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DEPARTMENT OF HEALTH AND HUMAN SERVICES

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute (NHLBI)

FY 2019 Budget Page No.

Organization Chart...........................................................................................................................2

Appropriation Language ..................................................................................................................3

Amounts Available for Obligation...................................................................................................4

Budget Graphs .................................................................................................................................5

Authorizing Legislation ...................................................................................................................6

Appropriations History ....................................................................................................................7

Justification of Budget Request .......................................................................................................8

Detail of Full-Time Equivalent Employment (FTE) .....................................................................18

Detail of Positions..........................................................................................................................19
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NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

For carrying out section 301 and title IV of the PHS Act with respect to cardiovascular, lung, 

and blood diseases, and blood and blood products, $2,237,268,000$3,112,032,000.
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Source of Funding FY 2017 Final FY 2018 Annualized 

CR

FY 2019 President's 

Budget

Appropriation $3,206,589 $3,206,589 $3,112,032

Mandatory Appropriation: (non-add)

Type 1 Diabetes (0) (0) (0)

Other Mandatory financing (0) (0) (0)

Rescission 0 -21,776 0

Sequestration 0 0 0

Secretary's Transfer -7,152 0 0

Subtotal, adjusted appropriation $3,199,437 $3,184,813 $3,112,032

OAR HIV/AIDS Transfers 10,492 0 0

Subtotal, adjusted budget authority $3,209,929 $3,184,813 $3,112,032

Unobligated balance, start of year 0 0 0

Unobligated balance, end of year 0 0 0

Subtotal, adjusted budget authority $3,209,929 $3,184,813 $3,112,032

Unobligated balance lapsing -86 0 0

Total obligations $3,209,843 $3,184,813 $3,112,032

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Amounts Available for Obligation1

(Dollars in Thousands)

1 Excludes the following amounts for reimbursable activities carried out by this account:

 FY 2017 - $17,559 FY 2018 - $17,904 FY 2019 - $15,603 
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Fiscal Year 2019 Budget Graphs

History of Budget Authority and FTEs:
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PHS Act/

Other Citation

U.S. Code

Citation

FY 2018 Annualized CR FY 2019 President's Budget

Section 301

Section 401(a) 42§281 Indefinite

Total, Budget Authority $3,184,813,054 $3,112,032,000

National Heart, Lung, and Blood Institute

$3,112,032,000 $3,184,813,054

Indefinite

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Authorizing Legislation

2018 Amount

Authorized

2019 Amount

Authorized

Research and Investigation 42§241 Indefinite Indefinite
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Budget Estimate to 

Congress House Allowance Senate Allowance Appropriation

$2,924,942,000 $3,025,500,000 $3,006,344,000 $3,015,689,000

$0

$3,050,356,000 $3,123,403,000 $3,066,827,000 $3,096,916,000

$0

$3,187,516,000 $3,182,524,000 $3,096,916,000

$27,192,768

$3,147,992,000 $3,147,992,000 $3,036,189,000 $3,084,851,000

$5,830,368

$3,076,067,000 $3,085,390,000 $3,079,020,632

$6,158,041

($154,545,663)

$3,098,508,000 $3,077,916,000 $2,988,605,000

$0

$2,987,685,000 $2,997,870,000

$0

$3,071,906,000 $3,035,062,000 $3,135,519,000 $3,115,538,000

$0

$3,113,533,000 $3,190,474,000 $3,242,685,000 $3,206,589,000

$0

$2,534,803,000 $3,256,521,000 $3,322,774,000 $3,206,589,000

$21,775,946

$3,112,032,000

1

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Appropriations History

Fiscal Year

2009

Rescission

2010

Rescission

2011

Rescission

2012

Rescission

2013

Rescission

Sequestration

2014

Rescission

2015

Rescission

2018

Rescission

2019

Budget Estimate to Congress includes mandatory financing.

2016

Rescission

20171

Rescission
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Justification of Budget Request

National Heart, Lung, and Blood Institute

Authorizing Legislation: Section 301 and title IV of the Public Health Service Act, as amended.

Budget Authority (BA):

FY 2017

Actual

FY 2018

Annualized 

CR*

FY 2019 President’s

Budget

FY 2019 +/-

FY 2018

BA $3,209,929,000 $3,184,813,000 $3,112,032,000 -$72,781,000

FTE 955 962 962 0

*this amount is rounded.

