COOPERATIVE CLINICAL TRIAL: PEDIATRIC RENAL TRANSPLANTATION Release Date: May 21, 1998 RFA: AI-98-012 P.T. National Institute of Allergy and Infectious Diseases Letter of Intent Receipt Date: July 21, 1998 Application Receipt Date: December 29, 1998 PURPOSE The National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), invites applications from consortia of institutions to participate in a multi-center, cooperative clinical trial program to improve graft acceptance and patient/graft survival in pediatric kidney transplant recipients up to 21 years of age. The goals of this research program are to: (1) evaluate the safety and efficacy of new and innovative therapeutic approaches; (2) evaluate the safety and efficacy of modifications in standard therapeutic approaches both to improve outcome and reduce deleterious side effects of current immunosuppressive regimens; (3) assess the underlying mechanisms of action of the therapeutic approaches under investigation; and (4) develop and validate immune and/or surrogate markers of graft acceptance and survival. All applicants must comply with the requirements outlined in the section below titled "SPECIAL REQUIREMENTS." HEALTHY PEOPLE 2000 The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of "Healthy People 2000," a PHS-led national activity for setting priority areas. This Request for Applications (RFA), Cooperative Clinical Trial in Pediatric Transplantation, is related to the priority area of diabetes and chronic disabling conditions. Potential applicants may obtain a copy of "Healthy People 2000" (Full Report: Stock No. 017-001-00474-0 or Summary Report: Stock No. 017-001-00473-1) through the Superintendent of Documents, Government Printing Office, Washington, DC 20402- 9325 (telephone 202-512-1800). ELIGIBILITY REQUIREMENTS Applications may be submitted by domestic for-profit and non-profit organizations; public and private institutions, such as universities, colleges, hospitals, laboratories, units of State and local governments; and eligible agencies of the Federal government. Foreign institutions are not eligible to apply. Racial/ethnic minority individuals, women, and persons with disabilities are encouraged to apply as Principal Investigators. MECHANISM OF SUPPORT The administrative and funding mechanism to be used to undertake this program will be the Cooperative Agreement (U01), an "assistance" mechanism, rather than an "acquisition" mechanism, in which substantial NIH scientific and/or programmatic involvement with the awardee is anticipated during the performance of the activity. Under the cooperative agreement, the NIH purpose is to support and/or stimulate the recipient's activity by involvement in and otherwise working jointly with the award recipient in a partner role, but it is not to assume direction, prime responsibility, or a dominant role in the activity. Details of the responsibilities, relationships, and governance of a study funded under cooperative agreement(s) are discussed later in this document under the section Terms and Conditions of Award. The total project period for an application submitted in response to this RFA may not exceed five years. At present, the NIAID is administratively limiting the duration of U01 cooperative agreements to four years; this administrative limitation may change in the future. At this time, the NIAID has not determined whether and how this solicitation will be continued beyond the present RFA. FUNDS AVAILABLE The estimated total funds (direct and indirect costs) available for the first year of support for all awards made under this RFA will be $2,050,000. In Fiscal Year 1999, the NIAID plans to fund at least two awards for consortia of institutions. The usual PHS policies governing grants administration and management will apply. Although this program is provided for in the financial plans of the NIAID, awards pursuant to this RFA are contingent upon the availability of funds for this purpose and the receipt of a sufficient number of applications of high scientific merit. Funding beyond the first and subsequent years of the grant will be contingent upon satisfactory progress during the preceding years and availability of funds. RESEARCH OBJECTIVES Background Kidney transplantation remains the therapy of choice for children with end- stage renal failure. Although dialysis offers an alternative treatment, the morbidity and side effects of this treatment remain significant. While the differences in one-year and five-year graft survival between children and adults are not as pronounced as when the first Cooperative Clinical Trial in Pediatric Transplantation (CCTPT) was established in 1994, children still are not achieving the long-term graft survival rates of adults who receive cadaveric renal transplants. This disparity in long-term graft survival is very problematic for young children; retransplantation requires going back on the waiting list and dialysis with its attendant morbidity and side effects. Therefore, young children are unlikely to achieve a normal life span, or an acceptable quality-of-life, as they are likely to receive a second, and even a third or fourth transplant in their lifetime. Although many factors have been implicated, the most important appears to be the pediatric immune system. In contrast to adults, children exhibit an "enhanced" immune state and require higher doses of immunosuppressive therapy to prevent rejection. This difference is reflected by measures of the immune system, such as increased total T lymphocyte counts vs. adults and their heightened response to mitogen stimulation. These findings are associated with more frequent and more episodes of vigorous graft rejection that are not as responsive to therapy as in adults, resulting in a higher frequency of graft loss due to irreversible rejection. For example, cyclosporine A (CsA) needs to be administered in higher doses to achieve effective blood levels because the shorter intestinal length of children results in reduced absorption. In addition, children must also receive CsA more frequently as they metabolize it faster. Further, these