This notice has expired. Check the NIH Guide for active opportunities and notices.

EXPIRED


COOPERATIVE CLINICAL TRIAL IN PEDIATRIC TRANSPLANTATION

RELEASE DATE:  March 26, 2002

RFA:  AI-02-004  January 12, 2007  - This RFA has been reissued as (RFA-AI-07-006).

National Institute of Allergy and Infectious Diseases  
 (http://www.niaid.nih.gov)

LETTER OF INTENT RECEIPT DATE:  September 10, 2002
APPLICATION RECEIPT DATE:  October 11, 2002

THIS RFA CONTAINS THE FOLLOWING INFORMATION

o Purpose of this RFA
o Research Objectives
o Mechanism(s) of Support 
o Funds Available
o Eligible Institutions
o Individuals Eligible to Become Principal Investigators
o Special Requirements
o Where to Send Inquiries
o Letter of Intent
o Submitting an Application
o Supplemental Instructions 
o Peer Review Process
o Review Criteria
o Receipt and Review Schedule
o Award Criteria
o Required Federal Citations

PURPOSE OF THIS RFA

The Division of Allergy, Immunology, and Transplantation (DAIT) of the 
National Institute of Allergy and Infectious Diseases (NIAID) 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 goal of this research program is to support multi-center 
cooperative clinical trials in pediatric renal transplantation that will: (1) 
evaluate new therapeutic regimens to enhance long-term graft survival; (2) 
investigate the underlying mechanisms of action of the agents under study; (3) 
develop diagnostic tests to predict graft rejection; and (4) develop surrogate 
biomarkers for acute and chronic rejection.  This Request for Applications 
(RFA) is a renewal of a previous RFA, AI-98-012.

RESEARCH OBJECTIVES
 
Background

Kidney transplantation remains the therapy of choice for children with end-
stage renal disease.  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 less pronounced than when the Cooperative Clinical Trial in 
Pediatric Transplantation (CCTPT) was established in 1994, children still do 
not achieve 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; graft loss requires that the patient be 
returned to the transplant waiting list and dialysis with its attendant 
morbidity and side effects.  In addition, young children are unlikely to 
achieve a normal life span or an acceptable quality-of-life because they will 
possibly receive a second and even a third or fourth transplant in their 
lifetimes.  Although many factors have been implicated in the difference in 
graft survival between pediatric and adult kidney transplant recipients, the 
most important appears to be the pediatric immune system.  In contrast to 
adults, children require higher doses of immunosuppressive therapy to prevent 
rejection.  This difference is reflected in higher total T lymphocyte counts 
and increased responses to mitogen stimulation as compared with adults.  These 
measures are associated with more frequent and vigorous episodes of graft 
rejection that are not as responsive to therapy as in adults, resulting in a 
higher rate of graft loss.  Higher doses of the immunosuppressive drug, 
cyclosporine A (CsA), must be administered 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.  These elevated doses of CsA induce hyperlipidemia, 
which increases the risk of atherosclerotic cardiovascular disease.  A serious 
problem, unique to the pediatric population, is growth retardation, a well-
documented side effect of the corticosteroids that are part of the standard 
immunosuppressive regimen.  Growth retardation can lead to psychological 
problems and the inability to lead a normal life.  It is most problematic for 
the very young transplant recipients, as they will never achieve normal 
stature.

Therefore, changes in standard immunosuppression or the use of new treatment 
regimens that reduce or abolish the need for global immunosuppression hold the 
promise of improving graft survival and reducing adverse side effects.  Such 
approaches include 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 multi-site, cooperative 
clinical trials in pediatric kidney transplantation to improve graft and 
patient survival.  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:

1. Clinical trials to evaluate the safety and efficacy of new and innovative 
therapeutic approaches to induce donor-specific tolerance with or without 
standard immunosuppression, including temporary or permanent withdrawal of 
standard immunosuppression.

2. Clinical trials to evaluate the safety and efficacy of new, less toxic 
immunosuppressive agents or regimens to prevent rejection or new approaches to 
reduce the number of immunosuppressive agents required to prevent rejection.

3. Adjunct studies of the underlying mechanisms of action of the therapeutic 
approaches under investigation, including changes in immune response, measures 
of donor-specific responsiveness and/or tolerance; and

4. 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. 