Program funds are allocated as follows: Competitive Grants/Cooperative Agreements; 

Contracts; Direct Federal/Intramural and Other.

Director’s Overview

The National Heart, Lung, and Blood Institute (NHLBI) will continue its strong tradition of 

supporting research to better understand the basic biology of the heart, lungs, blood, and sleep –

and to prevent and treat the disorders that occur when these organs and systems break down.

Public health outcomes that once seemed impossible are now within reach. In FY 2019, NHLBI 

will leverage emerging scientific opportunities to improve health and longevity for the millions 

of Americans suffering from heart, lung, blood, and sleep disorders. 

The Institute will explore gene editing technologies to accelerate the development of new cures 

for sickle cell disease. NHLBI’s growing precision medicine efforts will mine genomic data and 

other information about disease pathways to inform the development of more personalized

treatments. Working in partnership with the Food and Drug Administration (FDA), NHLBI will 

continue to advance the field of regenerative medicine. Moreover, by engaging with diverse 

communities, the Institute will improve the adoption of evidence-based interventions and reduce 

the impact of treatable health problems such as obesity. These efforts will be coupled to 

programs to nurture a diverse, talented generation of researchers to meet tomorrow’s public 

health challenges head on. 

Investing in Basic Research to Understand Health and Disease

NHLBI’s support of fundamental discovery science continues to make essential contributions to 

our understanding of normal biology and mechanisms of disease, and to the development of new 

approaches to prevent, diagnose, and treat heart, lung, blood, and sleep disorders. 

For example, basic research has helped reveal how stem cells build the lung’s complex 

architecture during development, and how stem-like cells remaining in the adult lung might be 

used to repair a damaged lung. In an NHLBI-funded study, researchers used prior knowledge 

about genes and molecules involved in lung development to provide visual signatures for unique
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lung cell types.1 They found two distinct populations of cells, MANC and AMP, that had 

distinct responses to injury. MANC cells promoted the growth and regeneration of functional 

lung tissue; whereas AMP cells promoted the creation of fibrous connective tissue, a harmful 

response and a known contributor to chronic lung diseases like idiopathic pulmonary fibrosis. 

This discovery may pave the way for new therapeutic approaches that tap into developmental 

pathways to promote recovery of healthy lung tissue and inhibit formation of scar tissue.

The Power of Data to Personalize Medicine

The NHLBI Trans-Omics for Precision Medicine program (TOPMed) has genomic data from 

about 120,000 diverse individuals enrolled in more than 60 NHLBI-funded studies. These data

will be analyzed along with data on medical history, socioeconomic status, lifestyle and 

environmental factors, imaging, and biomarkers – with the goal of discovering new disease 

pathways and developing more personalized interventions. The TOPMed dataset was one of 

three selected for inclusion in a pilot launch of the NIH Data Commons, a new public-private 

partnership that NIH will use to bring research findings into a cloud-computing environment 

with state-of-the-art data management and analysis tools to enhance data sharing, collaboration,

and innovation.

The Institute also recently provided early, open access to the complete primary dataset from the 

Systolic Blood Pressure Intervention Trial (SPRINT). This NHLBI-funded trial found that

intensive blood pressure treatment can reduce heart attacks, strokes, and death in high-risk adults 

over 50 years of age. The SPRINT Data Analysis Challenge, conducted in partnership with the 

New England Journal of Medicine, invited researchers to propose and explore new scientific 

questions based on the trial’s primary data.2

 The Challenge attracted global participations, with 

approximately 16,000 followers on social media, 200 competing teams, and three final winners 

who presented at a national conference. The winning team developed a tool that enables 

clinicians to quickly assess whether intensive blood pressure management is appropriate for a 

specific patient. 

Understanding Population Differences to Reduce Health Disparities

Fueled by progress in preventing and treating cardiovascular diseases (CVD), the Nation has 

experienced substantial declines in CVD death rates over the past 35 years. Yet many groups,

defined by gender, race, ethnicity, age, socioeconomic status, and geography, continue to 

experience a high risk of CVD and poor outcomes. A recent study found high CVD mortality 

rates throughout the U.S. heartland, from southeastern Oklahoma to eastern Kentucky.

3 Having 

such regional data can help inform efforts to reduce CVD mortality in high-burden communities.

