>> I WOULD LIKE TO WELCOME
EVERYONE TO THE 165th
MEETING -- 66th MEETING OF THE
NATIONALITY ADVISORY COUNCIL ON
ALCOHOL ABUSE AND ALCOHOLISM.
I'LL LET PHILIPPE GIVE
INSTRUCTIONS AFTER WE DO THE
INTRODUCTIONS.
I'M GOING TO CALL ON YOU AND
MAYBE SAY YOUR NAME AND WHERE
YOU'RE FROM AND YOUR -- MAYBE
ONE SENTENCE ABOUT WHAT YOU WORK
ON.
ALL RIGHT?
SO, I'M GOING TO START WITH
ZOOM, NANCY BARNETT.
>> HELLO, NANCY BARNETT FROM THE
SCHOOL OF PUBLIC HEALTH AT BROWN
UNIVERSITY.
I STUDY ALCOHOL USE IN YOUNG
PEOPLE FROM THE PERSPECTIVE OF
SOCIAL INFLUENCE AND SOCIAL
NETWORK ANALYSIS AND BY STANDARD
INTERVENTION I ALSO STUDY
ALCOHOL SENSORS AND THEIR
VALIDITY, WEARABLE ALCOHOL
BIOSENSORS.
>> THANKS, NANCY.
AND CAMERON.
>> [ GARBLED AUDIO ].
>> WE'LL HEAR HIM IF FRET, JOHNS
HOPKINS.
>> TINA CHAMBERS, UNIVERSITY OF
CALIFORNIA, SAN DIEGO,
DEPARTMENT OF PEDIATRICS, AND I
STUDY PRENATAL EXPOSURE TO
ALCOHOL AND HEALTH OUTCOMES FOR
THE MOTHER AND THE BABY.
>> OKAY.
THANK YOU, TINA.
WESTLEY CLARK CAN'T BE HERE, NOR
NANCY GONZALEZ, SO HAIDEN
HUSKAMP.
>> HAIDEN HUSKAMP FROM HARVARD
MEDICAL SCHOOL, HEALTH
ECONOMIST, UTILIZATION OF CARE,
INCLUDING OUTCOMES.
>> THANKS, WELCOME TO OUR
COUNCIL.
RHONDA JONES-WEBB.
>> GOOD MORNING, RHONDA
JONES-WEBB, PROFESSOR IN
DIVISION OF EPI AND COMMUNITY
HEALTH, SCHOOL OF PUBLIC HEALTH,
AND MY RESEARCH FOCUSES ON
ALCOHOL EPIDEMIOLOGY AND POLICY
WITH A SPECIAL FOCUS ON RACE,
CLASS, AND NEIGHBORHOOD
INFLUENCES.
>> THANKS, RHONDA.
AND DAVID KAREKEN.
>> DAVID KAREKEN, PROFESSOR AND
VICE CHAIR FOR RESEARCH AT
DEPARTMENT OF NEUROLOGY, INDIANA
UNIVERSITY SCHOOL OF MEDICINE,
ALSO DIRECTOR OF THE INDIANA
UNIVERSITY ALCOHOL RESEARCH
CENTER AND MY OWN RESEARCH
CENTERS ON HUMAN BRAIN IMAGING
AND ALCOHOL USE DISORDER RISK.
>> THANKS, DAVID.
AND FRANCES LEVIN?
>> ADDICTION PSYCHIATRIST, CHIEF
OF THE SUBSTANCE USE DISORDER
COLUMBIA UNIVERSITY NEW YORK
STATE PSYCHIATRIC INSTITUTES,
FOCUSING ON INTERVENTIONS FOR
INDIVIDUALS WITH A RANGE OF
SUBSTANCE USE DISORDERS,
COCAINE, MARIJUANA, OPIATES, AND
ALCOHOL, AND PARTICULAR EMPHASIS
ON PSYCHIATRIC COMORBIDITY WITH
PARTICULARLY WE'VE DONE WORK IN
THE AREA OF ADULT AND ADOLESCENT
ADHD AND SUBSTANCE USE
DISORDERS.
>> THANKS, FRANCES.
WELCOME TO OUR COUNCIL.
MICHAEL LEWIS?
YES, HELLO, EVERYONE.
MICHAEL LEWIS, AND I'M
PROFESSOR, DEPARTMENT OF
PSYCHOLOGY AT HUNTER COLLEGE,
GRADUATE CENTER, CITY UNIVERSITY
OF NEW YORK.
AND I'M INTERESTED IN LOTS OF
DIMENSIONS OF ALCOHOL BUT
ESPECIALLY INTERESTED IN
MOTIVATIONAL, AND CHEMICAL
INTERVENTIONS OF ALCOHOL ABUSE
AND GLAD TO BE HERE.
>> THANKS, MICHAEL.
DAYNE MAYFIELD.
>> DAYNE MAYFIELD, DEPARTMENT OF
NEUROBIOLOGY, WAGGONER CENTER,
UNIVERSITY OF TEXAS AT AUSTIN,
MY WORK UTILIZES BOTH HUMAN
POSTMORTEM BRAIN AND ANIMAL
MODELS, AND WITH FOCUS GENETIC
APPROACHES TO IDENTIFY TARGETS
FOR THERAPEUTIC DEVELOPMENT.
>> WELCOME.
KATIE WITKIEWITZ?
>> GOOD MORNING, KATIE
WITKIEWITZ, DISTINGUISHED
PROFESSOR OF PSYCHOLOGY
UNIVERSITY OF NEW MEXICO AND
DIRECTOR OF THE CENTER ON
ALCOHOL SUBSTANCE USE AND
ADDICTION, AND RESEARCH BROADLY
BEHAVIORAL TREATMENTS, PRECISION
MEDICINE, AND RECOVERY.
>> THANKS, EVERYBODY.
SO I'M JUST GOING TO INTRODUCE
SENIOR STAFF, I'LL LET THEM
INTRODUCE THEMSELVES AND WE'LL
GO FROM MYSELF TO MY RIGHT.
I'M OBVIOUSLY YOU KNOW ME,
DIRECTOR OF NIAAA, SO TRISH?
>> GOOD MORNING
DEPUTY DIRECTOR NIAAA.
>> GOOD MORNING, KATHY YOUNG,
DIRECTOR OF THE DIVISION OF
METABOLISM AND HEALTH EFFECTS,
THAT'S THE DIVISION THAT LOOKS
AT THE EFFECTS OF ALCOHOL ON
ORGAN DAMAGE.
>> HELLO, BRIDGE IT WILLIAMSON,
DIRECTOR OF OFFICE OF SCIENCE
POLICY COMMUNICATIONS AND
ASSOCIATE DIRECTOR FOR BASIC
RESEARCH NIAAA.
>> HI, DAVID GOLDMAN, CLINICAL
DIRECTOR, CHIEF OF THE LAB OF
NEUROGENETICS.
>> RAY LITTEN, DIVISION OF
TREATMENT AND RECOVERY.
>> HELLO, I'M ANTONIO, AND I'M
THE DIRECTOR OF THE DIVISION OF
NEUROSCIENCE AND BEHAVIOR.
>> DAVID GOLDMAN, COULD YOU
SHARE YOUR MICROPHONE AND LET
DAWN INTRODUCE HERSELF?
>> HELLO, DAWN WAYMAN,
SCIENTIFIC DIVERSITY OFFICER AT
NIAA.
>> DID YOU MISS ANYBODY?
MOST OF YOU KNOW THE STAFF.
IF YOU DON'T, YOU CAN
CERTAINLY -- OH, YEAH, SORRY.
>> PHILIPPE MARMMILLOT.
>> AND VICKIE, SORRY ABOUT THAT.
>> VICKIE BUCKLEY, NIAA
EXECUTIVE OFFICER AND DEPUTY
ETHICS COUNSELOR.
NICE TO SEE EVERYONE.
>> I'M GLAD MY STAFF SPEAKS UP
BECAUSE I'M ALWAYS DOING THIS.
SO, YOU KNOW.
>> ONE MORE PERSON, GEORGE.
>> ONE MORE PERSON, WHO IS THAT?
>> BOB FREEMAN.
>> BOB FREEMAN, DEPUTY CHEF, EPI
AND PREVENTION.
>> BOB'S HERE BECAUSE RALPH
WASN'T ABLE TO MAKE IT TO THIS
MEETING.
THANKS, BOB, FOR STEPPING IN.
ALL RIGHT.
SO I'M SUPPOSED TO DO A
DIRECTOR'S REPORT.
IT'S TIME FOR THE KOOB JOURNAL
CLUB.
CAN EVERYBODY SEE THIS, ONLINE
AND LIVE?
ALL RIGHT.
SO, I'M GOING TO BE -- NOT
MOVING.
I'M GOING TO BE DOING THAT
INSTITUTE AND NIH UPDATES.
OKAY.
WE'RE GOOD.
THANKS.
SO FIRST THING, SAD NEWS FOR US
AT NIAAA, DALE HERELD PASSED
AWAY, HE WAS AN MD/PHD THAT
SERVED WITH US FOR MANY YEARS.
HE SERVED AS HEALTH SCIENTIST
ADMINISTRATOR IN DIVISION OF
METABOLISM AND HEALTH EFFECTS
FROM 2008 UNTIL HIS RETIREMENT
IN 2019, MANAGED THE FETAL
ALCOHOL SPECTRUM DISORDERS
RESEARCH PORTFOLIO AND THEN WAS
NIAAA PROJECT SCIENTIST FOR
PRENATAL ALCOHOL SIDS, AND
STILLBIRTH RESEARCH, WHICH IS
THE PASS NETWORK, AND
COLLABORATIVE INITIATIVE ON
CIFASD, RESEARCH CONSORTIUM ON
COLLABORATION ON FASD
PREVALENCE, CoFASP.
HE REPRESENTED NIAA ON MANY
NIH-WIDE COMMITTEES AND
PROJECTS, A BELOVED MEMBER OF
THE NIAAA FAMILY, COUNTED
YOURSELF LUCKY TO HAVE KNOWN
HIM, WITNESSED HIS KINDNESS OR
TOUCH OF HIS QUICK-WITTED HUMAN,
WILL BE DEEPLY MISSED BY HIS
FAMILY, FRIENDS, NIAAA
COLLEAGUES.
SO WE LOST ONE OF OUR FORMER
REALLY DYNAMIC STAFF.
WE HAD A CONGRESSIONAL BRIEFING
JUST ABOUT THE TIME THEY WERE
VOTING ON THE BUDGET, AND SO IT
WAS REALLY QUITE NICE THAT
REPRESENTATIVE PAUL TONKO CAME
AND GAVE A FEW REMARKS AT THE
BEGINNING OF OUR CONGRESSIONAL
BRIEFING.
WE DO THESE ON A REGULAR BASIS
IN COLLABORATION WITH THE
FRIENDS OF NIAAA, THE AMERICAN
PSYCHOLOGICAL ASSOCIATION, AND
CONGRESSIONAL ADDICTION
TREATMENT AND RECOVERY CAUCUS.
IT'S USUALLY MOSTLY FOR STAFF
BUT OCCASIONALLY A CONGRESSMAN
SHOWS UP, AND THAT'S GOOD TOO.
SO THIS ONE WAS ENTITLED
PREVENTING ALCOHOL MISUSE,
RESEARCH TO IMPROVE AND SAVE
LIVES, IT FEATURED, AS I SAID,
PAULTONKO AND DR. WILLIAM
WIECZOREK, CHAIR OF FRIENDS OF
NIAAA, AND OVERVIEW OF THE NEEDS
AND OPPORTUNITIES IN PREVENTION
RESEARCH, THREE SPEAKERS GAVE
EXCELLENT TALKS, DR. PASCALL,
LIVINGSTON AND LEWIS AND
DISCUSSED RESEARCH ON INDIVIDUAL
AND ENVIRONMENTAL APPROACHES FOR
ALCOHOL MISUSE PREVENTION.
I ENJOYED IT VERY MUCH.
I THINK THE STAFF DID AS WELL.
AND THEN A BUDGET PASSED RIGHT
AFTER.
WITH TONKO RUNNING OUT THE DOOR
TO VOTE, I GATHER.
ANYWAY, SPEAKING OF THE BUDGET,
ON MARCH 23 PRESIDENT BIDEN
SIGNED THE FURTHER CONSOLIDATED
APPROPRIATIONS ACT OF 2024.
NIH RECEIVED $47.2 BILLION, .8%
DECREASE BELOW FISCAL 2023
ENACTED LEVEL.
WE RECEIVED $595.3 MILLION FOR
FISCAL YEAR 2024, THE SAME
AMOUNT APPROPRIATED IN FISCAL
YEAR 2023.
TO BE HONEST, WE'RE PRETTY
GRATEFUL THAT THAT'S WHAT THE
BUDGET WAS, IN THE CURRENT
CLIMATE.
AS PART OF THIS ABILITY, NIH
WILL INCREASE ANNUAL PAY 4% FOR
PRE-DOCTORAL TRAINEES, 8% FOR
POSTDOCTORAL SCHOLARS REPORTED
BY THE RUTH L. KIRSCHSTEIN
NATIONAL RESEARCH SERVICE
AWARDS.
ELIGIBLE PARTICIPANTS WILL ALSO
RECEIVE $500 INCREASES IN
SUBSIDIES FOR CHILD CARE, WHICH
RANGE NOW FROM $2500 TO $3,000,
AND ADDITIONAL $200 FOR
TRAINING-RELATED EXPENSES.
SO OUR BUDGET IS WHAT OUR BUDGET
IS.
I JUST, YOU KNOW, PUT IT IN
TERMS THAT WE LIVE WITH, WE HAVE
A PRETTY HIGH TURN THIS YEAR,
FUNDED A LOT OF GRANTS LAST YEAR
WITH OUR BUDGET INCREASE, AND
NOW WE'RE PAYING THEM AS
NON-COMPETING RENEWALS.
BUT OTHER THAN THAT WE'RE GOING
TO CONTINUE TO CONTINUE.
AND I'M PLEASED TO ANNOUNCE DR.
PHILIPPE MARMILLOT HAS BEEN
SELECTED AS NIAAA NEW DIRECTOR
OF OFFICE OF EXTRAMURAL
ACTIVITIES, HE SERVED AS ACTING
DIRECTOR PRIOR TO APPOINTMENT.
HE WILL PROVIDE OVERSIGHT OVER
NIAAA'S GRANTS MANAGEMENT, PEER
REVIEW, COMMITTEE MANAGEMENT
ACTIVITIES, INCLUDING EXECUTIVE
SECRETARY OF THE NIAAA ADVISORY
COUNCIL, WHICH HE'S OBVIOUSLY
DOING TODAY.
HE WILL SERVE ALSO AS REFERRAL
OFFICER AND RESEARCH INTEGRITY
OFFICER FOR INSTITUTE.
DR. MARMILLOT JOINT NIAAA IN
2007 AS A SCIENTIFIC REVIEW
OFFICERS.
SO, WE'RE PLEASED PHILIPPE WAS
WILLING TO TAKE THIS ON, AND HE
MANAGED TO SURVIVE BEING AN
ACTING DIRECTOR FOR I THINK
ABOUT A YEAR, AND SO I HOPE YOU
WILL WELCOME PHILIPPE TO HIS NEW
JOB AND BE PATIENT WITH US ALL.
AS IT TURNS OUT THIS IS A REALLY
TOUGH JOB BECAUSE YOU HAVE TO
MONITOR ALL THE CHANGES THAT ARE
COMING FROM BUILDING 1, AND
INTEGRATE THEM WITH ALL THE
CHANGES WE WANT TO EFFECT FROM
OUR END.
KEEP THAT IN MIND.
I WANTED TO ALSO HIGHLIGHT A NEW
COMMON FUND PROGRAM TO SUPPORT
CLINICAL RESEARCH IN PRIMARY
CARE SETTINGS.
THIS IS THE -- ONE OF THE
PROGRAMS THAT OUR NEW DIRECTOR,
DR. MONICA BERTAGNOLLI, IS
REALLY, REALLY, REALLY EXCITED
ABOUT HEALTH ABOUT.
THE HEALTH IS DECLINING,
STEEPEST AMONG UNDERSERVED AND
UNDERREPRESENTED POPULATIONS.
NIH SEEKS TO IMPROVE HEALTH
OUTCOMES IN RESEARCH, EQUITY, BY
ESTABLISHING A PRIMARY CARE
FOCUSED CLINICAL RESEARCH
NETWORK THAT IS DISEASE
AGNOSTIC, FACILITATING CLINICAL
RESEARCH IN MISSION AREAS,
INTEGRATED RESEARCH WITH
CLINICAL CARE IN REAL WORLD
SETTINGS CREATING FOUNDATION FOR
SUSTAINED ENGAGEMENT WITH
COMMUNITIES UNDERREPRESENTED IN
CLINICAL RESEARCH.
THERE'S A TIMELINE HERE OF
GATHERING FEEDBACK AND
INFORMATION, WHICH IS WHAT WE'RE
DOING CURRENTLY, AND A QUICK
LAUNCH SOMETIME IN 2024 ACTUALLY
I BELIEVE IT'S GOING TO BE JUNE
7, SO IT'S REALLY QUICK.
AND THEN TO EXPAND IT IN 2025
AND BEYOND.
NIH ANTICIPATES PROVIDING $5
MILLION IN FISCAL YEAR 2024 AND
$25 MILLION IN 2025 FOR THE
COMMON FUND PROGRAM.
FOLLOWING THE INITIAL FUNDING
THE BUDGET IS PROJECTED TO
INCREASE TO 50 TO 100 MILLION
PER YEAR AFTER ASSESSING
FEASIBILITY AND BUDGET
REQUIREMENTS.
IT'S AN INNOVATIVE IDEA.
THE PART FOR ME THAT'S REALLY
IMPORTANT IS IN REAL WORLD
SETTINGS AND THE FACT THAT IF WE
CAN -- IF THEY CAN PULL THIS
OFF, PRIMARY CARE SETTINGS WILL
BECOME A SOURCE OF CLINICAL
STUDY.
AND IT'S NOT GOING TO BE JUST
TESTING THE LATEST ASPIRIN ON
PATIENTS.
IT WILL BE CLINICAL STUDIES THAT
INVOLVE EVERYTHING FROM
PREVENTION, INTERVENTIONS, TO
NEW BEHAVIORAL TREATMENTS TO NEW
TELEHEALTH SO THAT
OPPORTUNITIES, SO I REALLY THINK
THAT I'M EXCITED ABOUT IT AND I
HOPE IT WILL PAY OFF WITH US,
AND WHEN WE HAVE OUR DISCUSSION
LATER TODAY ABOUT SOME OF THE
THINGS I LISTED, YOU THINK ABOUT
THIS IN CONTEXT OF ALCOHOL USE
DISORDER AS FIFTH VITAL SIGN.
I WANTED TO ALSO UPDATE YOU ON
THE WHITE HOUSE INITIATIVE ON
WOMEN'S HEALTH RESEARCH.
NOVEMBER 2023 THE WHITE HOUSE
ANNOUNCED A NEW INITIATIVE TO
GALVANIZE FEDERAL GOVERNMENT TO
CLOSE RESEARCH GAPS AND IMPROVE
WOMEN'S HEALTH, PART OF THIS
INITIATIVE MARCH 18 PRESIDENT
BIDEN ANNOUNCED EXECUTIVE ORDER
FOCUSED ON THE FOLLOWING KEY
AREAS.
PRIORITIZING INVESTMENTS IN
WOMEN'S HEALTH RESEARCH,
STIMULATING NEW RESEARCH ON
WOMEN'S MID-LIFE HEALTH,
DEVELOPING AND STRENGTHENING
RESEARCH AND DATA STANDARDS
THANE HANS -- THAT ENHANCE
WOMEN'S HEALTH, ASSESSING NEEDS
IN RESEARCH, INTEGRATING HEALTH
ACROSS THE FEDERAL RESEARCH
PORTFOLIO.
WE-- THERE ARE A NUMBER OF NEW
NOSIs OUT ON WOMEN'S HEALTH
RESEARCH SO IN COORDINATION WITH
THE WHITE HOUSE INITIATIVE ON
WOMEN'S HEALTH RESEARCH NIH
ISSUED A NOSI TO HIGHLIGHT OUR
INTEREST IN APPLICATIONS FOCUSED
ON DISEASES AND HEALTH
CONDITIONS THAT AFFECT WOMEN AND
ARE FEMALE SPECIFIC.
ALL NIH INSTITUTES AND CENTERS
ARE PARTICIPATING.
OUR SPECIFIC AREAS OF INTEREST
THAT WE SET UP ARE RESEARCH
FOCUSED ON MENTAL HEALTH OF
WOMEN INCLUDING ALCOHOL AND
OTHER SUBSTANCE USE DISORDERS,
RESEARCH ON HEALTH ISSUES THAT
AFFECT YOUNG WOMEN, INCLUDING
ETIOLOGY, PREVENTION, AND
TREATMENT OF ALCOHOL MISUSE, AND
NOTE ALCOHOL MISUSE AMONG
CERTAIN SUBPOPULATIONS, YOUNG
WOMEN IN PARTICULAR, INCREASE
AND EXCEEDS MALE COUNTERPARTS
FOR THE FIRST TIME AND INCREASES
WOMEN'S RISK FOR ALCOHOL-RELATED
POTENTIAL APPROACHESSOLOGY IN
ALL AGE GROUPS COMPARED TO YOUNG
MEN.
WHEN I TALK AT CRAN TOMORROW,
OUR JOINT MEETING WITH NIDA AND
NCI, I'LL PROBABLY SHOW A SLIDE
ON THIS ISSUE.
AND IN RESEARCH TO UNDERSTAND
THE MECHANISMS THROUGH WHICH
ENVIRONMENTAL FACTORS INFLUENCE
RESILIENCE AND DISEASE AMONG
WOMEN ACROSS THE LIFESPAN.
ONE OF OUR BIG FUNDING
OPPORTUNITIES THAT WE'RE REALLY
PROUD OF IS THE MODEL CONTINUUMS
OF CARE INITIATIVE TO ADVANCE
HEALTH EQUITY AND END HEALTH
DISPARITIES AMONG WOMEN AND
GIRLS IN RACIAL, ETHNIC,
MINORITY COMMUNITIES, THIS WILL
SUPPORT THE PLANNING PHASE OF
THE MODELS OF CONTINUUM OF CARE,
GOAL REDUCE PREVALENCE AND
IMPACT OF MULTI-MORBIDITY AMONG
RACIAL, ETHNIC MINORITY WOMEN
AND GIRLS OF REPRODUCTIVE AGE
WHO ARE AT RISK OF AND LIVING
WITH MENTAL HEALTH DISORDERS,
SUBSTANCE USE DISORDERS, COMMON
OCCURRING PHYSICAL CONDITIONS.
USING IMPLEMENTATION AND
DISSEMINATION SCIENCE, THE
INITIATIVE PROPOSES A CONTINUUM
OF CARE APPROACH THAT INTEGRATES
PREVENTIVE HEALTH SERVICES,
PRIMARY CARE, BEHAVIORAL HEALTH,
INTEGRATIVE CARE, CARDIO PULL
CARDIOPULMONARY, ENDOCRINE,
ANYONE WANTING TO HELP PROMOTE
THIS AS AMBASSADORS, CONTACT
DEIDRA ROACH, WORKING ON THIS
NOW FOR SEVERAL YEARS BUT WE'RE
OFF AND RUNNING AT THIS POINT.
WE ALSO HAVE NOTICES OF INTEREST
TO PUBLISH A FUNDING
OPPORTUNITY, NOTICE OF INTENT TO
PUBLISH FUNDING OPPORTUNITY FOR
SPECIALIZED ALCOHOL RESEARCH
CENTERS, P50, AND COMPREHENSIVE
P 60s, OVERARCHING GOAL OF THE
FORTHCOMING NIAAA NOTICES OF
FUNDING OPPORTUNITIES TO SUPPORT
A BROAD-BASED ALCOHOL RESEARCH
CENTERS PROGRAM TO FOSTER AND
CONDUCT INTERDISCIPLINARY
COLLABORATIVE RESEARCH ON
ALCOHOL USE DISORDER, ALCOHOL
MISUSE, AND ALCOHOL-RELATED
PROBLEMS AND OTHER
HEALTH-RELATED CONSEQUENCES
ACROSS THE LIFESPAN.
P60 INVOLVES A PUBLIC COMPONENT,
INTERACTION WITH THE COMMUNITY.
WE'VE HAD THIS CENTERS PROGRAM
SINCE 1977, BECAUSE I WAS PART
OF THE ORIGINAL SUBMISSION FROM
WHAT AT THE TIME WAS OUR
LABORATORY AT THE SALK INSTITUTE
LED BY FLOYD BLOOM, YOU COULD
WELL ASK WHY IT'S STILL AROUND,
AND THE REASON IS BECAUSE I FEEL
THE CENTER'S PROGRAM PROVIDES A
SEED AND GIVEN LOCALE AND GIVEN
DOMAIN OF FUNCTION, OR
DYSFUNCTION, IF THE CASE MAY BE,
AND SO BECAUSE WE STARTED IN
1977 WITH THE BUDGET OF $2
MILLION TOTAL COST, AND STILL
HAVE A BUDGET OF $2 MILLION IN
TOTAL COST IN 2024, WHICH IS 47
YEARS LATER, SOMETHING LIKE
THAT, IF I'VE ADDED CORRECTLY,
AND SO, YOU KNOW, WE'VE -- THE
ONE CHANGE I'VE MADE SINCE I
BECAME DIRECTOR IS TO FOCUS EACH
CENTER ON A GIVEN DOMAIN OF
ACTIVITY, COULD BE MICROBIOME,
CENTRAL NERVOUS SYSTEM, CRAVING,
COULD BE SOME PART OF
INTERVENTION PREVENTION.
SO, YOU KNOW, WE STILL HAVE OURS
CENTERS PROGRAM AND I INTEND TO
KEEP DOING IT IN THIS FASHION.
WE HAVE A REQUEST FOR
INFORMATION ON INNOVATIVE
NON-INVASIVE BIOSENSING
TECHNOLOGIES WITH HIGH ACCURACY
AND HIGH RESOLUTION DETECTION OF
BLOOD ALCOHOL LEVELS.
SO, WE DID THIS ONE IN
COLLABORATION WITH NATIONAL
INSTITUTE OF BIOMEDICAL IMAGING
AND BIOENGINEERING, WE'RE
SEEKING INFORMATION AND SOUGHT
INFORMATION ON CUTTING-EDGE
BIOSENSING TECHNOLOGIES TO
ACCELERATE DEVELOPMENT OF A
NON-INVASIVE INCONSPICUOUS
ALCOHOL BIOSENSORS THAT DETECTS
CONCENTRATION WAS HIGH ACCURACY
IN REAL TIME.
NANCY BARNETT IS STILL WORKING
WITH THE CURRENT ONES OUT THERE,
BUT WE WERE -- WE FOCUSED THIS
PARTICULAR RFI ON INFRARED
TECHNOLOGY AND WE'LL SEE WHAT
COMES IN.
AND THEN WE ARE ADVANCING
DIVERSITY, EQUITY, INCLUSION,
AND ACCESSIBILITY IN RESEARCH BY
PARTICIPATING IN MULTIPLE
FUNDING OPPORTUNITIES TO
INCREASE RESEARCH ON HEALTH
DISPARITIES.
ONE IS TRANSFORMATIVE RESEARCH
TO ADDRESS HEALTH DISPARITIES
AND ADVANCE HEALTH EQUITY, WHICH
IS A U01 CLINICAL TRIAL OPTIONAL
AND NIH BLUEPRINT IN BRAIN
INITIATIVE, ADVANCEMENT IN
NEUROSCIENCE AWARD KNOWN AS
F99/K00, CLINICAL TRIALS NOT
ALLOWED, THIS IS REALLY AN
EXCELLENT PROGRAM.
IT'S REALLY BEEN SUCCESSFUL AND
FOR ANY OF YOU INTERESTED IN
THIS, TAKE A LOOK AT IT ON THE
BRAIN WEBSITE.
AS MANY OF YOU KNOW, THE BRAIN
HAS STEPPED FORWARD IN A NUMBER
OF AREAS IN DIVERSITY, AND WE
TRY TO FOLLOW IN LOCK-STEP AT
NIAAA.
AND REQUEST FOR INFORMATION WAS
IMPROVING RESEARCH FRAMEWORKS TO
ENABLE RIGOROUS STUDY OF THE
EFFECTS OF RACISM ON BRAIN AND
BEHAVIORAL HEALTH ACROSS THE
LIFESPAN.
WE JOINED NIMH, NIDA, NIMHD,
ACKNOWLEDGING KNOWLEDGE GAPS AND
INTACT OF STRUCTURAL RACISM ON
BRAIN, COGNITIVE AND BEHAVIORAL
FUNCTION ACROSS THE LIFESPAN AND
ROLE OF STRUCTURAL SYSTEMIC
RACISM ON THE CONDUCT OF BRAIN
AND BEHAVIORAL RESEARCH.
