before it could be given to children with a lethal disorder, and that philosophy has changed.

In cancer-related research and in the AIDS-related research in children, which the Cancer Institute also supports, the philosophy has been to try to move into as much of a transition as possible. We think that there is an emerging consensus that the process has to go faster. We are very pleased, in fact proud, of the role that the NIH has had in making sure that this philosophy comes about.

USE OF FETAL TISSUE

Senator HARKIN. Dr. Fauci, in an October 1989 speech you discussed the theoretical possibility of using fetal cells to reconstitute the immune system of AIDS patients.

Unlike adult cell transplantations, I guess fetal cells would not provoke tissue rejection problems. Attempts to reconstitute the immune system of AIDS patients using bone marrow transplants from the patient's identical twin have not been successful.

Now, we discussed earlier with Dr. Raub about the ban on Federal funding for transplantation research using fetal tissue.

That ban would affect this type of research. Is that right or not? Dr. FAUCI. Yes; I was talking about a hypothetical situation. In fact the context in which I mentioned that was based on an ongoing study; trying to look at what the earliest cell in the development of the immune system is that could be infected with HIV.

We are investigating whether or not early precursor cells can be infected, and what the hypothetical situation would be that if, in fact, those cells were infected. We would then ask what the best possible avenue of research to take would be, and determine if you ould in fact transplant back into an individual those precursor Is which had been depleted, using fetal tissue of the immune

nator HARKIN. You cannot do that.

FAUCI. Now, if in fact that theoretical situation came to pass, the current moratorium of transplanting fetal tissue into from induced abortion, that would fall under the moratorideed that situation occurred.

HARKIN. Is there any foreign research being done using s?

To my knowledge right now, there are a couple of anof putting in fetal thymus tissue and fetal liver tissue, udies to my knowledge.

IN. Is any other research being done someplace else ban in this country? Are you aware of any?

k the important thing to establish, Mr. Chairhat we are actively doing in the laboratory pting to determine if there is a scientific here infection of those early cells, and if to replace them with transplantation. program to replace them, I think it fact they have been depleted, and of research right now.

SUBCOMMITTEE RECESS

Senator HARKIN. I thank you all very much for great testimony, and I also just want to thank you for all the wonderful work that you are doing out at NIH.

The subcommittee will stand in recess until 1:30 p.m., when we will hear from panel 3 and the rest of the Institutes.

[Whereupon, at 12:47 p.m., Tuesday, February 20, the subcommittee was recessed, to reconvene at 1:30 p.m., the same day.]

(AFTERNOON SEssion, 1:30 p.m., TUESDAY, FEBRUARY 20, 1990) DEPARTMENT OF HEALTH AND HUMAN SERVICES

NATIONAL INSTITUTES OF HEALTH

NATIONAL INSTITUTE OF DIABETES AND Digestive and KIDNEY DISEASES

STATEMENT OF DR. PHILLIP GORDEN, DIRECTOR

SUMMARY STATEMENT

Senator HARKIN. The Appropriations Subcommittee on Labor, Health and Human Services, and Education, and Related Agencies will come to order.

This afternoon we have our third panel: In addition to Dr. Raub; Dr. Phillip Gorden, Director of the National Institute of Diabetes and Digestive and Kidney Diseases; Dr. Duane Alexander, Director of the National Institute of Child Health and Human Development; Dr. David Rall, Director of the National Institute of Environmental Health Sciences; and Dr. Phillip Schambra, Director of the John E. Fogarty International Center.

Again, we will just go down that list in the order in which I called it.

First, Dr. Gorden, glad to have you with us. I notice that your Institute celebrates its 40th anniversary this year. We look forward to see what progress you are making. Your request for 1991 is $605.35 million is what my figures show, or about a 4.11 percentincrease.

So welcome to the subcommittee and we will try to go through the different things and we will go back to questioning because some of the questions go back and forth and they are interrelated. Dr. Gorden, please proceed. All of your statements will be made a part of the record in their entirety and if you would briefly summarize I would sure appreciate it.

Dr. GORDEN. Thank you, Mr. Chairman. This is a special year for us as it is our 40th anniversary. We were signed into law by President Harry Truman in August 1950.

In recognition of this milestone I would like to focus on a few examples of the many contributions of NIDDK's basic and applied research to clinical medicine.

One of the crowning research achievements of the past year is the discovery of the gene that causes cystic fibrosis. Discovery of the cystic fibrosis gene, however, would have been impossible without the earlier Nobel Prize winning research rooted in the NIDDK. The identification of the first enzyme known that could copy DNA, the unraveling of the code by which DNA translates itself into protein-building blocks of the body, and the discovery of the mecha

nism used by proteins to fold themselves into their proper shapes for activities are all three Nobel Prize winning endeavors.

Forty years ago when this Institute was founded, diabetes was an enigma. Today, we know that there are fundamentally two forms of diabetes: type I or insulin dependent diabetes is an immunologic abnormality where the body's immune system attacks the insulinproducing cells.

We know that a particular gene controls susceptibility to that disease; that is, a particular gene confers either protection or susceptibility to the disease. This gene is not sufficient to cause the disease, but is necessary.

The more prevalent form of diabetes, type II diabetes, or noninsulin dependent diabetes, is also a genetic disease. In this disease, in identical twins, there is a 90-percent chance that if one twin has diabetes the other twin will have diabetes within 5 years. That is a very powerful genetic statement.

At the present time we do not know what genes are involved in this disease, but it is a very important pursuit of the Institute.

Today the clinical management of diabetes is vastly improved. Diabetes can be diagnosed and treated earlier. Recombinant insulin is now available for treatment, a major accomplishment of the biotechnology industry.

Patients can conveniently test their blood sugars at home or at work. Research is also underway on implantable insulin pumps for improvement of the administration of insulin.

End-stage renal disease is another area of major achievement. When the NIDDK was founded in 1950, patients routinely died within days of kidney failure. Now, dialysis and transplantation have completely altered the outlook for end-stage renal disease patients. In addition, a new drug called erythropoietin combats the anemia of dialysis patients, enabling them to return to work and lead more fully productive lives.

Remarkable research advances have likewise been seen in liver disease. Forty years ago liver failure was an absolute death sentence. Today, two-thirds of transplant recipients survive 1 to 3 years after transplantation, and the long-term survival rate continues to improve. The NIDDK has contributed to the development of potent immunosuppressive drugs and organ preservation solutions that have been essential to these advances.

At the same time, we recognize that dialysis and organ transplantation are incomplete measures, and we remain firmly committed to research aimed at preventing end-stage kidney and liver dis

eases.

Important contributions have been made recently in type B and type C hepatitis in terms of specific therapies.

PREPARED STATEMENT

These examples of progress underscore the crucial importance of the Institute's 40 year record of achievement in basic and applied research, which has laid the foundation for landmark advances in biotechnology, drug and device development, and clinical procedures.