The Committee recommends an appropriation of $153,867,000 for the National Institute of Arthritis and Musculoskeletal and Skin Diseases [NIAMS]. This is $30,858,000 more than the administration request, $15,087,000 more than the fiscal year 1987 appropriation of $138,780,000, and $765,000 less than the House allowance.

The newly established NIAMS conducts and supports basic and clinical research and research training on a broad range of diseases including the many forms of arthritis, diseases of the musculoskeletal system, and diseases of the skin, as well as research on the normal structure and function of joints, muscles, bones, and skin.

Because the population is now undergoing a profound demographic change toward a higher median age, the number of those disabled by arthritis can be expected to rise perhaps by as much as one-third by the year 2000. Right now, the National Center for Health Statistics estimates that the total economic cost of disabilities caused by arthritis and musculoskeletal diseases is $37,600,000,000 each year. Clearly, identifying the causes and treatments for these diseases and conditions must be a priority of the first order.

Rheumatoid arthritis

The Institute reported that several research advances have occurred on this major crippler among the rheumatic diseases. Using recombinant DNA technology, researchers have discovered two new DNA fragments that pinpoint the exact site on the chromosome where susceptibility to rheumatoid arthritis resides. There is additional evidence that a small virus called a parvovirus is the initiating factor in rheumatoid arthritis. This has intensified the search for specific infectious agents as the triggering factor in individuals predisposed to the disease. The Committee urges an expanded research effort focused on this disease and that up to $3,000,000 be allocated for infectious disease theory research.

Osteoporosis

A recent study revealed that 24 million Americans have osteoporosis-the leading cause of bone fractures both in postmenopausal women and in the elderly of both sexes. To enhance communication among investigators and to speed research progress, the Institute is targeting research on osteoporosis and bone metabolism as an area of very special emphasis. A recent scientific workshop on research directions in osteoporosis provided recommendations for future research on cellular mechanisms in osteoporosis, risk factors, calcium requirements, estrogen and other hormone replacements, and other strategies for prevention and treatment of osteoporosis.

Systemic lupus erythematosus

Progress has been made in understanding and treating this disease through several avenues of research. However, the reasons for lupus being three times more common in black women than in white women are still unclear. Investigators are pursuing basic immunologic and genetic research on underlying causes and clinical studies for improved diagnosis and treatment. A promising research development implicating environmental factors is being actively pursued. The Committee urges that maximum possible funding be made available for meritorious applications addressing this disease entity.

Epidermolysis bullosa

Basic research continues to provide important insights into the causes of epidermolysis bullosa [EB]. Collagenase, the enzyme that destroys collagen, is produced in excess in this tragic blistering disease of the skin. The gene for collagenase has been recently cloned, which should lead to new research advances and understanding of EB. The Institute is supporting a national registry of patients and families that will provide information on the genetics and epidemiology of EB. The registry will also facilitate multidisciplinary studies on causal factors and development of new therapies.

The Committee continues to receive testimony indicating that research in dermatologic diseases has made major progress recently toward achieving a better understanding of the basic causes of a number of important skin disorders. Included in the list of diseases in which significant advances have been made are: epidermolysis bullosa [EB], a severe and incapacitating hereditary blistering disease; psoriasis, which affects approximately 2.5 million people in this country; malignant melanoma which is increasing at an alarming rate and is estimated to account for almost 6,000 deaths yearly; and a number of other afflictions of the skin, which are allergic or hereditary in nature.

The Committee continues to be concerned about the complex nature of such diseases, and in particular, of EB, with its terrible effects, and the impact on its victims, their families, and society. The Committee directs the Institute to continue to support high-quality research on EB and related disorders.

Osteoarthritis

Osteoarthritis, the most common form of arthritis, affects some 16 million Americans and is a leading cause of pain and disability. Recent research has shown that osteoarthritis is neither simply a wear-and-tear disease nor the result of aging. A recent advance is the development of a circulating biochemical marker (keratan sulfate) of cartilage degeneration in osteoarthritis. New studies of biochemical and ultrastructural changes in cartilage are providing new leads and innovative approaches to therapy.

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Sjogren's syndrome

The causes of Sjogren's syndrome and the best way to treat it are unclear. The disorder is an autoimmune disease which effects the loss of function of the mucous secreting glands of the body and consequent extra glandular manifestations. There appears to be a low level of research interest in the etiology and treatment of Sjogren's syndrome. The Committee directs NIAMS to support and encourage a multidisciplinary research strategy that will more effectively deal with this problem. The Committee also directs NIAMS to organize and convene a conference on Sjogren's syndrome.

Low back pain

The causes of low back pain and the best ways to treat it remain unclear, yet impairments of the back and spine are the most common cause of limitation of activity in young adults in the United States. Back pain research remains difficult because of the complexity of the back's anatomic structures and nerve pathways. The Committee supports and encourages multidisciplinary approaches to research in this important area and requests a report by January 15, 1988, on a research strategy to more effectively deal with this problem.

Exercise physiology and sports medicine

This area represents a new mandate for both the Institute and the NIH. A significant gap exists between basic knowledge about muscle metabolism and application of that research. The Committee urges NIAMS to direct its efforts to understanding responses of muscles to exercise and to physical training, and will encourage fundamental, interdisciplinary studies, not only on muscle, but on ligaments, tendons, and other supporting structures of connective tissues.

