Proposal on priority areas of scientific and research issues of Slovak health in 2008-2011:
List of assisted areas 2008
The material was adopted at the regular plenary session of the Scientific Council of the Ministry of Health of the Slovak Republic (hereinafter CoR MZ SR) on 7 February 2008. The CoR presidency of the Slovak Republic, after discussion and cooperation with the presidents of the competent advisory commissions of the CoR of the Slovak Republic, submits this proposal for public debate, in accordance with the
It also notes that, in line with the above-mentioned Directive, it is a list of priority areas for 2008 and, in the context of the foreseen call for the 4th round of project submission, a list of areas for project submission for 2008-2011.
Taking into account the comments of the CoR MZ SR will present material for the negotiation of the german meeting of the Minister of Health of the Slovak Republic. The document shall become binding on the date of its approval by a german meeting.
After evaluation of the discussion and the subjects received, the material will become the basis for the publication of the fourth round of the call in 2008 for the submission of the application for grant support for scientific research projects by the Ministry of Health of the Slovak Republic.
Your subjects, comments and suggestions for addition or modification can be submitted electronically to the Secretary of the Scientific Council of the Slovak Republic: Lenka.cellarova@health.gov.sk until 20.03.2008.
I. DISEASES OF THE HEART, PLOY AND CIVE
Cardiovascular Epidemiologicals
Cardiovascular and cerebrovascular diseases are the most common cause of mortality in the Slovak Republic. More than 50% of Slovak citizens die from complications of atherosclerosis. Research into causes, pathogenesis, clinical manifestations and complications of cardio- and cerebrovascular diseases is therefore a fundamental priority in the field of biomedical research.
Type 2 diabetes affects almost 7% and metabolic syndrome more than 20% of the Slovak population. Both diseases are associated with a 2-4-fold increased risk of cardiovascular disease development and diabetes is also associated with the risk of severe microvascular complications.
Epidemiology of respiratory diseases
In economically developed countries, chronic obstructive pulmonary disease (COPD) is the fourth most common cause of mortality, with COPD expected to be the third leading cause of death worldwide by 2020. Bronchial asthma and chronic cough are also significantly involved in morbidity in all European countries. The statistics of the European Respiratory Society report the presence of night cough in 30%, productive cough in 10% and non-productive cough in 10% of the population.
Sleep apnoea affects 4-6 percent of the adult population, with an independent risk factor for serious cardiovascular diseases such as arterial hypertension, stroke, coronary artery disease and heart failure. At the same time, sleep apnoea is associated with a high risk of insulin resistance, with the presence of metabolic syndrome and type 2 diabetes.
Research orientation on cardiovascular diseases
Atherosclerosis is the most important pathological-anatomic substrate of heart and vascular diseases. Analyses of pilot epidemiological studies carried out so far in Slovakia showed an alarmingly high incidence of serious risk factors for atherosclerosis. Risk factors for atherosclerosis often clump together in high risk conditions such as metabolic syndrome, type 2 diabetes mellitus, sleep apnoea, certain endocrine diseases (hypothyroidism, growth hormone deficiency, hypercorticism) and chronic renal disease. Research in recent years suggests that chronic subclinical inflammation plays an important role in the development of atherosclerosis. It is believed that subclinical inflammation may be involved in the development of cardiovascular diseases in metabolic syndrome, type 2 diabetes, COPD, sleep apnoea as well as systemic connective tissue disorders.
It is therefore proposed to support research projects aimed at: (a) the monitoring of genetic and environmental factors involved in the development of atherosclerosis, (b) the monitoring of genetic, humoral and environmental factors involved in the development of pathomechanisms in the development and development of obesity, metabolic syndrome and type 2 diabetes, (c) the conduct of a prospective randomised intervention study to monitor the pharmacological impact of risk factors on atherosclerosis; at the same time evaluate the pharmacoeconomic parameters of intensive and conventional care for patients with defined risk factors of atherosclerosis, (d) the monitoring of early myocardial injury markers.
Research direction on respiratory diseases
In the field of pneumology, it is necessary to focus research on obstructive pulmonary diseases It becomes a priority: a) epidemiologically map the occurrence of chronic obstructive pulmonary diseases in Slovakia, b) monitor interactions between genetic factors and the environment in the progression of obstructive ventilation disorder and/or chronic cough, c) identify pathogenicity mechanisms that contribute to the development of COPD and bronchial asthma. The incidence of atherosclerosis and its complications as well as the occurrence of metabolic disorders is higher in COPD patients than in the non-obstructive ventilation disorder population. At the same time, the frequent co-incidence of COPD with respiratory disorders in sleep is - obstructive sleep apnoea, which is often associated with arterial hypertension and metabolic syndrome. It is therefore necessary to focus research also on the monitoring of diseases associated with COPD and the so-called systemic manifestations of this disease.
