Exploratory Analysis Associates HIV Drug Abacavir with Elevated Cardiovascular Disease Risk in Large Global Trial

Current or previous use of the antiretroviral drug (ARV) abacavir was associated with an elevated risk of major adverse cardiovascular events (MACE) in people with HIV, according to an exploratory analysis from a large international clinical trial primarily funded by the National Institutes of Health (NIH). There was no elevated MACE risk for the other antiretroviral drugs included in the analysis. The findings will be presented at the 2024 International AIDS Conference (AIDS 2024) in Munich, Germany.

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NIAID's Approach to Women's Health Research

Why Is Women's Health a Priority for NIAID?

The National Institute of Allergy and Infectious Diseases (NIAID) mission is to conduct and support basic and translational research to understand, diagnose, prevent and treat infectious and immune-mediated diseases, including diseases that impact the health of women and girls. NIAID takes measures to ensure the involvement of women in clinical trials on various infectious and auto-immune diseases.

Scientific Advances in Women's Health Research

NIH Statement on Preliminary Efficacy Results of Twice-Yearly Lenacapavir for HIV Prevention in Cisgender Women

The injectable antiretroviral drug lenacapavir was safe and 100% effective as long-acting HIV pre-exposure prophylaxis (PrEP) among cisgender women in a Phase 3 clinical trial, according to top-line findings released by Gilead Sciences, Inc., the study sponsor. Lenacapavir is administered every six months, making it the most durable HIV prevention method to have shown efficacy in this population.

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Stepping into Science

NIAID Now |

‘Stepping into Science’ Highlights Variety of Scientific Careers

NIAID’s RML Campus Hosts Day-Long High School Program

Introducing local students to biomedical science and research has long been a feature of outreach programs at NIAID’s Rocky Mountain Laboratories in Hamilton, Montana.  However, realizing that traditional laboratory science – aka “bench research” – isn’t for everyone, RML staff recently invited two dozen area high school students to experience not only traditional research but also the lesser-known careers that make bench research possible.

Where bench science can be slow and methodical – scientists may spend their entire career investigating the same problem – jobs that support bench research often vary greatly from project to project. Both types of careers are rewarding and exciting – but appeal to different types of people.

“Stepping into Science,” held this spring at the RML campus, was the idea of Kamryn Cregger, who began postbaccalaureate research work at RML in August 2023. Cregger says she quickly realized that RML had amazing resources to benefit area students, and she hoped to provide them with a similar type of opportunity that she experienced as a high schooler in rural Maryland. Cregger enrolled in a biomedical leadership program that led to a pharmaceutical internship, two years of lab training, and ultimately a bachelor’s degree in plant sciences from the University of Tennessee.

Now working on tickborne disease projects at RML – and helping local middle-school students through RML’s Biomedical Research After School Scholars program – Cregger wanted to find a way to connect with college-bound high schoolers.

“With all of the scientists and staff members on site, why not show the local students what kinds of jobs there are in science in addition to bench work?” she thought. Making those types of connections also could establish the RML group as long-term mentors for students applying for college, internships, or career positions.

After a few months of planning meetings, coordinating with RML volunteers, and finding out what most appealed to students and faculty from Hamilton and Corvallis high schools – the groups arrived for the whirlwind day of activities at RML.

“Throughout the day,” Cregger said, “students asked questions about careers, RML research, medical school application processes, the differences in academic versus government research and even vaccine development!” Students received a campus tour, overview of the types of research done in the different laboratory groups and rotated through three hands-on demonstrations by virologists, animal care staff and  microscopists.

A team of RML virologists worked together to demonstrate biosafety knowledge, proper laboratory skills, such as pipetting, working in a biosafety cabinet, and dressing in personal protective equipment (PPE). They even designed a way for students to participate in a fun research-based game.

The three microscopists – Forrest Hoyt, Sophia Antonioli-Schmit and Bryan Hansen – all discussed their remarkable journeys from local high schools to RML.

In the animal care segment, “We taught them about animal husbandry, histology technicians, biologists and veterinarians,” veterinary pathologist Carl Shaia said. “Someone in each of those positions described their duties, education and how they came to RML. We also briefly touched on pay, the importance of benefits and the impact of student debt for higher education.”

RML biologist Tara Wehrly’s daughter participated in the events. Wehrly said she appreciated how the activities gave her daughter a greater understanding of the work she does.

