>>WELCOME EVERYONE TO THE
NATIONAL ADVISORY COUNCIL ON
AGING.
WE WILL BE -- I JUST HAVE A FEW
HOUSEKEEPING ITEMS.
SESSION IS BEING RECORDED, FIRST
OFF.
>> RECORDING IN PROGRESS.
>> AND VIDEOCAST TO THE GENERAL
PUBLIC.
SO, JUST TO KEEP THAT IN MIND.
AND I BELIEVE THAT'S ALL WE HAVE
TO REPORT AT THE MOMENT.
I'LL TURN IT OVER TO DR. HODES.
RICHARD?
>> THANK YOU, KEN.
WELCOME.
THIS IS WHERE I WALK UP TO THE
PODIUM.
AND THE SLIDES COME UP.
I'LL GIVE YOU A BRIEF
BACKGROUND.
YOU'LL SEE IN ADDITION TO THE
STATUS REPORT OF WHAT'S NEW,
THIS TIME BECAUSE THERE'S SO
MANY STAFF WHO HAVE COME ON, WE
HAVEN'T HAD A CHANCE TO
INTRODUCE THEM IN PERSON.
ONCE I'VE GONE THROUGH A FEW
ITEMS OF BACKGROUND, WE'LL HAVE
DIVISION DIRECTORS INTRODUCE TO
YOU SOME OF THE STAFF WHO HAVE
COME ON IN THE PAST YEARS.
NEXT SLIDE PLEASE.
ALWAYS AN IMPORTANT ISSUE AND
ALWAYS IN JANUARY, WE'RE IN THE
SAME SITUATION OF NOT HAVING AN
APPROPRIATION FOR THE CURRENT
YEAR, IN THIS CASE FY2022.
THIS IS A SUMMARY OF WHERE WE
STAND.
BACK IN JULY, THE HOUSE PASSED
ITS APPROPRIATIONS BILL.
IT CALLED FOR NEARLY
$49.4 BILLION OVERALL FOR ALL OF
NIH.
$3 BILLION FOR THE NEW ARPA-H.
UNDER THIS LANGUAGE, NIA
APPROPRIATION WOULD INCREASE TO
$4.3258 BILLION, $200 MILLION
FOR ADRD.
HERE ARPA IS LOWER, NIA TOTAL IS
LOWER, HERE THE NUMBERS, $235
MILLION FOR ADRD RESEARCH, $29
MILLION FOR RESEARCH ON OPIOIDS
AND PAIN.
AS MANY OF YOU WILL KNOW, THE
GOVERNMENT IS CURRENTLY
FUNCTIONING UNDER A CONTINUING
RESOLUTION TILL FEBRUARY 18 AND
HOPE WE HAVE APPROPRIATION.
ALTERNATIVE IS CONTINUED FURTHER
RESOLUTION.
UNDER THE CIRCUMSTANCES, WE'RE
FORCED TO BE CONSERVATIVE AND
FUNDING LINES, THE DIFFERENCE IS
INCREASE $200 MILLION-PLUS FOR
THE YEAR WILL MAKE A SUBSTANTIAL
DIFFERENCE IN FUNDS AVAILABLE
FOR GRANTS AND OTHER MECHANISMS.
WITH THESE CONSERVATIVE INTERIM
PAYLINES YOU'LL SEE FOR THE
GENERAL PAYLINE, IT'S NOT ADRD,
FOR THE MOST COMMON APPLICATIONS
UNDER $500,000, THE PAYLINE AT
THE EIGHTH PERCENTILE AND HOPING
FOR INCREASE BUT THIS IS THE
INTERIM.
WE GIVE ADVANTAGE TO NEW AND
EARLY-STAGE INVESTIGATORS, AT
THE 11th AND 13th
PERCENTILE, AS AS WE'VE BEEN
DOING FOR SOME YEARS HAVE HIGHER
BAR FOR FUNDING OF MORE
EXPENSIVE OVER $500,000
APPLICATIONS.
FOR AD ADRD, THE CIRCUMSTANCE IS
BETTER.
INTERIM PAYLINES 25th
PERCENTILE, WITH 28th AND 30,
RESPECTIVELY, FOR NEW AND
EARLY-STAGE INVESTIGATORS.
NEXT SLIDE PLEASE.
SIMILAR PAYLINES FOR
NON-PERCENTILED APPLICATIONS, A
SUBSTANTIAL DIFFERENCE BETWEEN
AD/ADRD, PAY LINES FOR PROGRAM
PROJECTS, 37, CAREER DEVELOPMENT
AT 28, BUT FOR GENERAL LINE
SUBSTANTIALLY LOWER, 13th
PERCENTILE FOR PROGRAM PROJECTS
AND OTHER NIA REVIEWED, 25th
FOR FELLOWSHIPS, WE MAKE EFFORT
EVEN UNDER INTERIM CONDITIONS,
RECOGNIZE THE IMPORTANCE OF OUR
EARLY CAREER FELLOWSHIP AND
CAREER DEVELOPMENT CATEGORIES.
SOME UPDATES.
I WANTED TO SHARE WITH YOU IN
THE AREA OF ALZHEIMER'S-RELATED
DEMENTIA, THIS UPDATED AS OF
SOME 365 TRIALS IN ALL THESE
CATEGORIES YOU CAN SEE.
72 TRIALS PHARMACOLOGIC
INTERVENTION, 120
NON-PHARMACOLOGIC, 155 DEMENTIA
CARE AND CAREGIVING.
IF YOU LOOK AT WHAT IS LISTED
UNDER THESE CATEGORIES, FOR
EXAMPLE, IN THE PHARMACOLOGIC
INTERVENTIONS NOTABLY EARLY
STAGE TRIALS, THE VARIETY OF
TARGETS ILLUSTRATING THE
COMMITMENT AND SUCCESS IN
FUNDING INNOVATIVE APPLICATIONS
THAT TARGET MOST POTENTIAL
COMPONENTS OF ALZHEIMER'S AND
RELATED DEMENTIAS DISEASE
PROCESSES.
IN TERMS OF COVID-RELATED
OPPORTUNITIES HERE WITH NIA
PARTICIPATION CURRENTLY ACTIVE,
ONE IN NEUROLOGIC SEQUELAE FROM
SARS, WE'LL HEAR LET ABOUT
LONG-TERM SEQUELAE OF COVID, AND
PROJECTS THAT ARE UNDERWAY TO
ADDRESS THESE WITH NIA
INVOLVEMENT.
ANOTHER ON SOCIAL, BEHAVIORAL,
ECONOMIC IMPACT OF COVID-19 IN
UNDERSERVED AND VULNERABLE
POPULATIONS PARTICULARLY.
NEXT PLEASE.
JUST A COUPLE OF NOTABLE
RELEASES HERE, NASEM DECADAL
SURVEY, LOOKING AT EFFORTS TO
REDUCE THE IMPACT OF DEMENTIA IN
AMERICA, SURVEY OF BIOBEHAVIORAL
AND SOCIAL SCIENCES,
RECOMMENDING THIS TO YOU.
LOOKS FOR EMPHASIS ON NOT JUST
IDENTIFYING CAUSES BUT SOLUTIONS
FOR DISPARITIES.
NEXT PLEASE.
IN COLLABORATION WITH OTHER
AGENCIES, OUR EXTENSIVE AND
CONTINUING NOTABLY WITH THE V.A.
FOCUSING ON RECRUITMENT OF
VETERANS INTO ALZHEIMER'S
DISEASE RESEARCH BECAUSE THE
IMPORTANCE OF THE POPULATION,
GIVEN THE VERY LARGE MEDICAL
CARE SERVICES POPULATION UNDER
V.A. AEGIS, AN OPPORTUNITY TO
INCREASE DIVERSITY OF STUDIES,
SUCCESSFUL SO FAR ESTABLISHING
THESE COLLABORATIONS WITH MORE
TO COME.
NEXT PLEASE.
AND EACH YEAR I WANT TO REMIND
YOU OF THE BUTLER-WILLIAMS
COLLEGE PROGRAM, OUTSTANDING
MULTI-DAY PROGRAM, ONCE AGAIN TO
BE HELD VIRTUALLY THIS SUMMER
2022, APPLICATION DEADLINE
SPRING OF 2022, BRINGING
TOGETHER PEOPLE AT EARLY STAGES
OF THEIR CAREER, TO DISCUSS THE
BREADTH OF AGING RESEARCH WITH
STRONG EMPHASIS ON HEALTH
DISPARITIES RESEARCH.
NEXT PLEASE.
HAPPY TO NOTE THAT
ALZHEIMER'S.GOV, YOU MAY
UNDERSTAND TO BE THE DESTINATION
FOR DEMENTIA RESOURCE TO BROAD
POPULATIONS IS FULLY AVAILABLE.
FULLY AVAILABLE IN SPANISH AND
WORKING ON OTHER LANGUAGES.
TO ILLUSTRATE EFFORTS
DISSEMINATING INFORMATION, IN
PERSON MEETINGS, WE WOULD PASS
AROUND A BOOK, RESEARCH
HIGHLIGHTS, BLOGS,
ANNOUNCEMENTS, SUMMARY OF THE
OPPORTUNITIES WE'VE HAD TO
DISCUSS WITH STAKEHOLDERS AND
CONGRESSIONAL BRIEFINGS OVER THE
PAST MONTHS.
NEXT PLEASE.
NIH UPDATES, ONE, COMMON FUND
INITIATIVE, VERY RELEVANT TO
NIA, SEPARATE APPROPRIATION FROM
CONGRESS, OVER $500 MILLION, AND
IT IS TARGETING RESEARCH THAT
SPANS THE INTEREST OF MULTIPLE
INSTITUTES AND CENTERS, BROAD
AND BOLD, HAS GOALS, AND ONE
THAT'S BEEN SPONSORED BY NIA,
WITH NCI, CELLULAR SENESCENCE
NETWORKS, ONE OF THE MECHANISMS
WHICH HAS A STRONG RELEVANCE TO
AGING, AGING PROCESSES, SO
AWARDS HAVE BEEN MADE TO A
VARIETY OF SITES THAT ARE
STUDYING CELLULAR SENESCENCE
ESTABLISHING OVER MULTIPLE
TISSUES IN HUMANS, AND NOW A
RELEASE, SOLICITATION FOR
APPLICATIONS TO DO SIMILAR IN
MOUSE, THE NOTION BEING
CROSS-TALK BETWEEN HUMANS ANDS
INTERVENTIONS IN A MOUSE MODEL
WILL BE EXTENSIVE SO A WAY WE'VE
LEVERAGED ACROSS ALL OF NIH OF
ONE OF THE MAJOR ASPECTS OF
BASIC BIOLOGY OF AGING SUPPORTED
HERE AT NIA.
NEXT PLEASE.
AD ADRD SUMMIT COMING UP, THEMES
OF ALZHEIMER'S, RELATED
DEMENTIAS, A SERIES OF THREE
SUMMITS, THE ALZHEIMER'S
RESEARCH SUMMIT, AD/ADRD SUMMIT
ON CARE AND SERVICES, THIS IS
THE ADRD SUMMIT, WILL BE
ORGANIZED BY NINDS WORKING WITH
NIA, ROD CORRIVEAU TAKING THE
LEAD, ENCOURAGING YOU TO SIGN ON
AND REGISTER.
THIS WILL BE FULLY VIRTUAL IN
LIGHT OF THE CONTINUING PANDEMIC
CONSTRAINTS.
NEXT PLEASE.
A MAJOR EVENT, ANNOUNCEMENT THAT
FRANCIS COLLINS STEPPED DOWN.
LARRY TABAK, LONG-TERM DEPUTY
DIRECTOR IS ACTING DIRECTOR NOW.
THIS MEANS REASSURINGLY TO ALL
OF US NIH IS FUNCTIONING AND
FUNCTIONING WELL WHILE WE AWAIT
THE PROCESS FROM THE WHITE HOUSE
IN APPOINTING OR NOMINATING THE
NEXT DIRECTOR OF NIH.
NEXT PLEASE.
AND NOW AS I MENTIONED STAFF
UPDATES.
SORRY WE HAVEN'T BEEN ABLE TO
HAVE THESE PEOPLE STAND UP AND
SAY A FEW WORDS OVER THE LAST
SESSIONS OF OUR COUNCIL MEETINGS
BUT INSTEAD GIVEN THE
CIRCUMSTANCES WE'RE GOING TO
HAVE THE DIVISION DIRECTORS
INTRODUCE THE NEW MEMBERS WHO
JOINED OUR STAFF.
>> RON, DO YOU WANT TO START?
>> I'M HERE.
JUST A MATTER OF GETTING THE
MOUSE TO COOPERATE.
THANK YOU.
I'D LIKE TO INTRODUCE HEALTH
SCIENCE POLICY ANALYST SHOBHAN
ADDIE, YOU CAN READ PARTICULARS.
BACKGROUND, SHE WORKED WITH ONE
OF OUR GRANTEES ON A Ph.D.
THESIS ON DNA DAMAGE AND REPAIR,
COMES TO US BY WAY OF NEW YORK
ACADEMY OF SCIENCES AND NATIONAL
ACADEMY OF SCIENCES ENGINEERING
AND MEDICINE.
DR. KATIYAR, HEALTH SCIENCE
SPECIALIST IN SUPPORT OF THE
CELLULAR SENESCENCE COMMON FUND
NETWORK.
AND SHE WAS AT THE NIA OFFICE OF
PORTFOLIO ANALYSIS, Ph.D. IN
TUMOR BIOLOGY WHICH THEN LED HER
TO WORK AT NCI, EXPERIENCE IN
PROGRAM FROM NHLBI.
LEONIT TSAP, IMAGING AND
VISUALIZATION.
HIS PROGRAM IS ON EMERGING
TECHNOLOGIES AND DEVELOPING
TECHNOLOGIES SPECIFICALLY FOR
USE IN BIOLOGY OF AGING.
DR. COG LIATI COMES FROM ITALY,
VIA THE U.K., AND HAS
CREDENTIALS IN WORK IN
VISUALIZATION, AND VISION AND
THE MECHANISMS OF VISUALIZATION,
PARTICULARLY IN STEM CELLS AND
IN THE DEGENERATION OF THE
NERVOUS SYSTEM.
SHE ALSO HAS VALUABLE EXPERIENCE
IN COMPLEXITIES OF BIOBANKS.
JENNIFER FOX COMES TO US FROM
NCI DIVISION OF CANCER
PREVENTION, SHE HAS SUBSTANTIAL
EXPERTISE AS WELL IN DRUG
DEVELOPMENT AND APPROVAL
PROCESSES.
WE ARE ECSTATIC TO HAVE THESE
NEW MEMBERS OF OUR DIVISION.
THANK YOU.
>> NEXT UP, LIZ NEILSEN,
DIVISION OF BEHAVIORAL AND
SOCIAL RESEARCH.
>> HI, EVERYONE.
THANK YOU FOR THIS OPPORTUNITY
TO INTRODUCE OUR NEW STAFF.
WE RECENTLY WELCOMED DR. PETRA
JACOBS TO LEAD OUR NEW OFFERS OF
BEHAVIORAL AND SOCIAL CLINICAL
TRIALS, DR. JACOBS COMES FROM
NIDA, SHE HELD A POSITION AT
CO-DIRECTOR OF NIDA CENTER FOR
CLINICAL TRIALS NETWORK AND SHE
HAS EXTENSIVE EXPERIENCE IN BOTH
PHARMACOLOGICAL AND BEHAVIORAL
TRIALS FOR DRUG ABUSE WHICH SHE
NOW WILL BE APPLYING TO
OVERSIGHT OF OUR PORTFOLIO OF
OVER350 CLINICAL TRIALS THAT WE
HAVE AND LEADING OUR CLINICAL
TRIALS TEAM IN ADMINISTRATION
THOSE GRANTS.
WE'RE PLEASED TO WELCOME BACK
DR. EMERALD NGUYEN, PROGRAM
OFFICIAL, DEGREE IN SOCIALOLOGY,
SHE WAS A AAAS FELLOW, HAD BEEN
AT NIGMS IN ANALYTICS, SHE WILL
BE TAKING OVER A PORTION OF OUR
PORTFOLIO ON MACRO SOCIAL TRENDS
IN AGING, LIFE COURSE HELD,
AD/ADRD.
NEXT SLIDE PLEASE.
AS I MENTIONED IN OUR BREAKOUT
GROUP, A LOT OF THE WORK WE DO
IN BSR REALLY DEPENDS ON A
TALENTED TEAM OF HEALTH
SPECIALISTS AND SOCIAL SCIENCE
ANALYSTS THAT ARE THE GLUE THAT
ENABLE OUR WORK TO BE COMPLETED,
CONDUCTING PORTFOLIO ANALYSES,
SUPPORTING THE WORK THAT OUR
MANY PROGRAM OFFICERS DO.
AS THE DIVISION HAS GROWN, WE
HAVE NOW BROUGHT ON BOARD NEW
FOLKS TO HELP US WITH THIS
REALLY LARGE WORKLOAD.
WE'RE EXCITED TO WELCOME REBECCA
RICKLIS IN THE INDIVIDUAL
BEHAVIORAL PROCESSES BRANCH AS A
HEALTH SPECIALIST, REBECCA WAS
PREVIOUSLY AT JOHNS HOPKINS
SCHOOL OF MEDICINE, AND HAS DONE
SOME WORK IN HIV.
CHARLES LE JOINED LAST WEEK IN
THE POPULATION AND SOCIAL
PROCESSES BRANCH, AND HE HAS AN
NIH BACKGROUND AT THE CENTER OF
SCIENTIFIC REVIEW WHICH WILL
SERVE HIM WELL IN WORKING WITH
US ON MANY ASPECTS OF INTERFACE
BETWEEN PROGRAM AND REVIEW.
NEXT SLIDE PLEASE.
ADDING TO THE TEAM WE ALSO HAVE
NICOLE KIDWILER, ASSISTING STAFF
AND PROGRAM ANALYSTS SINCE
JOINING FROM TOWSON UNIVERSITY,
THE PATHWAYS PROGRAM IS A REALLY
TERRIFIC WAY TO BRING YOUNG AND
NEW FOLKS INTO THE FEDERAL
WORKFORCE SO WE'RE PLEASED TO
WELCOME NICOLE TO THE TEAM.
AND OUR FINAL SOCIAL SCIENCE
ANALYST ALLIE WALKER JOINING
FROM OFFICE OF PLANNING RESEARCH
AND EVALUATION AT THE
ADMINISTRATION FOR CHILDREN AND
FAMILIES, AND WILL BE ASSISTING
WITH THE OTHER FOLKS IN
SUPPORTING PROGRAM IN OUR
MULTIPLE SCIENTIFIC ENDEAVORS.
SO WELCOME ALL OF THEM AND THANK
YOU FOR THE OPPORTUNITY TO
INTRODUCE THEM.
>> NEXT UP IS DR. ELEAZAR
MASNIOF.
>> THANK YOU FOR THE
OPPORTUNITY.
IT'S MY PLEASURE TO INTRODUCE
THREE NEW PROGRAM DIRECTORS TO
THE DIVISION OF NEUROSCIENCE.
FIRST PAUL GROTHAUS.
HE WILL BE INTEGRAL PART NOW OF
THE TRANSLATIONAL RESEARCH
BRANCH, WORKING TOGETHER WITH
LARRY ON A NUMBER OF NEW VERY
EXCITING TRANSLATIONAL PROGRAMS
THAT HAVE BEEN DEVELOPED, AND
PAUL HAS A BACKGROUND IN
MEDICINAL CHEMISTRY.
HE ACTUALLY ADVANCED A NUMBER
OF DRUGS THROUGH THE PIPELINE
AND HAS TREMENDOUS EXPERIENCE IN
DRUG DEVELOPMENT AND JOINS US
FROM -- HE WAS PREVIOUSLY AT
NCI.
NEXT ALSO ON THE TRANSLATION
RESEARCH BRANCH JENNIFER ISAACS,
SHE ALSO HAS A TREMENDOUS
EXPERIENCE IN MOLECULAR BIOLOGY
AND MOLECULAR MECHANISM,
CELLULAR MOLECULAR MECHANISMS
INCLUDING CHAPERONES, WILL BE
ALSO SUPPORTING THE
TRANSLATIONAL RESEARCH BRANCH IN
RELATION TO OUR RECENT EFFORTS
IN PRECISION MEDICINE, AND SHE
COMES TO US VIA BARDA AS WELL AS
NCI.
AND FINALLY ALESSANDRA
ROVESCALLI FAMILIAR TO SOME OF
YOU, A NEUROPHARMACOLOGIST, AND
PREVIOUSLY AT THE CENTER FOR
SCIENTIFIC REVIEW, AND SHE IS
JOINING THE CLINICAL
INTERVENTIONS AND DIAGNOSTICS
BRANCH, WHERE SHE IS GOING TO BE
WORKING TOGETHER WITH LORI AND
OTHERS SUPPORTING THE
DIAGNOSTICS PORTFOLIO AND
BIOMARKERS PORTFOLIO AMONG OTHER
FUNCTIONS, REALLY VERY EXCITED
TO HAVE THESE NEW MEMBERS.
AND THANK YOU.
>> THANKS, ELEAZAR.
NEXT UP IS DR. EVAN HADLEY,
DIVISION OF GERIATRICS AND
CLINICAL GERONTOLOGY.
>> WE'RE PLEASED THAT KATHLEEN
MERCURE JOINED US AS PROJECT
MANAGER, COMES FROM NCI, AND HER
MAIN ACTIVITIES HAVE BEEN IN
COORDINATING AMONG OUR LARGE
PROJECTS ON EXCEPTIONAL
LONGEVITY THAT THESE HAVE BEEN
RUNNING FOR QUITE A WHILE WITH
POTENTIAL FOR SYNERGY WITH
COHORT STUDIES, COLLABORATION,
FAMILY STUDIES COLLABORATION,
NEW STUDIES ON OMICS.
AND GETTING THE COMMUNICATION
AND ONGOING INTERACTIONS HAS
BEEN A REAL CHALLENGE FOR THESE
BIG PROJECTS, AND KATHLEEN
REALLY HAS A FLAIR FOR IT AND
WE'RE GRATEFUL SHE'S JOINED US.
>> THANK YOU, EVAN.
NEXT UP AGAIN, I'M KEN SANTORA,
DIRECTOR OF DIVISION OF
EXTRAMURAL ACTIVITIES, IT'S MY
PLEASURE TO ANNOUNCE SIX NEW
MEMBERS TO OUR DIVISION.
FIRST IS ASHLEY BUTTERFIELD
HEALTH SPECIALIST FROM URBAN
HOUSING AND DEVELOPMENT, NIH
GUIDE LIAISON, WHICH IS THE
PUBLICATION SYSTEM FOR ALL OUR
FUNDING OPPORTUNITY
ANNOUNCEMENTS HERE, SO SHE WILL
BE IN CHARGE OF THAT.
NEXT UP IS NEW SCIENTIFIC REVIEW
OFFICER REY DOMINGUEZ FROM
AUSTRALIA, HE'S GOING TO BE
ORGANIZING THE INITIAL PEER
REVIEW OF SPECIFIC RESEARCH
APPLICATIONS THAT ARE ASSIGNED
TO NIA.
WE WELCOME REY.
NEXT IS ANOTHER SCIENTIFIC
REVIEW OFFICER, JOSHUA PARK,
PREVIOUSLY WAS ASSISTANT
PROFESSOR AT UNIVERSITY OF
TOLEDO, COLLEGE OF MEDICINE, HE
WILL BE OVERSEEING REVIEW OF THE
CLINICAL SCIENCE SECTION, ONE OF
OUR STANDING STUDY SECTIONS HERE
AT NIA.
NEXT SLIDE.
NEXT IS LENIN GREENWOOD, NEW
SUPERVISORY GRANTS MANAGEMENT
SPECIALIST.
SHE WAS PREVIOUSLY A SENIOR
GRANTS MANAGEMENT SPECIALIST AT
ONE OF OUR SISTER AGENCIES,
NIDA.
AND SHE'S GOING TO BE OVERSEEING
THE BUSINESS MANAGEMENT AND
OTHER NON-PROGRAMMATIC ASPECTS
OF NOTICE OF AWARDS FOR NIA'S
DIVISION OF GERIATRICS AND
CLINICAL GERONTOLOGY.
NEXT IS KENJA LEWIS, SHE IS AN
EXTRAMURAL SUPPORT ASSISTANT.
SHE JOINS US FROM PRIVATE
INDUSTRY AND SHE'S GOING TO BE
WORKING IN OUR OFFICE OF
SCIENTIFIC REVIEW.
AND SHE ASSISTS REVIEW OFFICERS
IN ORGANIZING REVIEW MEETINGS,
MAKING ARRANGEMENTS AND
PREPARING SUMMARY STATEMENTS.
AND FINALLY MISS REBECCA ROPER,
SHE'S A HEALTH SCIENCE POLICY
ANALYST.
SHE IS NOW A NEW MEMBER OF OUR
NEWLY CREATED OFFICE OF CLINICAL
RESEARCH HERE IN THE DEA.
SHE WAS PREVIOUSLY A PROGRAM
OFFICER AT NHLBI, OVERSEEING THE
OUTREACH TO COMMUNITY-BASED
RESEARCH NETWORKS, ASSISTING
WITH CROMS AND OUTREACHPRO, TWO
MAJOR SYSTEMS CREATED FOR OUR
CLINICAL RESEARCH OFFICE.
NEXT SLIDE.
NEXT UP CONSIST DR. DAWN BERNARD
TO INTRODUCE THE NEXT SPEAKERS
BUT I WOULD FIRST LIKE TO
ANNOUNCE DR. BERNARD HAS BEEN
SELECTED TO SERVE AS NEW
DIRECTOR OF THE OFFICE OF
LEGISLATION POLICY AND
INTERNATIONAL ACTIVITIES.
SO CONGRATULATIONS TO DAWN FOR
THAT PROMOTION.
DAWN?
>> HI, KEN.
CAN YOU HEAR ME OKAY?
>> YES, THANKS.
>> THANK YOU.
GOOD MORNING, EVERYONE.
IT'S NICE TO MEET YOU VIRTUALLY.
I WANTED TO INTRODUCE TWO NEW
MEMBERS OF THE OLPIA TEAM.
DR. LINDA YANG HEALTH SCIENCE
POLICY ANALYST IN OUR OFFICE,
COMES FROM NIAID'S OFFICE OF
PLANNING AND EVALUATION, PhD
in biomedical sciences from
Mount Sinai, helping NIA cover
division of aging biology
programs and supporting
responses to Congress and other
stakeholders.
NEXT NEW ADDITION, WELL NEW TO
US AGAIN, COURTNEY WALLIN, DR.
WALLIN FROM "ALL OF US," PRIOR
TO THAT OFFICE OF LEGISLATION
AND POLICY.
SHE HAS HER Ph.D. IN COGNITIVE
NEUROSCIENCE FROM GEORGE
WASHINGTON UNIVERSITY, AND WILL
BE COVERING FOR THE OFFICE
DIVISION OF NEUROSCIENCE
CLINICAL PORTFOLIO AS WELL AS
OUR SBIR PORTFOLIO AND
CHALLENGES ACTIVITIES.
THANKS, KEN.