Summary of preferred areas:
- Prospective monitoring of risk factors of atherosclerosis and arterial hypertension in relation to total and cardiovascular mortality in the Slovak Republic, including identification of the most risky regions of Slovakia and preparation of corrective interventions.
- Pharmacovigilance assessment of intensive and conventional care for patients with defined risk factors for atherosclerosis.
- Molecular-biological aspects of obesity development with emphasis on the role of hormones.
- Genetic and environmental factors in the development of metabolic syndrome, type 2 diabetes and atherosclerosis.
- Markers early diagnosis and quality of early myocardial injury therapy and chronic heart failure.
- Monitoring of genetic, biochemical, immunological and environmental factors of aneurysm dilation of arteries. Endovascular treatment of arterial aneurysms and obliterating arterial and vein diseases.
- Monitoring the proportion of genetic and environmental factors in the occurrence and progression of chronic obstructive pulmonary diseases (bronchial asthma and chronic obstructive pulmonary disease) and their complications.
- Molecular-biological aspects of metabolic disorders in patients with respiratory disorders.
- Pathophysiological mechanisms in chronic cough, the role of pathological gastro-oesophageal reflux in the pathogenesis of asthma and chronic cough.
II. ONOLOGICAL DISEASES
Tumour diseases are among the main causes of morbidity and death in the population of industrialized countries, including the population of Slovakia. In recent years, there has been an explosion in the knowledge of cancers, which are concentrated in the following areas:
- to recognise or prevent disease changes that are at risk for the possible evolution of the cancer,
- early tumour diagnosis and inhibition of tumour proliferation,
- the area of tumour monitoring and early identification of any relapse,
- to improve the results of oncology patients, including their quality of life,
- to identify prognostic and predictive parameters of cancer,
- in the field of implementation of new methodologies and technologies used for the diagnosis, monitoring and treatment of cancer.
It is therefore desirable to direct the research capacity of Slovak health in the above mentioned areas, focusing in particular on the following main core programmes:
- diagnostic recognition and therapeutic solution of pre-cancer conditions,
- evaluation, innovation and optimisation of diagnostic, therapeutic and monitoring approaches to tackling oncological diseases in the context of the current science of appropriate practices;
- comprehensive and early diagnosis of cancer (including genomics and proteomics) in order to increase disease capture at its early stages;
- identification of new prognostic, predictive and therapeutically relevant markers,
- identification and possible effect of primary as well as treatment-induced tumour cell resistance mechanisms,
- diagnostics and monitoring of hereditary changes in expression of relevant genes whose products have a major impact on the efficacy and toxicity of currently used chemotherapeutic agents
The output of the solution of each submitted and approved scientific-research project in the field of -Oncology- should be the effort to improve diagnostic algorithms, innovation of therapeutic protocols, increasing individualisation of therapy and achieving improved quality of life and survival of the cancer patient.
III. Diseases associated with the Motherhood and the Childhood Age
III.1.a. Birthplace
The absence of a national peri-natal programme for the care of the mother, fetus and newborn has already produced the first negative results. In addition to the significant, almost 50% decline in birth rates, we achieved almost twice as bad results in perinatal mortality and morbidity in 15 years after the split of Czechoslovakia compared to the Czech Republic.
The national maternal, foetal and neonatal care programme, aimed primarily at prenatal diagnosis and in utero treatment of the foetus, will bring improvement in the quality of the statistical indicators of perinatal mortality and morbidity by improving the prenatal diagnosis of intrauterine threat to healthy foetuses by hypoxia and, at the same time, by improving the quality of the gene pool of the population by early diagnosis of genetically-related and treatment of congenital and metabolic foetal diseases.
An important part of the peri-natal programme - National programme for mother, foetus and newborn care is also an economic benefit in the form of reduced costs in health and social care of the physically or mentally affected individual, early prenatal diagnosis and effective intrauterine treatment of the endangered or affected foetus. An important component is to complete National Center of Maternal Fetal Medicine in Bratislava as a top professional facility for research, diagnosis and treatment of fetal and neonatal diseases.
