports both extramural and intramural research.
NIAID supports extramural studies initiated by individual investigators as well as those solicited by the Institute to address specific scientific opportunities, fill scientific gaps, and respond to insufficiently met public health needs. To ensure scientific quality and public health merit, all extramural research applications undergo an extensive, two-tiered review process. At the first tier, scientific review groups evaluate applications. At the second tier, the National Advisory Allergy and Infectious Disease (NAAID) Council gives the final approval to fund the applications. The quality and merit of intramural research is assured through the laboratory review process. Support of intramural laboratory projects is based on budget resources, the outcome of review by the Board of Scientific Counselors, the relevance of the work to NIH and NIAID areas of emphasis, and other considerations, such as congressional mandates.
on the NAAID Council.
Also, the NIAID Executive Secretariat in the Office of Policy Analysis and its Office of Communications and Public Liaison establish and maintain strong links between the Institute and the public. These units respond to public inquiries, communicate NIAID news to the public, and funnel public concerns to appropriate NIAID divisions. Moreover, lay organizations actively participate in NIAID planning meetings. For example:
Strategic plan development began in January 1999 with division staff outlining recommendations from the range of planning and consultative events NIAID has participated in and sponsored during recent years.
The Institute developed a strategic planning framework organized around four cornerstones, or broad areas, that encompass the NIAID research portfolio, including immune-mediated diseases, AIDS, emerging infectious diseases, and vaccines. In July 1999, the Institute convened a Strategic Planning Task Force composed of scientist and non-scientist members and comprising a panel for each cornerstone (see Appendix A). The panels deliberated the priority areas and suggested revisions to the draft plan. The next iteration of the plan was discussed during the September 1999 NAAID Council meeting. Following further revisions, the document was posted on the World Wide Web for public comment during November 1999. The subsequent draft, which reflected those comments, was submitted to the Director, NIH, and was discussed at the NAAID Council meeting in February 2000. (See Appendix B for NAAID Council membership.) Most recently, the plan was updated to reflect development of a separate NIAID strategic plan addressing health disparities.
Years of investment in basic research have generated remarkable opportunities to understand immune-mediated and infectious diseases. As biomedical research moves into the post-genomic era, DNA technologies are profoundly altering the health research landscape, including the study of immunology and infectious diseases. Those technologies and others are revolutionizing approaches to understanding pathogenesis, microbial physiology, and epidemiology of infectious diseases; radically advancing the understanding of immune activation and regulation; uncovering the genetic bases of disease susceptibility; and accelerating the development of new diagnostic, treatment, and intervention strategies.
Recent advances in computer modeling, x-ray crystallography, combinatorial chemistry, and robotics are being harnessed for rational drug design and high-throughput drug screening. These advances will provide faster and cheaper drug discovery, more precise and effective pharmaceuticals, and new drugs for diseases that have eluded previous treatment solutions.
Basic research has opened remarkable opportunities in other areas of immunology and infectious disease research. One of the most exciting, selectively blocking the immune response, might be used to treat many im-mune-mediated diseases. In addition, this approach may help achieve long-term, durable graft survival after transplantation.
Immunologic diseases, such as asthma and allergy, autoimmune diseases, and primary immunodeficiencies, afflict millions of Americans and result in considerable illness, death, and medical costs. In addition, graft rejection and the critical shortage of donated organs are the two major barriers to success in transplantation.
In addition to carrying the burden of the primary illness, people with immunologic diseases, and those taking immunosuppressive drugs to enhance graft acceptance, are at high risk for infections because of their compro-mised immune systems.
In the past decade, discoveries made by NIAID-supported scientists about mechanisms that activate and regulate the immune response have yielded a new approach to preventing transplant rejection. Rather than suppressing the entire immune system, a targeted strategy has been designed to induce tolerance (the lack of an immune response) by turning off the specific immune cells that attack the transplant. Although more research is needed to develop therapies, NIAID-supported research on immune tolerance is contributing to the eventual development of ways to improve transplant success and of new treatments for a wide range of immunologic disorders.
Infectious diseases are the second largest cause of death worldwide. The economic impact of infectious diseases is also great, with an estimated annual cost in excess of $120 billion.
