DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
Budget Request for FY 2010
Witness appearing before the
Senate Subcommittee on Labor-HHS-Education Appropriations
Dr. Lawrence A. Tabak, DDS, Ph.D.
National Institute of Dental and Craniofacial Research
May 21, 2009
Mr. Chairman and Members of the Committee:
I am pleased to present the President’s Fiscal Year 2010 Budget request for the National Institute of Dental and Craniofacial Research (NIDCR) of the National Institutes of Health (NIH). The FY 2010 budget includes $408,037,000 which is $5,385,000 more than the FY 2009 appropriation of $402,652,000.
FACING THE FUTURE
Extraordinary advances have been made in recent years at the interface of traditional scientific disciplines. Multidisciplinary teams of scientists, engineers and clinicians have combined advances in biochemistry, cell and molecular biology, engineering, genetics and neuroscience to gain a deeper understanding of the mechanisms underlying disease pathogenesis. This has yielded clues for the prediction of those most at risk for disease, approaches to personalized interventions, and strategies to prevent disease progression.
For example, who has not marveled at the complexity of a face? Or how nature designed the mouth and its unique soft and hard tissues as a gateway to the body and, in some creatures, a first line of defense? Among Nature’s greatest miracles of design and engineering is the craniofacial complex. Utilizing the many powerful research techniques and tools now available, teams of NIDCR-supported scientists are creating a publicly accessible informatics platform, termed FaceBase, that will enable multi-scale analysis of all aspects of craniofacial development. This basic understanding is key to one day preventing and more effectively managing craniofacial defects and disorders. Each year thousands of infants are born with a variety of craniofacial dysmorphologies. While many of these conditions, such as cleft lip and/or palate can be managed surgically and with supportive therapies, others are more challenging to treat. For example, children born with ectodermal dysplasias must deal with either malformed or multiple missing teeth.
The NIDCR’s new strategic plan captures the communal spirit required to address complex oral and craniofacial diseases and conditions. It lays out the challenges of the immediate road ahead for dental, oral, and craniofacial research – challenges that our 2010 budget positions us to meet. But above all, our plan lays out the great promise that awaits scientists and the American public in the years ahead.
WIDEN THE SCOPE OF INQUIRY
As the volume of biological information has grown, so, too, have the questions that scientists can ask. No longer must the human body be neatly subdivided into its constituent parts and studied in strict isolation, one organ from another. Biological clues in one part of the body often have application elsewhere in the body.
An excellent example is oral cancer which results in over 7,500 deaths each year in this Nation. Unlike cancers that arise in the internal organs, tumors of the oral cavity are often readily accessible for biopsy and prompt study. This has allowed a dedicated corps of scientists to make tremendous inroads into defining the molecular errors that trigger the disease. For example, a key signaling pathway, termed Akt-mTOR, is frequently dysregulated in head and neck carcinomas. Their research efforts not only will improve the diagnosis and treatment of oral cancer, it also will provide comparative data and possible new leads for scientists who study other less accessible tumors.
The same is true of research on the microbial biofilm that forms on the hard and soft tissues of the mouth. Oral health researchers have defined more than 600 microbes that inhabit the mouth and have spent generations studying the communal dynamics that contributes to common diseases, such as periodontal disease and tooth decay. This decades-long head start will help to guide research now under way on the other biofilms that form throughout the body. This line of study emerges from the growing recognition that subtle shifts in the composition of the body’s biofilms may play a major contributory role in myriad human diseases. Advances are being enabled by powerful new technologies that allow for the more facile sequencing and analysis of microbial genomes. Indeed, microbes that have not yet been cultivated are now amenable to study, in silico, which helps describe the lifestyle of each organism.
NIDCR intends to make considerable investments in genome wide association studies (GWAS) of diseases and conditions affecting the craniofacial complex that will also inform pathology in other regions of the body. For example, an analysis of genes associated with Sjögren’s syndrome, an autoimmune disease affecting 1 million or more Americans, will likely provide clues for other diseases such as rheumatoid arthritis or systemic lupus erythematosus. Chronic facial pain, including temporomandibular joint and muscle disorders, has begun to yield its secrets to the efforts of geneticists and neuroscientists. Particularly important are efforts to better understand the transition of acute to chronic pain. Compelling evidence suggests this may be related to neural plasticity, in a manner not dissimilar to mechanisms that underlie memory.
These are but a few of the cross-cutting issues that are now on NIDCR’s research agenda. To investigate them vigorously, the NIDCR must continue to encourage innovation and bring to bear the best science possible. But therein lays another challenge.
