Institutes and Research Divisions
National Heart, Lung, and Blood Institute


The National Heart, Lung, and Blood Institute (NHLBI):


Important Events in NHLBI History

June 16, 1948--President Harry S Truman signed the National Heart Act, creating and establishing the National Heart Institute in PHS and the National Advisory Heart Council.

July 7, 1948--The services of Dr. Paul Dudley White were secured under section 4b of the Heart Act "to be Executive Director of the National Advisory Heart Council and Chief Medical Advisor to the National Heart Institute."

August 1, 1948--Surgeon General Leonard A. Scheele, by General Circular No. 36, Organization Order No. 14, established NHI as one of the National Institutes of Health to administer functions of heart research, training, and administration set forth in the National Heart Act. Intramural research projects in cardiovascular diseases and gerontology conducted elsewhere in NIH were transferred to NHI. The director of NHI was designated as the focal point of leadership and coordination for the total heart program of PHS.

August 29, 1948--Surgeon General Scheele announced the names of the 16 members appointed to the first National Advisory Heart Council.

September 8, 1948--The first meeting of the National Advisory Heart Council was held.

January 1949--Cooperative research units were established at the University of California, University of Minnesota, Tulane University, and Massachusetts General Hospital, jointly financed by the institutions and NIH, pending completion of NHI's own research organization and the availability of further research facilities.

July 1, 1949--A comprehensive plan for NHI's intramural research program was instituted, organized on three general research levels, with three laboratory sections, five laboratory-clinical sections, and four clinical sections.

The Heart Disease Epidemiology Study at Framingham, Mass., was transferred from the Bureau of State Services, PHS, to NHI.

January 18-20, 1950--The first National Conference on Cardiovascular Diseases, sponsored by NHI and the American Heart Association, was held in Washington, D.C.

July 6, 1953--The first patient was admitted to the Clinical Center for heart disease research.

July 1, 1957--The first members of NHI's Board of Scientific Counselors began their terms. It was established in 1956 "to provide advice on matters of general policy, particularly from a long-range viewpoint, as they relate to the intramural research program."

February 19, 1959--A report to the Nation was presented by the American Heart Association and NHI on "A Decade of Progress Against Cardiovascular Disease," at Department of Commerce, Washington, D.C.

April 21, 1961--The President's Conference on Heart Disease and Cancer, whose participants on March 15 were requested by President John F. Kennedy to assist "in charting the Government's further role in a National attack" on these diseases, convened at the White House and submitted its report.

December 30, 1963--President Lyndon B. Johnson approved a joint resolution, unanimously passed by the Congress, to provide for designating the month of February in each year as "American Heart Month."

November 22-24, 1964--The Second National Conference on Cardiovascular Diseases was held at Washington, D.C., under cosponsorship of the American Heart Association, NHI and Heart Disease Control Program of PHS, to appraise developments since the first conference in 1950 and to determine needs and opportunities for continued and accelerated progress against heart and blood vessel diseases.

December 9, 1964--The President's Commission on Heart Disease, Cancer and Stroke, appointed by President Lyndon B. Johnson, March 7, 1964, to "recommend steps that can be taken to reduce the burden and incidence of these diseases," submitted its report.

October 16, 1968--A Nobel Prize in Physiology or Medicine was awarded to Dr. Marshall W. Nirenberg, chief of NHI's Laboratory of Biochemical Genetics, for discovering the key to deciphering the genetic code. Dr. Nirenberg was the first NIH Nobel laureate and the first Federal employee to receive a Nobel Prize.

October 26, 1968--NHI received the National Hemophilia Foundation's Research and Scientific Achievement Award for its "medical leadership ... tremendous stimulation and support of research activities directly related to the study and treatment of hemophilia."

November 14, 1968--The 20th anniversary of NHI was commemorated at the White House, with President Johnson and a notable array of prominent figures associated with NHI, past and resent, participating.

August 12, 1969--Major provisions of NHI reorganization plan established five program branches in extramural programs (arteriosclerotic disease, cardiac disease, pulmonary disease, hypertension and kidney diseases, and thrombosis and hemorrhagic diseases); a Therapeutic Evaluations Branch and an Epidemiology Branch under the associate director for clinical applications; and three offices in the Office of the Director (heart information, program planning, and administrative management).

November 10, 1969--National Heart Institute was renamed the National Heart and Lung Institute, reflecting expansion of functions.

February 18, 1971--In his Health Message to the Congress, the President identified sickle cell anemia as a high-priority disease target and called for increased Federal expenditures. Subsequently, the DHEW assistant secretary for health and scientific affairs, assigned the lead-agencies responsibilities for coordinating a National Sickle Cell Disease Program to NIH and NHLI.

March 24, 1972--President Nixon named Dr. John S. Millis to head a 20-member panel "to determine why heart disease is so prevalent and so menacing and what can be done about it."

March 27-31, 1972--First meeting of U.S.-U.S.S.R. Joint Committee for Health Cooperation was held to develop and plan an approach to the health exchange program in several specific areas, including the cardiovascular field. The NHLI director is a member of the committee.

May 23, 1972--A 5-year agreement for a Cooperative Health Program was signed by W. P. Rogers, U.S. secretary of state, and B. V. Petrovsky, U.S.S.R. minister of health. The agreement calls for cooperative studies in pathogenesis of arteriosclerosis; management of ischemic heart disease; myocardial metabolism; congenital heart disease; sudden death; and blood transfusions, blood components, and the prevention of hepatitis.

June 12, 1972--HEW Secretary Richardson approved a nationwide program of hypertension information and education. The secretary appointed the Hypertension Information and Education Advisory Committee, chaired by the director, NIH; and the Interagency Working Group, chaired by the director, NHLI, to implement the national effort. A High Blood Pressure Information Center was established within the NHLI Office of Information to collect and disseminate public and professional information about this disease.

July 1972--The NHLBI launched the National High Blood Pressure Education Program.

July 14, 1972--HEW Secretary Richardson approved a reorganization of NHLI, elevating the institute to bureau status within NIH, with seven division-level components: Office of Director, Division of Heart and Vascular Diseases, Division of Lung Diseases, Division of Blood Diseases and Resources, Division of Intramural Research, Division of Technological Applications, and Division of Extramural Affairs.

