June 1, 2012
NIH Podcast Episode #0160
Balintfy: Welcome to episode 160 of NIH Research Radio. NIH Research Radio bringing you news and information about the ongoing medical research at the National Institutes of Health – NIH . . . Turning Discovery Into Health®. I'm your host Joe Balintfy, and coming up in this episode, how scientists can now access select compounds from pharmaceutical companies, details on the future of Alzheimer’s disease research, and hidden treasures at the NIH’s National Library of Medicine.
But first, this news update. Here’s Craig Fritz.
Fritz: A new study supported by NIH shows that genetics can help determine whether a person is likely to quit smoking on their own or need medication to improve the chances of success. Scientists focused on specific variations in a cluster of nicotine receptor genes, which prior studies have shown contribute to nicotine dependence and heavy smoking. The study found that the effects of smoking cessation medications depend on a person’s genes. If smokers have the risk genes, they don't quit easily on their own and will benefit greatly from the medications. If smokers don’t have the risk genes, they are likely to quit successfully without the help of medications such as nicotine replacement. Researchers note that this study builds on our knowledge of genetic vulnerability to nicotine dependence, and will help us tailor smoking cessation strategies accordingly.
A treatment to reduce the body temperatures of infants who experience oxygen deficiency at birth has benefits into early childhood, according to a study by an NIH research network. Children who received the hypothermia treatment as infants were more likely to have survived to ages 6 and 7, than were children who received routine care. Researchers say the findings show that the use of this cooling technique after birth increases the chances of survival, without increasing the risk of long-term disability. Infants born at term may fail to get enough oxygen, from blood loss or other birth complications. In severe cases, death rates can reach 50 percent. Survivors often sustain brain damage, which can result in cerebral palsy, cognitive impairment, or hearing and vision loss. Even if they do not experience detectable brain damage, children who experience oxygen deficiency at birth are at higher risk for learning disabilities, language delays, and memory deficits.
For this NIH news update – I’m Craig Fritz
Balintfy: News updates are compiled from information at www.nih.gov/news. Coming up, a plan for Alzheimer’s disease research, a look into the world’s largest medical library, and how a partnership may lead to new therapies. That’s next on NIH Research Radio.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
NIH launches collaborative program with industry and researchers to spur therapeutic development
Balintfy: The drug development process is lengthy and expensive. Dr. Kathy Hudson, the acting Deputy Director of the NIH’s new National Center for Advancing Translational Sciences, or NCATS explains.
Hudson: So the drug development process really starts with an idea of what's going wrong in a specific disease and then the development of a chemical compound that alters that behavior in cells or in your body. And then that moves forward to figure out whether or not it really modulates the disease processes and then it's put into humans to see whether or not it's safe and then moves forward to see whether or not it's effective, and then is ultimately approved by the FDA and made available through your pharmacy with the prescription presumably.
There's really high failure at each of those steps, and so the estimates are that it takes a billion dollars in 15 years to develop a single drug. So any improvements in that process will be improvements for the American public and ultimately the global population.
Balintfy: Recently, the NIH has unveiled a collaborative program that will match researchers with a selection of pharmaceutical industry compounds to help scientists explore new treatments for patients.
Hudson: The goal of this new program called “Discovering New Therapeutic Uses for Existing Molecules” is really two-fold.
Balintfy: Dr. Hudson says the first goal is try out new models or templates for collaborations.
Hudson: And the second goal is to see whether or not we can use this new model to accelerate the drug development pipeline by providing new ways of working together.
Balintfy: NIH has partnered initially with Pfizer, AstraZeneca, and Eli Lilly and Company which have agreed to make dozens of their compounds available for the pilot phase of this initiative.
Hudson: So all of those compounds have been sitting in freezers and sort of in the proverbial attic of these companies, out of sight and out of reach from the biomedical research enterprise. So what we're able now to do through this collaboration is make those available to researchers and basically crowd source these compounds and get the very best ideas from all American researchers to see whether or not there is a way to use these compounds to help provide new medicines for different diseases.
Balintfy: Dr. Hudson explains that a compound may be a drug that was tested for a disease and didn’t work, so the pharmaceutical company shelved it.
