Urologic Diseases Research Updates
Winter 2008

NIDDK Seeks Studies in Pelvic Pain and Other Syndromes

RFA Calls for Multidisciplinary Approach to Study of Chronic Pelvic Pain

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has issued a Request for Applications (RFA) for a multidisciplinary approach to the study of chronic pelvic pain (MAPP).

The MAPP Research Network will adopt multisite, multidisciplinary, highly collaborative, novel approaches using traditional urologic and nonurologic expertise to address key questions in understanding chronic pelvic pain syndromes. This effort is expected to lead to critical new insights into the underlying causes of interstitial cystitis (IC)—also called painful bladder syndrome (PBS)—and chronic nonbacterial prostatitis (CP), or chronic pelvic pain syndrome (CPPS), as well as possible links between these conditions and comorbid disorders, which have the potential for creating future prevention and treatment strategies.

In a separate complementary effort, the NIDDK is developing new and more comprehensive research definitions and criteria for IC/PBS and CP/CPPS that will adopt the concept of systemic disease. With these new definitions and criteria, researchers hope to identify more specific and relevant patient profiles for IC/PBS and CP/CPPS.

Frustrating Conditions

IC/PBS causes recurring discomfort or pain in the bladder and surrounding pelvic region. CP/CPPS causes pain in the lower back and genital area. Urinary urgency and frequency commonly occur in both IC/PBS and CP/CPPS patients. Both conditions frustrate patients and their health care providers because so little is understood about the source of the pain. Effective treatments are equally elusive.

The NIDDK has supported a series of initiatives aimed at understanding conditions that cause chronic pelvic pain, including the

• Interstitial Cystitis Database Study
• Interstitial Cystitis Clinical Research Network
• Boston Area Community Health Survey
• Rand IC Epidemiology Study
• Chronic Prostatitis Clinical Research Network
• Chronic Prostatitis Clinical Database

The NIDDK also has funded many basic research studies focusing on the biology of the bladder and prostate in an attempt to better understand the pathological basis of urologic chronic pelvic pain conditions. Despite these efforts, much remains to be learned regarding the etiology and natural history of these diseases.

The clinical and basic research studies developed by the NIDDK and the research community have traditionally focused on the bladder and prostate as the origins of disease for IC/PBS and CP/CPPS, respectively. However, recent epidemiological studies have shown other illnesses that share chronic pain as a major symptom are often associated with these urologic conditions, including fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome. These findings suggest the possibility of a common underlying pathophysiology in chronic pain disorders that has not been adequately addressed in IC/PBS and CP/CPPS studies.

MAPP Research Network Structure and Organization

The MAPP Research Network will include up to six Discovery Sites that share the common goal of improving the understanding of the fundamental basis of disease pathophysiology and natural history—including predisposition for IC/PBS or CP/CPPS—and assessing potential relationships between IC/PBS and CP/CPPS and other chronic pelvic pain syndromes.

“The NIDDK’s MAPP Network, through its unique approach, will address many long standing questions regarding urologic chronic pelvic pain conditions and will provide an improved knowledge foundation for developing effective treatment and intervention efforts,” said Chris Mullins, Ph.D., the program’s director and the NIDDK director of Urology Basic Cell Biology Programs.

While the specific scientific interests of each Discovery Site may differ, they all must demonstrate a dedication to the study of IC/PBS or CP/CPPS as a central focus. Individual Discovery Sites will conduct multiple projects focused on the scientific priorities of the MAPP Network.

Efforts will involve both site-specific studies and highly collaborative multisite, or trans-network, studies using the combined resources and varied expertise of the MAPP Network. The MAPP Network will include two separate Core Sites that will serve as common resources:

• The Data Coordination Core (DCC) will provide expertise in the overall administration and coordination of multisite research studies and in data analysis for individual Discovery Site projects and multisite trans-network studies.

• The Tissue Analysis and Technology Core will provide tissue (biopsy, serum, and urine) collection, banking, annotation/blinding, distribution services, and histological and tissue morphology analyses. The Core also will provide genomics and proteomics analyses and generate assay platforms—such as for genomics and proteomics studies and tissue expression analyses—for multisite efforts and individual Discovery Site efforts, as needed.

In addition to providing these functions, Data Coordinating Core and Tissue Analysis and Technology Core funds will support MAPP Research Network Ancillary Projects beginning in the first year. These projects, which will be designed to enhance multisite scientific collaborative projects at two or more sites, will be developed by the MAPP Research Network Steering Committee and will be reviewed for scientific merit and feasibility by an external Scientific Advisory Committee.

The NIDDK anticipates that among those selected to serve as Discovery Site or Core Site directors and as project leaders on individual Discovery Site projects will be investigators from diverse fields and those who have not been traditionally involved in studies of urologic chronic pelvic pain, but who have expertise in relevant disciplines.

For more information, email Chris Mullins at MullinsC@extra.niddk.nih.gov.

NIH Publication No. 08–5743
March 2008

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