>> THANKS, DAWN.
NEXT SLIDE.
NOW WE ASK CINDY MCCONNELL,
DIRECTOR OF OFFICE OF
COMMUNICATIONS AND PUBLIC
LIAISON.
CINDY?
>> GOOD MORNING.
I'D LIKE TO WELCOME -- HOPEFULLY
MY VIDEO IS WORKING.
KATIE MURRAY AND ASHLEY NEGRO,
BOTH KATIE AND ASHLEY CAME TO US
FROM THE CENTERS FOR MEDICARE
AND MEDICAID SERVICES, CMS, AND
KATIE WILL BE FOCUSED ON WRITING
CONSUMER HEALTH CONTENT, SHE'S A
WRITER/EDITOR, AND ASHLEY IS
FOCUSED ON OUR MEDIA RELATIONS
BOTH PRO-ACTIVE AND REACTIVE.
A WARM WELCOME TO THEM BOTH.
>> THANKS, CINDY.
NEXT UP, HEAD OF OFFICE OF
ADMINISTRATIVE MANAGEMENT.
PATRICK?
>> THANKS, KEN.
AM I COMING THROUGH OKAY?
>> YES.
>> GREAT.
THANK YOU, EVERYBODY.
GOOD MORNING.
WE HAVE TWO NEW ADDITIONS,
NICHOLAS CAPELL, JOINING OUR
FINANCIAL MANAGEMENT BRANCH
FOCUSING ON OUR GRANTS TEAM.
COMES FROM UNIVERSITY OF OREGON,
WE'RE EXCITED TO HAVE HIM.
DAYANA ALBA.
>> AND DR. LUIGI FERUGGI.
>> GOOD MORNING, EVERYBODY.
I'M GOING TO TALK TO YOU ABOUT
THE FOUR PEOPLE THAT ARE FOUR
NEW ENTRIES IN THE INTRAMURAL
PROGRAM, BUT I'LL GIVE YOU IN MY
PRESENTATION A MUCH MORE
COMPREHENSIVE VIEW OF THE
INTRAMURAL PROGRAM.
LINUS JOSEPH IS COMPUTER
SCIENTIST.
AS YOU KNOW, MOST OF THE SCIENCE
WE DO PRODUCED MUCH MORE DATA
THAN WE CAN CRUNCH, AND SO THAT
REINFORCING, YOU KNOW, OUR I.T.
DEPARTMENT HAS BEEN FUNDAMENTAL
PROGRESS IN THE INTRAMURAL
PROGRAM, AND LINUS IN PARTICULAR
IS AN EXPERT IN PROGRAMMING IN
LINUX, AND OTHER LANGUAGES, AND
HIS ROLE IS REALLY TO MODERNIZE
SOME OF THE PROCESS AND
PROCEDURES FUNDAMENTAL, MOSTLY
TO MOVE DATA, WITHIN THE
DIFFERENT PARTS OF THE
INTRAMURAL PROGRAM.
ANNAMARIA RUDDDEROW, OFFICE OF
SCIENTIFIC DIRECTOR.
YOU KNOW, THE WORK IN THE
SCIENTIFIC DIRECTOR OFFICE HAS
EXPANDED TREMENDOUSLY, IN PART
BECAUSE OF THE ALZHEIMER'S
DISEASE AND RELATED DEMENTIA
OPERATION, ALSO BECAUSE WE HAVE
LAUNCHED MANY INTERNAL
COMPETITIVE INITIATIVES FOR
FUNDING.
AND SO THOSE ARE, YOU KNOW,
REQUIRE A LOT OF, YOU KNOW,
PROCESSES.
FOR EXAMPLE, YOU KNOW, THIS YEAR
WE HAD 69 PROJECT PROPOSALS THAT
NEEDED TO BE REVIEWED, AND SO WE
HIRED ANNAMARIA RUDDEROW,
TURNING OUT TO BE A FANTASTIC
ADDITION TO OFFICE OF SCIENTIFIC
DIRECTOR.
VICTORIA DAVIS, PEOPLE COME OP
SUNDAYS, EVENINGS, AVAILABLE
EARLY IN THE MORNING FOR
TESTING, VICTORIA HAS BEEN
ALWAYS A FANTASTIC CONTRIBUTOR
TO OUR PROGRAM SO SHE WAS HIRED
AS A NIGHT NURSE.
FINALLY DAN BENJAMINI, A RECENT
ACQUISITION IN THE TENURE TRACK
PROGRAM.
DAN CAME TO US FROM THE
FOUNDATION FOR ADVANCEMENT OF
MILITARY MEDICINE, TRULY UNIQUE
SKILLS.
HE IS AN IMAGING PERSON, MOSTLY
WORKING ON MRI, BUT NOT ONLY
MRI, AND HIS GOAL IS TO PUT
TOGETHER, YOU KNOW, THE
RELATIONSHIP BETWEEN IMAGING AND
-- (INDISCERNIBLE), HIGH FIELD
MRI IN MICE AND HUMANS, IN
DEMENTIA STUDY OF THE SAME
SECTION WITH MRI TO SEE WHETHER
THERE ARE WAYS TO RECOGNIZE
CHARACTERISTICS OF THESE
TISSUES, FOR EXAMPLE ANOTHER
THING HE WANTS TO DO IS
RECOGNIZE (INDISCERNIBLE) AND
HAS DEVELOPED A PROGRAM ABLE TO
DO THAT, AT LEAST IN MICE SO
FAR, AND IS JOINING OUR PROGRAM
WHERE THERE IS CONSIDERABLE
EXPERTISE IN IMAGING, AND SHE
WILL BE WORKING WITH SUSAN AND
ALL THE OTHER INVESTIGATORS AT
NIA.
>> THANK YOU, LUIGI.
I'LL TURN IT BACK OVER TO DR.
HOED ES.
>> THANKS FOR THE INTRODUCTIONS
SHARING THE EXCITEMENT OVER THE
PAST MONTHS, EVEN YEARS IN
COVID.
NOT ONLY HAVE WE BEEN WORKING
WITH YOU IN THE RESEARCH
COMMUNITY AND PUBLIC TO KEEP
THINGS GOING BUT WE'VE OF WE NOW
HAVE THE EXCITEMENT OF BEING
JOINED BY TALENTED, COMMITTED,
VIGOROUS FOLKS YOU'VE SEEN AT
LEAST REMOTELY.
WE LOOK FORWARD FOR THE CHANCE
FOR THEM TO MEET YOU IN PERSON
AND EXPERIENCE INTERACTIONS WITH
THEM.
HERE THE FINAL SLIDE TO HELP
REMIND YOU SOME OF THE WAYS TO
STAY CONNECTED WITH NEWS AS IT
HAPPENS.
WE HOPE YOU WILL LOOK INTO THESE
SITES FOR THE BLOG IN
PARTICULAR, SUBSCRIBING, COMING
TO YOU PROACTIVELY, ONE WAY TO
KEEP IN TOUCH WITH EVENTS AS
THEY HAPPEN.
KEN, BACK TO YOU.
>> THANKS, RICHARD.
ANY QUESTIONS NOW FOR DR. HODES
REGARDING HIS DIRECTOR'S STATUS
REPORT?
>> I'VE GOT A QUESTION, IF I
MAY.
>> CERTAINLY.
>> SO, THAT WAS SUCH A GREAT
REPORT.
TWO QUESTIONS, RICHARD.
THAT IS, YOU SAID AT ONE POINT
IN YOUR PRESENTATION THAT YOU
HAD A NUMBER OF BRIEFINGS WITH
CONGRESS, A NUMBER OF BRIEFINGS
WITH CONSTITUENTS.
HOW HAS THAT GONE UP OR DOWN
DURING COVID, YOUR NUMBERS, ARE
THEY THE SAME?
>> IT'S A GOOD QUESTION, TERRY.
MY SENSE IS YES, PRETTY MUCH THE
SAME.
>> THAT'S GREAT.
>> MEETINGS WITH CONSTITUENT AND
ADVOCATE GROUPS, MANY OF THEM
ARE REGULARLY SCHEDULED, AND
THEY HAVE CONTINUED NOW, JUST
REMOTE INSTEAD OF IN PERSON.
SIMILARLY FOR BRIEFINGS AND
HEARINGS.
>> THAT'S GREAT.
AND PART 2 QUICKLY IS YOU HAVE
INTRODUCED US TO AN ARRAY OF
WONDERFUL NEW STAFF.
ARE YOU NET POSITIVE OR NET
NEGATIVE IN YOUR STAFFING NOW?
>> VERY SIGNIFICANTLY POSITIVE.
>> GREAT.
>> SOME YEARS WE WERE AT STEADY
STATE, EVEN AS OUR SCOPE AND
BUDGET INCREASED.
BUT WE HAVE HAD THE OKAY TO DO
SUBSTANTIAL RECRUITMENT.
SO WE'RE WORKING EACH YEAR
ACROSS ALL THE PROGRAMS AND
DIVISIONS FOR STRATEGIC PLANS,
ASK WHAT'S NEEDED, SO FAR HAVE
BEEN ABLE TO MEET NEEDS AND
EXPAND.
INCREASING STAFFING TO MEET THE
DIVERSITY AND EXTENT OF OUR
SCIENCE INTERACTIONS WITH ALL OF
YOU.
>> ABSOLUTELY WONDERFUL.
THANK YOU.
>> OTHER QUESTIONS?
>> SALLY?
>> YES, I WANT TO CONGRATULATE
YOU, NIA AND STAFF FOR AMOUNT OF
WORK AND QUITE A SPECTACULAR
GROWTH IN NIA'S PORTFOLIO OVER
THE LAST DECADE.
THAT'S WONDERFUL AND
ENCOURAGING.
ONE FEEDBACK THAT I AND OTHERS
ARE RECEIVING FROM JUNIOR
COLLEAGUES IS EXTRAORDINARY
AMOUNT OF PAPERWORK AND
REGULATORY BURDEN THAT NEW
GUIDELINES AND IMPLEMENTATION OF
THE PREVIOUS GUIDELINES ARE
IMPOSING ON JUNIOR COLLEAGUES.
SUCH A LARGE PORTION OF THE
GRANT SUBMISSION RELATES TO
ADMINISTRATIVE ASPECTS, THAT THE
INVESTIGATORS, INDIVIDUAL
INVESTIGATORS, ESPECIALLY JUNIOR
INVESTIGATORS, HAVE VERY LITTLE
CONTROL OVER.
AND FIND IT EXCEEDINGLY
DIFFICULT TO MANAGE, EVEN THINGS
LIKE THOUSAND DOLLAR TRAVEL HAS
TO BE EXPLAINED MULTIPLE TIMES,
IN GREAT DETAIL.
AND ALTHOUGH THIS IS NOT
ENTIRELY NIA'S PURVIEW, I THINK
WE GET THE SAME FEEDBACK FROM
VARIOUS INSTITUTES, I THINK
THERE NEEDS TO BE SOME ATTENTION
GIVEN TO WHAT THE REVIEWERS CAN
REVIEW MEANINGFULLY AND WHAT THE
INVESTIGATORS CAN MEANINGFULLY
AND PRACTICALLY MANAGE IN TERMS
OF THE ADMINISTRATIVE ASSURANCES
AND BURDEN THAT IT IMPOSES.
>> THANK YOU FOR THE THOUGHTFUL
COMMENTS.
WE NEED TO PAY ATTENTION.
KEN, DO YOU HAVE ANY SPECIFIC
RESPONSE?
INCLUDING THE CHANNELS BY WHICH
WE CONVEY THESE KINDS OF
CONCERNS.
>> YES.
WE CERTAINLY RECOGNIZE THOSE
CONCERNS.
AND ALWAYS TAKE THAT INTO
CONSIDERATION WHEN WE'RE
IMPLEMENTING NEW POLICIES,
ESPECIALLY.
I THINK THERE'S BEEN A CONCERTED
EFFORT EVER SINCE THE 21ST
CENTURY CURES ACT CAME OUT
DURING THE OBAMA ADMINISTRATION.
ONE OF THE TENETS OF THAT WAS TO
TRY TO REDUCE ADMINISTRATIVE
BURDEN.
AND WE REALLY RECOGNIZE HOW MUCH
A BURDEN THAT IS ESPECIALLY IN
OUR EARLY CAREER AWARDEES
BECAUSE OF, YOU KNOW, SETTING UP
LABORATORIES, ET CETERA, YOU
KNOW, WRITING GRANTS, MANAGING.
VERY DIFFICULT TO MANAGE ALL
THOSE COMPONENTS.
WE DO RECOGNIZE THAT.
YOU KNOW, WE'RE TRYING TO
IMPLEMENT EFFICIENCIES WHERE WE
CAN, ESPECIALLY THROUGH OUR
ELECTRONIC AND I.T. DEPARTMENTS.
YOU KNOW, TO MAKE THINGS MUCH
MORE ARE STREAMLINED AND EASIER
TO MAKE ALL THOSE REQUIREMENTS.
WE'RE INTEGRALLY INVOLVED ALWAYS
IN THOSE REQUIREMENTS.
AND WE UNDERSTAND, BECAUSE AS
ADMINISTRATORS OF THOSE GRANTS
THOSE TIMES TEN ARE ON US ALSO.
AND WE THOROUGHLY UNDERSTAND
THAT.
UNFORTUNATELY, THE NECESSITY OF
DOING THOSE, BECAUSE MOST OF
THEM ARE BY REGULATION AND LAW
THROUGH THE FEDERAL GOVERNMENT,
AND SO WE DON'T HAVE A LOT OF
CHOICES IN IMPLEMENTING THOSE
TYPES OF THINGS.
BUT WE ARE ALWAYS TRYING TO HELP
OUR INVESTIGATORS, AND, AGAIN,
TRYING TO COME UP WITH SOME
EFFICIENCIES AS MUCH AS
POSSIBLE.
SO, BUT AGAIN IT'S A VERY GOOD
QUESTION.
AND WE'RE CONSTANTLY LOOKING FOR
NEW INNOVATIVE WAYS TO ALLEVIATE
THOSE ADMINISTRATIVE BURDENS
WHEN POSSIBLE.
>> I ONLY ADD WE APPRECIATE YOU
RAISING THE QUESTIONS, AND
WELCOME YOUR HELP AND AYE SIS
TANS, SHALI AND COUNCIL, IF
THERE'S SPECIFIC QUESTIONS WE
CAN LOOK INTO AND TEST
NECESSITY, WHETHER THERE'S ROOM
FOR MODIFICATION.
SO PLEASE CONTINUE TO CONVEY THE
GENERAL CONCERNS BUT ALSO ANY
SPECIFIC THOUGHTS YOU HAVE.
>> I'LL SEND AN E-MAIL WITH SOME
THOUGHTS ON IT BUT I'M GETTING
SO MUCH FEEDBACK WITHIN OUR
PEPPERER CENTER, I CAN'T TELL
WHAT THE AIRFARE IS TODAY VERSUS
TOMORROW AND TO EXPECT A
RATIONALIZATION OF A THOUSAND
DOLLARS IN TRAVEL EXPENSES SEEMS
MUCH, AN EXTREME EXAMPLE,
PERHAPS I HOPE AN UNCOMMON
EXAMPLE.
BUT 80% OF THE GRANT TODAY IS
NOT RELATED TO THE SCIENCE PART
OF IT.
AND SO MANY OF THESE
ADMINISTRATIVE ASSURANCES CAN BE
ASSIGNED TO THE NIH-FUNDED
INSTITUTIONS.
AND IT SEEMS TO ME TO PUT THOSE
150 PAGES INTO A GRANT DOESN'T
DO MUCH BECAUSE I AS A REVIEWER
HAVE VERY LITTLE TIME TO READ
THOSE 150 PAGES.
AT ANY RATE, I RECOGNIZE THAT
IT'S NOT ENTIRELY WITHIN THE
INSTITUTE NIA'S PURVIEW.
BUT IF IT'S NOT 27 INSTITUTES
PURVIEW WHOSE IS IT AND HOW CAN
WE ACCESS AND PROVIDE FEEDBACK
TO TOP LEADERSHIP SETTING THESE
POLICIES?
>> AGAIN, THANK YOU FOR THAT,
SHALI.
PLEASE SEND ME AND DR. HODES
SUGGESTIONS AND WE CAN FUNNEL TO
LEADERSHIP AT NIH TO MAKE SURE
THAT'S ALWAYS ON THE AGENDA.
I CAN ALSO ASSURE YOU THESE
DISCUSSIONS LIKE THIS ARE ALWAYS
HIGH IN PRIORITY TO THE NIH, AT
THE HIGHEST LEVELS, BECAUSE
OBVIOUSLY YOU'RE NOT THE ONLY
ONES THAT ARE BRINGING THIS TO
OUR ATTENTION THROUGHOUT THAT,
AND WE'RE WORKING THROUGH
CHANNELS.
BUT THE MORE EVIDENCE AND MORE
WE HEAR FROM YOU, THE BETTER.
AND WE CAN KEEP THAT
CONVERSATION GOING ALWAYS.
AND TRY TO WORK THROUGH THINGS
TO MAKE IT BETTER.
>> THANK YOU, KEN.
THANK YOU, RICHARD.
>> ANY OTHER QUESTIONS?
SO OF COURSE WE'LL STAY TUNED
FOR, YOU KNOW, HOPEFULLY WE'LL
GET A BUDGET IN THE NEXT THREE
WEEKS.
WE'LL SEE.
BUT LOTS DEPEND ON THAT, YOU
KNOW, TOO SO STAY TUNED FOR
THAT.
OKAY.
>> MERRILL HAD A COMMENT.
>> YES, DR. HODES, I THINK ONE
OF THE SLIDES THAT YOU PUT FORTH
REALLY SPEAKS TO THE
PRODUCTIVITY ON THE ACTIVE
CLINICAL TRIALS UNDERWAY.
I THINK THAT SHOULD BE USED MORE
OFTEN BECAUSE IT REALLY GIVES A
SNAPSHOT OF HOW EFFECTIVE THE
NIA HAS BEEN AND ACROSS VARIOUS
DOMAINS.
MY QUESTION TO YOU IS CAN YOU
GIVE US ANYPLACE INSIGHT INTO
ARPA-H AND HOW ITS POTENTIAL
IMPACT ON THE NIA?
>> THANKS FOR THAT COMMENT AND
QUESTION, MERYL.
NOT MUCH CAN I SHARE BECAUSE NOT
MUCH HAS BEEN DETERMINED.
THE ARPA-H PROPOSAL IS NOT YET
PASSED THROUGH AT THE LEVEL OF
EITHER AUTHORIZATION OR
APPROPRIATION.
SO IN GENERAL OF COURSE THE
VISUALIZATION HAS BEEN IT'S
SOMETHING LIKE DARPA, WHICH
MEANS IT HAS PARTICULAR
MECHANISMS FOR FACILITATING
PARTNERSHIPS, RAPID PROGRESS,
MILESTONE-DRIVEN DETERMINATIONS
OF SUCCESS OR FAILURE AT A
PROJECT LEVEL.
THE DECISION ABOUT WHETHER THERE
WILL BE AN ARPA-H, IF THERE IS
ONE WHETHER IT WILL BE WITHIN
NIH OR NOT, IS STILL A MATTER OF
SOME CONGRESSIONAL DISCUSSION.
AGAIN, IT NEEDS AUTHORIZATION
AND APPROPRIATION OF FUNDS,
NEITHER OF WHICH HAS YET
OCCURRED.
IF THERE'S A COMMON THEME FOR
DISCUSSIONS IF THIS COMES TO BE,
WHETHER WITHIN NIH OR NOT, IT
HAS TO BE SOMETHING QUITE
DISTINCT AND INDEPENDENT AT
LEVEL OF MANAGEMENT FROM NIH.
NOT MORE OF THE SAME, NOT TO
UNDERMINE THE VALUE OF WHAT NIH
DOES BUT IF IT'S VALUE ADDED IT
HAS TO HAVE A LEVEL OF AUTONOMY
WHILE IT ENTER ACCOUNT A --
INTERACTS WITH NIH, VERY LITTLE
IN RECENT WEEKS, CONGRESSIONAL
LEVEL, AUTHORIZATION OR
APPROPRIATION.
WE'LL KEEP YOU INFORMED AS
YOU'RE INTERESTED IN THE OUTCOME
OF THIS.
>> THANK YOU.
>> THERE'S VERY LIMITED LANGUAGE
WHEN IT CAME TO WHAT WAS BEING
PROPOSED DURING ARPA-H.
ONE OF THE THINGS THEY DID POINT
OUT IN THAT WAS ALZHEIMER'S
DISEASE.
SO WE ARE IN, YOU KNOW, KEEPING
THAT UNDER CONSIDERATION WHEN
WE'RE THINKING OF THE FUTURE
AND FUTURE PROJECTS FOR THE
INSTITUTE.
>> YES, THE ORIGINAL LANGUAGE
FROM THE PRESIDENT, ALZHEIMER'S
WAS ONE OF THREE EXAMPLES OF
DISEASE ALONG WITH CANCER THAT
HE CITED.
>> ALL RIGHT.
ANY OTHER COMMENTS OR QUESTIONS?
OKAY.
NOT HEARING ANY, I'D LIKE TO
THEN CONTINUE.
JUST TO KEEP EVERYONE INFORMED,
OUR NEXT COUNCIL DATE IS ON MAY
10 AND 11, THAT IS 2022.
WE AT THIS POINT DON'T KNOW IF
THAT WILL BE AN IN-PERSON
MEETING OR A VIRTUAL MEETING,
BUT WE'RE HOPEFUL.
AND WE'LL LET YOU KNOW AS SOON
AS WE HEAR MORE INFORMATION.
AND THEN OF COURSE YOU CAN SEE
ON THE SLIDE THE OTHER FUTURE
DATES FOR OUR COUNCIL MEETINGS.
THE NEXT ITEM ON OUR AGENDA IS
CONSIDERATION OF THE MINUTES OF
THE LAST MEETING.
I JUST WANTED TO GET A MOTION
FROM OUR COUNCIL MEMBERS TO
APPROVE THE MINUTES FROM THE
LAST MEETING.
>> SO MOVED.
>> SECOND?
>> SECOND.
>> ALL IN FAVOR?
>> AYE.
>> ANY DISSENT?
THANK YOU VERY MUCH.
WE HAVE APPROVAL OF THE MINUTES
FROM OUR LAST MEETING.
THANK YOU.
NEXT UP IS OUR REPORT FROM OUR
TASK FORCE ON MINORITY AGING
RESEARCH.
I'LL TURN IT OVER TO DOCTORS
WHITFIELD AND MANLEY.
>> THANK YOU.
PARTICULARLY GOOD MORNING TO THE
NEW MEMBERS.
I THINK THAT ONE OF THE THINGS
YOU'LL SEE THE TASK FORCE KICKS
OFF OUR MEETINGS ALL THE TIME.
OUR GOAL IS TO BE ABLE TO HAVE
SOME INTERESTING CHALLENGING
CONTROVERSIAL THOUGHT-PROVOKING
IDEAS THAT COME ACROSS TO BE
ABLE TO THINK ABOUT HOW AS PART
OF NIA'S MISSION WE CAN BE ABLE
TO ADVANCE WORK ON MINORITY
AGING RESEARCH.
SO JUST TO GIVE A VERY QUICK
RECAP, WE KICKED OFF YET WITH
DR. JONES' OPENING, AND STARTING
OFF BY INTRODUCING THE NEW
CO-CHAIR.
I WANT TO GIVE ALL THANKS AND
APPRECIATION TO JENNIFER FOR
STEPPING INTO THIS ROLE.
I THINK THAT IT'S CRITICALLY
IMPORTANT AND I THINK SHE'S
GOING TO DO AN INCREDIBLE JOB.
I THINK I'VE ONLY BEEN A
CO-CHAIR FOR LIKE A YEAR, ON MY
SECOND PERSON.
MAYBE I'M JUST WEARING THEM
DOWN.
A SPECIAL THANKS TO CLIFF
ROSEN.
HIS THOUGHTFUL, MEANINGFUL,
HEARTFUL APPRECIATION FOR THE
CONTRIBUTION OF HEALTH
DISPARITIES AND MINORITY AGING
IS CRITICAL IMPORTANT.
DR. JONES PROVIDED
ANNOUNCEMENTS, FIRST OFF 2022
BUTLER-WILLIAMS SCHOLAR PROGRAM,
MEETING AUGUST 23-25.
DR. JONES HAS BEEN ABLE TO RUN
THAT PROGRAM VIRTUALLY.
I KNOW SOME OF YOU, LIKE ME,
PARTICIPATED IN THE SUMMER
INSTITUTE PROGRAM OVER THE
YEARS.
AND THE DYNAMIC NATURE OF IT IN
PERSON IS SOMETHING THAT'S
SPECIAL THAT ANYBODY WHO HAS
BEEN THROUGH IT WILL RECOUNT
THAT EXPERIENCE.
BUT I THINK SHE'S BEEN ABLE TO
FIGURE OUT A WAY VIRTUALLY TO BE
ABLE TO CAPTURE THAT SAME KIND
OF EXCITEMENT AND ENTHUSIASM.
SO PLEASE SUGGEST TO PEOPLE THEY
APPLY AGAIN THIS YEAR, AND SHE
MENTIONED IT WILL BE VIRTUAL I
THINK, APPLICATIONS DUE BY APRIL
15, 2022.
SHE ALSO MENTIONED THE NIH
OFFICE OF DIRECTOR, OFFICE OF
SCIENTIFIC WORKFORCE DIVERSITY
QUARTERLY LECTURE SERIES
FOSTERING COHORT RECRUITMENT
WILL BE A 2 1/2-DAY VIRTUE FORUM
FEBRUARY 23-24, REGISTRATION
ANNOUNCED HOPEFULLY SOON BECAUSE
THAT'S COMING UP REAL SOON.
SHE ALSO MENTIONED REISSUING OF
NIH COMMON FUND, WHICH IS
TRANSFORMATIVE RESEARCH TO
ADDRESS HEALTH DISPARITIES AND
ADVANCE HEALTH EQUITY AT
MINORITY SERVING INSTITUTIONS
WITH PROPOSED MARCH 25, 2022,
APPLICATION DATE.
I THINK -- I DON'T KNOW IF WE
HAVE HBCUs OR MINORITY SERVING
INSTITUTIONS REPRESENTED HERE
BUT WE NEED TO REACH OUT AND
MAKE SURE THEY ARE AWARE OF THIS
FUNDING OPPORTUNITY.
SO NEXT WE DID TWO
PRESENTATIONS, I'M GOING TO
PREVENT THEM OUT -- PRESENT THEM
OUT OF ORDER FOR CONVENIENCE,
MINE WAS SECOND, A PRESENTATION
I DID WAS SECOND, AND BUT I'M
GOING TO SHARE WITH YOU THAT
HERE FIRST AND GIVE YOU A QUICK
RECAP, HOPEFULLY MITTING MOST OF
THE IMPORTANT HIGHLIGHTS.
SO, THE PRESENTATION WAS ON
CONTRASTING WITHIN AND BETWEEN
ANALYSES IN PURSUIT OF
UNDERSTANDING RACIAL DIFFERENCES
IN AGING POPULATIONS.