Hudson: So what does that mean shelving it? In most cases, they have an extensive set of data about that compound and they're going to make that available, and then they will also provide enough of the compound for their use in our funded studies. So whether that's capsules or tablets or injectables or whatever, it's in the form that we'll need it to study it for another indication.
Balintfy: A prime example of a compound that did not prove effective for its initial use but succeeded for a different one is AZT. That drug failed to fight cancer, but was later found to be the first medicine effective against HIV, the virus that causes AIDS. Dr. Hudson is looking forward to more similar discoveries.
Hudson: Certainly we anticipate that there will be great new science and biological insights that will come out of this program. And while we don't to have extraordinarily high expectations because there's high failure rates at every step in the drug development process, we do hope that this will prove helpful in developing new medicines for unmet medical needs.
Balintfy: She adds this new partnership is emblematic of a specific kind of research, translational science.
Hudson: Translational science for us is really re-engineering the process of moving basic discoveries to new medicines, and that pipeline has been sort of the same for decades and decades and decades. And so like the water mains and gas pipes in your cities and town, that pipeline needs to be re-engineered from time to time, and so that's what NCATS is really about is bringing about better ways to do the whole process of drug development.
Balintfy: For more information about the “Discovering New Therapeutic Uses for Existing Molecules” program, and the NIH’s National Center for Advancing Translational Sciences, visit the website http://ncats.nih.gov.
Alzheimer’s Disease Research Summit
Balintfy: This past month, NIH held the “Alzheimer’s Disease Research Summit 2012: Path to Treatment and Prevention.” Some 500 researchers, clinicians and members of the broader Alzheimer’s community contributed. Dr. Richard Hodes is director of the NIH’s National Institute on Aging.
Hodes: Participants in the meeting include representatives from academia, from industry, advocates, all representative of the very groups that need to work together if we're going to most effectively approach the problem that Alzheimer's disease creates for us.
Balintfy: Alzheimer's disease is the most common form of dementia among older people. Dementia is a brain disorder that seriously affects a person's ability to carry out daily activities. Dr. Neil Buckholtz, also with the National Institute of Aging here at NIH says the disease is a major public health problem.
Buckholtz: It affects obviously the people who have the disease itself but it also affects the family members. It's a very devastating disease. The course of the disease takes a number of years and it's a major stress both for the individual who has Alzheimer's disease as well as for the family members.
Balintfy: He adds that no new treatments have been approved by the Food and Drug Administration since the early 2000s.
Buckholtz: And what we would like to do with this summit meeting is to think about new ways of developing and testing treatments for Alzheimer's disease that will affect both the symptoms of the disease as well as modify the course of the disease, that is slow down the course.
Balintfy: NIA Director Dr. Hodes is optimistic.
Hodes: We hope and fully expect that the presentations of this meeting, the discussions that are ongoing will lead to a sense of the scientific community's highest priorities, those areas which are most important, which are most likely to be productive, ranging from basic science to translation and ultimately clinical trials in pursuit of effective prevention and therapeutic interventions.
Balintfy: Estimates vary, but experts suggest that as many as 5.1 million Americans have Alzheimer’s disease. Unless it can be effectively treated or prevented, the number of people with it will increase significantly if current population trends continue. That’s because the risk of Alzheimer’s increases with age, and the U.S. population is aging.
Petersen: We're at the point in this country and actually around the world right now where Alzheimer's disease is in fact a crisis.
Balintfy: Dr. Ronald Petersen is from the Mayo Clinic and was a summit participant. He says the summit marks the start of the first national plan to address Alzheimer’s disease research.
Petersen: So this is really the kick-off point if you will for the National Alzheimer's Project Act.
Balintfy: The National Plan to Address Alzheimer’s Disease sets forth specific goals, including the development of effective prevention and treatment approaches for Alzheimer’s disease and related dementias by 2025.
DeKosky: I think there are two reasons that the meeting is extraordinarily important.
Balintfy: Dr. Steven DeKosky is from the University of Virginia School of Medicine and was another participant in the summit.