HIV/AIDS is a truly global health threat affecting all nations and all population subgroups. Now, for the first time, there is a potent and inexpensive means of reducing the incidence of HIV/AIDS infection in one of the most vulnerable populations of all – newborn babies of HIV-infected mothers. In a collaborative effort involving research scientists at the Johns Hopkins University in Baltimore, the University of Washington in Seattle, and the Makerere University in Kampala, Uganda, investigators supported by NIAID’s HIV Prevention Trials Network (HIVNET) have achieved a stunning breakthrough – a practical means of significantly reducing the rate of maternal-to-infant HIV transmission. A single does of nevirapine, to mother and child, reduced the rate of maternal-infant transmission by half when compared to a similar short course of zidovudine (AZT). In developing countries, this approach may prevent 300,000 to 400,000 newborns from suffering the effects of HIV infection. The nevirapine regimen also has the potential to provide last-minute HIV prevention for the babies of pregnant women who do not know their HIV status until they are admitted to a health care facility for delivery. Nevirapine has significant implications for HIV-infected mothers in the United States as well, especially in minority populations that have been particularly stricken by the AIDS epidemic and that have limited access to prenatal care or to health care in general.
Institute-supported basic research was pivotal to the discovery and definition of the importance of the HIV protease enzyme, which is used by the virus to produce infectious HIV particles. Institute-supported scientists also helped determine the precise, three-dimensional structure of HIV protease, a crucial step in designing drugs that block the action of the enzyme. In addition, NIAID-supported researchers helped drug-screening efforts by developing simple, rapid tests to measure the inhibition of protease activity. These NIAID accomplishments set the stage for the institute’s successful collaboration with the pharmaceutical industry in developing the new class of anti-HIV drugs known as protease inhibitors.
As recently as 20 years ago, children worldwide frequently died of bacterial meningitis and 1 in 200 children in the United States contracted Haemophilus influenzae type B (Hib), the primary cause of bacterial meningitis. A quarter of those who survived had brain damage or hearing loss. Today, thanks to the Hib vaccine developed by NIAID-supported researchers, Hib is a rarity. Introduced in 1985, the Hib vaccine boosts immunity in infants (who have a poorly developed immune system) by linking the bacterium’s polysaccharide coat to a protein (thus creating a conjugate vaccine). The spinoffs of this breakthrough still reverberate. The conjugate vaccine technology developed for Hib, now a proven approach to the development of vaccines for the very young, is being applied to other diseases as well.
The outstanding contributions of NIAID-supported investigators extend from basic discoveries in microbiology and immunology to the development of vaccines, drugs, and diagnostic tools.
The NIAID investment in research on the processes of immune activation and regulation, and on the genetic basis of disease susceptibility, has elevated our conceptual understanding of the human immune system.
Some key discoveries in basic immunology research include discovering mechanisms of antibody diversity; defining humoral and cell-mediated immunity; discovering immune response genes and the genetic bases for many immune-mediated diseases; and developing ways to prevent and treat these diseases.
Research on allergies and asthma defined the role of inflammation and viral infections in asthma and delineated the molecular mechanisms of the allergic response, including the role of IgE antibodies, the characterization of the IgE receptor, and the discovery of leukotrienes.
In the United States and other parts of the industrialized world, the number of new AIDS cases and AIDS-related deaths has dropped dramatically. This has largely been the result of powerful new antiviral drug treatments that have prolonged and improved the quality of life for many HIV-infected people. NIAID-supported basic research identified the HIV protease enzyme as a target for antiviral drugs, which led to the development of very potent protease inhibitors. Later clinical studies demonstrated the effectiveness of triple-drug treatments (combinations of protease inhibitors and reverse transcriptase inhibitors), often called "highly active antiretroviral therapy," or HAART, over one- or two-drug treatments. NIAID research also led to better ways to prevent perinatal transmission of HIV, first by treating infected pregnant women and their infants with AZT, and more recently, by a single dose each to mother and child of the highy cost-effective drug nevirapine.
NIAID research strives to understand microbes, how they cause disease, and how they develop drug resistance, and to apply that knowledge to develop new diagnostic tools and interventions. Toward that goal, NIAID research has identified infectious agents for several human diseases, including Lyme disease, bronchopneumonia, hemorrhagic fevers, and diarrheal illness. The sequenced genomes of Treponema pallidum (syphilis), Escherichia coli strain K 12, Chlamydia trachomatis, Plasmodium falciparum chromosome 2 (malaria), and Mycobacterium tuberculosis will lead to more specific targets for diagnosis and antibiotic and vaccine development. Finally, NIAID-supported clinical trials have led to new therapies for influenza, Lyme disease, hantavirus pulmonary syndrome, and fungal infections.
Development of new vaccines provides safe, cost-effective, and efficient means of preventing disease, illness, disability, and death from infectious diseases. Just four of the many vaccines developed recently by NIAID and its collaborators (hepatitis B, Haemophilus influenzae type b conjugate, pneumococcus, and acellular pertussis) have the potential to save millions of lives annually. Other vaccines developed with substantial support from NIAID include hepatitis A, adenovirus, typhoid, meningococcus, and influenza.
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Last Updated December 19, 2011