I PROVIDED WITH YOU THE IDEA
THAT SOMETIMES I THINK WE THINK
ABOUT AGING RESEARCH, RELATIVE
TO DOING WHAT WE THINK IS MAYBE
MORALLY RIGHT.
BUT ACTUALLY SCIENTIFICALLY
RIGHT IS AN ISSUE THAT WE NEED
TO THINK ABOUT.
CULTURE ACTUALLY IMPACTS EVERY
STEP OF THE SCIENTIFIC PROCESS.
QUESTIONS, MODELS, TO
MEASUREMENT, TO ANALYSIS, EVEN
INTERPRETATION.
AND SO JUST TO PROVIDE A QUICK
SUMMARY, I TALKED ABOUT BETWEEN
GROUP QUESTIONS, I WANTED TO
MAKE IT CLEAR I SPENT MY CAREER
IN RESEARCH, I'M NOT AGAINST
BETWEEN GROUP BUT HAVE TO BE
THOUGHTFUL, WHAT FACTORS ACCOUNT
FOR DIFFERENCE.
I USED THE EXAMPLE OF COGNITIVE
PERFORMANCE BUT APPLIES TO
ANYTHING, PUT IN DIFFERENCES IN,
YOU KNOW, BIOINFORMATICS OR
WHATEVER AS A FACTOR.
ALSO ASKING QUESTIONS LIKE ARE
THERE DIFFERENCES IN COGNITIVE
PERFORMANCE BY RACE.
BUT THERE ARE ALSO VERY VALID
AND VERY USEFUL AND VERY
IMPORTANT IN-GROUP QUESTIONS.
WHAT ACCOUNTS VARIABILITY IN
COGNITIVE FUNCTION IN AFRICAN
AMERICANS, WHAT MAKES AFRICAN
AMERICANS AND CAUCASIANS
DIFFERENT IN COGNITIVE
FUNCTIONING AND WHY?
THAT'S A BIT OF A GROUP APPROACH
IN A MODIFIED SORT OF WAY
BECAUSE YOU'RE TRYING TO FIGURE
OUT WHAT THE EXPLANATORY FACTOR
IS BETWEEN THE TWO.
SO THAT'S AN IMPORTANT STEP TO
MAKE AS WELL.
I DID TALK ABOUT MODELS OF
CULTURAL DIFFERENCES CITING A
PAPER, I PROVIDED A 2008 PAPER I
HAVE, AS I OFTEN DO, I ASK
EVERYBODY TRY TO CITE THAT PAPER
SO I CAN GET MY CITATION IN,
IT'S ONE I HOPE THAT'S IMPORTANT
AND THOUGHT PROVOKING, TALKS
ABOUT WAYS WE AS SCIENTISTS
THINK ABOUT CULTURAL DIFFERENCE.
I TALK ABOUT ANALYSES AND TALK
ABOUT POWER CALCULATIONS, THERE
ARE POWER CURVES IN THAT PAPER.
THE MOST IMPORTANT PIECE, THE
LARGER THE DIFFERENCE BETWEEN
THE TWO GROUPS, THE LARGER THE
SAMPLE SIZES OVERALL NEED TO BE
TO GET PROPER POWER ESTIMATION.
ALSO MENTIONED A BIT ABOUT
INTERPRETATIONS THAT DIFFERENCES
CAN BE STRENGTH, TRAJECTORIES OF
CHANGE MY BE DIFFERENT.
SO AS IS A MAIN GOAL OF MUCH OF
WHAT WE TRY TO DO IN THE SCIENCE
OF AGING, TRYING TO GET
LONGITUDINAL STUDIES, SO THAT WE
DON'T JUST GET THE PSYCHOLOGICAL
MOMENT IN ONE MOMENT IN TIME.
WE GET TRAJECTORIES, PROCESSES
OF CHANGE CAN BE IDENTIFIED.
THOSE ARE THINGS THAT ARE VERY
IMPORTANT FOR LONGITUDINAL
STUDIES TO BE DONE, BOTH WITHIN
AND BETWEEN.
LASTLY, FOR BASIC AND APPLIES,
IF YOU HAVE PHENOMENA THAT ARE
IMPACTED BY SOCIAL AND
PSYCHOLOGICAL FACTORS, BUT
WIN-GROUP APPROACH IS VERY
USEFUL TO BE ABLE --
WITHIN-GROUP APPROACH IS USEFUL
TO IDENTIFY WHAT CAUSES
VARIABILITY, THAT MAY CAUSE
POPULATION VARIABILITY AS WE
LOOK AT SUBPOPULATIONS.
FUTURE RESEARCH UTILIZING
MINORITIES FOR UNDERSTANDING
RESEARCH AND DYSFUNCTION WILL,
IN MY THOUGHT, BE ABLE TO
ADVANCE SCIENCE AND AGING IN
GENERAL.
I GAVE THE EXAMPLE OF STUDYING
LONGEVITY IN AFRICAN AMERICANS.
SELF SERVING BUT IF WE LOOK AT A
GROUP, ALMOST DOING EXTREMES
ANALYSIS THINKING ABOUT FOLKS
WHO ARE AT THE VERY EXTREMES FOR
A PARTICULAR REASON FOR AFRICAN
AMERICANS BECAUSE OF THE EARLY
MORTALITY AND SHORTER LIFE
EXPECTANCY, THOSE WHO LIVE VERY
LONG LIVES REPRESENT EXTREME
SITUATIONS OF AGING.
SO THEY MILD PROVIDE SOME
INTERESTING INSIGHTS, IF WE
LEARN ABOUT THEM.
LASTLY, ALTERNATIVE STRATEGIES
FOR STUDYING MINORITIES, DOING
BETWEEN AND WITHIN, WILL HELP
ADVANCE OUR UNDERSTANDING OF
MINORITIES AND PEOPLE, AND ALL
PEOPLE.
SO THAT WAS MY PRESENTATION, THE
FIRST PRESENTATION WAS ACTUALLY
BY DR. WASHINGTON AND DR. MANLY
IS GOING TO PROVIDE AN OVERVIEW
OF HER PRESENTATION.
>> THANK YOU, DR. WHITFIELD, AND
PRESIDENT WHITFIELD.
I'LL GIVE A TWO OR THREE-MINUTE
OVERVIEW OF OR EXCELLENT TALK BY
DR. WASHINGTON.
DONNA WASHINGTON IS THE DIRECTOR
OF THE OFFICE OF HEALTH EQUITY,
AND QUALITY ENHANCEMENT CENTER
AT THE V.A.
THE TALK SHE GAVE TO US WAS A
REPORT ESSENTIALLY FROM THE
NATIONAL VETERANS HEALTH EQUITY
REPORT THEY RUN REGULARLY AT THE
V.A.
AND THE PURPOSE WAS OF THESE
REPORTS IS TO GO OVER THE STATUS
OF HEALTH EQUITY AT THE V.A. AND
V.A. HEALTH SYSTEM, AND SHE GAVE
A VERY USEFUL DEFINITION OF
HEALTH EQUITY, WHICH IS THE
ABSENCE OF UNFAIR AND AVOIDABLE
OR REMEDIABLE SITUATIONS,
DEFINED BY OTHER GROUP
DEFINITIONS.
AND THIS IS A W.H.O. DEFINITION
OF HEALTH EQUITY.
SO YOU CAN SEE HER REPORT
ORGANIZED AROUND THIS.
THE UNDERLYING PURPOSE REALLY
SEEMED TO BE, OF THESE REPORTS,
THAT YOU CAN ONLY CHANGE WHAT
YOU MEASURE.
AND THAT INCREASING KNOWLEDGE
AND AWARENESS OF THE STATE OF
HEALTH EQUITY AT THE V.A.
PROVIDES THE EVIDENCE BASE FOR
FIGURING OUT BARRIERS AND
RECOMMEND ACTIONS FOR IMPROVING
HEALTH EQUITY SYSTEMWIDE.
DR. WASHINGTON PROVIDED SOME
DEMOGRAPHICS OF THE PATIENT
GROUP AT THE V.A.
AND I'VE GOT A SCREEN SHOT
THERE, JUST INCIDENTALLY THIS
REPORT YOU CAN GOOGLE IT.
IT'S ONLINE.
AND YOU CAN GO THROUGH EXTREMELY
DETAILED AND SEE ALL THESE
TABLES AND GRAPHS I'LL FLASH BY
VERY QUICKLY ON THE REPORT.
THAT'S MEANT TO SAY 2021, BY THE
WAY.
THE FOCUS IN 2021 IN THEIR
EQUITY REPORT ON PATIENT
EXPERIENCES OF CARE, WITH SORT
OF A PATIENT-CENTERED CARE, AND
ALSO HEALTH CARE QUALITY.
THEY DEFINED DISPARITIES BOTH
USING AN ABSOLUTE METRIC, WHICH
IS STATISTICAL SIGNIFICANCE
METRIC BETWEEN TWO GROUPS.
AND ALSO A RELATIVE, HAVING A
RELATIVE DIFFERENCE OF AT LEAST
10%, SO THE DIAGNOSED PREVALENCE
OF A CONDITION OR HEALTH CARE
DIFFERENCE IN A GROUP WAS 10% OR
HIGHER THAN IT IS IN THE
REFERENCE GROUP, IS HOW THE
RELATIVE DIFFERENCE WAS DEFINED.
AND WHAT YOU CAN SEE, JUST BY
SQUINTING ON THE GRAPH, OR THE
FIGURE IN THIS SLIDE, IS THAT
THERE WAS GREATER RACIAL AND
ETHNIC DIVERSITY AMONG VETERANS
YOUNGER THAN 65, AND THEY FOUND
58% OF THE PATIENTS IN THE
SYSTEM HAD A SERVICE-CONNECTED
DISABILITY, SO JUST TO QUICKLY
SHOW YOU A FEW OF THE SLIDES
THAT DR. WASHINGTON SHOWED US,
THERE WAS A LOT OF DATA THERE,
REALLY IMPRESSIVE, IN THE FIRST
SLIDE ON THE UPPER LEFT I'M
SHOWING THE DIFFERENCES IN THE
PATIENTS WHO INDICATED THAT IN
THE LAST SIX MONTHS THEIR
PROVIDER ALWAYS SPENT ENOUGH
TIME WITH THEM.
SO THIS IS SOMETHING YOU WANT A
LOT OF.
AND THE REFERENCE IS THAT
PATIENTS IN THE CORRESPONDING
AGE GROUP, NON-HISPANIC WHITE
VETERANS.
RED BARS, THE GROUP WAS WORSE
THAN REFERENCE GROUP, IN YELLOW
THE SAME AS REFERENCE GROUP.
WHAT YOU CAN SEE IS THAT IN
ESPECIALLY MIDDLE AND OLDER AGE
GROUPS MANY ETHNICITY -- ETHNIC
AND RACIAL GROUPS FEWER FELT THE
PROVIDER WAS SPENDING ENOUGH
TIME WITH THEM.
LOWER RIGHT I'M SHOWING
DIFFERENCES IN THE PATIENTS WHO
SAID THEIR PROVIDER ASKED THEM
IF THERE WAS A PERIOD OF TIME
THEY FELT SAD, EMPTY, DEPRESSED.
HERE THE REFERENCE GROUP IS HIGH
SES PEOPLE FINDING A DISPARITY
HERE, EVEN ACROSS EACH AGE
GROUP.
IN GENERAL FREQUENCY OF THE
PROVIDERS ASKING ABOUT
DEPRESSION WAS LOWER AS PEOPLE
IN THE VHA FELT HEALTH SYSTEM
GOT OLDER.
SO IN SUMMARY, DR. WASHINGTON
SHOWED US MANY DISPARITIES IN
THE V.A. HEALTH SYSTEM IN
PERSON-CENTERED CARE, ACCESS TO
CARE, CARE COORDINATION.
DIFFERENCES BY RACE AND
ETHNICITY.
THERE WERE DIFFERENCES BY SES,
DIFFERENCES BY SEX/GENDER, AND
DIFFERENCES BY HEALTH, BY
SERVICE-CONNECTED DISABILITY.
THE PURPOSE OF THE ANALYSES THAT
DR. WASHINGTON HELPED US
UNDERSTAND IS TO IMPROVE THE
CARE OF ALL VETERANS
EXPERIENCING DISPARATE CARE OR
OUTCOMES, AND THE REPORT REALLY
WAS -- IS INTENDED TO RAISE
AWARENESS, AND TO BOLSTER
ACTION, IN IMPROVING THE LIVES
AND HEALTH CARE OF VETERANS.
I THINK THE WAY WE WERE SHOWN
THESE DATA IS A REALLY NICE
TEMPLATE OR EXAMPLE OF THE
EXTENT OF DATA COLLECTION NEEDED
TO ANALYZE, DESIGN, AND GENERATE
TOOLS AND INTERVENTIONS TO
NARROW DISPARITIES.
WE HAD A NICE DISCUSSION, A LOT
OF IT WAS ABOUT HIGH RATES OF
DEPRESSION AMONG VETERANS.
DR. WASHINGTON DESCRIBED, YOU
KNOW, AN APPROACH THAT THIS
REPORT POINTED TO, WHICH IS FOR
PROVIDERS TO REALLY ASK ABOUT
STRESSORS THAT THE PATIENTS ARE
GOING THROUGH, AND TO -- RATHER
THAN -- THERE MIGHT NOT BE
SPECIFIC ACTIONS THAT PROVIDERS
CAN DO BUT THEY CAN UNDERSTAND
WHAT THE PATIENTS ARE
EXPERIENCING.
AND THAT COMMUNICATION BETWEEN
PATIENTS AND PROVIDERS COULD BE
A KEY FOR REDUCING DISPARITIES.
WE ALSO HAD A QUESTION ABOUT
HEATHER -- HETEROGENEITY AND
COMBAT VETERAN STATUS THAT DR.
WASHINGTON SAID IS A FUTURE GOAL
FOR THE RESEARCH IN THIS AREA.
AND THAT'S MY SUMMARY OF DR.
WASHINGTON'S TALK.
>> ANY QUESTIONS OR ANY
FOLLOW-UP?
>> WHILE WE'RE WAITING FOR
QUESTIONS, I WANTED TO COMMENT.
THE COMMENT IS OF COURSE THANKS
TO ALL OF YOU, THE CO-CHAIRS AND
MEMBERS WHO PARTICIPATED.
BUT JUST TO POINT OUT TO THE
COUNCIL, PARTICULARLY NEW
COUNCIL MEMBERS AND OTHERS IN
THE AUDIENCE WHAT AN IMPORTANT
AND ARGUABLY UNIQUE PART THIS IS
OF OUR COUNCIL AND COUNCIL
ACTIVITIES, THIS TASK FORCE
BEGAN MANY YEARS AGO WITH GIANTS
LIKE JAMES JACKSON BEING SOME OF
THE FUNDING CHAIRS, HAS
CONTINUED TO BE CRITICALLY
IMPORTANT TO MAKE SURE WE DON'T
LOSE FOCUS, NOW OVER YEARS AND
DECADES, ABOUT THIS IMPORTANT
ASPECT.
IT'S A REGULAR INTEGRAL PART OF
THE COUNCIL MEETINGS, WE'RE
EXCITED TO HAVE IT BE SO.
THANK UP ALL -- THANK YOU ALL
FOR TAKING THE LEAD IN THIS.
>> SO ANY QUESTIONS FOR DOCTORS
WHITFIELD AND MANLY?
ALL RIGHT.
AGAIN, THANKS TO THE TASK FORCE
AND THANK YOU FOR THE SUMMARY OF
THE TWO VERY IMPORTANT TOPICS
FROM DOCTORS WHITFIELD AND
WASHINGTON.
APPRECIATE THE SUMMARIES.
>> THANK YOU.
>> NEXT UP IS OUR REPORT FROM
THE WORKING GROUP ON PROGRAM.
I'LL TURN THIS OVER TO DR.
MONICA DRISCOLL, OUR CHAIR.
>> THANKS VERY MUCH.
I WANTED TO START REALLY BY
CONGRATULATING AND THANKING
PROGRAM FOR ALL THE REALLY HARD
WORK IN DEVELOPING THESE
CONCEPTS.
AND TO THE COUNCIL MEMBERS FOR
THEIR TIME AND CAREFUL
CONSIDERATION OF WHAT HAS GONE
FORWARD.
WE HAVE A NUMBER OF CONCEPTS.
WE'LL START WITH THOSE FROM THE
DIVISION OF BEHAVIORAL AND
SOCIAL RESEARCH.
THE FIRST CONCEPT WAS -- OH, AND
I SHOULD -- I'M SORRY.
I SHOULD REMIND YOU THAT WE HAD
GREAT DISCUSSION OF THESE
PROPOSALS YESTERDAY.
TODAY, I'LL ANNOUNCE PRIMARY AND
SECOND REVIEWER, THE PRIMARY
WILL DO THE SUMMARY, EVERYONE
WILL HAVE A CHANCE TO COMMENT
BUT BE MORE CONCISE THAN WE WERE
YESTERDAY.
OKAY.
SO THE FIRST CONCEPT IS POLICY
IN AD/ADRD HEALTH CARE
DISPARITIES, ACCESS, UTILIZATION
AND QUALITY.
PRIMARY WE VIEWER DR. WHITFIELD,
SECONDARY WAS DR. FULLMER.
DR. WHITFIELD, IF YOU COULD
SUMMARIZE THE DISCUSSION
YESTERDAY.
>> YOU CAUGHT ME AT A LOSS.
I WAS WRITING SOMETHING IN THE
CHAT.
THIS WAS ABOUT ADHD HEALTH CARE
DISPARITIES, ACCESS AND
UTILIZATION.
WE WERE IN GENERAL SUPPORTIVE OF
THIS, THINKING THAT IF THERE
COULD BE WAYS IN WHICH POLICY
COULD ADD TO THE DISCUSSION, HOW
HEALTH DISPARITIES ARE TAKEN
CARE OF, IT WOULD BE VERY
IMPORTANT.
ONE OF THE COMMENTS THAT I CAN
REMEMBER THAT I HAD WAS THAT
PERHAPS RATHER THAN JUST SIMPLY
USING AN R01 MECHANISM, WHICH I
FEEL LIKE IN POLICY THIS IS A
LONG TIME, THAT ONE SUGGESTION
THAT CAME FROM ME WAS THE IDEA
OF USING AN R03, PERHAPS EVEN
R21 MECHANISM, TO TRY TO GET TO
SOME OF THE ANSWERS FOR HOW
DIFFERENT HEALTH CARE SETTINGS
AND HEALTH CARE ISSUES WERE
AFFECTING DISPARITIES, IN A
SHORTER TIME FRAME.
>> OKAY.
THANK YOU.
WERE THERE OTHER COMMENTS FROM
COUNCIL OR PROGRAM ON THIS
CONCEPT?
SO, HEARING NONE, ACTUALLY LET
ME MAKE SURE THAT I MAKE IT MORE
CLEAR TO MYSELF, BUT HEARING
NONE, I WOULD LIKE US TO VOTE ON
ACCEPTING THIS CONCEPT.
ALL THOSE IN FAVOR?
>> AYE.
>> ANY OPPOSED?
IF NOT, THIS CONCEPT IS APPROVED
BY COUNCIL.
WE'LL MOVE TO THE NEXT ONE.
SO, THE NEXT COUNCIL IS
UNDERSTANDING THE SUPPLY OF
PROFESSIONAL DEMENTIA CARE
PROVIDERS AND THEIR DECISIONS.
THE PRIMARY REVIEWER WAS TERRY
FULLMER.
SECONDARY WAS DAVID REUBEN.
TERRY, IF YOU CAN SUMMARIZE FOR
US THE DISCUSSION AND YOUR
RECOMMENDATION FROM YESTERDAY.
>> HAPPY TO.
THIS IS AN EXTREMELY IMPORTANT
AREA OF CONCERN.
AND THERE WAS ENORMOUS
ENTHUSIASM ABOUT GETTING AN
UNDERSTANDING OF THE SUPPLY FOR
PROFESSIONAL DEMENTIA CARE,
AMONG AND ACROSS ALL OF US WHO
KNOW THAT THE CONFLUENCE OF
WORKFORCE SHORTAGES IN
PARTNERSHIP WITH INCREASING
PERCENTAGES OF PEOPLE WITH
DEMENTIA MEAN WE HAVE TO
UNDERSTAND, GET OUR SCIENCE
STRAIGHT, MOVE IT FORWARD.
THERE WAS VERY ROBUST ENTHUSIASM
FOR THIS.
>> OKAY.
THANK YOU.
WERE THERE OTHER COMMENTS FROM
COUNCIL OR FROM -- FROM COUNCIL
ON THIS?
NOT HEARING OR SEEING ANY, I
WOULD LIKE TO SUGGEST THAT WE
VOTE ON MOVING THIS, ON
ACCEPTING THIS.
ALL THOSE WHO ARE IN FAVOR?
>> AYE.
>> ANY OPPOSITION?
NO, OKAY.
NOT HEARING ANY, COUNCIL VOTES
TO MOVE THIS FORWARD, THIS
CONCEPT FORWARD.
WE'LL MOVE TO THE NEXT ONE.
SO THE NEXT ONE IS ENTITLED,
MORE MOBILE MONITORING OF
COGNITIVE CHANGE, CONTINUED, THE
M 3C 3, SNAPPY TITLE.
PRIMARY WE VIEWER WAS JENNIFER
MANLY, SECONDARY WAS DAVID WEIR.
DR. MANLY, IF YOU WOULD LIKE TO
SUMMARIZE THE DISCUSSION FROM
YESTERDAY.
>> YES, SNAPPY TITLE, VERY
IMPORTANT RESEARCH THAT WAS
DESCRIBED IN THIS CONCEPT
CLEARANCE.
THERE HAVE BEEN TWO STUDIES THAT
HAVE BEEN ONGOING FOR THE LAST
FIVE YEARS THAT ARE DEVELOPING
MOBILE ASSESSMENT ALSO OF
COGNITION.
THEY ARE DOING THIS BASED ON --
ONE IS BASED ON THE NIH TOOLBOX,
A SET OF INSTRUMENTS THAT WERE
DEVELOPED FOR -- NOW DEVELOPED
FOR THE IPAD.
AND THE OTHER IS A MOMENTARY
COGNITIVE ASSESSMENT.
AND THE POINT IS THAT EVEN IF
YOU'RE NOT SITTING ACROSS THE
DESK FROM A PATIENT OR RESEARCH
PARTICIPANT, YOU CAN GET A SENSE
OF THEIR COGNITIVE FUNCTION, NOT
JUST, YOU KNOW, WHETHER THEY ARE
HAVING ANY COGNITIVE IMPAIRMENT
IN DOMAINS LIKE MEMORY,
EXECUTIVE FUNCTION, LANGUAGE,
BUT ALSO WHETHER THEIR COGNITION
HAS CHANGED OVER TIME.
THIS IS INCREDIBLY IMPORTANT FOR
SEVERAL GOALS AND MILESTONES OF
THE NIA IN THEIR AD AND ADRD
RESEARCH.
SO THIS CONCEPT CLEARANCE IS TO
BUILD ON THE WORK THAT'S BEEN
DONE IN THESE TWO COOPERATIVE
AGREEMENTS.
THEY NOW WANT TO INCLUDE, TO ADD
NON-COGNITIVE MEASURES,
BEHAVIORAL ASSESSMENTS, WIDER
DISSEMINATION OF THE INSTRUMENTS
TO ALLOW EACH STUDY USING THE
MEASURES TO CUSTOMIZE THE APPS
THAT HAVE BEEN DEVELOPED FOR
THIS WORK TO INCORPORATE
ELECTRONIC CONSENT FOR MOBILE
COGNITIVE ASSESSMENT, AND TO
WORK ON A COST MODEL THAT WILL
ALLOW FOR REGULAR UPDATES.
SO, THIS IS A CALL FOR
APPLICATIONS TO CONTINUE THAT
WORK, AND THAT THERE WAS A LOT
OF ENTHUSIASM ABOUT THIS
EXCITING WORK IN COUNCIL.
>> OKAY.
THANK YOU.
ARE THERE OTHER COMMENTS OR
POINTS TO ADD FROM COUNCIL?
OKAY.
HEARING AND SEEING NONE, I'LL
INVITE THE VOTE ON THIS CONCEPT,
MOVING FORWARD.
ALL THOSE IN FAVOR OF THE
CONCEPT?
>> AYE.
>> ANY OPPOSED?
OKAY.
THIS CONCEPT MOVES FORWARD AS
APPROVED BY COUNCIL.
THE NEXT CONCEPT IS MEASURES AND
METHODS FOR RESEARCH ON FAMILY
CAREGIVERS FOR PEOPLE LIVING
WITH AD/ADRD.
AND THE PRIMARY REVIEWER ON THIS
WAS DAVID WEIR, SECONDARY WAS
JENNIFER MANLY.
DR. WEIR, IF YOU'D LIKE TO
SUMMARIZE THE CONCEPT AND
DISCUSSION FROM YESTERDAY.
>> SURE.
THIS PROPOSAL MET WITH A LOT OF
ENTHUSIASM, RECOGNIZING THAT
FAMILY CAREGIVERS FOR PEOPLE
WITH DEMENTIA PROVIDE PROBABLY
WELL MORE THAN HALF OF THE TOTAL
CARE NEEDED BY PEOPLE WITH
DEMENTIA.
AND THAT CONCERN HERE IS THAT
WHILE ESTABLISHED PROJECTS AND
DBSR DO ASK AND FIND OUT
INFORMATION ABOUT CAREGIVERS AND
ABOUT RELATIONSHIP BETWEEN
CAREGIVERS AND PEOPLE THEY CARE
FOR, THE WORLD IS CHANGING.
IN PARTICULAR, MOST OF THOSE
UNPAID RELATIONSHIPS ARE BASED
ON A FAMILY CONNECTION AND
FAMILIES ARE CHANGING, FEWER
CHILDREN, LESS STABLE MARRIAGES,
AT LEAST GROWING RECOGNITION IF
NOT GROWING REALITY OF SEXUAL
AND GENDER MINORITY KINDS OF
RELATIONSHIPS.
SO EVEN AT THE LEVEL OF
TERMINOLOGY ARE WE ASKING ABOUT
PEOPLE IN THE RIGHT WAY TO
CAPTURE THE DIFFERENT KINDS OF
RELATIONSHIPS THAT MIGHT GIVE
RISE TO A CARE-GIVING
RELATIONSHIP.
SO, THIS WAS TO R21s, I
THOUGHT WAS A GOOD IDEA AS THEY
WOULD ENCOURAGE MORE JUNIOR
INVESTIGATIONS, INVESTIGATIONS
OF SOME OF THE VULNERABLE
POPULATIONS, R01s, TO DO MORE
LARGE SCALE PROJECTS, TO DEVELOP
NEW MEASURES THAT EXISTING
STUDIES MIGHT ALSO THEN ADOPT,
SO WE CAN GET A BETTER PICTURE
LOOKING AHEAD TO WHETHER MORE
BROADLY DEFINED NOTION OF FAMILY
IS GOING TO BE SUFFICIENT TO
PROVIDE THE CARE THAT THE BABY
BOOM GENERATION IS GOING TO NEED
WHEN THEY BEGIN TO DEVELOP
DEMENTIA IN LARGE NUMBERS.