- National peri-natal programme of mother, fetus and newborn
- As part of the peri-natal program, - to examine and analyse the impact of environmental external factors on foetal development
- Introduction of combined and integrated prenatal screening of genetically-related, metabolic and congenital foetal development defects in the first and second trimesters
- Development of a new screening test model for the exact diagnosis of intrauterine hypoxia in the foetus using new modern non-invasive and invasive investigation methods.
- Ensuring the complexity of prenatal screening for pregnant and potential intrauterine patients
- Determination of spectrum of indications for non-invasive and invasive investigational methods in the different trimesters of pregnancy
- Definition of ethical and legal standards on prenatal diagnosis and treatment of foetuses
- Development of standards / guidelines/ for prenatal non-invasive and invasive diagnosis of congenital foetal development defects in the different trimesters of pregnancy
- Development of standards / guidelines/ for non-invasive and invasive diagnosis of intrauterine foetal hypoxia in the second half of pregnancy
- Defining the range of options and indications for non-invasive and invasive foetal therapy as an intrauterine patient
- Development of standards / guidelines/ for non-invasive and invasive treatment of congenital developmental defects and foetal intrauterine hypoxia in utero
- Introduction of decision-making criteria in cases where foetuses with congenital developmental defects cannot be clearly and reliably established prenatal and post-natal prognosis
- In collaboration with biological parents and medical ethics and medical law experts to handle diagnostic and medical procedures in foetal medicine
III.1.b. Gynaecology
Mini-invasive surgery is an operating technique that saves the patient while maintaining the full extent of surgery. Such a procedure allows intimate contact with the surgical field, selective access to lymphatic system-sparing tissues and vegetative nerves. The result is early recovery, return to full life in the postoperative period and after radical surgery of patients with cancer and endometriosis.
The focus of the proposed scientific activity is:
- Treatment of mini-invasive procedures in the treatment of pelvic pain and endometriosis
- introduction of gentle operating techniques in cancer patients, setting limits for minimally invasive approaches in such diseases
- complex diagnostics and new procedures using foreign materials in the treatment of pelvic insufficiency and urinary incontinence
- Optimization of multi-disciplinary cooperation in addressing pelvic pathology
- minimally invasive procedures in mammology including Sentinel node complex
- scientifically develop a valid screening system, disease profile therapy, diagnosis, treatment and post-treatment surveillance for patients with malignant breast disease and malignant female genital disease.
III. 2. Children age
Baseline:
The incidence of congenital developmental defects, genetic and immune-related diseases is increasing in Slovakia, but the prevention and extent of diagnosis is still lagging behind developed countries.
Objectives of the programme:
The aim of the scientific programme is to stimulate activities aimed at promoting health and healthy lifestyles, reducing negative environmental impacts and increasing the efficiency and quality of health care provided in order to reduce the negative consequences of diseases. Academic research activities based on university institutions and applying newer biomedical knowledge, as well as multidisciplinary research networks in paediatric practice, are supported to study the health status of larger newborns, children and adolescents. An important tool to identify the impact of environmental, genetic, nutritional, social and other factors on children's health, as well as to know the relationships between prenatal parameters and chronic childhood and adult age diseases is long-term monitoring of cohort parents - children.
Programme Scientific Headings
The programme shall concentrate on:
- Developing practical approaches to childhood health problems by knowledge level
- extending existing and introducing new strategies for the prevention and treatment of childhood diseases
- application of the results of the human genome research project
- creating conditions for a healthy and fulfilling life for children and adolescents
Specific scientific areas of the project include:
- Genetic diseases and genetic predisposing factors for disease development
- malignant diseases in children and their diagnosis and treatment
- chronic diseases of child age (nephropathy, diabetes, bowel and liver diseases, hypertension, allergy, cystic fibrosis, etc.)
- nutrition disorders (anorexia, obesity)
- organ failure and organ transplantation
- intensive care and urgent medicine
- Identification and elimination of neonatal morbidity and mortality factors
- seeking social and environmental risk factors
Characteristics of the expected outcome of the solution:
- improvement of pre- and postnatal diagnosis of hereditary diseases
- Early diagnosis of progressive chronic diseases
- Reducing the incidence of chronic organ failure and reducing the consumption of economically challenging therapies
- establishment of national registers of children with different chronic diseases
- improving childcare and improving the quality of life of sick children.
IV. MOVEMENT SYSTEM DISEASES
Monitoring of autoimmune syndromes in chromosome aberrants.