SO THESE ARE OUT THERE.
AND I'M PROUD TO TELL YOU THAT
THE NEW NIAAA STRATEGIC PLAN
FISCAL YEARS 2024-2028 ADVANCING
ALCOHOL RESEARCH TO PROMOTE
WHOLE PERSON HEALTH AND
WELL-BEING, IS NOW LIVE ON THE
NIAAA WEBSITE.
AND I THINK BRIDGET
WILLIAMS-SIMMONS AND HER TEAM
DESERVE A ROUND OF APPLAUSE FOR
THIS ONE.
THIS WAS A LOT OF WORK.
SO THE PLAN CHARTS A COURSE FOR
RESEARCH OVER THE NEXT FIVE
YEARS, A LIVING DOCUMENT, WE
WELCOME YOUR FEEDBACK.
THANK YOU TO ALL NIAAA STAFF WHO
CONTRIBUTED TO THE STRATEGIC
PLAN CONTENT AND REVIEW, SPECIAL
THANKS TO THE STRATEGIC PLAN
TEAM.
THAT'S KARA, LAURA, LAURA,
BRIDGIT, AND RACHEL.
I CALL THIS THE FUTURE IS NOW
SLIDE.
THE PLAN SEEKS TO ADVANCE MANY
LONG HELD TRAINING PRIORITIES,
BUT I'M GOING TO HIGHLIGHT KEY
AREAS AND THEY GO AS FOLLOWING.
DIVERSITY, EQUITY, INCLUSION,
AND ACCESSIBILITY IN THE ALCOHOL
RESEARCH ENTERPRISE, WOMEN'S
HEALTH RESEARCH, WHOLE PERSON
HEALTH AND INTEGRATED HEALTH
APPROACHES, DATA SCIENCE,
ARTIFICIAL INTELLIGENCE AND DATA
MANAGEMENT, TRANSLATION AND BACK
TRANSLATION OF RESEARCH
FINDINGS, SOCIAL DETERMINANTS OF
HEALTH IN THE CONTEXT OF RISK
AND RESILIENCE, SOCIAL MEDIA
IMPACT ON ALCOHOL-RELATED
BEHAVIORS AND OUTCOMES, AND
SOCIAL MEDIA AS A TOOL FOR
INNOVATING INTERVENTIONS.
BRIDGIT, YOU'RE GOING TO GIVE A
BRIEF TALK ABOUT THIS?
NO, YOU'RE NOT?
I JUST DID IT?
OH, ALL RIGHT.
ALL RIGHT.
HOW DID YOU GET OUT OF THAT,
BRIDGIT?
SO WHAT'S AHEAD?
WE HAVE A PUBLIC MEETING OF THE
INTERAGENCY COORDINATING
COMMITTEE ON MAY 9, THIS WEEK,
AND THE ICCFASD FOSTERS IMPROVED
COMMUNICATION, COOPERATION,
COLLABORATION AMONG DISCIPLINES
AND FEDERAL AGENCIES THAT
ADDRESS ISSUES RELATED TO
PRENATAL ALCOHOL EXPOSURE.
IT WILL BE HERE IN PERSON, AND
ALSO ACCESSIBLE ONLINE BY
VIDEOCAST.
AND I MIGHT ADD JUST AS AN
ASIDE, WE'RE DOING A LOT OF
THESE HYBRID OR AT LEAST BEING
AVAILABLE ONLINE BY VIDEOCAST IN
OUR MEETINGS, EVEN OUR
SEMINARRERS IS.
MORE AND MORE PEOPLE ARE
ATTENDING THESE EVENTS LIVE BUT
IT DOES ALLOW FOR WHOLE HERDS OF
REASONS FOR PEOPLE WHO CAN'T
MAKE IT LIVE TO ACCESS THESE
MEETINGS, SO I FIND IT VERY
VALUABLE.
I MEAN, WHEN I GO TO WHEREVER
AND DO A GRAND ROUNDS, THERE'S
SOMETIMES 40, 60 PEOPLE IN THE
ROOM, AND MAYBE 100 OR MORE WHO
ARE ONLINE LISTENING TO THE
GRAND ROUNDS.
I MEAN, IT'S THE WAY THINGS ARE
BEING DONE THESE DAYS AND I'M
ASSUMING YOU ALL EXPERIENCE IT
AS WELL.
ALL RIGHT.
NOW WE ENTER THE KOOB JOURNAL
CLUB.
I ALWAYS PICK WITH THE HELP OF
STAFF, THE DIVISION DIRECTORS
AND ALL THEIR STAFF FEED ME
ARTICLES THEY THINK ARE QUITE
SALIENT FROM THE PREVIOUS FEW
MONTHS.
AND I'VE BEEN TRYING TO PICK A
THEME.
TODAY'S THEME IS HUMAN STUDIES
OF ALCOHOL MISUSE AS A
WHOLE-BODY DISORDER.
SO THE FIRST ONE I'M GOING TO
HIGHLIGHT IS ACTUALLY A CLINICAL
TRIAL THAT WAS RUN BY THE
ALCOHOL HEPATITIS NETWORK THAT
WE FUND AS A U MECHANISM.
SO, AS MANY OF YOU KNOW, SEVERE
ALCOHOL-ASSOCIATED HEPATITIS IS
ASSOCIATED WITH HIGH SHORT-TERM
MORTALITY.
SO, PREDNISONE IS STANDARD OF
CARE FOR TREATING SEVERE
ALCOHOL-ASSOCIATED HEPATITIS,
AND THERE WERE A NUMBER OF
STUDIES PRE-CLINICALLY THAT
SHOWED THAT ELEVATING
CIRCULATING CYTOKINE LEVELS, LOW
ZINC LEVELS, DISRUPTED GUT
MUCOSAL BARRIER ARE OBSERVED IN
PATIENTS WITH SEVERE
ALCOHOL-ASSOCIATED HEPATITIS,
AND IN ANIMAL MODELS, SO BOTH
CLINICAL AND PRE-CLINICAL
STUDIES.
IN PREVIOUS STUDIES, ANAKINRA,
DID I GET IT RIGHT, KATHY?
ANAKINRA, WHICH IS AN IL-1
RECEPTOR ANTAGONIST WITH
ANTI-INFLAMMATORY PROPERTIES,
WAS ASSOCIATED WITH REDUCTION IN
ALCOHOL-INDUCED HEPATIC KETOSIS,
PARTICULARLY IN PRE-CLINICAL
MODEL OF ALCOHOL-ASSOCIATED
HEPATITIS.
BUT ALSO IN PATIENTS WITH SEVERE
ALCOHOL-ASSOCIATED HEPATITIS.
THEY ADDED ZINC BECAUSE IT SEEMS
TO FACILITATE GUT INTEGRITY, AND
SO THIS WAS A DOUBLE BLIND
PLACEBO CONTROLLED PHASE 2
TRIAL, AND IT WAS CONDUCTED TO
COMPARE STANDARD OF CARE OF
PREDNISONE WITH THIS ANAKINRA
AND ZINC.
WHICH I'M GOING TO CALL FROM NOW
ON, BECAUSE I CAN'T PRONOUNCE
IT, AS AN IL-1 ANTAGONIST AND
ZINC.
SO, THE RANDOMIZED TRIAL WAS
STOPPED EARLY AFTER A
PRE-SPECIFIED INTERIM ANALYSIS
SHOWED PREDNISONE WHICH WAS
SUPPOSED TO BE THE CONTROL WAS
ASSOCIATED WITH HIGHER 90-DAY
OVERALL SURVIVAL, 90% VERSUS
70%, AND TRANSPLANT-FREE
SURVIVAL 88 VERSUS 64% COMPARED
TO IL-1 ANTAGONIST AND ZINC.
YOU COULD WELL ASK, HOW DID THIS
COME ABOUT?
WELL, THEY DID AN INTERIM
ANALYSIS WHEN THEY HAD HALF OF
THE -- IT WAS PRE-SPECIFIED WHEN
50% OF THE PATIENTS COMPLETED
THE DESIGNATED FOLLOW-UP, THEN
THEY STOPPED THE TRIAL BECAUSE
THEY HAD BEEN DOING WHAT THEY
CALL ALLELE 7-DAY STOP, SO
ALLELE SCORE IS BASICALLY
MEASURING YOUR BILIRUBIN LEVELS,
AND BILIRUBIN IS INVOLVED,
YOU'RE GOING TO BE AMAZED WHAT
I'VE LEARNED.
BILIRUBIN IS INVOLVED IN THE
DESTRUCTION OF -- RESULTS FROM
DESTRUCTION OF BLOOD VESSELS AND
ABNORMAL BLOOD CELLS, SO WHEN
THERE'S AN INCREASE IN BILIRUBIN
IT CAN LEAD TO JAUNDICE AND YOU
TURN KIND OF YELLOW, AND SO WHEN
HAVE YOU ALLELE SCORE .45,
GREATER THAN .45, THEY STOP THE
TREATMENT.
AND WHY IS THIS IMPORTANT?
WELL, WHEN YOU LOOK AT THESE
CURVES YOU SEE PREDNISONE WAS
WORKING AT 90% LEVEL, IF YOU GO
OUT EVEN 180 DAYS PREDNISONE HAD
AN 81% SURVIVAL RATE, WHERE THE
IL-1 ANTAGONIST HAD LESS THAN
70% SURVIVAL RATE.
THE REAL TAKEHOME MESSAGE FROM
THIS IS THAT TAILORS THE
DURATION OF GLUCOCORTICOID
THERAPY USING DAY 7 ALLELE SCORE
MAY BE EFFECTIVE STRATEGY FOR
PROMOTING 90-DAY SURVIVAL IN
INDIVIDUALS WITH SEVERE ALCOHOL
HEPATITIS.
AND I THINK THIS IS IMPORTANT
BECAUSE IT MAY MEAN THAT LESS
PREDNISONE IS BETTER THAN MORE,
CHRONIC ADMINISTRATION OF
PREDNISONE IS BACKFIRING IN THE
TREATMENT OF SEVERE
ALCOHOL-ASSOCIATED HEPATITIS.
IT WAS A NEGATIVE TRIAL AND IT'S
A VERY DIFFICULT PAPER TO
DISSECT BECAUSE IF YOU THINK THE
NEUROBIOLOGISTS LIKE ACRONYMS,
TRY THE LIVER DOCS.
BUT I THINK IT'S IMPORTANT, AN
IMPORTANT OBSERVATION.
I'LL FOLLOW WITH THE SECOND
STUDY, WHICH IS IN A SENSE A
COUSIN OF THE FIRST STUDY, IN A
DIFFERENT WAY.
THE N HERE IS VERY SMALL, WHEN
WE GET DOWN TO THE FINAL
ANALYSIS, THIS WAS A STUDY BY --
WELL, I DID MENTION THAT THERE
WAS THE STUDY WAS FROM THE --
PREVIOUS STUDY FROM ALCOHOL
NETWORK, THIS IS HARDETY CENTER,
UNIVERSITY OF LOUISVILLE, ANDREW
STOKES IS PART OF THIS.
THESE ARE THE PEOPLE I
RECOGNIZE.
IN ANY EVENT, THIS STUDY SHOWED
CHANGES IN LIVER PROTEINS THAT
WERE ASSOCIATED WITH
GLUCOCORTICOID RESPONSIVENESS,
MORTALITY, ALCOHOL-ASSOCIATED
HEPATITIS, APPROXIMATELY 40% OF
PATIENTS WITH ALCOHOL-ASSOCIATED
HEPATITIS DO NOT RESPOND TO
GLUCOCORTICOIDS.
I SHOWED YOU 90% RESPONDED.
IN THIS PARTICULAR STUDY THE
RESEARCHERS ANALYZED PROTEOMES
FROM SAMPLES FROM PATIENTS WITH
ALCOHOL-ASSOCIATED HEPATITIS
BEFORE TREATMENT IN TWO GROUPS.
ALCOHOL-ASSOCIATED HEPATITIS
SUBJECTS WHO RESPONDED TO
GLUCOCORTICOIDS, AND
NON-RESPONDERS.
THE NON-RESPONDERS, THIS IS
IMPORTANT, THE NON-RESPONDERS
WERE DIVIDED INTO SURVIVORS FOR
24 WEEKS, AND NON-SURVIVORS, A
SMALL N BUT FIRST OF ALL THEY
FOUND SEVERAL POTENTIAL
GLUCOCORTICOID MECHANISMS
CONTRIBUTED TO LACK OF RESPONSE
TO THE STEROIDS.
AND, YOU KNOW, THAT WAS ONE MAIN
FINDING IN THE STUDY.
BUT WHEN THEY DID AN ANALYSIS OF
THE DIFFERENTIALLY EXPRESSED
PROTEINS IN TREATMENT,
NON-RESPONDERS WHO SURVIVED 24
WEEKS RELATIVE TO NON-SURVIVORS
REVEALED SEVERAL PROTEIN
EXPRESSION CHANGES, INCLUDING
INCREASED LEVELS OF THE ACUTE
PHASE PROTEIN, ELEVATED
COAGULATION FACTORS, AND REDUCED
MASS CELL MARKERS.
BASICALLY DID LIVER BIOPSIES,
AND THEY WERE ABLE TO MEASURE IN
THE LIVER THESE DIFFERENT
PROTEINS BY LC/MS, LIQUID
CHROMATOGRAPHY MASS SPEC TROUGH
SCOPEY, YOU CAN SEE DECREASE IN
NON-SURVIVORS.
AND FROM THE SURVIVORS.
AND THIS IS -- THESE APP
PROTEINS ARE BASICALLY
ANTI-INFLAMMATORY SO YOU'RE
LOSING SOME ANTI-INFLAMMATORY
PROTECTION IN THE LIVER.
AND THEN ON THE CONVERSELY THE
MAST CELL MARKERS ARE INCREASED,
MAST CELLS ARE ASSOCIATED WITH
RELEASE OF CYTOKINES, THE BAD
GUYS.
YOU LOSE GOOD GUYS AND GAIN BAD
GUISE IN THE NON-SURVIVORS.
THIS STUDY IDENTIFIED POTENTIAL
MECHANISMS CONTRIBUTING TO LACK
OF STEROID RESPONSES, IN ALCOHOL
HEPATITIS AND APPROACHING
LANDSCAPE THAT MAY INFLUENCE
ALCOHOL HEPATITIS NON-RESPONSE
MORTALITY.
SO I'M SORRY TO REGALE YOU WITH
TWO PAPERS OF PEOPLE DYING FROM
LIVER DISEASE BUT THE FACT IS
WE'RE GETTING CLOSER TO BEING
ABLE TO IDENTIFY AT LEAST WITH
STANDARD OF CARE WHO IS GOING TO
RESPOND, WHO IS NOT GOING TO
RESPOND, AND MAYBE EVEN A NOVEL
WAY OF PROVIDING STANDARD OF
CARE FROM A NEGATIVE STUDY AT
NIAAA.
SO FOOD FOR THOUGHT.
ANOTHER STEROID PAPER THAT I
FOUND QUITE INTRIGUING FOR A
NUMBER OF REASONS, ONE IS WHICH
I'VE ACTUALLY WORKED IN THIS
AREA, BUT THIS ONE FOUND OUR
CORTISOL MARKER THAT WAS HIGHER
IN STRESS-RELATED BRAIN REGIONS
IN INDIVIDUALS WITH ALCOHOL USE
DISORDER.
SO, CHRONIC ALCOHOL USE IS
ASSOCIATED WITH DYSREGULATED
HYPO FLAMMIC PULMONARY THY TEAR
STRESS.
THERE'S ELEVATED TONIC LEVELS OF
CORTISOL IN HUMANS, WE KNOW
THERE'S BLUNTED RESPONSE BECAUSE
OF FEEDBACK TO THE PITUITARY
ADRENAL RESPONSE, BLUNT HPA
ACCESS FROM FURTHER RESPONDING.
THERE'S A SENSITIZATION AT THE
SAME TIME, INCREASE IN
GLUCOCORTICOID RECEPTORS IN THE
BRAIN, AND PARTICULARLY IN THE
AREAS OF THE BRAIN THAT DRIVER
RELEASING FACTOR, A STRESS
NEUROPEPTIDE.
RESEARCHERS IN THIS STUDY, YALE
UNIVERSITY, AND McGEE AND
COSGROVE GROUPS.
USED RADIOTRACER AND PET BRAIN
IMAGING TO MEASURE LEVELS OF 11
BETA HYDROXY STEROID
DEHYDROGENASE TYPE 1, CORTISOL
EGENERATING ENZYME, THIS
CONVERTS CORTISONE,
KORTECOSTERONE, HUMANS DON'T
RESPOND AS WELL AS CORTISOL.
AND CORTECOSTERONE, IF YOU WORK
YOUR WAY BACK, IS DERIVED FROM
CHOLESTEROL.
FINDINGS INDICATE THAT THOSE
WITH AUD HAD HIGHER BRAIN
AVAILABILITY OF THIS ENZYME IN
PREFRONTAL AND LIMBIC REGIONS
COMPARED TO UNAFFECTED
INDIVIDUALS.
IN ADDITION, HIGHER ENZYME
AVAILABILITY WAS ASSOCIATED WITH
DRINKS PER WEEK, QUANTITY PER
EPISODE AND AUD SEVERITY.
CENTRAL NERVOUS SYSTEM
GLUCOCORTICOID ACTIVITY IS
INCREASED IN INDIVIDUALS WITH
AUD IN ADDITION TO
DYSREGULATION, AND PROVIDE
INSIGHT IN DYSFUNCTION
ASSOCIATED WITH AUD.
THE BRAIN REGIONS WHERE THEY SAW
THESE, RED IS AUD HERE, THESE
INCREASES WERE ALL THE ONES I,
YOU KNOW, LOVE BEST AND
INCLUDING AMYGDALA AND
ACCUMBENS -- I'M SORRY, ANTERIOR
CINGULATE, I WANT YOU TO KNOW
VENTRAL MEDIAL PRE-FRONT CORTEX
CONTROLS STRESS RESPONSE IN THE
AMYGDALA, OFTEN A DAMP OTHER
STRESS RESPONSE, OFTEN A REGION
ALSO COMPROMISED IN
POSTTRAUMATIC STRESS DISORDER,
JUST FOR THE RECORD.
SO, ANOTHER INTRIGUING STUDY
ABOUT CORTISOL, AND I THOUGHT
THE THREE OF THESE TOGETHER WERE
PRETTY COMPELLING STORY FOR
TODAY.
AND THEN THIS ONE IS TO REMIND
US THAT WE DO HAVE THREE
FDA-APPROVED MEDICATIONS FOR
TREATMENT OF ALCOHOL USE
DISORDER.
THEY ARE EFFECTIVE.
AND AS MANY OF YOU HEARD ME SAY
BEFORE, THEY ARE AS ON AS IF
EFFECTIVE FOR ANY DISORDER.
RESEARCHERS INVESTIGATED
POSSIBLE MOLECULAR MECHANISMS
ASSOCIATED WITH ALCOHOL CRAVING,
AND THEY SUPERIMPOSED IN THIS
STUDY AS A KIND OF VALIDATION,
ANTI-CRAVING ALCOHOL USE
DISORDER, USED iPSC ASTROCYTE
CELL MODEL WITH RNA SEQUENCING.
SO, iPSCs ARE INDUCED
PLURIPOTENT STEM CELLS, THEY GOT
THE CELLS THEY TOOK FROM THE
BLOOD, PERIPHERAL BLOOD MONO
NUCLEAR CELLS, AND LET DAVID
GOLDMAN EXPLAIN THIS TO YOU IN
MORE DETAIL BUT CONVERTED THEM
TO ASTROCYTES USING IN VITRO
PROCEDURE.
AND THEN THEY MEASURED THESE
TRANSCRIPTION FACTOR INTERFERON
REGULATORY FACTOR.
IT ACTIVATES INTERFERONS ALPHA
AND BETA.
IT RESPONDS TO VIRAL INFECTION.
AND IT'S ACTIVATED BY TOLL LIKE
RECEPTORS WHICH MEANS IT'S A KEY
PART OF THE INNATE IMMUNE
SYSTEM.
SO, ACTIVATION OF THIS
TRANSCRIPTION FACTOR WAS
ASSOCIATED WITH ALCOHOL-INDUCED
-- WHAT'S IT CALLED?
E.R. STRESS.
I'M BLOCKENING ON E.R.
ENDOPLASMIC RETICULAR STRESS.
IT'S A MOLECULAR KIND OF STRESS
RESPONSE INTRACELLULARLY, AND
WHICH COULD BE ATTENUATED WITH
ANTI-CRAVING MEDICATION.
SO, IF YOU LOOK IN THE SLIDES
YOU SEE NALTREXONE INTERACTS
WITH THIS E.R. STRESS, THE
ALCOHOL CAUSES E.R. STRESS AND
YOU'LL SEE FROM THE SLIDES BELOW
THAT SINCE THEY HAVE TWO
DIFFERENT MECHANISMS OF ACTION
REDUCE EXPRESSION OF THE E.R.
STRESS.
LEFT-HAND PANEL.
AND ALCOHOL INDUCED IRF 3
BINDING TO GENES WAS DECREASED
IN PRESENCE OF THESE TWO
MEDICATIONS.
ALTOGETHER ACTIVATION OF
TRANSCRIPTION FACTOR IRF 3 WAS
ASSOCIATED WITH ALCOHOL INDUCED
E.R. STRESS WHICH COULD BE
ATTENUATED BY THE ANTI-CRAVING
MEDICATION.
IRF 3 REGULATION OF GENES
ASSOCIATED WITH ALCOHOL CRAVING
WERE IMMUNE RELATED PATHWAYS AS
I DESCRIBED, SUGGESTING POSSIBLE
RELATIONSHIP BETWEEN CRAVING AND
INFLAMMATION, SUGGESTING E.R.
STRESS ATTENUATION MIGHT BE A
TARGET FOR ANTI-CRAVING
MEDICATION.
MIGHT BE A SCREEN POSSIBLY FOR
SOME MEDICATIONS, WE DON'T KNOW
YET.
THIS IS FROM THE MAYO CLINIC,
DR. HO AND THE WEINSTHIBOUM
TEAM.
USING iPSC SELLS, SMALL N, AND
DOES SUGGEST THE POSSIBILITY
THAT WE WILL BE ABLE TO DO
SOMETHING, I KNOW RAY HAS ALWAYS
WANTED TO DO, WHICH IS HAVE A
MOLECULAR SCREEN FOR MEDICATIONS
THAT MIGHT ACTUALLY WORK.
SO, ONWARD AND UPWARD.
AND FINALLY, I'M GOING TO END ON
A LESS INTENSE MOLECULAR STUDY
WHICH IS ABOUT THE SOBER CURIOUS
PARTICIPATION, AND KNOWN AS
TACK, DRY JANUARY, SOBER
OCTOBER.
PARTICIPATION IN THE TWO
ACTIVITIES CORRELATED WITH
GREATER SUBSTANCE USE TREATMENT,
AND WITH MORE MOTIVATION TO QUIT
ALCOHOL IN EMERGING ADULTS.
SO RESEARCHERS EXAMINED
FAMILIARITY WITH THE SOBER
CURIOUS MOVEMENT AND
PARTICIPATION IN TEMPORARY
ALCOHOL ABSTINENCE CHALLENGES IN
U.S. EMERGING ADULTS.
THESE WHY YOUNG ADULTS 18-29.
THOSE WHO PARTICIPATED IN THE
CHALLENGES OR WERE AWARE OF
SOBER CURIOUS WERE MORE LIKELY
TO REPORT HEAVY DRINKING IN THE
PAST MONTH, HIGHER AUDIT-C
SCORES CIRCLED IN RED HERE, AND
GREATER PREVALENCE OF PAST
CANNABIS USE AND GREAT HE BE
NUMBER OF PAST YEAR ALCOHOL AND
CANNABIS CONSEQUENCES, COMPARED
TO THOSE WITHOUT AWARENESS.
SO, FIRST THING HERE IS BEING
AWARE OF THAT YOU MIGHT HAVE A
PROBLEM, INCREASED THE
LIKELIHOOD YOU WOULD PARTICIPATE
IN THESE TWO MOVEMENTS.
I CALL THEM MOVEMENTS.
HOWEVER, THOSE WHO WERE AWARE OF
SOBER CURIOUS OR THE CHALLENGES
WERE ALSO MORE LIKELY TO RECEIVE
PAST-YEAR SUBSTANCE USE
TREATMENT AND WERE NOR MOTIVATED
TO QUIT BOTH ALCOHOL AND
CANNABIS.
AND PART OF THIS IS ILLUSTRATED
IN THE BOTTOM ORANGE CIRCLES,
WHICH SHOW IF THEY PARTICIPATED
THEY HAD A 33% LIKELIHOOD OF
PARTICIPATING IN TREATMENT AND
IF THEY WERE IN A CHALLENGE THE
SAME, 18 TO 6%, THE OTHER WAS
33% TO 8%.
SO, YOU KNOW, THIS SUGGESTS THAT
SOMETHING THAT WE'VE BEEN
OBSERVING WHICH IS MORE INTEREST
IN DRY JANUARY AND THE SOBER
CURIOUS MOVEMENT, PARTICULARLY
IN YOUNGER GROUPS OF INDIVIDUALS
IN THE UNITED STATES.
SO I HOPE THIS STIMULATES MORE
STUDY OF THIS KIND.
I MEAN ONE OF THE THINGS I'D
LIKE TO KNOW IS WHETHER WE
REALLY DO HAVE A METRIC OF THE
FACT THAT MORE PEOPLE ARE
PARTICIPATING.
BUT I THINK IT AS -- ONE THING
THEY WROTE IN THE PAPER AS A
CONCLUSION, IT PROVIDES A
DENORMALIZATION OF DRINKING AND
THESE PROGRAMS PROVIDE
NORMALIZATION OF NON-DRINKING,
MANY OF YOU HEARD ME SAY BEFORE,
YOU KNOW, WE'VE GOT TO GET RID
OF STIGMA, BUT THERE'S STIGMA
ALSO IN NOT DRINKING.
IT'S VERY PREVALENT.
AND SO, YOU KNOW, NEVER HOLD A
RECEPTION OR PARTY WHERE A
NON-ALCOHOL-CONTAINING BEVERAGE
IS NOT AVAILABLE.
DOUBLE NEGATIVE.
AND THEN I WANT TO END AND I
HOPE I'M NOT OVER, HOW AM I
DOING, PHILIPPE?
AM I OKAY?
OKAY.
SO, I WANT TO REMIND YOU ABOUT
OUR RESOURCES.
WE HAD A WONDERFUL MEETING WITH
THE -- ABOUT INTEGRATED CARE OF
ALCOHOL USE DISORDER AND ALCOHOL
ASSOCIATED LIVER DISEASE.
BUT I WAS UNDER THE DISTINCT
IMPRESSION THAT MANY OF THE
PEOPLE AT THAT WONDERFUL MEETING
HAD LITTLE KNOWLEDGE OF OUR
ACTUAL RESOURCES.
SO, AGAIN, I'M GOING TO CHARGE
YOU AS COUNCIL MEMBERS TO BE
AMBASSADORS AND TAKE THIS BACK
TO YOUR HOME TURFS AND MAKE THEM
AMBASSADORS FOR EVERYTHING WE
HAVE AVAILABLE.
WE REALLY ARE NOT GETTING THE
WORD OUT.
I'M SORRY, BUT WE'RE NOT.
THERE WAS ONE CHAP AT THE
MEETING WHO I SAT NEXT TO, I
WON'T SAY WHERE HE WORKED FOR,
BUT IT WAS ONE OF THE BIG HEALTH
SERVICES IN THE UNITED STATES,
HE NEVER HEARD OF ACAMPROSATE.
THE ONLY DRUG HE KNEW ABOUT WAS
NALTREXONE.
WE HAVE A WEB RESOURCE, NIAAA
FOR MIDDLE SCHOOL, INTERACTIVE
ACTIVITIES FOR PARENTS,
CAREGIVERS, TEACHERS TO
REINFORCE MESSAGES ABOUT PEER
PRESSURE AND UNDERAGE DRINKING.
ANOTHER WEB RESOURCE NIAAA FOR
TEENS, RESEARCH-BASED ONLINE
RESEARCH FOR TEENS, HIGHLIGHTING
HOW ALCOHOL AFFECTS YOUR HEALTH,
WARNING SIGNS AND SYMPTOMS,
WHERE TO GET HELP FOR
ALCOHOL-RELATED PROBLEMS.
WE HAVE RETHINKING DRINKING, I
WON'T EXPLAIN THAT.
YOU KNOW ABOUT COLLEGE-AIM.
WE HAVE ALCOHOL TREATMENT
NAVIGATOR, YOU KNOW ABOUT THAT.
AND WE HAVE THE HEALTHCARE
PROFESSIONAL CORE RESOURCE.