>> OKAY.
THANK YOU.
ARE THERE OTHER COMMENTS FROM
COUNCIL MEMBERS ON THIS CONCEPT?
NOT HEARING OR SEEING ANY, I
WOULD INVITE THE COUNCIL TO VOTE
ON THIS CONCEPT.
AL
ALL THOSE IN FAVOR?
>> AYE.
>> YES.
>> ALL THOSE OPPOSED?
OKAY.
SO THIS CONCEPT MOVES AHEAD AS
APPROVED BY COUNCIL.
THE NEXT ONE IS BROADENING THE
SCOPE AND REACH OF NIA'S AD-ADRD
RESOURCE, THE RCMAR PROGRAM.
DR. WHITFIELD AND DR. APPLEBY.
DR. WHITFIELD CAN YOU SUMMARIZE
THE CONCEPT AND DISCUSSION FROM
YESTERDAY.
>> I'M READY FOR THIS ONE.
THIS ONE IS ON THE RCMAR
MECHANISM, AND THE RCMAR
MECHANISM HAS BEEN AROUND SINCE
I THINK 1997, IN ITS FIFTH ROUND
MUCH SUPPORT.
BY ALL METRICS A VERY SUCCESSFUL
MECHANIC, INCREASING RESEARCH OF
POPULATIONS.
THERE'S THREE BASIC PIECES TO
THIS.
NOT BASIC, ACTUALLY SOPHISTICATE
AND SUPPORTIVE ELEMENTS TO THIS.
THE FIRST ELEMENT IS AN RFA FOR
P30 APPLICATION REQUEST, AND
THIS IS FOR CONTINUING RCMAR
APPLICATIONS THAT FOCUS ON
BEHAVIORAL AND SOCIAL SCIENCE
RESEARCH RELATED TO AGING AND/OR
HEALTH DISPARITIES IN OLDER
ADULTS.
THERE'S A P30 APPLICATION PIECE
FROM INSTITUTION PROPOSING TO
DEVELOP OR RENEW RCMAR THAT
FOCUSES ON BEHAVIOR AND SOCIAL
SCIENCE RESEARCH RELATED TO
ALZHEIMER'S DISEASE AND RELATED
DEMENTIA.
THIRD IS A U24 TO SUPPORT A
RCMAR COORDINATING CENTER FOR
P30 AWARDEES.
ONE NEW ELEMENT THAT IS INCLUDED
IN THIS REQUEST IS THE IDEA OF
BEING ABLE TO MAKE BETTER MORE
EFFECTIVE AND DEEPER
COLLABORATIONS WITH RESEARCHERS
FROM HBCUs, HISTORICALLY BLACK
COLLEGES AND UNIVERSITIES, FROM
TCUs, TRIBAL COLLEGES AND
UNIVERSITIES, AND FROM MSI OR
MINORITY-SERVING INSTITUTION.
THE SCOPE OF THE RESEARCH
PROGRAM OVERALL IS ONE OF BEING
ABLE TO FOSTER ESSENTIAL
LEADERSHIP SKILLS AND KNOWLEDGE,
IMPLEMENT TEAM SCIENCE
STRATEGIES TO PROVIDE FLUBBING
OF INFRASTRUCTURE TO FOSTER
MULTI-DISCIPLINARY COLLABORATION
AND IMPROVE DIVERSITY.
THAT'S THE MEAT AND POTATOES OF
THIS RFA.
I HAD A COUPLE COMMENTS, SOME OF
THEM WERE ADDRESSED BY PROGRAM.
ONE WAS THAT WHY WEREN'T HSIs,
HISPANIC-SERVING INSTITUTIONS
MENTIONED, SIMPLY AN OVERSIGHT.
WHO WOULD BE RESPONSIBLE FOR
CONNECTIONS TO MINORITY
INSTITUTIONS?
AND THAT WAS PROVIDED, CLARITY
WAS PROVIDED BY PROGRAMMING,
THAT WOULD BE AT THE INDIVIDUAL
SITE LEVEL.
ALSO ARE THERE EXPECTATIONS FOR
LEADERSHIP AND CAREER
MANAGEMENT, AND, YES, THERE ARE.
THAT'S GOING TO BE DONE AT THE
SITE LEVEL.
ALSO, ONE COMMENT THAT I
PROVIDED WAS ABOUT WHETHER THERE
WOULD BE SUPPORT FOR ADDITIONAL
INTERACTIONS, OTHER THAN JUST
THE GSA YEARLY MEETINGS WHICH I
KNOW THE RCMAR TEAM THERE, AND
THAT WILL BE SOMETHING THAT IS
TAKEN INTO CONSIDERATION.
AND LASTLY, I OFFERED THIS PIECE
OF IT.
I THINK IT'S ONE WAY WE CAN
REALLY THINK ABOUT WAYS WE CAN
MAKE THE KINDS OF INTERACTIONS,
CONNECTIONS, AND KNOWLEDGE
SHARED ACROSS THE RCMARs, TO
CREATE ONLINE CONTENT, PERHAPS
CREATING MICROCREDENTIALS THAT
COULD BE SHARED, THE CONTENT
COULD BE SHARED,
MICROCREDENTIALS SHARED, RUN BY
A COORDINATING CENTER.
THOSE WERE MY COMMENTS AND I
SUPPORTED THIS CONCEPT.
>> THANK YOU.
ARE THERE OTHER COMMENTS OR
ADDITIONS FROM COUNCIL?
OKAY.
SO HEARING OR SEEING NONE, SOUND
LIKE THERE'S CONSIDERABLE
ENTHUSIASM FOR MOVING THIS
CONCEPT FORWARD.
I'D LIKE TO ASK FOR A VOTE ON
APPROVAL.
>> SO MOVED.
>> ALL THOSE IN FAVOR?
>> AYE.
>> ALL THOSE OPPOSED?
GREAT.
IF NOT, WE WILL MOVE TO THE LAST
APPLICATION FROM THE DIVISION OF
BEHAVIORAL AND SOCIAL RESEARCH.
THE TITLE OF THIS CONCEPT IS
PREDICTING EARLY ALZHEIMER'S
DISEASE AND RELATED DEMENTIA IN
DIVERSE POPULATIONS.
THE PRIMARY REVIEWER IS ERIC
REIMANN, SECOND WAS JENNIFER
MANLY.
DR. REIMANN, IF YOU WILL START
BY SUMMARIZING THE NATURE OF
THIS CONCEPT AND THE DISCUSSION.
>> THANK YOU, MONICA.
I'LL TAKE A LITTLE BIT MORE TIME
THAN USUAL TO SUMMARIZE THE
CONCEPT, AND THE DISCUSSION.
THIS CONCEPT IS A GRAND
CHALLENGE THAT WOULD CAPITALIZE
ON THE PRIZE COMPETITION
MECHANISM IN THE AMERICA
COMPETES ACT TO FIND BETTER WAYS
TO DETECT SUBTLE CHANGES
ASSOCIATED WITH PRE-CLINICAL
ALZHEIMER'S DISEASE AND RELATED
DEMENTIA IN DIVERSE POPULATIONS.
THE COMPETITION WOULD PROVIDE
THREE SEQUENTIAL CHALLENGES THAT
WOULD HAVE THE GOALS OF
PROVIDING COGNITIVE CLINICAL EHR
CLAIMS, BIOMARKERS, AND OTHER
KINDS OF DATA FROM DIVERSE
POPULATIONS, TO HELP UNDERSTAND
AND ADDRESS POTENTIAL BIASES,
MAKE THOSE DATA WIDELY AVAILABLE
THROUGH TRUSTED REPOSITORIES,
ESTABLISH ABILITY OF ARTIFICIAL
INTELLIGENCE MACHINE LEARNING
AND OTHER PREDICTIVE ALGORITHMS
TO CHARACTERIZE THE EARLIEST
MANIFESTATIONS OF ALZHEIMER'S
DISEASE, EXPLAIN TO STAKEHOLDERS
HOW ALGORITHMS REACH THEIR
CONCLUSIONS, AND DEMONSTRATE
THEIR ABILITY TO CHARACTERIZE
INDIVIDUALS FREE FROM RACIAL,
ETHNIC SOURCE OR ALGORITHMIC
BIASES.
THE GRAND CHALLENGE WAS
DEVELOPED IN RESPONSE TO NACA
MILESTONE 14-POINTC, RELATED
RECOMMENDATION ALSO FROM THE
2019 DIVISION OF NEUROSCIENCE
REVIEW COMMITTEE, WHICH SEEKS TO
CAPITALIZE ON NOVEL DISRUPTIVE
SCIENCE THAT WOULD INCENTIVIZE
INDIVIDUALS TO ADOPT
COLLABORATIVE AROACH TO RESEARCH
THROUGH USE OF TARGETED SMALL
FUNDING SCHEMES.
COUNCIL MEMBERS EXPRESSED
SUPPORT FOR THIS EXCITING
CONCEPT, BUT NOTED THE
DEVELOPMENT OF PREDICTIVE
ALGORITHMS FOR DETECTION OF
PRE-CLINICAL ALZHEIMER'S DISEASE
DEPEND ON SUFFICIENT AMOUNT OF
BIOMARKER DATA TO RELATE THESE
ALGORITHMS TOP DIAGNOSIS OF
PRE-CLINICAL ALZHEIMER'S
DISEASE, AND/OR TO PREDICT --
DATA TO PREDICT SUBSEQUENT
PROGRESSION TO CLINICAL STAGES
OF DISEASE INDEPENDENT MUCH
KNOWING WHO DOES OR DOES NOT
HAVE PRE-CLINICAL ALZHEIMER'S
DISEASE.
IN DIVERSE POPULATIONS,
INCLUDING HAVING SUFFICIENT
AMOUNT OF DATA FROM
UNDERREPRESENTED GROUPS.
WHILE THERE MAY BE SUFFICIENT
DATA TO ENABLE PREDICTIVE
ALGORITHMS TO INFORM COGNITIVELY
UNIMPAIRED PERSONS PROGNOSIS,
WITHOUT KNOWING WHETHER OR NOT
THEY HAD PRE-CLINICAL
ALZHEIMER'S DISEASE, THERE MAY
NOT BE SUFFICIENT BIOMARKER DATA
JUST YET IN UNDERREPRESENTED
GROUPS.
AND INSUFFICIENT NUMBERS OF
PERSONS FROM UNDERREPRESENTED
GROUPS HAVE PET OR CSF
BIOMARKERS TO CONFIRM
PRE-CLINICAL ALZHEIMER'S
DISEASE, USING THESE STANDARDS
OF TRUTH.
EMERGING BLOOD-BASED BIOMARKERS
ONCE VALIDATED AND SHOWN TO BE
GENERALIZABLE TO
UNDERREPRESENTED GROUPS WHICH
MAY HAPPEN IN THE NEXT ONE TO
TWO YEARS, IF SHOWN TO BE
ROBUST COULD ADDRESS THIS ISSUE.
THERE SHOULD BE EFFORT
INDEPENDENT OF CONCEPT TO ENSURE
BLOOD SAMPLES ARE AVAILABLE AND
THEN SUITABLE BLOOD-BASED
BIOMARKERS DEPLOYED FIRST IN A
SCALABLE WAY, SUCH THAT THE
CONCEPT COULD PROCEED LATER,
HOPEFULLY IN THE NEXT TWO YEARS,
AND HAVE A GREATER CHANCE OF
SUCCESS.
>> THANK YOU VERY MUCH.
SO, YES, THIS WAS A CONCEPT
WHERE THERE WAS CONSIDERABLE
DISCUSSION.
DID OTHER MEMBERS OF THE COUNCIL
WANT TO COMMENT ON THIS?
I'M SORRY, I HAVE TO CHANGE MY
VIEW.
>> MY ONLY COMMENT, DR.
DRISCOLL, I THINK THERE WAS A
LOT OF ENTHUSIASM ABOUT THE
CHALLENGE IDEA, IN THE PAST
THESE CHALLENGES HAVE REALLY
PROVIDED A WAY FOR TEAMS THAT
WOULDN'T NORMALLY GET INVOLVED
IN ALZHEIMER'S DISEASE RESEARCH
TO ENGAGE, AND THAT THE TEAMS
WOULD BE MULTI-DISCIPLINARY.
I DO WANT TO DOUBLE DOWN ON
SOMETHING THAT YOU SAID, WHICH
IS THAT RIGHT NOW A LOT OF THE
MULTI-LEVEL DATA THAT WOULD BE
NEEDED TO DEVELOP A REALLY
STRONG PREDICTIVE MODEL MAY NOT
BE THERE, ESPECIALLY FOR GROUPS
THAT EXPERIENCE HIGHER RISK OF
DEVELOPING ALZHEIMER'S DISEASE
AND DEMENTIA.
AND SO, YOU KNOW, WE LOOK
FORWARD TO THE CONCEPT
CLEARANCE, YOU KNOW, BEING VERY
CLEAR ABOUT WHERE THESE DATA
WOULD COME FROM AND AT WHAT
POINT THE WORK CAN ADVANCE, IF
THERE ISN'T THE AMOUNT OF DATA
OR THE SOPHISTICATION OF DATA
THAT IS NECESSARY TO DEVELOP
THESE MODELS.
>> THANK YOU.
ARE THERE OTHER COMMENTS?
OH, MERRYL PLEASE.
>> I WOULD LIKE TO SAY WITH THE
CHALLENGE AND OPPORTUNITY TO
HAVE CROSS-FUNCTIONAL TEAMS,
WHAT THE STUDIES HAVE SHOWN IS
THAT IT ALSO LEVELS THE PLAYING
FIELD FOR WOMEN RESEARCHERS.
SO I THINK THAT DYNAMIC SHOULD
BE RECOGNIZED FOR THE YOUNGER
INVESTIGATORS.
>> THANK YOU.
OTHER COMMENTS?
I THINK, YOU KNOW, IN THIS CASE
IT SOUNDS LIKE, AGAIN, AS DR.
MANLY WAS SAYING, THERE'S A LOT
OF ENTHUSIASM FOR THE CHALLENGE
IDEA AND THE STRUCTURING OF THE
APPROACH, BUT THERE'S SOME
CONCERNS ABOUT WHETHER IT'S THE
STARTING MATERIALS ARE THERE TO
ACTUALLY MOVE FORWARD.
AND SO I'M WONDERING IF THE TWO
REVIEWERS WANT TO SPECIFICALLY
STATE WHAT THE MOTION IS THAT
WE -- OR WHAT COUNCIL'S VOTE ON
THIS IS -- WHAT YOU'RE OF YOUR
PERCEPTION OF THAT IS.
>> I WOULD LIKE TO COMMEND NIA
FOR BRINGING THIS CHALLENGE
FORWARD.
I WOULD LIKE TO POSTPONE THE
DECISION TO A FUTURE TIME TO
CONSIDER THE CHALLENGE ONCE SOME
OF THE OTHER ISSUES ARE
ADDRESSED, AND HOPE THAT WE
WOULD BE ABLE TO SEE THE --
REVISIT THE CHALLENGE WITHIN THE
NEXT TWO YEARS.
SO I'D LIKE TO PROPOSE THAT
WE -- THAT CONTINUED ACTION
HAPPEN THAT WE ULTIMATELY SEE
THIS BUT THAT WE POSTPONE
APPROVAL AT THIS TIME.
>> I AGREE.
AND I ESPECIALLY AGREE WITH THE
COMMENDING OF THE -- OF NIA
PROGRAM FOR INNOVATING THIS
IDEA, ALWAYS THINKING ABOUT
INNOVATION, AND THE SPIRIT
BEHIND THIS IS ABSOLUTELY ON
POINT.
AND LOOK FORWARD TO WORKING ON
THE DETAILS.
>> THE MOTION OTHER VOTE ON THIS
PARTICULAR CONCEPT IS TO
POSTPONE, I DON'T KNOW, KEN, IF
THAT'S THE CORRECT TERMINOLOGY,
BUT THAT WOULD BE THE
RECOMMENDATION.
>> I THINK DEFER IS PROBABLY
CORRECT.
>> DEFER, OKAY.
SO THE VOTE IS WHETHER THE
COUNCIL APPROVES TO DEFER THIS
PARTICULAR CONCEPT.
>> ONE COMMENT.
>> PLEASE.
>> THANK YOU.
THEY COULD POSTPONE, I AGREE
WITH THAT.
>> JULIE, I'M HAVING A TINY BIT
OF TROUBLE HEARING YOU CLEARLY.
>> OH.
CAN YOU HEAR ME NOW?
>> MUCH BETTER, THANK YOU.
>> OKAY.
SO, I AGREE WITH THE WAY IT'S
CURRENTLY WRITTEN THAT IT WOULD
NEED TO BE POSTPONED, BUT COULD
ALSO CONSIDER RESTRUCTURING THE
PROPOSAL INTO -- RATHER THAN
NECESSARILY PRE-CLINICAL, INTO
VERY MILD CLINICAL DISEASE OR,
YOU KNOW, RISK FACTORS.
I DO THINK THERE COULD BE SPACE
FOR THIS, IF THEY MOVE OUT OF
THE PRE-CLINICAL SPACE.
THERE WOULD BE SPACE SOONER FOR
DOING SOME OF THESE
INVESTIGATIONS.
>> OKAY.
THANK YOU.
I THINK -- SO, AGAIN, KEN CAN
COMMENT ON THE OFFICIAL THINGS
WE CAN AND CAN'T DO.
I THINK WE'RE PRETTY MUCH BOUND
TO VOTE ON THE CONCEPT OR THE
CONCEPT CONSEQUENT TO DISCUSSION
WITH PROGRAM.
SO, YEAH, IS THAT CORRECT, KEN?
>> YES.
I'VE TAKEN NOTE OF ALL THE
COMMENTS AND CONSIDERATIONS.
WE'LL BRING THAT BACK TO
PROGRAM.
AND THEN WE CAN CIRCLE BACK WITH
THE COUNCIL MEMBERS AT A FUTURE
TIME.
>> THANK YOU.
ARE THERE OTHER COMMENTS ON
THIS?
HEARING AND SEEING NONE, I WOULD
LIKE TO JUST SUMMARIZE THAT
WE'RE ABOUT TO VOTE ON WHETHER
TO DEFER THIS PARTICULAR
CONCEPT.
SO, ALL THOSE IN FAVOR OF A
DEFERRAL?
>> AYE.
>> ANY OPPOSED?
OKAY.
NOT HEARING ANY, WE ARE MOVING
TO THE NEXT SET OF CONCEPTS, WE
HAVE ONE FROM DIVISION OF
GERIATRICS AND CLINICAL
GERONTOLOGY.
LET ME JUST PULL UP -- YEAH,
THERE WE GO.
THE TITLE IS OPTIMIZATION AND
PERSONALIZATION OF DIAGNOSTIC
TESTS FOR AD/ADRD IN OLDER
ADULTS WITH MULTIPLE CHRONIC
CONDITIONS, THE PRIMARY REVIEWER
WAS DAVID REUBEN, SECOND WAS
JENNIFER MANLY.
DR. RUBEN, IF YOU CAN SUMMARIZE
THE CONCEPT AND THE DISCUSSION
FROM YESTERDAY.
THANKS.
>> THANK YOU.
IT'S VERY TIMELY SINCE THIS IS A
CONCEPT CLEARANCE THAT WAS
DEFERRED LAST TIME.
AND THE NIA PROGRAM STAFF HAVE
WORKED ON IT, AND BOTH MYSELF
AND SPEAKING FOR JENNIFER, BOTH
FELT IT WAS CONSIDERABLY
APPROVED BY ITERATIVE PROCESS OF
GETTING FEEDBACK FROM COUNCIL
AND THEN REDOING IT.
IN THE NEW CONCEPT, THE FOCUS IS
NARROWED TO DIAGNOSTIC TESTING,
IN MCC, AND ALTHOUGH DIAGNOSTIC
TESTING HAS NOT BEEN AS HELPFUL
AS WE WOULD HOPE, IN THE CURRENT
MANAGEMENT OF ALZHEIMER'S AND
RELATED DEMENTIAS, AS NEW
THERAPEUTICS (INAUDIBLE) THIS
MAY BE INCREASINGLY IMPORTANT,
PARTICULARLY IF THOSE
THERAPEUTICS TURN OUT TO BE
EFFECTIVE.
IT ALSO MAY HELP CLARIFY THE
ROLE OF THE ALZHEIMER'S DISEASE
VERSUS THE ROLE OF MCCs IN
DETERMINING THE FUNCTIONAL AND
OTHER IMPAIRMENTS THAT ARE
ASSOCIATED WITH DEMENTIA.
FINALLY, THE OTHER THING THAT WE
THOUGHT WAS REALLY VALUABLE IS
THIS WOULD PROVIDE TREMENDOUS
INFORMATION ABOUT HELPING CMS IN
POLICY DECISIONS REGARDING
COVERAGE OF DIAGNOSTIC TESTING.
RIGHT NOW COVERAGE IS EXTREMELY
LIMIT OF LIMITED FOR LARGE
SEGMENTS OF THE POPULATION, WE
THOUGHT THAT WAS VALUABLE.
WE THOUGHT THE SET ASIDE AND
MECHANISM OF DOING THIS R24 WAS
APPROPRIATE AND GENERAL
DISCUSSION WAS QUITE SUPPORTIVE
OF THIS.
>> FANTASTIC.
ARE THERE OTHER COMMENTS FROM
COUNCIL ON THIS PARTICULAR
CONCEPT?
OKAY.
HEARING OR SEEING NONE, I WOULD
LIKE FOR US TO MOVE FORWARD AND
VOTE ON THIS, THE VOTE IS TO
APPROVE THIS PARTICULAR CONCEPT
CLEARANCE.
AL THOSE IN FAVOR?
>> AYE.
>> ANY OPPOSED?
OKAY.
SO THIS CONCEPT MOVES FORWARD AS
ACCEPTED BY COUNCIL.
OKAY.
SO THE NEXT GROUP IS FROM THE
DIVISION OF NEUROSCIENCE.
THE FIRST CONCEPT THAT WE'LL
CONSIDER IS PRECISION MEDICINE
APPROACHES IN ADDRESSING AD/ADRD
MINORITY AND HEALTH AND HEALTH
DISPARITIES.
PRIME REVIEWER WAS JENNIFER
MANLY, SECONDARY WAS KEITH
WHITFIELD.
DR. MANLY, IF YOU CAN SUMMARIZE
THE CONCEPT AND THE DISCUSSION
FROM YESTERDAY.
>> YES, SO THIS IS A CONCEPT
CLEARANCE FOR UH2/UH3 AWARDS,
THAT WOULD ENCOURAGE DEVELOPMENT
OF STUDIES CAPABLE OF
INVESTIGATING PRECISION MEDICINE
AND THAT IS TREATMENT,
PREVENTION, AND INTERVENTION
METHODS THAT ADDRESS CAUSAL
PATHWAYS THAT INFLUENCE
DISPARITIES IN AD AND ADRD, SO
FOCUSED ON DISPARITIES IN AD AND
ADRD AND HAS A PRECISION
MEDICINE CONCEPT GOING THROUGH
IT.
THE CONCEPT CLEARANCE
DESCRIPTION AND THESE AWARDS
REALLY CENTER THE NIA HEALTH
DISPARITIES FRAMEWORK, AS
FUNDAMENTAL TO THE RATIONALE FOR
THE FUNDING OPPORTUNITY.
THE RESEARCH QUESTIONS PROPOSED
UNDER THE MECHANISM CAN SUPPORT
EMERGING AD OR ADRD STUDIES OR
ESTABLISHED STUDIES NOT
CURRENTLY A.D. FOCUSED BUT HAVE
POTENTIAL TO ADD KNOWLEDGE ABOUT
ALZHEIMER'S DISEASE.
FIRST PHASE OF EACH STUDY WOULD
BE PLANNING OR EXPLORATORY.
THAT'S THE UH2 PHASE.
AND CAN INCLUDE DEVELOPMENT OF
NEW TOOLS OR METHODS, DATA
COLLECTION, ENGAGEMENT OF
MEANINGFUL STAKEHOLDERS WHICH IS
INCREDIBLY IMPORTANT IN
DISPARITIES RESEARCH.
AND WHILE -- AND THE PROCESS
DURING THE UH2 PERIOD OF THE
AWARD IS REALLY DESCRIBED AS A
COMMUNITY ENGAGED APPROACH.
SO, MINORITIYIZED COMMUNITIES
WOULD BE CENTERED AT EARLY STAGE
IN THE PROJECTS.
CONCEPT CLEARANCE DESCRIBES THE
DEFINITION OF INTERSECTIONALITY,
HOW THAT WOULD BE IMPLEMENTED BY
RESEARCHERS AT THIS DEVELOPMENT
STAGE.
THE CONCEPT CLEARANCE ALSO
DESCRIBES HOW THE CONCEPT OF
RESILIENCE IN MINORITIZED
POPULATIONS, RESEARCH IN DEVELOP
DEVELOPMENTAL STAGE CAN ADDRESS
ISSUES.
TEAMS BEING CALLED FOR ARE
DESCRIBED AS TRANSFORMATIVE,
MULTI-DISCIPLINARY, AND THEY CAN
INTEGRATE NEUROSCIENCE WITH
GENETIC OR BIOLOGICAL,
ENVIRONMENTAL, BEHAVIORAL AND
SOCIAL SCIENCE TO ADVANCE
UNDERSTANDING OF THESE CAUSAL
PATHWAYS AT THE MULTIPLE LEVELS
JUST LIKE WHAT WE ALL KNOW IS
DESCRIBED IN THE NIA HEALTH
DISPARITIES FRAMEWORK.
HEARKENING BACK TO DR.
WHITFIELD'S SUMMARY OF HIS TALK
TO US, THE CONCEPT CLEARANCE
STATES THAT THE PROPOSED
RESEARCH CAN FOCUS ON MULTIPLE
OR SINGLE MINORITIZED
POPULATIONS OR SUBGROUPS WITHIN
THESE POPULATIONS.
THE APPLICATION STATES THAT
MEMBERS OF THE INVESTIGATIVE
TEAM SHOULD DEMONSTRATE BEFORE
APPLYING A TRACK RECORD OF
WORKING WITH COMMUNITIES IN AN
ENGAGED WAY TO DEVELOP RESEARCH
PRIORITIES.
THE COUNCIL FELT THAT THIS WAS
AN EXTREMELY TIMELY TOPIC THAT
THERE WERE A NUMBER OF
MILESTONES AND PRIORITIES AT NIA
THAT WERE ADDRESSED BY THIS
TOPIC.
WE WERE ALL VERY EXCITED ABOUT
IT.
AND THAT THE COOPERATIVE UH2/UH3
PHASED COOPERATIVE AGREEMENT
MECHANISM WAS APPROPRIATE FOR
THIS CALL FOR APPLICATIONS,
FIRST HAVING A FEASIBILITY
STAGE, AND THEN HAVING A PILOT
DATA COLLECTION PHASE.
SO, THAT SUMMARIZES THE CONCEPT
CLEARANCE, OUR DISCUSSION WAS
THAT IT WAS REALLY EXCITING.
AND THAT'S MY SUMMARY.
>> GREAT.
THANK YOU VERY MUCH.
DOES COUNCIL HAVE ANY ADDITIONAL
COMMENT ON THIS CONCEPT?