DeKosky: The first is that the group has been charged with trying to give the best thoughts about what future research should be that the NIH decides to encourage and fund. The second is that because there is such a wide range of researchers here from neurobehavioral experts to epidemiologists to biochemists to clinical researchers, we're trying to get the word from everyone about what aspects of their areas of research are important enough to include in the plan with recommendations to the head of NIH, to the head of NIA, and to the government.
Balintfy: Drs. DeKosky and Pettersen also emphasize the importance of the public’s participation in Alzheimer’s disease research.
DeKosky: Families are the key to this because we will not conquer this disease without clinical trials. We will not do clinical trials in patients with Alzheimer's disease unless their families are willing to help or willing to make the observations they need to make to come to the clinic when they have follow-up appointments or come in for a scan or a blood test and be able to help describe what they see in their family members, some of which is qualitative, how was he doing. Much of it is checklist or some sort of scale from last time to the current time. So it isn't as if the families can sit back and the labs can solve this problem. They absolutely will not. It will take participation of families who have responded wonderfully well in many centers and it's up to us to give them more opportunities to be able to participate in research.
Petersen: At this point in time, one of the major obstacles to developing effective therapies for Alzheimer's disease, if not the major obstacle, is our inability to recruit subjects for clinical trials. That is, you can have the best compound out there that you think is going to be effective, but if it takes six months to a year to 18 months to complete enrollment, we lose the effectiveness of that particular trial. Consequently, the trial also costs much more than it had been budgeted. So if there were one thing that the general public could do to enhance research in Alzheimer's disease, it would be to consider participating in clinical trials at all stages of the disease.
Balintfy: The experts also point out that Alzheimer’s disease research to date has been progressing. Again, the NIH’s Dr. Hodes.
Hodes: This is a time when there is great national and global interest and concern about Alzheimer's disease. This also is a time in which scientific opportunities have been explosive. The time is therefore a critical one which we can bring together experts nationally and internationally to help us identify what the priorities are, what areas of research are going to be most important, most likely to lead as quickly as we can to the cures and preventions that we all are striving toward.
Balintfy: For more information about Alzheimer’s disease, research and clinical trials in Alzheimer’s disease, and the recent summit, visit www.nia.nih.gov. And coming up next on NIH Research Radio, Hidden Treasure.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
Balintfy: Just in time for graduation season, a gift option for a recent grad – or for anyone with interest in art, science or history – a new book gives a glimpse into the hidden treasures of the world’s largest medical library. The editor of the book, Dr. Michael Sappol [SAY-pole] says it was quite a project.
Sappol: A very complex, complicated project; in fact hideously gloriously complicated
Balintfy: Dr. Sappol explains that the book, a large, hardback with more than 200 pages, represents some of the diversity and wonders of the NIH’s National Library of Medicine.
Sappol: It is the world's largest medical library. It has an amazing historical collection going back to the 11th century from virtually every continent and every region of every continent.
Balintfy: The book also helps commemorate a significant anniversary of the library.
Sappol: We wanted to celebrate the 175th anniversary, but we wanted to make a book that was much more substantive that would outlast the occasion of the 175th anniversary and a book that would promote to the public, explain to the public what the National Library of Medicine is.
Balintfy: He explains that the National Library of Medicine founded in 1836 as the Surgeon General's Library, eventually moved to the campus of the NIH becoming one of the institutes of the National Institutes of Health in the 1950s. A much longer history of hidden treasures is covered in the book.
Sappol: So the title is “Hidden Treasure” which we have many hidden treasures in the library and the library itself is a hidden treasure.
Balintfy: The library has many very obscure and eccentric things in its collection, some of which actually have nothing to do with medicine because they were collected over a long period of time and now they are of interest to historians. Dr. Sappol continues that choosing which items to include in the book was not easy.
Sappol: It was very hard. It was like sort of how do you choose among your children? What are favorites? Sometimes they were just narrow little decisions about this binding is difficult to open or this thing is difficult to photograph. Sometimes it was a completely arbitrary choice. We have five of these kinds of things. We can only include one.
Balintfy: Ultimately a large list of items had to be narrowed down.
Sappol: Our initial list was about 400 objects, which would have been a very, very thick volume, and we ended up with 83. And even there, within those 83, we can only show off -- some of them are profusely illustrated books or manuscripts. We can only show off a little bit of the wonders of that thing to suggest some of the riches within.