increased doses of CsA induce hyperlipidemia, which increases the risk of atherosclerotic cardiovascular disease. A well-documented side effect of the corticosteroids that are part of the standard immunosuppressive regimen is growth retardation, a serious problem unique to the pediatric population. Growth retardation can lead to psychological problems and the inability to lead a normal life. It is most problematic for the very young children who receive a transplant, as they will never achieve normal stature. Therefore, changes in standard immunosuppression or use of new treatment regimens that reduce or completely abolish the need for global immunosuppression hold promise of improving graft survival while reducing adverse side effects. This includes the use of new, less toxic induction therapies, such as anti-IL-2 receptor antibodies to replace cyclosporine, or the use of less toxic replacements for steroids. The CCTPT provides the infrastructure to conduct these clinical trials, perform studies of underlying mechanisms and develop immune and surrogate markers of graft acceptance, rejection and function. Research Objectives and Scope The purpose of this RFA is to support a program of prospective, multi-site cooperative clinical trials in pediatric kidney transplantation, including the components outlined below. All participating clinical sites will utilize uniform controlled study designs and standardized data collection procedures. Pediatric patients up to 21 years of age may be studied, with the specific age groups to be determined by the design of the common protocols. Specifically, applications must propose: o Clinical trials to evaluate the safety and efficacy of new and innovative therapeutic approaches to improve graft and patient survival, including: pre-, peri-, and post-transplant tolerogenic and immunomodulatory interventions to induce donor-specific tolerance with and without temporary or permanent withdrawal of, or new combinations of, standard immunosuppression; new less toxic immunosuppressive agents to prevent rejection; and new approaches to reduce the number of immunosuppressive agents required to prevent rejection; o Clinical trials of the safety and efficacy of modifications in standard therapeutic approaches both to improve short- and long-term graft/patient survival and to reduce the deleterious side effects of current immunosuppressive regimens, including withdrawal of one or more standard therapies, reduction in dosage, and modifications in timing and administration or new combinations of immunosuppressive agents; o Adjunct studies of the underlying mechanisms of action of the therapeutic approaches being evaluated, including changes in immune response and function, measures of donor-specific tolerance and loss of tolerance; and o Adjunct studies to develop, evaluate and validate sensitive immune and/or surrogate markers of short- and long-term graft survival and rejection, with particular emphasis on defining clinically relevant predictors of acute and chronic rejection. The use of non-invasive approaches is highly encouraged. SPECIAL REQUIREMENTS A. Study Organization 1. Steering Committee A Steering Committee will be established to serve as the main governing body of the cooperative research program. At a minimum, the Steering Committee will be composed of the NIAID Pediatric Transplantation Research Coordinator (PTRC), the Principal Investigators, and one additional Senior Investigator from each consortium as a permanent member, or on a rotating basis, if appropriate, as determined by the protocols under development or implemented. A Senior Investigator is the person responsible for on-site scientific direction and implementation of the consensus protocols at a participating Pediatric Transplant Institution (PTI). Senior Investigators must be physicians with substantial experience in pediatric kidney transplantation and in the design, implementation and evaluation of clinical trials. The Steering Committee shall appoint an Adjunct Studies Subcommittee to design, implement and evaluate (1) studies of underlying mechanisms of action of the therapeutic approaches under investigation and (2) studies to develop, evaluate and validate immune and/or surrogate markers of graft survival and rejection. The members of the Adjunct Studies Subcommittee shall be selected by the Principal Investigators, with each Principal Investigator having two representatives on this Subcommittee, and shall include the PTRC as a voting member. The Chair of the Adjunct Studies Subcommittee shall be elected by its members, not including the PTRC, and shall serve as a voting member of the Steering Committee. The Subcommittee will meet annually in conjunction with Steering Committee meetings and its members will be expected to participate in all meetings and in other Subcommittee activities, e.g., conference calls. All major scientific decisions will be determined by the Steering Committee, with each Principal Investigator, Senior Investigator, Chair of the Adjunct Studies Subcommittee, and the NIAID PTRC having one vote. The Chairperson will be selected by the Steering Committee from among the non-Federal members during the first meeting of the Committee, to be convened by the NIAID PTRC. The Committee will meet at least twice during the first 12 months of the study and annually thereafter. This Committee will have primary responsibility for developing the common clinical protocols, approving the design and implementation of all adjunct studies, facilitating the conduct and monitoring of all clinical trials and adjunct studies, analyzing and interpreting study data, and reporting study results. Clinical trials and adjunct studies will proceed into the implementation stage only with the concurrence of both the Steering Committee and the NIAID PTRC. Each Steering Committee member will be expected to participate in all other Steering Committee activities, e.g., conference calls, special subcommittees as may be necessary, etc. Other subcommittees of the Steering Committee may be established as necessary. 