This is an interesting clinical problem from a rheumatological point of view. Pooled autoimmune diseases such as juvenile idiopathic arthritis, rheumatoid arthritis and systemic lupus erythematosus, or dermatomyositis/polymyositis, especially in Klinefelter syndrome, are common in these diseases. In Turner syndrome, juvenile idiopathic arthritis or rheumatoid arthritis-like arthritis may occur. As part of the forthcoming research in the coming years, it is desirable to try to monitor gene mutations in diffuse diseases in an effort to detect in our population suffering from autoimmune diseases, the mutation of genes involved in the development of autoimmune diseases, especially in juvenile idiopathic arthritis.
It is also recommended to monitor the genetic variation in the autoimmune gene PTPN22 to differentiate T lymphocytes in rheumatoid arthritis patients and their first-stage relatives. Rheumatoid arthritis is the most common systemic disease affecting approximately 1% of the world population. While the aetiology of RA remains unclear, it is now clear that genetic predisposition plays an important role in the development of the disease. Recent single-nucleotide polymorphism (C-on-T-position 1858) of the PTPN22 gene coding for lymphoid tyrosine phosphatase (LYP) is the second most common genetic variant associated with RA and other autoimmune diseases, such as type 1 diabetes, juvenile idiopathic arthritis, or systemic lupus erythematosus, following specific HLA variants in the major histocompatible complex. It is relatively well known that ancillary CD4+ T lymphocytes play a primary role in the development of inflammation in RA. RA is traditionally considered a disease led by Th 1 auxiliary lymphocytes. However, the latest data points to the key role of Th 17 subpopulations in RA development. Some interleukins (IL) such as IL-2 produce CD4+ lymphocytes necessary for the activation of cytotoxic CD8+ T lymphocytes involved in the destruction of tissue affected by the inflammatory process. Antigenic receptor T lymphocytes (TCR) is a significant mediator regulating CD4+ T lymphocytes. The PTPN22 T1858 allele leads to the substitution of arginine amino acid for tryptophan at 620 in LYP protein. The function of this protein is relatively little known and practically limited to interaction with signal kinases in CD4 lymphocytes. LYP is a negative kinase regulator that mediates signal transmission from the TCR complex (TCRζ/CD3) in CD4+ lymphocytes. TCR results in the transactivation of the IL-2 gene. Interestingly, the phosphatase activity of the LYP-encoded gene-associated variant RA (T1858) is higher than the normal variant. Paradoxically, there is a stronger inhibition of the signal from the TCR. What mechanism is therefore the T1858 variant involved in the development of an autoimmune process is not yet clear. Research aims to help clarify the LYP function in CD4+ lymphocytes. The working hypothesis is that the LYP variant, encoded by the T1858 allele gene, is involved in different naive CD4 cell graduations to individual stem types of ancillary lymphocytes (Th1, Th2 or Th17) compared to the normal 1858 allele in PTPN22. In the future, research will contribute greatly to understanding the impact of PTPN22 variation on the differentiation of T lymphocytes, which is
one of the key pathogenic processes in the development of chronic inflammation in RA.The third part of the research intention is to monitor musculoskeletal disorders in Down syndrome, focusing on skeletal changes, atlanto-axial dislocation, early development of degenerative joint changes, in particular coxarthritis, or arthropathy, which are very similar to the clinical picture of juvenile idiopathic arthritis. Early diagnosis and treatment of musculoskeletal disorders with the chromosome and picks listed above will help to reduce the progression and improve the prognosis of patients with Down syndrome, especially in terms of improving quality of life. It is desirable to work with the endocrinologist of adults and children, the SZU Down Syndrome Center, to select patients. Patients should be clinically evaluated, the autoantibodies profile, hormonal analysis shall be determined and the presence of inflammatory rheumatic diseases, or congenital or familial arthropathy, juvenile idiopathic arthritis or other locomopathic disorders such as hypermobile syndrome, premature coxarthritis and atlanto-axial dislocation shall be confirmed or excluded according to valid diagnostic criteria. It will also be important to monitor therapeutic practices from the basis of basal treatment for the occurrence of autoimmune diseases in chromosomes as well as special rehabilitation procedures.
Another part of potential research is the monitoring of genetic mutation in 18 chromosomes during chronic multifocal osteomyelitis in children and other autoimmune diseases such as familial hypertrophic synovitis in children. These nosological units are rare autoimmune diseases and their nosographic boundaries need to be developed further knowledge.