Balintfy: Dr. Sappol says that capturing the riches of the items in the book involved much more than simply scanning or digitizing images. The items, he explains, are not just information.
Sappol: These are not just information, these books and objects, these posters and slides and pamphlets and manuscripts. They also have a texture, a feel, a smell, and all of those things have meaning. And each copy is unique. Some copies have things written in them that are in no other copy. So no one copy can be digitized that stands for that book even though that's sort of what happens with digitization projects. Very often the library will say we'll try and pick the best copy among our libraries or there is some duplication.
So for example, the book starts with a printed book from the late 15th century. It's early print. It's Lambertus de Monte's commentary on St. Thomas Aquinas's commentary on Aristotle. So right there you get a kind of rich succession, a kind of little entry into book history and how complex and wonderful it is.
And this particular copy of the book is defaced with doodles by a student which sort of calls to every student who is ever chained to a desk at a boring lecture. There are lots of figures of people sticking their tongues out which was considered to be a very profane thing to do in the year 1500 or 1510. We're not sure exactly when the student did this. But all over this manuscript, there are notes and little pictures, which are partly note-taking, and then these desecrations of the material.
But in the same time, what's really interesting is the material is actually discussing something that relates to the tongue, which is that the tongue mediates between spirit and matter. The tongue is where speech comes. It's where people do their prayer. And that in the cultural hierarchy of early modern Europe was considered to be a very spiritual high thing. And yet, the tongue is where you taste things. It's where you eat things. It's a place of gross sensations where you spit and slobber.
So we recruited a scholar who wrote a beautiful, elegant, little mini-essay and discussed all those things, and we learned about it from that essay.
Balintfy: Each item in the book has an accompanying text, which Dr. Sappol says was also a challenge.
Sappol: There are 75 scholars who I recruited to write these very short mini-essays. They're kind of a scholarship form of speed dating or maybe haiku scholarship. And we gave them some books, some of which they were experts in and knew everything about, some of which were absolute mystery objects.
Balintfy: Hidden Treasure helps give these objects both a sense of touch and feel, as well as understanding, mixing art, science and medicine.
Sappol: We wanted to make this book entertaining and substantive.
Balintfy: He says the book is an invitation to both scholars to do further research and the public to see more of the library’s collection.
Sappol: We pick some images that are very pleasurable and some that are very disturbing and we want to show a range of things. Some of them are charming and disturbing at the same.
Balintfy: One previously uncataloged item, perhaps one of the more charming that made it not only in the book but on the cover, is a collection of glass slides.
Sappol: They're called lantern slides. They are slide projections from the 19th century that were used at St. Elizabeth's Hospital for the Insane in Washington D.C. Many of them are very charming. They are little panes of glass. Sometimes they are like two-cell animations. You can slide one pane in to make something happen in the slide. And they cover lots of different areas. Some of them are religious. Some of them are patriotic. Some of them are lessons in art or sentimental or moral. But the vast majority of them are funny.
Balintfy: But Dr. Sappol also highlights something on the more disturbing side:
Sappol: An early 20th century photographic anatomical atlas in which they do something called topographical anatomy which is anatomy that doesn't dissect but slices. And of course they're French so the method they use is something like a guillotine.
But you can see people's faces and bodies progressively cut to pieces.
And they're disturbing and people said, "Well, should we include these?" and we had discussion about that.
I felt that people will be disappointed if we didn't include this kind of material. We are a medical library. We have many, many shocking things in our library. And I wanted to indicate some aspects of that, and this kind of stands for a larger universe.
Balintfy: Dr. Michael Sappol is the editor of the new book, Hidden Treasure. For more about the book and the collection at the NIH’s National Library of Medicine, visit www.nlm.nih.gov. And look for a copy of Hidden Treasure from Blast Books at your choice of book retailers.
Balintfy: That’s it for this episode of NIH Research Radio. Please join us again on Friday, June 15 when our next edition will be available. Until next time, I'm your host, Joe Balintfy. Thanks for listening.
Announcer: NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland, an agency of the US Department of Health and Human Services.