A grant from the National Institutes of Health (NIH) is a sign research has promise. More than 50 consecutive years of NIH funding is a sign research has borne fruit.
Robert Bartlett, M.D., professor emeritus of surgery at Michigan Medicine, is behind that funding streak and will see it extended with a new award in September. It’s part of a strong tradition of research funding in the Department of Surgery, which for the past two years has had the most NIH funding of any surgery department in the country.
The pursuit of research and the funds to back it are rooted in a patient-centered approach for Bartlett.
“Biomedical research funded by NIH is always focused on solving a problem in the care of patients,” Bartlett said.
Fund it, prove it, fund it again
The work Bartlett has done with partners in his lab has applied to patients and revolutionized intensive care. His first NIH award, funded in 1972, was for developing devices and techniques to support life in patients with severe heart or lung failure.
The project, called prolonged extracorpopreal membrane oxygenation (ECMO), supports underdeveloped or stressed hearts and lungs via a modified heart-lung machine. Bartlett was the first to use it for cardiac and respiratory failure in children at the University of California, Irvine in 1975.
Bartlett brought that work with him to Michigan in 1980 and continued to refine ECMO in his lab, implementing advancements at patients’ bedsides. A scan of his NIH research grant titles over the years demonstrates how the work has progressed—from ECMO in newborn respiratory failure to ECMO in pediatrics and adults to ECMO in multiple organ failure and, most recently, ECMO without anticoagulation. The COVID pandemic put ECMO in the spotlight again; it was widely used for patients in severe respiratory and cardiac distress and saved countless lives.
The Extracorporeal Life Support Lab currently manages 10 research projects supported by 25 grants and contracts. Working on the projects are 15 principal investigators, four research fellows, 15 research staff, and 100 students.
Fifty years of continuous funding is likely a record for NIH investigators, and especially notable for surgeons, according to Bartlett. Keeping the funding flowing is easier when the research meets the goals and milestones, leading to the next phase of research.
“Once a concept is proven in animals, grants support initial clinical trials, then ongoing clinical research. Meanwhile the laboratory is developing the next potential clinical application.” Bartlett said.
For funding success, specialize—and sell your idea
For surgeons beginning a research career, Bartlett said it helps to have a surgery-specific focus and an idea that targets an existing clinical problem.
“There are a thousand Ph.D.s writing grants who do molecular biology all day long. My advice is to focus on a project that only surgeons can do. Pick a topic that requires you as a surgeon to do things that the average molecular biologist cannot do and focus the project on that,” Bartlett said.
Decades of NIH research have given Bartlett insight into the review process and the makeup of the groups who review and score grants. There is strong competition for NIH funds; In 2020, between 19% and 20% of research grant applications were funded, depending on the grant type.
Even the best ideas can struggle to find a funding match because of that competition. Bartlett emphasizes nailing the specific aims portion—essentially the sales pitch that describes the problem and how the research will advance solutions—of a grant application. The better the pitch and the less esoteric the science, the more likely the committee will take a closer look at the application.
“You have to convince them right away that this is worth funding. It really is like writing a letter to one person. It’s so hard for grant writers, especially young ones, to realize that," Bartlett said.
Michigan Medicine grant applicants have a leg up with securing NIH grants because of the institutional support mechanisms, Bartlett said. He credits the administrative support for helping make the process simpler and applications more successful.
“The atmosphere at Michigan makes it so easy to get involved with both clinical and basic science grants. I've been at Harvard and the University of California and they're not nearly as good as U-M at doing that,” Bartlett said.
As funding continues, so does the work
The latest NIH award Bartlett received, along with co-investigator Mark Meyerhoff, Ph.D. from the Department of Chemistry, will advance ECMO further. The $2.5 million grant will run through 2026 and help them refine the system they developed to prevent coagulation in artificial organs by using nitric oxide.
The aim is to run ECMO without using anticoagulant drugs, which keep blood from clotting in the machine, but can cause bleeding in patients.
“The reason blood doesn't clot in your blood vessels is that they make nitric oxide that prevents clotting at the surface. We’re making a plastic that secretes nitric oxide the same way that a normal endothelium does—and, what do you know, it works,” Bartlett said.
Bartlett is set on tackling another big problem: keeping organs alive longer for transplantation.
The window for transplanting hearts and lungs is short. Those organs typically are only viable for four to six hours outside of the body. Livers and kidneys have longer viability windows of about 12 to 36 hours respectively but still require urgent harvesting, transporting and transplanting. Extending the viability of organs would allow for the establishment of organ banks, and ultimately more organs for transplantation .
Funding from the Frankel Innovation Initiative supported front-edge research that Bartlett would like to parlay into NIH funding. He sensed that the concept needed to be developed and proven before he and his team approached the NIH. After five years of work, Bartlett said the team is able to keep hearts alive for three days.
“That idea is so very far out of the box that you couldn’t convince the NIH to spend a penny on it until you got the research further along. Now we have the science nailed down enough that we think the NIH is going to be interested in it,” Bartlett said.
By Colleen Stone