Applications that contain any of the following will not be accepted: 
transplantation of multiple organs (e.g. combined kidney-pancreas 
transplantation), transplantation of organs other than kidneys, 
xenotransplantation, or transplantation in animal models.

MECHANISM OF SUPPORT

This RFA will use the NIH Cooperative Agreement (U01).  The U01 is a 
cooperative agreement award mechanism in which the Principal Investigator 
retains the primary responsibility and dominant role for planning, directing, 
and executing the proposed project, with NIH staff being substantially 
involved as a partner with the Principal Investigator, as described under the 
section "Cooperative Agreement Terms and Conditions of Award"

This RFA is a one-time solicitation.  Future unsolicited, competing-
continuation applications based on this project will compete with all 
investigator-initiated applications and will be reviewed according to the 
customary peer review procedures.

The total project period for applications submitted in response to this RFA 
may not exceed five (5) years. At this time, the NIAID has not determined 
whether and how this solicitation will be continued beyond the present RFA.

FUNDS AVAILABLE
 
NIAID intends to commit approximately $2,500,000 in FY 2003 to fund 
approximately two (2) new and/or competitive continuation grants in response 
to this RFA. An applicant may request a project period of up to five years and 
a budget for direct costs of up to $1,250,000 per year. Because the nature and 
scope of the proposed research will vary from application to application, it 
is anticipated that the size and duration of each award will also vary. 
Although the financial plans of NIAID provide support for this program, awards 
pursuant to this RFA are contingent upon the availability of funds and the 
receipt of a sufficient number of meritorious applications. At this time, it 
is not known if this RFA will be reissued.

ELIGIBLE INSTITUTIONS
 
Domestic institutions may submit applications if they have any of the 
following characteristics:

o For-profit or non-profit organizations 
o Public or private institutions, such as universities, colleges, hospitals, 
and laboratories 
o Units of state and local governments
o Eligible agencies of the Federal government   

INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS   

Individuals with the skills, knowledge, and resources necessary to carry out 
the proposed research are invited to work with their institutions to develop 
an application for support.  Individuals from underrepresented racial and 
ethnic groups as well as individuals with disabilities are always encouraged 
to apply for NIH programs.   

SPECIAL REQUIREMENTS

The study organization will consist of the following: a  Steering Committee, 
an Adjunct Studies Subcommittee, a Data and Safety Monitoring Board, and a 
data coordination and management plan that will be direct by NIAID.  These are 
described further in the "Terms and Conditions of Award".

COOPERATIVE AGREEMENT TERMS AND CONDITIONS OF AWARD

The following terms and conditions will be incorporated into the award 
statement and provided to the Principal Investigator (PI) 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 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's 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 Scientific Coordinator.

1.  Monitoring Clinical Studies.  

When clinical studies or trials are a component of the research proposed, 
NIAID policy requires that studies be monitored commensurate with the degree 
of potential risk to study subjects and the complexity of the study.  Terms 
and Conditions of Award will be included with awards.  NIAID policy was 
announced in the NIH Guide on February 24, 2000 and is available at: 
http://grants.nih.gov/grants/guide/notice-files/NOT-AI-00-003.html.  The full 
policy, including terms and conditions of award, is available at: 
http://www.niaid.nih.gov/ncn/pdf/clinterm.pdf

2.  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 AI-02-004 and for performing the scientific activities. 

The PI's responsibilities regarding Steering Committee membership, protocol 
development and conduct, and data coordination and management are described 
under Collaborative Responsibilities.  In brief, the PI will be a voting 
member of the Steering Committee and will be required to participate in all 
Steering Committee activities and to follow the policies and procedures that 
are developed by the Steering Committee.  The PI will be required to provide 
primary study data to NIAID for management, quality control, and analysis.  
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.

3. NIAID Staff Responsibilities

Program Director

NIAID staff assistance will be provided by the Chief of the Transplantation 
Immunobiology Branch, Division of Allergy, Immunology and Transplantation, or 
designate, who will serve as the Program Director, responsible for normal 
program stewardship and administration.  The Program Director may also serve 
as, or appoint, the Scientific Coordinator.  The Government, via the NIAID 
Program Director, 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.