2. Data and Safety Monitoring Board An independent Data and Safety Monitoring Board, to be appointed by the NIAID, will review progress at least annually and report to the NIAID PTRC. Clinical protocols and adjunct studies will be subject to review by the Data and Safety Monitoring Board in an advisory capacity prior to implementation. 3. Data Coordination and Management The NIAID will be responsible for ensuring the provision of centralized data collection, management and quality assurance. Under the direction of the Steering Committee, the NIAID will provide technical assistance and data management services to the PTIs with respect to quality control, uniformity of data collection, management of the collective data base, and data analysis. PTIs will submit data to the NIAID or its designate; specific data analyses to be carried out will be determined by the Steering Committee and the results of those analyses will be delivered to the Steering Committee as the group responsible for determining which further analyses should be performed, how the results are interpreted, whether the results should influence ongoing data collection, and how the findings should be disseminated. Although the PTIs will be closely involved with these centralized data collection and management services, applicants should include in their budget requests only support for on-site data collection and transmittal. B. Minimum Requirements for Application To promote the development of a collaborative program among the award recipients, a minimum number of issues need to be addressed in the applications, as outlined below. 1. The application must include two (2) proposed protocols for clinical trials that meets the objectives and scope of this RFA, as well as a discussion of the rationale for the patient population, the statistical calculations and considerations in determining sample size, the study design and the therapeutic approach(es) selected for study, and an assessment of how anticipated study results can be expected to contribute to improvements in patient/graft survival. One protocol must be using new or innovative approaches and one must be modification of standard therapeutic approaches. Award of the Cooperative Agreement does not imply that any of the proposed protocols will be implemented. Since the actual protocols will be selected by the Steering Committee, the final clinical trials may not reflect any single protocol submitted in response to this RFA. 2. The application must include at least two (2) proposed hypothesis-driven adjunct studies of underlying mechanisms of action to be carried out as part of each of the proposed protocols, including: the rationale for the adjunct studies proposed in terms of feasibility, validity, and sensitivity/specificity; the specific aspects of immune response and function to be measured; a description of the patient samples required, including time and frequency of collection, number and quantity of samples required and methodologies to be used to analyze patient samples, including new and non- invasive techniques for collection and analysis; and a discussion of how the results of the adjunct studies will contribute to further understanding of the clinical effects of the therapeutic approaches under investigation. As in the case of the proposed clinical protocols, award of the Cooperative Agreement does not imply that any proposed adjunct studies will be implemented. Actual studies to be performed will be selected or designed by the Adjunct Studies Subcommittee, and approved by the Steering Committee 3. The application must include at least one proposed adjunct study to develop, evaluate and validate sensitive immune and/or surrogate markers of short- and long-term graft survival and/or rejection. One of the overall goals of these adjunct studies is to develop predictors of rejection prior to organ damage. Descriptions of proposed adjunct studies are to include: identification of and rationale for the immune and/or surrogate markers selected, including published data from animal and/or human studies; description of the source, quantity and number of patient samples required; methodologies proposed to collect and analyze samples; and a discussion of how the results of the proposed adjunct studies will contribute to improvements in the capacity to utilize immune and surrogate markers to predict graft acceptance, changes in graft function, rejection and patient survival. It is not a requirement that these adjunct studies be associated with the clinical protocols proposed in the application. However, studies may use patient samples from the proposed protocols or from other sources. Applications must identify the source of patient materials required for the adjunct studies, and provide documentation of the availability of the appropriate number and type of patient materials and the willingness of the source to make such samples available to the investigators. As in the case of the proposed clinical protocol, award of the Cooperative Agreement does not imply that any proposed adjunct studies will be implemented. Actual studies to be performed will be selected or designed by the Adjunct Studies Subcommittee, and approved by the Steering Committee. 4. The applicant institution and each institution participating in the consortium must document: their experience and capacity to recruit and retain pediatric study participants up to 21 years of age, including sufficient numbers of patients for Phase III efficacy trials; provide a description of the population currently available for the proposed protocol; and describe proposed mechanisms for monitoring accrual performance and criteria for continued participation by each participating institution. 5. The application must identify the single applicant organization that will be legally and financially responsible and accountable for the use and disposition of funds awarded on the basis of this RFA to PTIs and other institutions participating in the consortium, and show availability of personnel and facilities capable of performing and supporting the administrative functions necessary. 