July 24, 1973--The 5-volume National Heart, Blood Vessel, Lung and Blood Program was transmitted to Congress. The comprehensive, 5-year plan of attack against heart, blood vessel, lung and blood diseases and research and management of blood resources was developed by the director, NHLI, with the advice of the National Heart and Lung Advisory Council, in accordance with a provision of the National Heart, Blood Vessel, Lung and Blood Act of 1972 (P.L. 92-423).

April 5, 1974--The HEW assistant secretary for health released the Report to the President by the President's Advisory Panel on Heart Disease. The report surveys the problem of heart and blood vessel disorders and recommends how illness and death from these disorders may be reduced.

August 2, 1974--Regulations were approved governing the establishment, support, and operation of National Research and Demonstration Centers for heart, blood vessel, lung, and blood diseases. The regulations concern the implementation of section 415(b) of the PHS act, as amended by the National Heart, Blood Vessel, Lung and Blood Act of 1972, which authorized the establishment and support of National Research and Demonstration Centers.

June 25, 1976--NHLI was redesignated the National Heart, Lung, and Blood Institute by an amendment to Public Health Service Act (P.L. 94-278). This further enlarged institute authority to advance the national attack on heart, blood vessel, lung, and blood diseases and the conduct of research in the use of blood and blood products and in the management of blood resources.

July 1, 1976--The National High Blood Pressure Education Program releases the first Joint National Committee Report on the Detection, Evaluation, and Treatment of High Blood Pressure.

October 28, 1977--The U.S.-U.S.S.R. Cooperative Health Program was renewed for another 5 years with the signing of an agreement by Dr. Julius B. Richmond, HEW assistant secretary for health, and Dr. Dmitri D. Venedictov, U.S.S.R. deputy minister of health.

February 1978--The NHLBI and American Heart Association jointly celebrated their 30th anniversary.

September 1979--The Task Force on Hypertension, established in September 1975 to assess the current state of hypertension research, completed its in-depth survey and recommendations for improved prevention, treatment, and control in 14 major areas. These recommendations are intended to guide the NHLBI in its future efforts.

November 1979--The results of the Hypertension Detection and Followup Program, a major clinical trial started in 1971, provided evidence that tens of thousands of lives are being saved through treatment of mild hypertension and that perhaps thousands more could be saved annually if all people with mild hypertension were under treatment.

November 21, 1980--The Albert Lasker Special Public Health Award is presented to the institute for its Hypertension Detection and Followup Program, "which stands alone among clinical studies in its profound potential benefit to millions of people."

September 8, 1981--A Working Group on Arteriosclerosis, convened in 1978 to assess present understanding, to highlight unresolved problems, and to emphasize opportunities for future research in arteriosclerosis, completed its report. Volume I presents conclusions and recommendations in nontechnical language. Volume II provides in-depth substantial basis for the conclusions and recommendations contained in volume I.

October 2, 1981--The Beta-Blocker Heart Attack Trial (BHAT) demonstrated benefits to those in the trial who received the drug propranolol compared with the control group.

October 26, 1983--The Coronary Artery Surgery Study (CASS) results were released. They demonstrated that mildly symptomatic patients with coronary artery disease can safely defer coronary artery bypass surgery until symptoms worsen. Results of this clinical trial will help patients and their physicians decide whether and when bypass surgery should be undertaken. They can base their decisions on firmer scientific footing.

January 12, 1984--The Lipid Research Clinics Coronary Primary Prevention Trial established conclusively that reducing total blood cholesterol reduces the risk of coronary heart disease in men at increased risk because of raised cholesterol levels. Each 1 percent decrease in cholesterol can be expected to reduce heart attack risk by 2 percent.

April-September 1984--The Tenth Report of the Director, NHLBI, commemorated the 10th anniversary of the passage of the National Heart, Blood Vessel, Lung, and Blood Act. The publication reviews 10 years of research progress and presents a 5-year research plan for the national program.

April 1984--The Division of Epidemiology and Clinical Applications was created. The reorganization provides the institute with a focus on clinical trials; prevention, demonstration, and education programs; behavioral medicine; nutrition; epidemiology; and biometry. It also provides opportunities to examine the interrelationships of cardiovascular, respiratory, and blood diseases.

April 1985--Results of phase I of the thrombolysis in myocardial infarction (TIMI) trial comparing streptokinase (SK) with tissue plasminogen activator (rt-PA) produced by recombinant means were published. The new thrombolytic agent rt-PA is approximately twice as effective as SK in opening thrombosed coronary arteries.

October 1985--The NHLBI Smoking Education Program was initiated.

November 1985--The National Cholesterol Education Program was inaugurated.

June 1986--Results of the prophylactic penicillin trial were released. They demonstrate the efficacy of propylactic use of penicillin in reducing the morbidity and mortality associated with pneumococcal infections in children with sickle cell disease.

Major national efforts to prevent early death in the at-risk pediatric population are now possible.

October 1986-September 1987--The NHLBI celebrated its 40th anniversary and the NIH centennial with a year-long series of events. Activities included scientific symposia and conferences, commemorative publications and exhibits, and a reunion of former NHLBI directors.

October 1987--The NHLBI established the National Blood Resource Education Program.

March 1989--The NHLBI initiated the National Asthma Education Program.

September 1990--NHLBI and NCI scientists began the first gene therapy trial in a human patient, a 4-year-old girl with an inherited immune dysfunction.

January 1991--The NHLBI Obesity Education Initiative began to educate the public and health professionals about obesity as an independent risk factor for cardiovascular disease and its relationship to other risk factors such as high blood pressure and high blood cholesterol.

February 1991--Expert panel of the National Asthma Education Program released "Guidelines for Diagnosis and Management of Asthma" report to educate physicians and other health care providers in asthma management.

June 11, 1991--The NHLBI initiated a National Heart Attack Alert Program to reduce premature morbidity and mortality from acute myocardial infarction and sudden death. The program emphasizes rapid disease identification and treatment.

July 1991--Results of the Systolic Hypertension in the Elderly Program (SHEP) were released. They demonstrate that low-dose pharmacologic therapy of isolated systolic hypertension in those over age 60 significantly reduces stroke and myocardial infarction.

August 1991--Results of the Studies of Left Ventricular Dysfunction were released. They demonstrated that the use of the angiotensin converting enzyme inhibitor enalapril causes significant reduction in mortality and hospitalization for congestive heart failure in patients with symptomatic heart failure.

October 30, 1992--The National High Blood Pressure Education Program celebrated is 20th anniversary. The fifth Joint National Committee Report on the Detection, Evaluation, and Treatment of High Blood Pressure and the first report on the Primary Prevention of Hypertension were released.