“My daughter knows I work here, and I talk about scientific matters, but until she was on campus, it was more of an abstract concept,” Wehrly said. “I feel that Kamryn (Cregger) found the right people to give enthusiastic, informative presentations communicating the fun parts of their jobs to this group of teenagers. The discussions the kids had with post-bacs and post-docs gave them information about potential career paths that they might not have considered prior to this.”

Cregger and other event organizers already are discussing where to take the idea next, starting off with hopes of continuing the program for years to come. RML would like to inspire generations of science-loving people “and is honored to help guide the students down whatever path they choose,” according to Cregger. 

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Apply to Develop Global Infectious Disease Research Training Programs

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A significant obstacle to advancing evidence-based treatment and control of infectious diseases in low- and middle-income countries (LMICs) is the lack of capability to conduct research tailored to local needs. As a result, NIAID, in partnership with the Fogarty International Center (FIC), has put out a notice of funding opportunity (NOFO) Global Infectious Disease Research Training Program (D43, Clinical Trial Optional), calling for applications for collaborative training programs that will strengthen the capacity of LMIC institutions to carry out infectious disease research (not including HIV/AIDS). 

The primary aim of this initiative is to cultivate scientific knowledge and skills among trainees from LMICs, thereby strengthening the research capacity of institutions in these countries to investigate methods for preventing, treating, and controlling infectious diseases that pose significant health risks. This announcement encourages joint applications from LMICs and U.S. research institutions.  

Research Objectives and Scope 

The objectives of the Global Infectious Disease Research Training program are as follows: 

  • To develop research training opportunities and professional development activities for a collaborative group of LMIC scientists and health research professionals at an LMIC institution to strengthen its capacity to conduct independent, sustainable infectious disease research. 
  • To provide mentored infectious disease research experience that is directly relevant to the health priorities of the LMIC of the trainees. 
  • To strengthen the capabilities of trainees at the proposed LMIC institution to lead, manage, and train others in infectious disease research. 

This NOFO can support research training related to infectious disease prevention, care, and treatment in a broad range of technical areas including: 

  • Basic, epidemiologic, clinical, behavioral, and social science research 
  • Bioengineering 
  • Bioinformatics, biostatistics, disease modeling 
  • Genetics/genomics 
  • Vector biology 
  • Pathophysiology, diagnostics, and therapeutics research 
  • Implementation, health economics, health services and systems research  
  • Clinical trials 

Applicants are also encouraged to design multidisciplinary research training programs with a focus on a global infectious disease cross-cutting theme.  

Note, however, that this program does not support HIV/AIDS research training. Applicants interested in HIV research training should apply to the FIC HIV Research Training Program Funding Opportunities

Award and Deadline Information  

Application budgets are limited to $230,000 per year for new awards and $276,000 per year for renewal awards (total direct costs). The maximum project period allowed is 5 years.  

Awards may provide stipends as a subsistence allowance to help defray living expenses during research training. They may also support the cost of tuition and fees at the rate already in place at U.S. or foreign institutions. Trainees may be paid a stipend comparable to their professional experience and U.S. or foreign institutional requirements. Refer to the NOFO for additional information on trainee travel and training related expenses.  

Non-domestic (non-U.S.) entities (foreign organizations) are eligible to apply, but non-domestic components of U.S. organizations are not eligible to apply.

Note, though, that only individuals who are citizens of LMICs (defined by the World Bank classification system) are eligible for research training support or other training activities. Individuals who have dual citizenship or permanent residency in the United States, other high-income countries, or ineligible countries as described in the NOFO are not eligible for training support. 

Be aware that the NOFO lists out specific instructions for how you should complete the budget section of your application. It also describes required International Training Data Tables.  

Note that clinical trials are optional, however, for applications proposing training in clinical trials, the recruitment and selection plans should include specific strategies to identify trainees who have the potential to organize, manage, and implement clinical trials. 

For applications proposing training in clinical trials research, remember to include plans for training in data management and statistics relevant to clinical trials, good clinical practice (GCP), and good laboratory practice (GLP). Also provide documentation of the administrative, data coordinating, enrollment, and laboratory or testing centers, appropriate for the clinical trial at the training sites. 

Contacts 

For questions related to your application, contact Dr. Barbara Sina at the Fogarty International Center at sinab@mail.nih.gov or 301-402-9467, or Dr. Stephanie Coomes at stephanie.coomes@nih.gov or 301-761-6855.