AND, YOU KNOW, THIS IS THE ONE
THAT I THINK IS NOT ONLY USED
FOR HEALTH CARE PROFESSIONALS,
AND I MEAN THE WHOLE GAMUT OF
HEALTH CARE PROFESSIONALS FROM,
YOU KNOW, PHARMACISTS TO
PHYSICIAN ASSISTANTS TO NURSE
PRACTITIONERS TO, YOU KNOW,
CLINICAL PSYCHOLOGISTS, TO
PRIMARY CARE DOCS, WHAT WE AIMED
AT, TO BOARD CERTIFIED ADDICTION
MEDICINE SPECIALISTS.
I DON'T THINK WE CAN PROMOTE
THIS RESOURCE LESS.
I MEAN, ANYONE WHO IS INTERESTED
IN ALCOHOL IS GOING TO FIND
THINGS IN THIS RESOURCE THAT'S
VALUABLE.
SO, THAT'S IT.
THANK YOU.
AND THANKS A LOT TO LAURA AND
DEAF INAND TRISH AND BRIDGET AND
VAN VAN FOR THE SLIDES.
I TORTURE THEM BEFORE COUNCIL,
AND IT TAKES A VILLAGE.
SO THANKS VERY MUCH.
>> IF THERE'S ANY QUESTIONS, HOW
MUCH TIME DO WE HAVE, PHILIPPE?
ANYBODY HAVE QUESTIONS OR
COMMENTS?
I'M HAPPY TO TAKE THEM NOW.
WE'RE GOING TO HAVE A BIG
DISCUSSION LATER BUT FEEL FREE.
IS THERE ANYTHING --
>> MAYBE THIS WILL COME UP IN
TERMS OF THE STRATEGIC PLANNING,
ONE PRIORITY AREA WAS
TRANSLATION AND BACK-TRANSLATION
AND RESEARCH FINDINGS.
CAN YOU SAY A LITTLE BIT MORE
ABOUT WHAT THAT MEANS?
>> YEAH, SO TRANSLATION, I
THINK, YOU KNOW, WOULD BE THE
CLASSIC WAY IS THAT YOU HAVE A
PRE-CLINICAL OBSERVATION LIKE
THAT IL-1 ANTAGONIST BLOCKS SOME
OF THE SIGNS OF KETOSIS IN THE
LIVER, AND YOU MOVE IT TO A
PHASE 1 CLINICAL TRIAL TO SEE
WHETHER, YOU KNOW, IT CAUSES ANY
PROBLEMS AND THEN YOU MOVE IT
INTO THE PHASE 2 CLINICAL TRIAL.
THAT'S FORWARD TRANSLATION.
BACK TRANSLATION WOULD BE THAT
YOU DISCOVER PREDNISONE GIVEN
FOR SHORT PERIOD OF TIME WORKS
BETTER THAN PREDNISONE FOR A
LONG PERIOD OF TIME IN HUMANS.
LIKE I SHOWED YOU IN SLIDE 1.
AND THEN YOU ARE GO BACK TO THE
RESEARCH, PRE-CLINICAL PEOPLE,
AND SAY, SHOW ME WHAT'S CHANGING
IN ONE WEEK OF TREATMENT OF
PREDNISONE THROUGH A RODENT OR
PRIMATE, OR A MONTH-LONG
TREATMENT OF PREDNISONE.
BACK TRANSLATION IS A WAY OF
GENERATING NEW INFORMATION BY
GOING BACK TO THE PRE-CLINICAL
SIDE.
AND I WAS AT A TRANSLATIONAL
NEUROSCIENCE THINK TANK WITH
THREE, FOUR OTHER NIH DIRECTORS
TWO WEEKS AGO.
AND THEY WERE FOCUSED ON MENTAL
ILLNESS IN GENERAL WITH MOSTLY
BIPOLAR AND AUTISM AND
PARKINSON'S DISEASE BUT SOME
PRINCIPLES HELD UP.
ONE THING COMING OUT OF THE
BRAIN INITIATIVE, AND I PROBABLY
CAN'T EXPLAIN THIS AS WELL AS
SHANGHAI, BUT THEY HAVE BEEN
ABLE THROUGH CELL CENSUS PROGRAM
IDENTIFY EVERY CELL AS UNIQUE
MOLECULAR ENTITY, EVERY
DIFFERENT CELL IN THE BRAIN OF A
MOUSE.
AND THE ALLEN BRAIN INSTITUTE
NOW IS TAKING THAT INFORMATION
AND THEY ARE GOING TO BE ABLE TO
EVENTUALLY IDENTIFY ALL OF THE
GENES THAT ARE INVOLVED.
AND THEN YOU'RE GOING TO BE ABLE
TO FIND SOME GENE IN HUMANS AND
BACK TRANSLATE IT TO THE MOUSE,
AND SEE WHAT NETWORKS ARE
AFFECTED, GENE NETWORKS, BUT
EVEN NEURAL NETWORKS.
DID I GET THAT RIGHT, DAVID?
IS THAT REASONABLY ACCURATE
EXPLANATION?
>> NOW WITH SPATIAL
TRANSCRIPTOMICS THAT IS LETTING
YOU NOT ONLY SINGLE CELL
SEQUENCE BUT SEE EXACTLY WHERE
EACH OF THOSE CELLS SITS IN THE
STRUCTURE.
>> THIS CAME OUT OF SITTING FOR
FOUR DAYS WITH A BUNCH OF THINK
PEOPLING ABOUT TRANSLATION
NEUROSCIENCE.
THE OTHER WAS BIOMARKERS.
DUH.
SO, YOU KNOW, EVERYBODY HAD
BIOMARKERS RIGHT AT THE TOP OF
THE LIST.
EVEN BIOMARKERS CAN BE
BACK-TRANSLATED TO FIND OUT WHAT
IT IS, WHAT WAS THE ONE I
IDENTIFIED TODAY?
WELL, ENDOPLASMIC RETICULAR
STRESS WAS IN HUMAN iPSC
CELLS.
BASIC RESEARCHERS CAN GO BACK
AND FIND OUT WHAT IS THE PATHWAY
THAT ULTIMATELY ENDS UP DRIVING
ALCOHOL USE DISORDER IN A
RODENT.
BUT, YOU KNOW, IT'S A VERY GOOD
QUESTION.
THANKS FOR ASKING IT.
YOU KNOW, I'VE BEEN A PROPONENT
OF BACK-TRANSLATION FOR YEARS.
BUT IT IS NOT THAT WELL EMBRACED
BUT I THINK IT CAN BE NOW.
ESPECIALLY WITH WHAT WE'RE
LEARNING IN NEUROSCIENCE.
YOU MAY WONDER WHY DO WE SPEND
ALL THIS MONEY IN NEUROSCIENCE?
HOPEFULLY SOME DAY IT'S GOING TO
PAY OFF WITH IDENTIFYING NOVEL
TREATMENTS AND NOVEL TREATMENTS
THAT CAN BE NOT ONLY MEDICATIONS
BUT EVEN BEHAVIORAL TREATMENTS
AND INTERVENTIONS.
ANY OTHER THOUGHTS OR QUESTIONS?
THAT WAS A REALLY GOOD QUESTION,
RHONDA.
THANK YOU.
ANYTHING ELSE?
ALL RIGHT.
WE'LL CARRY ON.
AND USUALLY I RUN OVER SO I'M
FEELING GOOD TODAY.
WE MAY GET AN EARLY BREAK FOR
LUNCH.
AFTER LUNCH DAVID GOLDMAN WILL
GIVE THE TALK, OUR CLINICAL
DIRECTOR, REALLY LOOKING FORWARD
TO THAT.
AND SHOULD BE A LOT OF FUN.
SO, ANY DISCUSSION ABOUT
ANYTHING?
KATIE, AS I SAID, WAS VERY BRAVE
BEING THE FIRST PERSON IN A
NUMBER OF YEARS TO RAISE A HIGH
PRIORITY.
PLEASE FEEL FREE TO DO THIS.
WHEN I WAS ON NIDA STUDY
SECTION, NOT STUDY SECTION,
COUNCIL, YEARS AND YEARS AGO,
WAS WHEN THE ENDOCANNABINOID
WORK WAS COMING OUT.
I HIGHLIGHTED A NUMBER OF THOSE
GRANTS IN THE EARLY DAYS.
AND I FEEL, I MEAN, YOU KNOW,
I'M A LITTLE NARCISSISTIC SO I
FEEL THOUGH THAT I REALLY
ACTUALLY HELPED MOVE THE FIELD
FORWARD A LITTLE BIT BECAUSE IT
STARTED, YOU KNOW, A PROGRAM
THAT HAS BEEN VERY RICH, AND WE
HAVE A HUGE PROGRAM ON
ENDOCANNABINOIDS IN OUR
INTRAMURAL PROGRAM AND EVEN
EXTRAMURALLY.
QUESTIONS, COMMENTS?
TINA?
>> I'M INTERESTED IN LEARNING
MORE ABOUT THIS COMMON FUND
PRIMARY CARE NETWORK.
I THINK THAT HAS TREMENDOUS
POTENTIAL FOR PEDIATRIC AND
OB/GYN BEING PRIMARY CARE
ABILITY TO BE ABLE TO TEST
INTERVENTIONS AND SO ON.
YOU MENTIONED THAT IT WOULD
START SMALL AND EXPAND.
CAN YOU EXPAND ON OR MAYBE
INFORMATION ISN'T AVAILABLE YET
BUT HOW BIG WOULD THE NETWORK BE
AND WOULD THIS BE A BASIS
WHEREBY RFAs WOULD COME OUT
FROM DIFFERENT INSTITUTES TO USE
THE NETWORK AS A PLATFORM?
>> YEAH, I THINK YOU NAILED IT
WITH YOUR LAST SENTENCE.
I'M GUESSING THAT'S HOW IT'S
GOING TO BE FORMULATED
EVENTUALLY.
BUT I BELIEVE THEY ARE PLANNING
TO HAVE THREE SITES THAT THEY
HAVE ALREADY IDENTIFIED AND THAT
WILL BE ANNOUNCED I THINK ON
JUNE 7.
BUT I DON'T KNOW WHAT THOSE
SITES ARE.
AND I'M GUESSING IT'S GOING TO
BE MORE RELATED TO PROBABLY
PHYSICAL AILMENTS TO START WITH,
HEART DISEASE OR SOMETHING LIKE
THAT, OR ENDOCRINE.
BUT, YOU KNOW, I THINK AN
OPPORTUNITY FOR US TO FOLD IN
MINIMUM, YOU KNOW, MY FAVORITE,
THE AUDIT-C.
AND MANY OF YOU KNOW DAVID
GOLDMAN INSTITUTED THAT AT THE
CLINICAL CENTER.
SO IT IS DONE WITH EVERY PATIENT
NOW THAT INTAKES IN THE CLINICAL
CENTER.
OUR CLINICAL CENTER BUILDING 1.
SO, BUILDING 10.
MONICA WOULD NOT WANT THE
CLINICAL CENTER TO BE IN
BUILDING 1.
BUILDING 10.
SO, I DON'T KNOW MUCH MORE.
YOU KNOW, I HOPE THAT THERE WILL
BE EQUAL PLAY FOR THE MENTAL
DISORDERS AS WELL AS PHYSICAL
DISORDERS.
AND, YOU KNOW, HOW MANAGEABLE
IT'S GOING TO BE, I DON'T KNOW.
BUT I'VE ALWAYS FELT, YOU KNOW,
I CALL IT FREE RANGING CHICKEN
KIND OF APPROACH TO DOING
RESEARCH.
I OVERHEARD VENTURE CAPITALISTS
AND SOME OF THE PHARMACEUTICAL
INDUSTRY PEOPLE THAT WERE AT
THIS TRANSLATIONAL NEUROSCIENCE
COMPLAINING ABOUT PROFESSIONAL
PARTICIPANTS IN STUDIES.
IN OTHER WORDS, THEY JUST GO
FROM STUDY TO STUDY.
DAVID, MAYBE YOU COULD
ELABORATE.
APPARENTLY IT'S A PAIN NOW, THEY
MANAGE TO CONVINCE PEOPLE THEY
ARE DEPRESSED AND HAVE AN
ANXIETY DISORDER AND THEY GO TO
THE NEXT TRIAL.
I THINK THAT'S HOW IT WORKS.
DAVID, DO YOU WANT TO --
>> YEAH, I THINK SPECIALLY
UNIVERSITY ENVIRONMENTS, A LARGE
PART OF THE PROBLEM IS YOU GET
HIGHLY NON-REPRESENTATIVE VERY
OVEREDUCATED INDIVIDUALS
INHERENTLY INTELLECTUALLY
INTERESTED IN RESEARCH, NOT
REPRESENTATIVE OF THE GENERAL
POPULATION.
SOME SOCIODEMOGRAPHIC FACTORS
THAT CONTRIBUTE TO LOWER QUALITY
OF HEALTH, SO I THINK I GUESS
WHAT'S EXCITING TO ME IS IF YOU
CAN -- IF THIS DOES COME OUT OF
PRIMARY CARE CLINICS, ESPECIALLY
IN PERHAPS NON-UNIVERSITY
ENVIRONMENTS, OR URBAN
ENVIRONMENTS, RURAL
ENVIRONMENTS, MAYBE THERE'S A
CHANCE TO OVERCOME SOME OF THAT.
SO I THINK THAT'S A VERY
EXCITING INITIATIVE.
>> AND THEN ONE MORE THING FROM
THE DISCUSSIONS, TINA, THAT THEY
ARE TALKING ABOUT ELECTRONIC
HEALTH RECORDS HERE.
SO THAT'S GOING TO BE THE
METRIC.
AND THAT HAS SOME LIMITATIONS,
BUT THEY CAN ALSO BE IMPROVED.
AND WE'LL TALK ABOUT THAT LATER
TODAY BUT THAT'S ANOTHER BEE IN
MY BONNET, COMMON DATA ELEMENTS.
KATIE?
>> JUST TO FOLLOW UP, I AGREE
THIS IS AN IMPORTANT PROGRAM BUT
I'M CURIOUS WORKING WITH
COMMUNITY CLINICS, FQHCS, STAFF
ARE EXTREMELY TAPPED, CURIOUS IF
NIH AS PART OF THE PROGRAMS
MIGHT HAVE THE ABILITY TO INVEST
IN THESE PROGRAMS AS WELL, AS
FAR AS LIKE IF WE'RE GOING TO DO
RESEARCH IN THE PROGRAM THAT WE
CAN PAY STAFF TIME, WE CAN PRAY
PROVIDER TIME, BECAUSE IN OUR
EXPERIENCE THAT'S BEEN A REAL
BARRIER TO DOING WORK WITHIN
THESE -- SPECIAL RURAL PRIMARY
CARE SETTINGS.
>> YEAH, GOOD POINT, DULY NOTED.
I'LL PROBABLY RAISE THE ISSUE IF
NOT RAISED BY SOMEONE ELSE WHEN
IT IS LAUNCHED IN JUNE, AND AS
WE START MOVING INTO LATER
PHASES IT MAY TURN OUT TO BE
MORE EXPENSIVE THAN ANYONE
ANTICIPATES BUT I DO THINK IT'S
ALSO, YOU KNOW, A POTENTIAL FOR
RICH WINDOW ON DIVERSITY ISSUES
ACROSS THE BOARD, RURAL, CITY,
RACIAL, CULTURAL GROUPS.
AND, YOU KNOW, THINGS ARE GOING
TO HAVE TO PROBABLY BE MODIFIED,
SCALES THAT ARE DONE FOR WHITE
ANGLO SAXONS MAY HAVE TO BE
MODIFIED FOR OTHER CULTURAL
GROUPS.
EVERYTHING MAY CHANGE.
IF IT'S AN ENGINE FOR THAT KIND
OF CHANGE I THINK IT'S GOING TO
BE GOOD.
OTHER THOUGHTS?
ANYBODY?
HOW ARE WE DOING ON TIME?
>> I WANT TO FOLLOW UP WITH
KATIE SAID.
I THINK COMMUNITY ENGAGEMENT
PIECE ALREADY CRITICAL TO THIS
SUCCESS.
>> YEAH, AND THAT'S A NEW THRUST
AT NIH.
ALMOST ALL THE INSTITUTES,
INCLUDING OURSELVES, WITH MCCI,
BUT THIS IS THE INVOLVEMENT OF
COMMUNITY, THE HEAL INITIATIVE
HAS BEEN WORKING HARD TO INVOLVE
COMMUNITY IN THEIR OPIOID
INTERVENTIONS, AND THEY ARE
GETTING THE ENGAGEMENT.
YOU KNOW, FINDING WHAT'S
SUCCESSFUL, WHAT'S NOT
SUCCESSFUL IS A CHALLENGE.
BUT THEY ARE AT LEAST DOING IT.
THERE'S FUNDS BEING SPENT IN THE
CONTEXT OF THE HEAL INITIATIVE
ON THIS.
AND I KNOW NIH, LBI, THE HEART
INSTITUTE HAS BEEN DOING THIS AS
WELL.
SO I'M SURE -- AND NIDA IS BIG
IN IT BECAUSE THEY ARE RUNNING
THAT PART OF THE HEAL INITIATIVE
AT THIS POINT.
BUT I BELIEVE NINDS IS DOING IT
AS WELL IN THE CONTEXT OF PAIN.
SO ... IS THAT CORRECT, MARK?
ARE YOU HERE?
>> YEAH, WE HAVE SOME OF THE
"HEAL" MONEY, THAT'S CORRECT.
WE'LL FOCUS ON COMMUNITY
ENGAGEMENT.
>> OKAY.
ALL RIGHT, GOOD.
I DIDN'T IMAGINE IT.
ANYTHING ELSE?
WELL, OVER LUNCH TIME TALK TO
YOUR FELLOW COUNCIL MEMBERS, AND
THINK ABOUT THINGS YOU WANT TO
TALK ABOUT.
I MEAN, WE'RE OPEN FOR BUSINESS.
WE GOT THROUGH THE STRATEGIC
PLAN.
WE GOT THROUGH THE BUDGET ISSUE.
IT COULD HAVE BEEN WORSE.
COULD HAVE BEEN BETTER, BUT
COULD HAVE BEEN WORSE.
AND, YOU KNOW, WE'RE ANXIOUS TO
MEET SOME OF THE GOALS THAT YOU
SAW IN THAT SLIDE FOR OUR
STRATEGIC PLAN.
SO START THINKING ABOUT WAYS,
FROM YOUR PERSPECTIVES, THAT WE
COULD START DOING THAT.
THAT'S THE CHALLENGE.
ALL RIGHT.
SO, PHILIPPE, DO YOU WANTS TO
SAY ANY WORDS ABOUT HOW PEOPLE
GET LUNCH?
>> SURE.
THERE'S A CAFETERIA ON THE FIRST
FLOOR, IN THIS BUILDING AREA.
AND THAT'S YOUR CHANCE FOR
LUNCH.
IT'S ON -- IT'S A FEW BUILDINGS
DOWN THE PATH.
>> DOES ANYBODY KNOW WHAT
BUILDINGS, CAN FIND IT?
>> SURE.
HOLD ON.
>> IS THERE SOMEBODY FROM NIAAA
THAT COULD LEAD EVERYONE DOWN
TOWARD THIS?
>> YES.
>> CAN YOU LEAD THEM, PHILIPPE?
>> I CAN, NOT A PROBLEM.
>> YOU'RE DESIGNATED LEADER.
FOLLOW PHILIPPE LIKE
KINDERGARTEN, WE'LL TAKE CARE OF
EVERYBODY.
HAVE A ROPE.
>> 6610 IN CASE YOU CAN'T FIND PHILIPPE.
>> WE'LL RECONVENE THE OPEN
SESSION OF THE 166th MEETING
OF THE NATIONAL ADVISORY COUNCIL
FOR ALCOHOL ABUSE AND
ALCOHOLISM.
>> OKAY, EVERYONE.
DID YOU SAY 1:15 ONLINE?
>> YES.
>> ALL RIGHT.
SO, ANDREW CAMERON, ARE YOU ON?
>> I AM.
THANK YOU FOR HAVING ME.
>> COULD YOU INTRODUCE YOURSELF?
EVERYBODY GOT TO INTRODUCE
THEMSELVES, NAME, RANK, SERIAL
NUMBER.
KIDDING.
>> ANDREW CAMERON, I'M A LIVER
TRANSPLANT SURGEON UP AT JOHNS
HOPKINS, INTERESTED IN SEVERE
ALCOHOLIC HEPATITIS AND USE OF
LIVER TRANSPLANTATION FOR THAT
CONDITION.
THANKS AGAIN FOR HAVING ME
INCLUDED.
>> THANKS, ANDREW.
THANKS FOR JOINING US.
I KNOW YOU PROBABLY HAVE AN EVEN
BUSIER SCHEDULE THAN I DO.
>> HAPPY TO BE HERE.
>> ALL RIGHT.
SO, NEXT ON OUR LIST IS, AS I
PREVIEWED EARLIER, WE'LL HAVE A
PRESENTATION BY DR. DAVID
GOLDMAN.
AND I'M GOING TO INTRODUCE HIM
AND TELL YOU A LITTLE BIT ABOUT
DAVID.
BUT THE TITLE OF HIS TALK IS
GENOMIC MEDICINE OF ALCOHOL USE
DISORDER, WHY ONLY SOME DRINKERS
DEVELOP ALCOHOL USE DISORDER AND
ONLY SOME HEAVY DRINKERS DEVELOP
LIVER DISEASE.
SO, DAVID IS CHIEF OF THE
LABORATORY OF NEUROGENETICS,
CLINICAL DIRECTOR AT NIAAA,
GRADUATED FROM YALE UNIVERSITY,
UNIVERSITY OF TEXAS MEDICAL
BRANCH IN GALVESTON, CAME TO NIH
FIRST ON A THREE-MONTH
EXTERNSHIP AS A SENIOR MEDICAL
STUDENT, A YEAR LATER IN 1979
JOINED NIH, AND HAS BEEN HERE
EVER SINCE, BOTH IN NIMH AND IN
NIAAA.
HE HAS TAKEN ON SEVERAL
ADMINISTRATIVE ROLES FOR EXAMPLE
CHAIRING NIAAA IRB FOR A DECADE,
HELPING SHEPHERD MERGER WITH
OTHER INSTITUTES FOUNDED AND
CHAIRED BY NIAAA/NIDA,
SCIENTIFIC REVIEW COMMITTEE,
FOUNDED THE NIAAA OFFICE OF
CLINICAL DIRECTOR, WHEN HE
BECAME CLINICAL DIRECTOR.
HE HAS FOCUSED ON IDENTIFYING
GENES THAT INFLUENCE VULNERABLE
TO ALCOHOL USE DISORDER, AND
OTHER PSYCHIATRIC DISEASES,
INCLUDING IN FOUNDER POPULATIONS
SUCH AS NATIVE AMERICAN TRIBES
AND FINLAND.
HIS LABORATORY USES COMBINATION
OF GENOMIC INTERMEDIATE
PHENOTYPE AND FUNCTIONAL GENETIC
METHODS TO IDENTIFY FUNCTIONAL
VARIANTS THAT CAUSALLY INFLUENCE
VULNERABILITY TO PSYCHIATRIC
DIAGNOSES.
THESE METHOD OVER 500 PAPERS
INCLUDING FIRST IMAGING GENETIC
STUDIES, IDENTIFYING LOCI OF
MODULATED RISK DISORDERS AMONG
THE MOST HIGHLY CITED IN
PSYCHIATRIC GENETICS, DISCOVERED
INHERITED GENE VARIATIONS THAT
INFLUENCE VULNERABILITY, AND
TRACED EFFECTS THESE VARIATIONS
FROM MOLECULAR LEVEL TO COMPLEX
BEHAVIORS IN HUMAN RESEARCH
STUDIES AND MODEL ORGANISMS.
AMONG HIS AWARDS, DR. GOLDMAN
WON DISTINGUISHED RESEARCHER AND
MENTORING AWARDS, RESEARCH
SOCIETY ON ALCOHOLISM,
OUTSTANDING RESEARCHER JAMES
ISAACSON RESEARCHER AWARD OF THE
INTERNATIONAL SOCIETY FOR
BIOLOGICAL RESEARCH ON
ALCOHOLISM, AND MULTIPLE NIH
DIRECTORS AWARDS.
HE WROTE OUR GENES, OUR CHOICES,
WHICH IS A BOOK, AND IT WON THE
BRITISH MEDICAL ASSOCIATION TOP
PRIZE AND IS IN ITS SECOND
EDITION.
HIS CURRENT BOOK IS ABOUT THE
NATURE OF LIFE, "IMMORTAL."
DAVID, IT'S ALL YOURS.
>> THANKS FOR YOUR HELP.
OKAY.
IS EVERYTHING WORKING?
RIGHT.
SO I'M GOING TO TRY TO USE THE
POINTER.
I THINK THAT I CAN TELL IF THE
POINTER IS ON.
SO FIRST I WANT TO THANK ALL THE
MEMBERS OF THE COUNCIL.
WAS VERY HAPPY TO SEE ANDREW
CAMERON JOINED US THIS
AFTERNOON.
PART OF THIS TALK WILL BE ABOUT
ALCOHOL-ASSOCIATED HEPATITIS AND
LIVER DISEASE, AND ALL THE REST
OF YOUR SAGE ADVICE FOR TAKING
THE TIME TO CONTRIBUTE NIAAA.
THIS IS NOT ADVANCING YET.
THERE IT IS.
SO, ALCOHOL USE DISORDER IS A
GENE BY ENVIRONMENT INTERACTION.
IT'S CONTINGENT ON EXPOSURE AND
CONTINGENT ON SOCIAL CONTEXT.
UNRECOGNIZED ASPECT IS
CORRELATION BETWEEN GENE AND
ENVIRONMENT WHICH SO OFTEN
HAPPENS WITH ALCOHOL USE
DISORDER.
THIS IS BOTH PASSIVE, THE THEME
ONE SHOULD CHOOSE ONE'S PARENTS
WISELY BECAUSE YOUR PARENTS ARE
GOING TO NOT ONLY PASS ON THEIR
GENES TO YOU BUT ALSO EXPOSE YOU
TO THEIR BEHAVIORS.
THE THINGS THAT WE EVOKE IN OUR
ENVIRONMENT, OR THE THINGS THAT
WE TRIGGER, AND OF COURSE THE
THINGS THAT WE CHOOSE AND
CREATE.
SO, THE HERITABILITY OF
ADDICTIVE DISORDERS ENCOMPASSES
ALCOHOL USE DISORDER.
YOU CAN SEE THAT IT'S PRETTY
MUCH RIGHT IN THE MIDDLE HERE,
HERITABILITY OF 50%, THIS
DOESN'T MEAN THAT IT'S 50%
ENVIRONMENTAL.
IT MEANS THAT WE CAN MEASURE
THAT THE HERITABILITY IS 50%.
SO THAT'S THE MEASURED COMPONENT
AND IT'S A GENETIC COMPONENT,
IT'S DUE TO NOT EPIGENETIC
FACTORS, OR ENVIRONMENTAL
FACTORS, BUT TO ACTUAL GENETIC
VARIANTS INHERITED FROM PARENT
TO CHILD THAT TEND TO BE SHARED
AMONGST PEOPLE WHO ARE RELATED.
BUT IN ADDITION TO WHAT IS
INHERITED, MUCH IS ACQUIRED, IN
THE ADDITIONS.
AND THIS IS THE KOOB CYCLE OF
ADDICTION, WHICH WAS ORIGINALLY
PROPOSED BY GEORGE BUT THEN WAS
ACTUALLY SCORCHED TO BE
VALIDATED WITHIN THE INTRAMURAL
DATA STATE, SUBSEQUENTLY
REPLICATED ALSO.
YOU SEE SOME PAPERS THERE, KWAKO
ET AL., AND THOSE DIMENSIONS ARE
PREOCCUPATION, BINGES
INTOXICATION,
WITHDRAWAL/NEGATIVE AFFECT.
NOT ONLY DO THESE TEND TO HAPPEN
DURING THE COURSE OF ADDICTION
BUT PEOPLE START OFF ALREADY
WITH VARIATION IN THESE
DIMENSIONS.
THEY START WITH VARIATIONS IN
NEGATIVE AFFECT, NEGATIVE
EMOTIONALITY, ANXIETY AND
DEPRESSION BEING HERITABLE.
THEY START WITH DIFFERENCES IN
EXECUTIVE FUNCTION AND START
WITH DIFFERENCES IN SALIENCE.
THESE DIFFERENCES ARE THEN
AMPLIFIED BY ADDICTION.
AND A TERRIBLE THING ABOUT THE
ADDICTIONS IS THAT ALTHOUGH
PEOPLE START OFF BEING
VULNERABLE IN SO MANY DIFFERENT
WAYS, THAT THERE ARE THESE FINAL
COMMON PATHWAYS OF ADDICTIONS.