Program Review
The NIAID Program Director will review the progress of each participating 
institution 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.

Organizational Changes
Certain organizational changes require the prior written approval of the NIAID 
Program Director.  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 PI, 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 Program Director.

Regulatory Affairs
The Program Director may also be the responsible person for Investigational 
New Drug (IND) Applications, as applicable.

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 breach 
of the protocol, (b) substantive changes in the consensus 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.

Scientific Coordinator

The NIAID Scientific Coordinator will have substantial scientific involvement 
during the conduct of this activity through technical assistance, advice and 
coordination above and beyond normal program stewardship for grants. The NIAID 
Scientific Coordinator will serve as a voting member of the Steering Committee 
and will participate in all Committee activities.  The NIAID Scientific 
Coordinator will also serve on the Adjunct Studies Subcommittee.

Protocol Development
As a member of the Steering Committee, the NIAID Scientific Coordinator 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 Scientific Coordinator will be determine the mechanism(s) for 
acquisition and distribution of those study materials involved in the 
consensus protocols developed by the Steering Committee.  The Scientific 
Coordinator will also assist in the development, assembly, and submission of 
all required regulatory documents, e.g. those regarding the use 
investigational drugs, to the Food and Drug Administration.  

Monitoring Study Performance
The NIAID Scientific Coordinator 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 patient accrual.

Data Coordination and Management
The NIAID Scientific Coordinator will be responsible for ensuring the 
provision of centralized data management and coordination assistance.  Under 
the direction of the Steering Committee, the NIAID Scientific Coordinator will 
provide technical assistance and data management services to the participating 
institutions with respect to quality control, uniformity of data collection, 
management of the collective database, and data analysis.

Publication and Presentation of Study Findings
The NIAID Scientific Coordinator 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 Scientific Coordinator will be subject to approval 
in accordance with NIH policies regarding staff authorship of publications 
resulting from extramural awards.

4.  Collaborative Responsibilities

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 Scientific Coordinator, the Principal 
Investigators, and one additional Senior Investigator from each consortium 
rotating on an annual basis.  A Senior Investigator is the person responsible 
for on-site scientific direction and implementation of the consensus protocols 
at his/her participating institution.  Senior Investigators must be physicians 
with substantial experience in pediatric kidney transplantation and in the 
design, implementation, and evaluation of clinical trials.  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 Scientific Coordinator having one vote.  The 
Steering Committee will elect a Chairperson from among its non-Federal members 
during the first meeting of the Committee, to be convened by the NIAID Program 
Director.  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 Program Director.  
Each Steering Committee member will be expected to participate in all Steering 
Committee activities, e.g., meetings, conference calls, special subcommittee 
activities, etc. as may be necessary.  Participating institutions will be 
required to accept and implement the consensus protocols and procedures 
approved by the Steering Committee.  The Steering Committee shall appoint an 
Adjunct Studies Subcommittee, as described below.  Other Subcommittees may be 
appointed, as required, by the Steering Committee.

Adjunct Studies Subcommittee
The Steering Committee shall appoint an Adjunct Studies Subcommittee to 
design, implement, and evaluate: (1) studies of the underlying mechanisms of 
action of the therapeutic approaches under investigation and (2) studies to 
develop, evaluate and validate immune and/or surrogate markers of kidney graft 
survival and rejection.  Each PI shall select two representatives from his/her 
consortium as voting members of the Adjunct Studies Subcommittee.  In 
addition, the NIAID Scientific Coordinator shall serve as a voting member.  
The non-federal members of the Adjunct Studies Subcommittee shall elect its 
Chair, who 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, 
conference calls, and other Subcommittee activities.

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 Program 
Director.  Clinical protocols and adjunct studies will be subject to review by 
the Data and Safety Monitoring Board, in an advisory capacity, prior to 
implementation. 

Data Coordination and Management  
Each participating institution will be responsible for providing NIAID with 
all primary study data for management, quality control, and analysis using 
procedures and standards determined by the Steering Committee.  Under the 
direction of the Steering Committee, the NIAID will provide technical 
assistance and data management services to the participating institutions with 
respect to quality control, uniformity of data collection, management of the 
collective database, and data analysis.  The NIAID will be responsible for 
ensuring the provision of centralized data collection, management, and quality 
assurance.  Specific analyses to be performed will be directed by the NIAID 
with the input of the Steering Committee.  The results of those analyses will 
be delivered to the Steering Committee, which is responsible for determining 
how the results are interpreted, whether the results should influence ongoing 
data collection, and how the findings should be disseminated.  All data will 
be available to all awardees.  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.  Although the 
participating institutions 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. 