6. The application must name a single Principal Investigator (PI) who will have scientific responsibility for the application as a whole, including all consortium-related research activities. The PI must be a physician with substantial experience in pediatric kidney transplantation, and in the design, implementation and evaluation of clinical trials. In addition, applications must name a single Senior Investigator for each PTI in the consortium who will be responsible for on-site clinical and scientific implementation, direction and management of the clinical protocols, as well as the coordination of requirements for adjunct studies of underlying mechanisms and immune/surrogate markers. The P.I. would be the Senior Investigator from his or her Institution. Senior Investigators must also be physicians with substantial experience in pediatric kidney transplantation and in the design, implementation and evaluation of clinical trials. 7. Applications must demonstrate the scientific expertise required to design, conduct and analyze all adjunct studies. Such expertise may be provided by a single scientist serving the entire consortium or more than one such scientist depending upon the proposed clinical protocols and adjunct studies. 8. The application must name a Project Coordinator who is an individual with substantial technical/administrative experience in managing patient enrollment, patient follow-up, and multi-source data collection for clinical studies. Each participating institution associated with an applicant consortium must also name such a Project Coordinator. 9. The application must provide: a clear, concise plan, in narrative and diagrammatic form, that depicts the interrelationships among the members of the consortium, their relevant experience/expertise, and the contribution of each to fulfillment of the objectives of this RFA; an organizational chart of the consortium showing the name, organization, and scientific discipline of the PI and of all key scientific, technical and administrative personnel; and a mechanism for selecting and replacing key professional or technical personnel. 10. The application must provide a plan to assure the maintenance of close cooperation and effective communication among members of the consortium, including letters of commitment to this plan from all participating institutions. 11. The application should discuss the capability of the applicant organization and each institution in an applicant consortium to participate and interact effectively in cooperative, multi-center clinical trials. 12. The application must include a written commitment to accept the participation and assistance of NIAID staff in accordance with the guidelines outlined under "Terms and Conditions of Award: NIAID Staff Responsibilities." The application must also include a written commitment to the cooperative organization and willingness to serve on the Steering Committee and adhere to the decisions reached by that Committee, including following the consensus protocols and adjunct studies. Also, PTIs will be required to affirm that their commitment of patients to the CCTPT for specific protocols will take precedence over subsequent non-CCTPT clinical trials started after the CCTPT protocols are implemented. 13. All costs required for the proposed protocols and adjunct studies must be included in the application and must be fully justified. These include the additional costs of clinical research associated with the proposed protocols, costs for patient recruitment and follow-up, adjunct studies, data collection, and participation in on-site quality assurance audits. Requested budgets should also include: (1) travel to the Chicago, Illinois area for two 1-day Steering Committee meetings during the first 12 months, and annually thereafter for the Principal Investigator and one Senior Investigator for the consortium, and (2) travel to the Chicago, Illinois area for annual one-day meetings of the Adjunct Studies Subcommittee for the two representatives from each consortium. TERMS AND CONDITIONS OF AWARD The following terms and conditions will be incorporated into the award statement and provided to the principal Investigator as well as the institutional official at the time of award. These special Terms of Award are in addition to, and not in lieu of, otherwise applicable OMB administrative guidelines, HHS Grant Administration Regulations at 45 CFR part 74 and 92, and other HHS, PHS, and NIH Grant Administration policy statements. The administrative and funding instrument used for this program is the cooperative agreement (U01), an "assistance" mechanism (rather than an "acquisition" mechanism), in which substantial NIH scientific and/or programmatic involvement with the awardee is anticipated during the performance of the activity. Under the cooperative agreement, the NIH purpose is to support and/or stimulate the recipient's activity by involvement in and otherwise working jointly with the award recipient in a partner role, but it is not to assume direction, prime responsibility, or a dominant role in the activity. Consistent with this concept, the dominant role and prime responsibility for the activity resides with the awardees for the project as a whole, although specific tasks and activities in carrying out the research will be shared among the awardees and the NIAID PTRC. 1. Awardee Rights and Responsibilities Awardees will have primary responsibility for defining the research objectives, approaches and details of the projects within the guidelines of the RFA and for performing the scientific activity. Specifically, awardees have primary responsibility as described below. Steering Committee Membership and Meeting Attendance Each Principal Investigator and Senior Investigator from a consortium will serve as a voting member of the Steering Committee and will participate in all scientific decisions. Each Principal Investigator and Senior Investigator (or his/her designee) from a consortium will be responsible for attending all Steering Committee meetings, including not less than two meetings during the first 12 months of the study and