>> MONICA, I WAS SECONDARY ON
THAT, THE ONLY THING I WOULD ADD
IS THAT I JUST ADDED A COMMENT
ABOUT MAKING SURE THERE WAS
APPROPRIATE ATTENTION TO SUBJECT
RECRUITMENT, JUST GIVEN THE
CHALLENGES THAT THAT CAN BE IN
SOME MINORITY POPULATIONS, BUT I
FELT CONFIDENT FROM THE RESPONSE
FROM PROGRAM THAT THAT WAS GOING
TO BE ADDRESSED.
>> GREAT.
EXCELLENT.
VERY GOOD POINT.
OTHER COMMENTS?
OKAY.
NOT HEARING ANY, I WOULD MOVE TO
ACCEPT THIS CONCEPT CLEARANCE.
THOSE WHO ARE IN FAVOR, AYE?
>> AYE.
>> ANY OPPOSED?
OKAY.
NOT HEARING ANY OPPOSITION, THIS
CONCEPT MOVES FORWARD AS
APPROVED BY COUNCIL.
WE'LL MOVE TO THE NEXT
APPLICATION, NEURONAL
VULNERABILITY TO PROTEINOPATHIES
IN ALZHEIMER'S DISEASE AND
ALZHEIMER'S DISEASE-RELATED
DEPARTMENTS.
DR. HUANG, IF YOU WANT TO
SUMMARIZE THE CONCEPT AND THE
DISCUSSION FROM YESTERDAY.
>> YES.
SO, THIS CONCEPT CLEARANCE
PROPOSED TO USE THE R01 ACTIVITY
CODE TO SUPPORT SPECIFY
PROJECTS, CHARACTERIZING
NEURONAL AND GLIAL CELL
POPULATION SELECT OR VULNERABLE
TO PROTEINOPATHY, AD AND ADRD.
REVIEWERS ON COUNCIL GENERALLY
AGREED THIS COUNSEL CLEARANCE
TARGETED ONE VERY IMPORTANT
UNANSWERED QUESTION IN THIS
FIELD.
AND ESPECIALLY RECOGNIZED THIS
IS TIMELY, ESPECIALLY DUE TO THE
CURRENT ADVANCEMENT OF SINGLE
CELL TRANSCRIPTOMIC EPIGENOMIC
AND SPATIAL TECHNOLOGY WHICH NOW
CAN USE TO CHARACTERIZE CELL
TIMES AT A MOLECULAR LEVEL AND
RESOLUTION.
SO, THE REVIEWER AND COUNCIL
ALSO RECOGNIZED VERY UNIQUE
FEATURE IN THIS CONCEPT
CLEARANCE THAT IS ENCOURAGE
COLLABORATION WITH INVESTIGATORS
WHO ARE CURRENTLY FUNDED BY THE
BRIDGE INITIATIVE AND ALSO
VIEWED ON EXISTING REFERENCE
BRAIN ATLAS AND DATABASE AND
ALSO ENCOURAGING GENERAL SHARE
OF THE DATA.
SO, DURING THE DISCUSSION THERE
WAS ONE CLEARANCE REQUIRED, AND
THE PROGRAM OFFICER ADDRESSED
THAT VERY CLEARLY.
THAT IS WHETHER THIS CONCEPT
ONLY COVER THE TAUOPATHY OR
OTHEROPATHYS, PROTEINOPATHIES,
INCLUDING TGP 43 OR
ALPHA-SYNUCLEIN, AND THE PROGRAM
OFFICER ADDRESSED CLEARLY NOT
JUST TAUOPATHY BUT OTHER
PROTEINOPATHIES, SO THE SUMMARY
THE COUNCIL WAS VERY SUPPORTIVE
OF THE CONCEPT CLEARANCE.
>> THANK YOU VERY MUCH.
ARE THERE OTHER COMMENTS ON THIS
CONCEPT?
OKAY, NOT HEARING OR SEEING ANY,
I WOULD INVITE PEOPLE TO VOTE ON
THE APPROVAL OF THIS CONCEPT.
ALL THOSE IN FAVOR?
>> AYE.
>> ANY OPPOSED?
OKAY.
SO NOT HEARING ANY, THIS CONCEPT
IS APPROVED BY COUNCIL VOTE.
THE NEXT APPLICATION -- THE NEXT
CONCEPT IS DEMONSTRATION
PROJECTS TO PROMOTE ALLS OF
INTERPRACTICABLE HEALTH RECORDS
IN CLINICAL RESEARCH IN OLDER
ADULTS.
THE PRIMARY REVIEWER WAS DAVID
REUBEN, SECOND REVIEWER WAS ERIC
REIMANN.
DR. REUBEN IF YOU CAN SUMMARIZE
THE CONCEPT AND NATURE OF
DISCUSSION.
>> THIS IS A VERY INTERESTING
CONCEPT.
IT ADDRESSES AN ISSUE THAT HAS
REALLY BEEN DEFICIENCY AND
PROBLEM WITH HOW ELECTRONIC
HEALTH RECORDS HAVE BEEN
DEVELOPED IN THE UNITED STATES.
THEY ARE NOT VERY
INTEROPEARABLE, NUMBER ONE.
NUMBER TWO, THEY DON'T COLLECT
DATA, VERY IMPORTANT DATA, USING
DEFINED FIELDS THAT ARE
EXPORTABLE.
SO THIS ATTEMPTS TO REMEDY SOME
OF THIS BY ALLOWING RESEARCH
PARTICIPANTS TO DONATE THEIR
ELECTRONIC HEALTH RECORD, AND
THEN HAVING THE AWARDEES, GRANT
AWARDEES, CREATE ESSENTIALLY A
DATABASE OF THE INFORMATION
PARTICULARLY RELATED TO MEDICAL
HISTORY, MEDICAL CONDITIONS,
SELF-REPORTED CONDITIONS, THAT
WILL BE VERY USEFUL TO THE
RESEARCH.
ONE OF THE CAVEATS, IT HAS TO BE
ABLE TO ACCOMMODATE ALL OF THESE
ELECTRONIC HEALTH RECORDS.
FOUR ACCOUNT FOR 77% OF ALL
ELECTRONIC HEALTH RECORDS IN THE
UNITED STATES.
THIS WAS SUPPORTED IN GENERAL IN
THE DISCUSSION, AND BY DR.
REIMANN AS WELL.
WE ALSO -- ANY LED TO
INTERESTING QUESTION ABOUT
GETTING THE EHR VENDORS INVOLVED
IN THIS, AND TO DATE NONE OF THE
MAJOR VENDORS HAVE ACTUALLY BEEN
LEADS IN NIA GRANTS, BUT IN FACT
COLLABORATION WITH THEM WOULD BE
VERY VALUABLE.
THAT'S ANOTHER WAY TO APPROACH
THIS DEFICIENCY OF GETTING
CLINICAL DATA INTO CLINICAL
RESEARCH.
SO OVERALL WE WERE QUITE
SUPPORTIVE OF THIS.
THE MECHANISM WILL BE THROUGH
THE R01 ACTIVITY CODE, AND IT'S
ANTICIPATED SOME OF THESE WILL
BE ALZHEIMER'S AND DEMENTIA,
DISORDERS RELATED, AND SOME OF
THEM WON'T.
>> OKAY.
THANK YOU VERY MUCH.
ARE THERE OTHER COMMENTS FROM
COUNCIL? NOT HEARING ANY, I
WOULD PROPOSE THAT WE VOTE TO
ACCEPT THIS CONCEPT CLEARANCE.
IN FAVOR?
>> YES.
>> AYE.
>> ANY OPPOSED?
OKAY.
THEN THIS CONCEPT MOVES FORWARD
AS APPROVED BY COUNCIL.
THE FINAL CONCEPT CLEARANCE HAS
A LOT OF LETTERS IN THE TITLE,
AND IS NIA, AD, ADRD, SBIR, STTR
REISSUE, ADVANCING RESEARCH ON
AD AND ADRD.
THE PRIMARY REVIEWER WAS DR.
REIMANN, SECONDARY WAS DR.
COMER, DR. REIMANN, SUMMARIZE
THE CONCEPT AND DISCUSSION FROM
YESTERDAY.
>> THANKS, MONICA.
THIS CONCEPT WOULD REISSUE THE
SMALL BUSINESS INNOVATION
RESEARCH, SMALL BUSINESS
TECHNOLOGY TRANSFER PROGRAMS FOR
ALZHEIMER'S DISEASE, ALZHEIMER'S
DISEASE RELATED DEMENTIAS.
BEFORE THEY ARE SET TO EXPIRE IN
SEPTEMBER 2022.
SBIR AND STTR GRANTS SUPPORT THE
DEVELOPMENT OF PRODUCTS OR
SERVICES IN AREAS OF ALZHEIMER'S
DISEASE AND RELATED DEMENTIA
TREATMENT, PREVENTION,
DIAGNOSIS, CARE, RESEARCH, AND
CLINICAL TOOLS.
PHASE 1 GRANTS ARE INTENDED TO
DEMONSTRATE TECHNICAL MERIT AND
FEASIBILITY OF THE PRODUCT OR
SERVICE AND QUALITY PERFORMANCE
OF THE SMALL BUSINESS ITSELF,
WHEREAS THE PHASE 2 AND 2B
GRANTS ARE INTENDED TO FURTHER
DEVELOP THE PRODUCT OR SERVICE,
PROPOSED PROGRAMS WOULD CONTINUE
TO USE CONGRESSIONALLY MANDATED
SET-ASIDE FUNDS, AVERAGING $20
MILLION PER YEAR FOR SBIR GRANTS
AND $4 MILLION PER YEAR FOR STTR
GRANTS, THE GRANTS ARE CAPPED AT
500K, TOTAL COST, 2.5 MILLION
FOR PHASE 2, $3 MILLION FOR
PHASE 2B STUDIES.
THE PROGRAM ALSO CAPITALIZES ON
CONFERENCES, WORKSHOPS, NUMEROUS
INDIVIDUAL INTERACTIONS TO REACH
OUT TO EDUCATE AND HELP TRAIN
POTENTIAL APPLICANTS, RESULTING
IN IMPROVEMENT IN APPLICATION
QUALITY IN THE LAST THREE YEARS.
SINCE THE ORIGINAL FOAs THAT
WERE ISSUED IN 2017, THERE WAS
184% INCREASE IN THE NUMBER OF
THESE GRANTS.
COUNCIL MEMBERS EXPRESS STRONG
SUPPORT FOR THE REISSUE, AND IT
WAS NOTED THAT IN THOSE
INSTANCES IN WHICH BUDGETARY
LIMITATIONS MIGHT PREVENT
BUSINESSES FROM ACHIEVING THEIR
SCIENTIFIC GOALS WITH ADEQUATE
POWER, THERE WERE OTHER
MECHANISMS THAT COULD BE PURSUED
INDEPENDENT OF THIS.
SO THERE WAS A STRONG SUPPORT
FOR THE REISSUE OF THESE
PROGRAMS.
>> THANK YOU.
IS THERE OTHER COMMENT ON THIS
CONCEPT?
>> IF I COULD ALSO MENTION ONE
OTHER THING DURING THE
DISCUSSION, MEMBERS ALSO NOTED
THE OPPORTUNITY TO LEVERAGE
BUSINESS-RELATED GRANTS AND
OTHER MECHANISMS, TO FOSTER
INNOVATION, ALSO THE INCLUSION
OF FEMALE INVESTIGATORS AND
INVESTIGATORS FROM
UNDERREPRESENTED GROUPS.
AND IT WAS -- WE HAD A NICE
DISCUSSION ABOUT WHAT NIA HAS
BEEN DOING IN THAT REGARD.
>> THANK YOU.
MERYL?
>> YES, JUST RESPECTFULLY, I
CANNOT CLAIM TO BE A DOCTOR OR
Ph.D., SO FOR THE RECORD, BUT
THANK YOU.
>> YES, YOU CERTAINLY IN OUR
EYES ARE ABOVE DOCTOR LEVEL.
SO THANK YOU.
OTHER COMMENTS OR QUESTIONS?
IF NOT, I WOULD LIKE TO INVITE A
VOTE ON THIS CONCEPT FOR WHICH
THERE WAS CONSIDERABLE POSITIVE
ENTHUSIASM.
ALL THOSE WHO ARE IN FAVOR OF
ACCEPTING THIS CONCEPT?
>> AYE.
>> OKAY.
ANY OPPOSED?
>> AYE.
>> OKAY.
I'M NOT SURE IF THAT NEEDS TO BE
NOTED.
BUT IT SEEMS, KEN, THAT THE
MAJORITY VOTE IS IN FAVOR OF
ACCEPTING THIS CONCEPT.
>> OKAY.
>> YEAH.
AND THEN I THINK WE ARE DONE
WITH THE CONCEPTS.
THANK YOU ALL, REVIEWERS, AND
PANEL MEMBERS, FOR REALLY
INTERESTING AND I THINK
CONSTRUCTIVE DISCUSSION.
>> YES, I WOULD LIKE TO THANK
MONICA FOR HER LEADERSHIP ON
WORKING GROUP AND THANK ALL THE
MEMBERS FOR THEIR REVIEWS OF
THESE CONCEPTS.
I WANT TO REMIND EVERYONE THAT
THESE CONCEPTS THAT ARE APPROVED
BY COUNCIL WILL BE PUBLISHED ON
OUR WEBSITE, SO IF YOU JUST
GOOGLE NIA CONCEPTS, HOPEFULLY
WITHIN THE WEEK THEY WILL BE UP,
WITH MORE LENGTHY SUMMARY OF THE
CONCEPTS THEMSELVES AND A
PROGRAMMATIC CONTACT FOR EACH OF
THEM SO IF YOU'D LIKE TO HAVE
FURTHER DISCUSSION WITH PROGRAM
ON ANY OF THESE PLEASE CONTACT
THEM SO THEY WILL BE PUBLISHED
ON OUR WEBSITE.
YOU CAN GET AN EARLY START
THINKING ABOUT PERHAPS PROPOSALS
IN A -- THAT YOU WOULD LIKE TO
START INITIATING.
ALL RIGHT.
SO, NEXT IN OUR AGENDA IS OUR
NEXT THREE SPEAKERS, BUT BEFORE
WE DO THAT I'D LIKE TO GIVE
EVERYONE A FIVE-MINUTE BREAK TO
STRETCH YOUR LEGS, SO IT IS NOW
11:50 EASTERN TIME.
I'D LIKE TO GIVE EVERYONE FIVE
MINUTES.
WE'LL RECONVENE AT 11:55, AND WE
WILL START WITH OUR NEXT
SPEAKER
>> WELCOME BACK.
WE'LL CONTINUE WITH OUR OPEN
SESSION.
I'D LIKE TO TURN THIS OVER TO
DR. HODES TO INTRODUCE OUR FIRST
SPEAKER.
RICHARD?
>> YES, IT'S A PLEASURE TO
INTRODUCE DR. CLINTON WRIGHT
FROM NINDS, A VERY IMPORTANT
TOPIC AS WE'RE COPING WITH ACUTE
IMPACT OF SARS-COV-2 INFECTIONS,
IT'S CLEAR SEQUELAE INFECTION
HAVE BEEN PROMINENT,
PREDOMINANT, A SOURCE OF ONGOING
RESEARCH, CLINT HAS BEEN ONE OF
THE CO-LEADS IN THIS INITIATIVE,
NIH RECOVER INITIATIVE AND WILL
SPEAK TO US TODAY.
>> IT'S A PLEASURE TO BE HERE.
CAN YOU HEAR ME?
>> LOUD AND CLEAR.
>> FANTASTIC.
YES, THANK YOU FOR INVITING ME
TO TALK TO YOU TODAY ABOUT
POST-ACUTE SEQUELAE OF COVID AND
RECOVER INITIATIVE, FIRST
TALKING ABOUT THE DEFINITION
BECAUSE THERE ARE A NUMBER OF
DEFINITIONS OUT THERE AND I
THINK A LOT OF PEOPLE HEARD THE
TERM LONG COVID USED BUT THE
NIH IS USING POST-ACUTE SEQUELAE
OF COVID TO INCLUDE DIFFERENT
CONCEPTS LIKE MULTI-INFLAMMATORY
SYNDROME IN ADULTS AND CHILDREN,
AS WELL AS VERY INTERESTING
PROBLEM OF CONDITIONS THAT MAY
ARISE AS A CONSEQUENCE OF
SARS-COV-2 INFECTION THAT MIGHT
BE DIABETES OR MIGHT BE SOME
OTHER RISK FACTOR THAT MAY LEAD
TO OTHER ORGAN DAMAGE.
CLEARLY SYMPTOMS CAN RANGE FROM
MILD TO SEVERE, AND SO THAT
REALLY NEEDS TO BE UNDERSTOOD
MUCH BETTER, AND A BROADER TERM
I THINK IS GOING TO BE HELPFUL
WITH THAT.
AND AGAIN MANY SYMPTOMS HAVE
BEEN DESCRIBED OVER THE YEARS.
SORRY, OVER THIS ACUTE PANDEMIC.
YOU COULD SEE SOME THEM LISTED
HERE, THIS IS ONLY REALLY A
SHORT LIST.
AND THE UNDERSTANDING IS QUITE
LIMITED BECAUSE OF THE VERY
SHORTENED TIME FRAME THAT WE'VE
HAD TO STUDY THIS PROBLEM.
>> I'M SORRY, DR. WRIGHT, IF I
COULD INTERRUPT.
WE DON'T HAVE YOUR SLIDES UP AT
THE MOMENT.
>> OH, THANKS FOR LETTING ME
KNOW.
>> YES.
ARE YOU SHARING YOUR SCREEN?
>> I PRESSED THE BUTTON BUT I
THOUGHT -- SORRY ABOUT THAT.
I ASKED IF YOU COULD HEAR ME BUT
DIDN'T IF YOU COULD SEE WHAT I
WAS PRESENTING.
DO YOU SEE NOW?
>> YES, WE CAN SEE YOUR SLIDES.
>> MY APOLOGIES.
WELL, ANYWAY, I WILL SKIP
THROUGH WHAT I ALREADY SAID BUT
ESSENTIALLY THIS IS WHAT I SAID
ABOUT THE DEFINITION OF PAST, I
WAS TALKING ABOUT THE VARIED
SYMPTOMS AND THE NEED TO
CHARACTERIZE THAT.
THE EPIDEMIOLOGY PIECE HAS BEEN
A CHALLENGE.
WE NEED MORE ROBUST DATA IN THIS
AREA, AND THAT'S REALLY THE MAIN
PURPOSE OF RECOVER, BUT THE
STUDIES TO DATE AS MANY PEOPLE
ON THIS CALL ARE AWARE, HAVE
BEEN VERY HETEROGENEOUS, AND
MANY OF THEM HAVE HAD
SIGNIFICANT LIMITATIONS, EITHER
BECAUSE THE SAMPLE ADVISES HAVE
BEEN SMALL OR WORK HAS BEEN DONE
QUITE QUICKLY, PUBLISHED IN
PRE-PRINT FORM, AND MAY THE NEW
HAVE BEEN PEER REVIEWED, SO
WE'RE NOT SURE IF THOSE FINDINGS
WILL HOLD UP.
EPIDEMIOLOGY WILL DEPEND ON
DEFINITION USED.
THERE ARE A NUMBER OF
DEFINITIONS, LIKE I SAID, THAT
HAVE BEEN USED ACROSS
ORGANIZATIONS AND EVEN AGENCIES,
AND SO WE NEED TO BE MORE
HARMONIZED IN THE USE OF THOSE
DEFINITIONS OR BE CLEAR ABOUT
THEM.
AND THEN WE WANT TO RECOGNIZE
THAT PASC DOES OCCUR IN
CHILDREN, MAY BE LESS FREQUENT
BUT MAY BE QUITE DIFFERENT.
WE WANTED TO MAKE SURE THAT THAT
WAS STUDIED IN ITS OWN RIGHT.
THIS STUDY I THINK IS AN
INTERESTING ONE THAT INCLUDED
ABOUT A QUARTER OF A MILLION
COVID-19 SURVIVORS THAT WERE
ASSESSED FOR PASC AFTER 30 DAYS
FROM INFECTION, AND 57 STUDIES
IF YOU LOOK AT THE PANELS ON THE
SLIDE YOU SEE THE ENORMOUS
VARIABILITY IN THE DIFFERENT
SYMPTOMS AND PROBLEMS THAT HAVE
COME OUT IN THE STUDY.
AND SO IT JUST HIGHLIGHTS THE
IMPORTANCE OF GETTING ALL OF OUR
HEADS TOGETHER, AND STUDYING
THIS IN AN ORGANIZED AND
HARMONIZED WAY.
WHAT IS THE PREVALENCE OF PASC?
THAT IS OBVIOUSLY SOMETHING THAT
IS REALLY AN ITERATIVE PROCESS
OF TRYING TO UNDERSTAND, THIS
STUDY OUT OF THE U.K. THAT
INVOLVED MORE THAN 300,000
PEOPLE THAT ANSWERED A SURVEY,
YOU CAN SEE THAT IN THE
BEGINNING ABOUT 30 DAYS OUT FROM
INFECTION, ALMOST A FIFTH OF THE
POPULATION THAT HAS BEEN
INFECTED COMPLAINS OF SYMPTOMS
THAT HAVE LASTED THAT LONG, AND
THEN OVER THE NEXT COUPLE OF
MONTHS THAT DROPS DOWN, AND
SEEMS LIKE IT LEVELS ON OF, ENDS
UP AT 12% IN THIS ONE STUDY, BUT
ONE OF THE THINGS THAT IS VERY
INTERESTING ABOUT IT, AND ALSO
MAKES IT A CHALLENGE TO STUDY,
IS THAT IT SEEMS TO VARY BY THE
SEVERITY OF THE ILLNESS, SO YOU
CAN SEE THAT THE SYMPTOMS
CONSISTENTLY GREATER IN PEOPLE
WITH POOR BASELINE HEALTH AND
MORE SEVERE ACUTE INFECTION, AND
THE LITTLE PANEL TO THE RIGHT
WITH THE COLOR-CODED BARS SHOW
YOU THAT IF PEOPLE WERE NOT
HOSPITALIZED, THE RATES WERE
MUCH LOWER THAN THOSE WHO WERE
EITHER HOSPITALIZED OR PUT IN
INTENSIVE CARE BECAUSE OF THE
COVID-19.
SO IT COMPLICATES THE
UNDERSTANDING OF PASC.
AND THIS SLIDE, ALTHOUGH YOU
DON'T NEED TO READ EACH EVERY
ROW, WHAT IT SHOWS IS ACROSS THE
NON-HOSPITALIZED/HOSPITALIZED AT
ICU, DARKER RED AND PURPLE SHOW
MORE HEAVY BURDEN OF THE
SYMPTOMS, YOU CAN SEE THEY
GENERALLY KIND OF GO UP WITH
SEVERITY OF THE ILLNESS.
BUT I ALSO PUT THESE PANELS HERE
BECAUSE THEY ACTUALLY HIGHLIGHT
THE AGE GROUPS THAT I THOUGHT
THE NIA WOULD BE INTERESTED IN
BECAUSE THIS TABLE'S MUCH
LARGER, THIS LOOKS AT PEOPLE
LESS THAN 60, 60 TO 70, GREATER
THAN 70.
WHAT I THOUGHT WAS INTERESTING
ABOUT THIS IS THAT IN SOME OF
THE CASES, THE SYMPTOMS SEEM TO
GET WORSE AS PEOPLE GET OLDER.
BUT IN SOME CASES THEY SEEM TO
BE WORSE IN YOUNGER GROUPS.
AND SO THAT'S ALSO SOMETHING
THAT NEEDS TO BE REALLY
UNDERSTOOD A LOT BETTER.
SO, THE PERSISTENCE OF SYMPTOMS
HAS BEEN STUDIED IN RANDOM SORT
OF COMMUNITY-BASED SAMPLES LIKE
I MENTIONED EARLIER, AND THIS
ONE ALSO FROM THE U.K., MORE
THAN HALF A MILLION PEOPLE, THE
PREVALENCE OF SELF-REPORTED
COVID WAS 19%, BUT OF THOSE
ABOUT 40% REPORTED AT LEAST
HAVING ONE SYMPTOM, 12 WEEKS,
LASTING 12 WEEKS OR MORE AFTER
INFECTION, WHICH IS QUITE HIGH.
AND THEY IDENTIFIED IN THIS
STUDY TWO DISTINCT CLUSTERS,
TIREDNESS CLUSTER, WHERE
TIREDNESS CO-OCCURRED WITH
MUSCLE ACHES AND DIFFICULTY
SLEEPING AND SHORTNESS OF BREATH
AND RESPIRATORY THAT INCLUDED
SHORTNESS OF BREATH BUT
TIGHTNESS OF THE CHEST AND CHEST
PAIN, AND UNDERSTANDING HOW
CLUSTERS, MAYBE PHENOTYPES ARE
REALLY GOING TO BE HELPFUL IN
UNDERSTANDING PASC AND HOW TO
TARGET THE TREATMENTS.
YOU CAN SEE HERE SORT OF GETTING
BACK AMOUNT WHAT I MENTIONED
EARLIER A HIGHER PERCENTAGE OF
PEOPLE IN THE RESPIRATORY
CLUSTER REPORTED SEVERE CLUSTERS
THAN TIREDNESS BUT THAT MAY HAVE
TO DO WITH SEVERITY OF THE
ILLNESS THAT THEY HAD.
SOME GREAT AND VERY IMPORTANT
DATA HAVE COME OUT OF THE U.S.
DEPARTMENT OF VETERANS AFFAIRS
HEALTH DATABASE, WHERE PEOPLE
HAVE BEEN -- THEY HAVE HAD
75,000 PEOPLE THAT THEY HAVE
IDENTIFIED WITH A COVID
DIAGNOSIS, AND THEY WERE ABLE TO
COMPARE THAT TO ROUGHLY 5
MILLION PEOPLE WHO USE THE
HEALTH CARE SYSTEM AND WERE
FOUND -- NOT FOUND TO HAVE A
COVID INFECTION DURING THE STUDY
PERIOD.
BEYOND THE FIRST 30 DAYS, PEOPLE
WITH COVID-19 DID HAVE A GREATER
RISK OF DEATH AND USE OF HEALTH
CARE RESOURCES, MEANING THAT
PEOPLE ARE AT RISK OF DEATH EVEN
BEYOND THAT, YOU KNOW, EARLY
INFECTION STAGE.
SO THIS IS SOMETHING THAT REALLY
NEEDS TO BE DELVED INTO FURTHER.
AND THERE WERE MANY DIFFERENT
SYSTEMS INVOLVED, INCLUDING
RESPIRATORY, NERVOUS SYSTEM
INCLUDED NEUROCOGNITIVE
DISORDERS AND MENTAL HEALTH,
OTHER SYSTEMS AS WELL, ALSO AN
INCIDENT USE OF MANY DIFFERENT
MEDICATION TYPES, INCLUDING PAIN
MEDICATIONS, ANTI-DEPRESSIVE,
ANXIOLYTIC, ORAL HYPOGLYCEMICS
AS I REFERRED TO AT THE
BEGINNING OF THE TALK, THERE'S
AN INTEREST IN HOW SARS-COV-2
MAY ACTUALLY CREATE A RISK FOR
DEVELOPING SOME OTHER RISK
FACTORS FOR WELL KNOWN DISEASES.