For example, researchers with NHLBI’s Strong Heart Study are partnering with educators to 

implement a CVD prevention program in ten medically underserved Montana towns. In rural 

North Carolina, researchers are studying the use of mobile health technology to improve CVD 

education and prevention efforts.

4

 A new NHLBI initiative, DECIPHeR, will solicit and 

 1 Zepp, JA et al. Cell, 2017. https://www.ncbi.nlm.nih.gov/pubmed/28886382 2 https://challenge.nejm.org/pages/home

3 Roth, GA et al. JAMA, 2017. https://www.ncbi.nlm.nih.gov/pubmed/28510678 4 See 5R01HL120702-04 and 5R01HL120690-04 at https://projectreporter.nih.gov 
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coordinate further studies of this kind, to explore how evidence-based interventions can be 

adapted to the needs, resources, and sociocultural norms of diverse communities across the U.S.

Nurturing a Diverse and Talented Biomedical Workforce

NHLBI is committed to developing, sustaining, and strengthening a robust biomedical workforce 

that reflects the Nation’s diversity and breadth of talent.

NHLBI is finding other innovative ways to increase support for early-stage investigators. In FY 

2017, a new program5 issued its first awards to support 39 emerging and outstanding 

investigators who are conducting high-risk, high-reward research. NHLBI also offers short-term 

bridge awards to promising scientists so that they can stay productive and have time to compete

for longer-term funding. The Institute is committed to bringing more physicians into the 

research workforce, and a new program launched in FY 2018 – Stimulating Access to Research 

in Residency – will help train more clinician-scientists. These and other ongoing NHLBI 

programs align with NIH’s Next Generation Researchers Initiative.

Advancing Stem Cell Science for Safe and Effective Regenerative Medicine

NHLBI has taken a lead role in managing the Regenerative Medicine Innovation Project (RMIP)

under the 21st Century Cures Act.6 The Act authorized NIH, in coordination with FDA, to invest 

$30 million in clinical research with adult stem cells over four years, beginning in FY 2017.

Working closely with FDA, a trans-NIH Regenerative Medicine working group led by NHLBI 

solicited research proposals from the regenerative medicine community, leading to eight projects 

that cover a broad spectrum of science and new technologies, and have the potential to advance 

understanding and treatment of common diseases – including diabetes, anemia, corneal and other 

eye diseases, and chronic skin ulcers – as well as rare diseases, including idiopathic pulmonary 

fibrosis, inherited skin diseases, and sickle cell disease. NIH will continue to work with FDA to 

engage the research community and to solicit new applications under the RMIP to bring the use 

of adult stem cells safely into clinical practice.

Program Descriptions and Accomplishments

Cardiovascular Diseases

This program supports research to advance understanding, prevention, and treatment of pediatric 

and adult cardiovascular diseases (CVD), including heart attack, heart failure, stroke, and 

congenital heart disease. Additionally, the program supports the development of innovative 

technologies for early detection and intervention in patients with CVD. 

Although CVD is often considered a disease of aging, the program’s comprehensive portfolio is 

aimed at keeping the heart healthy across the entire lifespan. This approach recognizes that risk 

factors for CVD, such as unhealthy behaviors (e.g., smoking) or an unhealthy environment (e.g., 

second-hand smoke), can start in childhood and persist long after. Researchers with NHLBI’s 

Coronary Artery Risk Development in Young Adults (CARDIA) Study have found that a risk 

 5 https://grants.nih.gov/grants/guide/rfa-files/RFA-HL-16-024.html 6 https://www.nih.gov/research-training/medical-research-initiatives/rmi
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calculator based on lifestyle measures can be used to estimate cardiovascular risk 25 years out, 

and may be a useful tool in CVD prevention efforts targeting young people.

7

In addition to prevention efforts, NHLBI is investing in new ways to treat CVD. For example, 

NHLBI-funded researchers have learned that inflammation plays an important role in CVD, and 

have identified specific inflammatory pathways as targets for therapy. Since the 1970s, NHLBI 

has supported basic research on a secreted protein called Interleukin-1 (IL-1) and its role in 

atherosclerosis, a disease that involves inflammation within arteries and is a significant 

underlying cause of cardiovascular events such as heart attack and stroke. 