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NIAID Raises Awareness to Malaria-like Diseases in W. Africa

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NIAID Raises Awareness to Malaria-like Diseases in W. Africa

Dengue, Zika, Chikungunya Viruses in Mali; Disease Likely Misdiagnosed

NIAID scientists and colleagues have identified dengue, Zika and chikungunya viruses in the West African country of Mali, where health care providers likely misdiagnose patients with illness from those viruses due to unavailable diagnostic tools. Because malaria is the most common fever-causing illness in rural sub-Saharan Africa, most medical workers presume patients with a fever have malaria. The primary cause of all four infectious diseases is a mosquito bite.

Records from the Malian Health Information System show that about one-third of all patient visits to health care facilities are related to malaria, with 2.37 million clinical cases.

A new study from NIAID’s Rocky Mountain Laboratories and the University of Sciences, Techniques and Technologies in Mali aims to help spread information to medical workers about the existence of the additional viral diseases. Ideally, circulating the information will help them obtain the necessary diagnostics.

The study, published in The American Journal of Tropical Medicine and Hygiene, involved 600 residents, 200 from each of the southern Malian communities of Soromba, Bamba and Banzana. The scientists detected antibodies to dengue virus in the blood of 77.2% of the residents tested; to Zika virus in 31.2%, and to chikungunya virus in 25.8%. They detected at least one of the three viruses in 84.9% of participants, meaning just 15.1% tested negative to any of the three viruses.

Evidence of the parasites that cause malaria was found in 44.5% of those tested. Unlike malaria, however, where most cases are found in children under age 14, residents over age 50 were most likely to have been exposed to dengue, Zika or chikungunya viruses. 

“Despite the high exposure risk to dengue virus in southern Mali, dengue fever cases have rarely been reported,” the researchers write. “This is likely due to the lack of diagnostic testing and the biased clinical focus on malaria in the region. Awareness of dengue virus as a cause of febrile illness needs to be urgently established in medical communities as an important public health measure.”

The scientists are hoping data from a more in-depth clinical study that just ended will provide additional details about the prevalence of these viruses in Mali. They also are planning to examine patients who have undiagnosed fevers to establish infection rates.

NIAID scientists are investigating dengue, Zika and chikungunya viruses to try and develop preventive and therapeutic treatment options, none of which exist.

Reference: S Bane, et alSeroprevalence of Arboviruses in a Malaria Hyperendemic Area in Southern MaliThe American Journal of Tropical Medicine and Hygiene DOI: 10.4269/ajtmh.23-0803 (2024).

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Advance HIV Service Delivery Through Pharmacies and Pharmacists

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NIAID is among several NIH institutes and centers (ICs) participating in a pair of notices of funding opportunities (NOFOs)—Advancing HIV Service Delivery Through Pharmacies and Pharmacists (R01, Clinical Trial Optional) and Advancing HIV Service Delivery Through Pharmacies and Pharmacists (R21, Clinical Trial Optional)—designed to seek research to capacitate, transform, and scale the delivery of HIV testing, prevention, and care services through pharmacists and pharmacies in U.S. or global settings. This includes the advancement of training curricula to enable pharmacy students, pharmacists, pharmacies, and pharmacy systems to deliver the spectrum of needed HIV services with ease, equity, and effectiveness. 

Although pharmacies and pharmacists offer many advantages for HIV service delivery and have made significant contributions to HIV prevention and care, key challenges in pharmacy-based HIV service delivery have hindered these efforts. These NOFOs call for research that will help to address these challenges, scale pilot programs, and create innovative models of HIV service delivery through pharmacies and pharmacists.  

Areas of Research Interest 

The NOFOs provide a long list of example topics of interest, including: 

  • Research that advances pharmacy-based health screenings for HIV alongside screenings for multiple chronic illnesses and common comorbid conditions. 
  • Studies designed to create and scale models of pharmacy-based HIV pre-exposure prophylaxis (PrEP) delivery and adherence support. 
  • Research to improve access and use of HIV post-exposure prophylaxis (PEP) through pharmacies. 
  • Studies to expand the delivery and use of long-acting injectable PrEP or antiretroviral therapy (ART) regimens though pharmacists and pharmacies.

Refer to the NOFOs linked above for a longer list of possible topics. 

Key Considerations 

For these NOFOs, applicants must propose a research team that includes one or more pharmacists.