annually thereafter. The Steering Committee shall be responsible for determining the frequency of meetings and scheduling the time and location. Each Principal Investigator and Senior Investigator (or his/her designee) from a consortium will be expected to participate in all other Steering Committee activities, e.g., conference calls, special subcommittees as may be necessary, etc. Subcommittees of the Steering Committee may be established as necessary. At a minimum, the Steering Committee will establish an Adjunct Studies Subcommittee to provide advice to the Steering Committee with respect to research on the pediatric immune system, as described under the section "RESEARCH OBJECTIVES." The Adjunct Studies Subcommittee will be composed of two representatives selected by each consortium Principal Investigator, as well as the NIAID PTRC. This Subcommittee will meet annually in conjunction with the Steering Committee meetings. Protocol Development and Conduct The Steering Committee will define protocol objectives and approaches and design the consensus protocol or establish a Protocol Design Subcommittee to perform this function. Each PTI will follow the procedures required by the consensus protocol generated by the Steering Committee regarding study conduct and monitoring, patient management, data collection and quality control. Data Coordination and Management Each PTI will be responsible for providing the NIAID with all primary study data for management, quality control and analysis, using procedures and standards determined by the Steering Committee. All data will be available to all awardees. Specific analyses to be performed by NIAID will be directed by the Steering Committee. The awardees will retain custody of and have primary rights to all data developed under these awards, subject to Government rights of access consistent with HHS, PHS, and NIH policies. Publication and Presentation of Study Findings Early publication of major findings is encouraged. Publications and oral presentations of work performed under this agreement will require appropriate acknowledgment of both the PTIs and NIAID support. Analyses to be performed using the collective data from all PTIs will be determined and directed by the Steering Committee. PTIs wishing to perform analyses of local data will inform the Steering Committee of any such analyses prior to initiation in order to avoid duplication. Review and approval by the Steering Committee will be required for all analyses prior to publication or presentation according to criteria that will be developed by the Steering Committee. The Steering Committee may establish a Publications Subcommittee to serve this function. Monitoring Study Progress The Steering Committee will establish mechanisms for assessing performance of the PTIs, including institutions participating in consortia arrangements, with particular attention to accrual of adequate numbers of eligible patients, timely submission and quality of required data and conscientious observance of protocol requirements. Federally Mandated Regulatory Requirements Each PTI participating in a consortium arrangement is required to meet the DHHS/PHS regulations for the protection of human subjects and FDA requirements for the conduct of research using investigational agents. At a minimum, these include: methods for assuring that each institution at which PTI investigators are conducting clinical studies has a current, approved assurance on file with the Office of Protection from Research Risks (OPRR); that study protocols are reviewed and approved by the responsible Institutional Review Board (IRB) prior to patient entry; that active protocols are reviewed at least annually by the IRB; and that all protocol amendments are approved by the IRB. methods for assuring or documenting that each patient, or patient's parent/legal guardian, gives fully informed consent to participation in a research protocol prior to the initiation of the experimental intervention. All informed consent documents must be available for review upon request by the PTRC or Steering Committee, or FDA or Industry sponsor, if applicable. 2. NIAID Staff Responsibilities NIAID staff assistance will be provided by Dr. Stephen Rose, Ph.D., Chief, Genetics and Transplantation Branch, Division of Allergy, Immunology and Transplantation, NIAID who will serve as NIAID's Pediatric Transplant Research Coordinator (PTRC). The NIAID PTRC will have substantial scientific/programmatic involvement during the conduct of this activity through technical assistance, advice and coordination above and beyond normal program stewardship for grants, as described below. Steering Committee Membership and Meeting Attendance The NIAID PTRC will serve as a voting member of the Steering Committee, will attend all Steering Committee meetings, and will participate in other Committee activities, e.g., conference calls, special subcommittees. The NIAID PTRC will also serve on the Adjunct Studies Subcommittee. Protocol Development As a member of the Steering Committee, the NIAID PTRC will serve as a resource with respect to the design of the protocol and will assist the Steering Committee in protocol development. Study Materials The NIAID PTRC will be responsible for the acquisition and distribution of those study materials involved in the protocol developed by the consensus of the Steering Committee. The NIAID will also arrange for the appropriate approvals (when necessary) from the Food and Drug Administration (FDA) with respect to the use investigational drugs. The PTRC may also be the responsible person for any Investigational New Drug Applications (IND), as applicable (e.g.