Full Text HL-94-006 SPECIALIZED CENTERS OF RESEARCH - MOLECULAR GENETICS OF HYPERTENSION NIH GUIDE, Volume 22, Number 45, December 17, 1993 RFA: HL-94-006 P.T. 04 Keywords: Hypertension Molecular Genetics 0705048 National Heart, Lung, and Blood Institute Letter of Intent Receipt Date: October 1, 1994 Application Receipt Date: December 8, 1994 PURPOSE The objective of this initiative is to establish a collaborative network of closely interacting, multiproject Specialized Centers of Research (SCORs) to study the molecular genetics of hypertension. Three broad areas will be considered responsive to the initiative: (1) mapping and identification of genes responsible for high blood pressure or its complications in humans and in experimental animal models; (2) mechanistic studies on the biological consequences of variations in genes linked to hypertension or its complications; and, (3) studies utilizing molecular genetic techniques to elucidate basic mechanisms of normal and altered regulation of blood pressure. An important facet of the SCOR program will be a network of centers under the oversight of a steering committee, comprised of SCOR directors, that will ensure effective collaboration among centers. 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), Specialized Centers of Research - Molecular Genetics of Hypertension, is related to the priority area of heart disease and stroke. 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 202-783-3238). ELIGIBILITY REQUIREMENTS Applications may be submitted by for-profit and non-profit domestic institutions, public and private, such as universities, colleges, hospitals, and laboratories. This RFA is intended to support SCOR grants for basic and clinical investigations; therefore, applications that include only basic or only clinical research will not be responsive to this announcement. In addition, clinical research projects focused on large epidemiologic studies or large clinical trials will be considered unresponsive to this RFA. Awards will not be made to foreign institutions. However, under exceptional circumstances, a foreign component critical to a project may be included as a part of that project. Women and minority investigators are encouraged to apply. The Principal Investigator should be an established research scientist with the ability to ensure quality control and the experience to administer effectively and integrate all components of the program. A minimum time commitment of 25 percent is expected for this individual. The Principal Investigator must also be the project leader of one of the component research projects. If, through peer review, this project is not recommended for further consideration, the overall SCOR application will not be considered further. If this project is judged by peer review to be of low scientific merit, it will markedly reduce the overall scientific merit ranking assigned to the entire application by the review committee. Project leaders must agree to commit at least 20 percent effort to each project for which they are responsible. MECHANISM OF SUPPORT This RFA will use the National Heart, Lung, and Blood Institute (NHLBI) SCOR (P50) grant to support this research program. Responsibility for the planning, direction, and execution of the proposed project will be solely that of the applicant. All current policies and requirements that govern the research grant programs of the NIH will apply to grants awarded under this RFA. Basic and Clinical Research The overall concept of a SCOR program focuses on scientific issues related to diseases relevant to the mission of the NHLBI. It is essential, therefore, that all applications include both basic and clinical research projects. Interactions between basic and clinical scientists are expected to strengthen the research, enhance transfer of fundamental research findings to the clinical setting, and identify new research directions. Plans for transfer of findings from basic to clinical studies should be described. Each SCOR grant application and award must include research involving human patients/subjects. Support may be provided for human biomedical and behavioral studies of etiology, pathogenesis, prevention and prevention strategies, diagnostic approaches, and treatment of diseases, disorders, or conditions. Small population-based studies, where the research can be completed within five years, may also be proposed. In addition, basic research projects must be included that relate to the clinical focus. A SCOR may also contain one or more core units that support the research projects. Length of SCOR Programs Each NHLBI SCOR program is limited to 10 years of support. Exceptions to this policy will be made only if a thorough evaluation of needs and opportunities, conducted by a committee composed of non-federal experts, determines that there are extraordinarily important reasons to continue a specific SCOR program. Under this policy, a given SCOR grant is awarded for a five-year project period following an open competition. Only one five-year competing renewal is permitted, for a total of 10 years of support, unless the SCOR program is recommended for extension. The NHLBI comprehensive evaluation of the Molecular Genetics of Hypertension SCOR program will be conducted during the second project period according to the following timetable: Program Announced FY 1994 Project Period (First Competition) FY 1996 to FY 2000 Program Reannounced FY 1999 Project Period (Second Competition) FY 2001 to FY 2005 Letter to SCOR Directors FY 2002 (midway through year 02 Regarding SCOR Evaluation Plans of 2nd project period) SCOR Evaluation Meeting FY 2003 (late in year 02 of 2nd project period) Notification of SCOR Directors FY 2003 (midway