June 15, 1993--The Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults was released.

January 30, 1995--Results of the Multicenter Study of Hydroxyurea were released through a clinical alert. They demonstrate that hydroxyurea reduced the number of painful episodes by 50 percent in severely affected adults with sickle cell disease. This is the first effective treatment for adult patients with this disorder.

September 21, 1995--Results of the Bypass Angioplasty Revascularization Investigation were released through a clinical alert. They demonstrate tht patients on drug treatment for diabetes who had blockages in two or more conronary arteries and were treated with conronary artery bypass surgery (CABG) had, at 5 years, a markedly lower death rate than similar patients treated with angioplasty. The clinical alert recommends CABG over standard angioplasty for patients on drug therapy for diabetes who have multiple coronary blockages and are first-time candidates for either procedure.

November 5-6, 1995--The first Conference on Socioeconomic Status (SES) and Cardio-vascular Health and Disease was held to determine future opportunities and needs for research.

December 4-5, 1995--A celebration of the 10th anniversary of the NCEP is held in conjunction with the NCEP coordinating committee meeting. Results of the 1995 Cholesterol Awareness Surveys of physicians and the public are released at the accompanying press conference.

May 21, 1996-- The NHLBI announces results from the Framingham Heart Study that conclude earlier and more aggressive treatment of hypertension is vital to preventing congestive heart failure. Lifestyle changes, such as weight loss, a healthy eating plan, and physical activity, are crucial for reducing blood lipids in those treated for stage I hypertension.

September 1996--Findings from the Asthma Clinical Research Network show that for people with asthma, taking an inhaled beta-agonist at regularly scheduled times is safe but provides no greater benefit than taking the medication only when asthma symptoms occur. The recommendation to physicians who treat patients with mild asthma is to prescribe inhaled beta-agonists only on an as-needed basis.

November 13, 1996-- The NHLBI releases findings from two studies that show lifestyle changes, such as modifying one’s diet and losing weight, substantially reduce blood pressure in adults and can keep older patients off antihypertensive medication.


NHLBI Legislative Chronology

June 16, 1948--The National Heart Act (P.L. 80-655) authorized NHI. The purpose of the act was "To improve the health of the people of the United States through the conduct of researches, investigations, experiments, and demonstrations relating to the cause, prevention, and method of diagnosis and treatment of diseases of the heart and circulation; assist and foster such researches and other activities by public and private agencies, and promote the coordination of all such researches and activities and the useful application of their results; provide training in matters relating to heart diseases, including refresher courses for physicians; and develop, and assist States and other agencies in use of the most effective methods of prevention, diagnosis, and treatment of heart diseases."

June 25, 1948--The Second Deficiency Appropriation Act of 1948 (P.L. 80-785) appropriated "For an additional amount, Fiscal year 1949 for `National Institute of Health, operating expenses,' $500,000: Provided, that appropriations under said head for the Fiscal year 1949 shall be available for carrying out the purposes of the National Heart Act, including erection of temporary structures for storage of equipment and supplies and housing of animals."

June 29, 1949--The Labor-Federal Security Appropriation Act 1950 (P.L. 141) appropriated $10,725,000 for expenses necessary to carry out the purposes of the National Heart Act, including grants-in-aid for drawing plans, erection of buildings, and acquisition of land therefor, and, in addition to the amount appropriated, authorized "the Surgeon General, upon recommendations of the National Advisory Heart Council, to approve applications for research and training grants, including grants for drawing plans, erection of buildings, and acquisition of land therefor, not to exceed a total of $5,350,000, for periods beyond the current Fiscal year, and such grants shall, if approved during the current Fiscal year, constitute a contractual obligation of the Federal Government."

August 15, 1950--The Omnibus Act of 1950 (P.L. 81-692) provided for the termination of all appointments to the heart and other councils on September 30, and for appointment of a full new membership on October 1, 1950. The act established uniformity in composition of membership and term of office for all councils.

December 30, 1963--House Joint Resolution 848 (P.L. 88-254) of the 88th Congress was approved, which authorized and requested the President to issue an annual proclamation designating February as American Heart Month, inviting governors of states and territories to issue similar proclamations.

October 6, 1965--P.L. 89-199 provided supplemental appropriations for FY 1966 to implement recommendations of the President's Commission on Heart Disease, Cancer, and Stroke that fall within existing legislative authorities. NHI received funds to expand training programs and plan research centers.

May 16, 1972--The National Sickle Cell Anemia Control Act (P.L. 92-294) established a national program for the diagnosis, control, and treatment of and research in sickle cell anemia. The act does not mention NHLI but has special pertinence because NHLI has been designated to coordinate the National Sickle Cell Disease Program.

September 19, 1972--The National Heart, Blood Vessel, Lung, and Blood Act of 1972 (P.L. 92-423) enlarged the authority of the institute to advance the national attack on heart, blood vessel, lung, and blood diseases. The act provides for expanded, intensified, and coordinated institute activities in accordance with a comprehensive, specified National Heart, Blood Vessel, Lung, and Blood Disease Program to be planned by the director and the National Heart and Lung Advisory Council.

Other provisions include the establishment of prevention and control programs; development of 15 new centers for basic and clinical research, training, demonstration, and prevention programs for heart, blood vessel, and blood diseases; and development of 15 such centers for chronic lung diseases.

June 25, 1976--Title I of the Health Research and Health Services Amendments of 1976 (P.L. 94-278) redesignated NHLI as National Heart, Lung, and Blood Institute to advance the national attack on heart, blood vessel, lung, and blood diseases, and to conduct research in the use of blood and blood products and in the management of blood resources. The NHLBI director with the aid of the institute's Advisory Council continues to plan the national program under the basic P.L. 92-423 provisions with some refinements.

August 1, 1977--The Biomedical Research Extension Act of 1977 (P.L. 95-83) reauthorized NHLBI, with continued emphasis on both the national program and related prevention and dissemination activities.

December 17, 1980--The Health Programs Extension Act of 1980 (P.L. 96-538) reauthorized NHLBI, with continued emphasis on both the national program and related prevention programs.

September 20, 1988 and November 4, 1988--The National Bone Marrow Donor Registry (P.L. 100-436, P.L. 100-607) was established. With the enactment of these authorization and appropriation measures, NHLBI is given the task of developing an implementation plan for the voluntary bone marrow registry.

