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production to diabetics also moved forward this year when NIDDK grantees

successfully used the thymus of rats as a new site for transplanting insulin

producing cells.

With this approach, they enhanced both immune tolerance to

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grafts at other sites and graft survival.

Progress is also being made in understanding non-insulin-dependent


Glucose transport mechanisms are emerging as a major new target for

potential treatment of this disease.

Studies in animals are defining more

precisely the cascade of molecular events involved in the production and

action of insulin, in order to pinpoint how resistance to insulin occurs.


related research, scientists have identified the cell receptor that binds

drugs used to treat non-insulin-dependent diabetes, thus paving the way for

more effective drug development.

A key source of knowledge about the

metabolic abnormalities and complications of non-insulin-dependent diabetes

are NIDDK studies of the Pima Indians, who have the world's highest prevalence

of this disease.

Applicable to both forms of diabetes are studies on the genetic

components of this disease.

Research clues are helping to narrow the search

for the diabetes genes.

Gene mapping strategies are bearing their first

fruits of success with the identification of a linkage of a genetic locus in a

rare form of non-insulin-dependent diabetes.

The genetic puzzle of diabetes

remains a complex challenge, however.

To help meet this challenge, I am

pleased to tell you that the Institute will begin a new Diabetes

Interdisciplinary Research Program in 1992 in an innovative par

ership with

the Juvenile Diabetes Foundation, International.

This follows a productive

partnership previously established with the Cystic Fibrosis Foundation.

For kidney and urologic diseases research, I am pleased to report several

exciting scientific events.

With NIDDK grant support, kidney researchers have

made inroads in understanding polycystic kidney disease (PKD), in which cyst

formation can impair and destroy kidney function. Recently, NIDDK grantees

discovered that the combined action of two known growth-promoting chemicals

can initiate cyst formation.

This finding has already resulted in the testing

of candidate drugs in mice with PKD, thus opening new therapeutic windows.

In seeking to combat end-stage renal disease (ESRD), the NIDDK is

supporting studies to understand the strikingly high incidence of the kidney

disease of diabetes mellitus (KDDM) among the ESRD patient population, and

among Native Americans and Blacks.

The NIDDK is also studying the genetic

causes of KDDM in Native Americans, and is designing a therapeutic

intervention study. The NIDDK-supported U.S. Renal Data System is helping to

shed light on the natural history of ESRD and its precursor diseases.


on insights already gained, the NIDDK plans to launch a pilot clinical study

in 1992 on kidney disease and hypertension in Blacks. Thus, the NIDDK has

intensified basic and clinical research on the kidney diseases that lead to

ESRD, for which annual dialysis and transplantation costs are $5.4 billion.

Building a strong urologic diseases research program is a high

priority. The NIDDK is seeking to intensify high-quality research in

interstitial cystitis, a debilitating disease that primarily affects women;

benign prostatic hyperplasia (BPH), which most men develop as they age; and

diabetes-related urologic disorders.

New knowledge about inflammatory

mediators, growth factors and basic bladder function is helping to construct a

solid science base in urology, from which future clinical achievements will


To expand research in pediatric kidney and urologic diseases, the NIDDK

will soon be funding its first research center in these fields.

Achievements in blood disease research are moving steadily toward

clinical applications.

The NIDDK was a major research contributor to the

development of recombinant erythropoietin, a drug that has proven outstanding

in alleviating the anemia of ESRD patients, and was just recently approved by

the FDA for treating the anemia of AIDS patients.

In preliminary clinical

studies, NIDDK scientists recently demonstrated the effectiveness of the drug

hydroxyurea in reducing the complications of sickle cell disease, one of the

most devastating diseases of Black Americans. Now, researchers are combining

this drug with other agents in attempts to extend clinical improvement.

Progress has also been made toward the development of effective oral drugs to

remove the excess iron that accumulates in Cooley's anemia patients as a

result of frequent blood transfusions.

In preliminary NIDDK-supported tests

in animals, these oral chelating drugs have shown their ability to remove

iron, while appearing to have low toxicity. We also support research on bone

marrow transplantation as a treatment method and a vehicle for gene therapy.

In digestive diseases, compelling research advances abound.

A broadlyo

supported multicenter clinical trial has confirmed the results of the

pioneering discovery by our intramural scientists that the drug interferon

alfa is effective in treating hepatitis B and C.

For ulcers, NI DDK grantees

have developed a simple, noninvasive breath test for determining which

patients have an underlying bacterial infection that can be eradicated by


Grantees have also identified a possible marker for inflammatory

bowel disease.

If this marker can distinguish between the two forms of this

disease--ulcerative colitis and Crohn's disease--it may help to reveal their

respective causes.

In other studies, the immunosuppressive drug FK506

continues to show enormous promise in liver transplantation, with fewer side

effects than conventional drugs. With NIDDK support, a useful animal model

was developed for primary biliary cirrhosis, which primarily affects women and

is the most frequent indication for liver transplantation in adults.

We are:

also beginning to understand the relationship between obesity and the

development of gallstones, and are following closely the new surgical

procedure for gallbladder removal. Malabsorption syndromes, such as celiac

disease, are the focus of studies aimed at identifying factors that decrease

or prevent nutrient absorption by the gastrointestinal tract.

This knowledge

may also be useful in addressing the wasting syndrome of AIDS.