V. TRANSMISSION DISEASES AND IMMUNITY
The present state of knowledge.
Transmissible diseases are still a serious problem in the world's healthcare systems. The changing socio-economic conditions on the continents, together with the global development of trade, tourism, urbanisation, population migration, conditional economic, social, religious, ethnic and military conflicts, contribute to the rapid adaptability of infectious agents in new conditions and to their transfer between different ecosystems, as well as to the unprecedented overcoming of barriers between the animal kingdom and man. In this situation, the barrier between developed and developing countries is also being wiped out as regards the incidence of infectious diseases. Therefore, experts caution against reducing the attention of infectious diseases and the development of new therapeutic and preventive measures. New types of infectious diseases, caused by unknown or new agents, appear and emerge, as was the case with Lyme borreliosis, Legionnaire's disease, STSS, AIDS, SARS, avian influenza and others.
Current scientific knowledge provides evidence that infectious diseases and subsequent immune disorders are also involved in cardiovascular, endocrine and musculoskeletal disorders. Recent evidence from cancer also suggests that micro-organisms play a significant role in cancer development of up to 70%.
The effectiveness of the treatment of infectious aetiology diseases is undermined by increasing resistance of micro-organisms to antibiotics and biocides.
The incidence of allergic diseases is a significantly increasing trend. Skin and respiratory allergies are increasing in both adult and paediatric populations with a proportion of germ agents as triggers for these diseases. Immune system disorders based on both endogenous and exogenous factors are also on an increasing trend. It is important to realise that the diseases in question have an extremely serious impact on the economy of the Slovak Republic through losses caused by the loss of labour and the cost of health and social care. Moreover, the high incidence of these diseases hinders a faster increase in the life expectancy of our population.
Focus of research
It is therefore an absolute priority for every state, including our Republic, to enable the development of science and research activities which can make a fundamental contribution to:
- Knowing the role of specific environmental factors in the aetiology of infectious, immunological (allergic, autoimmune), degenerative and cancer diseases.
- Knowledge of the mechanisms responsible for the progression of these diseases
- The introduction of preventive and therapeutic measures to reduce or cure the incidence and severity of these diseases.
New scientific knowledge acquired by creative research activities in the above mentioned
focussed is a real basis for strategic decision-making aimed at improving the diagnosis, prevention and treatment of diseases caused by infectious agents. In order to fulfil this objective, scientific research activities need to focus on the following areas:
- Research of pathogenesis, diagnosis, therapy and prevention of diseases of microbic aetiology, focusing on molecular and cellular mechanisms using knowledge and methodology of genomics, proteomics, transcriptomics and bioinformatics. Use of new knowledge from the above disciplines for the development of personalised pharmacotherapy, terranostics, target therapy and also the use of biomarkers in diagnostics.
- Examination of the importance of the immune system in defence against infectious, degenerative and cancer diseases. Knowing the structural, genetic and functional laws of the human body's immune system in order to apply new knowledge in the control and prevention of diseases caused by micro-organisms, but also by non-priritive environmental factors and allergens.
- Clarifying the relationship of genetic factors to the function of the immune system and to the activity of metabolizing xenobiotics (foreign substances in the environment).
- Examining the relationship of biotic and abiotic environmental factors to the incidence and severity of tumors and autoimmune diseases.
- Development of new means of rapid diagnosis of infections and immune system disorders. Early diagnosis is a highly effective tool reducing costs and losses caused by infections in the human population.
- Development of neonatal, mucosal and nutritional component based vaccines (edible vaccines). Vaccination is one of the most effective instruments for disease prevention. It is therefore justified to develop research and development on new or improved vaccines, to increase their protective efficacy, to explore new forms of vaccination and to detect still unknown areas of macro-organism immune response.
- Development of preventive measures and rational therapy of diseases of the immune system, infectious diseases, inflammatory diseases of non-infectious origin and cancer.
VI. NEUROPOLOGICAL AND PSYCHIATRIC DISEASES
Cerebrovascular diseases are still a serious medical and socio-economic problem in Slovakia, as, unlike other developed states, mortality and morbidity have not only fallen, but have increased in some population groups. Although the main risk factors and underlying pathophysiological mechanisms of cerebrovascular disease are common to other cardiovascular diseases, there are demonstrably specifics that require special access to vascular strokes. Research projects should focus on:
- The role of genetic factors in the pathogenesis of vascular diseases of the brain.