November 4, 1988--The Health Omnibus Extension Act of 1988 (P.L. 100-607) reauthorized NHLBI, with $1.4 billion for programs other than control and $101 million for control programs for FY 1989. In addition, it allocated such sums as are necessary for FY 1990.

June 10, 1993--The NIH Revitalization Act of 1993 (P.L. 103-43) established the National Center on Sleep Disorders within NHLBI.


Biographical Sketch of NHLBI Director

Claude Lenfant, M.D.

Dr. Lenfant was appointed NHLBI director on July 6, 1982. He was born on October 12, 1928, in Paris, France. He received his B.S. degree in 1948 from the University of Rennes, France, and his M.D. in 1956 from the University of Paris.

Upon completing his medical studies, he assumed the position of director of the Laboratory of Experimental Surgery, Centre Marie Lannelongue, in Paris. While there he directed research into extracorporeal oxygenation of blood and the use of deep hypothermia in cardiac surgery.

In 1957 Dr. Lenfant was appointed postdoctoral fellow at the University of Buffalo, and the following year continued that appointment at Columbia University in New York. His postdoctoral interests were directed to respiratory and circulatory physiology.

Returning to France, he assumed a teaching position as assistant professor of physiology at the University of Lille. He soon returned to the U.S., however, where he was appointed to a joint position in the departments of medicine and of physiology and biophysics at the University of Washington, Seattle. He rose to the rank of professor in both departments. He published extensively on the dynamics of blood-gas exchange in humans and various other species under normal conditions and under conditions of altitude and pressure. Respiratory adaptation to hypoxia, anemia, alkalosis and acidosis also were investigated.

In 1970 Dr. Lenfant was appointed the first associate director for lung programs of the then National Heart and Lung Institute, and also assumed the position of acting associate director for collaborative research and development programs. This program evolved into the Division of Lung Diseases, formed in 1972, with Dr. Lenfant as its director. For his accomplishments he was awarded the HEW Superior Service Honor Award in 1974. The Division of Lung Diseases continued to grow and to coordinate a strong and diverse program of research into the prevention, diagnosis and treatment of lung diseases.

He became NIH associate director for international research and director of the Fogarty International Center in 1981, positions he held until his appointment as director of NHLBI. In 1983 he was elected member of the Institute of Medicine, NAS. He was named Distinguished Executive of the Senior Executive Service in 1991 and Federal Executive of the year for 1992 by the institute alumni association.

Dr. Lenfant received the Surgeon General's Exemplary Award in 1993, the American Academy of Allergy and Immunology and the Giovanni Lorenzi Foundation Prize for the Advancement of Biomedical Science in 1994, and the Laura Graves Award--National Marrow Donor Program and the Consortium of Southeastern Hypertension Centers' Excellence in Leadership Award in 1995

He holds honorary degrees from the universities in Taipei, Taiwan; Lima, Peru; and from the University of New York at Buffalo (D.Sc., 1988).

His memberships include the Soviet Union’s Academy of Medical Sciences and of the National French Academy of Medicine. He is a fellow of the Royal College of Physicians (London), an honorary member of the Royal Society of Medicine, and an honorary fellow in the Polish Society of Hypertension.

Dr. Lenfant is a member of a number of professional societies including the American and French Physiological Societies, the American Society for Clinical Research, the American Society for Clinical Investigation, and the Association of American Physicians. He has served on the editorial board of American Journal of Physiology, Journal of Applied Physiology, American Review of Respiratory Disease, Revue Francaise des Maladies Respiratories and the American Journal of Medicine. He is the chief editor of a series of monographs, Lung Biology in Health and Disease that includes 102 volumes. He has published more than 225 papers in his areas of research interest.

Director's of NHLBI

NameDate of Birth Dates of Office
Cassius James Van SlykeDec. 1, 1900 Aug. 1, 1948Nov. 30, 1952
James WattApr. 28, 1911Dec. 1, 1952Sept. 10, 1961
Ralph E. Knutti1901Sept. 11, 1961July 31, 1965
William H. Stewart1921Aug. 1, 1965Sept. 24, 1965
Robert P. GrantSept. 17, 1915Mar. 8, 1966Aug. 15, 1966
Donald S. FredricksonAug. 8, 1924Nov. 6, 1966March 1968
Theodore CooperDec. 28, 1928Mar. 15, 1968Apr. 19, 1974
Robert L. Ringler (Acting)Mar. 27, 1922Apr. 19, 1974July 14, 1975
Robert I. LevyMay 3, 1937Sept. 16, 1975September 1981
Claude LenfantOct. 12, 1928Sept. 6, 1982


NHLBI Programs

Heart and vascular diseases affect at least 57 million people and continue as the leading cause of death in the United States. Important progress in the reduction of morbidity and mortality from these diseases has been achieved since 1963, when coronary heart disease mortality was at its peak.

The NHLBI uses research grants, program project grants, specialized center grants, cooperative agreements, research contracts, research career development awards, and institutional and individual national research service awards to support research and research training. The four program divisions and one center of the NHLBI offer support in the following areas.

Division of Heart and Vascular Diseases

The Division of Heart and Vascular Diseases plans and directs a program of fundamental and clinical research in heart and vascular diseases. AIDS-associated cardiovascular disorders are also included. The division provides training and career development for research in these areas; specific programs foster career development for minority students and scientists. Among these programs are minority institutional research training awards, minority school faculty development award, research development award for minority faculty, and short-term training for minority students program.

The division is divided into two program areas: heart research and vascular research. The heart research program supports clinical and fundamental research in cardiology. Specific areas of interest include arrhythmias and cardiomyopathies, congenital heart disease, heart failure and shock, ischemic heart disease, interventional cardiology, infections of the heart, and relevant bioengineering. In addition, other investigations involve angiogenesis, gene-nutrient interactions in the pathogenesis of congenital heart defects, transition to overt heart failure, and development of innovative ventricular assist systems. The vascular research program oversees research in atherosclerosis, hypertension, vascular biology, vascular medicine, cardiovascular homeostasis and bionutrition, and molecular genetics and medicine. Research on the etiology, pathogenesis, and treatment of excess cardiovascular disease in diabetes mellitus is also supported by this program.