SO THEY ROB PEOPLE OF THEIR
INDIVIDUALITY.
THERE'S A DIFFERENCE IN
RESPONSE, BUT ON THE OTHER HAND
THERE'S A SAMENESS TO PEOPLE
WITH ADDICTIONS.
SO, WE MIGHT THINK FROM THESE
INTERMEDIATE PHENOTYPES THAT WE
DISCUSSED, FROM GENE BY
ENVIRONMENT INTERACTION BEING SO
IMPORTANT IN AUD THAT GENE BY
ENVIRONMENT INTERACTION STUDIES
AND INTERMEDIATE PHENOTYPE
STORIES WOULD BE THE WAY FORWARD
AND WE USED TO THINK SO BECAUSE
OF LARGE GWAS STUDIES.
THIS IS WHERE THINGS WERE 10
YEARS AGO.
WE HAD GENES SUCH AS THESE,
FKBP5, IN THE ULTRA SHORT
FEEDBACK LOOP TO INHIBIT
CORTISOL RESPONSE, OR MAOA, NPY,
ONE COULD VERY POWERFULLY SHOW
GENE BY ENVIRONMENT
INTERACTIONS.
AND THERE'S A VAST LITERATURE
AND A LOT OF CONTROVERSY.
THE FIELD HAS MOVED ON, IF YOU
WILL, HERE IS ANOTHER GENE BY
ENVIRONMENT INTERACTION.
THIS IS FROM OUR GROUP WHERE WE
SHOW PEOPLE WITH A FUNCTIONAL
OXIDASE A POLYMORPHISM ARE
LIKELY TO HAVE AGGRESSIVE
BEHAVIOR OR DISCONTROL IF THEY
HAVE HIGH EXPOSURES TO
TESTOSTERONE.
WHICH MALES -- MANY MALES DO,
AND FEMALES DON'T.
SO, YOU SEE ON THE LEFT THAT
THERE'S THIS RELATIONSHIP
BETWEEN TESTOSTERONE LEVEL AND
BROWN/GOODWIN LIFETIME
AGGRESSION SCORE.
ON THE RIGHT PEOPLE WITH THE
OTHER MAO GENOTYPE, NO
RELATIONSHIP.
SO THERE WE WERE WITH MAOA, AND
WE WERE WITH NEUROPEPTIDE Y,
WITH A POWERFUL RELATIONSHIP
BETWEEN NEUROPEPTIDE Y GENOTYPE
AND MFRI ACTIVATION OF THE BRAIN
BEING PREDICTED BY FUNCTIONAL
DIPLOTYPE.
A STRONG EFFECT ON THE
PHENOTYPE, ON MOLECULES.
ON THE OTHER HAND WEAK EFFECTS
JUST LIKE MOST OTHER GENOTYPES
ON THE FINAL BEHAVIOR, THE
BEHAVIOR OF ANXIETY.
YOU MIGHT THINK THIS WOULD BE
THE WAY FORWARD.
BUT IT'S -- AND I'M GOING TO
SKIP THIS, BUT IT'S, AGAIN -- I
DON'T KNOW IF I'LL SKIP IT BUT
THIS IS A DISCOVERY OF THE STOP
CODON WHICH HAS A ROLE IN
EXTERNALIZING BEHAVIOR.
I'M GOING TO MOVE TO THEN WHAT
IS GENOME WIDE ASSOCIATION?
GENOME WIDE ASSOCIATION IS WHAT
I THINK TOOK OVER OUR FIELD, IT
IS ALLELE BASED, MILLIONS OF
ADDITIONAL SNPs,
BIOINFORMATICALLY IMPUTED SO ONE
GENERATES A MANHATTAN PLOT, YOU
SEE ON THE LEFT, WHERE YOU HAVE
A GENOME WIDE THRESHOLD AND
CERTAIN LOCI THAT RISE ABOVE
THAT THRESHOLD.
AND ON THE OTHER HAND WE HAVE
THE MANHATTAN CARTOON BY WELL
KNOWN AMERICAN ARTIST THERE ON
THE RIGHT SIDE.
JUST TO SHOW YOU WHY THEY CALL
IT MANHATTAN PLOT.
I'M NOT SURE ABOUT THE WORD
"PLOT."
MAYBE WE SHOULD BE CAREFUL ABOUT
THE USE OF THAT WORD IN THIS
CONTEXT.
WHAT DOES GWAS FOR ALCOHOL USE
DISORDER TELL US?
WELL, IT BRINGS US BACK TO OLD
TERRITORY FROM THE CANDIDATE
GENE ERA, ALSO TO NEW TERRITORY.
THERE ARE 281 GWAS LISTINGS FOR
AUD, TODAY, IN THE GWAS CATALOG,
OVER A THOUSAND FOR DRINKING
INCLUDING CLASSICS WHERE YOU SEE
THE P-VALUE IS 10 TO THE MINUS
4740.
WHICH MEANS THAT WHEN WHEN WE'RE
CERTAIN OF THAT, WE'RE NOT
LIVING IN SOME KIND OF ELABORATE
SIMULATION, AND THERE'S ADH1B,
HIGHLY SIGNIFICANT BUT, AGAIN,
EXERTS LARGE EFFECT ON
PHENOTYPE.
NOW, MOST GWAS FINDINGS DO NOT
EXHORT LARGE EFFECTS ON
PHENOTYPES.
THEY ARE CONDUCTED IN THESE, AS
YOU'LL SEE, IN THESE EXTREMELY
LARGE DATASETS, THE ADVANTAGE OF
THAT IS THAT VERY SMALL EFFECTS
CAN BE DETECTED AS A LARGE
DATASET.
THE DISADVANTAGE IS THAT THE
VARIANTS IMPLICATED, THE GENES
IMPLICATED, ARE OF VERY SMALL
EFFECT AGAINST THOSE PHENOTYPES.
BUT THESE ARE SOME OF THE NEW
PATHWAYS THAT HAVE BEEN
IMPLICATED BY GWAS OF AUD,
ETHYL-C3, ION TRANCE PORTER.
FGF CO-RECEPTOR, GLUCOKINASE
RECEPTOR, ALL OF THESE THEN
REPRESENT A NEW TERRITORY FOR
FUNCTIONAL STUDIES.
SO, HERE THIS BIG GWAS OF
ALCOHOL USE DISORDER, YOU SEE
THE MANHATTAN PLOT, AND YOU SEE
THERE'S A WHOLE CLUSTER OF HITS
WHICH ALL REPRESENT THE ALCOHOL
DEADROGENESE CLUSTER IN THE
MIDDLE.
OLD FAVORITES ALSO ON THIS MAP
INCLUDING SOMEWHERE ON THEIR IS
DRD2, THERE'S FTO, WHICH IS A
GENE THAT'S INVOLVED IN OBESITY
AND METABOLIC SYNDROME.
THERE ARE A LOT OF VERY SENSIBLE
FINDINGS, AS WELL AS FINDINGS
WHICH ARE NOT WELL UNDERSTOOD.
BUT THEN IT WENT TO BIGGER GWAS.
YOU SEE THIS BIGGER GWAS IS OVER
400,000 PEOPLE.
AND ONE FINDS NOT ONLY LOCI THAT
WOULD HAVE BEEN SUBTHRESHOLD, IF
YOU ONLY STUDIED 200,000 PEOPLE
BUT ALSO POSSIBLE WITH POLYGENIC
SCORES TO LOOK AT OVERLAP
BETWEEN THE WELCOME FOR ALCOHOL
USE DISORDER AND RISK FOR OTHER
BEHAVIORAL TRAITS.
SO YOU SEE MANY OTHER TRAITS
THAT ARE LISTED HERE IN THIS
PAPER, CHANCELLOR AND GELLER,
THAT GROUP.
IT'S WORKING AGAIN.
AND YOU SEE THAT SOME TRAITS ARE
POSSIBLY ASSOCIATED WITH AUD AT
THE GENETIC LEVEL, AND THEN SOME
ARE ACTUALLY NEGATIVELY
ASSOCIATED.
AND SOME OF THE ONES THAT ARE
POSITIVELY ASSOCIATED ARE QUITE
SENSIBLE, TRAITS LIKE RISK
TAKING, TRAITS LIKE ANXIETY, THE
DEPRESSIVE SYMPTOMS,
SCHIZOPHRENIA.
ON THE OTHER HAND, THERE ARE
TRAITS WHICH ARE NEGATIVELILY
CORRELATED, AGE, NUMBER OF
OFFSPRING IN A FAMILY, AGE OF
FIRST BIRTH, ET CETERA.
WE'LL TOUCH UPON THAT A LITTLE
BIT MORE.
THIS IS AGAIN THE CLASSIC STORY
OF THE ALDAHYDE AND ALCOHOL
POLYMORPHISMS THAT WE NEED TO
IDENTIFY FUNCTIONAL LOCI.
WE KNOW FUNCTIONAL LOCI OF BOTH
OF THESE GENES LEAD TO ENHANCE
THE ACETALDEHYDE LEVELS AFTER
DRINKING, PRODUCING THE FLUSHING
RESPONSE WHICH IS PROTECTIVE, ON
THE OTHER HAND IF PEOPLE DRINK
NEVERTHELESS RISK OF BREAST AND
UPPER G.I. CANCER ARE ELEVATED.
GOOD NEWS/BAD NEWS SITUATION.
THE WORST NEWS PEOPLE WHO
EXHIBIT THIS ALCOHOL INDUCED
FLUSHING ARE NOW A LOT MORE
LIKELY TO TAKE ANTIHISTAMINE
DRUGS, AND THE ANTIHISTAMINES
WHEREAS THEY BLOCK THE FLUSHING
THEY DO NOT BLOCK THE
GENOTOXICITY.
THIS IS A MAJOR PUBLIC HEALTH
PROBLEM TODAY.
SO WHAT IS CONSEQUENT TO THE
ALCOHOL EXPOSURE AT THE
EPIGENETIC LEVEL?
WELL, THERE'S AN INVESTIGATOR AT
NIAAA DOING A SERIES OF STUDIES,
MOST WITH US SINCE WE'VE BEEN
DOING THE METHYL ARRAYS IN MY
LAB.
WE FOUND THAT IF ONE DRINKS
HEAVILY, AND IF ONE IS STRESSED,
EPIGENETIC AGING IS ACTUALLY
ACCELERATED.
SO YOU SEE THE ACCELERATION OF
EPIGENETIC AGE IS ON THE ORDER
OF TWO YEARS FOR THE EARLY LIFE
STRESS, AND TWO YEARS FOR THE
HEAVY DRINKING, AND IT'S
APPROXIMATELY ADDITIVE.
THIS WAS RECENTLY PUBLISHED ,
THE LEAD AUTHOR AT THE TOP.
THERE'S MOLECULAR IMPRINT OF
ALCOHOL ON THE GENOME.
YET THAT'S NOT WHY ALCOHOL USE
DISORDER IS HERITABLE.
BECAUSE THE HERITABILITY IS NOT
DUE TO EPIGENETIC VARIATIONS BUT
DUE TO GENETIC VARIATIONS
BETWEEN RELATED INDIVIDUALS.
NOW I TURN TO THE QUESTION OF
WHY ONLY SOME DRINKERS WILL
DEVELOP LIVER DISEASE.
AND TO POINT OUT FIRST OF ALL
ABOUT 90% OF HEAVY DRINKERS WILL
DEVELOP ALCOHOL FATTY LIVER
DISEASE BUT AS KATHY COULD TELL
US 10 TO 35% PROGRESS TO AH, 20%
TO ALCOHOL CIRRHOSIS.
YOU SEE THE HISTOLOGY OF THOSE
DISEASES, NOTING THE LYMPHOCYTIC
INFILTRATION IN ALCOHOL
CIRRHOSIS, WHICH DOES
DISTINGUISH IT HISTOLOGICALLY
FROM -- I'M SORRY, LYMPHOCYTIC
INFILTRATION DISTINGUISHED FROM
ALCOHOL CIRRHOSIS.
WE'VE CONTRIBUTED TO SEVERAL
GENOMIC CONSORTIA WHICH ARE
STUDYING ALCOHOL LIVER DISEASE,
AND DONE THAT VIA THE NIAAA
INTRAMURAL DATASET.
ALL SUBJECTS THAT ARE STUDIED ON
OUR UNIT, AND YOU SHOULD
ENCOURAGE PEOPLE TO GET
REEVALUATION AND CARE, AT THE
NIH CLINICAL CENTER THEY CAN GO
TO THE NIAAA WEBSITE AND JOIN
THE STUDY BUTTON, AND BY THAT
GET FIVE WEEKS OF FREE INPATIENT
EVALUATION CLINICAL CARE.
THIS POPULATION IS FIRST OF ALL
SCREENED WITH PSYCHIATRIC
INTERVIEWING AND PSYCHOLOGICAL
ASSESSMENTS.
THEY ALL ARE GENOMICALLY
ANALYZED, ACTUALLY IN MY LAB
EXOME SEQUENCED, METHYLOMES ARE
DONE, SNP ARRAYS WITH DOING,
INCREASINGLY DOING TRANSCRIPTOME
ANALYSIS WITH CLIP RATTER OF
DANE MAYFIELD, LAWYERING
FERGUSON.
WE ARE DEPOSITING OUR DATA INTO
THE NIAAA DATA ARCHIVE AND
dbGAP, INTO THE NIH CLINICAL
CENTER SYSTEM, BTRIS.
AND SO WHAT HAPPENS IN THESE
COLLABORATIVE GENOMIC STUDIES IS
FIRST OF ALL WE CAN FIND LOCI
FOR ALCOHOL CIRRHOSIS AND AS
I'LL SHOW YOU FOR ALCOHOL
HEPATITIS.
AND SO HERE IS THE GWAS OF
ALCOHOL CIRRHOSIS DONE IN
COLLABORATION WITH GENOME ALK,
WHERE WE PROVIDED MOST OF THE
NON-ALD HEAVY CONTROLS FOR THIS
STUDY, AND YOU SEE THERE'S
SEVERAL LOCI THAT WERE DETECTED
IN THIS STUDY, ACTUALLY HAVE
LARGE EFFECT SIZES AND WHICH ARE
INVOLVED IN LIPID DROPLET
FORMATION.
AND THOSE ARE AT THE TOP THERE.
THERE'S THE P.I. OF THAT STUDY,
DEVANSIH SETH, AND I'LL SHOW YOU
LATER INSPIRED BY THIS STUDY,
INDICATING THERE WERE HEPATOCYTE
INTRINSIC GENES LIKE PNPLA3, WE
PROCEEDED TO MAKE INDUCED
HEPATOCYTE-LIKE CELLS FROM
iPSCs OF CIRRHOSIS PATIENTS.
IF YOU EXPOSE THE IHLCs TO
ALCOHOL THERE'S A MASSIVE
INDUCTION OF PNPLA3, THE TOP
GWAS HIT IN ALCOHOL CIRRHOSIS,
AND THAT'S BANI MUKHOPADHYAY'S
WORK.
ILLUSED TO BE IF YOU WANTED TO
ADVANCE THE SLIDES YOU HAD TO
HIT THE BUTTON ON THE KEYBOARD.
WE'VE GOT PAST THAT NOW.
SO, ACTUALLY I WAS FASCINATED
GEORGE PRESENTED TWO PAPERS AT
HIS JOURNAL CLUB ON ALCOHOL
HEPATITIS, WHICH IS UNIQUE AND
CLINICALLY PERILOUS DISEASE.
WHAT HE SHOWED US WAS THAT IF
YOU USED A DIFFERENT PREDNISONE
REGIMEN, THAT SURVIVAL OUT TO
THREE MONTHS MIGHT BE QUITE
HIGH.
IT LOOKED LIKE IT WAS WELL OVER
95%.
ON THE OTHER HAND, ALCOHOL
HEPATITIS PATIENTS ARE VERY
LIKELY TO DIE, IN MONTH THREE.
DAVE LOVINGER WAS LOOKING IT UP,
MORTALITY WAS SOMETHING LIKE 30%
IN THE PAPER THAT HE FOUND.
AND IN SHORT TIME INTERVALS.
AND SO IT IS A DIFFERENT
CHALLENGE THAN ALCOHOL
CIRRHOSIS.
IT'S MARKED BY INFLAMMATION OF
THE LIVER WITH T CELLS AND MANY
OTHER CELLS INVADING THE LIVER,
ACUTE PHASE REACTANTS IN THE
SERUM, ABDOMINAL PAIN, NAUSEA,
FEVER, JAUNDICE.
NEVER APPROACHED BEFORE IN GWAS.
THE PATIENTS DO TEND TO DIE.
AND THEN THE LARGE SAMPLES OF
WELL CHARACTERIZED PATIENTS
WEREN'T AVAILABLE.
SO ANOTHER LARGE CONSORTIUM THAT
NIAAA STUDIED WAS THIS
CONSORTIUM, WITH THE P.I. LAURA
NAGY TOP RIGHT, ALCOHOL GENOMICS
CONSORTIUM.
1735 HEAVY ALCOHOL DRINKERS WERE
STUDIED.
YOU SEE THAT ABOUT HALF OF THEM
HAD ALCOHOL HEPATITIS, THE
REMAINDER WERE HEAVY DRINKING
CONTROLS, ALCOHOL LIVER DISEASE,
THESE CONTROLS WERE MAINLY FROM
OUR INTRAMURAL PROGRAM.
THEY WERE ALL VERY DEEPLY
CLINICALLY PHENOTYPED.
SO, TO ANALYZE THESE GENOMICALLY
WE SEQUENCED THE EXOME, ABOUT 58
MEGABASES OF DNA.
VERY HIGH LEVELS OF ACCURACY AND
COMPLETION.
THE YIELD, SOMETHING LIKE
45,000, 50,000 GENETIC VARIANTS
PER PERSON, WITHIN THAT 58
MEGABASE TARGET, IT'S THOSE
GENETIC VARIANTS THAT ARE AT
GENES THAT ARE ACTUALLY THE
SUBJECT OF THIS STUDY.
LET'S SEE IF I PRESS THE RIGHT
BUTTON.
AH, I DID IT.
HERE IS THE RESULT, AND THE
MANHATTAN PLOT.
AND WITH THE PREVIOUSLY KNOWN
LIVER DISEASE GENE, AND TWO NEW
ONES, INCLUDING TOX4.
I'M NOT GOING TO EMPHASIZE
ANYTHING EXCEPT FOR LARGE ODDS
RATIOS.
SO IN CONTRAST TO THE USUAL GWAS
FINDINGS, THESE ARE GENES OF
LARGE EFFECT WITH ODDS RATIOS OF
1.73, FOR PNPLA3, 1.7 FOR
ICOSGL, AND ULTIMATELY POINT
CLINICALLY TO HOME IN ON
FUNCTIONAL LOCI.
WHAT ABOUT THE POLYGENIC
COMPONENT OF ALCOHOL HEPATITIS?
WELL, THE WAY THAT WAS
INVESTIGATED WAS THAT WE RANK
ORDERED ALL GENES, STUDIED IN
OUR EXOME SEQUENCING BY
P-VALUES, SO THAT WOULD BE ONE
TO 16,700 OR WHATEVER IT IS
P-VALUES.
RANK ORDERING ALL THESE
P-VALUES.
AND THEN TOOK THOSE P-VALUES
AGAINST CERTAIN FAMILIES OF
GENES WHICH HAD BEEN PREVIOUSLY
IDENTIFIED, OBJECTIVELY
IDENTIFIED, EITHER BECAUSE THEY
WERE THE TOP GWAS HITS FOR A
CERTAIN PHENOTYPE OR BECAUSE
THEY WERE ONE OF THE WIKI
PATHWAYS FOR PHYSIOLOGICAL
PATHWAY, AND SO WHAT THAT LET US
DO WAS TO SEE THAT THE GENES
THAT ARE IMPLICATED WERE -- I'M
TRYING TO FIGURE THIS OUT,
LOOKING AT TWO DIFFERENT PLACES.
THAT IF YOU LOOK AT GENES THAT
ARE INVOLVED IN ALCOHOL USE
DISORDER OR OF A HEAVY DRINKING,
THERE'S ONLY A WEAK SIGNAL FOR
THESE GENES TO BE INVOLVED IN
ALCOHOL HEPATITIS.
AS TIME GOES ON, ALCOHOL
HEPATITIS GWAS STUDIES GET
LARGER AND LARGER, THEN THE ROLE
OF SUCH GENES WOULD OF COURSE BE
DETECTABLE BUT THEIR EFFECT
SIZES NOT LARGER.
ON THE OTHER HAND, THERE WERE
NEW PATHWAYS INCLUDING VITAMIN D
PATHWAY, PROBABLY AT THE TOP
RIGHT.
SHOWED ENORMOUS ENRICHMENT.
AND FURTHERMORE THIS MASTER
REGULATORY PATHWAY FOR LIPID
SYNTHESIS, SREBP, STRONGLY
IMPLICATED, AND THE WAY THESE
P-VALUES ARE DETERMINED IS
EMPIRICALLY, HAVING THE -- FIRST
OF ALL, YOU JUST RUN A RANDOM
LIST OF 96 GENES OR 225 GENES
AGAINST ALL THE P-VALUES FROM
THE EXOME SEQUENCING AND SEE
WHAT CONSTITUTES SIGNIFICANT
ENRICHMENT VERSUS RANDOM
ENRICHMENT.
AND SO NOW I'M GOING TO MOVE TO
OUR iPSC PAPER.
SO, THIS JUST CAME OUT IN NATURE
COMMUNICATIONS, AND REMINISCENTS
OF THE WINSELBOMB PAPER
PRESENTED THIS MORNING.
WHAT WE'VE DONE IS TO DERIVE
FROM PATIENTS THE iPSCs MADE
FROM PERIPHERAL BLOOD, POSITIVE
T CELLS, CRYOPRESERVED, BY THE
WAY, AND TRANSFORMED USING THE 4
YAMANAKA, USING A PROTOCOL BY
SOMEBODY NAMED TAKEDA, SO WHAT
THAT DOES IS TO -- IT ALLOWS US
TO LOOK FOR INTRINSIC
DIFFERENCES IN THOSE IHLCs
FROM THE ALCOHOL CIRRHOSIS
PATIENTS, ALSO LETS US TEST
DRUGS THAT MIGHT BE EFFICACIOUS
IN PREVENTING OUTCOMES.
FIRST OF ALL HERE IS HOW YOU
MAKE THEM.
IT'S DONE IN STAGES.
AND YOU SEE IT TAKES ABOUT THREE
MONTHS BEFORE ONE HAS IHLCs
PRODUCED.
iPSCs TAKE ABOUT A MONTH TO
MAKE.
YOU SEE THE PROCESS BY WHICH
IHLCs ARE MADE, CHANGING FROM
DAY 5 COLONIES, LUMPS OF CELLS,
UNTIL FINALLY WHEN YOU HAVE
IHLCs, YOU HAVE NICE CUBOIDAL
HEPATOCYTE-LIKE CELLS.
THIS IS SHOWING PLURIPOTENCY
MARKER, AND ON THE RIGHT
COMPARING THE PATIENT AND
CONTROL IHLCs, TWO MARKERS,
THAT INDICATE MATURITY OF
HEPATOCYTES.
THESE MARKERS ARE HNF 4,
ALBIONS, PROTEINS THAT
HEPATOCYTES EXPRESS IN ABUNDANCE
INDUCED WHEN YOU DIFFERENTIATE
CELLS INTO IHLCs.
I'M NOT SHOWING BUT GREAT
STRENGTH OF THIS CELL MODEL IS
THAT THESE CELLS ARE ABOUT 95%
PURE, SO 95% HEPATOCYTE-LIKE
CELLS.
AND CORRELATION ACROSS MANY
THOUSANDS OF TRANSCRIPTS, R
SQUARED OF .95 REGARDLESS OF
CONDITION OR INDIVIDUAL.
THERE'S A LOT OF VARIATION WHICH
IS CAUSED OR ATTRIBUTABLE
ACTUALLY TO THE DIAGNOSIS BUT ON
THE OTHER HAND IT'S -- THESE
CELLS ARE MORE ALIKE JUST LIKE
PEOPLE ARE MORE ALIKE THAN THAT
THEY ARE DIFFERENT.
SO THIS IS SHOWING THE
DIFFERENCE IN LIPOGENESIS AND
NUMBER OF LIQUID DROPLETS IN THE
IHLCs.
YOU CAN'T SEE THE IMAGES VERY
WELL SO WE'LL LOOK AT THE BAR
GRAPHS.
WHAT YOU SEE WITH RED BARS IS
THAT MOSTLY THE LIPID STAINS,
RED LIPID STAINING, AND THERE'S
ANOTHER ONE, ADIPO GREEN,
MASSIVELY INCREASED IN THE AC
IHLCs VERSUS CONTROL IHLCs.
THIS IS JUST BASELINE.
WHERE MIGHT THAT BE?
WELL, THERE'S A METABOLIC
DIFFERENCE, WHAT YOU CAN DO IS
TAKE THESE CELLS, PUT THEM IN
THE SEAHORSE INSTRUMENT,
BIZARRELY ENOUGH, WHICH ENABLES
YOU TO MEASURE OXYGEN
CONSUMPTION RATE OF THE CELLS,
YOU MEASURE THAT RATE AFTER
GIVING DIFFERENT COMPOUNDS THAT
BLOCK DIFFERENT COMPONENTS OF
THE RESPIRATORY TRANSPORT CHAIN.
AND WHAT YOU SEE IS THAT THE
BASAL RESPIRATORY, SPARE
CAPACITY, MAXIMAL RESPIRATORY OF
THE RED ALCOHOL CIRRHOSIS
IHLCs ARE ALL LOWER, WHEREAS
THE NOT MITOCHONDRIAL
RESPIRATION, A FRACTION OF THE
CELLS, YOU SEE ON THE LEFT HERE
IT'S ONLY A SMALL PART OF THE
TOTAL RESPIRATION OF THE CELL,
THAT RESPIRATION IS NOT
DIFFERENT IN THE CONTROLS VERSUS
ALCOHOL CIRRHOSIS CELLS.
IT'S FASCINATING YOU TAKE THE
CELLS OUT OF A PERSON, CULTURE
THEM IN VITRO, THEY HAVE NOT
BEEN EXPOSED TO ANYTHING THAT
THE PERSON IS EXPOSED TO FOR
MONTHS.
DEDIFFERENTIATED WIPING OUT MUCH
OF EPIGENETIC MEMORY YET STILL
KNOW IN SOME WAY THAT THEY NEED
TO BE METABOLICALLY ABNORMAL.
HERE IS THE LOWER MITOCHONDRIAL
RESPIRATION AC IHLCs, FOR TIME
I'M GOING TO SKIP THIS BUT YOU
CAN SEE THE RED ONES, RED BARS,
ARE ALWAYS LOWER.
SO HERE IS THEN THE WAY THAT
HE'S CELLS WITH UTILIZE FATTY
ACIDS AND GLUTEMANE AS
SUBSTRATES.
ON THE TOP TREATED WITH ETOMOXIR
WE'RE SEEING THAT THEY UTILIZE
THE ALTERNATIVE FATTY ACIDS LESS
WELL.
AND ON THE BOTTOM TREATED WITH
BPTES, UTILIZING LESS WELL.
SO WE NATURALLY HAVE DONE
TRANSCRIPTOMICS ON THESE CELLS.
INSTEAD OF JUST LOOKING AT
THINGS THAT YOU KNOW, YOU'RE
OBJECTIVELY INVESTIGATING WHAT
PATHWAYS ARE DISTURBED, WHAT
MIGHT BE NORMAL, IN THESE
ALCOHOL CIRRHOSIS CELLS.
WHAT YOU SEE IS THE
DOWNREGULATED PATHWAYS, THIS IS
THE TOP PATHWAYS, INCLUDE
GLUCONEOGENESIS, OXIDATIVE
PHOSPHORYLATION, WHAT'S
UPREGULATED IS APOPTOSIS, DNA
DAMAGE, MAPK SIGNALING, I
WOULDN'T DOUBT E.R. STRESS IS
ALSO UPREGULATED IN THESE CELLS.
I'M GOING TO SKIPS THIS PROPOSED
MECHANISM.
PHILIPPE, I THINK A DIFFERENT
VERSION OF THE SLIDES ENDED UP
GETTING USED HERE.
AND GO TO THE POTENTIAL USE OF
CELLS, OF THESE CELLS IN DRUG
SCREENING.
ONE OF THE THINGS WE DID WAS TO
LOOK AT THE POTENTIAL EFFECT OF
ON THE HEALTH OF THESE CELLS,
ARAMKOL IS DRUG USED IN A
COLLABORATOR OF OURS, AND IN
PHASE 2B TRIAL, YOU SEE THE
RESULTS A RUN GOT, WHERE ARAMKOL
IS RESOLVING AT THE TIME WHAT
WAS CALLED NASH, NOW CALLED
MASH, METABOLIC ASSOCIATED
HEPATITIS, AND THAT THERE'S
STRONG EVIDENCE THAT ARAMKOL IS
GOOD FOR LIVER DISEASE, SO HERE
WE TREATED THESE ALCOHOL
CIRRHOSIS IHLCs WITH ARAMCOL,
IMPROVED PERFORMANCE, BASAL
RESPIRATION, MAXIMAL
RESPIRATION, SPARE RESPIRATORY
CAPACITY AND ATP PRODUCTION ARE
ALL IMPROVED.