- may "hold" the IND) Monitoring Study Performance The NIAID PTRC will provide assistance to the Steering Committee in the development of mechanisms and procedures for monitoring study performance. This includes participation in periodic on-site monitoring with respect to compliance with protocol specifications, quality control and accuracy of data recording, and accrual. Data Coordination and Management The NIAID will be responsible for ensuring the provision of centralized data management and coordination assistance. Under the direction of the Steering Committee, the NIAID will provide technical assistance and data management services to the PTIs with respect to quality control, uniformity of data collection, management of the collective data base, and data analysis. The Government, via the NIAID PTRC, will have access to data generated under this Cooperative Agreement and may periodically review the data and progress reports. NIAID Staff may use information obtained from the data for the preparation of internal reports on the activities of the study. However, awardees will retain custody of and have primary rights to all data developed under these awards. Publication and Presentation of Study Findings The NIAID PTRC may contribute, through review, comment, analysis, and/or co- authorship, to reporting results of the study to the investigator community and other interested scientific and lay organizations. Co-authorship by the NIAID PTRC will be subject to approval in accordance with NIH policies regarding staff authorship of publications resulting from extramural awards. Organizational Changes Certain organizational changes require the prior written approval of the NIAID PTRC. These changes include the addition or replacement of a physician, scientific investigator, affiliate, component, or research base that is associated with this study. A change in the Principal Investigator, or in any key personnel identified on the Notice of Award, must have the prior written approval of the NIAID Grants Management Specialist in consultation with the NIAID PTRC. Program Review The NIAID PTRC will review the progress of each PTI through consideration of the annual reports, site visits, patient logs, etc. This review may include, but is not limited to, compliance with the study protocol, meeting patient enrollment targets, adherence to uniform data collection procedures, and the timeliness and quality of data reporting. The NIAID reserves the right to terminate or curtail the study (or any individual award) in the event of (a) substantial shortfall in participant recruitment, follow-up, data reporting, quality control, or other major breech of the protocol, (b) substantive changes in the agreed-upon protocol to which the NIAID does not agree, (c) reaching a major study endpoint substantially before schedule with persuasive statistical significance, or (d) human subject ethical issues that may dictate a premature termination. 3. Collaborative Responsibilities A Steering Committee, composed of the Principal Investigators and Senior Investigators from each consortium and the NIAID PTRC, will be the main governing body of the study and will have primary responsibility for all scientific decisions, including: defining protocol objectives and approaches; designing and implementing the protocol; developing procedures for data collection, management and quality control; establishing procedures for assessing performance with respect to accrual, timely submission and quality of data, and conscientious observance of protocol requirements; analyzing and interpreting study data; and publishing/presenting study findings. Each member of the Steering Committee will have one vote. The chairperson will be selected by the Steering Committee from among the non-Federal members. Subcommittees will be established by the Steering Committee, as it deems appropriate. At a minimum, the Steering Committee will establish an Adjunct Studies Subcommittee to provide advice with respect to the mechanistic research and immune/surrogate marker studies as described under "RESEARCH OBJECTIVES." The Adjunct Studies Subcommittee will be composed of two representatives from each consortium selected by the Steering Committee, as well as the NIAID PTRC. This Subcommittee will meet annually in conjunction with the Steering Committee meeting. An independent Data and Safety Monitoring Board, to be appointed by the NIAID, will review progress at least annually and report to the NIAID PTRC. All proposed protocols and adjunct studies will be subject to review by this Board in an advisory capacity. PTIs will be required to accept and implement the common protocol and procedures approved by the Steering Committee. Studies will proceed into the implementation stage only with the concurrence of the Steering Committee and the NIAID PTRC. 4. Arbitration Any disagreement that may arise on scientific or programmatic matters (within the scope of the award) between award recipients and the NIAID may be brought to arbitration. An arbitration panel will be composed of three members -- one selected by the Steering Committee (with the NIAID member not voting) or by the individual awardee in the event of an individual disagreement, a second member selected by the NIAID, and the third member with expertise in the relevant area and selected by the two prior members will be formed to review any scientific or programmatic issue that is significantly restricting progress. While the decisions of the Arbitration Panel are binding, these special arbitration procedures will in no way affect the awardee's right to appeal an adverse action in accordance with PHS regulations at 42 CFR Part 50, subpart D, and HHS regulations at 45 CFR Part 16. Cooperative agreements are subject to the administrative requirements outlined in OMB circulars A-102 and A-110. All pertinent HHS, PHS, and NIH grant regulations, policies and procedures, with particular emphasis on PHS regulations at 42 CFR Part 52 and HHS regulations at 45 CFR Part 74, are applicable. These special terms and conditions pertaining to the scope and nature of the interaction between the NIAID and the investigators will be incorporated in the Notice of Grant Award. However, these terms will be in addition to, not in lieu of, the customary programmatic and financial negotiations that occur in the administration of cooperative agreements. INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS It is the policy of the NIH that women and members of minority groups and their subpopulations must be included