In 1996 the division implemented six new initiatives, two of which specifically target women. One is a trial to assess the effects of hormone replacement therapy and/or antioxidant treatment on coronary plaques in women using angiographic changes as primary endpoints. The study will elucidate the mechanisms by which the treatments modify atherosclerosis. The other is a trial to investigate methods to improve the diagnostic reliability of cardiovascular testing in the evaluation of ischemic heart disease in women. Secondary objectives are to develop safe, efficient, and cost-effective diagnostic approaches for evaluating women with suspected ischemic heart disease; to determine the frequency of myocardial ischemia in the absence of significant epicardial coronary stenosis; and to ascertain the frequency of nonischemic or noncardiac chest pain.

Other new initiatives involve research using either humans or human tissue or animal models. The studies will:

In addition, the division renewed an initiative in 1996 that will examine how the presence of diabetes increases the risk of cardiovascular disease from both the basic and clinical research perspectives.

Quality-of-life endpoints have become important measures in clinical trials. The division initiated a multicenter, randomized clinical trial to test the efficacy of interventions that provide social support and ameliorate depression in post-MI patients in FY 1995. Coronary heart disease death and reinfarction are the primary endpoints. Secondary outcomes include health-related quality of life and adherence to medical and lifestyle change regimens.

Another clinical trial recently begun will compare the impact on total mortality of a strategy of attempting to maintain sinus rhythm with antiarrhythmic drugs to a strategy of merely controlling the heart rate. Important secondary endpoints will include quality of life and cost of therapies.

Several trials have suggested that beta-blockers improve ventricular function in congestive heart failure and may also reduce mortality. While a reasonable theoretical basis and suggestive clinical studies exist, the concept that beta-blockers reduce mortality in congestive heart failure patients remains unproven. The division has initiated a clinical trial to determine whether the addition of a beta-blocking agent to standard therapy reduces the total mortality of patients with moderate to severe congestive heart failure.

In FY 1995 the division supported Specialized Centers of Research on the genetic determinants of high blood pressure and ischemic heart disease in blacks. Solicitations of applications were issued for research on elucidation of mechanisms responsible for myocardial dysfunction, specifically, those involved in the transition from cardiac hypertrophy to overt heart failure; and for research on atherosclerotic lesions using human tissues.

Division of Epidemiology and Clinical Applications

The Division of Epidemiology and Clinical Applications has the primary responsibility for epidemiologic studies, clinical trials, prevention studies, and demonstration and education research in heart and vascular, lung, and blood diseases and for basic and applied research in behavioral medicine. The division identifies research opportunities; stimulates and conducts research on the causes, prevention, diagnosis, and treatment; and assesses the need for technologic development in the acquisition and application of research findings. It evaluates and uses basic and clinical research findings in defined populations (such as occupational groups, school children, health professionals, and minorities) and community settings, with an emphasis on studies of primary and secondary prevention in nonhospitalized patients or populations.

The division is divided into two programs: 1) clinical applications and prevention and 2) epidemiology and biometry. Clinical applications and prevention oversees research in prevention of heart and vascular, pulmonary, and blood diseases through activities such as clinical trials, health promotion- disease prevention community interventions, health education research, nutrition research, and behavioral medicine.

Clinical trials are used to test the efficacy of various drugs therapies in hypertensive patients and to study the effects of various medical treatments in cardiac patients. Among the issues being investigated are whether the combined incidence of fatal CHD and nonfatal myocardial infarction differs between diuretic-based and newer antihypertensive treatments (angiotensin-converting enzyme inhibitor, calcium channel blocker, alpha blocker) in high-risk hypertensive patients; whether an implantable cardiac defibrillator is more effective than conventional pharmacological therapy in reducing mortality in patients who have been resuscitated from sudden cardiac death; whether addition of a beta-blocker to standard therapy reduces mortality from chronic congestive heart failure; and which of two antiarrhythmic drug therapy strategies is more effective in reducing mortality in patients with atrial fibrillation.

The behavioral medicine area encourages basic and clinical collaborations between biomedical and behavior scientists. Targeted areas include risk factor modification (smoking prevention and cessation, physical activity, diet, weight loss, and blood pressure regulation); role of psychosocial factors in the development of cardiovascular disease (anger, hostility, anxiety, exhaustion, stress, and depression); role of social support in recovery; biobehavioral treatment of hypertension; factors affecting adherence to medical regimens; and treatment variables affecting quality of life. The prevention and education programs support research to test effectiveness and demonstrate capability of preventive interventions that are designed to reduce cardiovascular risk factors. Specific programs attempt to identify psychosocial and organizational factors that may facilitate or interfere with prevention of cardiovascular diseases.

Special population groups, e.g., minorities and children in social units such as the school and workplace, are often studied. Ongoing programs include: a study involving 20 U.S. communities that will examine the effect of community-wide education on reducing the time from onset of cardiac symptoms to receipt of medical care; a study that will evaluate the effectiveness of behavioral interventions, in primary health care settings, to encourage sedentary patients to increase their physical activity; and a study that investigates the effects of psychosocial support on morbidity and mortality in a clinical trial of patients recently hospitalized with acute MI.

The Epidemiology and Biometry Program supports and conducts epidemiological studies of heart and vascular, lung, and blood diseases in defined populations in the U.S. and other countries. It focuses on development and progression of cardiovascular disease risk factors in children and young adults; development and progression of atherosclerosis measured noninvasively or at autopsy in middle-age or older adults; and development and progression of overt cardiovascular and pulmonary disease in older adults. Other areas include genetic and environmental influences on cardiovascular disease and its risk factors; trends in incidence, prevalence, and mortality from cardiovascular disease, stroke, peripheral vascular disease, congestive heart failure, and cardiomyopathy; and relationships between insulin, insulin resistance, and overt diabetes and cardiovascular disease and its risk factors.

In 1996, two new initiatives and one renewal were supported by the division. One initiative will determine whether the addition of angiotensin converting enzyme inhibitor to standard therapy in patients with known coronary artery disease and preserved left ventricular function will prevent CVD mortality and reduce the risk of experiencing a myocardial infarction. The other initiative will assess the effectiveness of school-based intervention in the primary prevention of obesity among American Indian elementary school children. The division will continue the large, multicenter, standardized survey of CVD and CVD risk in American Indians begun in 1988. In phase III, atherosclerosis assessed by ultrasonography will be evaluated in relation to cardiac structure and function, renal dysfunction, and traditional CVD risk factors.

Office of Prevention, Education, and Control

OPEC, located in the NHLBI Office of the Director, is the institute’s technology transfer arm, relaying the results of heart, lung, and blood research to health care professionals, their patients, and the public. Its function is to disseminate and translate up-to-date research findings that will help practitioners be more effective, and provide scientific knowledge to patients and the public that will enable them to make “healthy decisions.”

