The NIDDK Celebrates its 75th Anniversary! – Chris Mullins, PhD – CAIRIBU

First, hello to the CAIRIBU community! Dr. Kris Penniston asked me to provide a few words from the NIDDK for this inaugural issue of the Trainee Newsletter and periodically in future issues. I’ll try to cover broad topics of relevance to you, including updates on research and training/career development opportunities, NIH grant preparation and review, summaries of new findings from NIDDK-sponsored study groups, and other news. Today, I will focus on a big milestone this year in the history of the NIDDK: Our 75^th Anniversary! I’ll review the Institute’s history and celebrate the work of the NIDDK Urology Program from the turn of the century to present as it evolves to advance science in our shared pursuit to improve the health of the American public.

The National Institute (still singular until the 1948 National Heart Act) of Health – as renamed in 1930 from the founding Hygienic Laboratory – began a period of growth following World War II in its grants program and through the proliferation of new, individual institutes. Between 1946 and 1949, the U.S. Congress created institutes for research on mental health, dental diseases, and heart disease. In 1948 the original NIH divisions were divided into the National Microbiological Institute (NMI) and the Experimental Biology and Medicine Institute (EMBI). President Harry S. Truman signed the Omnibus Medical Research Act into law in 1950 establishing the National Institute of Arthritis and Metabolic Diseases (NIAMD), which absorbed EMBI and expanded to include clinical investigation in rheumatic diseases, diabetes, and selected metabolic, endocrine, and gastrointestinal diseases (this began the work of the present day NIDDK). After a series of legislative name and mission changes over the next 30 plus years, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) split off and the resulting Institute was renamed the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) through the Health Research Extension Act of 1985.

As of 2024 the NIDDK was the fifth largest of the 27 Institutes and Centers comprising the NIH (by now very plural!) with a budget of approximately $2.3 billion – big growth from the 1986 budget of $544 million even after adjusting for inflation! The NIDDK is comprised of both Intramural (i.e., biomedical research conducted at laboratories and clinical facilities in Bethesda, MD and Phoenix, AZ) and Extramural (i.e., the funding component that supports research external to the NIH campus) Programs all under the leadership of the current NIDDK Director, Griffin P. Rodgers, MD. The NIDDK’s broad mission is to conduct and support medical research and research training and to disseminate science-based information on diabetes and other endocrine and metabolic diseases; digestive diseases, nutritional disorders, and obesity; and kidney, urologic, and hematologic diseases, all to improve health and quality of life. NIDDK-supported science has addressed this mission through untold breakthroughs – too many to list here. A few examples include development of SGLT2 inhibitors that lower blood sugar levels in Type 2 diabetes and can slow the progression of chronic kidney disease, improvements in management of Type 1 diabetes through demonstrating the critical nature of early glucose control and creation of artificial pancreas devices, and discovery of the hepatitis B virus protein that proved critical for prevention and management strategies for hepatitis and liver cancer, among many others.

Of the three NIDDK Extramural Program Divisions, the Division of Kidney, Urologic and Hematologic Diseases (KUH) is the NIH’s primary home for non-cancer urologic research and training. The KUH Urology Program mission interests encompass benign prostatic hyperplasia (BPH), urinary incontinence, urinary tract infections, stone disease, erectile dysfunction, urologic chronic pelvic pain syndrome, congenital urologic disorders, repair and regeneration of lower urinary tract organs, and lower urinary tract development and physiology.

Like the overall NIDDK, the Urology Program has experienced vast growth, notably from the early 2000s-to-present. Funding trends in recent years reveal an upward trend in total awarded dollars for urology research even outpacing the general NIDDK increase. This includes successes in supporting junior and early stage investigators (a big priority in urology). During this period KUH expanded internal Programmatic expertise for urology and newly emphasized integration of broad disciplines outside the traditional community, as well as patient input, into funded research. This corresponded with important scientific advances, such as initiation in 2001 of the first of its kind Urologic Diseases in America (UDA) project that through its regular UDA Compendium continues to document the impact of urologic diseases on the American public, publication of the landmark Medical Therapy of Prostatic Symptoms (MTOPS) Study clinical trial results in 2003 showing combination medical therapy as more effective over single therapy for reducing the risk of BPH clinical progression; and a broad expansion and diversification of the Urology Centers Program from its inception as the George M. O’Brien Urology Centers in 1987. This included introduction of several new types of P20 Research Centers from 2010-2021 and the Urology Centers Program Interactions Core (formalized from a pilot in 2020) and in 2018 initiation of Collaborating for the Advancement of Interdisciplinary Research in Benign Urology (CARIBU) as a newly assembled community of researchers and trainees involved in the study of urologic disease.

In the last 15 years the Urology Program also initiated a surge of new and innovative clinical consortia that have yielded major progress in diverse mission areas. For example, the Multi-disciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network (est. 2008) and the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) (est. 2012) have generated new insights into pathophysiology and risk factors, identified patient sub-groups (phenotypes) based on symptom profiles and associated biological correlates, and generated powerful tools for clinical characterization for Urologic Chronic Pelvic Pain Syndrome and broad lower urinary tract disorders, respectively. These studies have now positioned the field for new, targeted clinical trials founded in a greatly expanded evidence base. The Prevention of Lower Urinary Tract Symptoms (PLUS) Consortium (est. 2015), a novel patient-oriented, population-based effort, has helped define the “healthy bladder” and informed strategies to improve lower urinary tract health in women and girls. In addition, the Urinary Stone Disease Research Network (USDRN) (est. 2015) performed the largest-to-date clinical trial assessing how behavioral modification moderating water intake may impact stone recurrence and also defined risk factors for ureteral stent-associated pain following ureteroscopy.

Concurrent with these research efforts, the Urology Program created multiple career development awards to build the non-malignant urologic research and clinical community. These included the Multidisciplinary K12 Urologic Research (KURe) Career Development Program in 2008 to assist investigators with doctoral degrees develop skills for an independent career in urological research and the Urological Epidemiology (UroEpi) Institutional Research Career Development Program in 2016 to support development of skills necessary for a career in urologic disease epidemiology. These urology-specific awards complement numerous other NIDDK training and career development opportunities that enhance the urologic community, such as the more recent Institutional Network Award for Promoting Kidney, Urologic and Hematologic Research Training (U2C/TL1) program launched in 2020.

Collectively, the diversity and success of these efforts illustrate the NIDDK’s continuing commitment to biomedical research and training the next generation(s) of investigators. Such work at the NIDDK, as well as the other NIH Institutes and Centers, supports exciting future discoveries and still unimagined treatments for diseases and disorders afflicting the American people.

I hope this brief walk through the NIDDK’s history, and the more recent work of the Urology Program was interesting and that you’ll find these columns informative, as well as encouraging, as we face new challenges and look for new opportunities to support our field and ultimately improve urologic health during changing times.

Best regards,