through year 03 of NHLBI Decision of 2nd project period) The NHLBI does not limit the number of SCOR applications in a given SCOR program from one institution provided there is a different SCOR principal investigator for each application and each application is self-contained and independent of the other(s). This does not preclude cooperation, planned or possible, among participants of SCORs after awards are made. Scientific overlap among applications will not be accepted. If more than one application is envisioned from an institution, the institution is encouraged to discuss its plans with the NHLBI SCOR program administrator. FUNDS AVAILABLE Applicants may request up to $1,100,000 in direct costs, not including indirect costs for collaborating institutions, in the first year with a maximum increase of no more than four percent in each additional year requested in the application. Award of grants pursuant to this RFA is contingent upon receipt of funds for this purpose. It is anticipated that approximately six SCOR grants will be funded for a total not to exceed $9.9 million in FY 96. Equipment is included in the budget limitation. However, requests for expensive special equipment that cause an application to exceed this limit may be permitted on a case-by-case basis following staff consultation. Such equipment requires in-depth justification. Final decisions will depend on the nature of the justification and the Institute's fiscal situation. Consortium Arrangements If a grant application includes research activities that involve institutions other than the grantee institution, the program is considered a consortium effort. Such activities may be included in a SCOR grant application, but it is imperative that a consortium application be prepared so that the programmatic, fiscal, and administrative considerations are explained fully. The published policy governing consortia is available in the business offices of institutions that are eligible to receive Federal grants-in-aid. Consult the latest published policy governing consortia before developing the application. If clarification of the policy is needed, contact Ms. Jane Davis, Grants Operations Branch, NHLBI, 301-594-7436. Applicants of SCOR grants should exercise great diligence in preserving the interactions of the participants and the integration of the consortium project(s) with those of the parent institution, because synergism and cohesiveness can be diminished when projects are located outside of the group at the parent institution. Indirect costs paid as part of a consortium agreement are excluded from the limit on the amount of direct costs that can be requested. RESEARCH OBJECTIVES Background Hypertension, a complex disease that involves the interplay of genetic and environmental factors, affects an estimated 50 million Americans and is a major predisposing factor for myocardial infarction, heart failure, vascular disease, stroke, and renal failure. Hypertension is a polygenic disease, and it has been estimated from segregation analysis and twin studies that approximately 45 percent of the interindividual differences in blood pressure are accounted for by genetic differences. The identification of the genes whose variants contribute to high blood pressure will have far-reaching effects on our understanding of the pathophysiology of the circulation and may suggest rational therapeutic approaches and new preventive measures, and thereby shift the national health focus in hypertension from post-onset therapy to prevention. In addition, the genetic approach may lead to the identification of primary molecular defects that will form the basis for mechanistic studies in humans and animals on normal blood pressure regulation and on the pathophysiology of hypertension. The genetic approach may also offer crucial new insights into the biochemical and physiological pathways that link various risk factors to high blood pressure. The division of the general population suffering from essential hypertension into subgroups, defined by genotypes, may allow for the evaluation of therapies in more homogeneous groups. Knowledge of these defects can provide new targets for specifically-designed therapies. Additionally, it may be possible to use existing therapies in a more directed way to treat individuals with specific genotypes. It may not be necessary to negate the effects of all the genes contributing to hypertension to treat the disease in an individual. It is likely that many genetic effects act in concert and that neutralizing one or two of the genetic determinants operating in an individual may be sufficient to reduce blood pressure to a level that has less associated risk. An understanding of the basis for genetic susceptibility to hypertension would help identify individuals at risk for developing the disease before the manifestation of clinical symptoms. A major challenge of the future in the hypertension field will be the development and implementation of effective preventive measures. A better understanding of disease mechanisms should strengthen efforts at prevention by helping to identify individuals at risk for developing the disease before the manifestation of clinical symptoms. Furthermore, molecular genetic studies will help investigators characterize the prevalence of genetic variants associated with hypertension at the population level. Interventions based on this information applied in advance of the rise in blood pressure have the greatest potential for preventing the disease of hypertension. The identification of hypertension genes provides the basis for an understanding of the interactions between genes and environmental factors. It is very likely that particular environmental