The institute has targetted six areas for educational emphasis with OPEC. They include: high blood pressure; cholesterol; asthma; heart attack alert; sleep disorders; and obesity. Three of these (high blood pressure, cholesterol, and obesity) address major modifiable risk factors for CVD.

The National High Blood Pressure Education Program (NHBPEP) was established in 1972 with a goal of reducing death and disability related to high blood pressure through professional, patient, and public education. Strategies to achieve this goal include stimulating education and information programs to increase public awareness about the disease, promoting activities encouraging detection of the disease especially for underserved groups, encouraging hypertensive patients to seek medical care and follow their doctor’s advice, providing education programs and materials for health professionals, and providing technical support to community health programs so they may carry these activities to their geographic areas.

Dissemination of national guidelines on the prevention of high blood pressure is a major priority of the NHBPEP. Recently two new guidelines, Hypertension in Children and Adolescents and Hypertension and Renal Disease, have become available. The guidelines for children provide new criteria for classification of high blood pressure in young age groups. A statement on high blood pressure and the need to reduce salt consumption was released by the Program and was accepted by the U.S. Dietary Guidelines Committee.

The National Cholesterol Education Program (NCEP) was initiated in 1985 to educate health professionals and the public about high blood cholesterol as a risk factor for coronary heart disease and about the benefits of lowering cholesterol levels to reduce illness and death from CHD. In its 10 years of existence, the NCEP has made significant strides toward its goal of reducing the prevalence of high blood cholesterol as shown by the results from the latest Cholesterol Awareness Survey of physicians and the public.

From 1983 to 1995, the percentage of the public who ever had their cholesterol level checked rose from 35 to 75 percent. In other words, 70 to 80 million Americans who were unaware of their cholesterol level in 1983 have now taken steps to have it measured. In addition, physicians are currently initiating diet and drug treatment at much lower cholesterol levels than in 1983 and are adopting major elements of the NCEP guidelines for detection and treatment into their practice. Moreover, results from the third National Health and Nutrition Examination Survey support these findings. They show that, from 1978 to 1990, the public’s intake of fat and saturated fat decreased significantly resulting in impressive declines in average blood cholesterol levels (from 213 mg/dL to 205 mg/dL) with the accompanying prevalence of high blood cholesterol in the U.S. population reduced from 36 to 29 percent.

The NCEP pursues a dual strategy for educating the American people on the importance of blood cholesterol reduction. One strategy is directed toward individuals whose high blood cholesterol places them at increased risk for CHD and emphasizes the need for detection and treatment. The other strategy is directed at the general public and encourages heart-healthy eating patterns to lower average cholesterol levels.

The National Asthma Education and Prevention Program (NAEPP) was initiated in March 1989 to raise awareness of asthma as a serious, chronic disease and to promote more effective management of asthma through professional, patient, and public education. Its role is to provide up-to-date information on asthma care. Presently it is revising the expert panel’s report on the diagnosis and management of asthma which provides the science base for the program. It is also assisting in the implementation of the panel’s recommendations by providing materials developed for this purpose.

The NAEPP convened a task rorce to examine the cost-effectiveness, quality, and financing of asthma care; its report was recently published in a professional journal.

The National Heart Attack Alert Program (NHAAP) was initiated in June 1991 to reduce morbidity and mortality from acute myocardial infarction (AMI) and sudden death through education of health professionals (e.g., physicians, nurses, and emergency medical services personnel) and patients about the importance of rapid identification and treatment of individuals with heart attack symptoms and signs. To date, the program has developed recommendations for emergency department management of individuals presenting with characteristic signs of AMI. It has developed recommendations for health care providers in emergency departments concerning current and new tests/technologies for detecting AMI (including acute cardiac ischemia) and has prepared a paper for providers of high-risk patients about educational strategies to reduce prehospital delay in patients at high risk for an AMI. In addition, the NHAAP has prepared background papers on 911 emergency telephone systems; staffing and equipment requirements for emergency medical services systems; emergency medical dispatching processes and procedures; and factors associated with patient/bystander delay in seeking care for AMI manifestations.

The NHLBI Obesity Education Initiative (OEI) was started in January 1991 to inform the public and health professionals on the health risks associated with overweight and obesity. Obesity is not only an independent risk factor for CVD but also a contributor to high blood pressure and high blood cholesterol and is related to sleep apnea. In an effort to educate health care professionals on treatment for this condition, the OEI, as part of its high-risk strategy, convened an expert panel to consider the scientific evidence related to the identification, evaluation, and treatment of obesity in adults, especially those with other risk factors for CVD. Together with the NIDDK’s National Task Force on the Prevention and Treatment of Obesity, the panel will develop clinical practice guidelines for use by physicians and other health care providers. The report is expected to be released at the National Conference on Cardiovascular Health: Coming Together for the 21st Century, February 19-21, 1998, in San Francisco.

The NHLBI Ad Hoc Committee on Minority Populations, established in 1975, facilitates communication between minority communities and the NHBPEP. As the NHLBI developed new programs, the role of the ad hoc committee was expanded. Today, the committee provides direct input to the NHLBI regarding the development and implementation of all outreach and education projects specifically designed to improve the health status of minority populations.

The NHLBI and the Office of Research on Minority Health (ORMH), NIH are currently collaborating on several projects associated with improving the cardiovascular health of blacks and Latinos. The National Physicians’ Network, one such project, tries to get physicians who provide care to blacks to become more involved in prevention and education activities in black communities.

Results from the NHLBI Report of the Working Group on Research in Coronary Heart Disease in Blacks, indicated that, even when controlling for socioeconomic, demographic, and medical care factors, blacks are less knowledgeable about CHD symptoms, risk factors, and methods of prevention than whites. To address these issues, the NHLBI and the ORMH are collaborating with historically black colleges and universities, particularly those with medical schools and allied health programs, to conduct forums to share the latest research and treatment information to prevent and control CVD risk factors.

The Latino CVD Prevention and Outreach Initiative, “Salud para su Corazon,” (Health for Your Heart), is a comprehensive community-based health promotion project designed to raise awareness of CVD prevention and promote heart-healthy lifestyles among Latinos in the Washington, D.C., area. This model project will provide the foundation for similar health campaigns in Latino communities across the Nation.


