Monday, June 11, 2012

Highlights from the NIDA Director’s Report from NIDA at the 2012 CPDD Plenary Session

LA QUINTA, CA – Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA), presented her annual Report from NIDA yesterday morning at the 2012 CPDD Plenary session. She began by thanking CPDD researchers for their wisdom and efforts to advance substance abuse research. She noted that the work of researchers guides NIDA in its efforts to facilitate the development of addiction science and to create the vision for future addiction science research directions.

Dr. Volkow reported that the structural merger process for formulating the new NIH substance use disorders Institute is well underway, and that the timeline now is finite. The draft plan currently is being created and is scheduled for public release in the Fall of this year, at which point, a public comment period will open. In December 2012, the plan and public comments will be presented to NIH Directors, who will configure the final plan that will be submitted to Congress in January or February, 2013. Congress will review the plan and establish its funding allocation in the Spring of 2013, and the new Institute will begin funded operations in FY 2014 (October 2013). Dr. Volkow indicated that NIDA will alert researchers when the public comment period opens in the Fall so they have time to provide feedback.

She then acknowledged NIDA staff who she referred to as “silent warriors” and “altruistic” partners in advancing substance abuse research and treatment.

She presented a slide showing how the NIDA budget is allocated to substance abuse research areas, and she noted that the NIDA funding allocation for new medication development portfolio has remained stable at about 12% for some time, despite concerns expressed by some researchers that funding in other areas is being sacrificed to support the medication development portfolio.

She then turned to the science and highlighted 3 main topics, big dataset science, novel treatment approaches, and HIV research and treatment.

Big dataset science typically involves the use of very large data sets acquired by pooling data from many investigators applying similar experimental designs. Accretion of such data substantially increases statistical power, enabling more detailed and complex analyses of complex systems. Dr. Volkow asserted that the field is heading in the direction of supporting more big dataset science initiatives involving genetics, epigenetics, proteomics, brain imaging, clinical data, and systems biology. She also noted that we are not ready yet to take full advantage of big dataset research, and that we are behind other fields including physics, which have developed processes and systems to conduct this type of work. Dr. Volkow indicated that NIH has a data and informatics working group charged to enhance our abilities to work with large databases. She also indicated that NIDA is working on implementing processes to enable large dataset research with brain imaging data.

In terms of novel treatments, Dr. Volkow noted that NIDA has been supporting big pharma development of dopamine D3 receptor antagonists to treat stimulant disorders, since it is known both from animal and human studies that D3 receptor densities are elevated in subjects exposed to stimulants. Recently, it was appreciated that the approved anxiolytic drug buspirone, which is a high affinity partial agonist at serotonin 5-HT1A receptors, also has very high affinity for dopamine D3 receptors (it also appears to be a high affinity dopamine D4 receptor antagonist). She showed PET imaging data documenting that buspirone reduces dopamine D3 receptor binding in nonhuman primates, supporting additional study of buspirone as a treatment for substance abuse disorders.

The other novel treatment approach Dr. Volkow discussed during her presentation is nicotine and cocaine antibody production. Phase III trials with the nicotine vaccine have achieved only limited success, primarily because only 30% of those immunized sustain adequate antibody levels. Those individuals do reduce nicotine intake, indicating that the mechanism does work. Thus, researchers are working on ways to increase efficiency of antibody production, and also are working on ways to identify individuals who upon immunization are likely to produce high antibody levels. New research using adenovirus vectors, which are extremely efficient at producing high antibody levels that are sustained for long periods, suggests that the adenovirus approach may work well: PET imaging results document that adenovirus anti-cocaine immunized monkeys do not sustain significant brain cocaine levels after cocaine administration, suggesting that this approach may be effective in humans.

The last scientific topic covered in the presentation was the breakthrough finding that antiretroviral treatment (ART) for HIV infection not only slows HIV progression, but also prevents new infections in partners of HIV-infected subjects. The work that led to this discovery was funded by a NIDA Avant-Garde program grant to Julio Montaner in 2008, which itself led to a Canadian government grant to focusing on substance abusing populations and aggressively seek, test, and treat subjects to reduce transmission. Dr. Volkow lamented that despite this research, daily injection drug abusers still are less likely than other HIV positive individuals to receive ART until later in the disease process, meaning that its more likely they can infect others. She noted that this gap in application of evidence-based science supporting early ART must be overcome by instituting a cultural change among treating physicians.

Dr. Volkow ended her presentation by once again highlighting the power and value of big dataset science, citing the recent brain imaging and genetics study of over 400 twin pairs that elucidated the influence of genes on human brain structure.

CPDDBLOG welcomes CPDD member’s thoughts on these issues.

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