This 40-year investment into research on IL-1 is paying off in the form of new therapies being 

tested in clinical trials. An industry-sponsored study published in 2017 showed that 

Canakinumab, a drug that targets inflammation, reduced the risk of heart attacks, strokes, and 

death by 15 percent among people who had survived a prior heart attack.8 A current NHLBIfunded study, the Cardiovascular Inflammation Reduction Trial (CIRT), is testing methotrexate, 

a less expensive anti-inflammatory drug, to determine if it reduces heart attacks, strokes, or death 

in people who have multiple coronary blockages or have experienced a prior heart attack.9

Another line of research points to a potential new therapeutic approach for patients with heart 

failure. The adult human heart has little regenerative capacity under normal conditions, but 

NHLBI-funded researchers have found new evidence that the failing heart has the capacity to 

repair itself. In a study on mice with heart failure, they found that by interrupting a signaling

pathway that normally represses survival genes in heart muscle cells, they were able to improve 

heart function in the mice.10

 7 Gooding, HC et al. JAMA Intern Med, 2017. https://www.ncbi.nlm.nih.gov/pubmed/28715555 8 Ridker, PM et al. NEJM, 2017. https://www.ncbi.nlm.nih.gov/pubmed/28845751 9 https://projectreporter.nih.gov/project_info_description.cfm?aid=9266464

10 Leach, JP et al. Nature, 2017. https://www.ncbi.nlm.nih.gov/pubmed/28976966
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Program Portrait: Addressing HIV-related Comorbidities

The human immunodeficiency virus (HIV) epidemic is evolving. Once a death sentence, HIV infection has become 

a chronic, manageable disease thanks to antiretroviral therapies (ART). People with HIV are living longer, healthier 

lives, but as they age, they also face unique susceptibilities to age-related cardiovascular disease (CVD). For 

example, people with HIV have a two to ten-fold greater risk of venous thromboembolism (a blood clot in a vein) 

and an approximately two-fold greater risk of heart attack compared to people without HIV.11 By 2030, it is 

estimated that 78 percent of HIV-positive individuals will be diagnosed with some form of CVD.12

NHLBI has been at the forefront of efforts to address CVD among people with HIV. For example, in FY 2014, in 

collaboration with the National Institute of Allergy and Infectious Diseases, NHLBI began funding the Randomized 

Trial to Prevent Vascular Events in HIV (REPRIEVE) study. This is the first large-scale clinical trial to test whether 

a daily dose of lipid-lowering medication (pitavastatin) can reduce the risk of heart disease among HIV-infected 

individuals.13

In addition to CVD, researchers are learning that there is an exceptionally high prevalence of chronic lung diseases 

and sleep disorders among older people with HIV, as well as blood disorders that may occur as a complication of 

ART. Thus, while preventing and curing HIV infection remains a high priority, researchers from different 

disciplines are also mobilizing to understand and reduce the impact of these comorbidities. To facilitate this effort, 

two established population studies that NIH has funded for several decades will now be followed and analyzed as a 

combined cohort. The Multicenter AIDS Cohort Study (MACS) started in 1984, and includes more than 2,000 men; 

the Women’s Interagency HIV Study (WIHS) started in 1994, and includes more than 2,300 women. Both studies 

include HIV-positive and HIV-negative participants. If appropriations allow, awards to support this combined 

cohort study will be issued in FY 2019, with NHLBI acting as the primary steward in close collaboration with 11 cofunding Institutes.

Lung Diseases

This program conducts and supports research that expands our understanding of lung biology 

and how lung diseases start and progress, as well as basic and clinical studies that lead to new 

and improved ways to diagnose, treat, and prevent lung diseases. Research areas include asthma, 

chronic obstructive pulmonary disease (COPD), cystic fibrosis, sleep-disordered breathing, 

pulmonary fibrosis, lymphangioleiomyomatosis (LAM), pulmonary complications of AIDS and 

tuberculosis, pediatric lung diseases, and more. 

Among these diseases, COPD takes the greatest toll in terms of sheer numbers, affecting 16 

million Americans and causing more deaths each year than any other disease but CVD or cancer.

To confront this national health problem, NHLBI collaborated with Federal agencies, patients, 

caregivers, health care providers, non-profit organizations, and others to develop a COPD 

National Action Plan.