Immunologic diseases of skin

Important new immunologic and cellular bases for allergic reactions of the skin have been discovered. The identification of newly recognized specialized cells and mediators involved in allergic contact dermatitis has been recently reported. Researchers are also making progress in the understanding and treatment of other immune-mediated skin diseases, such as psoriasis and vitiligo.

Molecular biology

A recent conference on molecular biology and rheumatology research gave special emphasis to basic research on immune-mediated diseases such as rheumatoid arthritis and lupus, inherited metabolic diseases, and connective tissue diseases. The Institute will pursue these recent advances in molecular biology.

Specialized centers for research

The 1987 appropriation included funds for nine specialized centers of research [SCOR's]-three each in the high priority areas of rheumatoid arthritis, osteoarthritis, and osteoporosis. The response from the scientific community is encouraging, with over 30 applications for these SCOR's having been submitted.

Dermatology research centers

The Committee has received testimony which indicates that research in dermatologic diseases has made major contributions recently in achieving better understanding of the basic causes of a number of important disorders. Included in the list of diseases in which significant advances have been made are epidermolysis bullosa, a severe and incapacitating hereditary blistering disease, psoriasis which affects approximately 2.5 million people in this country, malignant melanoma which is increasing at an alarming rate and is estimated to account for almost 6,000 deaths yearly, mycosis fungoides, a type of leukemia of the skin, and a number of allergic disorders including various types of ec

zema.

Furthermore, a dermatologic research is in the forefront of investigations into a number of important diseases including AIDS which often is first recognized because of the many skin manifestations of this dread disease.

The bill includes funds for NIAMS in the amount of $1,250,000 to support the creation of three dermatology core research centers for fundamental cutaneous biological research to be established at institutions with dermatology research programs of demonstrated excellence. These centers will serve as focal points for shared research in the use of innovative techniques which will lead to a better understanding at a basic level of a large number of skin diseases. The Committee has also included $100,000 to begin planning efforts for three additional dermatology core research centers.

1987 comparable appropriation. 1988 appropriation request. House allowance1.

Committee recommendation..

RESEARCH RESOURCES

1This does not include $25,661,000 provided for AIDS in another section.

$322,906,000

280,415,000

338,991,000

367,415,000

The Committee recommends an appropriation of $367,415,000 for research resources. This is $87,000,000 more than the administration request, $44,509,000 more than the fiscal year 1987 appropriation of $322,906,000, and $28,424,000 more than the House allowance.

The DRR develops, supports, and administers research resources through five multicategorical programs of specialized research facilities and environments that undergird the efforts of research scientists holding more than 5,800 PHS research grants, totaling in excess of $1,000,000,000.

Clinical research

The 78 general clinical research centers, which comprise the equivalent of a 600-bed research hospital, provide essential research environments for clinical investigators supported by PHS awards, and for recruiting young physicians into careers in clinical research. Over the past 2 years the Clinical Research Program has experienced a threefold increase in the use of these facilities to accommodate the increase in

AIDS-related research. Many of the centers are currently involved with studies defining the natural history of AIDS and the effect of treatment with either immunomodulating agents or drugs that affect the replication of the AIDS virus within cells.

The Committee is pleased with the efforts of DRR to encourage the development of nursing research protocols within clinical research centers. The Committee appreciates the support DRR has provided to the National Center for Nursing Research and nursing research within existing DRR programs. The Committee also appreciates DRR's efforts to ensure that native Hawaiians and other native American Pacific Islanders are encouraged to pursue careers in the behavioral and biological sciences.

The Committee strongly supports the development and utilization of alternative research models which do not rely on the use of animals. Among those alternatives is the National Disease Research Interchange [NDRI], whose mission is to ensure regular access to human tissues and organs for biomedical researchers throughout the country.

The Committee strongly supports the development and utilization of alternative research models which do not rely on the use of animals. One of those alternatives is the National Disease Research Interchange [NDRI], whose mission is to ensure regular access to human tissues and organs for biomedical researchers throughout the country. Another alternative, recommended by the National Research Council and elaborated on by the Santa Fe Institute, is the establishment of a knowledge base of biological data bases to be used as a tool in biomedical research. Such a data base would link a computer science group and a theoretical group in the biomedical sciences, with researchers who would utilize the system. Consistent with the congressional mandate directing NIH to develop research methods which do not rely on the use of animals, the Committee expects the Division of Research Resources, through the Biological Models and Materials Resources Section [BMMRS], to give efforts such as these high priority in fiscal year 1988.

Biomedical research technology

The biomedical research technology [BRT] Program administers resources that identify, develop, and provide access to advanced technologies needed in biomedical research. The program emphasizes biomedical computing, biomedical engineering, and technologies for the study of biomolecular and cellular structure and function. Researchers supported by this program have developed a new technique of using laser technology to integrate a gene directly into the human chromosome, a method of considerable potential value in genetic engineering. Other researchers supported by this program, at the BRT resource center at Stanford University, have developed a new diagnostic procedure-synchrotron radiation angiography. It is a much safer procedure than conventional x-ray angiography in that it requires no arterial catheter and reduces radiation exposure while promising to produce comparable results.