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 the participating institutions and NIAID support.  Analyses 
to be performed using the collective data from all participating institutions 
will be determined and directed by the Steering Committee.  Participating 
institutions 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 carry out this function.

Monitoring Study Progress
The Steering Committee will establish mechanisms for assessing the performance 
of the participating institutions, 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.

5.  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 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, selected by the two prior 
members.  The Panel 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.

WHERE TO SEND INQUIRIES

We encourage inquiries concerning this RFA and welcome the opportunity to 
answer questions from potential applicants.  Inquiries may fall into three 
areas:  scientific/research, peer review, and financial or grants management 
issues:

o Direct your questions about scientific/research issues to:

Shiv A. Prasad, Ph.D.  
Division of Allergy, Immunology, and Transplantation
National Institute of Allergy and Infectious Diseases  
Room 5125, MSC-7640
6700-B Rockledge Drive
Bethesda, MD  20892-7640 (20817 for express delivery)
Telephone:  (301) 496-5598
FAX:        (301) 402-2571
E-Mail:      [email protected]
  
o Direct your questions about peer review issues, address the letter of 
intent, and mail two copies of the application and all five sets of appendices 
to:
  
Priti Mehrotra, Ph.D.  
Division of Extramural Activities  
National Institute of Allergy and Infectious Diseases  
Room 2100, MSC-7610
6700-B Rockledge Drive  
Bethesda, MD  20892-7610 (20817 for express/courier delivery)
Telephone:  (301) 435-9369
FAX:        (301) 402-2638
E-Mail:      [email protected]

o Direct your questions about financial or grants management matters to:

Maryellen Connell  
Division of Extramural Activities  
National Institute of Allergy and Infectious Diseases  
Room 2123, MSC-7610
6700-B Rockledge Drive  
Bethesda, MD  20892-7610 (20817 for express/courier delivery)
Telephone:  (301) 402-5576
Fax:        (301) 480-3780
E-Mail:      [email protected]

LETTER OF INTENT

Prospective applicants are asked to submit a letter of intent that includes 
the following information:

o Descriptive title of the proposed research
o Name, address, and telephone number of the Principal Investigator
o Names of other key personnel 
o Participating institutions
o Number and title of this RFA 

Although a letter of intent is not required, is not binding, and does not 
enter into the review of a subsequent application, the information that it 
contains allows IC staff to estimate the potential review workload and plan 
the review.

The letter of intent must be sent by September 10, 2002 to:

Priti Mehrotra, Ph.D.  
Division of Extramural Activities  
National Institute of Allergy and Infectious Diseases  
Room 2100, MSC-7610
6700-B Rockledge Drive  
Bethesda, MD  20892-7610 (20817 for express/courier delivery)
Telephone:  (301) 435-9369
FAX:        (301) 402-2638
E-Mail:      [email protected]

SUBMITTING AN APPLICATION

Applications must be prepared using the PHS 398 research grant application 
instructions and forms (rev. 5/2001). The PHS 398 is available at 
http://grants.nih.gov/grants/funding/phs398/phs398.html in an interactive 
format.  For further assistance contact GrantsInfo, Telephone (301) 710-0267, 
E-mail: [email protected].

SUPPLEMENTAL INSTRUCTIONS

Minimum Requirements for Application  

To promote the development of a collaborative program among the award 
recipients, a minimum number of issues must be addressed in the application, 
as outlined below.  

1. The application must include two (2) proposed protocols for clinical trials 
that meet 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 may use new or innovative approaches, 
and one may focus on the modification of standard therapeutic approaches.  
Award of the Cooperative Agreement does not imply that any of the proposed 
protocols will be implemented.  Because the actual protocols will be selected 
by the Steering Committee, the final clinical trials implemented by the CCTPT 
may not reflect any single protocol submitted in response to this RFA. 