I'D LIKE TO JUST SUMMARIZE NOW.
ALCOHOL USE DISORDER OVERLAPS
WITH OTHER SUBSTANCE USE
DISORDERS AND PSYCHIATRIC
DISEASES, INHERITANCE AND
MECHANISMS, A CLASSIC GENE BY
ENVIRONMENT INTERACTION
DISORDER.
GENE EFFECTS ARE STRONG OTHER
MOLECULES IMMEDIATE PROCESS BUT
VERY LARGE GWAS ON CRUDE
PHENOTYPES DETECT KNOWN GENES IN
MANY MORE OF SMALL EFFECT,
LARGELY UNKNOWN.
THE REASON IS THAT THE GWAS
STUDIES ARE JUST SO LARGE THAT
THEY HAVE POWER TO DETECT
MINUSCULE EFFECT, AND VERY LARGE
NUMBER OF THEM.
SO ALCOHOL HAS POWERFUL
EPIGENETIC EFFECTS THAT ARE NOT,
HOWEVER, INVOLVED IN THE
HERITABILITY OF ALCOHOL USE
DISORDER.
GENES ALTERING RISK OF AUD,
ALCOHOL ASSOCIATED CIRRHOSIS AND
HEPATITIS ARE OVERLAPPING, BUT
THEY ARE DISTINCT.
WE KNOW IN VITRO THAT THERE'S AN
INTRINSIC METABOLIC ABILITY OF
HEPATOCYTES DERIVED FROM AC
PATIENTS, IT APPEARS CONSERVED,
AND POTENTIAL MODEL FOR TESTING
EFFECTS OF NEW DRUGS.
SO I WANT TO THANK YOU FOR YOUR
ATTENTION.
AND GIVE SPECIAL THANKS TO THE
ALCOHOL CIRRHOSIS GENOME
CONSORTIUM, DEVANSHI AND TIM,
AND THE ALCOHOL HEPATITIS
GENOMICS CONSORTIUM,
PARTICULARLY SOMEONE IN MY LAB
WHO HAS WRITTEN A PAPER AND
COLIN HODGKINSON, AND BANI IS
RIGHT NOW IN PORTUGAL PRESENTING
THIS WORK.
AND SHE WAS RECENTLY KEYSTONE
MEETING DOING THE SAME.
AND THEN FOR THE EPIGENETIC
STUDIES, FALK LOHOFF AND JEESUN
JUNG.
THANK YOU.
>> I'LL LEAD OFF WITH A
QUESTION.
DAVID, COULD YOU USE THE SAME
TECHNIQUE THAT YOU USED FOR THE
LIPID DYSFUNCTION IN THE LIVER
WITH iPSCs FOR ONE OF THOSE
GENES THAT'S NOT SO HIGHLY
REPRESENTED IN THE GWAS STUDY?
IN OTHER WORDS, DOESN'T HAVE THE
HIGH, WHATEVER IT IS, MANHATTAN
SCORE, WHAT'S THE WORD FOR THAT?
BUT ANYWAY, IS THERE -- I MEAN,
DO YOU NEED TO -- DO YOU HAVE A
MUCH HIGHER SIGNAL BEFORE YOU
WOULD EMBARK ON iPSCs?
HOW DO WE GO FORWARD WITH THE
GWAS ON THE AUD?
>> YES, IT'S A WONDERFUL
QUESTION.
THE SUGGESTION FROM JOSH GORDON
WHO ABLY LED NIMH FOR MANY YEARS
HAS BEEN THAT THE ONLY GENES
THAT REALLY SHOULD BE FOLLOWED
UP ON ARE ONES THAT HAVE, YOU
KNOW, SIGNALS, THERE ARE
MULTIPLE WAYS TO GET A
SIGNIFICANT SIGNAL, NOT JUST
GWAS STUDY, ALSO TRANSCRIPTOME
OR EPIGENETIC-WIDE ASSOCIATION
STUDIES.
THERE ARE WAYS, JOSH RESPONDED
AT A MEETING FIVE YEARS AGO,
THAT ONE COULD GET A GENOME WIDE
SIGNIFICANT SIGNAL.
THE QUESTION IS SHOULD YOU
FOLLOW UP ON SUCH LOCI?
AND THE REASON NOT TO IS THAT
THE END GAME IS THAT THE VARIANT
THAT YOU'RE FOLLOWING UP ON
MIGHT NOT BE VERY STRONG.
BUT THE REASON TO DO IT IS THAT
NOT ONLY DO YOU HAVE A SIGNAL
THAT PARTICULAR GENE IS
IMPORTANT BUT MIGHT HAVE A
SIGNAL THAT A PATHWAY IS
IMPORTANT, A NEW PATHWAY.
THERE ARE MANY WAYS TO TARGET
SUCH PATHWAYS MOLECULARLY.
YOU MIGHT DO THAT WITH ANTISENSE
RNA, IN A KNOCKOUT ANIMAL, WHERE
THE GENE IS KNOCKED OUT.
YOU MIGHT DO IT AS WE ARE DOING
BY GENE EDITING INTO iPSCs,
PARTICULAR VARIANTS.
THERE'S ALSO NOW, SHOWING
POSSIBILITY OF TARGETING THE
EPIGENETIC CONTROL OF GENES.
SO, I THINK THE ANSWER, GEORGE,
IS YES, THAT THE SIGNALS THAT
ARE EVEN SUBTHRESHOLD IF
POINTING TO PATHWAYS AND IF THEY
ARE COHERENT WITH OTHER GENES,
IF THAT GENE HAS OTHER GENES
THAT ARE FRIENDS OF IT AND THAT
ARE DOING THE SAME THING, THAT
THEN YOU HAVE -- YOU HAVE A
NOVEL PATHWAY TO STUDY.
>> DAVE, GO AHEAD.
>> YEAH, I WAS REALLY AMAZED TO
SEE EFFECTS ON METABOLISM, SO
THAT GOT ME THINKING ABOUT
NEURONS.
ARE THERE COMPARABLE DATA FROM
NEURONS?
AND THIS REMINDS ME A LOT OF
SOME OF THE OTHER NEURONAL
DISORDERS WHERE MITOCHONDRIA
BECOME A MORE AND MORE PART OF
THE PICTURE.
AND SO WITH ALCOHOL HAVE YOU --
AUD, HAVE YOU SEEN THIS, OR
ANYONE SEEN THIS SORT OF
DISORDER IN NEURONS?
>> YEAH, SO WE HAVE A WHOLE
OTHER SERIES OF STUDIES,
COLLABORATIVE WITH NIMH, WITH
PETER SCHMIDT ON OVARIAN STEROID
TRIGGERED -- AND WE'RE STUDYING
NEURONS DIFFERENTIATED FROM
iPSC, AND FASCINATING THING
ABOUT THESE OVARIAN STEROID
TRIGGERED MOOD DISORDERS THE
WOMEN WHO HAVE NORMAL LEVELS BUT
DIFFERENCE IN CELLULAR RESPONSE
MUCH AS DIFFERENCE IN RESPONSE
TO ALCOHOL IN PEOPLE HIGH OR LOW
RESPONDERS IS NOT DUE PRIMARILY
TO MA METABOLISM BUT
PHARMACODYNAMIC RESPONSE.
WE'VE BEEN ABLE IN THOSE LCL
STUDIES AND ALSO MAKING SOME
NEURONAL TYPES TO SEE THESE
DIFFERENTIAL EFFECTS OF
RESPONSE, WE HAVE A SERIES OF
PAPERS ON ENTITIES LIKE
PRE-MENSTRUAL DYSPHORIC
DISORDER, DEPRESSION.
THE LIMITATION, SEEN IN SOME OF
FRED GAUGE'S WORK ON
SCHIZOPHRENIA, ON NEURONS, IS
THAT IF YOU DON'T HAVE A MODEL
WHERE YOU CAN CONSISTENTLY
PRODUCE THE CELLULAR -- THE SAME
CELLULAR -- A LOT OF NOISE, YOU
HAVE THE POSSIBILITY THAT YOUR
CELLS FROM YOUR CASES JUST HAVE
DIFFERENTIATED IN DIFFERENT WAY
THAN THE CELLS FROM YOUR
CONTROLS, SO YOU'RE NOT THE
FIRST PLACE COMPARING DIFFERENT
APPLES TO OTHER TYPES OF APPLES
BUT COMPARING APPLES TO ORANGES,
AND THAT YOU CAN SEE IF YOU HAVE
A DIFFERENT PERCENTAGE OF CELL
TYPES, IN THAT WHICH YOU STUDY.
IT'S VERY IMPORTANT THAT THE
IHLC WORK, AS WE'VE SHOWN BY
ANALYTIC CELL SORTING, YOU END
UP WITH 95% HEPATOCYTE-LIKE
CELLS AND THEY ARE FAIRLY
CONSISTENT IN THEIR LEVEL,
LEVELS OF GENE EXPRESSION.
IT'S UNKNOWN HOW POWERFUL THAT
STUDIES OF NEURONS ARE GOING TO
BE.
THE LIMITATION OF STUDIES OF
NEURONS IS THAT HEPATOCYTE
EXISTS NOT IN THE ABSENCE OF
INTERACTION WITH OTHER CELLS.
IT'S INTERACTING WITH OTHER
CELLS, IN VERY IMPORTANT WAYS.
BUT AS COMPARED TO A NEURON IT'S
DOING NOTHING.
SO, A NEURON MAY BE SYNAPSING
WITH 50 OR 100 OR WHATEVER
NUMBER OF CELLS, AND IF YOU'VE
EVER LOOKED AT THE NEUROPILE OF
DOPAMINE NEURON, RECENTLY IN A
SEMINAR, IT'S JUST AMAZING
BECAUSE YOU HAVE THIS ABSOLUTELY
TANGLED MASS OF WHATEVER THEY
ARE, DENDRITES OR AXONS,
WHATEVER.
SO, YOU KNOW, I THINK THAT THE
FACT THAT WITH NEURONS THAT THE
ISSUES OF GEOMETRY AND
INTERACTION IS SO MUCH MORE
IMPORTANT MAY MEAN THAT IT'S
GOING TO BE MORE DIFFICULT TO
APPLY THESE -- YOU KNOW, APPLY
THIS IN VITRO MODEL TO NEURONS,
AND WE'VE ALSO SEEN THAT IN THE
SENSE IF YOU LOOK AT DIFFERENT
PARTS OF THE PLATE, WHERE YOU
HAVE NEURONS FROM ONE PERSON IN
ONE PART OF THE CULTURE DISH
NEURONS ARE DOING ONE THING AND
OVER THERE THEY ARE DOING
SOMETHING A LITTLE BIT
DIFFERENT.
SO MAKING THIS WORK FOR NEURONS
HAS DIFFERENT SORT OF CHALLENGE
THAN FOR SOME OTHER TYPES OF
CELLS.
>> THANK YOU FOR THAT WONDERFUL
RICH TALK.
I WAS WONDERING IF YOU COULD
COMMENT FURTHER ON GENOMIC
VERSUS EPIGENETIC CHANGES IN ANY
OF THE RESEARCH YOU TALKED
ABOUT.
>> YEAH, THANKS A LOT.
IT'S A LOT OF CONFUSION ABOUT
GENOMIC -- GENETIC VERSUS
EPIGENETIC.
PART IS BECAUSE WHEN CONRAD
WARRINGTON COINED THE WORD
EPIGENETIC, WHICH HE DID TO
EXPLAIN HOW CELLS DIFFERENTIATE
FROM PRIMORDIAL GERM CELL HE
USED THE TERM EPIGENETIC, ABOVE
GENETIC SO PEOPLE SOMETIMES
THINK THAT EPIGENETIC IS NOT A
CHANGE IN DNA BUT OF COURSE
THERE ARE MANY EPIGENETIC
CHANGES WHICH DIRECTLY ARE
CHANGES IN DNA, DNA METHYLATION,
TELOMERE SHORTENING IS CHANGE IN
DNA.
EPIGENETIC CHANGE IS A CHANGE
THAT'S READILY REVERSIBLE.
WHEREAS A AGAINST CHANGE IS VERY
DIFFICULT TO REVERSE, ESPECIALLY
IF IT'S A POINT SUBSTITUTION,
REVERSING -- GENETIC CHANGES
OCCUR ON ORDER IF THEY ARE NOT
SHORT CHAIN REMEET POLY MORPH
ITS ONE TIMES 10 TO THE MINUS 8,
EPIGENETIC CHANGES ARE HAPPENING
EVERY MOMENT.
I THINK VIRTUE OF EPIGENETIC
WORK IS IT LETS US CAPTURE
EFFECTS OF EXPOSURES, IN A
DRAMATIC WAY.
YOU CAN SEE A PERSON HAS BEEN
EXPOSED TO ALCOHOL OR TO
NICOTINE OR TO STRESS, AND NOT
ONLY THAT THEY HAVE BEEN
EXPOSED, THE RESPONSE TO THE
EXPOSURE, ALL THE TIME WE ARE --
INFORMATION ON CHILDHOOD TRAUMA,
CHILDHOOD NEGLECT, BUT MAYBE
YOU'RE GLAD YOUR DOG DIED OR NOT
AS UPSET AS THE PERSON REALLY
ATTACHED TO THAT DOG WAS.
THE SAME EFFECT HAS VERY
DIFFERENT SIGNIFICANCE FOR
DIFFERENT PEOPLE.
AND PART OF THE DIFFERENCE IN
RESPONSE CAN BE THE RESILIENCE
OR VULNERABILITY OF THE
INDIVIDUAL ALSO.
IT'S THE SAME EXPOSURE, WITH THE
SAME PSYCHOLOGICAL MEANING, CAN
HAVE A VERY DIFFERENT
PHYSIOLOGIC RESPONSE IN TWO
DIFFERENT PEOPLE.
SO I THINK THE EPIGENETIC
REVOLUTION WHICH IS ENABLED BY
THE 850,000 FEATURE EPIC ARRAYS
WHICH MEANS CpG SITE AND MAYBE
CpG METHYLATION TAKE US INTO A
NEW ERA OF EPIGENETIC WORK.
THAT'S A STANDARD PRODUCT.
IT ALSO IS -- THE STRENGTH OF IT
IS IS THAT LIKE WITH ANYTHING
GENOMIC, IT LETS US PUT THE DATA
AGAINST A COMMON RUBRIC, AGAINST
THE GENOME.
SO THIS IS THE CpG METHYLATION
SITE, AND OF COURSE WHO LOOKS AT
THAT SITE CAN TALK ABOUT THE
SAME SITE.
AND VERY OFTEN MEASURED WITH THE
SAME PRODUCT.
>> HAVE YOU CONSIDERED SOME OF
THE TREATMENT RAMIFICATIONS OF
EPIGENETICS VERSUS GENETIC
COMPONENT?
>> YEAH, VERY GOOD QUESTION.
IT'S NOT -- IT'S NOT FULLY KNOWN
TO WHAT EXTENT EPIGENETIC
CHANGES ARE REVERSIBLE.
WE KNOW THAT YOU CAN MAKE
MATTERS WORSE, BUT CAN YOU MAKE
MATTERS BETTER?
AND VERY LIKELY REVERSIBLE
BECAUSE THERE ARE READERS,
WRITERS, AND ERASERS FOR ALL OF
THESE EPIGENETIC MARKS.
AND TELOMERE SHORTENING ITSELF
IS, YOU KNOW, REVERSED BY
TELOMEREASE, WHICH BUILDS BACK
TELOMERES.
IT'S NOT KNOWN BECAUSE
LONGITUDINAL STUDIES HAVE NOT
REALLY BEEN DONE TO WHAT EXTENT
THESE EPIGENETIC CHANGES CAN BE
REVERSED, OR POTENTIALLY TO STOP
THEM FROM WORSENING.
>> THANK YOU.
>> YOU'RE WELCOME, MICHAEL.
>> ANY OTHER QUESTIONS?
>> GO AHEAD.
>> DAVID, YEAH, THIS IS -- YOU
USED THE WORD EPIC STUDIES, THIS
IS REALLY AN EPIC STUDY, I
CONGRATULATE YOU FOR THAT.
IT'S REALLY WONDERFUL.
I WANT TO FOLLOW UP A LITTLE BIT
ON THE QUESTION ABOUT TREATMENT
OPTIONS, AND IN THINKING ABOUT
THIS, THIS HAS BEEN 50 YEARS
WE'VE BEEN WAITING FOR SOMEBODY
TO START PUTTING TOGETHER THE
GENOMICS OF ALCOHOL USE
DISORDER, ALCOHOL LIVER DISEASE,
AND YOU'RE GETTING THERE.
THAT'S WHAT I LIKE TO SAY.
AND I THINK THAT -- CAN YOU PUT
YOUR FINGER ON HOW MANY FACTORS
DO YOU NEED, CAN YOU SAY IF WE
FIND A PERSON WHO HAS TWO OF THE
FACTORS, THEIR LIKELIHOOD IS
MUCH HIGHER, THEY HAVE THREE
EVEN HIGHER AGAIN, AND IF YOU
THEN INTERVENE WITH TWO OUT OF
THE THREE MAYBE THAT'S A
TREATMENT STRATEGY.
I THINK YOUR TOOL, IHSCs, IS
WONDERFUL, IF WE'RE LOOKING AT
BOTH INHIBITORS AND ACTIVATES OR
OF VARIOUS GENES YOU HAVE TO SEE
WHETHER YOU CAN GO THROUGH SOME
LARGE SCALE SCREENING OF DRUGS
TO TRY AND ELEVATE OR INHIBIT
THE PARTICULAR PROTEIN THAT IS
CAUSING THE EFFECT.
ALL OF THAT GOES TO SAY THAT
WE'RE GETTING THERE.
WE'RE GETTING CLOSE AND WE CAN
ALWAYS ASK THE QUESTION HOW DO
WE TREAT IT.
>> THE MILLION DOLLAR QUESTION.
I FORGET WHAT THE BUDGET IS,
$550 MILLION QUESTION.
>> WE NEED MORE.
>> THE THING IS THAT THERE ARE
MANY PHENOTYPES INCLUDING AUD
AND LIVER DISEASE, WHICH ARE THE
PRODUCT OF A LARGE NUMBER OF
GENES AND A PRODUCT OF MULTIPLE
PATHWAYS OF THE DOESN'T MEAN
MULTIPLE PATHWAYS HAVE TO BE
ADDRESSED IN THERAPY.
IT CAN BE SUFFICIENT TO ADDRESS
A KEY CHECKPOINT OR BOTTLENECK.
THAT'S A LESSON.
THAT'S APPLICABLE FOR AUD.
NOW, YOU MIGHT -- IF YOU HAVE A
PROBLEM WITH THE APPENDIX, TAKE
IT OUT.
YOU DON'T HAVE TO KNOW
EVERYTHING ABOUT THE BIOLOGY OF
THE APPENDIX, OR ALL THE GENES
INVOLVED IN THE VULNERABILITY,
ALL THE PATHWAYS, ET CETERA.
JUST TAKE IT OUT.
THERE ARE A LOT OF DISEASES THAT
ARE ACTUALLY TREATABLE THAT WAY.
MOST GENETIC DISEASES
SUCCESSFULLY TREATED HAVE NOT
BEEN TREATED BY ADDRESSING THE
PRIMARY GENE THAT IS DISTURBED
TO CREATE THE VULNERABILITY IN
THE FIRST PLACE.
THEY HAVE BEEN ADDRESSED SOME
OTHER WAY.
SOME OTHER WAY.
AND SO THAT'S SOMETHING THAT I
THINK THAT WE SHOULD TAKE TO
HEART.
WE WANT THE GENETICS TO TELL US
ABOUT PATHWAYS.
AND ABOUT MECHANISMS.
BUT WE CAN'T ALLOW OURSELVES TO
GET HYPNOTIZED BY THE IDEA THAT
WE GOT TO TARGET THIS GENE, FIX
THAT GLITCH.
WE NEED THAT FIRST, WHATEVER
THAT TAKES.
>> THANK YOU.
>> THANK YOU, DAVID, FOR A
REALLY WONDERFUL TALK.
AND STIMULATING A LOT OF
INTEREST.
DAVID IS GENEROUS SO IF ANYONE
HAS QUESTIONS I'M SURE HE'LL BE
HAPPY TO ANSWER YOUR E-MAILS AND
GIVE YOU REFERENCES.
BUT WE SHOULD PROBABLY MOVE ON
AT THIS POINT.
SO, NEXT SPEAKER IS JOAN
ROMAINE, HEALTH SPECIALIST IN
THE DIVISION OF TREATMENT AND
RECOVERY, TREATMENT HEALTH
SERVICES AND RECOVERY BRANCH,
SHE'LL PRESENT ON NIAAA'S
PARTICIPATION IN THE DHHS CENTER
FOR FAITH-BASED AND NEIGHBORHOOD
PARTNERSHIPS, MATERNAL OUTCOMES
MATTERS TOUR, THE ACRONYM IS
APPROPRIATELY MOMS, M-O-M-S.
I WANT TO SAY A FEW OTHER THINGS
ABOUT JOAN.
JOAN IS -- I MENTIONED DEIDRA
ROACH EARLIER TODAY BUT JOAN IS
ALSO CONTRIBUTING MASSIVELY TO
OUR WOMEN'S HEALTH INITIATIVES
AT NIAAA.
AND SHE'S ALSO THE FOUNDER WITH
OTHERS OF THE RELIGION AND
SPIRITUALITY INTEREST GROUP,
WHICH HAS TAKEN OFF AT NIH, AND
NOW EXTENDS ACROSS ALL OF NIH.
AND WE'RE PROUD OF JOAN'S
EFFORTS IN THESE AREAS.
BECAUSE IT -- AS DAVID POINTED
OUT, WE'RE TALKING ABOUT THE
WHOLE BODY, WHEN WE TALK ABOUT
ALCOHOL USE DISORDER.
THE WHOLE BODY INCLUDES THE
ENVIRONMENT THE BODY IS LOCATED
IN.
SO, I WILL TURN IT OVER TO YOU,
JOAN, JUST TO MENTION THE MOMS
TOUR, A TWO-YEAR COMMUNITY BABY
SHOWER TOUR TARGETING 36 CITIES
ACROSS THE UNITED STATES,
REACHING UP TO 25,000 EXPECTANT
MOTHERS IN COMMUNITIES WITH HIGH
MATERNAL MORTALITY AND MORBIDITY
RATES.
IT'S ALL YOURS, JOAN.
>> I'M JOAN REMAIN.
IT'S AN HONOR AND PRIVILEGE TO
BE HERE TODAY TO TELL YOU ABOUT
A REALLY IMPORTANT AND EXCITING
INITIATIVE THAT'S FUNDED BY THE
DEPARTMENT OF HEALTH AND HUMAN
SERVICES, CENTER FOR FAITH BASED
AND NEIGHBORHOOD PARTNERSHIPS,
AS DR. KOOB SAID THE NAME IS THE
MATERNAL OUTCOMES MATTER, OR
MOMS TOUR.
AND I'M JUST REALLY HONORED TO
GET TO SPEAK WITH YOU ABOUT IT.
THE WAY I'M GOING TO FRAME MY
TIME WITH YOU TODAY IS BASICALLY
TO FOCUS ON THREE POINTS.
FIRST I'M GOING TO TELL YOU WHAT
THE MOMS TOUR IS.
THEN I'M GOING TO TELL YOU AND
SHARE WHAT NIAAA IS DOING.
THEN I'M GOING TO EMPHASIZE WHY
THIS IS IMPORTANT AND HOW WE
THINK THIS FURTHERS OUR GOALS,
PARTICULARLY RELATED TO WOMEN
AND GIRLS AND HEALTH
DISPARITIES.
SO BEFORE I BEGIN, FIRST
QUESTION, HOW MANY OF YOU HAVE
GONE TO A BABY SHOWER?
SHOW OF HANDS.
DON'T BE BASHFUL.
GREAT, THERE'S MEN AND WOMEN.
I LOVE THAT!
SO YOU HAVE AN IDEA OF WHAT
TAKES PLACE AT A BABY SHOWER,
RIGHT?
THEY ARE FUN, THERE'S GAMES,
FOOD, PRIZES, PRESENTS, AND IT'S
FOCUSED ON THE PREGNANT WOMAN,
RIGHT?
SECOND QUESTION HOW MANY OF YOU
HAVE GONE TO OR HEARD OF A MOMS
TOUR BABY SHOWER?
YAY!
THANK YOU, MY ESTEEMED
COLLEAGUES WHO PARTICIPATED IN
CALVETTON, MARYLAND.
THE ACRONYM STANDS FOR MATERNAL
OUTCOMES MATTERS SHOWER.
AND THIS IS A TWO-YEAR COMMUNITY
BABY SHOWER TOUR THAT STARTED
LAST YEAR KICKING OFF IN AUGUST
IN DETROIT, MICHIGAN.
AND IT'S GOING TO END THIS YEAR
ON NOVEMBER 23 IN PUERTO RICO.
IT'S TARGETING 36 CITIES ACROSS
AMERICA, WITH THE GOAL OF
REACHING UP TO 25,000 EXPECTANT
MOTHERS, IN COMMUNITIES WITH
HIGH MATERNAL MORTALITY AND
MORBIDITY RATES.
I'M NOT GOING TO READ THROUGH
ALL THE DIFFERENT PARTNERS THAT
ARE INVOLVED HERE BUT I SHARED
LOGOS OF SOME MAJOR PARTNERS SO
YOU CAN SEE THE COLLABORATION OF
BOTH FAITH GROUPS AND ACADEMIC
GROUPS AND NON-PROFITS AND
HEALTH SERVICE PROVIDERS.
AND ALSO FEDERAL GOVERNMENT.
I WILL POINT OUT THAT NIAAA IS
THE ONLY NIH INSTITUTE
PARTICIPATING IN THIS
INITIATIVE.
SO, WHAT DOES THIS INITIATIVE
DO?
IT BRINGS TOGETHER A MATRIX OF
PROFESSIONALS TO ADDRESS THE
PROBLEM.
I'LL TALK MORE ABOUT SPECIFIC
LIVE WHO THOSE PROFESSIONALS
ARE.
AND IT EDUCATES AND EMPOWERS
EXPECTANT MOMS AND NEW MOMS AND
DADS ON THIS ISSUE.
AND PERHAPS MOST IMPORTANTLY IT
LINKS THESE WOMEN TO SERVICES
AND SUPPORTS.
THIS IS NOT JUST TALKING ABOUT
THE PROBLEM.
THIS IS REALLY GOING TO WHERE
THE WOMEN ARE, MEETING THEM
WHERE THEY ARE AT AND LINKING
THEM TO SERVICES.
I'LL GIVE YOU SOME EXAMPLES OF
WHAT THOSE SERVICES ARE.
THE GOAL IS TO MAKE THE UNITED
STATES ONE OF THE SAFEST
COUNTRIES FOR WOMEN TO GIVE
BIRTH.
AND THIS MATERNAL HEALTH FOCUS
WE'VE ALREADY HEARD IS A
PRIORITY FOR THIS
ADMINISTRATION.
AND IT'S TO REDUCE UNACCEPTABLY
HIGH MATERNAL MORTALITY AND
MORBIDITY RATES IN THE UNITED
STATES ESPECIALLY AMONG BLACK
AND AMERICAN INDIAN AND ALASKA
NATIVE MOMS.
LOOK AT THIS STATISTIC HERE.
BLACK WOMEN ARE THREE TIMES MORE
LIKELY AND AMERICAN INDIAN
ALASKA NATIVE WOMEN TWO TIMES
MORE LIKELY TO DIE FROM
PREGNANCY-RELATED CAUSES THAN
WHITE WOMEN.
AND OVER 80% OF THOSE DEATHS ARE
PREVENTIBLE.
SO LET'S GET INTO IT.
ON THE RIGHT YOU'LL SEE A
DEPICTION, I COULDN'T FIT THE
WHOLE SCREEN SHOT SO IT'S THE
TOP OF THE WEBSITE AND THEN THE
BOTTOM JUST TO SHOW YOU.
AND WHO IS INVOLVED IN THESE
EVENTS?
THE BEST WAY TO DESCRIBE
IMAGINING THE EVENT IS SAY
YOU'RE AT A SCIENTIFIC
CONFERENCE, YOU GO TO THE
EXHIBIT HALL, ALL THESE TABLES
OF BOOTHS AROUND THE ROOM.
PERHAPS IN THE CENTER OF THAT
EXHIBIT HALL THERE'S TABLES OR
CHAIRS DECORATED WITH BABY
SHOWER THEMES.