in all NIH supported biomedical and behavioral research projects involving human subjects, unless a clear and compelling rationale and justification are provided that inclusion is inappropriate with respect to the health of the subjects of the purpose of the research. This policy results from the NIH Revitalization Act of 1993 (Section 492B of Public Law 103-43). All investigators proposing research involving human subjects should read the "NIH Guidelines for Inclusion of Women and Minorities as Subjects in Clinical Research", which have been published in the Federal Register of March 28, 1994 (FR 59 14508-14513) and the NIH Guide for Grants and Contracts, Vol. 23, No. 11, March 18, 1994. Investigators may obtain copies from these sources or from Dr. Stephen Rose (listed in INQUIRIES below) who may also provide additional relevant information concerning the policy. INCLUSION OF CHILDREN IN RESEARCH INVOLVING HUMAN SUBJECTS It is the policy of NIH that children (i.e., individuals under the age of 21) must be included in all human subjects' research, conducted or supported by the NIH, unless there are scientific and ethical reasons not to include them. This policy applies to all initial (Type 1) applications submitted for receipt dates after October 1, 1998. All investigators proposing research involving human subjects should read the "NIH Policy and Guidelines on the Inclusion of Children as Participants in Research Involving Human Subjects" that was published in the NIH Guide for Grants and Contracts, March 6, 1998, and is available at the following URL address: https://grants.nih.gov/grants/guide/notice-files/not98-024.html LETTER OF INTENT Prospective applicants are asked to submit, by July 21, 1998, a letter of intent that includes a descriptive title of the overall proposed research; the name, address and telephone number of the Principal Investigator; and the number and title of this RFA. Although the letter of intent is not required, is not binding, does not commit the sender to submit an application, and does not enter into the review of subsequent applications, the information that it contains allows NIAID staff to estimate the potential review workload and to avoid conflict of interest in the review. The letter of intent is to be sent to Dr. Madelon Halula at the address listed under INQUIRIES. APPLICATION PROCEDURES The research grant applications form PHS 398 (rev. 5/95) is to be used in applying for these grants. Application kits are available at most institutional offices of sponsored research and may be obtained from the Division of Extramural Outreach and Information Resources, National Institutes of Health, 6701 Rockledge Drive, MSC 7910, Bethesda, MD 20892-7910, telephone (301) 710-0267, email: Grantsinfo@nih.gov. For purposes of identification and processing, item 2 on the face page of the application must be marked "YES" and the RFA number "AI-98-012" and the words "Cooperative Clinical Trials in Pediatric Renal Transplantation" must be entered on the face page. Applications must be received by December 29, 1998. Applications that are not received as a single package on the receipt date or that do not conform to the instructions contained in PHS 398 (rev. 5/95) application kit (as modified in, and superseded by, the special instructions below, for the purposes of this RFA), will be judged non-responsive and will be returned to the applicant. The RFA label available in the application form PHS 398 must be affixed to the bottom of the face page. Failure to use this label could result in delayed processing of the application such that it may not reach the review committee in time for review. If the application submitted in response to this RFA is substantially similar to a grant application already submitted to the NIH for review, but that has not yet been reviewed, the applicant will be asked to withdraw either the pending application or the new one. Simultaneous submission of identical applications will not be allowed, nor will different review committees review essentially identical applications. Therefore, an application that is essentially identical to one that has already been reviewed cannot be submitted in response to this RFA. This does not preclude the submission of substantial revisions of applications already reviewed, but such applications must include an introduction addressing the previous critique. It is highly recommended that the appropriate NIAID program contact be consulted before submitting the letter of intent and during the early stages of preparation of the application. (See program contacts under INQUIRIES). Submit a signed, typewritten original of the application, including the checklist, and three signed, exact, single-sided photocopies, in one package to: CENTER FOR SCIENTIFIC REVIEW NATIONAL INSTITUTES OF HEALTH 6701 ROCKLEDGE DRIVE, ROOM 1040 - MSC 7710 BETHESDA, MD 20892-7710 BETHESDA, MD 20817 (for express/courier service) At the time of submission, two additional exact copies of the grant application and all five sets of any appendix material must be sent to Dr. Madelon Halula at the address listed under INQUIRIES. Applicants from institutions that have a General Clinical Research Center (GCRC) funded by the NIH National Center for Research Resources may wish to identify the GCRC as a resource for conducting the proposed research. If so, a letter of agreement from either the GCRC Program Director or Principal Investigator should be included with the application. REVIEW CONSIDERATIONS Review Considerations Upon receipt, applications will be reviewed for completeness by the NIH Center for Scientific Review (CSR) and for responsiveness by NIAID staff. Applications judged to be incomplete and/or non-responsive will be returned to the applicant without review. Applications that are complete and responsive will be reviewed for scientific and technical merit by a review committee convened by the Division of Extramural Activities, NIAID. As part of the initial merit review, applications may be subjected to a process by an NIAID peer review group to determine their scientific merit relative