14 Finalized and released in May 2017, the plan is organized around five 

goals: To empower the COPD community to recognize and reduce the burden of COPD; to 

improve the diagnosis, prevention, treatment, and management of COPD; to collect, analyze, 

report, and disseminate COPD-related public health data; to increase and sustain research related 

to COPD; and to translate national policy, educational, and program recommendations into

research and public health care actions. Since the release of the plan, NHLBI’s Division of Lung 

Diseases has continued to work closely with other Federal agencies, medical and scientific 

 11 Funderburg, NT et al. Thrombosis Research, 2014. https://www.ncbi.nlm.nih.gov/pubmed/24759134 12 Smit, M et.al. Lancet Infectious Diseases 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4528076/ 13 https://clinicaltrials.gov/ct2/show/NCT02344290 14 https://www.nhlbi.nih.gov/health-pro/resources/lung/copd-national-action-plan
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organizations, and patient advocacy groups to ensure that the collaboration so important to the 

plan’s development continues and drives the plan’s implementation.

At the same time, guided by the plan and the Institute’s Strategic Vision, NHLBI continues to 

support research to better understand COPD and develop more effective interventions against it. 

For example, NHLBI’s Subpopulations and Intermediate Outcome Measures in COPD 

(SPIROMICS) study is looking at genetic, clinical, biological, and other data including lung 

imaging, to help understand risk factors for COPD and poor outcomes from the disease.

Data from the Centers for Disease Control and Prevention show that women are more likely to 

die from COPD than men,15 and new research shows that genetic factors may play a role in this. 

In one study, researchers analyzed genetic data from more than 10,000 current and former 

smokers with COPD and found that variations in a fetal lung development gene, CELSR1, were 

associated with COPD in women, but not men.16 Identification of further sex-specific risk 

factors and pathways may enable new interventions to reduce death and disability from COPD in 

women. 

Genetic and disease pathway information is also helping researchers develop more precisely 

tailored interventions for severe asthma. Prior NHLBI-funded research has demonstrated that 

symptoms and long-term outcomes of severe asthma can differ significantly from patient to 

patient, which has led to the identification of several clinical asthma subtypes.17 Building from 

this information, NHLBI is supporting a new Precision Interventions for Severe and 

Exacerbation Prone Asthma (PrecISE) Network, in which targeted interventions will be guided 

by biomarkers specific to different asthma subtypes. Moreover, PrecISE will use a sequential, 

adaptive trial design allowing researchers to continuously analyze data as it is collected, to add 

new biomarkers for distinct asthma types, and to adjust the trial interventions as needed.18

Translational and clinical research programs, such as the Centers for Advanced Diagnostics and 

Experimental Therapeutics in Lung Diseases (CADET), are helping translate new knowledge 

about disease mechanisms into new therapies. As researchers learn more about the inflammatory 

pathways involved in lung diseases, treatments are moving beyond steroids into a first wave of 

new therapeutics that target inflammation, such as compounds that target FBXO3, a protein 

known to promote inflammation. Other potential therapies under development are focusing on 

breaking apart mucus to improve airflow.19

Researchers are also beginning to understand how cellular aging contributes to the risk and 

progression of idiopathic pulmonary fibrosis (IPF). A recent NHLBI-supported study showed 

that aging cells, without the capacity to produce new lung tissue, are increased in the lungs of 

patients with IPF and contribute to disease progression in a mouse model of IPF.

20 Selective 

 15 http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/learn-about-copd/how-serious-iscopd.html

16 Hardin, M et.al. Am J Respir Cell Mol Biol, 2017. https://www.ncbi.nlm.nih.gov/pubmed/27854507/ 17 http://www.severeasthma.org/home.html 18 https://grants.nih.gov/grants/guide/rfa-files/RFA-HL-17-010.html

19 Livraghi-Betrico, A et al. Mucosal Immunol 2017.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5250616/

20Schafer, MJ et al. Nat Communications 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5331226/
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elimination of these aged cells improved lung health in the IPF mouse models. Other NHLBIfunded studies are revealing how the age-related shortening of telomeres, the caps on the ends of 

chromosomes, is associated with IPF and may be a useful diagnostic tool.21

Program Portrait: Supporting Women’s Health During and After Pregnancy

For reproductive-age women, health complications during pregnancy are a serious concern, particularly for women 

giving birth to their first child. To better understand and predict the health risks facing first-time mothers, the 

Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) is examining the risk factors 

associated with adverse pregnancy outcomes in a cohort of more than 10,000 women of geographically and 

ethnically diverse backgrounds. Past studies provided evidence to support a link between the risk of cardiovascular 

disease and certain pregnancy complications, including gestational hypertension and preeclampsia – which is 

marked by hypertension and elevated protein in urine. However, these studies lacked sufficient cohort sizes and 

often did not include measurements of biological markers. NHLBI is collaborating with the National Institute of 

Child Health and Human Development (NICHD) to fund extended analyses of the nuMoM2b cohort, specifically 

examining the links between pregnancy, sleep health, and cardiovascular outcomes.