NHLBI Appropriations -- Grants and Direct Operations
[Amounts in thousands of dollars]

Total Grants1
Direct Operations
1950 8,634 2,09110,725
1962 114,18218,730132,912
1969128,840 38,087166,927
1982 420,545139,092559,637
1989825,686 219,8221,045,508
1991870,662 255,2531,125,915
1Since 1973 includes research grants and research manpower development awards; and excludes contracts.


Division of Lung Diseases

Lung diseases are among the leading causes of death and disability in the United States. Excluding cancer, it accounts for 224,000 deaths annually, and is a contributing cause to perhaps an equal number of additional deaths.

More than 25 million persons suffer from chronic bronchitis, emphysema, asthma, or other obstructive or interstitial lung diseases. In 1994, pulmonary diseases accounted for 26 percent of all hospitalizations of children under 15 years of age.

The division plans and directs research in lung diseases, encompassing basic and targeted research, clinical trials and demonstration trials, national pulmonary SCORs, technological development, and application of findings. It assesses the national need for research in the causes, prevention, diagnosis, and treatment of lung diseases; in technological development; and for manpower training in these areas.

The division comprises two program areas, airway biology and disease and lung biology and disease. Asthma, chronic obstructive pulmonary disease and environment, cystic fibrosis, and neurobiology and sleep are under the purview of the airway biology and disease program. Targeted research programs include delineation of the genetic and metabolic defects underlying pulmonary complications associated with cystic fibrosis, ion channels in pulmonary cells, alpha- 1-proteinase inhibitor deficiency, pathogenesis of smoking- and environmentally related airway diseases, genetics and treatment of asthma, gene therapy, and neurochemical in control of breathing.

The lung biology and disease program oversees research related to AIDS and tuberculosis, critical care and acute lung injury, developmental biology and pediatrics, immunology and fibrosis, and lung cell and vascular biology. Projects representative of the areas of concern for the program include: a clinical network for treatment of acute respiratory distress syndrome, an epidemio-logic study of sarcoidosis, an investigation of lung injury following bone marrow transplantation, a clinical study of the cardiopulmonary complications of HIV infection in infants and children, several programs to address pathobiology of TB and Pneumocystis carinii and basic cell biology of pulmonary manifestations of AIDS, a program to develop lung specific drug delivery systems for enhanced TB treatment, and a program to design behavioral interventions for control of TB.

Five new initiatives and one renewed study were funded by the division in 1996. Two new initiatives are specialized centers of research (SCORs). One will foster multi-disciplinary research to enable basic science findings to be applied more rapidly to clinical problems related to lung development. The program will focus on identifying molecular variables involved in lung development and assessment of the impact of injury during critical periods. The other SCOR will apply critical science and technology to increase understanding of cellular and molecular mechanisms of asthma, including those mechanisms underlying the biological impact of environmental factors.

Other initiatives involve research to:

  • Explore the etiology and pathogenesis of pulmonary LAM using cellular and molecular approaches;
  • Develop new therapies for CF through support of basic research on the pathogenesis of CF and its complications;
  • Examine possible mechanisms that lead to activation of HIV-1 in the lung and mechanisms by which cofactors may lead to increased HIV-associated pulmonary disease;
  • Seek to improve the quality of medical school curricula; physician, patient, and community education; and clinical practice related to the recognition, prevention, and management of mycobacterial tuberculosis in the U.S.

Division of Blood Diseases and Resources

Blood diseases, including both acute and chronic disorders, resulted in 268,000 deaths in 1995; 259,000 of them due to thrombotic disorders and 9,000 due to diseases of the red blood cells and bleeding disorders.

The Division of Blood Diseases and Resources plans, directs, and evaluates the institute programs in hematology, hematologic diseases (except malignancies of the blood and immunologic and other disorders of white blood cells), transfusion medicine, blood resources, and marrow and stem cell transplantation. The programs include basic research; prevention; applied research and development; clinical trials; and education, demonstration, and control activities. Research on the use of blood and blood components in the treatment and prevention of disease and the management of the nation’s blood resources and transplantable tissue are also supported. A variety of support mechanisms are used, including research grants, contracts, cooperative agreements, centers, grants, career development awards, fellowships, and research training grants.

The division is divided into two programs, blood diseases and blood resources. The blood diseases area supports research in sickle cell disease and cellular hematology. Targeted programs include disorders of the red blood cell, disorders of hematopoiesis, thalassemia, and sickle cell disease. Investigators studying thalassemia focus their attention on genetics, pathophysiology, prevention, diagnosis, treatment, iron chelation, development of pharmacologic agents that enhance fetal hemoglobin production or rehydrate red blood cells, and development of animal models for the disease.

In the area of hematopoiesis disorders, research is supported on growth factors and cytokines, hematopoietic stem cell biology, stem cell purification, stem cell transplantation research, aplastic anemias and other nonneoplastic disorders of the bone marrow, and pathophysiology of bone marrow in AIDS and related hematologic disorders. Hereditary and acquired anemias resulting from disorders of hemoglobin, the red blood cell membrane, or enzyme systems are additional targeted programs. Sickle cell disease research is directed towards membrane function, red cell rheology, and adherence of red cells to vascular endothelium. A multidisciplinary approach to sickle cell disease is supported through comprehensive sickle cell centers.

The blood resources area oversees studies in transfusion medicine, bone marrow transplantation, and thrombosis and hemostasis. It supports basic, clinical, and applied research on unrelated-donor marrow transplantation and pathogenesis, prevention, diagnosis, and treatment of major complications of transplantation. Studies of transplantation of stem cells from marrow, peripheral, and cord blood are emphasized.

The program is also supporting research on thromboembolic disorders, platelet disorders, megakaryocytes, and hemorrhagic disorders. Other targeted areas include blood component and blood derivative therapy, safety of blood therapy, immunohematology, develop ment of blood substitutes, and blood resource management. Research to develop and test methods to reduce the risk of HIV-infection by transfusion of blood, blood components, and blood derivatives is emphasized.

