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Interviewer: We're at the Utah Cardiac Recovery Symposium with Dr. Gary Gibbons, Director of the National Heart, Lung, and Blood Institute, and Dr. Stavros Drakos, a cardiologist and a professor in internal medicine at University of Utah Health. Dr. Gibbons, in your keynote address you talked about the strategic direction of NHLBI and your talk title is "Advancing Discovery Science for Public Health Impact." What does that mean?

Dr. Gibbons: Well, that relates in part to our mission. Our mission is to turn discovery science into the health of the nation. And to do so, we do that in partnership and collaboration with researchers from all over the country and around the world. And an element of that is to have a strategic plan or strategic vision that helps organize and prioritize those research investments we're going to make. And that's a process that has been very inclusive. It's included over 4,500 individuals around the country and around the world that have given us ideas, the most compelling questions and critical challenges we could take on in the next 5 to 10 years that will help us fulfill that mission to turn discovery into the health of the nation.

Dr. Drakos: What is your major goals or major goal with this vision?

Dr. Gibbons: So the strategic vision, we've designed it to really capture four basic goals. Goal one is around understanding how normal human bodily systems function to maintain health and wellness. It's important to understand how these incredible body systems are able to sustain us in wellness. And that we think that's important in understanding any transition to ill health.

And the second goal relates to understanding the pathobiology of disease, the pathways mediators and mechanisms by which people develop, for example, heart disease and therefore getting insights into how we might intervene and change the natural history, maybe even preempt chronic diseases. And so goal three relates to accelerating the translation of discovery science, say, at the bench, the laboratory and making sure that they have an impact eventually on patient care, patient care even in the real world. And so that translational research is important part of our portfolio. And finally, the fourth goal relates to the biomedical workforce overall, the training and enabling resource mission that we have as stewards to ensure that we're creating a diverse next generation of scientific leaders who will drive the breakthroughs of tomorrow.

Interviewer: So what are some of the research areas you think could make the biggest impact?

Dr. Gibbons: Well, a key part of the NHLBI portfolio is the fact that we have within it the major killers of men and women in this country, particularly heart disease and as well as chronic lung disease which is a major cause of death and morbidity in this country. Asthma is a major cause of morbidity among children. So, within our portfolio, we have a number of disorders that affect literally millions of Americans and has an impact on their death and life course. And so discovery sciences that can improve their health can have a dramatic effect on outcomes for our country.

Dr. Drakos: Can you please give us examples of specific translation on research programs that are taking new and exciting approaches to breach this gap between discovery science and public health?

Dr. Gibbons: I think one of the things that's particularly exciting is an appreciation for some of the pathways that are governing the transition between health and disease. I'm excited to be here at the Utah meeting here. We're talking about cardiac recovery, and it highlights what we are learning about heart failure. Very common condition, one of the most common causes of hospitalization. One of the drivers of healthcare expenses, and the more we can understand about what maintains a normal heart and what happens when it declines in function. And more importantly, how we can develop new therapeutic strategies to help it remain more resilient to not just stimuli and injury as well as recover its function is critically important.

We're excited about some of the presentations that have been made here that highlight, for me, one of the paradigmatic examples of a heart recovery that relates to a peripartum cardiomyopathy. That's a situation clinically that many physicians are familiar with in which an otherwise vibrant and healthy woman of reproductive age develops heart failure for unclear reasons as the result of pregnancy. And what's particular remarkable is that we can get her through the pregnancy. Often after giving birth to the child, much of that heart function recovers. And that's an extraordinary clinical observation, but we often didn't really understand what was going on and why.

And the recent research that the institute has funded indicate that a number of these individuals have variants in their genetic code that predisposes them to developing heart failure and cardiomyopathy. And by recognizing that, that gives us an opportunity to diagnose those individuals much earlier in the course and perhaps do interventions that might change the natural history of the disease. And so we're very excited about that.

Indeed, we're doing studies in our top at our Precision Medicine Program where we've now achieved almost 150,000 whole genome sequences of individuals who were carefully characterized in our cohort studies, and we think this is the beginning of being able to identify a lot of the predisposing factors to heart disease and, more importantly, the pathways that promote disease so we can have a whole new generation of novel therapeutic strategies to preempt chronic disease or perhaps, again, facilitate that recovery. So that's the exciting thing.

Interviewer: Yeah. That's fascinating. I mean, you know, it's interesting to think about these differences between individuals. But we know that there's differences regionally as well. And so for example, here in Utah, we actually have pretty good heart health compared to other parts of the country. Is NHLBI thinking of ways to address those variations too?

Dr. Gibbons: Yeah. No. It's a great point that you make. And, you know, part of it is understanding what is it about Utah that keeps you so healthy up here. And I must admit in this day that the clean, dry air and the mountains to walk and stay healthy, I'm sure are a part of that. But we also recognize there are communities in this country where that exposure to a healthy lifestyle is not there. And we can appreciate with congested areas and air pollution that these are things that have a deleterious effect on cardiovascular health. And so understanding these geographic variances and disparities can give us insight into what are the drivers that, again, maintain health and wellness relative to those that might predispose disease.

And hopefully some of those things can be modified and so certainly we're appreciating that the adaption of a healthy diet, indeed access to healthy diet, fresh fruits and vegetables for example, can play an important role in your cardiovascular health and prognosis. And so understanding those variations can help us appreciate it for a complex disorder like heart disease. It's not only your genetic predisposition, but it's your environmental factors and behavioral habits all working together that can, again, promote wellness and prevent disease. And some of those things are the things that are most . . . have the greatest impact in preventing and preempting disease and so things that we need to do more effectively.

Interviewer: Yeah. I mean that's interesting. When I think of the National Institutes of Health and the different institutes within it, I think of them as being drivers of science research, clinical trials. But are you saying that you'll be involve in kind of these more social aspects as well?

Dr. Gibbons: We think it's still within our mission that there's a whole spectrum of taking a discovery and making sure that it's not only something that's seen in a dish or in a mouse, but also translates to humans and communities and appreciating that some of the best interventions may not always be at the level of a cell or individual, but actually may be a community. And so it may be a research question to ask what would be the impact of creating more walkways in certain communities or bringing supermarkets that have fresh fruit and vegetables. Can we change the trajectory of health of individuals in that community just as easily as we might by giving them more pills that might influence their health? Both are probably important.

Dr. Drakos: So how do you hope, Dr. Gibbons, that NHLBI's vision will change our public health landscape during the next five years and beyond?

Dr. Gibbons: Well, I'm actually very excited about that landscape. We think that we have the tools in hand to make a big difference in which the . . . as I mentioned before, we have initiated the Top Med Program at Precision Medicine, where we think we can take some of those unknowns, like the woman who has peripartum cardiomyopathy, and start to be able to diagnose what's really going on with new diagnostic capabilities that are emerging. We also think that that may help us target treatment so that we're not taking a guess as to whether someone's going to respond to a therapy or not. But we have increased the probability that we're giving the right drug to the right person at the right time that can actually prevent or preempt their disease. And I think we have an armamentarium now that's going to give us that capability better than ever and we think that's very exciting and in hand.

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