SO IT SEEMS THERE'S A RISK
GRADIENT ACCORDING TO THE
SEVERITY THAT WE REALLY NEED TO
FURTHER UNDERSTAND.
BUT NOW WE ARE IN A SITUATION
WHERE MANY PEOPLE ARE BECOMING
VACCINATED, WE HOPE.
AND THERE ARE PEOPLE THAT HAVE
BEEN VACCINATED, PEOPLE THAT
HAVE BEEN BOOSTED, AND SO THE
QUESTION IS HOW DOES THAT RELATE
TO PASC?
AND THIS ONE STUDY HERE FOUND
THAT FULLY VACCINATED PEOPLE WHO
DEVELOPED BREAKTHROUGH
INFECTIONS WERE ABOUT HALF AS
LIKELY AS UNVACCINATED PEOPLE TO
REPORT SYMPTOMS OF LONG COVID
THAT LASTED AT LEAST FOUR WEEKS
AFTER INFECTION.
AND THE DEPARTMENT OF VETERANS
AFFAIRS DATABASE HAS ALSO
YIELDED SOME IMPORTANT RESULTS
HERE AS WELL, WHERE IT FOUND, A
STUDY FROM HERE FOUND THAT
PEOPLE WITH COVID-19 AND
BREAKTHROUGH HAD A GREATER RISK
OF DEATH AND BROAD ARRAY OF
POST-ACUTE SEQUELAE BEYOND THE
FIRST 30 DAYS, COMPARED TO
PEOPLE WITH NO EVIDENCE OF
COVID-19, BUT A LOWER RISK
COMPARED TO PEOPLE WHO ARE
UNVACCINATED, AND YOU COULD SEE
THAT ALSO SEEMS TO DIFFER BY
HOSPITALIZATION STATUS, WHICH IS
WHAT IS SHOWN IN THE PANEL ON
THE RIGHT SIDE.
SO WE REALLY NEED MORE ROBUST
DATA, EPIDEMIOLOGIC DATA.
WE THINK IT'S VERY IMPORTANT TO
UNDERSTAND PHENOTYPES AND
CLINICAL SPECTRUM OF PASC IN
ORDER TO BE ABLE TO APPROACH IT
PROPERLY.
WE NEED TO UNDERSTAND THE
DURATION OF PASC, THOSE OF YOU
WHO REMEMBER THE -- WELL, YOU
WOULDN'T REMEMBER THE INFLUENZA
PANDEMIC FROM A HUNDRED YEARS
AGO BUT YOU REMEMBER READING
ABOUT IT.
AND YOU REMEMBER THAT TEN YEARS
LATER PEOPLE DEVELOPED -- SOME
PEOPLE DEVELOPED PARKINSON'S,
RIGHT?
SO, HOW LONG DOES IT TAKE FOR
SOME OF THESE SYMPTOMS TO SHOW
UP AND SIGNS TO SHOW UP?
THIS NEEDS TO REALLY BE
UNDERSTOOD.
WHAT ARE THE RISK FACTORS FOR
THE DEVELOPMENT OF PASC?
THE IMPACT OF VACCINATION,
EFFECT OF DIFFERENT VARIANTS,
NOW WE ARE OF COURSE HOPEFULLY
ON THE TAIL END IN SOME PLACES
OF OMICRON, OF COURSE IN OTHER
PLACES WE'RE NOT.
WE NEED TO UNDERSTAND GIVEN THAT
OMICRON BEHAVES DIFFERENTLY THAN
DELTA DID, FOR EXAMPLE, DOES
THAT HAVE AN EFFECT ON HOW THE
TYPES OF SYMPTOMS DEVELOPED POST
INFECTION AND SYNDROMES,
PHENOTYPES, IF YOU WILL.
WHAT IS THE UNDERLYING
PATHOBIOLOGY?
AND THEN OF COURSE IDENTIFYING
THERAPEUTIC TARGETS.
SO, WHAT DO WE KNOW ABOUT THE
CAUSES?
WELL, IT'S VERY MUCH AN EARLY
STAGE IN UNDERSTANDING THIS.
BUT THERE'S CERTAINLY CERTAIN
TISSUES THAT SEEM TO
STIMULATE -- THAT HAVE ONGOING
DYSFUNCTIONAL IMMUNE RESPONSES
AND TISSUE DAMAGE.
DYSREGULATED IMMUNE REACTIONS
THAT RESULT IN INFLAMMATION,
THAT MAY ALSO BE INVOLVED.
THERE'S EVIDENCE OF ABNORMAL
PROFILES IN IMMUNE CELLS AND
INFLAMMATORY MOLECULES THAT NEED
TO BE FURTHER UNDERSTOOD.
AND THEN THERE'S THE ASPECT OF
AUTOIMMUNITY, PERSISTENCE OF
VIRAL PARTICLES, VIRAL
INFECTION, THAT MAY SET UP AN
AUTOIMMUNE REACTION.
AND THEN THE DAMAGE TO SPECIFIC
ORGANS AND TISSUES THAT RESULT
IN DIFFERENT SYSTEMS BEING
DYSFUNCTIONAL.
THAT'S VERY DIFFICULT AND VERY
CHALLENGING TO STUDY IN PATIENTS
BECAUSE IT'S HARD TO SEPARATE
THE WHEAT FROM THE CHAFF IN
TERMS OF WHAT HAPPENED WHEN THEY
HAD ACUTE ILLNESS VERSUS LATER
EFFECTS.
SO WE HAVE THIS POTPOURRI OF
SYMPTOMS THAT YOU SEE HERE ON
THE LEFT, AND MANY DIFFERENT
ORGAN SYSTEMS, AND CONDITIONS,
INVOLVED ON THE RIGHT.
SORT OF SEPARATING THESE OUT AND
THEN UNDERSTANDING, YOU KNOW,
HOW THEY RELATE TO EACH OTHER
REALLY REQUIRES A VERY
MULTI-PRONGED APPROACH,
ESPECIALLY IF WE'RE GOING TO
HOPE TO DEVELOP TREATMENTS.
SO IN TERMS OF POTENTIAL
TREATMENTS, RIGHT NOW THERE ARE
THREE MAIN AREAS.
THE IDEA OF PERSISTENT
SARS-COV-2 VIRUS THAT WOULD BE
AMENABLE TO ANTI-VIRALS, THE
POTENTIAL FOR DYSREGULATED
IMMUNE RESPONSE TO RESPOND TO
IMMUNE MODULATORS, AND THEN SOME
VERY ORGAN AND TISSUE-SPECIFIC
INTERVENTIONS THAT MAY EITHER BE
MEDICATIONS OR
NON-PHARMACOLOGICAL
INTERVENTIONS THAT COULD HELP
WITH TARGETING SPECIFIC AREAS,
LUNG, HEART, BLOOD VESSELS.
THERE ARE A NUMBER OF
NEUROCOGNITIVE AND OTHER
REHABILITATIVE STRATEGIES THAT
MAY BE HELPFUL, AND COGNITIVE
BEHAVIORAL THERAPIES, AND ON AND
ON.
SO ALL OF THESE THINGS NEED TO
BE PUT IN THE PERSPECTIVE AS WE
GAIN MORE INFORMATION.
BUT I THINK THE TAKEHOME MESSAGE
FROM ALL OF THIS IS THAT WE
REALLY NEED TO CHARACTERIZE
WHAT'S GOING ON FIRST BEFORE WE
CAN REALLY HOPE TO TREAT IT.
SO THE NIH RECOVER INITIATIVE,
THE MAIN GOAL BEING TO RAPIDLY
IMPROVE UNDERSTANDING, HAS KEY
SCIENTIFIC AIMS HERE, MOST OF
WHICH I HAVE ALREADY KIND OF
RUN THROUGH.
I WANT TO EMPHASIZE THE GUIDING
PRINCIPLE OF THIS EFFORT HAS
BEEN TO CREATE A
PATIENT-CENTERED APPROACH BUT
THIS HAS A NATIONAL SCALE.
IT'S VERY MULTI-DISCIPLINARY, AS
I ALREADY MENTIONED.
IT HAS TO BE ADAPTIVE BECAUSE,
YOU KNOW, NOW WE'RE IN OMICRON,
HOPEFULLY THERE WON'T BE ANOTHER
VARIANT, BUT THERE ARE WAVES AND
WAVES OF THESE VARIANTS THAT
HAVE CAUSED MAYBE DIFFERENT
SEQUELAE THAT WE DON'T EVEN KNOW
ABOUT.
THERE ARE A NUMBER OF
STAKEHOLDERS THAT I'VE LISTED
HERE, ON THE RIGHT-HAND SIDE,
THAT ARE WORKING TOGETHER AND
COLLABORATING.
AND SO THE RECOVER CORES
INCLUDE A SCIENCE CORE, DATA
CORE, BIOREPOSITORY THAT SUPPORT
THE DIFFERENT STUDIES.
THE THREE MAIN STUDIES ARE
RECOVER SET OF COHORTS THAT ARE
GOING TO ACTUALLY ENROLL PEOPLE,
I'LL TELL YOU A LITTLE BIT THAT
IN A SECONDS.
A VERY ROBUST ELECTRONIC HEALTH
RECORD SYSTEM METHOD THAT WILL
INCLUDE 40 MILLION RECORDS AND
ABOUT 4 MILLION CASES PLUMBED
AND ALWAYS-BASED STUDY TO LOOK
AT MORE THAN 50 TISSUE TYPES.
AND THERE ARE MANY RESOURCES
THAT SUPPORT THIS.
AND SO IN TERMS OF THE COHORTS,
THERE'S AN ACUTE INFECTION
COHORT WHERE WE HAVE THE
OPPORTUNITY TO BRING PEOPLE IN
AND FOLLOW THEM, AND SEE WHO
DEVELOPS PASC.
WE ALSO HAVE A POST-ACUTE
INFECTION COHORT WHERE PEOPLE
HAVE ALREADY BEEN INFECTED, WE
CAN TEST THEM FOR DIFFERENT
ANTIBODIES AND FIND OUT IF THEY
WERE INFECTED, AND THEN RETRO
S PECTIVE STUDIES, ABILITY TO
STUDY PREGNANT WOMEN, AND
CHILDREN, IN THE COHORTS,
INCLUDING 40,000 PEOPLE FROM 200
SITES ACROSS ALL 50 STATES. AND
THEN THE PEOPLE THAT ARE IN THE
COHORT STUDIES WILL BE SCREENED
AND THEY WILL UNDERGO WHAT WE
CALL THE TIER 1 LEVEL
ASSESSMENTS THAT WILL INCLUDE
MANY QUESTIONNAIRES AND CLINICAL
ASSESSMENTS AND SOCIAL
DETERMINANTS OF HEALTH AND
PSYCHOSOCIAL FACTORS, AND THEN
DEPENDING ON HOW THEY RESPOND TO
THOSE QUESTIONNAIRES AND
INSTRUMENTS, A RANDOM SAMPLE
WILL BE SELECTED TO UNDERGO TIER
2, SO 40,000 PEOPLE AS I
MENTIONED ALREADY IN TIER 1,
ABOUT 10,000 IN TIER 2, AND
ABOUT 5,000 WILL GO EVEN DEEPER,
UNDERGO EVEN DEEPER PHENOTYPING,
THAT YOU CAN SEE LISTED HERE
INCLUDING DEEP IMAGING AND SO
ON.
ONE OF THE MOST IMPORTANT THINGS
ABOUT COVID THAT HAS BEEN VERY
INSTRUCTIVE HAS BEEN THE
DISPARITIES IN COVID AND THE
DISPARITIES IN PASC.
AND SO WHEN RECOVER WAS
DESIGNED, THE IDEA WAS TO TARGET
THE POPULATIONS THAT WERE MOST
AFFECTED BY COVID, RATHER THAN
SIMPLY REPRESENT THE U.S.
POPULATION.
SO YOU CAN SEE THE TARGET
ENROLLMENT FOR THE DIFFERENT --
SOME DIFFERENT RACIAL AND ETHNIC
GROUPS HERE, THEY ARE SOMEWHAT
OVERSAMPLED IN ORDER TO TRY AND
ACCOMPLISH THAT.
SO IN TERMS OF WHAT NIA MAY BE
INTERESTED IN, I CREATED A FEW
SLIDES JUST LOOKING A LITTLE
DEEPER AT THE TIER LEVEL
ASSESSMENTS THAT MAY BE
SPECIFICALLY RELEVANT TO NIA, SO
YOU CAN SEE THE DISABILITY
SCREENS, COMORBIDITY, PHYSICAL
FUNCTION ASSESSMENTS, LABORATORY
TESTS DONE IN DIFFERENT TIERS
COLOR CODED TO TIER 1, TIER 2,
TIER 3 ON THE BOTTOM OF THE
SLIDE.
NEUROFILAMENT LIGHT AND TAU, FOR
EXAMPLE, WILL BE IN TIER 3, THAT
THE SIX-MINUTE WALK TEST, GRIP
STRENGTH, QUADRICEP STRENGTH AND
TIMED UP AND GO WILL BE IN TIER
2.
AND THEN ON THIS SLIDE YOU CAN
SEE THAT MRI AND LUMBAR PUNCTURE
TIER 3 IN-DEPTH TESTING, OTHER
NEUROPSYCH TESTING AS PART OF
TIER 2.
SOME OF THESE ARE INTERESTING, I
THINK, IN TERMS OF AGING AND
ADRDs.
I WANTED TO MENTION ALSO THAT
THE AUTOPSY COHORT WILL INCLUDE
COMPREHENSIVE EXAM OF THE
CENTRAL NERVOUS SYSTEM, AS WELL
AS SPECIFIC SAMPLING,
POSTMORTEMCS BRAIN MRI.
THIS IS MORE OPEN FOR YOUR
DISCUSSION.
WHAT IS THE PREVALENCE AND
INCIDENCE OF PASC IN AGING
POPULATIONS COMPARED WITH
YOUNGER ADULTS?
WHAT DIFFERS BY AGE, THE
CLINICAL COURSE, THE
SUBPHENOTYPES, UNDERLYING
MECHANISMS.
AND DOES THE PATHOPHYSIOLOGY OF
COVID AND/OR PASC DIFFER BY AGE
AT INFECTION OR AGE AT DEATH.
AND UNDERSTANDING THE PASC
FEATURES THAT AFFECT AGING, THE
NEUROLOGICAL CONSEQUENCES,
COGNITIVE CONSEQUENCES,
VARIABILITY ACROSS SEQUELAE IN
POPULATION DEMOGRAPHICS,
RELATIVE RELATIVE TO AGE, SEX,
ETHNICITY.
WE NEED TO UNDERSTAND
PHYSIOLOGIC AND ENVIRONMENTAL
AND BEHAVIORAL FACTORS THAT MAY
CONTRIBUTE TO THE SUSCEPTIBILITY
OF OLDER ADULTS TO SEQUELAE OF
SARS-COV-2 AND EFFECT OF
SYMPTOMS AND SEQUELAE ON
IMPORTANT OUTCOMES TO THE AGING
POPULATION.
AND THEN OTHER QUESTIONS HAVING
TO DO SPECIFICALLY WITH AD AND
ADRD ARE WHAT DOES SARS-COV-2
INFECTION AND/OR PASC HAVE TO DO
WITH PROGRESSION, DEVELOPMENT
AND PROGRESSION OF AD AND
ADRDs, AND WHAT DOES
UNDERLYING SUBCLINICAL OR EARLY
ADRDs, WHAT AFFECT DUGS THAT
HAVE ON THE COMORBIDITY OF THE
SARS-COV-2 AND HOW THAT PLAYS
OUT.
AND WHAT ARE INTERACTIONS AND
INCIDENTS AND PROGRESSION OF
DIFFERENT OVERLAPPING MIXED
ETIOLOGIES.
SO THAT'S ALL I HAVE FOR YOU AT
THIS TIME.
I HOPE IT'S BEEN HELPFUL.
IT'S KIND OF A BROAD OVERVIEW.
IT GIVES YOU A PERSPECTIVE ON
WHERE RECOVER IS HEADED.
I WANTED TO JUST MENTION THAT
THE SENIOR OVERSIGHT COMMITTEE
IS LED BY DOCTORS FAUCI, GIBBONS
AND KOROSHETZ, AND I'M PREPARED
TO TAKE ANY QUESTIONS THAT YOU
MAY HAVE.
THANK YOU.
>> TERRIFIC.
THANK YOU VERY MUCH, DR. WRIGHT.
REALLY GREAT OVERVIEW OF THE
RECOVER INITIATIVE.
QUESTIONS FROM OUR COUNCIL
MEMBERS?
YES, AMY?
>> YEAH, THANK YOU VERY MUCH
FOR YOUR VERY CLEAR
PRESENTATION.
I WANTED TO ASK A QUESTION ABOUT
HOW UNIQUE PASC IS IN THE
CONTEXT OF OTHER RESPIRATORY
VIRUSES, AND IF THAT IS A
COMPONENT OF UNDERSTANDING THAT
THE RECOVER MISSION ENTAILS
INCLUDES.
>> GREAT QUESTION.
FROM THE STANDPOINT OF DATA OUT
THERE, IT DOES SEEM AS IF THAT
SARS-COV-2 HAS MORE SEVERE OR AT
LEAST THE EARLIER FORMS HAD A
MORE SEVERE SET OF OUTCOMES THAN
LET'S SAY INFLUENZA.
OF COURSE, THERE'S A LOT OF
DIFFERENT PATHOGENS OUT THERE,
AND SOME ARE RARER THAN OTHERS.
SO, IT'S A LOT EASIER TO STUDY
THE MORE PREVALENT SUCH AS
INFLUENZA.
NOW THAT WE'RE IN OMICRON
THOUGH, IT'S INTERESTING BECAUSE
IT'S A LITTLE BIT HARDER TO
PARSE THAT OUT BECAUSE MANY
TIMES LET'S SAY A COLD VIRUS
MIGHT NOT BE REPORTED AND IT'S
HARD TO REALLY STUDY THAT.
SO I THINK IT'S A REALLY
INTERESTING QUESTION.
ONE OF THE THINGS THAT'S REALLY
EXCITING ABOUT THE EHR DATA AND
REAL WORLD DATA, AND BY THE WAY,
YOU KNOW, I THINK IT'S BEEN A
TREMENDOUS OPPORTUNITY, YOU
KNOW, BECAUSE OF THE PANDEMIC TO
REALLY GET THIS HUGE DATA
TOGETHER, AND IT WILL I THINK
LIFT ALL BOATS IN TERMS OF
UNDERSTANDING MANY DIFFERENT
PROCESSES.
BUT BEING ABLE TO LOOK AT
MILLIONS AND MILLIONS OF RECORDS
WILL HELP US TO UNDERSTAND SOME
OF THOSE THINGS YOU JUST ASKED
ABOUT.
>> GREAT.
THANK YOU.
>> CLIFF?
>> YEAH, HI.
CLIFF ROSEN.
I JUST FINISHED ON COUNCIL.
THANK YOU FOR YOUR EFFORTS.
THIS IS A COMPLEX AND
MULTI-LAYER PROCESS.
I THINK THE NIH HAS DONE AN
AMAZING JOB WITH, QUOTE, THE
SYNDROME TRYING TO UNDERSTAND
HOW TO MEASURE IT AND ALSO
MOVING FORWARD THE PATHOBIOLOGY.
WE JUST ISSUED THE OTA FOR
PATHOBIOLOGY GRANTS.
I WANT TO SAY THANK YOU AGAIN
FOR BEING SO INCLUSIVE ABOUT
TRYING TO DISCOVER WHAT REALLY
IS BEHIND COVID-19'S LONG COVID.
>> THANK YOU.
>> WE HAVE TWO OTHER QUESTIONS.
YADONG AND SHALI.
>> THANK YOU FOR THE CLEAR TALK.
QUICK QUESTION, GENDER
DIFFERENCE IN TERMS OF THIS
RECOVERY?
>> YES, SO WHAT WE KNOW FROM
THE SELF-REPORTED SYMPTOMS IS
THAT WOMEN SEEM TO HAVE MORE
SYMPTOMS THAN MEN, SO FAR,
SIGNIFICANTLY GREATER NUMBER OF
SYMPTOMS AND A BROADER ARRAY OF
SYMPTOMS.
IT'S A VERY, VERY INTERESTING
AREA THAT WE DON'T REALLY
UNDERSTAND BECAUSE I THINK WHAT
RECOVER WILL ALLOW US TO DO
WHEN WE REALLY GET INTO THE MORE
IN-DEPTH PHENOTYPING IS
UNDERSTAND, YOU KNOW, WHAT ARE
THE UNDERLYING REASONS FOR
DIFFERENCES.
RIGHT NOW WE SORT OF SEE SORT OF
THE BIG PICTURE OF PEOPLE'S
EXPERIENCE, BUT WHAT WE NEED TO
DO IS DELVE INTO THE
PATHOBIOLOGY AND DELVE INTO SOME
OF THESE OTHER UNDERLYING RISK
FACTORS, FOR EXAMPLE, DIFFERENT
STAGES OF LIFE, AND SO WE -- AS
WAS JUST POINTED OUT BY THE LAST
COUNCIL MEMBER, IT'S INCREDIBLY
COMPLEX AND DIFFICULT TO STUDY
AND SO WE'VE REALLY TRIED TO
INCLUDE ALL THE DIFFERENT GROUPS
THAT WE THOUGHT WERE GOING TO BE
AT THE HIGHEST RISK.
>> SO WHAT IS THE BALANCE, THREE
DIFFERENT TIERS, ABOUT THE
RECRUITMENT?
>> WHAT IS THE BALANCE?
>> YEAH, I MEAN THE GENDER
BALANCE THERE.
HALF/HALF OR --
>> YES, YES, I THINK RIGHT NOW
IT'S HALF/HALF.
BUT AS WE -- AS I THINK THE
OPPORTUNITY THAT WE HAVE,
BECAUSE IT'S AN ITERATIVE
PROCESS, IS WE'RE ONLY BEGINNING
WITH THE INITIAL RECRUITMENT, IF
WE START, WE CAN SORT OF TURN
THE BOAT, IF YOU WILL, AS WE
DISCOVER THAT WE WANT TO GO IN A
PARTICULAR DIRECTION, WE CAN
OVERSAMPLE PARTICULAR AREAS.
THAT'S ONE OF THE BEAUTIES OF
THE TIERS, AND I EXPECT WE'LL BE
ABLE TO DO THAT.
>> THANK YOU.
>> SHALI, GO AHEAD.
>> YEAH, THANK YOU, DR. WRIGHT,
FOR THE VERY LUCID COMPREHENSIVE
OVERVIEW OF THE COMPLEX
SYNDROME.
GIVEN THE EXTRAORDINARY SUCCESS
THAT NIH HAD IN INITIAL
INITIATIVES RELATED TO COVID,
PARTICULARLY THE VACCINE
DEVELOPMENT OPERATION WARP
SPEED, ARE THERE SIMILAR PLANS
ALREADY IN PLACE, PLANS TO
EXPEDITIOUSLY FUND AND IMPLEMENT
INTERVENTION TRIALS FOR THE
VARIOUS POSTULATED MECHANISMS
FOR THIS PARTICULAR --
>> YES.
YES, ACTUALLY WE'RE LEVERAGING
THE MECHANISMS THAT WERE USED IN
THE DIFFERENT COVID, YOU KNOW,
VACCINE SPACE, THE ACTIV
PROGRAM, AS WELL AS SOME OF THE
OTHER ONES, TO RESOURCE THAT
PIECE, THE INTERVENTIONAL PIECE.
SO, YOU KNOW, THE EARLIER WE CAN
START WITH SYMPTOMATIC
TREATMENTS, OBVIOUSLY THAT WILL
START FIRST, AS WE UNDERSTAND
PATHOPHYSIOLOGY, AS I MENTIONED
IN ONE OF THE SLIDES, THEN WE
CAN START TO SELECT TARGETS TO
GO AFTER IN DIFFERENT REALMS,
WHETHER THEY BE ANTI-VIRAL,
IMMUNE MODULATOR,
ANTI-INFLAMMATORY, SO ON.
YES, WE ARE VERY MUCH LEVERAGING
THE RESOURCES THAT WERE BROUGHT
TO BEAR ON THE INITIAL COVID
PANDEMIC.
>> GREAT.
IN THE INTEREST OF TIME I THINK
WE'RE GOING TO HAVE TO MOVE TO
OUR NEXT SPEAKER, BUT AGAIN I
WANTED TO THANK DR. WRIGHT FOR
HIS VERY INFORMATIVE TALK AND
APPRECIATE YOU TAKING THE TIME
OUT AND GIVING THE UP THE ON THE
RECOVER INITIATIVE.
>> THANK YOU FOR HAVING ME.
THANK YOU VERY MUCH.
BYE-BYE.
>> ALL RIGHT.
NEXT I'D LIKE TO ASK DR. LIZ
NEESON TO INTRODUCE THE NEXT
SPEAKER.
>> IT'S MY PLEASURE TO INTRODUCE
DR. ELENA FAZIO, SOCIOLOGIST AND
PROGRAM OFFICIAL IN THE
POPULATION AND SOCIAL PROCESSES
BRANCH OF DIVISION OF BEHAVIORAL
AND SOCIAL RESEARCH AT NIA WHERE
SHE MANAGES A PORTFOLIO OF
RESEARCH ON LONG-TERM SERVICES
AND SUPPORTS FOR OLDER ADULTS,
WITH FOCUS ON DEMENTIA CARE AND
DEMENTIA CARE WORKFORCE.
IN ADDITION, DR. FAZIO PLAYS A
LEADING ROLE IN COORDINATING
ALZHEIMER'S DISEASE APROJECTS
ACROSS OUR DIVISION INCLUDING
COORDINATION OF OUR DEMENTIA
CARE SUMMITS AND SERVING AS
LIAISON TO NATIONAL ACADEMY ALSO
ON THIS NIA COMMISSION DECADAL
SURVEY, THE ROLE OF BEHAVIORAL
AND SOCIAL SCIENCES CAN PLAY IN
ADDRESSING THE CHALLENGE OF A.D.
WHICH SHE WILL BE TALKING TO US
ABOUT TODAY.
ELENA, OVER TO YOU.
>> THANK YOU SO MUCH, LIZ.
GOOD AFTERNOON, I'M ELENA FAZIO
FROM NIA DIVISION OF BEHAVIORAL
AND SOCIAL RESEARCH, BSR FOR
SHORT.
TODAY I WILL BE TALKING ABOUT
NATIONAL ACADEMIES OF SCIENCE,
ENGINEERING AND MEDICINE REPORT
REDUCING IMPACT OF DEMENTIA IN
AMERICA, DECADAL SURVEY.
NEXT SLIDE.
I WILL PROVIDE BACKGROUND ON
WHAT IS A DECADAL SURVEY AND
TURN TO REPORT RECOMMENDATIONS
COUPLED WITH RESEARCH
INITIATIVES IN PROJECT AND LOOK
TOWARD THE FUTURE.
NEXT SLIDE.
WHAT IS A DECADAL SURVEY?