2. The application must include at least one (1) proposed hypothesis-driven 
adjunct study of the underlying mechanisms of action 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; a 
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 improve 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.  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; provide a description of 
the population currently available for each proposed protocol; and describe 
proposed mechanisms for monitoring accrual performance and criteria for 
continued participation by each participating institution.  The ability to 
meet enrollment objectives may be documented by recruitment for prior CCTPT 
studies or other studies sponsored by Federal or non-Federal organizations.  
Studies will not be approved if the NIAID or the Steering Committee determines 
that it will not be feasible to accrue patients within the specified time 
frame.  Furthermore, applicant and participating institutions must agree that 
the approved trials within the CCTPT will have priority over any subsequent 
non-CCTPT trial in pediatric kidney transplantation.  Exemptions from this 
agreement require approval by the NIAID and the Steering Committee.

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 participating 
institutions 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 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 participating institution in 
the consortium who will be responsible for on-site clinical and scientific 
implementation, direction and management of the clinical protocols, and the 
coordination of requirements for adjunct studies of underlying mechanisms and 
immune/surrogate markers.  

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 and 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 to adhere 
to the decisions reached by that Committee, including following the consensus 
protocols and adjunct studies. 

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 Bethesda, MD area for two 2-day 
Steering Committee meetings during the first 12 months, and annually 
thereafter, for the Principal Investigator and one Senior Investigator for 
each institution participating in the consortium, and (2) travel to the 
Bethesda, MD area for annual one-day meetings of the Adjunct Studies 
Subcommittee for the two representatives from each consortium.


USING THE RFA LABEL: The RFA label available in the PHS 398 (rev. 5/2001) 
application form must be affixed to the bottom of the face page of the 
application.  Type the RFA number on the label.  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, the RFA title and 
number must be typed on line 2 of the face page of the application form and 
the YES box must be marked. The RFA label is also available at: 
http://grants.nih.gov/grants/funding/phs398/label-bk.pdf.

SENDING AN APPLICATION TO THE NIH: Submit a signed, typewritten original of 
the application, including the Checklist, and three signed, photocopies, in 
one package to:
 
Center For Scientific Review
National Institutes Of Health
6701 Rockledge Drive, Room 1040, MSC 7710
Bethesda, MD  20892-7710 (20817 for express/courier delivery)

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:

Priti Mehrotra, Ph.D.  
Division of Extramural Activities  
National Institute of Allergy and Infectious Diseases  
Room 2100, MSC-7610
6700-B Rockledge Drive  
Bethesda, MD  20892-7610 (20817 for express/courier delivery)
Telephone:  (301) 435-9369
FAX:        (301) 402-2638
E-Mail:      [email protected]

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).

APPLICATION PROCESSING: Applications must be received by October 11, 2002.  If 
an application is received after that date, it will be returned to the 
applicant without review.  Applications that are not received as a single 
package on the receipt date will be judged non-responsive and will be returned 
to the applicant.
 
The Center for Scientific Review (CSR) will not accept any application in 
response to this RFA that is essentially the same as one currently pending 
initial review, unless the applicant withdraws the pending application.  The 
CSR 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.

PEER REVIEW PROCESS  

Upon receipt, applications will be reviewed for completeness by the CSR and 
responsiveness by the NIAID. Incomplete and/or non-responsive applications 
will be returned to the applicant without further consideration.

Applications that are complete and responsive to the RFA will be evaluated for 
scientific and technical merit by an appropriate peer review group convened by 
the NIAID in accordance with the review criteria stated below.  As part of the 
initial merit review, all applications will:

o Receive a written critique
o Undergo a process in which only those applications deemed to have the 
highest scientific merit, generally the top half of the applications under 
review, will be discussed and assigned a priority score
o Receive a second level review by the National Advisory Allergy and 
Infectious Diseases Council

REVIEW CRITERIA

The goals of NIH-supported research are to advance our understanding of 
biological systems, improve the control of disease, and enhance health.  In 
the written comments, reviewers will be asked to discuss the following aspects 
of your application in order to judge the likelihood that the proposed 
research will have a substantial impact on the pursuit of these goals: 

o Significance 
o Approach 
o Innovation
o Investigator
o Environment

The scientific review group will address and consider each of these criteria 
in assigning your application's overall score, weighting them as appropriate 
for each application.  Your application does not need to be strong in all 
categories to be judged likely to have major scientific impact and thus 
deserve a high priority score.  For example, you 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 your study address an important problem? If the aims 
of your application are achieved, how do they advance scientific knowledge?  
What will be the effect of these studies on the concepts or methods that drive 
this field?