Additionally, consider the following directions when planning your project: 

  • Partner with chain, independent, or specialty pharmacies on their work, or pharmacies in diverse settings such as hospitals, correctional health, or tribal health settings. 
  • Provide letters of support from research partners that demonstrate commitment to provide pharmacists protected time for any expanded practice activities and for participation in the research activities (e.g., meetings, research documentation). 
  • Discuss potential reimbursement models for any pharmacist- or pharmacy-based services that they will advance. 
  • Describe plans for developing collaborative practice agreements that cover the scope of care described in the grant application. 
  • Describe an approach that meaningfully incorporates input from relevant community members with a diversity of perspectives, knowledge, and lived experiences. Community members may include people with HIV, people placed at risk for HIV, and representatives of pharmacy groups, public health agencies, healthcare organizations, social service agencies, faith-based communities, or other stakeholders. 
  • Employ and document implementation science frameworks, approaches, and research designs or methodologies in the proposed research. 
  • Identify policy, regulation, or other potential challenges and barriers that may exist to implementing or scaling study results. Projects proposing innovative implementation strategies designed to address these barriers, or that take advantage of new or pending regulatory or policy changes are welcome.  
  • Consider examining the resource needs or cost effectiveness of the care model being tested. 
  • Budget funds for travel to one meeting of awardees at NIH’s campus in Bethesda, Maryland. Principal investigators are expected to attend the meeting and may also budget for other key personnel to attend. 

Conversely, you must not include in your application any investigational new drug or device trials which must be registered with FDA.

NIAID’s Priority Research Areas  

NIAID is most interested in research on the implementation of evidence-based HIV interventions, including integrated health services, tailored to communities disproportionately impacted by HIV in the United States. Applicants should identify partnerships with relevant policy or program leaders with a stated commitment to evaluate and incorporate changes proven to be both successful and cost-effective. 

Below is a list of additional research areas of interest to NIAID: 

  • Research on forming or sustaining collaborative efforts between public health departments and pharmacies to achieve public health goals for HIV testing, prevention, and treatment. 
  • Studies that test integrated approaches to deliver screening, prevention, treatment, and care services for HIV and common co-infections, including interventions to address sexually transmitted (e.g., doxyPEP) and opportunistic infections. 
  • Research on pharmacy-based testing, prevention, and treatment strategies directed towards communities experiencing HIV clusters and outbreaks. 
  • Studies designed to assess or prepare for the implementation of FDA-approved ‘next generation’ HIV interventions, such as long-acting injectable ART. 
  • Research that leverages information and communication technologies in the pharmacy, including digital technology, telehealth, electronic health records, and data exchange, to facilitate response to HIV outbreaks, or engagement and retention in HIV prevention, treatment, or care services. 
  • Studies on pharmacy-centered service delivery models tailored to adolescents. 

NIAID will not support clinical trials using experimental drugs or diagnostic tools, or using existing drugs or diagnostics for new purposes in response to these NOFOs.   

Pre-Application Webinar 

The National Institute of Mental Health (NIMH) will host a pre-application webinar for potential applicants to this initiative. The seminar will take place on June 21, 2024, from 10 a.m. to 11:30 a.m. Eastern Time. Find registration details in the May 20, 2024 Guide notice, as well as instructions to submit questions before the webinar.  

Submission Information 

In choosing between the two NOFOs, remember that the R21 grant mechanism is meant for shorter, exploratory projects without much preliminary data, while the R01 can support larger research projects that are well-supported by preliminary data.  

Budget requests for the entire project period under the R21 NOFO may not exceed $275,000 in direct costs, with no more than $200,000 requested in any single year. The scope of the proposed project should determine the project period, though it cannot exceed 2 years. 

For the R01 NOFO, application budgets are not limited but need to reflect the actual needs of the proposed project. The scope of the proposed project should determine the project period, though the maximum project period is 5 years. 

NIMH and its partnering ICs plan to fund 8 to 12 awards across the two NOFOs in fiscal year 2025. 

Applications are due on August 13, 2024, by 5:00 p.m. local time of the applicant organization.  

Contact Information 

Direct inquiries to NIAID’s scientific/research contact Tia Morton at frazierti@mail.nih.gov or 301-222-7795.

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NIAID Research Team Develops 2nd Model of Crimean-Congo Fever

NIAID Now |

A NIAID research team has developed an additional nonhuman primate study model for Crimean-Congo hemorrhagic fever (CCHF), providing an alternative for development of critically needed vaccines and therapeutics. They hope the effort, described in a new study published in npj Vaccines, will lead to a widely available replicating RNA-based vaccine that they are testing against CCHF. In some outbreaks CCHF has had a case fatality rate up to 40%.