A METHOD TO ENGAGE MEMBERS OF
THE RESEARCH COMMUNITY TO
IDENTIFY LINES OF RESEARCH WITH
GREATEST POTENTIAL FOR IMPACT
OVER A TEN-YEAR PERIOD IN THE
PURSUIT OF A PARTICULAR GOAL.
IT IS A SURVEY OF THE FIELD, SO
TO SPEAK.
NATIONAL ACADEMIES PIONEERED
THIS APPROACH IN 1964, HIGHLY
REGARDED BUT SPARINGLY USED.
FEWER THAN TWODOZEN SURVEYS
CONDUCTED, TEN YEAR RESEARCH
AGENDA FOR BEHAVIORAL AND SOCIAL
SCIENCE RESEARCH ON DEMENTIAS.
SO AGAIN THE GOAL IS IN FACT
THIS TEN-YEAR AGENDA.
THE WHO IS AN AD HOC COMMITTEE
AND ADVISORY PANEL.
THE PROCESS INCLUDED INFORMATION
GATHERING, REALLY CAREFUL
DELIBERATION IN THE SERVICE OF
REPORT CREATION.
COMMITTEE MEMBERS REPORT A BROAD
SET OF DISCIPLINES FROM
ECONOMICS TO BIOETHICS HEALTH
SERVICES, AND BEYOND.
THE
THE STAFF RELATED TO DECADAL
SURVEY TO ENSURE THAT
PERSPECTIVES FROM THE COMMUNITY
OF INDIVIDUALS DIRECTLY AFFECTED
BY DEMENTIA WERE INCLUDED IN THE
INFORMATION GATHERED TO ADDRESS
THE STUDY CHARGE.
THEY ALSO PROPOSED REPORT THAT
COALESCED AROUND FOUR THEMES,
INCLUDING DIFFICULTY IN
OBTAINING ACCURATE AND TIMELY
DEMENTIA DIAGNOSIS, PROBLEMS IN
OBTAINING SUPPORTS AND SERVICES,
COMMUNICATION CHALLENGES, FEAR
AND LOSS.
TWO CURRENT COUNCIL MEMBERS
PLAYED KEY ROLES IN THIS
PROCESS.
WE'D LIKE TO THANK IN PARTICULAR
CYNTHIA HUMMEL AND DAVID REUBEN.
NEXT SLIDE.
DECADAL REPORT
>> SOCIAL AS WELL AS THE V.A.
THE OFFICE OF THE ASSISTANT
SECRETARY OF PLANNING AND
EVALUATION, AARP, ALZHEIMER'S
ASSOCIATION AND THE AMERICAN
PSYCHOLOGICAL ASSOCIATION, JPB
AND THE JOHN H. HARTFORD
FOUNDATION.
WHY DID NIA INVEST IN THE
SURVEY?
ALZHEIMER'S DISEASE AND RELATED
DEMENTIA EXPANDS MANY TOPICS AND
WE FUNDED THIS WORK TO CREATE A
BROAD 10-YEAR RESEARCH AGENDA
WITH GREATEST POTENTIAL IMPACT.
THE AD HOC COMMITTEE WAS CHARGED
WITH DEVELOPING THIS AGENDA IN
THE FOLLOWING AREAS, POPULATION
EPIDEMIOLOGY, BEHAVIORAL AND
SOCIAL RISK FACTORS AND
UNDERLYING CAUSAL PATHWAYS
TOWARDS DEMENTIA, PRIMARY AND
SECONDARY DEMENTIA PREVENTION,
FINANCING AND LIVING WITH
DEMENTIA AND THE WORK FORCE AND
INTERVENTIONS WITH PEOPLE LIVING
WITH DEMENTIA AND HIGH RISK
POPULATIONS AND METHODOLOGICAL
APPROACHES.
THE COMMITTEE IDENTIFIED FIVE
PRIORITIES TO ENSURE THE
BEHAVIORAL AND SOCIAL SCIENCE
WILL HAVE A MAXIMUM IMPACT IN
REDUCING THE NEGATIVE IMPACTS OF
DEMENTIA AND THE GREATER FOCUS
ON THE LIVED EXPERIENCE OF
DEMENTIA AND DESIGNING STUDIES
WITH POTENTIAL TO RECTIFY
INEQUITIES AND DISPARITIES,
THIRD, THE NEED FOR INNOVATIVE
METHODOLOGIES AND MEASUREMENT,
FOURTH, GREATER ATTENTION TO
COST AND ECONOMIC ANALYSES AND
FIFTH, STRENGTHENING RESEARCH
INFRASTRUCTURE INCLUDING
RESOURCES.
THE EIGHT CHAPTERS OFFER
RECOMMENDATIONS FOR ADVANCING
RESEARCH ON RISK FACTORS AND
PREVENTION, IMPROVING FACTORS
AND ADDRESSING THE DIVERSE NEEDS
OF CAREGIVERS, ENHANCING OUR
INFORMATION OF HOW COMMUNITY
RESOURCES CAN BE MOBILIZED,
IMPROVING MODELS OF CARE ACROSS
THE WHOLE DISEASE DISEASE
CONTINUUM, GETTING ON THE HANDLE
OF COSTS AND STUDY FINANCIAL
INCENTIVES AND FINALLY PROMOTING
RIGOR AND MEASUREMENT OF
ENVIRONMENTAL AND SOCIAL
EXPOSURES AND COGNITIVE
OUTCOMES.
SEVERAL RESEARCH PRIORITIES ARE
ALIGNED WITH THE SRs
INITIATIVES.
THIS MEANS OUR SCAN OF
LITERATURE AND OTHER EXPERT
INPUTS ARE ALIGNED IN TERMS OF
FUTURE PRIORITIES.
THE REPORT PROVIDES 150
RECOMMENDATIONS.
WILL NOT TEAMED TO COVER THEM
ALL SINCE THEY'RE BROAD AND
DEEP.
I'LL HIGHLIGHT A FEW EXAMPLES.
RESEARCH TOPICS WERE SIGNIFICANT
PROGRESS HAS BEEN MADE, RESEARCH
AREAS THAT ARE AND THOSE TOPICS
THAT CAN CATEGORIZED AS EARLY
STAGES AND I'LL DISCUSS PROGRESS
MADE AND RESEARCH OPPORTUNITIES
THAT SPEAK TO AND ADD TO THE
10-YEAR RESEARCH AGENDA.
FIRST THE COMMITTEE IDENTIFIED
CAUSAL AFFECTS OF SOCIAL FACTORS
OF HEALTH RELATED BEHAVIORALS AS
A KEY RECOMMENDATIONATION AREA.
THIS CAN MEAN MANY THINGS
INCLUDING HOW SOCIAL FACTORS
MIGHT IMPACT THE INCIDENTS AND
RATE OF PROGRESSION OF DEMENTIA
AND HEALTH RELATED BEHAVIORS AND
THEIR MANAGEMENT OVER THE LIFE
COURSE.
IN ADDITION, MODIFIABLE DRIVERS
OF RACIAL AND ETHNIC INEQUITY
AND OTHER DIMENSIONS OF
INEQUALITY AND THERE'S AN RFA ON
THE RELATIONSHIP BETWEEN
EDUCATION AND COGNITION AND THE
HIGH SCHOOL AND BEYOND RESOURCES
AND A NEW CENTER ON EMOTIONAL
WELL BEING AND BRAIN AGING.
AS PREVIOUSLY MENTIONED, IT'S AN
NIA SUPPORTED DATA SOURCE AND
HAS RICH EARLY LIFE COURSE
MEASURES, DATA FOR SOME
PARTICIPANTS STARTS AS EARLY AS
AS ADOLESCENCE AND HAS A DIVERSE
SAMPLE.
EDUCATIONAL EXPERIENCES OF AAD
HEALTH MEMBERS AND THE SCHOOLS
THEY ATTENDED ARE INCLUDED FOR
SOME INCLUDING ALL THE WAY TO
MIDDLE SCHOOL AND GRADES
RECEIVED, WHAT CLASSES PEOPLE
TOOK AND WHAT THEIR SCHOOLS
LOOKED LIKE.
IT SUPPORTED UNIVERSITY OF
VERMONT FOR RISK.
THE COMMITTEE SUGGESTS SEVERAL
AREAS FOR EXPLORATION AND
MODIFIABLE DRIVERS OF RACIAL AND
ETHNIC IN EQUALITY AND
IDENTIFYING RISK FACTORS THAT
CAN BE THE BASIS FOR PRECISE
RECOMMENDATIONS FOR INDIVIDUALS
ABOUT DECISION MAKING AND
POPULATION LEVEL POLICIES TO
PROMOTE BRAIN HEALTH AND
CONDUCTING LONGITUDINAL HEALTH
AND CHANGE AND DEMENTIA OUTCOMES
IS ALSO NEEDED.
THE REPORT S ADVANCED IN DATA
COLLECTION AND RESEARCH
METHODOLOGY ARE NEEDED TO
SUPPORT PROGRESS IN VIRTUALLY
EVERY DOMAIN.
NIH'S DIVISION OF BEHAVIORAL AND
SOCIAL SCIENCES INVESTED IN THIS
TYPE OF DATA INFRASTRUCTURE WITH
EMPHASIS ON SEVERAL FLAGSHIP
STUDIES LIKE THE HEALTH AND
RETIREMENT STUDY AS WELL AS
SUPPORT FOR TECHNOLOGY FOCUSSED
RESEARCH AND INFRASTRUCTURE.
IT'S A LONGITUDINAL PANEL STUDY
THAT SURVEYS A REPRESENTATIVE
SAMPLE OF APPROXIMATELY 20,000
PEOPLE IN AMERICA 50 YEARS AND
OLDER.
IT PROVIDES AN INVALUABLE BODY
OF RESEARCH DATA RESEARCHERS CAN
USE TO ADDRESS IMPORTANT
QUESTION THE CHALLENGES AND
OPPORTUNITIES OF AGING.
THIS MAP YOU SEE ON THE SCREEN
ILLUSTRATE THE VARIOUS PLACES
AROUND THE WORLD INTERNATIONAL
STUDIES ARE CONDUCTED INCLUDING
LOW AND MIDDLE INCOME COUNTRIES
LIKE CHINA, MEXICO AND INDIA AND
THIS CAN HELP INFORM THE
U.S. AND BEYOND AND THE PROTOCOL
IS AN ONGOING INTERNATIONAL
MEASURE TO UNDERSTAND DEMENTIA
RISK WITHIN LONGITUDINAL STUDIES
AROUND THE WORLD TO FACILITATE
ACROSS NATIONAL COMPARISONS.
IT'S ASSOCIATED WITH A GROWING
NUMBER OF HRS SISTER STUDIES AND
WILL CONTINUE TO ADDRESS A
NUMBER OF THE TODAY REPORT
RECOMMENDS.
AS EXPRESSED BY THE COMMITTEE
INCLUDES TOUGHERSES FOR NEW AND
INNOVATIVE SOURCES AND NEW DATA
SETS AND THE EVALUATION OF
BIASES AND SELECTION OF
PARTICIPANTS AND BIASES AND
MEASUREMENT DEVELOPMENT.
THE TOPIC OF INCLUSIVE RESEARCH
PARTICIPATION CAN SPEAK TO THE
INCLUSION OF THOSE WITH AND
WITHOUT COGNITIVE IMPAIRMENT AND
DIVERSITY OF PARTICIPANTS BY
RACE, GENDER AND GEOGRAPHY AND
BEYOND.
TURNING TO ANOTHER AREA WE NODE
THE DIVISION OF BEHAVIORAL
RESEARCH FOCUSSED ON
NON-PHARMACOLOGICAL APPROACHES
TO PREVENTION MUCH AD/ADRD AND
ADDRESSED THE DIFFERENT ASPECT
OF INTERVENTION AND DEVELOPMENT.
A FEW TAKEAWAYS FROM THE
WORKSHOP INCLUDE THE NEED TO
IDENTIFY BIOMARKERS THAT WOULD
SHOW EARLY EVIDENCE OF DISEASE
MODIFICATION AND THE IMPORTANCE
OF MEASURING COGNITIVE OUTCOMES
USING METHODS WITH LARGE SCALE
TRIALS OF DIVERSE POPULATIONS,
NEED TO DESIGN THE MOST
INFORMATIVE TRIALS AND THE NEED
TO GENERATE CAUSAL EVIDENCE FROM
OBSERVAL STUDIES TO NEAR
RANDOMIZED CONTROL STUDY OR
RCTs.
RESEARCH OPPORTUNITIES INCLUDE
INTERVENTIONS TO MODIFY RISK
FACTORS TO REDUCE INCIDENTS MUCH
DEMENTIA AND ASSESS HOW
INTERVENTIONS DELAY OR PREVENT
DEMENTIA MAY HAVE EFFECTS ON
HEALTH AND HEALTH CARE
DISPARITIES.
THE COMMITTEE IDENTIFIED NEEDS
RELATED TO TO DISCLOSURE OF
DIAGNOSTIC INFORMATION AND THE
USE OF BIESHL
BIOMARKERS AND THE IN THECATIONS
THECATION -- THE INDICATIONS FOR
PEOPLE SHOWING BIOMARKERS AND
USE DIAGNOSTIC TOOLS AND
APPROACHES AND QUALITATIVE
RESEARCH ON THE IMPACT OF
PERSONS RECEIVING A DEMENTIA
DIAGNOSES AND UNDER SCORE THE
DIGNITY WITH THE PEOPLE WITH
DEMENTIA.
NOTABLE PROGRESS INCLUDES THE
NIH MOBILE TOOLBOX AND MOBILE
MONITORING FOR COGNITIVE CHANGE,
ADVANCES IN COGNITIVE SCREENING
TOOLS IN ELECTRONIC HEALTH
RECORDS AND PRE-CLINICAL OR
PRE-SYMPTOMATIC CHANGES THAT MAY
POINT TO FUTURE DIAGNOSIS.
THE WORKSHOP SHOWED A
PRECLINICAL APPROACH TO AD
DIAGNOSES AND CAN WE AFFORD THE
COST OF AD/ADRD DIAGNOSTIC
APPROACHES IF WHEN THEY ENTER
CLINICAL PRACTICE AND HOW
PRE-CLINICAL DIAGNOSTIC
INFORMATION SHOULD BE DISCLOSED
TO STAKEHOLDERS?
KEY WORKSHOP TAKEAWAYS INCLUDE
MOST THE DATA ON RISK OF DECLINE
AND MARKER EXPOSURE IS ACQUIRED
IN NON-REPRESENTED POPULATIONS
PRIMARILY IN HIGHLY EDUCATED
PEOPLE WILLING TO UNDER GO
TESTING IN ACADEMIC CENTERS AND
THERE'S LET DATA AVAILABLE IN
DIVERSE POPULATIONS IN TERMS OF
RACE AND EDGE NICHT.
-- ETHNICITY.
THERE'S THE DIFFERENCE SCREEN
APPROACHES AND RESEARCH ON WHOM
AND WHEN TO SCREEN AND IMPROVED
ACCURACY AND SCREENING
APPROACHES ACROSS POPULATIONS
AND COORDINATION OF RESOURCES
FOR PATIENTS ONCE DIAGNOSED.
THERE'S ALSO A NEED FOR THE
REPORT FOR RESEARCH ON THE
EVALUATION OF DEMENTIA EDUCATION
PROGRAMS FOR HEALTH CARE
PROVIDERS.
IN THE REPORTS CHAPTER FOR END
OF LIFE CARE AND THOSE LIVING
WITH DEMENTIA THERE'S A
DISCUSSION HOW THOSE LIVING BIG
DEMENTIA AND EMPHASIS ON THOSE
RECEIVING CARE END OF LIFE.
THE NATIONAL INSTITUTE OF AGING
ON BEHAVIORAL AND SOCIAL SCIENCE
FUNDS A CENTER ON PALLIATIVE
CARE IN DEMENTIA.
IT PROVIDES RESEARCH
INFRASTRUCTURE AND DEVELOPS
TESTS AND IMPLEMENT PALLIATIVE
CARE INTERVENTIONS FOR THOSE
WITH DEMENTIA AND CAREGIVERS
USING ECONOMICS AND DATA SCIENCE
STRATEGY.
ANOTHER INFRASTRUCTURE PROJECT
FUNDED BY THE DIVISION OF
GERIATRICS AND GERONTOLOGY ARE
THE INDEPENDENCE CENTER THE ONE
AT THE SCHOOL OF MEDICINE AT
MOUNT SINAI WHICH CONDUCTS
RESEARCH ON PALLIATIVE CARE.
MORE RESEARCH IS NEEDED.
END OF LIFE RESEARCH
RECOMMENDATIONS FROM THE REPORT
INCLUDE THE NEED FOR STUDIES OF
THE IMPACT OF ADVANCED CARE
PLANNING AT ALL STAGES OF
DEMENTIA AND ASSESSMENT OF
PREFERENCES.
THE NEED FOR RESEARCH ON THE
EFFECTS OF DIFFERENT TYPES OF
DEMENTIA CARE PROGRAMS AND THE
TIMING OF HOSPICE REFERRALS AND
THE EVALUATION OF THE
FEASIBILITY FOR FAMILIES
FOREGOING AGGRESSIVE PROCEDURES.
THE NEXT RECOMMENDATION FOCUSES
ON PLATFORMS TO FACILITATE THE
FIELDING OF PRAGMATIC AND HEALTH
CARE SYSTEMS.
AND THESE ARE DESIGNED TO
EVALUATE WHETHER AN INTERVENTION
CAN IMPROVE HEALTH OUTCOMES
UNDER IDEAL HIGHLY CONTROLLED
CONDITIONS.
IN CONTRAST PRAGMATIC CLINICAL
TRIALS ARE EMBEDDED IN
FUNCTIONING HEALTH CARE SYSTEMS
AND DESIGNED TO EVALUATE THE
EFFECTIVENESS OF REAL WORLD
CONDITIONS.
THE IMPACT IS TO CONDUCT
PRAGMATIC TRIALS OF
INTERVENTIONS FOR THOSE LIVING
WITH DEMENTIA AND CARE PARTNERS.
THE IMPACT COLLABORATORY HAS A
NEW FUNCTIONING PILOT PROGRAM.
A COUPLE EXAMPLES OF RECENTLY
FUNDED PILOTS INCLUDE ONE
WORKING TO IMPROVE ALZHEIMER'S
AND RELATED DEMENTIA CARE
MANAGEMENT ACROSS IN THE
DISCIPLINARY TEAMS AND A SECOND
THAT FOCUSES ON DESIGNING MOBILE
APPS TO HELP ADULT DAY SERVICE
CENTERS PREVENT MINOR HEALTH
ISSUES FROM ESCALATING.
THE COLLABORATORY MADE GREAT
STRIDES BUT MORE OPPORTUNITIES
ARE AVAILABLE.
THE RECOMMENDATIONS IN THIS AREA
INCLUDE A FOCUS ON THE
EFFECTIVENESS OF PATIENT AND
CAREGIVER SUPPORT AND MANAGEMENT
SYSTEMS EMBEDDED IN HEALTH CARE
SYMPTOMS AND SYSTEM CAPACITY FOR
MULTI-FACETED INTERVENTIONS AND
THE NEXT ARE RECOMMENDATIONS IN
THE EARLY STAGES OF SCIENTIFIC
DEVELOPMENT.
FIRST AREA IS APPROACHES FOR
INTEGRATING AND COORDINATING
CARE.
IDENTIFICATION OF THE EFFECTIVE
APPROACHES FOR INTEGRATING CARE
SERVICES ACROSS HEALTH CARE
DELIVERY AND COMMUNITY-BASED
ORGANIZATIONS.
A SIMILAR TOPIC IS CAPTURED BY
APP RESEARCH IMPLEMENTATION
MILESTONE MANY ARE FAMILIAR WITH
THE RESEARCH IMPLEMENTATION
MILESTONES ON THE INTEGRATION OF
LONG-TERM SERVICES AND SUPPORTS,
HOME BASED CARE AND MEDICAL CARE
WITH PARTICULAR ATTENTION PAID
TO CARE TRANSITIONS.
RESEARCH OPPORTUNITIES IN THIS
AREA INCLUDE THE NEED TO DEVELOP
AND EVALUATE COMPREHENSIVE CARE
MODELS THAT EXPAND HEALTH CARE
AND COMMUNITY-BASED
ORGANIZATIONS AND STUDY
EVIDENCE-BASED MODELS OF
DEMENTIA CARE IN RURAL AREAS IN
DEMOGRAPHICALLY DIVERSE AREAS.
PER THE REPORT, MANY GROUPS ARE
DEVELOPING INITIATIVES THAT FALL
UNDER THE UMBRELLA OF DEMENTIA
FRIENDLY COMMUNITIES AND FOCUS
ON ASSETS THEY BRING AND WAYS OF
ENGAGING CAREGIVERS IN CARE AND
OTHER ISSUES.
THEY GENERALLY OFFER EDUCATION
AND TRAINING FOR MEMBERS OF THE
COMMUNITY AND ALSO INCLUDE
RESPITE CARE AND OTHER SERVICES.
RESEARCH OPPORTUNITIES IN THIS
AREA INCLUDE DEVELOPING MEASURES
FOR COMMUNITY-LEVEL OUTCOMES,
GENERATING RESEARCH-BASED MODELS
FOR COLLABORATION AMONG
ORGANIZATIONS AND RESOURCES,
EVALUATING INNOVATIVE HOUSING
ARRANGEMENTS AND MODELLING
APPROACHES ON HOW COMMUNITY
FACTORS WITHIN A SYSTEM TO
IMPLEMENT DEMENTIA RISK AND THE
LIVED EXPERIENCE OF DEMENTIA.
FINANCING STRUCTURES IS ANOTHER
EARLY STAGE RECOMMENDATION.
DEVELOPMENT AND TESTING
APPROACHES TO INTEGRATIVE
FINANCIAL AND SOCIAL SERVICES IS
KEY TO PURSUE.
A NEW AD RESEARCH MILESTONE 13P
IS IN ALIGN WITH THIS
RECOMMENDATION ACCORDING TO THE
COMMITTEE HERE INCLUDE STUDIES
OF HOW MEDICARE ADVANTAGE PLANS
AND ALTERNATIVE PAYMENT MODELS
BEST PROVIDE INCENTIVES TO
IMPLEMENT ACTIVE CARE AND
LOOKING AT THE EFFECTS OF
CHANGES OR DIFFERENCES IN
MEDICAID PAYMENT MODELS ON THE
QUALITY OF NURSING HOME AND
COMMUNITY-BASED SERVICES FOR
THOSE LIVING WITH DEMENTIA.
A FINANCIAL EARLIER STAGE
RECOMMENDATION IS TO FURTHER
ADDRESS THE CHALLENGE OF
MEASURING EXPOSURES AND
COGNITIVE OUTCOMES FOR THOSE
LIVING WITH DEMENTIA.
IT'S MER -- MORE RESILIENT AS
GROUPS ARE INCLUDED IN RESEARCH
AND SELECTION AND RELEVANT
EXPOSURES FOR IMPROVEMENT OF
QUALITY OF LIFE FOR THOSE LIVING
WITH DEMENTIA AND CAREGIVERS ARE
SIMILAR IMPORTANT AND EVOLVING.
SOCIAL AND BEHAVIORAL
RESEARCHERS WILL NEED TO BE
FULLY ENGAGED TO CHALLENGE
NARROW CONCEPTUALIZATIONS AND
RELEVANT RISK FACTORS AND
CONSIDER THE IMPLICATIONS OF
ALTERNATIVE MEASUREMENT
APPROACH.
THE CHALLENGES OF AMERICA FAMILY
CENTERED OUTCOMES IN DEMENTIA
RESEARCH IS RELEVANT TO NEARLY
EVERY TOPIC IN THE REPORT.
RESEARCH OPPORTUNITIES IN THIS
AREA INCLUDE THE DEVELOPMENT OF
STANDARDIZED DEFINITIONS AND
TOOLS FOR IDENTIFYING DEMENTIA
AND CAPTURING STAGES OF DISEASE.
IMPROVING MEASUREMENT VALIDITY,
DEVELOPING SCHOOLS TO SUPPORT
CROSSWALKS FROM SPECIMENS FROM
DIFFERENT MODALITIES AND
MEASUREMENTS FOR DIVERSE
POPULATIONS INCLUDING
HETEROGENEOUS SETTINGS AND
LINGUISTIC BACKGROUNDS.
THE RECOMMENDATIONS AND THE
SUBJECT PROVIDE AN IMPORTANT
PATH FORWARD AND INASMUCH AS THE
PROGRAMS IN AD/SCIENCE AND WE
THANK ALL THOSE WHO CONTRIBUTED
TO THIS REPORT LAYING OUT A RICH
AND ACTIONABLE 10-YEAR AGENDA.
WE HOPE THE RECOMMENDATIONS WILL
BE TAKEN UP BY THE FIELD ACROSS
MANY DISCIPLINES AND ORGANIZERS
WITHIN AND BEYOND NIH.
VISIT OUR WEB PAGES ON AD
RESEARCH AND KWON ME MAKT ME OR
OTHER STAFF AND CONTACT US.
>> THANK YOU FOR THE OVERVIEW OF
THE PUBLICATION AND IT'S
IMPLEMENTATION BY NIA.
DO WE HAVE QUESTIONS FOR ELENA?
>> THAT WAS TERRIFIC AND WHAT A
RICH AGENDA.
REALLY IMPRESSIVE.
I HAVE TWO QUESTIONS.
ONE, ON YOUR END DO YOU HAVE TO
ASSESS THE ETHICS REVEALING
PEOPLE'S TEST RESULTS AND I WAS
WONDERING HOW THOSE DECISIONS
GET MADE AND WHO MAKES THOSE
DECISIONS ABOUT THE ETHICS OF
THAT AND ON THE SECOND QUESTION,
WE TALKED ABOUT MEASURES AND
COMMUNITY LEVEL OUTCOMES AND
WONDERED IF YOU CAN GIVE
EXAMPLES OF THAT.
>> THE FIRST QUESTION, I THINK
THIS IS BEST SUITED FOR OUR
INVESTIGATORS PREPARING FOR AND
PROPOSING THEIR STUDIES.
THIS IS A TREMENDOUSLY IMPORTANT
TOPIC.
WE DON'T HAVE -- I DON'T HAVE
THE ANSWER TO YOUR QUESTION
DIRECTLY IN TERMS OF HOW WE
WOULD DEAL WITH THE ETHICAL
CONSIDERATIONS BUT IT IS
SOMETHING THAT WE WHERE
INTERESTED IN STUDY AND THE
WORKSHOP ON PRE-SYMPTOMATIC
DIAGNOSIS DEALT WITH ETHICAL
QUESTIONS BEFO S BROADLY AND THAT DID
TOPIC COME UP AND I'D LIKE TO
DISCUSS WHAT WAS DISCUSSED
AROUND ETHICS BUT I DON'T HAVE A
SPECIFIC ANSWER OTHER THAN TO
SAY WE'RE INTERESTED IN THAT
TOPIC AND IT DID COME UP IN THE
WORKSHOP AND THIS MAY HAVE
SOMETHING TO ADD TO THAT AS
WELL.