variables exert effects only in the presence of certain genotypes. Moreover, the effects of certain environmental factors may be difficult to detect in a genetically heterogeneous group. Until recently, the techniques for dissecting the genetic determinants of high blood pressure and for studying the molecular and physiological consequences of gene variation were not available or were not developed to an extent that would make such studies feasible. Several recent advances in technology and analytical methods, together with the rapid construction of genetic and physical maps, have substantially improved the likelihood of detecting these genetic factors and understanding their biological implications. These techniques have already been applied with considerable success to single-gene disorders, such as Duchenne muscular dystrophy, retinoblastoma, cystic fibrosis, and neurofibromatosis. The time is now opportune for applying these new technologies on a more comprehensive basis to complex polygenic disorders, such as hypertension. Purpose of the SCOR Network The identification of hypertension genes and a mechanistic analysis of how these genes contribute to blood pressure regulation and to the pathophysiology of hypertension will require the collaboration of investigators with expertise in genetics, biostatistics, clinical science with an emphasis on hypertension, molecular biology, biochemistry, and physiology. Economies of scale can be accomplished by sharing technology, data, skills, and biological materials. Although some research centers will have access to all necessary resources, many of the investigators critical to the success of the project may be located in different institutions that lack important elements, such as the necessary human subjects. Applicants from institutions that have a General Clinical Research Center (GCRC) funded by the 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 could be included with the application. The choice of the word network to describe these groups emphasizes that all of the necessary expertise, resources, and infrastructure need not be localized at one geographical site. The networks will provide the cohesion and coordination that will link the best people in several locations, covering such expenses as the exchange of scientists, travel costs of participating groups, shipping costs of samples and probes, data transmission and data storage costs, and the costs of regular meetings to coordinate the activities of the network participants. In order to ensure the cooperative nature of this endeavor, exchange visits of scientists among the groups will have a high priority in the use of these funds. In addition, key aspects of infrastructure can also be supported, and might include immortalization of cell lines to act as perpetual sources of DNA, the banking of DNA, the development and maintenance of appropriate databases, and so forth. It is important to emphasize that the approaches may differ among and within the SCORs that will make up the network. Regardless of the particular strategy chosen, the applicants must carefully justify the methodologies to be used and describe the strengths and limitations of the proposed approaches. Role of the Steering Committee A meeting will be convened of all center directors at the time of award to establish the framework for a fully functional SCOR network by the end of the first year of funding. An integral part of this network will be a steering committee composed of the center directors. A major function of the steering committee will be to establish and encourage well focused collaborations among network centers. The steering committee will be expected to meet approximately twice a year, and center applications should include travel funds within the budget for this purpose. Steering committee meetings will be held in addition to the biennial one- to two-day grantee meetings in which research accomplishments are presented by participating investigators in each of the center grants. The steering committee will be responsible for overall guidance of the center network, encouraging collaborations within and among centers, sharing resources such as animals and samples obtained from human subjects, and ensuring a minimum of research and budgetary duplication. The ability to interact within a SCOR network, under the overall guidance of a steering committee, will also be an important criterion for evaluation. While it is anticipated that applications for support of research centers will encompass a complete, well balanced multiproject research program, it is also expected that the application will address the means by which the proposed research program would participate in and contribute to the broader scope and needs of a network of genetic centers. Because it is essential that the SCOR network be dynamic and flexible and able to respond to rapid scientific developments, applications should include a detailed discussion of how a particular center will be poised to take advantage of technical and methodological advances. Although a key factor in the funding of centers will be the scientific and technical merit as judged through the peer review system, willingness and ability to participate actively in an ongoing research center network will also be a key factor in selecting applications for award. Proposed Research The principal research aim of this RFA is to encourage basic and clinical research that is oriented toward mechanisms of blood pressure control and hypertension at the genetic level. Three broad areas will be considered responsive to the initiative: (1) mapping and identification of genes responsible for high blood pressure or its complications in humans and in