Our nutrition program is breaking new ground in understanding nutrient

metabolism and energy expenditure. Of particular concern is obesity, a

disproportionate health problem in minority populations and a major risk

factor for non-insulin-dependent diabetes, heart disease, gallbladder disease,

and other serious illnesses

NIDDK grantees are searching for obesity-related

genes in experimental animal models, as well as for mechanisms that regulate

the flow of metabolic fuels and lead to the storage of fat.

Achievements in endocrinology and metabolism are applicable to many

diseases because of the far-reaching effects of hormones and metabolic

processes throughout the body.

The Institute's research on the endocrinology

and metabolism of bone is highly relevant to combating osteoporosis--a

critical health problem of elderly women.

NIDDK grantees have identified a

number of growth factors that may play an influential role in the regulation

of bone metabolism and the osteoporosis disease process.

The Institute is

also generating knowledge about the mechanisms whereby the female hormone

estrogen protects against bone resorption in osteoporosis.

Research on inherited metabolic diseases advanced this year with the

approval by the FDA of a treatment for children whose immune systems are

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delivery system was used to treat the first child to receive experimental gene

therapy, and NIH investigators now wait to determine whether the newly

inserted gene will make a normal product. Clearly, this new formulation of an

enzyme treatment will be a valuable ad junct to gene therapy research.

The NIDDK research mission is broad and complex, encompassing many costly

chronic diseases; health problems of the young and the elderly; and diseases

that particularly affect women and minorities.

In highlighting some of our

research advances, I hope I have conveyed the scientific momentum we feel as

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Education: B.A., Vanderbilt University, Nashville, Tennessee, 1957; M.D., Vanderbilt University School of Medicine, Nashville, Tennessee, 1961.

Professional History: 1961-62, Intern, Yale University, New Haven,
Connecticut. 1962-64, A88istant Resident, Yale University, New
Haven, Connecticut. 1964-65, USPHS clinical Fellow in Metabolism,
Yale University, New Haven, Connecticut. 1965-66, USPHS Research
Fellow in Metabolism, Yale University, New Haven, Connecticut.
1966-74, Senior Investigator, clinical Endocrinology Branch, National
Institute of Arthritis, Metabolism, and Digestive Diseases, National
Institutes of Health. 1974-78, Senior Investigator, Diabetes Branch,
National Institute of Arthritis, Diabetes, and Digestive and Kidney
Diseases, National Institutes of Health. 1974-76, clinical Director,
National Institute of Arthritis, Metabolism, and Digestive Diseases,
National Institutes of Health. 1976-78, Visiting Professor, Insti-
tute of Histology and Embryology, University of Geneva School of
Medicine, Geneva, Switzerland. 1978-present, Chief, Section on
clinical and Cellular Biology, Diabetes Branch, National Institute
of Arthritis, Diabetes, and Digestive and Kidney Diseases, National
Institutes of Health. 1980-1986, clinical Director, National
Institute of Arthritis, Diabetes, and Digestive and Kidney Diseases,
National Institutes of Health. 1983-1989, Chief, Diabetes Branch,
National Institute of Arthritis, Diabetes, and Digestive and Kidney
Diseases, National Institutes of Health. 1986-present, Director,
National Institute of Diabetes and Digestive and Kidney Diseases,
National Institutes of Health.

Professional Organizations : American College of Physicians,
American Diabetes Association, American Federation of clinical
Research, American Society for Clinical Investigation, Endocrine
Society, American Society for Cell Biology, Association of American
Physicians, American Society for Biochemistry and Molecular Biology.

Honors, Awards: Alpha Omega Alpha Medical Fraternity, 1961.
Doctor of Medicine (Honoris Causa) University of Geneva, Geneva,
Switzerland, 1986. Public Health Service Distinguished Service
Medal, 1986. Public Health Service Commendation Medal, 1988.
Distinguished Alumnus Award and Medal, Vanderbilt Medical School,


Senator HARKIN. Thank you, Dr. Gorden.
I know that Senator Reid has some questions for you.

Senator REID. You are very kind, Mr. Chairman, in allowing me to appear out of order after you have been here all morning.

Dr. Gorden, last year the committee provided the urology program an additional $2.5 million to be directed toward research on interstitial cystitis. Can you tell me how you intend to direct these funds?

Dr. GORDEN. Yes, sir; at the present time we have a request for applications for new research project grants in this area, and in addition we are soliciting applications for the establishment of a data base or registry. Both of those programs, that is, this increased research project grant program and the registry or data base program, are well on their way, and will be inaugurated in the very near future.

Senator Reid. Will these moneys be used this year?

Dr. GORDEN. They will be used this year with the possible exception of the data base/registry, which may be difficult to fund this fiscal year for technical reasons relating to timing of the review process. But if it is not this fiscal year, it will be done very early in the next fiscal year.

Senator REID. Doctor, how much of the money is designated for the interstitial cystitis register?

Dr. GORDEN. We do not have the proposals in, so I cannot be precise. But we estimate a figure of something in the range of about $650,000, which would include a data coordinating center and three proposed clinical centers that will actually support this data coordinating center with clinical studies. And that is our present estimation at this point.

Senator REID. And is this a sufficient amount, as far as you know?

Dr. GORDEN. We believe that it will be sufficient. It always has the possibility of flexibility in the future once we get this program started.

Senator REID. I have some other questions that I will submit to the panel in writing, Mr. Chairman.

I would acknowledge that I am going to visit your facility sometime early next month, I think on the eighth.

Dr. GORDEN. We would be very pleased, Senator Reid.
Senator REID. Thank you, Mr. Chairman.

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