In 2011, NHLBI and NICHD began the nuMoM2b Sleep-Disordered Breathing Study, which has found that 

pregnant women with obstructive sleep apnea (interrupted breathing during sleep) have an increased risk of 

hypertensive disorders and diabetes during pregnancy. In 2018, NHLBI and NICHD will build on this finding and 

launch a phase III clinical trial to determine whether treatment of sleep apnea reduces the risk of gestational 

hypertension, diabetes, and pre-eclampsia. NHLBI also has launched the nuMoM2b Heart Health Study to assess 

how sleep-disordered breathing contributes to risk of cardiovascular disease and other adverse outcomes after

pregnancy, which may lead to targeted screening and intervention protocols. 

Blood Diseases

This program supports research on the causes, prevention, and treatment of non-cancerous blood 

diseases including anemias, such as sickle cell disease and thalassemia; venous 

thromboembolism; malaria; and hemophilia. The program also assumes major responsibility in 

ensuring the adequacy and safety of the Nation’s blood supply and in supporting scientific 

advances in stem cell biology, and new gene and cell-based therapies to repair and regenerate 

human tissues.

In recent years, there has been encouraging progress in understanding the intricate machinery 

and behavior of diverse cell types in the blood, which is yielding promising drug targets for 

blood disorders. For example, recent studies highlight the importance of autophagy; this is a 

naturally occurring process that helps cells stay healthy by recycling or destroying nonfunctional proteins and other cell components that can become toxic. In one recent NHLBIfunded study, researchers used patient-derived cells to screen for potential drugs to treat a rare

blood disorder, Diamond-Blackfan anemia (DBA), which affects the ability of bone marrow to 

produce red blood cells. By testing more than 1,200 small molecules on cells from DBA 

patients, the researchers found one molecule that enhanced the production of red blood cells by 

stimulating autophagy.

22 This study could serve as a model for future large-scale genetic and 

chemical screens to identify potential drug therapies for a variety of blood disorders. 

 21 Newton, CA et al. JHLT, 2017. https://www.ncbi.nlm.nih.gov/pubmed/28262440 22 Doulatov, S et al. Science Trans Med 2017. https://www.ncbi.nlm.nih.gov/pubmed/28179501
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Another recent study found that autophagy also may be involved in helping preserve the 

regenerative capacity of blood-forming cells, called hematopoietic stem cells, as they age.23 The 

potential to modulate autophagy and thus improve the functional lifespan of these stem cells 

could lead to new approaches for stabilizing a patient’s blood supply without relying entirely on 

blood donation and transfusion. 

Other new research shows that certain types of hematopoietic stem cells can be generated in an 

unexpected place – the lungs. While bone marrow is known to be the body’s major source of 

hematopoietic stem cells, NHLBI-funded researchers recently found that the lungs contain stem 

cells that can produce some types of immune cells, as well as platelets, the cells that accumulate 

to create blood clots and stop bleeding.24 Further study of hematopoietic stem cells in the lungs 

could reveal pathways and signals for platelet production distinct from those in bone marrow, 

and thus lead to new strategies to treat platelet deficiency, which is common in people with 

cancer and certain viral infections, including HIV.

NHLBI researchers also are working to bring more effective treatments to patients with

hemophilia, a blood-clotting disorder that causes a risk of severe bleeding, even from relatively 

minor wounds. The current standard treatment, developed in part through NHLBI-funded 

research, is replacement therapy – in which clotting factors (Factors VIII or IX) are infused into 

the patient’s bloodstream. However, in some patients, factor replacement therapy triggers an 

immune response that limits it effectiveness. Thus, new alternative therapies, including gene and 

cell therapy techniques, are being developed and tested. For example, an NHLBI-funded clinical 

trial is testing the safety and efficacy of gene therapy in men with hemophilia B.25 Early 

promising results show that close to half of the men who received the normal factor IX gene 

were able to stop their regular replacement therapy.26 NHLBI also is supporting new research

centers that will focus on strategies for preventing or eliminating the immune response to factor 

replacement therapy.