experimental animal models; (2) mechanistic studies on the biological consequences of variations in genes linked to hypertension or its complications; and (3) studies utilizing molecular genetic techniques to elucidate basic mechanisms of normal and altered regulation of blood pressure. Because this SCOR program will involve a highly interactive network, it is not necessary for a single center to dedicate resources to all of the above areas. Each SCOR will require a close association of basic bench-level and clinical research. At times, the clinical studies will act as the driving force and lead the overall direction of the center network by identifying genes that are closely associated or linked to the hypertension or to an intermediate phenotype related to high blood pressure in humans. However, animal models will play at least two crucial roles. First, animals can be used for direct mapping of genes responsible for experimental hypertension, as long as the comparative gene mapping efforts will ultimately be directed toward the identification of the corresponding genes in humans. Second, animal models might also be used subsequent to primary identification of human genes related to high blood pressure as a means to clarify pathophysiological mechanisms. Confirmation of the pathophysiology derived from animal studies can then be undertaken in human subjects. Mapping and identification of genes responsible for hypertension, whether conducted initially in humans or in animals, will continually provide candidate loci and hypotheses for testing in humans. 1. Mapping and Identification of Genes Mapping of relevant genetic loci and identification of underlying genetic mutations responsible for high blood pressure in humans or in experimental animal models of hypertension is an area that may be supported through the SCOR mechanism. Gene mapping and identification will be complementary to other scientific efforts to be supported by the NHLBI or through other sources. Studies may be directed toward understanding the simultaneous occurrence, on a genetic level, of hypertension and other diseases, such as various forms of kidney disease, left ventricular hypertrophy, adult-onset diabetes mellitus, and atherosclerosis. Eventually, it may be possible to define specific genotypes that will identify individuals at high risk for developing other diseases along with high blood pressure. Two principal approaches may be used to map genes that may be linked to hypertension: the first entails a whole genome search using anonymous highly informative genetic markers spread throughout the genome; the second approach involves the systematic study of candidate genes. Mapping can be carried out with methodologies such as linkage in affected sib pairs, genetic linkage analysis of large pedigrees, and association methods. To reduce the impact of genetic heterogeneity, the study population may be subdivided by defining intermediate phenotypes (characteristics that have greater heritability than the complex trait itself), or a population may be studied that has originated from a restricted founder population or has been isolated in some way as to limit the number of genetic variants present. The relative level of research activity devoted to gene mapping in the network of centers will depend in part on the success of gene mapping endeavors in other research programs that are not supported by this center mechanism. As other research programs successfully identify genetic loci, assessments will be made by the SCOR steering committee as to the areas that should receive scientific attention within the SCOR network. The center network will always be poised to continue gene mapping and identification efforts as the state-of-the-science requires. 2. Mechanistic Studies on the Consequences of Genetic Variation Investigators may select genetic variations for mechanistic studies from a number of sources. For instance, SCOR investigators may choose to study allelic variations linked to high blood pressure that have been identified and reported in the literature or that have been identified from mapping activities within the SCOR program. In addition, candidate genes that are well justified in the application may also be studied, even if they have not yet been linked to hypertension in humans or specific animal models. Studies may be conducted at any level of investigation, from the molecular to the whole animal. For example, consideration may be given to approaches examining the implications of genetic mutations on: cellular function, including changes in the processing of genetic information, synthesis or degradation of vasoactive substances, signal transduction pathways, receptor structure and function, and response to cytokines and growth factors; and whole animal integrated function, using genetically altered animals, such as congenics, transgenics, and knockouts, to clarify modifications of organ function and implications for acute and chronic blood pressure control. 