AND THERE'S AN AREA FOR A PANEL
OF SPEAKERS TO DO EDUCATIONAL
PANELS FOR THE WOMEN.
AT EACH OF THESE EVENTS
PARTICIPANTS ARE MOMS AND DAD,
SOMETIMES THEIR KIDS.
THEY ARE REGISTER FOR THE EVENT
OR WALK IN FROM THE STREET.
THERE ARE VOLUNTEERS FROM THE
LOCAL COMMUNITIES THAT ENSURE
EVERYTHING GOES SMOOTHLY DURING
THE EVENT.
AND THERE'S HUNDREDS OF
PARTICIPANTS WHO GO TO THESE
EVENTS, FOR EXAMPLE THE EVENT
HELD IN BOSTON HAD OVER 300
PEOPLE ATTEND.
EVENTS WE'VE GONE TO IN MARYLAND
HAVE PROBABLY TWO OR THREE
HUNDRED PEOPLE ATTEND AS WELL.
DR. DEIDRA ROACH AND I JUST GOT
BACK FROM WILMINGTON EVENT
SATURDAY, UPWARDS OF 200 PEOPLE.
THERE ARE ALSO PANELISTS.
THESE ARE THE HEALTH CARE
PROFESSIONALS.
OB/GYNs, MIDWIVES, DOULAS,
WOMEN WITH LIVED EXPERIENCES,
THERE ARE MENTAL HEALTH
THERAPISTS THERE AND THEY ARE
TALKING WITH THE AUDIENCE.
EDUCATING THEM ON HOW TO
ADVOCATE FOR THEMSELVES, GIVING
THEM INFORMATION, FOR EXAMPLE,
ON BLACK BIRTHING BILL OF
RIGHTS, TEACHES WOMEN THEY HAVE
A SAY IN THEIR MEDICAL CARE.
THEY CAN FIRE A DOCTOR THAT
ISN'T LISTENING TO THEM OR
RESPECTING THEM.
IT'S REALLY, REALLY JUST A
WONDERFUL THING TO SEE.
THERE ARE EXHIBITORS SUCH AS
NIAAA BOOTH, AND THEY ALSO HAVE
POP-UP CLINICS, IN CALVERTON,
MARYLAND, FOR EXAMPLE DOING
SONOGRAMS AND VACCINATIONS ON
SITE AT THE CHURCH.
AND THERE'S ALSO WHAT'S
WONDERFUL TO ADDRESS THIS
PROBLEM IS THEY HAVE FINANCIAL
SUPPORT TO REGISTER AND TRAIN
BLACK DOULAS FROM THE COMMUNITY,
AND WILL STAY VESTED IN THE
COMMUNITY AND HELP THOSE WOMEN
THROUGH THE BIRTHING PROCESS.
THE MOM'S LOUNGE, DAD'S DEN AND
KIDS CORNER, THE MOMS WITH BE
WITH WOMEN, DADS WITH OTHER MEN
AND TALK ABOUT THEIR ANXIETY OR
QUESTIONS ABOUT BEING A DAD, AND
THEN VOLUNTEERS IN ANOTHER ROOM
WITH KIDS READING BOOKS TO THEM,
DOING ARTS AND CRAFTS SO MOM AND
DAD WITH ATTEND TO THE LEARNING.
JUST LIKE REGULAR BABY SHOWER,
THEY GET A NICE FREE LUNCH,
THERE'S MUSIC, THERE'S GAMES,
THERE'S RAFFLES, A FUN GREAT
EVENT, SERVING THOSE AT GREATEST
RISK.
THIS IS JUST TO GIVE A SCHEDULE
OF WHERE THE EVENTS HAVE TAKEN
PLACE OVER THE LAST YEAR AND
WHERE THEY ARE GOING TO BE
COMING UP.
I WOULD ENCOURAGE YOU IF YOU CAN
TO GO TO ONE OF THESE EVENTS, IF
IT'S NEAR YOU.
HAPPY TO PROVIDE MORE
INFORMATION.
CAN YOU GO TO THE WEBSITE AND
REGISTER OR JUST WALK IN.
I KNOW THIS IS A BUSY SLIDE BUT
I WANTED TO KIND OF JUST FOCUS
ON THE AGENDA, EACH OF THESE
EVENTS HAS BEEN BASICALLY THE
SAME FORMAT.
THEY GO FROM ELEVEN TO TWO, FOUR
KEY COMPONENTS, ALL HAVE
EXHIBITORS, ALL HAVE A PRESS
CONFERENCE, ALL HAVE TWO
EDUCATIONAL PANELS, ONE FOR
MATERNAL AND MENTAL HEALTH, ONE
FOR MATERNAL OUTCOMES.
SO THE TYPES OF THINGS THEY ARE
TALKING WITH THE WOMEN ABOUT ARE
THINGS LIKE DEPRESSION, THINGS
LIKE HYPERTENSION, THINGS LIKE
PREECLAMPSIA, THINGS LIKE ALL
KINDS OF THINGS, GETTING
YOURSELF A DOULA, GETTING A
MIDWIFE.
AND THERE'S A LOT OF POLITICAL
INVOLVEMENT AS WELL, DIFFERENT
CONGRESSIONAL REPRESENTATIVES,
DIFFERENT STATE AND LOCAL
REPRESENTATIVES ARE THERE.
AND THE PRESS CONFERENCE IS TO
GET AWARENESS OUT ABOUT THIS
ISSUE AND TO EDUCATE EVEN THE
LARGER COMMUNITY FOR THOSE THAT
ARE NOT THERE.
SO WHAT IS NIAAA DOING?
WELL, BASICALLY DR. DEIDRA ROACH
AND I ARE SEARCHING ON THE
EXECUTIVE PLANNING COMMITTEE OF
THESE EVENTS.
THAT MEANS WE SIT ON AS MANY
CALLS AS WE CAN AND THERE CAN BE
UP TO SIX CALLS A WEEK, FOR
THESE EVENTS TO GIVE INPUT ON
MAKING SURE THEY ARE GETTING
PANELISTS, MAKING SURE THEY ARE
THINKING OF DIFFERENT PEOPLE TO
HAVE AS EXHIBITORS AT THESE
EVENTS.
WE ARE BRINGING THE BOOTH TO
SOME OF THESE EVENTS, AND WHEN
WE'RE AT THOSE EVENTS WE'VE BEEN
TO TWO OF THEM SO FAR, WE'RE
TALKING WITH THE ATTENDEES.
WE'RE GIVING OUT OUR MATERIALS.
WE HAVE NIAAA ALCOHOL TREATMENT
NAVIGATOR IPAD THERE AND PEOPLE
HOW TO USE IT AND IDENTIFY WHERE
TO FIND TREATMENT.
OFTEN WE'LL HEAR FROM MOMS, YOU
KNOW, I DON'T DRINK, BUT MY
UNCLE DOES.
OR, YOU KNOW, I DON'T NEED THIS,
BUT MY HUSBAND DOES.
OR MY BOYFRIEND DOES.
AND SO WE'RE GIVING OUT OUR
INFORMATION WITH OUR RESOURCES
AND OUR RESEARCH FINDINGS.
WHEN WE'RE NOT ATTENDING THE
EVENTS, WHAT WE ARE DOING IS
INCLUDING NIAAA INFORMATION ON A
RESOURCE LIST THAT EVERY SINGLE
ATTENDEE GETS.
SO IT WILL TALK ABOUT OUR
INSTITUTE, WILL GIVE INFORMATION
FOR OUR WEBSITE, INFORMATION TO
E-MAIL, INFORMATION TO CALL,
INFORMATION FOR ALL OF OUR
SOCIAL MEDIA.
SO THAT YOU KNOW WHERE THEY CAN
GET THIS INFORMATION.
AND THEN ALSO WE'RE HELPING TO
PROMOTE THE EVENT, USING OUR
COMMUNICATION TO HELP PUSH OUT
THE REGISTRATION FLYERS FOR
THESE EVENTS AND CREATE
AWARENESS FOR THEM.
THIS IS JUST TO SHOW SOME
EXAMPLES OF THE TYPES OF THINGS
WE'RE DISTRIBUTING AT THESE
EVENTS.
IN ENGLISH AND SPANISH, I'VE
ONLY INCLUDED THE ENGLISH HERE.
LASTLY, WHY.
WHY IS THIS IMPORTANT AND HOW
DOES THIS FURTHER OUR GOALS
PARTICULARLY RELATED TO WOMEN
AND GIRLS AND HEALTH
DISPARITIES.
I THINK IT'S OBVIOUS, YOU KNOW,
THIS EXTENDS THE REACH OF WHAT
WE'RE DOING TO MINORITY WOMEN
AND DADS AND CHILDREN IN
COMMUNITIES WHERE THEY LIVE,
WHERE THERE'S HEALTH
DISPARITIES, AND, YOU KNOW,
WHERE THEY MIGHT NOT OTHERWISE
BE GETTING THIS INFORMATION.
IT GENERATES PUBLICITY AND
CREATES AWARENESS FOR NIAAA AND
OUR WORK.
IT PROMOTES OUR RESEARCH
FINDINGS.
IT IMPROVES ACCESS TO OUR
INFORMATION.
WE'RE ALSO SHOWING FOR EXAMPLE
THE DELAWARE SITE I HAD MY
LAPTOP SHOWING THE HEALTH CARE
PROVIDERS THERE THE CORE
RESOURCE BECAUSE THERE ARE
DOULAS, NURSES, MIDWIVES THERE
THAT DON'T KNOW ABOUT THIS.
I WAS GOING THROUGH IT WITH
THEM.
IT ALSO FOSTERS RELATIONSHIP
BUILDING AND GOODWILL AMONG
OTHER PARTNERS, THESE ARE WITH
OUR OTHER EXECUTIVE PLANNING
COMMITTEE MEMBERS, COMMUNITY
GROUPS AND MEMBERS, THE OTHER
EXHIBITORS, THE OTHER
VOLUNTEERS.
I WAS JUST MENTIONING THAT
HAVING BEEN THERE ON SATURDAY,
WE HAD TWO PEOPLE FROM THE
WILMINGTON DEPARTMENT AND REC,
TELL US WE'RE HAVING ANOTHER
EVENT IN AUGUST, WE WANT YOU TO
COME BACK WITH YOUR NIAAA BOOTH.
I THINK THESE ARE JUST
WONDERFUL.
THIS NEXT SLIDE I WANTED TO
SHARE BECAUSE THESE ARE FLYERS,
WHAT GETS SENT OUT TO INVITE
PEOPLE TO REGISTER.
WHAT REALLY, REALLY IMPRESSES ME
ABOUT THIS INITIATIVE IS THAT
THEY REALLY COMMUNICATE TO THE
AUDIENCES THEY ARE TRYING TO
REACH.
FOR EXAMPLE, WHEN THEY WENT TO
BOSTON THERE WAS A LARGE HAITIAN
CREOLE POPULATION.
IN ADDITION TO ENGLISH AND
SPANISH THEY HAD EVERYTHING
TRANSLATED IN HAITIAN CREOLE.
YOU CAN SEE RESOURCES AND PRIZES
WOMEN GET, LIKE A BABY SHOWER.
THEY HAVE TO VISIT EACH BOOTH,
GET IT CHECKED OFF, GET PRIZEs
AT THE END.
THEY ARE GETTING CAR SEATS, BOPY
PILLOWS, STROLLERS, DIAPERS,
WIPES, PRACTICAL THINGS.
I'D LIKE TO THANK MY ESTEEMED
COLLEAGUES LISTED HERE AND SHOWN
HERE WHO VOLUNTEERED THEIR
SATURDAY TO COME OUT FOR THE
CALVERTON, MARYLAND, EVENT.
I'M SURE THEY COULD ALSO SHARE
THEIR EXPERIENCES OF HOW THIS
WAS BUT YOU CAN SEE IT WAS IN A
BALLROOM.
WE WERE ON THE PERIMETER OF THE
BALLROOM.
THAT'S WHERE THE EVENT TOOK
PLACE.
HERE ARE SOME ADDITIONAL PHOTOS
OF THAT EVENT.
YOU CAN SEE THE PANELISTS UP
TOP, SPEAKING WITH THE AUDIENCE.
YOU CAN SEE SOME OF THE
ENGAGEMENTS, DR. ROACH SHOWING A
PARTICIPANT, A DAD, HOW TO USE
ALCOHOL TREATMENT NAVIGATOR
WEBSITE.
WE IDENTIFIED AT THE LAST MINUTE
WHEN A NEED CAME UP AN EXPERT
SPEAKER FROM HOPKINS, A NURSE
MIDWIFE, WHO SPOKE ON THE PANEL
FOR THIS EVENT.
AND FINALLY IN SUMMARY THESE ARE
REALLY IMPORTANT AND IMPACTFUL
EVENTS THAT ARE TARGETING A HIGH
PRIORITY AREA FOR THIS
ADMINISTRATION.
AND OUR ABILITY IS REALLY
UNIQUE.
OUR ABILITY TO PARTICIPATE IN
THESE, AS I MENTIONED, WE'RE THE
ONLY NIH INSTITUTES
PARTICIPATING, BASED ON PRIOR
RELATIONSHIP WITH DR. ENGLISH
AND THAT OFFICE.
INEXPENSIVE, STAFF TIME, AND
PARTNERING WITH DEPARTMENT OF
HEALTH AND HUMAN SERVICES WITH
APPROVAL FROM THE WHITE HOUSE.
OUR INVOLVEMENT ALLOWS US TO
EXPAND OUR AWARENESS AND
EDUCATION AND OUTREACH
ACTIVITIES, TO HIGH PRIORITY
POPULATION AND THESE ARE IN
URBAN AND RURAL SITES ADDRESSING
HEALTH DISPARITIES AND MATERNAL
MORBIDITY AND MORTALITY PROBLEM.
PARTICULARLY IN MINORITY
AUDIENCES, AND ONE OF THE KEY
MESSAGES WE TRIED TO GET TO THE
WOMEN WHEN WE HAVE THEIR
ATTENTION AT THE TABLE IS THAT
THERE'S NO SAFE LEVEL OF ALCOHOL
FOR WHEN YOU'RE PREGNANT.
WE ONLY HAVE A FEW SECONDS.
AND THEN THIS JUST ALLOWS US TO
SHARE OUR IMPORTANT RESOURCES
WITH, YOU KNOW, HUNDREDS,
HUNDREDS OF PEOPLE.
I WOULD LIKE TO THANK THE
INDIVIDUALS LISTED HERE WHO HAVE
BEEN A GREAT SUPPORT TO THIS
PROGRAM AND/OR HAVE PARTICIPATED
IN THIS INITIATIVE.
AND LASTLY JUST A PARTING
THOUGHT OF MY OWN, WHEN I WAS AT
THE CALVERTON, MARYLAND, EVENT,
IN THE BALLROOM I SAW IT FILLED
WITH BLACK AND BROWN WOMEN.
AND IT REMINDED ME TO 30 YEARS
AGO WHEN I WAS A PEACE CORPS
VOLUNTEER IN GABON.
I'LL SPARE YOU THE FRENCH
PRONUNCIATION.
THERE'S A PROVERB WHEN WORKING
IN WOMEN IN DEVELOPMENT IN
AFRICA, NOT A PROVERB, JUST A
PHRASE.
IT IS TO TEACH A WOMAN IS TO
EDUCATE A NATION.
AND THIS IS REALLY WHAT I FELT
WHEN I SAW ALL THOSE WOMEN IN
THAT BALLROOM.
THANK YOU.
[SPEAKING FRENCH].
>> MERCI.
>> JOAN, THAT WAS GREAT.
SERIOUSLY, I WANT EVERYBODY TO
KNOW HERE THAT THIS WAS A
PROGRAM THAT CAME UP FROM THE
PROGRAM OFFICERS, THIS CAME FROM
JOAN AND D.E.I.DRA, CERTAINLY
NOT MY IDEA, AND I THINK IT'S A
WONDERFUL IDEA.
AND WE'RE ALWAYS TALKING ABOUT
HOW TO SCALE UP SOME OF THESE
THINGS.
AND I MEAN, JOAN, DO YOU HAVE
ANY THOUGHTS ON HOW WE COULD
CONNECT THIS, YOU KNOW, SHOULD
WE PRESENT TO OUR ALCOHOL
CENTERS ACROSS THE NATION?
I MEAN, YOU KNOW, ANY THOUGHTS
YOU HAVE ON HOW WE COULD
ACTUALLY GET MORE ENGAGEMENT
FROM OUR ALCOHOL COMMUNITY?
WHAT ABOUT RFAs, SHOULD -- I'M
HAPPY TO PUT SLIDES IN MY TALK
THIS YEAR, ALTHOUGH LAURA
LEONARDI MIGHT KILL ME BECAUSE
WE'RE STARTING TO PACK THINGS IN
THERE.
WHAT DO YOU THINK?
>> I THINK IT WOULD BE
WONDERFUL.
OBVIOUSLY NOW THE INITIATIVE
GOES UNTIL NOVEMBER 23.
I SAID 36 CITIES AND SHOWED 35.
THAT'S BECAUSE WE'RE CURRENTLY
DISCUSSING ADDING ANOTHER SITE
WHICH I DON'T HAVE THAT INFO
YET.
I I DON'T KNOW IF WE'LL GET
FUNDING TO CONTINUE BUT IF
THERE'S ANYTHING WE CAN DO WHILE
IT'S STILL HAPPENING, THERE ARE
OTHER SHOWERS, THAT WOULD BE
WONDERFUL.
ANYTHING WE CAN DO TO GET THE
WORD OUT THERE WOULD BE
WONDERFUL.
ONE OF THE THINGS I KEEP
THINKING OF HOW CAN WE MAXIMIZE
THE UTILITY OF THESE EVENTS FOR
OTHER THINGS LIKE WE WERE
TALKING ABOUT COULD WE HAVE
SOMEONE DOING SCREENING AND
BRIEF INTERVENTION REFERRAL TO
TREATMENT THERE?
COULD WE HAVE INFORMATION ABOUT
CLINICAL TRIALS THERE?
AND PARTICIPATION.
I JUST THINK THESE ARE A
WONDERFUL VEHICLE FOR US TO
REACH REALLY IMPORTANT AUDIENCE
AND WE SHOULD TRY TO MAXIMIZE,
YOU KNOW, THE OPPORTUNITY.
>> A LOT OF QUESTIONS,
CLARIFICATION, WHO IS FUNDING
THIS?
IS HHS AND WHAT DEPARTMENT?
>> YOU SAW THE PARTNERS LISTED
THERE.
IT'S A LOT.
SOME OF THESE ARE ACTUALLY
RELIGIOUS GROUPS.
LIKE WORLD VISION AND LATTER DAY
SAINTS.
JUST SERVE ORGANIZATION IS
ANOTHER -- I BELIEVE IT'S A
RELIGIOUS ORGANIZATION BUT THEY
ARE RECRUITING ALL OF THE
VOLUNTEERS FOR, YOU KNOW, ALL
THE SHOWERS ACROSS THE COUNTRY.
THAT'S THE PART THEY ARE DOING.
THERE'S ALSO DIFFERENT NGOs
AND LOCAL GROUPS.
I COULDN'T LIST THEM ALL.
IT DOES VARY BY LOCATIONS THAT
ALSO PROVIDE SUPPORT.
>> DAVID?
>> YEAH, JUST ACTUALLY ON A
RELATED NOTE, OBVIOUSLY THERE'S
A LOT TO BE GAINED AT AN
IN-PERSON EVENT LIKE THIS BUT
SINCE IT IS LIMITED IN CITIES I
WONDER IS THERE AN ADAPTABLE
VERSION THAT COULD HAPPEN
REMOTELY SO CHURCH GROUPS ACROSS
THE COUNTRY AT ONE GIVEN TIME
MIGHT BE EXPOSED TO THE
EDUCATIONAL COMPOUNDS OF IT?
>> IT'S A GREAT IDEA.
WE CAN BRING IT UP TO REVEREND
ENGLISH AND HER TEAM.
MAYBE IT'S RECORDING PANEL
DISCUSSIONS AND DOING VIRTUAL
BABY SHOWERS.
GREAT IDEA, THANK YOU.
>> ALONG THE SAME LINES, JOAN,
THAT WAS FANTASTIC.
>> THANK YOU.
>> THAT YOU'VE DONE THAT.
JUST AMAZING.
I CAN ENVISION WHENCE YOU LEAVE
THEY ARE THINKING, WELL, OKAY,
200 OTHER PREGNANT WOMEN WOULD
LIKE TO COME NEXT WEEK AND DO
THE SAME THING.
WONDERING WHEN YOU IDENTIFY A
CITY AND FIND PARTNERS IN THE
CITY TO HELP YOU PUT THIS ON
COULD YOU KIND OF PACKAGE THAT
TO SAY, OKAY, YOU GUYS CARRY
THIS FORWARD?
AND DO IT?
YOU KNOW, EVERY THREE MONTHS,
EVERY SIX MONTHS, WHATEVER.
SO THAT YOU COULD MAYBE EXTEND
YOUR REACH BEYOND YOUR TOUR?
>> I THINK THAT'S A WONDERFUL
IDEA AS WELL.
I WILL SAY, YOU KNOW, SO
BASICALLY THE INITIATIVE ITSELF
HAD ALREADY BEEN WRITTEN BY
REVEREND DR. Q ENGLISH.
WHEN I LEARNED FROM HER SHE WAS
WAITING FOR DEPARTMENTAL AND
WHITE HOUSE APPROVAL.
SO WE WEREN'T REALLY IN ON THAT
STAGE OF IT.
WE JOINED THE EXECUTIVE PLANNING
COMMITTEE AFTER THAT.
BUT I THINK THAT'S A GREAT IDEA
AND ONE OF THE THINGS DEIDRE AND
I AS AN EXAMPLE THIS PAST
SATURDAY IN WILMINGTON, WHEN WE
GIVE INFORMATION TO PEOPLE
BECAUSE WE HAVE THAT CAPTIVE
AUDIENCE THEY HAVE TO GET OUR
SIGNATURE ON THEIR BINGO CARD
BEFORE THEY GET THEIR PRIZES.
WE TRY TO SAY, YOU KNOW, PLEASE
BE AN AMBASSADOR FOR THIS
INFORMATION IN YOUR COMMUNITY
WITH YOUR FAMILY, ET CETERA.
SO WE'RE TRYING TO EXTEND IT
THAT WAY, AND YEAH, HAVING
FURTHER INROADS.
THERE'S A LOT OF I WOULD SAY
POLITICAL SUPPORT FOR THIS.
AND SO, YOU KNOW, THOSE PEOPLE
ARE DOING THAT KIND OF WORK AT
THAT LEVEL IN DIFFERENT STATES
AND LOCALITIES.
>> IT'S JUST A FANTASTIC
PROJECT, VERY IMPRESSED.
AND I REALLY SEE NIAAA THAT'S AN
IMPORTANT ROLE TO PLAY IN TERMS
OF JUST THAT NIAAA CARES DEEPLY
ABOUT THESE KINDS OF ISSUES OF
THE I WAS WONDERING -- THE
PROGRAM FOCUSES ON GIVING --
HELPING WOMEN ADVOCATE FOR
THEMSELVES.
THAT'S ONE ASPECT, RIGHT?
I DO WONDER HOW WELL -- THE
OTHER SIDE IN TERMS OF THE
PROVIDER SIDE, RIGHT?
WHAT CAN NIAAA NIMHD DO TO
REALLY ALSO KIND OF HIGHLIGHT
THOSE KINDS OF FACTORS THAT
AFFECT MATERNAL HEALTH OUTCOMES
PARTICULARLY IN BLACK WOMEN, SO
PROVIDER BIAS, RIGHT?
>> YEAH.
>> A NUMBER OF DEATHS DUE TO
HYPERTENSION, HOW MUCH EDUCATION
DO PROVIDERS HAVE AROUND THAT
PARTICULAR LINK?
SO I DON'T KNOW IF THAT'S A ROLE
IN TERMS OF PARTNERSHIP ROLE,
NIMHD, BUT REALLY THINKING ALSO
ABOUT THOSE SYSTEMIC KINDS OF
FACTORS AS WELL THAT KIND OF
DEEPLY AFFECT MATERNAL OUTCOMES.
>> ABSOLUTELY.
I GRABBED -- I WENT AROUND ON
SATURDAY AND PULLED SOME
INFORMATION AND, YOU KNOW, JUST
RIGHT NEXT TO US ONE OF THE
BOOTHS HAD THE BLOOD PRESSURE
STUFF AND HYPERTENSION STUFF.
AND LINKING THEM TO SERVICES,
SOME OF THESE WOMEN, YOU KNOW,
THEY ARE DEPENDING ON THE
LOCATION EITHER GETTING SIGNED
UP FOR FEDERAL GOVERNMENT
SERVICES FOR FOOD ASSISTANCE OR
OTHER HEALTHY START IS THERE.
YOU KNOW, YOU SAW ACRONYMS FOR
OTHER FEDERAL AGENCIES,
ASSOCIATION FOR CHILDREN AND
FAMILIES, HRSA, SAMHSA, ET
CETERA.
SO THERE'S DEFINITELY PLUGGING
THEM INTO DIFFERENT SERVICES,
DEPENDING ON INCOME AND
EVERYTHING ELSE, BUT YOU'RE
RIGHT, LIKE PHYSICIANS AND
OTHERS ALSO NEED TO BE PART OF
THE SOLUTION.
I THINK .
>> OTHERWISE IT PUTS THE BURDEN
ON THE WOMEN SO PROVIDERS, THAT
EDUCATION AS WELL.
TO BE AROUND ALCOHOL USE AS
WELL.
>> YEAH.
THAT'S WHY I ALSO LOVED LIKE I
PICKED UP THIS, YOU KNOW, BLACK
BIRTHING BILL OF RIGHTS THAT THE
NATIONAL ASSOCIATION TO ADVANCE
BLACK BIRTH WAS THERE.
AND, YOU KNOW, WOMEN COULD GET
THOSE AND HAVE THIS WITH THEM
AND THE WOMEN ARE REALLY
ENCOURAGED TO CONSIDER, YOU
KNOW, HAVING A MIDWIFE, CONSIDER
USING A DOULA, ET CETERA.
SO THESE ARE THINGS THAT MAYBE
THEY DIDN'T EVEN KNOW WHY --
WERE AVAILABLE TO THEM BEFORE.
I LOVE THEY ARE TRAINING AND
CERTIFYING DOULAS FROM THOSE
COMMUNITIES VESTED AND COMMITTED
TO THOSE COMMUNITIES AND WILL
STAY IN THOSE COMMUNITIES
WORKING WITH THOSE WOMEN AND
FAMILIES.
>> WE DO HAVE A HEALTH SERVICES
DIVISION, RIGHT?
>> YES, WE DO.
LAURA KWAKO IS IN THE BACK.
SHE'S OUR BRANCH CHIEF.
I'LL MENTION LAURA HAS DONE A
GREAT JOB OVER THE PAST COUPLE
YEARS OF ADVANCING HEALTH
SERVICES.
YOU KNOW, FUNDING SOME REALLY
IMPORTANT STUDIES ONE OF OUR
IMPORTANT MISSIONS IS TO GET
EVIDENCE-BASED TREATMENTS OUT TO
THE PUBLIC.
YOU KNOW, THAT SHOULD BE ONE OF
OUR TOP AREAS THAT WE SHOULD DO.
IT'S REALLY HARD WHEN YOU SEE
SOMEBODY YOU CARE ABOUT, THEY
ARE GETTING TREATMENT BUT IT'S
NOT STATE-OF-THE-ART TREATMENT.
THEY ARE NOT GETTING THE
TREATMENT THEY SHOULD BE
GETTING.
WHAT IS IT TO GET RESEARCH
EVIDENCE-BASED TREATMENT IS
NOBODY'S USING THEM?
AND SO THAT'S SOMETHING THAT'S
VERY IMPORTANT TO US AND WE NEED
TO GET OUT TO THE COMMUNITY.
IT'S GOING TO BE CHALLENGING TO
GET THIS OUT BECAUSE I DON'T
KNOW ANY OTHER COMPLEX DISEASE
THAT GETS LESS TREATMENT THAN
WITH ALCOHOL USE DISORDER.
SO WE HAVE A BIG CHALLENGE BUT
WE ARE MAKING PROGRESS.
AND IT DOES TAKE A VILLAGE.
ANY WAY THAT WE CAN GET THIS
INFORMATION OUT WE'RE GOING TO
DO IT.
>> OKAY.
THAT'S A GOOD SEGUE TO WHAT
WE'RE SUPPOSED TO BE DOING NEXT.
THANK YOU, AGAIN, JOAN.
IS EVERYBODY IF WE JUST CONTINUE
TO THE END?
WE DON'T HAVE THAT MUCH TO DO.
PHILIPPE WANTED TO KNOW WHETHER
WE NEEDED A SHORT BREAK BUT I
THINK WE'RE GOOD.
