How to obtain a National Heart, Lung, and Blood Institute-sponsored K08 and K99/R00 grant in the current funding climate.

I write this editorial in an attempt to help applicants and their mentors as they prepare their National Heart, Lung, and Blood Institute (NHLBI)-supported K08 or K99/R00 applications. In my view, these programs are critical for the future of cardiovascular research in the United States because they support talented new investigators at a particularly vulnerable period in their careers. In this issue, Circulation Research has published an article from the NHLBI that details critical aspects of these programs.1 Cardiovascular disease is still the number 1 cause of death in the United States.2 There is an obvious need to develop novel therapies to prevent or reverse the consequences of these diseases. New therapies should reduce the morbidity and mortality of cardiovascular disease, lower associated costs of health care, and improve the lives and productivity of affected patients. Basic, translational, and clinical research is the foundation on which these new therapies will be developed. High-impact discoveries that lead to medical advances are usually made by well-trained biomedical scientists, and many of these investigators have started their careers with support from NHLBI K08 (Mentored Clinical Scientist) and K99/R00 (Pathway to Independence) awards. These grants support training of young scientists in premier laboratories to prepare them for careers in what has been, in my view, the best biomedical science environment in the world, the United States. This “pipeline” of young talent is challenged by the current funding environment. In my view, the current lack of support for the biomedical research puts our leadership position in this field at risk. I digress. I have spent 25 years reviewing different types of grants for the NHLBI, and I have had significant experience both mentoring K08 awardees and reviewing K08 and K99/R00 applications. In this editorial, I give my personal views on who would make an ideal candidate for each of these awards. I also discuss my personal views on those aspects of K08 and K99/R00 applications that, to me, make them outstanding. I write this editorial in the hope that I can be helpful to applicants, so that their grants do not fall on the wrong side of the pay line for reasons that they can avoid. Make no mistake about where we are right now; we are in full crisis mode. The current3 NHLBI pay line of 19 (raw score, 10–90 scale with 10 being the best score) for K awards means that the application must receive some scores of 1 (the very best score, which in olden days was rarely given) by some reviewers. A score of 1 (translates to a 10) is described as “exceptionally strong, with essentially no weaknesses.”4 It is not the fault of the NHLBI that the pay line for these awards has plummeted. This pay line reflects the reduced support for the National Institutes of Health, and thereby training of the next generation of biomedical scientists. Given this highly competitive environment, every aspect of the application needs attention, because reviewers pay attention to the entire application, not just the science. What follows are my opinions of who should apply for K08 (Mentored Clinical Scientist) and K99/R00 (Pathway to Independence) awards and what makes a candidate special to me.