to other applications received in response to this RFA. The NIAID will withdraw from competition those applications judged to be non-competitive for award and will notify the applicant and institutional business officials. The National Advisory Allergy and Infectious Diseases Council will provide the second level of review. Review Criteria The criteria to be used in the evaluation of grant applications are listed below. To put those criteria in context, the following information is contained in instructions to the peer reviewers. The goals of NIH-supported research are to advance our understanding of biological systems, improve the control of disease, and enhance health. The reviewers will comment on the following aspects of the application in their written critiques in order to judge the likelihood that the proposed research will have a substantial impact on the pursuit of these goals. Each of these criteria will be addressed and considered by the reviewers in assigning the overall score weighting them as appropriate for each application. Note that the application does not need to be strong in all categories to be judged likely to have a major scientific impact and thus deserve a high priority score. For example, an investigator may propose to carry out important work that by its nature is not innovative but is essential to move a field forward. 1. Significance. Does this study address an important problem? If the aims of the application are achieved, how will scientific knowledge be advanced? What will be the effect of these studies on the concepts or methods that drive this field? 2. Approach. Is the conceptual framework, design, methods, and analyses adequately developed, well integrated, and appropriate to the aims of the project? Does the applicant acknowledge potential problem areas and consider alternative tactics? 3. Innovation. Does the project employ novel concepts, approaches or method? Are the aims original and innovative? Does the project challenge existing paradigms or develop new methodologies or technologies? 4. Investigator. Is the investigator appropriately trained and well suited to carry out this work? Is the work proposed appropriate to the experience level of the principal investigator and other researchers (if any)? 5. Environment. Does the scientific environment in which the work will be done contribute to the probability of success? Do the proposed experiments take advantage of unique features of the scientific environment or employ useful collaborative arrangements? Is there evidence of institutional support? The initial review group will also examine: the appropriateness of proposed project budget and duration; the adequacy of plans to include both genders and minorities and their subgroups as appropriate for the scientific goals of the research and plans for the recruitment and retention of subjects; adequacy of plans for including children as appropriate for the scientific goals of the research; the provisions for the protection of human and animal subjects; and the safety of the research environment. AWARD CRITERIA Funding decisions will be made on the basis of scientific and technical merit as determined by peer review, program balance, and the availability of funds. The earliest anticipated date of award is September 1, 1999. INQUIRIES Written and telephone inquiries concerning this RFA are encouraged. The opportunity to clarify any issues or questions from potential applicants is welcome. Direct inquiries regarding programmatic issues to: Stephen Rose, Ph.D. Division of Allergy, Immunology and Transplantation National Institute of Allergy and Infectious Diseases 6003 Executive Boulevard, Room 4A14 Bethesda, MD 20892-7640 Telephone: (301) 496-5598 FAX: (301) 402-2571 Email: sr8j@nih.gov Direct inquiries regarding review issues and special instructions for application preparation; address the letter of intent to; and mail two copies of the application and all five sets of appendices to: Madelon Halula, Ph.D. Division of Extramural Activities National Institute of Allergy and Infectious Diseases 6003 Executive Boulevard, Room 4C16 Bethesda, MD 20892 Telephone: (301) 402-2636 FAX: (301) 402-2638 Email: mh30x@nih.gov Direct inquiries regarding fiscal matters to: Celeste M. Kerner Division of Extramural Activities National Institute of Allergy and Infectious Diseases 6003 Executive Boulevard, Room 4B32 Bethesda, MD 20892 Telephone: (301) 402-6213 FAX: (301) 480-3780 Email: ck103k@nih.gov Schedule Letter of Intent Receipt Date: July 21, 1998 Application Receipt Date: December 29, 1998 Scientific Review Date: March 1999 Advisory Council Date: May 1999 Earliest Award Date: September 1, 1999 AUTHORITY AND REGULATIONS This program is supported under authorization of the Public Health Service Act, Sec. 301 (c), Public Law 78-410, as amended. The Catalogue of Federal Domestic Assistance Citation is (Sec. 93.856, Microbiology and Infectious Diseases Research, or No. 93.855 - Immunology, Allergy, and Transplantation Research, or both, as appropriate). Awards will be administered under PHS grants policies and Federal Regulations 42 CFR Part 52 and 45 CFR Part 74. This program is not subject to the intergovernmental review requirements of Executive Order 12372 or Health Systems review. The PHS strongly encourages all grant and contract recipients to provide a smoke-free workplace and promote the non-use of all tobacco products. In addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain facilities (or in some cases, any portion of a facility) in which regular or routine education, library, day care, health care or early childhood development services are provided to children. This is consistent with the PHS mission to protect and advance the physical and mental health of the American people.
Return to NIH Guide Main Index
Office of Extramural Research (OER) |
National Institutes of Health (NIH) 9000 Rockville Pike Bethesda, Maryland 20892 |
Department of Health and Human Services (HHS) |
||||||||
Note: For help accessing PDF, RTF, MS Word, Excel, PowerPoint, Audio or Video files, see Help Downloading Files. |