- The role of coagulopathy, haemoreological factors and changes in endothelial function in the pathogenesis of cerebral circulation disorders.
- The relationship between heart and vascular diseases in the brain.
- Epidemiologicals of brain vascular diseases in terms of their prevalence and occurrence of risk factors.
In the context of the general ageing population, ensuring decent old age is one of the key tasks of modern society. Dementia is one of the diseases that particularly reduce the quality of life of both the elderly and the part of the working age population (due to care responsibilities). Research projects should focus on:
- Mapping the incidence of genetic mutations associated with dementia in the Slovak population.
- Assessment of the possibility and effectiveness of modifying the known risk factors of Alzheimer' s disease and vascular dementia or mixed dementia.
- Identification of optimal diagnostic procedures under conditions of clinical practice in Slovakia
- Finding the real incidence and prevalence of dementias in the Slovak population as well as the current situation in dementia therapy.
Neurodegenerative and demyelinating diseases are among the most common neurological diseases, which, due to the chronic course and the debilitating nature, affect the quality of life of patients in ways and represent a long-term social and economic burden for society as a whole. Research projects should focus on:
- Genetics and molecular biology of neurodegenerative diseases
- Biological markers of neurodegeneration
- Functional imaging methods in the diagnosis of neurodegenerative diseases
- Optimization of treatment multiple sclerosis
- Impact of chronic neurological diseases on quality
Intervertebral disc disease and its consequences, i.e. spinal cord compression, in the cervical and chest regions, or spinal cord roots in the lumbar region, affect the vast majority of the population to varying degrees, are also one of the most common causes of incapacity for work and often lead to disability. Research projects should focus on:
- identification of causes of development and progression of degenerative changes of intervertebral plates
- evaluation of relevant diagnostic procedures and indications of medical and/or surgical treatment
- drawing up scientifically justified recommendations for each type of operation and type of material used for implantation
In order to improve comprehensive care for patients with brain tumours, research projects should focus on:
- Optimisation of brain glioma treatment
- Complex therapy of tumours of the hypophyso-hypothalamic region.
In Slovakia, patients with mental disorders account for 11 percent of all patients. It is necessary to ensure implementation of the principles of the National Programme for the Development of Mental Health and research projects should focus on:
- Research on the incidence and prevalence of mental disorders (depressions, schizophrenia, anxiety disorders, alcohol and drug abuse, Alzheimer' s dementia).
- Research on the etiopathogenesis of mental disorders, in order to ensure early diagnosis and rational therapy taking into account also pharmacoeconomic indicators.
- Genetics and molecular biology of psychological disorders
- Optimization of diagnostics and treatment of schizophrenia
- Psychoneuroendocrinology: gender differences in the incidence of psychiatric disorders, the specificity of the generation periods in women's life and their importance for the development and progression of psychiatric disorders.
- Introduction of modern imaging techniques into research, diagnosis and treatment of mental disorders: fMRI, MRI, PET, SPECT.
- Research of psychological factors, environmental impact and lifestyle changes on the incidence and prevalence of mental disorders.
VII. TRANSPLANTATION OF BODIES AND TANKS
Tissue and organ transplantations have now become relatively common and effective methods for treating numerous diseases. More than 20,000 new transplants are witnessing this, which are growing annually and whose success is increasing. The trend of transplant development has also been noted by Slovakia, which is mainly evidenced by kidney, bone marrow, heart transplants, which are performed in addition to Bratislava in Košice, Banská Bystrica and in Martin. The development of transplantation continues both in terms of research and practical and organisational. Slovakia cannot afford to lag behind in this dynamically developing medical area, especially now that it has already become a member of the European Union and is trying to get into its transplant companies. In particular, transplant research should focus on the following issues:
- application of the scientific results of research in the field of immunogenicity of the HLA transplant system into diagnostic practice,
- involve HLA-typing centres in the international network as required by the European Immunogenicity Federation (EFI);
- study of post-transplant rejection mechanisms (HvG and GvH), both immunological and genetic, which predetermine a type of reaction and allow it to be predicted to some extent. Identify in particular risk markers for long-term graft survival prognosis
- Monitoring of the effect of new immunosuppressive biological agents
- in the field of haematopoietic cell transplantation, the effect of growth factors (G-CSF, GM-CSF) on rapid haematopoietic recovery and stem cell issues should be addressed;
- monitor the efficacy of cord blood transplantation, storage and survival
- study of the potential for tissue and organ regeneration through autologous and allogeneic stem cells derived from bone marrow, fat tissue and other tissue species relevant to the yield of pluripotent-like cells.