(2) APPROACH:  Are the conceptual framework, design, methods, and analyses 
adequately developed, well integrated, and appropriate to the aims of the 
project?  Do you acknowledge potential problem areas and consider alternative 
tactics?

(3) INNOVATION: Does your project employ novel concepts, approaches or 
methods? Are the aims original and innovative?  Does your project challenge 
existing paradigms or develop new methodologies or technologies?

(4) INVESTIGATOR: Are you appropriately trained and well suited to carry out 
this work?  Is the work proposed appropriate to your experience level as the 
principal investigator and to that of other researchers (if any)?

(5) ENVIRONMENT: Does the scientific environment in which your 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?

ADDITIONAL REVIEW CRITERIA: In addition to the above criteria, your 
application will also be reviewed with respect to the following:

o PROTECTIONS: The adequacy of the proposed protection for humans to the 
extent they may be adversely affected by the project proposed in the 
application.

o INCLUSION: The adequacy of plans to include subjects from both genders, all 
racial and ethnic groups (and subgroups), and children as appropriate for the 
scientific goals of the research.  Plans for the recruitment and retention of 
subjects will also be evaluated. (See Inclusion Criteria included in the 
section on Federal Citations, below)

o DATA SHARING: The adequacy of the proposed plan to share data within the 
CCTPT.

o BUDGET: The reasonableness of the proposed budget and the requested period 
of support in relation to the proposed research.  However, this will not be 
part of the overall score.

o APPLICABILITY: The potential for widespread clinical application of the 
proposed clinical trials.

o TOXICITY REDUCTION: The use of immunosuppressive protocols that are less 
toxic than the current therapies.

o RECRUITMENT: The ability of the applicant consortium to recruit and retain 
pediatric study participants up to 21 years of age.  Details may be found 
above, under "B. Minimum Requirements for Application."

o ADJUNCT STUDIES: The merit of the proposed adjunct studies, the innovation 
of the methods used, and the ability to procure sufficient numbers of samples 
for statistically valid analyses.

RECEIPT AND REVIEW SCHEDULE

Letter of Intent Receipt Date:     September 10, 2002
Application Receipt Date:          October 11, 2002
Scientific Peer Review Date:       February, 2003
Advisory Council Review:           June, 2003
Earliest Anticipated Start Date:   August, 2003 

AWARD CRITERIA

Award criteria that will be used to make award decisions include:

o Scientific merit (as determined by peer review)
o Availability of funds
o Programmatic priorities.

REQUIRED FEDERAL CITATIONS 

MONITORING PLAN AND DATA SAFETY AND MONITORING BOARD: Research components 
involving Phase I and II clinical trials must include provisions for 
assessment of patient eligibility and status, rigorous data management, 
quality assurance, and auditing procedures.  In addition, it is NIH policy 
that all clinical trials require data and safety monitoring, with the method 
and degree of monitoring being commensurate with the risks (NIH Policy for 
Data Safety and Monitoring, NIH Guide for Grants and Contracts, June 12, 1998: 
http://grants.nih.gov/grants/guide/notice-files/not98-084.html).  

INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH: It is the policy of 
the NIH that women and members of minority groups and their sub-populations 
must be included in all NIH-supported clinical research projects unless a 
clear and compelling justification is provided indicating that inclusion is 
inappropriate with respect to the health of the subjects or 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 clinical research should read the AMENDMENT "NIH 
Guidelines for Inclusion of Women and Minorities as Subjects in Clinical 
Research - Amended, October, 2001," published in the NIH Guide for Grants and 
Contracts on October 9, 2001 (http://grants.nih.gov/grants/guide/notice-
files/NOT-OD-02-001.html); a complete copy of the updated Guidelines are 
available at 
http://grants.nih.gov/grants/funding/women_min/guidelines_amended_10_2001.htm. 
The amended policy incorporates: the use of an NIH definition of clinical 
research; updated racial and ethnic categories in compliance with the new OMB 
standards; clarification of language governing NIH-defined Phase III clinical 
trials consistent with the new PHS Form 398; and updated roles and 
responsibilities of NIH staff and the extramural community.  The policy 
continues to require for all NIH-defined Phase III clinical trials that: a) 
all applications or proposals and/or protocols must provide a description of 
plans to conduct analyses, as appropriate, to address differences by 
sex/gender and/or racial/ethnic groups, including subgroups if applicable; and 
b) investigators must report annual accrual and progress in conducting 
analyses, as appropriate, by sex/gender and/or racial/ethnic group 
differences.

INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS: 
The NIH maintains a policy 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 is available at 
http://grants.nih.gov/grants/funding/children/children.htm. 

REQUIRED EDUCATION ON THE PROTECTION OF HUMAN SUBJECT PARTICIPANTS: NIH policy 
requires education on the protection of human subject participants for all 
investigators submitting NIH proposals for research involving human subjects.  
You will find this policy announcement in the NIH Guide for Grants and 
Contracts Announcement, dated June 5, 2000, at 
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html.

HUMAN EMBRYONIC STEM CELLS (hESC): Criteria for federal funding of research on 
hESCs can be found at http://grants.nih.gov/grants/stem_cells.htm and at 
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-005.html.  Only 
research using hESC lines that are registered in the NIH Human Embryonic Stem 
Cell Registry will be eligible for Federal funding (see http://escr.nih.gov).   
It is the responsibility of the applicant to provide the official NIH 
identifier(s)for the hESC line(s)to be used in the proposed research.  
Applications that do not provide this information will be returned without 
review. 

PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT: The 
Office of Management and Budget (OMB) Circular A-110 has been revised to 
provide public access to research data through the Freedom of Information Act 
(FOIA) under some circumstances.  Data that are (1) first produced in a 
project that is supported in whole or in part with Federal funds and (2) cited 
publicly and officially by a Federal agency in support of an action that has 
the force and effect of law (i.e., a regulation) may be accessed through FOIA.  
It is important for applicants to understand the basic scope of this 
amendment.  NIH has provided guidance at 
http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm.

Applicants may wish to place data collected under this PA in a public archive, 
which can provide protections for the data and manage the distribution for an 
indefinite period of time.  If so, the application should include a 
description of the archiving plan in the study design and include information 
about this in the budget justification section of the application. In 
addition, applicants should think about how to structure informed consent 
statements and other human subjects procedures given the potential for wider 
use of data collected under this award.

URLs IN NIH GRANT APPLICATIONS OR APPENDICES: All applications and proposals 
for NIH funding must be self-contained within specified page limitations. 
Unless otherwise specified in an NIH solicitation, Internet addresses (URLs) 
should not be used to provide information necessary to the review because 
reviewers are under no obligation to view the Internet sites.   Furthermore, 
we caution reviewers that their anonymity may be compromised when they 
directly access an Internet site.

HEALTHY PEOPLE 2010: The Public Health Service (PHS) is committed to achieving 
the health promotion and disease prevention objectives of "Healthy People 
2010," a PHS-led national activity for setting priority areas. This RFA is 
related to one or more of the priority areas. Potential applicants may obtain 
a copy of "Healthy People 2010" at http://www.health.gov/healthypeople.

AUTHORITY AND REGULATIONS

This program is described in the Catalogue of Federal Domestic Assistance in 
the following citations: No. 93.855, Immunology, Allergy, and Transplantation 
Research and No. 93.856, Microbiology and Infectious Diseases Research. Awards 
are made under authorization of Sections 301 and 405 of the Public Health 
Service Act as amended (42 USC 241 and 284) and administered under NIH grants 
policies and Federal Regulations 42 CFR 52 and 45 CFR Parts 74 and 92.  This 
program is not subject to the intergovernmental review requirements of 
Executive Order 12372 or Health Systems Agency review.

The NIH Grants Policy Statement is available at 
http://grants.nih.gov/grants/policy/policy.htm.  This document includes 
general information about the grant application and review process; 
information on the terms and conditions that apply to NIH Grants and 
cooperative agreements; and a listing of pertinent offices and officials at 
the NIH.

The PHS strongly encourages all grant recipients to provide a smoke-free 
workplace and discourage the 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.




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