27

The blood disease program also is playing a lead role in working with investigators across the 

country to accelerate cures for sickle cell disease and thalassemias as part of the NIH Sickle Cell 

Cures Initiative, which is expected to deliver new therapies to patients within five years. 

 23 Ho, TT et al. Nature 2017. https://www.ncbi.nlm.nih.gov/pubmed/28241143 24 Lefrançais, M et al. Nature 2017. https://www.ncbi.nlm.nih.gov/pubmed/28329764 25 https://clinicaltrials.gov/ct2/show/study/NCT00979238 26 Nathwani, AC et al. NEJM 2014. https://www.ncbi.nlm.nih.gov/pubmed/25409372 27 https://grants.nih.gov/grants/guide/rfa-files/RFA-HL-18-014.html
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Program Portrait: Sickle Cell Cures Initiative 

As many as 100,000 people nationwide, most of them African American, have sickle cell disease (SCD), in which 

red blood cells take on a sickle shape and can block the flow of blood to the body, leading to frequent pain. 

Although a bone marrow transplant can cure the disease for young patients who have an immunologically matched 

donor, this treatment is not an option for many patients.

However, thanks to NHLBI-funded research, a cure that works for all SCD patients is within sight. SCD is caused 

by a mutation in hemoglobin—the protein that carries oxygen in red blood cells. Building on a foundation of basic 

research on hemoglobin, coupled with exciting recent advances in gene editing technology, researchers are now able 

to correct for this mutation in laboratory studies. NIH and NHLBI are leveraging these advances to launch a Sickle 

Cell Cures Initiative that will mobilize researchers to develop and deliver new therapies to patients within the next 

five years. 

The framework for the Sickle Cell Cures initiative is based in part on an NHLBI workshop held in March 2017, 

“Accelerating Cures in Hemoglobinopathies,” which brought together top researchers and industry leaders. The 

initiative will include establishing a consortium of professionals and patients to accelerate promising new gene- and 

cell-based therapies. To save costs and maximize gains from existing resources, the initiative will coordinate 

ongoing NHLBI-funded clinical trials and support the manufacture of new cell-based therapies through NHLBI’s 

Production Assistance for Cellular Therapies (PACT) program. 

Intramural Research

The Intramural Research Program provides a unique environment for conducting innovative 

basic and clinical research at laboratories on the NIH campus, including studies at the NIH 

Clinical Center, often conducted in partnership with local hospitals. The program provides 

opportunities for scientists and trainees to work together towards a better understanding of 

molecular, cellular, and organ physiology, and ultimately the treatment of human diseases.

The NHLBI intramural program is leading the world’s most cutting-edge research and clinical 

trials on sickle cell disease (SCD), a rare blood disorder caused by a genetic mutation. While 

certain medications can reduce pain and hospitalizations from SCD, and a bone marrow 

transplant can effectively cure the disease for some patients, there is currently no cure that works 

for everyone. Because bone marrow typically must come from an immunologically matched 

relative, this treatment is not a viable option for most patients. To make such transplants more 

widely applicable, intramural researchers have developed a new protocol and are now testing it 

in a clinical trial; known as a haploidentical transplantation, it involves obtaining bone marrow 

from a parent, child, or sibling of the patient who is a partial immunological match.28

Researchers are also working to develop gene- and cell-based therapies that are effective and 

safe for all patients. Recognizing that bone marrow stem cells produce all types of blood cells 

for the life of the patient, one strategy involves genetic approaches to replace or repair bone 

marrow stem cells. By using the patient’s own bone marrow stem cells, researchers can replace 

a faulty hemoglobin gene or edit the misspelled gene and transplant the corrected cells back into 

the patient, without the risk of immune rejection. This remarkable progress, the diligence and 

creativity of NHLBI intramural researchers, and the heroic contributions of patients with SCD,

were featured in the First in Human documentary series about research at that NIH Clinical 

Center. 