WHAT ARE WE DOING NEXT?
>> DISCUSSION.
>> IT'S MY DISCUSSION, YEAH.
THE FOCUS DISCUSSION.
SO I JUST THREW THESE OUT
LITERALLY, TRISH AND I WROTE
THESE IN LESS THAN THREE
MINUTES, THERE'S NOTHING CAST IN
STONE HERE, DIDN'T HAVE TO DO
ANY HOMEWORK.
IF YOU DID SOME HOMEWORK, THAT'S
FINE.
BUT I JUST WANTED TO HAVE SOME
TIME SET ASIDE AT COUNCIL FOR
ANYTHING THAT COMES TO YOUR
HEADS THAT YOU WANT TO TALK
ABOUT BASICALLY.
THEY ARE DOING THIS NOW AT THE
INSTITUTE DIRECTORS' MEETINGS,
SO MONICA GOT, OUR FEARLESS
LEADER, GOT UPSET BECAUSE
SOMEONE KEPT GOING ON AND ON AND
ON ABOUT VERY DETAILED
INFORMATION IN SLIDES, CUTTING
INTO OUR RAISE YOUR HAND AND SAY
WHATEVER YOU WANT SESSION AT THE
INSTITUTE DIRECTORS MEETING.
I WANT TO DO IT HERE TOO.
I HAD FOUR THINGS, ALCOHOL AS A
FIFTH VITAL SIGN, ALCOHOL
PATHOLOGY -- TRISH REMINDED ME
ALCOHOL IS FIFTH VITAL SIGN, NOT
ALCOHOL USE DISORDER.
WE OFTEN PUT ALCOHOL USE
DISORDER IN THERE BUT THERE'S A
LOT IN BETWEEN ALCOHOL AND
ALCOHOL USE DISORDER.
ALCOHOL PATHOLOGY AND TREATMENT,
SAME.
ALCOHOL AND WOMEN, AND ALCOHOL
AND AGING.
AND TOMORROW I WILL IN THE CRAN
TALK AT LEAST HAVE ONE SLIDE ON
ALCOHOL AND WOMEN, ALCOHOL AND
AGING.
I THINK YOU'RE ALL AWARE BUT
THERE WILL BE A SLIDE ON THIS
TOMORROW.
YOU'RE ALL AWARE WOMEN NOW IN
THE COLLEGE-AGE RANGE ARE BRINGE
DRINKING MORE THAN MEN, AND
DRINKING MORE THAN MEN FOR THE
FIRST TIME EVER.
CROSSOVER OCCURRED ABOUT --
RIGHT AT THE BEGINNING OR PEAK
OF THE PANDEMIC.
THREE YEARS AGO, THREE OR FOUR
YEARS AGO.
AND THAT'S WHERE -- I MEAN THE
LINES WERE WEDY TO CROSS OVER
BUT THEY SEEM TO HAVE BEEN
ACCELERATED IN CROSSING OVER.
ONE OF THE BIGGEST ISSUES I
ALREADY RAISED TODAY, I'LL RAISE
THE FIRST PART, WHAT YOU HEARD
FROM JOAN.
I MEAN, PEOPLE DO NOT HAVE THE
INFORMATION THEY NEED TO MAKE
PROPER DECISIONS ABOUT THEIR USE
OF ALCOHOL.
IT'S JUST FLAT OUT A BIG
PROBLEM.
AND IT RANGES FROM EVERYTHING
FROM KNOWING WHAT THE DIETARY
GUIDELINES ARE, KNOWING WHAT A
STANDARD DRINK IS, TO KNOWING
THAT THERE ARE MEDICATIONS AND
BEHAVIORAL TREATMENTS THAT ARE
QUITE EFFECTIVE FOR TREATING
ALCOHOL USE DISORDER, MUCH LESS,
YOU KNOW, LIVER DISEASE,
PANCREATITIS, CANCER, THE WHOLE
NINE YARDS.
SO IT'S -- THE FIRST TOPIC,
ALCOHOL AS FIFTH VITAL SIGN,
SIMPLY, YOU KNOW, I'M SURE LAURA
AND RAYE WILL CORRECT ME ON THIS
BUT AT THE INTEGRATED ALCOHOL
USE DISORDER LIVER DISEASE
MEETING WE HAD, YOU KNOW,
SOMEBODY MENTIONED THEY COULD DO
A BRIEF INTERVENTION IN TWO
MINUTES.
YOU KNOW, IN THE DOCTOR'S
OFFICE.
WHEN I RAISED THESE KIND OF
ISSUES AT HOWARD UNIVERSITY A
MONTH OR SO AGO WHEN I GAVE A
TALK THERE, THE LADY, WHO IS A
DOCTOR, WHO WAS IN CHARGE OF
TRAINING PRIMARY CARE, YOU KNOW,
SO, YOU KNOW, WAS BASICALLY
THROWING UP HER HANDS IN FRONT
OF THE CHAIR OF PSYCHIATRY
SAYING WHERE ARE WE GOING TO
FIND THE TIME TO DO THIS IN
MEDICAL SCHOOL EDUCATION?
OR IN PRIMARY CARE DOCTOR'S
OFFICE?
AND, YOU KNOW, THAT'S A
CHALLENGE THAT WE'RE WORKING ON.
WE ARE STARTING TO WORK ON
TAKING THE HEALTHCARE
PROFESSIONAL CORE RESOURCE AND
MAKING A 30-MINUTE PRESENTATION
FOR MEDICAL SCHOOLS.
SO WE'RE WORKING ON THAT.
MANY NEXT COUNCIL WE'LL HAVE
SOMETHING TO TALK ABOUT.
WE STILL HAVE A BIGGER PROBLEM.
YOU KNOW, I WAS THINKING WHEN
JOAN WAS TALKING WE COULD USE
SOCIAL MEDIA TO GET THIS OUT
THERE.
BUT IT HAS -- YOU WOULD ALMOST
NEED A TEAM, JOAN, THAT WOULD GO
FROM CITY TO CITY IN THE UNITED
STATES AND DO WHAT WAS IT OBAMA
USED TO DO, LOCAL ORGANIZATIONS
OR COMMUNITY -- COMMUNITY --
COMMUNITY ORGANIZING, YEAH, IT'S
A POLITICAL TERM.
LET'S TURN IT INTO A HEALTH
TERM.
WE COULD DO COMMUNITY
ORGANIZING.
BUT WHO IS GOING TO GIVE US THE
MONEY TO SEND A SWAT TEAM TO
EVERY CITY IN THE UNITED STATES,
TO DO COMMUNITY ORGANIZING?
THAT'S MY SOLILOQUY.
I'LL STOP THERE AND LET'S HEAR
FROM THE REST OF YOU.
KATIE?
>> YEAH, THANKS, GEORGE, FOR
HAVING THIS TIME FOR US.
I ALSO WANTED TO FOLLOW UP ON
THE MOMS TOUR, IT FEEDS INTO
THIS.
I THINK THERE'S A LOT OF
OPPORTUNITIES THAT WE DON'T TAP
INTO WITH RESPECT TO -- WE HAVE
UNIVERSITIES AROUND THE COUNTRY,
AROUND THE WORLD, THAT HAVE
UNDERGRADUATE, GRADUATE, HEALTH
PROFESSIONAL STUDENTS INTERESTED
IN BEING ENGAGED IN THEIR
COMMUNITIES.
AND MIGHT NOT HAVE THE TOOLS OR
RESOURCES TO BE ENGAGED.
AND I'M REALLY EXCITED THAT MOMS
TOUR IS COMING TO ALBUQUERQUE
AND WE WILL SIGN UP.
YOU CAN SIGN UP TO BE AN
EXHIBITOR FOR FREE, YOU CAN
VOLUNTEER.
THESE SEEM LIKE GREAT
OPPORTUNITIES THAT I WONDER IF A
SMALL INVESTMENT FROM NIAAA
WOULD BE CREATING A TRAINING
PROGRAM FOR NIAAA AMBASSADORS
THAT WOULD BE UNDERGRADUATE,
GRADUATE HEALTH PROFESSIONAL
STUDENTS ACROSS THE U.S., ACROSS
THE WORLD, WHO COULD GO TO
EVENTS LIKE THIS AND TABLE AND
BE EXHIBITORS AND VOLUNTEER.
A LOT OF PEOPLE WANT TO GIVE
BACK.
THEY JUST DON'T KNOW WHERE OR
HOW OR HAVE THE RESOURCES TO DO
SO.
MIGHT NOT HAVE THE TRAINING TO
DO SO.
SO CREATING A PROGRAM LIKE THAT
WHERE PEOPLE COULD GET, YOU
KNOW, THAT OPPORTUNITY, THOSE
OPPORTUNITIES, AND ALSO, YOU
KNOW, SOMETHING ON THEIR CV THEY
ARE ENGAGING WITH ONE OF THE
NATIONAL INSTITUTES OF THE
HEALTH.
I THINK THAT WOULD BE A WAY TO
MAY BE -- MAKE THE MONEY GO
FURTHER AND TRAIN THE NEXT
GENERATION, WHICH IS ALSO
IMPORTANT.
>> I LIKE THAT.
I TAUGHT UNDERGRADUATE AT UCSD
FOR 40 YEARS, YOU CAN DO THE
SAME THING IN MEDICAL SCHOOLS
FOR UNDERGRADUATES RIGHT DOWN
THE LINE.
YOU KNOW.
SOMEBODY COULD BANG IT INTO
THEIR NEUROSCIENCE COURSE OR
MENTAL HEALTH COURSE, PSYCHOLOGY
DEPARTMENT.
>> PRE-MED CURRICULUM, ALL
RIGHT?
YOU COULD ENCOURAGE THE
PRE-MEDS.
THAT'S A WAY OF GETTING THEM
EVEN FURTHER UPSTREAM.
>> TO ADD TO WHAT KATIE SAID, I
CAN TALK TO YOU OFFLINE, JOAN,
AN ISSUE IN PREGNANCY, THE
MESSAGE IS NO AMOUNT OF ALCOHOL
IS SAFE IN PREGNANCY BUT WHEN
YOU'RE TALKING TO PREGNANT WOMEN
MANY HAVE ALREADY CONSUMED
ALCOHOL.
IT'S A MORE NUANCED DISCUSSION.
WE HAVE TO GET THE INFORMATION
OUT THERE AND HAVE RESOURCES
THAT ALLOW THEM TO TALK TO
SOMEBODY ABOUT WHAT'S ALREADY
HAPPENED.
I THINK IT'S IMPORTANT TO
PARTNER WITH GROUPS THAT CAN
PROVIDE THAT KIND OF ONE-ON-ONE
NUANCED CONVERSATION AND I THINK
NIAAA COULD REALLY FACILITATE
THAT.
>> YEAH, JUST THAT THE TIME
ISSUE REALLY IS IMPORTANT.
I KNOW MOST OF THE PEOPLE IN MY
DEPARTMENT ARE PHYSICIANS AND IN
PRIMARY CARE I KNOW THAT JUST
THE APPRECIATE TO SEE HIGH
NUMBERS OF PATIENTS WITH
DROPPING REIMBURSEMENT AND DOING
IT VERY QUICKLY AND BEING
EXTREMELY FOCUSED ON THE PROBLEM
I THINK A LOT OF PEOPLE APPROACH
THOSE FOLKS AND SAY, HEY, CAN
YOU DO THIS, CAN YOU DO THAT?
THEIR ANSWER IS NO.
I'VE GOT ENOUGH TO DO AS IT IS.
SO I THINK THE KEY PROBABLY IS
FIGURING OUT HOW TO WORK IT IN
OUTSIDE OF THE PHYSICIAN.
AND WITH SOME OF THE SUPPORT
STAFF.
>> I DO THINK THEY HAVE THE TIME
TO DO IT.
WE OUTLINED THIS VERY CLEARLY IN
THE CORE RESOURCE BUT THE KEY IS
THAT THEY GOT TO WANT TO DO IT.
THAT WE HAVE TO SHOW THEM IT
WILL HELP THEIR PRACTICE.
IF SOMEBODY COMES IN WITH A HIGH
BLOOD PRESSURE AND STUFF, FOR
THEM TO KNOW WHETHER OR NOT THEY
HAVE BEEN DRINKING AND DO A
BRIEF INTERVENTION, THAT'S PART
OF THE THERAPY THEY ARE GIVING.
IF THEY DON'T ADDRESS THAT, MOST
AREN'T ADDRESSING THAT, YOU TRY
TO TREAT THE BLOOD PRESSURE BUT
THEY ARE STILL DRINKING, OR THE
LIVER DOCTORS.
YOU KNOW, WE'RE BEGINNING AT
LEAST THE RESEARCHERS AND LIVER
DOCTORS BEGINNING TO REALIZE,
HEY, WE NEED TO DO SOMETHING
ABOUT THEIR DRINKING TO REALLY
TREAT THE LIVER DISEASE.
SO IT'S REALLY IMPORTANT THAT
THEY -- THAT THIS IS GOING TO
BENEFIT THEM.
THIS IS NOT AN EXTRA LAYER FOR
THEM OR EXTRA WORK.
THIS IS SOMETHING THAT IS GOING
TO HELP THEM IN THEIR PRACTICE.
THAT'S THE MESSAGE WE HAVE TO
GET ACROSS.
>> YOU DON'T HAVE TO CONVINCE ME
BUT I THINK THE COMPETITION FOR
THEIR TIME AND ATTENTION IS
REALLY INTENSE AND I THINK IT
HAS TO -- YOU KNOW.
>> YEAH, I ALSO HAD A FOLLOW-UP
ON DAVID'S COMMENT WHICH IS THAT
WE FINALLY AFTER TWO YEARS GOT
THE AUDIT-C INTO THE ELECTRONIC
HEALTH RECORD.
AND NOW WE HAVE ONE YEAR
EXPERIENCE WITH IT.
SO THERE ARE OVER 500 NURSES
THAT HAD TO BE TRAINED IN DOING
THE AUDIT-C AND WE DID A
QUESTIONNAIRE AS TO HOW WELL IT
WORKED.
100% OF THESE 500 NURSES SAID
THAT IT WAS WORTHWHILE TO DO THE
AUDIT-C.
BY THE WAY, LAURA GOT THIS INTO
THE "ALL OF US" PHENOTYPING
QUESTIONNAIRE, SHE WAS
INSTRUMENTAL IN DOING THAT.
WE'VE DOUBLED THE NUMBER OF
ADDITION CONSOLE REFERRALS,
THERE HAVE BEEN PROBABLY --
WE'RE STILL DEBATING PROCESSING
THE NUMBERS, WE DON'T WANT TO
COUNT PEOPLE TWICE BUT IT SEEMS
THERE WERE 70 OR 80 NIH CLINICAL
CENTER PATIENTS WHO WERE ABOVE
THE AUDIT-C THRESHOLD.
I THINK THAT SCORE IS ABOUT SIX.
THE KEY THING IS THAT IT'S
ADMINISTERED ON ADMISSION BY THE
NURSES, AND NOT BY A PHYSICIAN
OR A PHYSICIAN PRACTITIONER.
IT GOES RIGHT INTO THE
ELECTRONIC HEALTH RECORD.
>> YES, THAT'S GREAT.
CONCEPTUALLY HOW WOULD ALCOHOL
AS A FIFTH VITAL SIGN BE
SEPARATE AND DISTINCT FROM THE
AUDIT-C?
>> THAT'S IT.
IT'S THREE QUESTIONS, IT'S JUST
THREE QUESTIONS.
AND IT'S EXECUTED IN ABOUT TWO
MINUTES.
>> IT WOULDN'T NECESSARILY.
I'M VERY UNPOPULAR WITH MY
FELLOW I.C. DIRECTORS BECAUSE I
TRY TO GET THE AUDIT-C INTO
EVERY COHORT AT NIH.
SO THEY DON'T WANT TO HEAR IT
ANYMORE BUT DO PUT IT IN THERE.
I SO I THINK YOU ALL AS
RESEARCHERS COULD START LOOKING
AT -- EVEN AT HEART LUNG AND
NEUROLOGY, YOU MIGHT FIND ACTUAL
NUMBERS THERE.
YOU WERE LOOKING ON THE WEBSITE
OR QUERYING ONE OF THE PROGRAM
OFFICERS.
>> THE OTHER THING I'D LIKE TO
ADD IS WE RAN -- WE DID THE
RECEIVER OPERATING CURVE AGAINST
SEVEN OR EIGHT HUNDRED
INDIVIDUALS WHO WE STUDIED UNDER
OUR NATURAL HISTORY PROTOCOL.
AND SO IT'S A DATASET THAT'S
ABOUT 60% AUD AND 40% SOMETHING
ELSE.
THE AREA UNDER THE CURVE WAS
.95.
SO, JUST THESE THREE QUESTIONS
PRETTY RELIABLY TELL YOU WHETHER
SOMEBODY HAS AN ALCOHOL PROBLEM.
>> AND AS YOU KNOW, A LOT OF
TIMES YOU GO TO THE DOCTOR, FILL
OUT THESE FORMS AHEAD OF TIME.
THOSE COULD BE FILLED OUT AHEAD
OF TIME FOR THEM TO LOOK AT.
SO IT WOULDN'T TAKE ANY OF THEIR
TIME.
>> THE JUSTIFICATION FOR IT TO
BE A VITAL SIGN IS THE YIELD.
THERE ARE A LOT OF THINGS THAT
YOU GET ASKED ABOUT WHEN YOU GO
TO THE DOCTOR, THE ANSWER IS
ALWAYS NO.
AND SO HERE'S A QUESTIONNAIRE
WHERE THE ANSWER REALLY SHOULD
BE YES, QUITE OFTEN, GIVEN THAT
THE ONE-YEAR PREVALENCE OF AUD
IS ABOUT 10% SO VERY HIGH YIELD.
AS I THINK YOU JUST SAID, IT
AFFECTS EVERYTHING ELSE A
PHYSICIAN MIGHT BE WANTING TO
DO, DRUGS THEY ARE PRESCRIBING,
INTERPRETING LAB TEST RESULTS,
SYMPTOMS THE PATIENT IS
EXPERIENCING, EVERYTHING.
>> YOU KNOW, NORTHERN CALIFORNIA
HAS ALL THEIR PRIMARY CARE
PHYSICIANS, ABOUT 600, ACTUALLY
DOING THIS RIGHT NOW WHEN THEY
SEE IT.
YOU KNOW, THEY FIND OUT IF
THERE'S HEAVY DRINKING.
IN FACT RIGHT NOW THEY HAVE A
REGISTRY OF 1.1 MILLION PATIENTS
THAT HAD SOME PROBLEMATIC
DRINKING THAT THEY ACTUALLY
FOLLOW UP.
ACTUALLY HAVE A CONTRACT WITH
THAT WE'RE DOING ALL KINDS OF
ACKNOWLEDGE SIS, GETTING OUT
THREE OR FOUR PAPERS A YEAR NOW.
IT'S SUCH A RICH DATASET.
IT DID SHOW ORGANIZATION LIKE
KAISER, PRIMARY CARE PHYSICIANS
CAN DO THIS AND WORK IT IN TO
THEIR 15-MINUTE SCHEDULE
>> DO YOU FIND IN RESPONSE TO'D
AING AUDIT-C THERE'S AN
INCREASED RATE OF PRESCRIPTION
BY PRIMARY CARE PHYSICIANS OF
MEDICATIONS LIKE ACAMPROSATE?
>> I DON'T KNOW IT'S SO
DIFFICULT FOR PRIMARY CARE
PHYSICIANS TO SUBSCRIBE --
PRESCRIBE MEDICATIONS,
FDA-APPROVED MEDICATION.
EVEN KAISER, PRIMARY CARE
PHYSICIANS, WERE RELUCTANT TO
GIVE, SAY NALTREXONE OR AL CAMP
ROW SAY -- ACAMPROSATE.
THEY WOULD EXPLAIN ABOUT GIVING
THE MEDICATIONS, STARTED PICKING
UP, STARTED PRESCRIBING FDA
MEDICATIONS, BY DOING THAT, AND
THEN I THINK THE PHYSICIANS GOT
MORE COMFORTABLE.
NOT QUITE SURE WHY THEY FEEL
UNCOMFORTABLE.
I DON'T KNOW IF THEY ARE
CONFUSING WITH BUPRENORPHINE
WHERE THEY HAVE TO BE ADDICTIVE
AND STUFF.
THESE ARE NOT ADDICTIVE.
>> GIVEN LIKE ANTIDEPRESSANTS.
>> DAVE KRAB AT IU DID A SURVEY
AT ESKENAZI HOSPITAL, PHYSICIANS
DON'T FEEL COMFORTABLE.
IGNORANCE WAS A LOT OF IT.
THEY ARE NOT COMFORTABLE WITH
THE DATABASE.
>> I HAVE TO TELL YOU, WHEN THEY
TAKE THESE DRUGS, ACAMPROSATE OR
NALTREXONE, AND THE PEOPLE THAT
DO RESPOND TO THESE AND THESE
ARE PEOPLE THAT HAVE BEEN
DRINKING 15, 20 YEARS, THEY NO
LONGER HAVE THE DESIRED URGE TO
DRINK ANYMORE, IT'S QUITE
REMARKABLE TO SEE SOMETHING LIKE
THAT.
AND THAT'S WHY IT'S KIND OF
HEARTBREAKING, MORE PEOPLE
AREN'T USING THIS.
THEY CAN BE HELPING SO MANY
PEOPLE IF MORE PEOPLE WERE USING
SOMETHING LIKE THIS.
>> I FEEL LIKE IT REMINDS ME OF
THE COLLABORATIVE CARE MODELS,
AND SORT OF FIGURING OUT WAYS TO
SUPPORT THE PRIMARY CARE
PHYSICIANS WHO AREN'T
COMFORTABLE DOING THIS, OR, YOU
KNOW, NEED SOME EXTRA SUPPORT
LIKE ADDING A PHARMACIST TO THE
TEAM OR ADDING AN ADDICTION
SPECIALIST TO THE TEAM OR
WHATEVER DIFFERENT CREATIVE WAYS
TO TRY TO SUPPORT THE PROVISION
FOR THE CLINICIANS WHO WANT TO
DO IT BUT AREN'T COMFORTABLE OR
FEEL THEY DON'T HAVE TIME.
>> BUT WE ALSO HAVE TO ADDRESS
THOSE SUPPORT PEOPLE.
SO ONE OF MY PROUDEST MOMENTS
WHEN I WAS TEACHING AT UCSD WAS
WHEN I WENT UP TO THE PHARMACY,
MY PHARMACY, TO PICK UP MY
OMEGA-3 OR WHATEVER IT WAS I
TAKE.
AND I WAS TEACHING IN THE
PHARMACY SCHOOL AS WELL AS IN
THE PSYCHOLOGY DEPARTMENT.
AND THE LADY, THE PHARMACIST,
HAD BEEN ONE OF OUR STUDENTS AND
SAID, OH, DR. KOOB, WE'RE SO
GLAD YOU'RE HERE.
WE HAVE A PATIENT WHO IS GOING
TO GO A VISITROL BUT ONLY WANTS
TO GO ON ONE COURSE.
CAN WE START ON ONE OR DOES IT
HAVE TO BE TWO I SAID TAKE
WHATEVER YOU CAN GET.
IT WAS INTERESTING TO ME THEY
ALSO NEED TRAINING.
YOU KNOW, WE HAVE TO START AT
EVERY LEVEL TO GET THIS
INFORMATION OUT.
IT'S-- YOU GUYS ARE STARTING TO
THINK OF CREATIVE IDEAS BUT I DO
THINK, YOU KNOW, WE NEED TO
SCALE UP A WHOLE VARIETY OF
AREAS.
WE'RE GOING TO BE MEETING WITH
SAMHSA SOON, I THINK.
WE'VE ALREADY BEGUN DISCUSSIONS
WITH THEM.
THEY HAVE SOME HUGE PROGRAMSER
THAT GOING TO BE PUTTING OUT
THERE.
BUT SAMHSA DOESN'T EVALUATE
THEIR PROGRAMS.
WE WANT TO GET ONE LEG IN TO BE
THE EVALUATION ARM FOR SAMHSA TO
FIND OUT WHETHER THIS IS IN THE
PREVENTION INTERVENTION DOMAIN,
TO FIND OUT WHETHER WE CAN
EVALUATE ONE OF THEIR BIG
PROGRAMS AND SEE WHETHER IT'S
ACTUALLY EFFECTIVE, YOU KNOW.
>> ONE OF THE APPROACHES IS AS
WE GET THESE INSTRUCTIONAL
CASSETTES THAT WE PUT THEM UP ON
OUR WEBSITE AND FOR IT TO BE A
MODULE THAT IS FAIRLY WELL --
YOU KNOW, SELF-CONTAINED AND
THAT IS TARGETED TO A CERTAIN
CATEGORY OF INDIVIDUAL AND, FOR
EXAMPLE, WE WOULD BE GLAD TO
SUPPLY THE AUDIT-C TRAINING
MATERIALS, YOU KNOW, LIKE THEIR
VIDEOS.
THERE ARE EXPLANATIONS, THERE
ARE SLIDES.
BUT TO HAVE THIS MODULES OF
THESE THINGS THAT JUST
DIGESTIBLE BITS.
>> STILL TRYING TO GET RSA TO
NOTICE THAT WE HAVE A WEBSITE.
FRANCES, I UNDERSTAND ONLINE
THAT YOU HAVE A QUESTION.
I'M GOING TO ASK ANDREW IF HE'S
STILL THERE AND WHO ELSE IS
ONLINE?
NANCY.
I LEFT YOU OUT.
I APOLOGIZE.
FRANCES?
>> THANK YOU.
NO, I JUST WAS AGREEING AS
EVERYBODY WAS TALKING TODAY.
I'M SORRY I'M NOT THERE IN
PERSON.
YOU KNOW, I MEAN, AS A PHYSICIAN
I WILL TELL YOU THAT THE MESSAGE
ABOUT THAT THESE MEDICATIONS
WORK ARE JUST NOT OUT THERE.
AND THAT MOST PHYSICIANS JUST,
YOU KNOW, UNLESS THEY HAVE AN
EFFECT SIZE OF 1, FOR SOME
REASON WE EXPECT A LOT MORE OUT
OF THESE MEDICATIONS THAN OTHER
PSYCHIATRIC MEDICATIONS.
SO HOW TO GET THAT MESSAGE OUT
IS REALLY CRUCIAL.
I THINK WITH MEDICAL STUDENTS,
YOU HAVE A SHOT BECAUSE, YOU
KNOW, THEY ARE STILL NOT BIASED
AGAINST TREATING SUBSTANCE USE
DISORDERS.
THERE'S BEEN A REAL SEA CHANGE,
THEY WANT MORE ON SUBSTANCE USE
DISORDERS, PARTICULARLY OPIATE
USE DISBOARDS, DRAMATIC DEATHS
THAT HAVE BEEN NOTICED WITHOUT
UNDERSTANDING ALCOHOL ALSO LEADS
TO MORE DEATHS OVER TIME.
THE OTHER THING, I'M INVOLVED IN
THE PCSS MEDICATIONS FOR OPIOID
USE DISORDER, NOW THERE'S ONE
WITH SAMHSA ON ALCOHOL USE
DISORDER, PROBABLY WILL HAVE A
VERY WIDE AUDIENCE, PHYSICIANS
HOPEFULLY WILL PARTAKE OF IT.
WHEN YOU CAN GET SORT OF -- I
WON'T SAY A STICK BUT WHEN YOU
HAVE A STICK TO USE WITH
PHYSICIANS THEY DO CHANGE THEIR
BEHAVIORS, SO FOR EXAMPLE NOW IF
YOU WANT YOUR D.A. LICENSE AND
PRESCRIBE CONTROL SUBSTANCE YOU
HAVE TO LISTEN TO AN 8-HOUR
COURSE.
ON THE PCSS MOUD WEBSITE WE HAD
36,000 PHYSICIANS LAST MONTH
ATTEND OUR COURSE BECAUSE THEY
KNEW THEY NEEDED THAT FOR THEIR
LICENSURE.
I DON'T KNOW HOW YOU WOULD DO
THAT WITH GETTING PHYSICIANS TO
LISTEN ABOUT, YOU KNOW,
NON-CONTROLLED SUBSTANCES BUT I
THINK IT'S AN AUDIENCE TO TRY TO
GO AFTER THROUGH THE -- IF YOU
CAN COLLABORATE WITH SAMHSA,
THERE'S A LOT OF PRACTITIONERS
GOING TO THE WEBSITE.
PCSS MOUD HAD OVER 100,000 GO TO
THE WEBSITE AND WATCH WEBINARS
AND STUFF.
WITH THE PCSS AUD COMING OUT
ALCOHOL USE DISORDER THIS IS AN
OPTION.
BUT I THINK GRASS ROOTS
TRAINING.