- Study of regeneration of ischaemically impaired myocardial infarction by cellular therapy.
In parallel with the study of previous issues, attention should also be paid to cell therapy for vascular insufficiency.
Of all these areas, the issue of establishing a reference laboratory for the determination of HLA-aliel and HLA-antigens and its accreditation by the European Immunogenicity Federation is most acute. Without this accreditation, international cooperation is not possible, especially recognition of the results of HLA-typing, organ exchange, creation of voluntary donor registers, participation in waiting lists for kidney transplantation, etc. In Slovakia, there are several HLA-laboratories, from which either the workplace at the Slovak Organ Transplant Centre or the laboratory of Hematology and Blood Transfusions FNsP Petržalka should undertake this task. Although professional activity is involved, it is closely related to research activity, because the field of transplant immunology, immunogenicity, immunotherapy, etc. is developing and its development needs to be kept in step and contribute to it by its own research activity.
VIII. GENOMICA AND PROTEOMICS
The development of molecular medicine, like in European Union countries, is one of the priorities of Slovak medical research. It remains an important task to build a strong infrastructure and to promote the application of molecular medicine knowledge to prevention, diagnosis and therapy for building the foundations of personnel medicine, including the creation of effective bioinformation tools for the processing and interpretation of ever-increasing amounts of genome data and making them available to professionals in usable form. Within this area, support will focus on application, interdisciplinary or internationally oriented quality teams and top-level projects to develop new or improve existing diagnostic and therapeutic practices. Priorityly supported areas of medical genomics in Slovakia include molecular biology and genetic factors in diagnostics, prognosis, prevention and treatment of serious multifactorial-related diseases (cardiovascular, cerebrovascular, respiratory, diabetes, tumor, neurological, psychological, etc.), building and supporting clinical and research bases in the field of prevention and intergenerational transmission of gene or genome anomalies, building and linking the information network of medical, molecular-biological and genetic workplaces, and harmonising existing databases as well as the use of gene manipulations in mammals in the study of pathogenesis of human diseases, and supporting research in the field of biotechnology and nanotechnology and risk assessment and benefits of the use of nanomaterials.
Specific themes 2008-2011
- The most common social serious diseases (e.g. cardiovascular and respiratory diseases, diabetes mellitus, tumours) - molecular epidemiology, diagnosis, prevention and treatment using knowledge of molecular biology, genomics and proteomics.
- Genomics and proteomics of serious hereditary diseases and predisposition to serious diseases.
- Interactions gene-environment and risk environmental factors contributing to disease development.
- The molecular nature of aging and aging disease (Alzheimer's, Parkinson's etc.)
- Research in stem cells and potential applications related to the development of regenerative and transplant medicine.
- Alternative methods in in vitro toxicology.
- New biotechnology, risks and benefits of nanotechnology.
- Building a common database by combining existing studies or data and information sources for the purpose of pooled analysis of data and information (e.g. genetic defects affected by the same polymorphisms of genes for the metabolism of phase I and II, reparation genes, etc.; diseases from oxidative stress; chronic diseases; congenital disorders of metabolism or embryonic development, etc.).
- Brains, nervous system disorders and psychiatric disorders. Genomics, proteomics and other modern procedures in knowing and treating nervous system disorders.
- Portable diseases, use of genomic knowledge in diagnostics and epidemiology.
- Organ and tissue transplantation application of genomic knowledge to determine the risk of graft loss. New procedures in the selection of donor-beneficiary pairs.
- Development and testing of new immunotherapeutic tools. Genomics of Immune System Disorders (allergy)
- Development of effective therapeutic or preventive procedures and measures to protect the sex cell genome and emerging individuals.
IX. PUBLIC HEALTH
According to the WHO, around a quarter of deaths and global disease burden can be attributed to living conditions, including working conditions. There is evidence that environmental factors play a role in more than 80% of the diseases regularly reported to the WHO.
In the period 2008 - 2011 we recommend focusing research on three main areas: environmental health, occupational health and epidemiology of infectious and non-infectious mass diseases. The general objective of environmental health research will be to clarify the relationship (and in particular their causality) between the exposure of the population and its selected sub-groups (e.g. children, pregnant women, workers and the elderly) to the factors of the environment and the working environment and the health status of the population.