 28 Bauer, DE et al. Blood Cells, Molecules and Diseases 2017. https://www.ncbi.nlm.nih.gov/pubmed/28893518
NHLBI-17

Intramural researchers are also leading the way in developing imaging techniques to monitor 

sub-cellular structures and processes, in animals and humans. Using high-speed microcopy to 

capture real-time imaging of artery perfusion and permeability in mouse blood vessels, one team

found that pressure changes within arteries are transmitted to and absorbed by the endothelial 

basement membrane, which may protect endothelial cells from mechanical forces caused by 

changes in blood pressure.29

Research Management and Support (RMS)

RMS activities include administrative and technical functions that support and enhance the 

effectiveness of the Institute’s research investments. This includes providing administrative, 

budgetary, logistical, and scientific support in the review, award, and monitoring of research 

grants and clinical trials, training awards, and research and development contracts. RMS 

functions also encompass strategic planning, trans-NHLBI and NIH coordination, evaluation of 

the Institute’s programs, regulatory compliance, international coordination, interactions with 

other Federal agencies and Congress, and dissemination of research findings to the public.

 29 Lucotte, BM et al. PNAS 2017. https://www.ncbi.nlm.nih.gov/pubmed/28373558
NHLBI-18

Civilian Military Total Civilian Military Total Civilian Military Total

Center for Translation Research and Implementation Science

Direct: 15 3 18 18 3 21 18 3 21

Reimbursable: - - - - - - - - -

Total: 15 3 18 18 3 21 18 3 21

Division of Blood and Resources

Direct: 33 - 33 31 - 31 31 - 31

Reimbursable: - - - - - - - - -

Total: 33 - 33 31 - 31 31 - 31

Division of Cardiovascular Sciences

Direct: 124 1 125 120 2 122 120 2 122

Reimbursable: - - - - - - - - -

Total: 124 1 125 120 2 122 120 2 122

Division of Extramural Research Activities

Direct: 92 - 92 91 - 91 91 - 91

Reimbursable: - - - - - - - - -

Total: 92 - 92 91 - 91 91 - 91

Division of Intramural Research

Direct: 446 8 454 446 12 458 446 12 458

Reimbursable: 38 1 39 38 1 39 38 1 39

Total: 484 9 493 484 13 497 484 13 497

Division of Lung Diseases

Direct: 31 - 31 33 - 33 33 - 33

Reimbursable: - - - - - - - - -

Total: 31 - 31 33 - 33 33 - 33

Office of the Director

Direct: 135 4 139 142 1 143 142 1 143

Reimbursable: 23 1 24 23 1 24 23 1 24

Total: 158 5 163 165 2 167 165 2 167

Total 937 18 955 942 20 962 942 20 962

FTEs supported by funds from Cooperative Research and 

Development Agreements. 0 0 0 0 0 0 0 0 0

FISCAL YEAR

2015

2016

2017

2018

2019

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Detail of Full-Time Equivalent Employment (FTE)

OFFICE/DIVISION

FY 2017 Final FY 2018 Annualized CR FY 2019 President's Budget

Includes FTEs whose payroll obligations are supported by the NIH Common Fund.

12.6

Average GS Grade

12.5

12.5

12.6

12.6
NHLBI-19

FY 2017 Final FY 2018 Annualized 

CR

FY 2019 President's 

Budget

2 2 2

357,923 364,902 368,047

92 92 92

158 158 158

194 194 194

75 78 78

54 54 54

0 0 0

44 44 44

9 9 9

9 9 9

3 3 3

0 0 0

7 7 7

3 3 3

1 1 1

1 1 1

650 653 653

0 0 0

2 2 2

6 6 6

6 7 7

3 4 4

1 1 1

0 0 0

18 20 20

329 329 329

662 685 685

959 996 996

955 962 962

178,962 182,451 184,024

12.6 12.6 12.6

110,769 112,929 113,903

1

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Detail of Positions1

GRADE

Total, ES Positions

Total, ES Salary

GM/GS-15

GM/GS-14

GM/GS-13

GS-12

GS-11

GS-10

GS-9

GS-8

GS-7

GS-6

GS-5

GS-4

GS-3

GS-2

GS-1

Subtotal

Grades established by Act of July 1, 1944 (42 U.S.C. 207)

Assistant Surgeon General

Director Grade

Senior Grade

Full Grade

Senior Assistant Grade

Assistant Grade

Subtotal

Ungraded

Average ES salary

Average GM/GS grade

Average GM/GS salary

Includes FTEs whose payroll obligations are supported by the NIH Common Fund.

Total permanent positions

Total positions, end of year

Total full-time equivalent (FTE) employment, end of year