AND THE OTHER THING I'D THROW IN
AS A PSYCHIATRIST, I THINK A LOT
OF THESE PATIENTS HAVE --
PARTICULARLY WOMEN HAVE
PSYCHIATRIC CO-MORBIDITIES AND
WHEN HAVE YOU ADDITIONAL
PSYCHIATRIC COMORBIDITIES
DOCTORS, INTERNISTS GET MORE
NERVOUS ABOUT THE COMBINATION
AND WANTING TO REFER THEM RATHER
THAN TAKE IT ON.
HAVING BEHAVIORAL HEALTH
SPECIALISTS IN THE PRIMARY CARE
SETTINGS COULD HELP A LOT OR
FACILITATE THIS POPULATION
WHICH, YOU KNOW, CAN BE
COMPLICATED.
IT'S NOT JUST GIVING ACAMPROSATE
AND NALTREXONE.
THOSE ARE SOME OF MY THOUGHTS.
>> THANKS, FRANCES.
EXCELLENT.
NANCY BARNETT, DO YOU HAVE
ANYTHING YOU'D LIKE TO ADD TO
THIS OR START A NEW
CONVERSATION?
>> THANK YOU, GEORGE.
NO, I'M HERE LISTENING, BUT
DON'T HAVE ANY QUESTIONS TO ADD.
THANK YOU.
>> AND ANDREW, ARE YOU STILL ON?
>> SURE AM.
EXCELLENT DISCUSSION.
REALLY APPRECIATE DAVID'S
PRESENTATION.
THE QUESTION OF WHO GETS SICK
FROM ALCOHOL USE DISORDER
CLINICALLY, FROM SIMILAR AMOUNTS
OF ALCOHOL EXPOSURE IS AN AWFUL
INTERESTING ONE.
HE IS LOOKING AT LARGE
POPULATIONS AND MOVING FORWARD
TO TRY AND UNDERSTAND THAT
QUESTION.
WE'RE SORT OF TRYING TO REVERSE
ENGINEER IT.
WE'RE LOOKING AT PEOPLE WHO HAVE
TERRIBLE OUTCOMES FROM MAYBE
SIMILAR EXPOSURE TO ALCOHOL AS
OTHER PEOPLE THAT DIDN'T HAVE A
TERRIBLE OUTCOME.
WHEN WE EXPLANT THEIR LIVES
BECAUSE THEY NEED AN ENERGY LIFE
SAVING LIVER TRANSPLANT WE'RE
ABLE TO EXAMINE THAT LIVER TO
SEE IF THERE'S ANYTHING THAT
MAKES THEM DIFFERENT FROM OTHER
FOLKS THAT, FOR EXAMPLE, DIED
WITHOUT LIVER DISEASE.
AND WE'RE TRYING TO COME TO
SIMILAR UNDERSTANDINGS OF WHY
SOME PEOPLE GET HORRIBLY ILL
FROM ALCOHOL EXPOSURE, OTHERS
DON'T.
IT'S A VERY INTERESTING TOPIC.
GREAT SCIENCE BUT VERY IMPORTANT
CLINICAL TRANSLATION QUESTION,
VERY IMPORTANT TO OUR SICK
PATIENTS.
>> RHONDA, THAT'S ANOTHER
EXAMPLE OF BACK-TRANSLATION.
HE'S TAKING LIVES OUT OF PEOPLE
WHO ARE VERY, VERY SICK AND THEN
TRYING TO FIGURE OUT WHAT IS
DIFFERENT ABOUT THOSE LIVES THAT
COULD THEN FEED FORWARD TO HELP
PEOPLE NOT GET THAT SICK.
IT'S REALLY FASCINATING APPROACH
AND I REMEMBER WHEN YOU FIRST
CAME DOWN TO TALK ABOUT THAT.
THAT WAS, TO ME, ONE OF THE MORE
INTRIGUING PARTS.
>> I COULD ADD ONE POINT TO THE
LAST DISCUSSION?
IF YOU THINK ABOUT THE TREATMENT
CASCADE PEOPLE FALL OUT OF IT AS
LOTS OF POINTS.
SOME PEOPLE NEVER GET IDENTIFIED
IN PRIMARY CARE.
SOME PEOPLE GET IDENTIFIED AND
NEVER GET THE CONVERSATION WITH
THE CLINICIAN.
SOME GET CONVERSATION BUT NEVER
GET THE PRESCRIPTION WRITTEN FOR
THEM.
SOME GET THE PRESCRIPTION BUT
NEVER FILL IT.
AND THEN SOME PEOPLE GO AND FILL
IT BUT THEN THEY STOP TAKING IT.
SO WE REALLY NEED SUPPORT IN ALL
OF THOSE PIECES.
I THINK THE PATIENTS NEED
ADDITIONAL SUPPORT AND
EDUCATION.
I'M DOING WORK RIGHT NOW LOOKING
AT PEOPLE WHO GET A PRESCRIPTION
AND STOP, MEDIAN NUMBER OF DAYS
SUPPLY THEY GET BEFORE THEY STOP
IS 30.
SO LOTS OF PEOPLE ARE GETTING
ONE SCRIPT AND NEVER GOING BACK
AND YOU DON'T KNOW IF THEY TAKE
IT AND HAVE SIDE EFFECTS SO THEY
STOP, OR THEY NEVER ACTUALLY
TOOK IT ONCE THEY FILLED IT
BECAUSE THEY HAD SECOND THOUGHTS
OR NEEDED EXTRA SUPPORT IN SORT
OF GETTING THEM OVER THE HUMP.
THINKING ABOUT ALL OF THOSE
PIECES OF THE PROCESS IS
IMPORTANT WHEN WE'RE THINKING
ABOUT HOW TO IMPROVE
CONTINUATION ON MEDICATION
TREATMENT.
>> , YEAH YOU RAISE AN IMPORTANT
ISSUE THAT I'VE COME TO REALIZE
DONE SOMETIMES IN MORE SEVERE
MENTAL ILLNESSES, MANY ONE OF
YOU CLINICIANS CAN HELP ME OUT
WITH THE OFFICIAL WORD.
THERE ARE PEOPLE WHO GUIDE THE
PATIENT THROUGH THE DIFFERENT
PARTS OF THE MEDICAL SYSTEM.
THEY HAVE A NAME FOR THEM.
>> NAVIGATORS.
>> THANK YOU VERY MUCH.
YEAH, PATIENT NAVIGATOR.
MAYBE WE NEED TO HAVE SOMETHING
LIKE THAT FOR ADDICTION.
FRANCES, DO YOU HAVE PATIENT
NAVIGATORS FOR SEVERE ALCOHOL
USE DISORDER?
>> NO.
IT WOULD BE A GOOD IDEA.
YOU KNOW, THERE'S BEEN SEVERAL
MODELS WITH, YOU KNOW, STARTING
PEOPLE ON MEDICATION IN THE
EMERGENCY ROOM AND HAVING THAT
PERSON WORK WITH THEM TO GET
THEM INTO TREATMENT WHEN THEY
COME OUT OF THE -- WHEN THEY
LEAVE THE EMERGENCY ROOM BUT I
THINK THAT APPROACH WOULD BE,
YOU KNOW, WOULD BE GREAT.
I'M SURE THERE'S PROBABLY
RESEARCH ON THIS, BUT, YOU KNOW,
IN TERMS OF ALCOHOL, BUT, YOU
KNOW, THERE ARE SO MANY REASONS.
EVEN DRUGS THAT HAVE ABUSE
LIABILITY LIKE I TREAT PATIENTS
WITH ADHD, AND MANY TAKE THEIR
STIMULANTS.
EVERYONE IS WORRIED ABOUT MISUSE
OF STIMULANTS BUT A LOT OF KIDS,
YOUNG ADULTS DON'T WANT TO TAKE
THE MEDICATION.
EVEN WITH MEDICATIONS, WHEN
MEDICATION DOESN'T HAVE AN
EFFECT, OFTEN THE ABSENCE OF
EFFECT MAKES IT SO THEY DON'T
SEE THE UTILITY IN TAKING IT.
EXCEPT BUPRENORPHINE YOU'LL HAVE
WITHDRAWAL, EVEN THAT 50% STOP
TAKING BUPRENORPHINE.
HOW TO KEEP PEOPLE ADHERENT IS
AN ISSUE, TRUE WITH HYPERTENSION
MEDICATIONS, KEEPING THEM IN IT,
CASCADES JUST DESCRIBED, REALLY
TRUE ALONG MANY MEDICAL
ILLNESSES.
>> IT WAS SAID YEARS AGO
ADHERENCE TO MEDICATIONS FOR
BLOOD PRESSURE AND HEART DISEASE
WERE NO BETTER THAN ADHERENCE
FOR ADDICTION MEDICINES, BUT
THAT'S NOT SOLVING OUR PROBLEM.
DAYNE, ANY THOUGHTS ABOUT ANY
PART OF THIS?
YOU WORK WITH DEAD BRAINS.
>> MOST OF THE TIME.
YEAH, I THINK THIS WHOLE
DISCUSSION UTILIZATION OF
CLINICAL RECORDS IS CRITICAL FOR
A LOT OF MOLECULAR STUDIES WE
DO.
SO WE CAN CORRELATE TO CLINICAL
OUTCOMES AND DAVID'S
IMPLEMENTATION OF AUDIT IS A
GREAT WAY TO DO THAT.
ONE OF THE PROBLEMS THAT WE HAVE
THOUGH IS IT COMES DOWN TO THE
TERMS THAT WE'RE GOING TO USE,
COMMON DATA ELEMENTS, WHAT ARE
WE GOING -- WHEN WE GET OUR
TERMS FROM CLINICAL RECORDS,
THEY DON'T ALWAYS MEAN THE SAME
AS, YOU KNOW, THE RECORD FROM
ANOTHER PLACE.
SO ONE OF ONE OF OUR BIG
CHALLENGES IS COMING TO GRIPS
WITH THE TERMS WE'RE GOING TO
USE BECAUSE IF YOU HAVE TEN WAYS
TO SAY THE SAME THING, WE'RE
GOING TO HAVE TEN WAYS TO
CORRELATE A FINDING TO MOLECULAR
FINDINGS.
SO I THINK BUILT INTO ALL OF
THIS THERE NEEDS TO BE SOME WAY
TO COME UP WITH COMMON TERMS
THAT ARE DESCRIPTIVE AND
ACCURATE.
>> YEAH, GLAD YOU MENTIONED
THAT.
I WANTED TO SAY SOMETHING ABOUT
THAT.
THERE IS ALREADY EFFORTS IN THE
CLINICAL DOMAIN FOR COMMON DATA
ELEMENTS BUT IT IS SOMETHING
PAROCHIAL TO NIAAA THAT WE
PROBABLY SHOULD -- WE WILL BE
ADDRESSING.
AND I'M EVEN IN COMMON DATA
ELEMENTS FOR PRE-CLINICAL DATA,
AND I THINK THERE'S THIS -- KEEP
IING IN THE DARK, IN THE CAGE,
GETS ACCESS TO ALCOHOL IN THE
DARK, SOPHISTICATED BEHAVIOR
HERE.
BUT THEY DRINK A LOT.
WHEN YOU DO THAT.
IF YOU KEEP DOING IT THEY DRINK
EVEN MORE.
THESE MICROPHONES ARE GOING.
BUT ACTUALLY THE MICE WILL
ATTAIN A BLOOD ALCOHOL ABOVE --
WITHIN TWO HOURS.
TALKING TO HOWARD BECKER LAST
WEEK, PRESIDENT OF OUR LATEST
YEAR, CLINICAL RESEARCHER, MUSC,
HE SAID EVERYBODY, GEORGE, IS
DOING IT DIFFERENTLY.
BUT CAN WE GET A METRIC, EVEN IF
THEY ARE DOING IT DIFFERENTLY,
YOU KNOW, LIKE A BLOOD
COLLABORATIVE LEVEL AFTER X
AMOUNT OF TIME THAT COULD BE
USED AS SOMETHING THAT WOULD
MAKE IT SO MUCH EASIER TO
FACILITATE THESE KIND OF
ANALYSES THAT WE CAN NOW DO.
SO, IT IS SOMETHING WE'LL BE
TALKING ABOUT, ELIZABETH POWELL
IS OUR -- NOT TRISH POWELL,
THERE'S ANOTHER POWELL IN DNB,
LEADING OUR DATA ANALYSIS AND
MANAGEMENT AND WE HAVE A TEAM
WORKING ON THIS.
WE'LL BE WORKING IN DOMAIN BUT
WE'LL NEED YOUR CREATIVE
THINKING ON HOW TO DO THIS.
THE MICROPHONES ARE FADING IN
AND OUT.
>> MAYBE I USED IT TOO MUCH.
I'M PARTICULARLY INTERESTED IN
WHAT WE CAN DO IN THE
PRE-CLINICAL DOMAIN.
SO DAVID OLDMAN, WE'RE
PARTICULARLY INTERESTED IN WHAT
WE NEED TO DO IN THE CLINICAL
DOMAIN TO MAKE LIFE EASIER FOR
THE KIND OF WORK YOU'RE DOING.
>> ONE OF THE THINGS THAT IS
HELPFUL IS THAT THE SORT OF
HARMONIZATION IS BEING DONE IN
THE NIAAA DATA ARCHIVE, WHEREAS
WHEN YOU -- AS YOU ENTER DATA
INTO THE ARCHIVE YOU WORK WITH
THIS TEAM TO TRY TO IDENTIFY AN
ALREADY EXISTING TERM.
IF YOU GO TO "ALL OF US," AS
WE'VE BEEN DOING FOR
IRON-RELATED TERMS YOU MIGHT
FIND EHR 20 OR EVEN TWO DOZEN
VERY SIMILAR TERMS FROM
TRANSFERRIN LEVEL, ON AND ON, A
HUGE PROBLEM TO FIGURE OUT HOW
TO COMBINE THE DATA.
IN THE INTRAMURAL SAMPLES
WE'VE -- I ADDRESSED THIS AT THE
BEGINNING BECAUSE AT THE
BEGINNING YOU HAVE EVERYBODY WHO
TAKES PART IN A NATURAL HISTORY
STUDY, BUT CERTAIN DATA ELEMENTS
THAT ARE COLLECTED IN COMMON
ACROSS EVERYBODY.
IT NEEDS TO BE DONE EITHER
INITIALLY WHERE SOMEBODY HAS TO
DO THE WORK LATER TO FIGURE OUT
AS YOU SAID HOW TO RATIONALIZE
AND HARMONIZE THESE ELEMENTS.
IF WE DON'T DO IT WE'RE NOT ABLE
TO TAKE ADVANTAGE OF POWER OF
THESE LARGE DATASETS.
>> WE HAVE A COUPLE MORE MINUTES
LEFT.
ANYTHING ELSE FROM ANYONE?
I THINK I MANAGED TO CALL ON
EVERYONE, OR EVERYONE
VOLUNTEERED.
WHO HAVE I MISSED?
OH, KATIE.
>> I'VE BEEN VERY VOCAL TODAY.
TWO COMMENTS.
ONE, DR. GOLDMAN PRESENTED GWAS
THAT RELIED ON THE V.A. DATA,
SINCE 2007.
SO I AGREE MORE PLACES WE CAN DO
GIVING THAT MEASURE.
I WANTED TO GO BACK TO SOMETHING
DR. LEVIN SAID ABOUT
COMORBIDITY.
I HAD A CHANCE THIS MORNING TO
LOOK BRIEFLY AT THE STRATEGIC
PLAN, THE NEW ONE.
I'M A LITTLE BIT SURPRISED TO
SEE LESS FOCUS ON COMORBIDITY IN
THE NEW STRATEGIC PLAN SO I'M A
LITTLE BIT WORRIED AND WONDERING
IF THAT'S NO LONGER A PRIORITY
AREA FOR NIAAA OR IF IT'S MAYBE
EMBEDDED WITH OF THROUGHOUT THE
STRATEGIC PLAN AND THAT'S WHY
I'M NOT SEEING IT BOLDED BUT I
WOULD LOVE TO HEAR IF ISSUES OF
COMORBIDITY, IT TIES INTO THE
TOPIC OF ALCOHOL IN WOMEN AS DR.
LEVIN MENTIONED, CURIOUS IF
THAT'S STILL A PRIORITY AREA.
>> IT'S A BURGEONING PRIORITY
AREA.
BUT I'LL LET -- I'LL PUT POOR
BRIDGIT ON THE SPOT.
>> I DON'T REMEMBER ALL THE
PLACES BECAUSE IT IS
DISTRIBUTED.
LIKE THERE'S A SECTION WE TALK
ABOUT IT IN WHOLE PERSON HEALTH.
IT IS SPREAD OUT.
SO IT HASN'T BEEN DEPRIORITIZED.
IT'S A VERY IMPORTANT AREA THAT
WE WANT TO CONTINUE TO FOCUS
ENERGY ON.
THAT'S THE THING I SHOULD POINT
OUT.
BECAUSE YOU MAY NOT SEE
SOMETHING SPECIFIC OR MAY NOT
SEE IT A LOT OF TIMES DOESN'T
NECESSARILY MEAN IT'S NOT A
PRIORITY FOR US.
THERE'S SO MANY THINGS WE HAVE
TO COVER BUT IT'S GOOD TO ALWAYS
CHECK.
>> THANK YOU.
>> TO THAT POINT, KATIE, WHEN I
WAS AT CPDD LAST YEAR, NOT THIS
YEAR, WE HAD A SYMPOSIUM ON
READDICTION, OR WHATEVER,
SOMETHING LIKE THAT.
IT CAME UP WITH A LOT OF
QUESTIONS FROM THE AUDIENCE.
THERE WAS REAL CONCERN THAT
HISTORICALLY WE EXCLUDE
COMORBIDITY AND TRY TO GET THESE
PURE AUDs IN STUDIES.
I DO THINK RAYE WILL TELL ME IT
COSTS A LOT MORE MONEY IF YOU
INCLUDE THEM BUT I DO THINK AT
SOME POINT MAYBE THE PRIMARY
CARE NETWORK THAT MONICA IS
THINKING OF, IF WE GET INTO IT,
IN THE MENTAL HEALTH WAY, THEN
MAYBE THAT'S GOING TO BE ONE OF
THE SOURCES FOR THIS INFORMATION
BECAUSE THERE WILL BE A LOT OF
PEOPLE PRESUMABLY.
BUT IT IS A CHALLENGE.
THAT'S A CHALLENGE.
BUT I DO THINK IT'S INCREDIBLY
IMPORTANT.
COMORBIDITY IS 20 TO 40% FOR
EFFECTIVE DISORDERS, ANXIETY
DISORDERS, PTSD, BIPOLAR, JUST
GO DOWN THE LINE.
>> KATIE, IT IS IN OUR
ANNOUNCEMENT FOR OUR DIVISION.
COMORBIDITY.
AND WE HAVE OVER THE YEARS
ACTUALLY DID FUND MOSTLY
MEDICATIONS WITH COMORBIDITY.
A LOT OF DEPRESSION, EVEN
BIPOLAR, SOME SCHIZOPHRENIA.
GENERALLY WHAT WE FOUND WAS THAT
IT IS HARDER FOR RESEARCHERS TO
RECRUIT COMORBIDITY.
I CAN'T TELL YOU THEY NEEDED
EXTRA TIME OR JUST NEVER GOT.
IT'S MORE DIFFICULT TO DO THAT.
IT IS IMPORTANT.
AND YOU KNOW WHEN WE WERE LIKE
DOING DEPRESSION, AND ALCOHOL,
PAST 20, 30 YEARS WE DID FUND
SOME STUDIES ON THAT.
AND WE WERE JUST WANTING TO
ANSWER SOME SIMPLE QUESTIONS
THAT IF YOU TREAT THE DEPRESSION
WILL THAT REDUCE DRINKING OR IF
YOU REDUCE DRINKING, AND IT
TURNED OUT TO BE COMPLEX, THAT'S
SURPRISING.
EVERYTHING IN ALCOHOL RELATED
SEEMS TO BE HETEROGENEITY, AND
JUST DEPEND.
I THINK WHAT WE ENDED UP SAYING
IS PROBABLY BEST TO TREAT BOTH.
PROBABLY THE SAFEST THING TO DO.
YES, WE ARE INTERESTED.
A LITTLE MORE CHALLENGING.
ALSO STUDIES WE'VE DONE SAY WITH
NALTREXONE, MAYBE ACAMPROSATE,
SEEMS TO WORK WELL TO REDUCE
DRINKING IF THEY ARE DEPRESSED
OR NOT DEPRESSED, EVEN
SCHIZOPHRENIA, THEY SEEM TO HAVE
THE SAME TYPE OF EFFECT.
WE DIDN'T REALLY SEE ANYTHING
DRAMATIC LIKE IT DOESN'T WORK IF
YOU'RE DEPRESS AND DRINKING,
STEAMS TO WORK ABOUT THE SAME.
BY-- SEEMS ABOUT THE SAME.
ANTIDEPRESSANTS ARE ABOUT THE
SAME TOO, DRINKING OR NOT
DRINKING, AT LEAST THAT I
EXPERIENCED FROM THE RESEARCH.
>> OKAY.
ONE LAST COMMENT, QUESTION, FROM
ANYBODY?
YOU GUYS ARE SO ON TIME TODAY.
IT'S EERIE.
ALL RIGHT.
IT IS 3:15.
AND WE'RE SUPPOSED TO HAVE
PUBLIC COMMENTS AND COUNCIL
DISCUSSION.
WE'VE HAD A LARGE AMOUNT OF
COUNCIL DISCUSSION.
DO WE HAVE ANYBODY FOR PUBLIC
COMMENT?
>> THERE WAS NO REQUEST, THERE
WAS SOMEONE REACHING OUT BUT
THERE WAS NO FOLLOW-UP.
THE PERSON WAS NOT INTERESTED IN
PARTICIPATING.
>> WHY DON'T YOU GO OVER THE
SCHEDULE FOR THE NEXT COUNCIL
MEETING, FOR TOMORROW.
>> THE NEXT MEETING?
YOU WANT ME TO GO THROUGH THE
MINUTES FIRST?
>> OH, YES, THE MINUTES.
DO ALL YOUR THINGS.
>> SURE, SURE.
SO, YEAH, I WANT TO MENTION THE
MINUTES OF THE LAST COUNCIL
MEETING WERE POSTED ON ECB FOR
THE 165th NCAA MEETING BACK IN
FEBRUARY.
AND ALSO THERE WAS THE STANDARD
OPERATING PROCEDURE WANTED TO
KNOW IF YOU HAVE COMMENTS,
QUESTIONS, ANY DISCUSSION
REGARDING THE TWO DOCUMENTS, WE
NEED TO HAVE APPROVAL FROM
COUNCIL FOR THESE TWO DOCUMENTS.
UNLESS THERE ARE ANY OTHER
QUESTIONS, ANY COMMENTS, OR I
WOULD LIKE TO ENTERTAIN A MOTION
FOR APPROVAL OF THE MINUTES OF
THE 165th --
>> SO MOVED.
THANK YOU VERY MUCH.
AS WELL AS FOR THE SOPs.
AND SO IN FAVOR, THEN SO
OPPOSED?
ALL IN FAVOR?
THANK YOU VERY MUCH.
THE MOTION -- ABSTAIN.
AND THEREFORE THE MOTION
CARRIES.
THANK YOU VERY MUCH.
AND SINCE DR. KOOB MENTIONED
NEXT DATES FOR THE MEETINGS OF
THE NIAAA COUNCIL AS WELL AS
CRAN, SO YOU HAVE THE
INFORMATION, YOU CAN PUT IT ON
THE SCREEN REALLY QUICK.
2024 IT'S SEPTEMBER 12 FOR
NIAAA.
2025 FEBRUARY 6, MAY 13,
SEPTEMBER 4.
FOR 2026, IT WILL BE FEBRUARY 5,
MAY 5, AND SEPTEMBER 17 FOR
NIAAA COUNCIL.
FUTURE MEETING DATES OF CRAN
JOINT ADVISORY COUNCIL, NIAAA
AND NIDA AND NCI, 2025, MAY 7.
I MEAN IT WAS ACTUALLY -- I'M
SORRY, I'M CONFUSED HERE.
FOR THIS YEAR, TOMORROW, MAY 8,
FOR TOMORROW.
AND FOR 2025 IT WILL BE MAY 14.
AND FOR 2026, IT'S GOING TO BE
MAY 6.
>> AND WHAT DO PEOPLE NEED TO
KNOW ABOUT TOMORROW MORNING,
WHEN DO WE START?
>> SO TOMORROW MORNING THIS IS
THE 11th CRAN MEETING,
STARTING AT 10 A.M. HERE IN THIS
MEETING ROOM, IF YOU CAN COME A
FEW MINUTES, OR I THINK IT
WORKED PRETTY WELL THIS MORNING,
IF YOU COME WITHIN 20 MINUTES TO
30 MINUTES BEFORE THE MEETING
YOU HAVE TIME TO GET SETTLED,
GET COFFEE, MAKE SURE YOU HAVE
INTERNET CONNECTION.
THAT WILL BE HERE TOMORROW
MORNING.
>> IF YOU HAVEN'T BEEN AT A CRAN
MEETING, SO THE WAY WE DO IT
NORA AND I ALTERNATE.
I BELIEVE SHE'S THE HOST THIS
YEAR AND WILL START THE MEETING.
I END THE MEETING.
AND THEN SHE GIVES THE
DIRECTOR'S PRESENTATION OF 30
MINUTES, THEN I HAVE A 30-MINUTE
PRESENTATION.
AND THEN WE'LL HAVE ALSO NCI
UPDATE.
AND THEN WE HAVE AN HBCD STUDY
UPDATE, THAT'S HEALTHY BABY
COGNITIVE DEVELOPMENT STUDY.
DID I GET THAT RIGHT?
AND AN ABCD STUDY UPDATE FROM
GAYA DOWLING.
KATHY COLE DOING HBCD.
I FENCE YOU'LL FIND IT QUITE
INTERESTING.
PARTICULARLY ABCD, BECAUSE THOSE
INDIVIDUALS ARE NOW GETTING INTO
THE AREA OF THE AGE WHERE THEY
MAY START DOING DRUGS AND
DRINKING AND OTHER THINGS.
AND THEN WE HAVE A PRESENTATION
ABOUT THE START PROGRAM,
PREDICTING ADOLESCENT ALCOHOL --
CAN YOU TAKE OVER FOR ME?
>> SURE, WE HAVE TWO
PRESENTATIONS OF PEOPLE WHO HAVE
BEEN USING ABC DATA, ONE IS THE
START PROGRAM OVERVIEW,
ADVANCING THE PREDICTION OF
ADOLESCENT ALCOHOL USE ONSET BY
DERIVING POLICY EXPOSURE ALCOHOL
RISK SCORES USING ABCD STUDY.
AND SECOND ONE IS RACIAL
INEQUITIES IN NEUROIMAGING
STUDIES IN ABCD.
YOU'LL HEAR A GENERAL OVERVIEW
AND TWO PROJECTS AND DATA FROM
IT.
>> THANKS.
THANKS, TRISH.
SO, THAT'S IT.
THE ROUNDTABLE DISCUSSION AND I
GET TO CLOSE US OUT.
SO IT SHOULD BE FUN.
I ALWAYS ENJOY THE CRAN MEETING
BECAUSE WE GET TO SEE OUR FELLOW
RESEARCHERS IN ADDICTION AND
THERE'S ALWAYS SOMETHING THEY
ARE DOING THAT WE WANT TO DO AND
PROBABLY THINGS WE'RE DOING THEY
WANT TO DO.
SO IT'S A GOOD
CROSS-FERTILIZATION.
ALL RIGHT.
ANYTHING ELSE FROM ANYONE ABOUT
ANYTHING?
HAPPY TO -- ANYBODY ONLINE WITH
ANY FURTHER COMMENTS?
ALL RIGHT.
WELL, THANK YOU ALL.
I THINK WE HAD SOME LIVELY
DISCUSSION AND A LOT OF
PARTICIPATION THIS TIME.
I THINK WE'RE GOING TO KEEP
DOING IT THIS WAY.
REMEMBER, IN GENERAL, WE HAVE
LIVE COUNCIL MEETINGS EXCEPT IN
JANUARY, FEBRUARY, WHEN WE DO
NOT HAVE LIVE COUNCIL MEETINGS.
WE HAVE -- WE'LL DO IT PROBABLY
VIRTUAL BECAUSE OF TRAVEL.
I JUST HAVE SEARING MEMORIES,
MAYBE CLIMATE CHANGE WILL CHANGE
THIS, BUT I HAVE LOTS OF
MEMORIES OF MOST OF OUR COUNCIL
MEMBERS BEING STUCK IN AIRPORTS
IN CHICAGO, INDIANAPOLIS, AND
ALL KIND OF OTHER PLACES.
DALLAS AND SO ON AND SO FORTH.
SO WE DO IT VIRTUALLY IN
FEBRUARY.
OKAY.
THANKS, EVERYBODY.
[END OF PROGRAM]