3. Molecular Genetic Studies on Basic Mechanisms of Normal and Altered Blood Pressure Control Molecular and genetic approaches that focus on the genes for other proteins for which there is ample evidence of possible involvement in blood pressure regulation are also excellent areas for study. However, mechanistic studies should address the implications of genetic alterations on normal blood pressure regulation and the pathophysiology of hypertension. Understanding the genetic regulation of cellular and organ responses to elevated blood pressure is an additional area that may be supported through the Hypertension SCORs. Research on cellular and organ responses to hypertension includes studies on the complications associated with the disease, such as investigation at a genetic level on conditions such as nephropathy or cardiac hypertrophy. Other topics, such as genetic determinants of vascular remodeling as a function of high blood pressure, are also appropriate responses. Other possible research areas are: development and use of techniques to introduce and express new genetic information; development and use of approaches to abolish or modify the expression of endogenous genes, such as homologous recombination and other gene targeting techniques; development and application of novel approaches to alter endogenous gene expression, such as antisense genes, ribozymes, dominant negative mutation, or double knockouts; identification of new genes and proteins involved in blood pressure regulation by insertional mutagenesis; utilization of genetic ablation techniques to unravel the complex interactions of systems comprised of multiple cell types; and, isolation, characterization, propagation of embryonic stem cells from rats, rabbits, and other species. Identification of the consequences of long-term hypertension on organ adaptation and eventually on end stage target organ disease is another important objective of this solicitation. It will be particularly interesting to determine how organ adaptations to high blood pressure are affected by predisposing genetic factors. Some of the sequelae to hypertension that may be studied include kidney disease, stroke, myocardial infarction, heart failure, vascular disease, and retinal disease. Biennial Research Meetings Upon initiation of the program, the NHLBI will sponsor periodic meetings to encourage exchange of information among investigators who participate in this program and to stimulate collaboration. Applicants should request additional travel funds for a two-day meeting every other year, most likely to be held in Bethesda, Maryland. Applicants should also include a statement in their applications indicating their willingness to participate in these meetings. STUDY POPULATIONS SPECIAL INSTRUCTIONS TO APPLICANTS REGARDING IMPLEMENTATION OF NIH POLICIES CONCERNING INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH STUDY POPULATIONS NIH policy is that applicants for NIH clinical research grants and cooperative agreements will be required to include women and minorities in study populations so that research findings can be of benefit to all persons at risk of the disease, disorder, or condition under study. Special emphasis should be placed on the need for inclusion of women and minorities in studies of diseases, disorders, and conditions that disproportionately affect them. This policy is intended to apply to males and females of all ages. If women or minorities are excluded or inadequately represented in clinical research, particularly in proposed population-based studies, a clear compelling rationale should be provided. The composition of the proposed study population must be described in terms of gender and racial/ethnic group. In addition, gender and racial/ethnic issues should be addressed in developing a research design and sample size appropriate for the scientific objectives of the study. This information should be included in the form PHS-398 in Sections 1-4 of the Research Plan AND summarized in Section 5, Human Subjects. Applicants are urged to assess carefully the feasibility of including the broadest possible representation of minority groups. However, NIH recognizes that it may not be feasible or appropriate in all research projects to include representation of the full array of United States racial/ethnic minority populations (i.e., Native Americans [including American Indians or Alaskan Natives], Asian/Pacific Islanders, Blacks, Hispanics). The rationale for studies on single minority population groups should be provided. For the purpose of this policy, clinical research includes human biomedical and behavioral studies of etiology, epidemiology, prevention (and preventive strategies), diagnosis, or treatment of diseases, disorders, or conditions, including, but not limited to, clinical trials. The usual NIH policies concerning research on human subjects also apply. Basic research or clinical studies in which human tissues cannot be identified or linked to individuals are not subject to these policies. However, every effort should be made to include human tissues from women and racial/ethnic minorities when it is important to apply the results of the study broadly, and this should be addressed by applicants. If the required information is not contained within the application, the application will be returned. Peer reviewers will address specifically whether the research plan in the application conforms to these policies. If the representation of women or minorities in a study design is inadequate to answer the scientific question(s) addressed AND the justification for the selected study population is inadequate, it will be considered a scientific weakness or deficiency in the study design and will be reflected in assigning the priority score to the application. NIH funding components will not award grants or cooperative agreements that do not comply with these policies. LETTER OF INTENT Prospective applicants are asked to submit, by October 1, 1994, a letter of intent that includes a descriptive title of the proposed research; the name, address, and telephone number of the Principal Investigator; the identities of other key personnel and participating institutions; and the number and title of the RFA in response to which the application may be submitted. Although a letter of intent is not required, is not binding, and does not enter into the review of subsequent applications, the information that it contains is helpful in planning for the review of applications. It allows NHLBI 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: Chief, Review Branch Division of Extramural Affairs National Heart, Lung and Blood Institute Westwood Building, Room 557A Bethesda, MD 20892 APPLICATION PROCEDURES The research grant application form PHS 398 (rev. 9/91) is to be used in applying for these grants. These forms are available at most institutional offices of sponsored research and may be obtained from the Office of Grants Information, Division of Research Grants, National Institutes of Health, Westwood Building, Room 449, Bethesda, MD 20892, telephone 301/710-0267. The RFA label available in the PHS 398 application form must be affixed to the bottom of the face page of the application. 