Given the past inherited pollution of Slovakia's environment, the lifestyle of the Slovak population characterised by many unhealthy elements, changing working conditions and associated health risks and morbidity associated with a particular ethnic group, it is necessary to give priority to research in the field of environmental health based on the latest scientific knowledge on pathogenesis of a wide range of diseases, where one of the most important tasks is played by interaction between the genes of the individual concerned and environmental factors. Environmental factors are considered in the broadest sense, including chemical and physical components of the environment and lifestyles. According to this idea, which is increasingly supportive of scientific evidence, the interaction between individual genes and environmental factors leads to the emergence of most chronic degenerative diseases. Scientific activities aimed at the knowledge of the mutagenic, carcinogenic and immunomodulatory properties of xenobiotics, their capacity to induce allergies and atopics and their properties as endocrine disruptors shall be encouraged to characterise these interactions. Priority in this area will be given to programmes aimed at:
- changes in gene expression due to environmental exposures, including clarification of the epigenetic mechanisms responsible for altered gene expression,
- individual sensitivity, changes in time and its impact on certain genes and environmental factors;
- toxicogenomics as a genome determine the body's response to environmental toxicants by applying gene and protein technologies in environmental medicine to identify biomarkers of the effect and exposure to toxic substances;
- the role of free oxygen radicals in the pathogenesis of chronic degenerative diseases, DNA damage and repair mechanisms related to pathogenesis of diseases and their prevention,
- toxicokinetics of significant pollutants of the environment and the working environment.
In particular, projects and topics in the following specific scientific fields will receive support:
- Epidemiological studies on air pollution as a significant health harmful factor due to the relationship between exposure to respirable particles and death and hospitalisation of patients with cardiorespiratory diseases and shorter life expectancy.
- Projects aimed at clarifying mechanisms for the action of persistent organic pollutants, in particular polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs) and polychlorinated biphenyls (PCBs), identification of biomarkers of their effect and exposure and epidemiology of their toxic effects on humans, with particular emphasis on the paediatric population.
- Projects focusing on pollutants in the external and internal environment, passive smoking and genetic factors related to the risk of asthma and allergic diseases in general, especially in childhood.
- Projects aiming at the combined effect of chemical factors in the living and working environment on human health, as the real exposure scenario is almost always multifactorial.
- Research on the health consequences of long-term professional and non-professional exposure to low-term, low-level exposure.
- Use of the geographical information system in the epidemiology of infectious and non-infectious diseases.
- Population health indicators for international reporting.
- Participation of lifestyle factors in the development of chronic degenerative diseases (except for poor eating habits, lack of exercise, smoking and other factors need to be examined for genetic and environmental factors of alcohol abuse, including alcohol foetal syndrome).
- Epidemiological studies on obesity in children and young people, but also in adults, including comorbidity.
- Scientific projects, which will aim at the primary prevention of chronic degenerative diseases, in particular diabetes, osteoporosis and cardiovascular diseases.
- Scientific projects focusing on epidemiology, differential diagnosis and prevention of professional and non-professional changes to the musculoskeletal system, in particular DJZ diseases, including spine diseases
- Longitudinal cohort epidemiological studies of couples mother – child, since foetal development and early childhood growth may be the most important determinants of diseases in later life. In this context, attention is focused mainly on cancer, asthma, allergies, immunological diseases, autism, birth defects, diabetes, obesity. and cardiovascular and respiratory disorders.
- Research on carcinogenicity, reproductive toxicity, neurotoxicity and immunotoxicity of substances used in alternative medicine, including the action of acute high doses but also long-term effects of chronic exposure to these substances.
- Epidemiological studies to investigate the toxic effects of endocrine disruptors on the human reproductive system, as a group of substances with properties likely to disrupt normal hormonal signalling are enlarged.
- Projects aiming at phototoxicity and photocarcinogenicity of sunlight in relation to the public health dimension of skin malignancies, in particular with a focus on gene expression, toxicity and carcinogenicity in combination with locally or globally applied substances.
- Research on immunotoxicity, neurotoxicity, carcinogenicity and reproductive toxicity of drinking water chlorination by-products
- Scientific projects on vaccine effectiveness and side effects
- Projects oriented towards the germ profile of the healthcare facility, resistance to disinfectants, surveillance and prevention of nosocomial diseases
- Epidemiological studies on optimization of working conditions of the elderly population and criteria for assessment of medical fitness for work
Prof. MUDr. Luke Plank, CSc.
Chairman of the Scientific Council of the Slovak Republic
Date of issue: 22.02.2008