Cynomolgus macaques (CM), which typically develop mild to moderate CCHF disease, are the preferred model available to study how the virus causes infection and disease in people. During the COVID-19 pandemic, however, CMs were prioritized for other research, and scientists at NIAID’s Rocky Mountain Laboratories (RML) sought to develop an alternative model using rhesus macaques (RM) to continue promising pre-clinical work on a CCHF vaccine.

CCHF virus primarily is spread by Hyalomma ticks throughout Africa, the Middle East, Asia and parts of Europe. The disease, first described in 1944, infects up to 15,000 people annually, according to the World Health Organization. About 1 in 8 of those who are infected develop severe disease, which leads to about 500 deaths each year. A vaccine developed in 1974 in Bulgaria is available in some places but has not been approved by the U.S. Food and Drug Administration or the European Medicines Agency. The World Health Organization lists CCHF virus as a priority pathogen for development of vaccines.

The RML group in Hamilton, Montana, has worked with University of Washington and HDT Bio collaborators in Seattle for about 6 years on developing and evaluating the replicating RNA vaccine platform for SARS-CoV-2 and CCHFV. A collaboration between NIAID, HDT Bio and the University of Texas Medical Branch was recently awarded more than $80 million dollars in funding by the Department of Defense to advance the replicating RNA vaccine for CCHFV and Nipah virus into human clinical trials.

The researchers decided to try and adapt their CM study model to infect RMs. CMs and RMs are the two most commonly used research animals among the 22 different macaque species. RMs infected with CCHFV developed mild-to-moderate disease, similar to the CM model and consistent with mild-to-moderate disease in humans. 

The scientists then used a prime-boost schedule to show that the experimental vaccine provided six infected RMs with a protective immune response that controlled CCHF virus. The results are consistent with their findings using CMs and support continued advancement of this vaccine into human trials.

Future work with the vaccine is planned to try and pinpoint how it triggers immune responses in the animals and provides protection from CCHF virus infection. They also plan to explore which animal models will most accurately predict how the vaccine might act in people.

References:

D Hawman, et al. A replicating RNA vaccine confers protection in a rhesus macaque model of Crimean-Congo hemorrhagic fever. npj Vaccines DOI: 10.1038/s41541-024-00887-z (2024).

S Leventhal, et alReplicating RNA vaccination elicits an unexpected immune response that efficiently protects mice against lethal Crimean-Congo hemorrhagic fever virus challenge. eBio Medicine DOI: https://doi.org/10.1016/j.ebiom.2022.104188 (2022).

E Haddock, et al. A cynomolgus macaque model for Crimean–Congo haemorrhagic fever. Nature Microbiology DOI: 10.1038/s41564-018-0141-7 (2018).

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NIAID Targets Transport System as Lyme Disease Treatment

NIAID Now |

NIAID scientists and colleagues are investigating a potential treatment strategy against Lyme disease that would directly suppress Borrelia burgdorferi, the bacterium that causes the disease. If successful, their idea could reduce or end aggressive broad-spectrum antibiotic treatments that can be drawn-out and destroy the body’s helpful bacteria. The study appears in Frontiers in Antibiotics from scientists at NIAID’s Rocky Mountain Laboratories and colleagues at Purdue University.

The strategy involves the oligopeptide (Opp) transport system that most bacteria use as a secondary nutrition route to move small protein-like peptides through the bacteria. But B. burgdorferi, the researchers learned in a 2017 study, depends on the Opp system for survival, growth, and replication. They subsequently hypothesized that if they could impede the Opp system, maybe the bacterium would stop growing and die.

To test their theory they developed a method to screen 2,240 chemical compounds from a commercial library used for small-molecule drug discovery. They wanted to know if any compounds would bind to a prominent transport system protein known as OppA2. The research team identified eight compounds that did so, and of those, two compounds – C2 and C7 – significantly slowed B. burgdorferi growth, making the Opp system a viable, previously unexplored treatment target.

Next the scientists plan to screen more compounds, hoping to optimize binding to different OppA proteins (there are five to investigate) while still hindering B. burgdorferi growth.

“By targeting a system that appears to be only essential to Borrelia, it is possible that we could vastly improve current treatments by replacing them with a highly specific treatment that could reduce post-treatment complications,” study senior author Ashley Groshong, Ph.D., said.

Reference:

K Holly and A Kataria, et al. Unguarded Liabilities: Borrelia burgdorferi’s complex amino acid dependence exposes unique avenues of inhibition. Frontiers in Antibiotics DOI: 10.3389/frabi.2024.1395425 (2024).

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