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. In addition, to identify the application as a response to this RFA, check "YES", enter the title "Specialized Centers of Research -- Molecular Genetics of Hypertension," and the RFA number HL-94-006-H on Line 2a of the face page of the application. Send or deliver a signed, typewritten original of the application, including the checklist, and three signed photocopies, in one package to: Division of Research Grants National Institutes of Health Westwood Building, Room 240 Bethesda, MD 20892** Send two additional copies of the application to the Chief, Review Branch at the address listed under LETTER OF INTENT. It is important to send these two copies at the same time as the original and three copies are sent to the Division of Research Grants (DRG), otherwise the NHLBI cannot guarantee that the application will be reviewed in competition for this RFA. Applications must be received by December 8, 1994. If an application is received after that date, it will be returned to the applicant. DRG will not accept any application in response to this announcement that is essentially the same as one currently pending initial review, unless the applicant withdraws the pending application. DRG will not accept any application that is essentially the same as one already reviewed. This does not preclude the submission of substantial revisions of applications already reviewed, but such applications must include an introduction addressing the previous critique. REVIEW CONSIDERATIONS Upon receipt, applications will be reviewed by National Institutes of Health (NIH) staff for completeness and responsiveness. Incomplete applications or applications deemed not responsive to the RFA will be returned to the applicant without further consideration. Crucial to the initial scientific review will be a triage process that will eliminate all applications that are deemed not scientifically competitive within the goals and criteria of the RFA. Those applications that are complete and responsive will be evaluated for scientific and technical merit by an appropriate peer review group convened by the NHLBI. The second level of review will be provided by the National Heart, Lung, Blood Advisory Council. Factors to be considered in the evaluation of each application will be similar to those used in review of traditional research grant applications and, in addition, will include overall proposed interactions among basic and clinical research projects. Major factors to be considered in the evaluation of applications include: o Scientific merit of the proposed basic and clinical research projects including significance, importance, and appropriateness of the theme; innovation, originality, and feasibility of the approach; and adequacy of the experimental design. o Leadership, scientific stature, and commitment of the program director; competence of the investigators to accomplish the proposed research goals and their time commitment to the program; and the feasibility and strength of consortium arrangements. o Collaborative interaction among basic and clinical research components, the balance between them, and plans for transfer of potential findings from basic to clinical studies. o Adequacy of the environment for performance of the proposed research including clinical populations and/or specimens; laboratory facilities; proposed instrumentation; quality controls; administrative structure; institutional commitment; and, when needed, data management systems. o Appropriateness of the budget for the proposed program. INQUIRIES Written and telephone inquiries concerning this RFA are encouraged. The opportunity to clarify any issues or questions from potential applicants is welcome. Special supplemental instructions for the preparation of grant applications for SCORs may be obtained by contacting the Hypertension SCOR Program Administrator, as indicated below. Direct inquiries regarding scientific issues to: Paul A. Velletri, Ph.D. Division of Heart and Vascular Diseases National Heart, Lung and Blood Institute Federal Building, Room 4C10 Bethesda, MD 20892 Telephone: (301) 496-1857 FAX: (301) 402-2044 Direct inquiries regarding fiscal and administrative matters to: Ms. Jane Davis Division of Extramural Affairs National Heart, Lung and Blood Institute Westwood Building, Room 4A15C Bethesda, MD 20892 Telephone: (301) 594-7436 FAX: (301) 594-7492 AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance No. 93.837, Heart and Vascular Diseases. Awards will be made under the authorization of the Public Health Service Act, Title IV, Part A (Public Law 78-410, as amended by Public Law 99-158, 42 USC 241 and 285) and administered under PHS grants policies and Federal Regulations 42 CFR 52 and 45 CFR Part 74. This program is not subject to the intergovernmental review requirement of Executive Order 12372 or Health Systems Agency review. .
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