In 1996, five new initiatives, including two SCORs, and one renewal were supported by the division. The objectives of the initiatives are to:

  • Ascertain the long-term effects, if any, of hydroxyurea usage in patients who participated in the initial Multicenter Study of Hydroxyurea in Sickle Cell Disease;
  • Evaluate human umbilical cord blood as an alternative to bone marrow as a source of hematopoietic stem cells for recipients with a variety of genetic and hematologic diseases;
  • Stimulate research leading to the development of therapeutic approaches for the treatment of sickle cell disease;
  • Refine one or more nucleic acid-based techniques for the direct detection of blood-borne viruses in donors of blood for transfusion and organs for transplantation;
  • Stimulate basic research and clinical investigations in hemostatic and thrombotic diseases; and
  • Improve safety and efficacy of transfused blood and blood components, determine the indications for their use, and evaluate and possibly modify immunological responsiveness following their administration.

National Center on Sleep Disorders Research

The National Center on Sleep Disorders Research (NCSDR) plans, directs, and supports a program of basic, clinical, and applied research; health education; and prevention-related research in sleep and sleep disorders. It maintains surveillance over developments in its program areas; assesses the national need for research on the causes, diagnosis, treatment, and prevention of sleep disorders; and coordinates sleep research activities across the Federal Government.

In 1996, the center supported three new initiatives. One of them is a SCOR program in the neurobiology of sleep and sleep apnea. Another is a program supported jointly by the NIMH, the NICHD, and NIAMS, to examine the molecular biology and genetics of sleep and sleep disorders. The Sleep Academic Award will enable development of a program to improve the quality of medical school curricula; physician, patient, and community education; and clinical practice for the prevention, management, and control of sleep disorders, while also promoting high-quality clinical research in sleep.

Division of Intramural Research

The 16 Bethesda-based laboratories and branches conduct clinical research on the normal and pathophysiologic functioning of the cardiac, pulmonary, blood and endocrine systems and basic research on normal and abnormal cell behavior at the molecular level.

The Cardiology Branch conducts basic and clinical investigations in hypertrophic cardiomyopathy (HCM). The branch is exploring the genetic causes of HCM and the phenotypic variation in its clinical presentation. By studying the possible mechanisms that trigger sudden death in persons with HCM, investigators hope to find an effective treatment. Other areas include: vascular biology associated with endothelial dysfunction, molecular mechanisms involved in restenosis following angioplasty, interventions to facilitate collateral growth in ischemic heart disease, and application of nuclear cardiology techniques to study abnormalities in performance and metabolism in cardiac patients.

The Hematology Branch performs research on the pathogenesis of hematological diseases at the molecular and cellular levels and seeks to develop strategies for treatment. Individual, investigator-led units focus on bone marrow failure and its mechanism, especially immune suppression of hematopoiesis and the interaction of viruses with hematopoietic cells. Bone marrow transplantation, both autologous and allogeneic, with emphases on stem cell isolation and mechanisms of graft-versus-host and graft-versus-leukemia effects is another area of concern. Other activities include research on the pathogenesis and treatment of aplastic anemia and B19 parvovirus-induced disease.

Vasoactive substances regulating blood pressure and hypertension, molecular events leading to vascular hypertrophy and hyper-plasia, and studies of pheochromocytoma are principal interests of the Hypertension-Endocrine Branch.

The Molecular Disease Branch is concerned with elucidating the molecular mechanisms involved in lipid transport and metabolism in normal individuals and patients with disorders of lipid metabolism and atherosclerosis. The branch also conducts clinical studies on the effects of drugs and diet.

The principal goal of the Molecular Hematology Branch is to develop the understanding and technology necessary to carry out human gene therapy. Targeted diseases include genetic and cardiovascular diseases and cancer. Mechanisms and regulation of gene expression are also studied.

The Pulmonary/Critical Care Medicine Branch focuses its efforts toward understanding basic mechanisms in inflammatory and immune processes in health and disease, with emphasis on the pathogenesis of disorders of the human lung. A broad range of laboratory approaches, particularly those of molecular biology, are used to study proteases and antiproteases. Emphasis is given to defining mutations in the relevant genes and how they cause human disease.

The Laboratory of Biochemistry is involve in research concerned with the elucidation of various mechanisms of metabolic regulation. Special interests include the physiologic and pathologic effects of oxidation, signal transduction, and protein chemistry.

The Laboratory of Biophysical Chemistry investigates the physical and chemical properties of molecules in order to relate their structures to biochemical functions. Techniques used include nuclear magnetic resonance, mass spectrometry, x-ray crystallography, scanning tunneling/force field microscopy, chromatography, and laboratory computer applications.

The Laboratory of Biochemical Genetics studies molecular mechanisms that regulate gene expression during embryonic development. Interests include homeobox genes and neuron-specific enhancer sequences.

The Laboratory of Animal Medicine and Surgery studies intracardiac flow dynamics with digital acquisition and analysis of color Doppler ultrasound imaging techniques.

The Laboratory of Cell Biology investigates diverse biomedical problems using multiple approaches. It directs attention towards biophysical studies of bioenergetics in eukaryotic and prokaryotic cells; biochemical and genetic studies of heat-shock proteins; the molecular mechanisms of cell motility; and the development and application of laser-based, time-resolved fluorescence spectroscopy to understand the structure of macromolecules.

The goal of the Laboratory of Cardiac Energetics is to develop a better understanding of the cellular processes involved in the performance of work by the heart in vivo. Strategies are under development for prevention and treatment of heart disease. State-of-the-art noninvasive magnetic resonance (MR) and optical spectroscopy are used, as well as conventional microspectrophotometric imaging techniques, to study cardiac biochemistry and function in vivo.

The Laboratory of Cell Signaling studies the mechanisms by which signal activated phospolipases like phospho-inositide-specific phospholipase C and phosphocholine-specific phospholipase D are modulated and the role of these enzymes in human disease.

The goal of the Laboratory of Kidney and Electrolyte Metabolism is to understand kidney function. Major objectives are to elucidate the basic processes at molecular and cellular levels, determine how they are controlled, and analyze how they are integrated to result in overall renal function.

The Laboratory of Molecular Cardiology investigates the regulation, expression, and function of contractile proteins in vertebrate muscle and nonmuscle cells. Studies use the techniques of molecular genetics, protein biochemistry, and video-enhanced microscopy. Areas of particular interest include mechanisms responsible for regulating the contractile activity of smooth muscle and nonmuscle cells and factors that regulate the expression of the genes encoding the contractile proteins.

The Laboratory of Molecular Immunology focuses its attention on the T-cell activation process in normal and pathological states. Scientific findings derived from this research will lead to a better understanding of immunodeficiency, cancer, and autoimmune diseases. Scientific studies to elucidate the mast cells activation process will provide information on its role in asthma and other allergic diseases.