KEEP THE PIPELINE STRONG
For the Nation’s oral health community to tackle NIDCR’s ambitious research agenda successfully, it needs tight integration among research, practice, and education. This synergy holds the key to solving the many disorders that affect the oral and craniofacial complex. During 2010, the Institute will continue to emphasize training and career development for oral health professionals, to ensure that we increase a thriving community of dentist-scientists ready to capitalize on the rapid and significant advances occurring in biomedical and behavioral research. At the same time, the Institute must continue to attract scientists from outside its traditional research arenas. We will need to cover all of the scientific bases, from chemists and computer scientists to molecular biologists and mathematicians. All play critical roles and will be invaluable in ensuring that the best science moves rapidly into clinical studies. In an effort to strengthen the pipeline at every stage, the NIDCR is determined to maintain its high level of commitment in 2010 to funding new and early-stage investigators in a wide range of scientific fields.
PROMOTE CLINICAL INNOVATION
Moving forward in the clinical realm will require a great deal of innovative thinking. In 2010, NIDCR will continue to lay the foundation for the next great revolution in oral health care: biology-based dental care. As the name suggests, dentistry will launch molecular-based healthcare over the next several decades. Using salivary-based diagnostics, this new oral health paradigm will provide patients with more precise diagnoses and a greater opportunity to practice prevention. Greater understanding of disease pathogenesis and the variation in individual susceptibility will yield targeted and personalized therapies to treat their conditions more efficiently. This will provide a better chance to maintain their teeth and supporting bone ultimately leading to a lifetime of high-quality health.
To catalyze adoption of these advances, and to further the evidence base of the dental profession, in 2010, the NIDCR will continue to support its Practice Based Research Networks initiative, which now engages hundreds of dentists nationwide in scientific studies.
ADDRESS HEALTH DISPARITIES
As beneficial as biology-based dental care will be one day in improving the oral health of Americans, every effort must be made, now and in the future, to combat oral health disparities. Millions of primarily low-income Americans have yet to benefit fully from advances in dental care, including countless children and their families.
The FY 2010 budget request will allow the NIDCR to maintain strong support for its Centers for Research to Reduce Health Disparities. These Centers continue to demonstrate the value of partnering with communities throughout the research process in order to gain a complete understanding of the factors contributing to dental disease in each community and to develop appropriate intervention strategies. Emerging from this initiative will be a greater focus to identify the many complex factors that contribute to the disparities, targeted, multi-tiered research to address the problem, and coordinated efforts to promote greater awareness of oral disease.
The Institute also plans to continue partnering with the Centers for Disease Control and Prevention to monitor the status of the Nation’s oral health. As a part of this effort, the NIDCR will seek to validate new methods to measure and document oral, dental, and craniofacial diseases.
DENTAL CARE IN THE FUTURE
Biology-based dental care will transform the most fundamental principle of the profession: restoration of form and function. No longer will dentists rely as readily on mechanical instruments and ceramo-metallic materials to repair damaged tissue. They will regenerate form and function (a) using the precision of molecular information – or, the underlying cause of the disease - as their operational guide and (b) employing the body’s own cells and biochemistry as their engineering materials.
Future dentists will possess more powerful optical instruments to visualize and accurately characterize whether near microscopic losses of mineral from a tooth surface will be self correcting or whether they will progress to full blown decayed lesions. Advances in imaging, genomics and proteomics will allow a clinician to profile the circuitry of a tumor cell biopsied from the mouth. This diagnostic work-up will guide the choice of chemotherapy drugs to those that are most likely to target the internal wiring of the tumor cell and kill it. Targeted treatments will allow the removal of only the cancerous tissues.
In closing, and as highlighted in our 2010 budget justification, the NIDCR will continue to invest in research and research training to meet emerging scientific opportunities and challenges. This budget request will enable us to work towards achieving the four goals outlined in our strategic plan. These goals are attainable, and in striving to meet them, we can realistically expect to improve the Nation’s oral health for generations to come.
BIOGRAPHY FOR DR. LAWRENCE TABAK
Dr. Lawrence A. Tabak was appointed as the seventh director of the NIDCR in September 2000. As Director, he provides leadership for a team of ~500 scientists, administrators and support staff with an approximate annual budget of ~$400 million. He has played a leadership role in several NIH-wide initiatives including the Interdisciplinary Research Teams of the Future component of the NIH Roadmap and the Enhancing Peer Review project. In November 2008, Dr. Tabak was appointed as acting principal deputy director of the NIH. While serving in this capacity, Dr. Tabak continues as NIDCR director.
Prior to joining NIH, Dr. Tabak was the senior associate dean for research and professor of dentistry and biochemistry & biophysics in the School of Medicine and Dentistry at the University of Rochester in New York. A former NIH MERIT recipient, Dr. Tabak’s major research focus has been on the structure, biosynthesis, and function of mucin-glycoproteins. He continues work in this area, maintaining an active research laboratory (within NIDDK) in addition to his administrative duties.
Dr. Tabak has received several honors and awards for his work, including being elected a fellow of the AAAS and a member of the Institute of Medicine of the National Academies. Dr. Tabak received his undergraduate degree from City College of the City University of New York, his D.D.S. from Columbia University, and a Ph.D. from the State University of New York at Buffalo.