>> ON THAT POINT, I THINK PART
OF THE STIMULUS FOR THE WORKSHOP
THE MORE TARGETED WORKSHOP WAS
THE TENSION THAT ARISES BETWEEN
THE DESIRE TO GET EVIDENCE OF
EARLIER FUNCTIONAL OR
PSYCHOLOGICAL CHANGES OR EARLY
BIOLOGICAL CHANGES FOR RESEARCH
PURPOSES AND POTENTIALLY FOR
DIAGNOSTIC PURPOSES IN CLINICAL
CONTEXT AND THE QUESTION OF WHAT
ARE THE IMPLICATION FOR RESEARCH
PARTICIPANTS OR PATIENTS THANE
CASE.
WE'RE ALL INTERESTED IN MOVING
EARLIER TO POTENTIALLY OFFER
BENEFIT BUT THE DECISION FOR
WHETHER ONE REVEALS THAT IS
DIFFERENT FROM THE DECISION IN A
CLINICAL CONTEXT WHERE I THINK
THE MEDICAL COMMUNITY ENDS UP
COMING UP WITH RECOMMENDATIONS
THERE.
SO WE WERE GRAPPLING WITH THE
ISSUE OPPOSED TO COMING UP WITH
AN ANSWER FOR IT, IF YOU WILL.
>> AROUND ANN, TO YOUR SECOND
QUESTION IF I HEARD YOU
CORRECTLY I THINK I WERE
INTERESTED IN COMMUNITY-LEVEL
OUTCOMES.
THERE'S MANY WAYS TO APPROACH
THIS.
ONE WAY THAT COMES TO MIND IS
WHEN I THINK OF ACCESS TO
SERVICES AS THE COMMUNITY LEVEL.
THE AVAILABILITY OF SERVICES AND
HOW WE WHO GETS THEM AND WHO
DOESN'T.
HOW WELL YOUR COMMUNITY ALLOWS
YOU ACCESS AND YOU AND QUALITY
OF VERY DIFFERENT SERVICES
DEPENDING ON THE NEEDS OF THE
PERSON WITH DEMENTIA AND
CAREGIVER.
THERE'S OTHER INFRASTRUCTURE
OUTCOMES TO THINK ABOUT AS MENG
FROM THE REPORT AND THE DEMENTIA
FRIENDLY COMMUNITIES BRINGS TO
MIND QUESTIONS HOW THE BROADER
COMMUNITY IS AVAILABLE TO HELP
WITH NOT ONLY SERVICE PROVISION
BUT THE PHYSICAL ENVIRONMENT FOR
THOSE WITH DEMENTIA.
THOSE ARE TWO EXAMPLES THAT COME
TO MIND.
>> THANK YOU, ELENA.
ANY OTHER QUESTIONS?
>> THAT WAS A FANTASTIC
PRESENTATION.
THERE'S A STRUCTURAL DETERMINATE
OF HEALTH IN GENERAL AND VERY
IMPORTANT FOR PEOPLE LIVING WITH
DEMENTIA.
I THINK IT HAS AN IMPACT ON
DETECTION AS WELL THE
COMMUNITIES PEOPLE ARE LIVING
IN.
THE KIND OF INFRASTRUCTURE THAT
THEY HAVE IN THEIR HOME.
SO HOW WOULD YOU -- GIVEN WHAT
YOU KNOW ABOUT WHAT GRANTEES ARE
DOING OR WHAT THE VSRs DOING,
WHAT ARE THE NEXT STEPS FOR
ADDRESSING HOUSING AS IT'S A BIG
TOPIC AND SOMETHING THAT OFTEN
TIMES, I'M AT COLOMBIA
UNIVERSITY, WHAT INDIVIDUAL
INVESTIGATORS CAN DO TO CHANGE
THE HOUSING CONDITIONS.
>> GREAT QUESTION, JENNIFER.
FROM MY PERSPECTIVE WHEN WE TALK
ABOUT HOUSING WE MEAN MANY
THINGS AND ISSUES WITH HOUSING
STOCK AND DISPARITIES AND
AVAILABILITY OF NOT ONLY QUALITY
BUT FINANCIALLY VIABLE HOUSING.
THERE'S THE FINANCIAL
PERSPECTIVE WHICH WE KNOW PLAYS
A ROLE IN HEALTH AND HEALTH CARE
AS WELL.
THERE'S A LOT OF INTERCONNECTION
BUT THE HOUSING PART COULD BE
ABOUT FINANCING AND STOCK AND
THE TYPE OF HOUSING FOR OLDER
ADULTS AND PERSONS LIVING WITH
DEMENTIA THEY MAY NEED CERTAIN
TYPES OF SUPPORTIVE SERVICES
CONSIDERED UNDER THE HOUSING
UMBRELLA, IF YOU WILL.
THERE'S MANY WAYS TO THINK OF
HOUSING.
TO YOUR POINT IN TERMS OF NEXT
STEPS, I THINK THERE'S WAYS TO
ADDRESS THIS PERHAPS UNDER THE
RECOMMENDATION OF DEMENTIA
FRIENDLY COMMUNITIES THINKING OF
THE PHYSICAL ENVIRONMENT AND THE
EXPERIENCE OF LIVING IN
SOMEBODY'S OWN HOME.
I KNOW SOME OF OUR INVESTIGATORS
LOOK INTO THOSE WHO LIVE ALONE
SO THEY'RE HOME ENVIRONMENT IS
VERY DIFFERENT THAN OTHERS AND I
THINK THAT CONTINUES TO BE A
CONCERN IN TERMS OF NOT ONLY THE
PROVISION OF SERVICES BUT THE
THAT WE'RE ABLE TO CONDUCT WITH
AND ON THOSE LIVING ALONE WITH
DEMENTIA IN THEIR HOME AND
THERE'S A MEETING THAT TALKED
ABOUT ENVIRONMENTAL FACTORS IN
HOUSING.
YOU MAY HAVE BEEN A PART OF THAT
DISCUSSION.
THERE'S A LOT OF THERE AND I
WOULD SAY VSR IS POISED TO THINK
ABOUT HOUSING IN A NUMBER OF
DIFFERENT CONTEXTS INCLUDING THE
ONES I'VE MENTIONED.
>> GREAT, THANK YOU.
AND THANK YOU AGAIN FOR YOUR
PRESENTATION TODAY.
I THINK WE'RE GOING MOVE ON THEN
TO OUR NEXT SPEAKER.
I'D LIKE TO INVITE RON COHANSKI
TO INTRODUCE OUR NEXT SPEAKER.
>> I THINK WE SWITCHED IT UP ON
YOU A LITTLE BIT.
HI, EVERYBODY.
I'M CANDACE KERR A PROGRAM
OFFICER IN THE DIVISION OF AGING
BIOLOGY AND PLEASED TO ANNOUNCE
DR. WEN WALSH IS A LOCKHART
McGUIRE PROFESSOR AT THE
UNIVERSITY OF VIRGINIA HIS
RESEARCH IS IMPACTING THE AGE OF
CARDIOVASCULAR BIOLOGY AND LOOK
AT INTERTISSUE COMMUNICATION TO
UNDERSTAND BETTER THE INTEGRATED
PHYSIOLOGICAL REASONS TO IMPACT
AGING AND HE'S RECEIVED NUMEROUS
AND AWARDS FROM NHLBI AND THE
COUNSEL OF ARTERIOSCLEROSIS THAT
NAMED HIM AS THE AMERICAN HEART
ASSOCIATION DISTINGUISHED
SCIENTIST MANY YEARS AGO.
WHAT BETTER WAY TO STUDY THE
INTEGRATIVE THE PATHOPHYSIOLOGY
OF AGING AND THIS IS
INVESTIGATING HEMATOPOIESIS AND
WE LOOK FORWARD TO HEARING MORE
ABOUT THIS TODAY.
I'M GOING TO TELL YOU ABOUT
CLONAL HEMATO-POESE -- HEMATO
HEMATOPOIES
HEMATOPOIESIS.
I'LL START WITH A TEXTBOOK
DEFINITION.
IT'S A CONDITION IN WHICH A
SUBSTANTIAL PROPORTION OF MATURE
BLOOD CELLS ARE DEVISED FROM A
SINGLE HEMATOPOIETIC STEM CELL
AND THERE WAS AN EMERGING VIEW
IT'S THOUGHT TO BE A CAUSAL RICK
FACTOR FOR CARDIOVASCULAR AS
PREVALENT FOR THE RISK FACTORS
STUDIED FOR RISK FACTORS AND THE
THINGS THE PRIMARY CARE
PHYSICIAN TELLS YOU ABOUT, HYPER
CHOLESTEROL, DIABETES, SMOKING
AND YOUR FAMILY HISTORY.
YOUR INHERITANCE.
ADVANCED AGE IS THE GREATEST
CARDIOVASCULAR DISEASE FACTOR
AND ADVANCED STAGE IS A RISK
FACTOR FOR MANY DISEASES,
CANCER, ARTHRITIS, ALZHEIMER'S
DISEASE AND OTHERS.
THE ASPECT OF AGING THAT HAS ME
PARTICULARLY INTERESTED IN THE
LAST FIVE OR SIX YEARS IS
REFERRED TO AS SOMATIC MOAISISM
IN DEVELOPS.
IT'S ESTIMATED FROM ULTRA DREAM
SEQUENCING THAT PROBABLY BY AGE
50 EVERY CELL IN OUR BODY
ARETIRED BETWEEN 1,000 AND
10,000 SOMATIC MUTATIONS.
AND THE THING I WANT TO POINT
OUT IS THAT BECAUSE CELLS ARE IN
CONSTANT COMPETITION WITH ONE
ANOTHER, IT CAN GIVE RISE TO
CLONAL EVENTS.
THEY EXIST AS A PASSENGER AND
SOMETIMES IT HITS AN ESSENTIAL
GENE AND THE CELL WILL BE LOST
BUT THEY HAPPEN IN GENES THAT
ARE CALLED DRIVER GENES THAT
GIVE THE SELECTIVE TO THE CELL
AND THERE'LL BE A CLONAL
EXPANSION AND WHAT WE'VE COME TO
RECOGNIZE THROUGH MANY STUDIES
AS WE AGE, WE BASICALLY BECOME A
MOSAIC OF PATCH WORK OF THOUSAND
OF CLONES IN MULTIPLE TISSUES.
THIS IS SORT OF LISTED HERE.
THESE ARE JUST SOME OF THE
RECENT CELL NATURE SCIENCE
PAPERS ON SOMATIC MOSAICIC IN
COL
COLON, BLOOD, ENDOMETRIUM AND
BLOOD.
AND FIRST OF ALL I WOULD SAY
CLONAL HEMATOPOIESIS IF YOU
THINK ABOUT IT THE WHITE CELLS
ARE MULTI-TASKERS AND TRAVEL
THROUGHOUT THE BODY AND
COMMUNICATE AND ELIMINATE
DAMAGED CELLS AND ENABLE US TO
COPE WITH THE ENVIRONMENTAL
STRESS AND WHEN THEY GET OUT OF
CONTROL THEY PARTICIPATE IN
MULTIPLE CHRONIC DISEASES SUCH
AS CARDIOVASCULAR DISEASE.
THERE'S BEEN PAPERS ASSOCIATED
MUTANT BLOOD CELLS OR MUTATIONS
WITH AGING AND IN PAPER THEY
ABLATED A DNA REPAIR PROTEIN IN
THE HEMATOPOIETIC CELLS AND THE
ANIMALS DISPLAYED PREMATURE
SENESCENCE AND IMPACTING SUCH
THE SYSTEM AFFECT THE HEART,
KIDNEYS, BRAIN, METABOLIC
SYSTEM, ALL SYSTEMS.
LED TO SYSTEMIC TISSUE DAMAGE
AND DECREASE IN LIFE SPAN.
THE OTHER ISSUE I WANT TO POINT
OUT ABOUT THE HEMATOPOIETIC
SYSTEM IS UNDER SELECTIVE
PRESSURES.
BLOOD CELLS ARE TINY AND GET
TURNED OVER RAPIDLY.
THEY'RE LIFE SPANS ARE ON THE
ORDER OF 3 TO 120 DAYS AND
REPRESENTED 90% OF THE CELLULAR
TURNOVER IN THE BODY 370 MILLION
CELLS A DAY AND FAT AND MUSCLE
HAVE LIFE SPANS BETWEEN 12 AND
50 YEARS.
IF THEY GET MUTATED BY A DRIVER
GENE, THEY ACQUIRE A MUTATED
DRIVER GENE THEY WON'T HAVE THE
ABILITY TO UNDER GO THE CLONAL
EXPANSION LIKE WHAT WE SEE IN
THE HEMATOPOIETIC SYSTEM.
TO MAKE THIS BITE SIZED THIS IS
MY RESEARCH.
WITHIN THE HEMATOPOIETIC SYSTEM
OCCASIONALLY ONE OF THESE
MUTATIONS WILL HAPPEN IN A
DRIVER GENE THAT HAS A CLONAL
EXPANSION AND IT'S A TWO-STAGE
PROCESS AND THE CELLS GIVE RISE
TO LEUKOCYTES THAT HAVE BEEN
GENETICALLY CORRUPTED BECAUSE
THEY ALSO HARBOR THE SAME DRIVER
GENE MUTATION AND THAT COULD
IMPACT THEIR PHENOTYPE AND
THEREBY IMPACT PROCESSES AND
IT'S RELATIVELY EASY TO DETECT
THIS.
YOU BASICALLY DO DEEP SEQUENCING
OF THE MUTANT ALLELE.
THERE'S AN EASE OF SAMPLE
COLLECTION AND WE HAVE ACCESS TO
MANY BIOBANKS.
WHAT ARE SOME OF THE MUTATIONS
THAT GIVE RISE TO CLONAL
HEMATOPOIESIS?
THERE'S A WHOLE SPECTRUM.
WHAT WE MOSTLY FOCUS ON THE CHIP
DRIV
GENES AND THESE ARE DRIVER
GENES.
SOME OF THESE ARE RECURRENTLY
MUTATED IN BLOOD CANCER.
IT MAKES SENSE THEY WOULD BE A
DRIVER GENE.
HOWEVER, YOU CAN HAVE MOSAIC
CHROMOSOMAL ALTERATIONS WHERE
YOU HAVE LOGS OF HETEROZYGOSITY
AND WHAT HAPPENED WHAT LED TO
THIS RESURGENT INTEREST IN THIS
FIELD IS THAT THERE WERE TWO
PAPERS PUBLISHED BACK TO BACK IN
2014 IN THE NEW ENGLAND JOURNAL
OF MEDICINE AND BASICALLY SHOWED
CLONAL HEMATOPOIESIS WAS
PROBABLY MORE PREVALENT THAN WE
PREVIOUSLY UNDERSTOOD.
IN A PAPER THERE WAS A CLEAR
INCREASE WITH AGE, THE ABILITY
FOR THEM TO DETECT CLONAL
HEMATOPOIESIS AND WERE USING
RELATIVELY INCENSENSITIVE METHODS
BACK THEN AND BUT WHEN
INDIVIDUALS REACHED 70, 10%
EXHIBITED CLONAL HEMATOPOIESIS
AND IT INCREASED GREATER FROM
THERE.
THE THING THAT CAUGHT
EVERYBODY'S ATTENTION AT THE
TIME WAS IT WAS FOUND THAT
INDIVIDUALS THAT HAD CLONAL
HEMATOPOIESIS HAD AN INCREASE IN
MORTALITY.
THERE WAS ABOUT A 40% IN
MORTALITY ON THE FOLLOW-UP
PERIOD ON BOTH STUDIES.
THE QUESTION BECAME, WHAT IS
THIS MORTALITY ASSOCIATED WITH
AND YOU WOULD THINK WELL,
HEMATOLOGIC CANCER PROBABLY
BECAUSE WE'RE LOOKING AT THE
FIRST STEP IN A LONG PATH
DEVELOPING A BLOOD CANCER.
HOWEVER, THE ISSUE HERE IS THAT
BLOOD CANCERS RELATIVELY
SPEAKING ARE KIND OF RARE IN THE
POPULATION AND REALLY CANNOT
REALLY ACCOUNT FOR THE BIG
INCREASE IN MORTALITY OBSERVED
IN THE STUDY.
IT TURNED OUT THE FIRST CLUES
WERE PROVIDED IN THE
SUPPLEMENTARY DATA SECTION OF
THE PAPER.
THERE WAS A SECONDARY ANALYSIS
AND BASICALLY FOUND THAT CLONAL
HEMATOPOIESIS WAS ASSOCIATED
WITH INCREASED CORONARY HEART
DISEASE AND STROKE WHICH WAS BIG
CONSIDERING THE PREVALENCE IN
THE POPULATION.
IT WAS A STRIKING FINDING AND
PEOPLE DIDN'T REALLY PAY
ATTENTION UNTIL THIS ASPECT.
PEOPLE PAID ATTENTION TO THE
MORTALITY BUT NOT TO THE
CARDIOVASCULAR DISEASE.
MANY STUDIES ASSOCIATED
HEMATOPOIESIS WITH THE STUDY AND
WITH CARDIOVASCULAR DISEASE.
BURY -- I WANT TO POINT OUT
IT'S BEEN ASSOCIATED WITH
CHRONIC KIDNEY DISEASE AND
ACCELERATED AGING, OSTEOPOROSIS,
PREMATURE MENOPAUSE, DIABETES,
ETCETERA.
WITH THE STUDIES IT'S
EPIDEMIOLOGY AND WE DON'T KNOW
WHAT'S CAUSAL AND DIRECTIONAL
AND HAVE NO IDEA ABOUT
MECHANISM.
IT COULD BE FOR EXAMPLE, AS WE
AGE WE DEVELOP CLONAL
HEMATOPOIESIS AND DEVELOP
CARDIOVASCULAR DISEASE AND
THEY'RE A PHENOMENON OF THE
AGING PROCESS AND WE WANTED TO
LOOK AT EXPERIMENTAL SYSTEMS AND
TEST WHETHER CLONAL
HEMATOPOIESIS IS DIRECTLY
UPSTREAM FROM CARDIOVASCULAR
DISEASE.
WE BASICALLY BUILT MOUSE MODELS
AND HAVE DONE THIS WITH A NUMBER
OF CLONAL HEMATOPOIESIS OR CHIP
DRIVER GENES AND OTHERS AND WHAT
I'LL SHARE QUICKLY SOME OF THESE
EARLY DATA IN OUR FIRST WE DID A
BONE MARROW TRANSPLANT AND
WANTED TO LOOK AT THE AMOUNT OF
MUTANT HEMATOPOIETIC CELLS AND
TAKE CELLS AND COMBINE THEM WITH
90% BONE MARROW CELLS IN
RECIPIENT MICE IRRADIATED.
THE MICE THAT RECEIVED THE
KNOCKOUT BONE MARROW CELLS WE
COULD LABEL.
WILD TYPE STAYS AT 10% AND YOU
SEE THEY INCREASED STRIKINGLY.
HAVE TO DO DNA SEQUENCING AND
ONE FINDS AN AMPLIFICATION OF
THE MUTANT DRIVER GENE AT THE
EXPENSE OF WILD TYPE CELLS
BECAUSE THE CELLS BASICALLY HAVE
A SELECTIVE ADVANTAGE AND THAT'S
CONSISTENT WITH THE CLINICAL
PARADIGM OF CLONAL HEMATOPOIESIS
AND WHEN A MOUSE DEVELOPS HEART
FAILURE THEY FIND THE CLONAL
HEMATOPOIESIS WILL LEAD TO
INCREASE IN CARDIOVASCULAR
DISEASE.
WE'RE SEEING ABOUT A 60%
INCREASE IN ATHEROSCLEROTIC
PLAQUE SIZE PROVIDING THE FIRST
EVIDENCE THAT CLONAL
HEMATOPOIESIS COULD BE A DRIVER
OF CARDIOVASCULAR DISEASE.
TO SUMMARIZE ALL THIS, THERE'S A
PREVALENT PRE-CANCEROUS STATE IN
THE BLOOD THAT PROMOTE S
CARDIOVASCULAR DISEASE AND CELLS
WILL GET PEPPERED WITH
MUTATIONS, WHEN THAT HAPPENS THE
SUBJECT WILL UNDER GO CLONAL
HEMATOPOIESIS AND THAT'S UP
STREAM OF ATHEROSCLEROSIS OUR
HEART FAILURE OR OTHER DISEASES
WE MODEL.
THE QUESTION IS WHAT'S THE
MECHANISM AND IF WE UNDERSTAND
THE MECHANISM WOULD THAT PROVIDE
NEW INSIGHTS ABOUT POTENTIAL
THERAPIES?
IT TURNED OUT -- I ALWAYS
THOUGHT IT WOULD IN MORE COMPLEX
BUT IT SEEMS THE PARADIGM IS
DEVELOPING MANY DRIVER GENES
SEEM TO BE WORKING THROUGH THE
IL BETA, IL6 PATHWAY IN MYELOID
CELLS AND THIS IS FIRST DATA AND
MORE ON THE BETA PRODUCTION AND
TAKE CELLS THE MICE AND WHEN
STIMULATED MAKE MORE IL6 AND CAN
SHOW IN EARLY STUDIES TO TAKE AN
INHIBITER BLOCK AND BASICALLY
RESERVE THE PATHOLOGICAL
PHENOTYPE CONFERRED BY THIS
MODEL OF CLONAL HEMATOPOIESIS
AND THERE'S CLINICAL EVIDENCE.
IF YOU LOOK AT THE TOP MED
COHORT USING HEMATOPOIESIS IS
ASSOCIATED WITH IL6 AND IL1 BETA
AND THERE WAS A STUDY IN THE
U.K. DEMONSTRATING A COMMON IL6
RECEPTOR POLYMORPHISM SERVING AS
A PROXY AND IN THOSE INDIVIDUALS
THAT HAVE CLONAL HEMATOPOIESIS
IT ELIMINATES THE ASSOCIATION
BETWEEN THAT CONDITION AND
INCIDENT CARDIOVASCULAR DISEASE.
FINALLY IN THE CANTOS TRIAL
TESTING A NEUTRALIZING ANTIBODY
AND THE INDIVIDUALS ENROLLED IN
THE TRIAL EXHIBITED A SUPERIOR
RESPONSE AND IF YOU LOOK AT THE
STUDY POPULATION THERE WAS A 15%
REDUCTION IN MAJOR
CARDIOVASCULAR EVENTS BUT
INDIVIDUALS WITH HEMATOPOIESIS
THERE WAS A 60% REDUCTION
SUGGESTING IF YOU EVALUATE AN
INDIVIDUAL'S CLONAL
HEMATOPOIESIS IT MAY PROVIDE
PERSONALIZED INFORMATION OR FIND
PEOPLE TO BETTER RESPOND TO
DISEASE PROCESS.
I HAVE 10 MINUTES.
LET ME TELL BUT ONE OF THE
THINGS THAT BOTHERED ME SINCE
THE BEGINNING ABOUT THE FIELD OR
SINCE 2017 WHEN THIS WAS
PUBLISHED.
THE CHIP DRIVER GENES
RECURRENTLY MUTATED IN CANCER
PROBABLY ONLY ACCOUNT FOR THE
MINORITY OF CLONAL EVENTS IN THE
BLOOD AND POINTED OUT WHEN THEY
DID A NON-BIASSED WHOLE GENOME
SEQUENCE ANALYSIS AND 13% OF THE
CLONAL EVENTS THEY COULD DETECT
WERE ASSOCIATED WITH MUTATIONS
IN KNOWN DRIVER GENES, YET THE
BIG GROUP OF UNKNOWN HERE STILL
EXHIBITED MORTALITY AND THIS IS
THE FIRST DISCLOSURE AND OF A
FUND STUDY AND BECAUSE IT'S AN
NIA MEETING I THOUGHT IT WOULD
BE APPROPRIATE BUT WE'RE
RERESPONDING -- RESPONDING TO
COMMENTS RIGHT NOW AND FEMALES
81 YEARS AND MALES 76 YEARS
FEMALES LIVING LONGER IS BAKED
IN OUR CULTURE AND THERE'S MANY
MEN IN THE UNITED STATES IT'S
MANY MILLIONS OF YEARS OF LIFE
LOST.
WE DON'T UNDERSTAND THIS.
MOST OF YOU PROBABLY ASSUME THAT
MEN WE HAVE TESTOSTERONE AND
MAKES OUT -- US STUPID AND THE
GENETIC COMPONENT MEN WILL LOSE
THE Y CHROMOSOME.
IT'S THE GENE THAT CONFERS
MALENESS AND IT'S THE MOST DIAG
ZYGOTIC GENE AND MOST MEN LOSE
THIS AND THERE'S A NUMBER OF
SOMATIC MUTATIONS TO THE CHIP
GENE SO IT'S A BIG DEAL ABOUT
4.5 TIMES IF YOU LOOK AT MALES
2.25 TIMES IF YOU LOOK AT
FEMALES.
AND STRIKINGLY, MOSAIC LOSS OF Y
IS INCREASED IN CANCER MORTALITY
AND DIAGNOSIS OF ALZHEIMER'S
DISEASE.
OUR COLLABORATOR IN THIS STUDY
MADE THIS FIRST ASSOCIATION WITH
MORTALITY WAS QUOTED AS SAYING
IT SPEAKS TO THE LOSS OF
MORTALITY FOR MEN COMPARED TO
WOMEN.
IT'S A SMALL CHROMOSOME AND
CHARACTERIZED AS A GENETIC WASTE
LAND AND HAS 71 GENES AND MANY
ARE DUPLICATED SO ONLY ENCODES
FOR 27 UNIQUE PROTEINS AND 9 ARE
UBIQUITOUS AND IT COMES DOWN TO
THE SAME QUESTION AS WITH CHIP,
IS MOSAIC LOSS OF Y CAUSALLY
ASSOCIATED WITH MORBIDITY AND
MORTALITY AND NO STUDIES HAVE
ADDRESSED THIS.
WE CREATED A MODEL OF MOSAIC
LOSS OF Y AND WE TOOK BONE
MARROW CELLS AND INFECT THEM
WITH A VIRUS THAT EXPRESSES A
GUIDE RNA THAT TARGETS THE Y
CHROMOSOME AND EFFECTIVE AT
ELIMINATING THE Y CHROMOSOME.
WE CAN ELIMINATE WITH OUR BEST
GUIDE RNA 90% OF THE Y
CHROMOSOME.
HERE YOU SEE IN THE FISH
ANALYSIS THE Y CHROMOSOME IS
GONE AND IF YOU LOOK AT THE
CELLS LABELLED WITH THE VIRUS
GFP YOU CAN SEE IF YOU LOOK AT Y
EXPRESSED GENES, WHY CHROMOSOME
EXPRESSED GENES IN BLOOD CELLS
IT KNOCKS DOWN THE DETECTABLE
EXPRESSION OF THESE GENES.
WE DID THIS BONE MARROW
TRANSPLANTATION AND SAID WHAT DO
WE DO WITH THE MICE.
THEY SHARE FEATURED WITH MEN AND
THIS IS DONE IN MALE MICE.
THEY EXHIBITED DIMINISHED
SURVIVAL AND DEVELOPED AN AGE
RELATED CARDIO MYOPATHY.
THEY HAD MORE PULMONARY AND
RENAL FIBROSIS AND COULD DETECT
A COGNITIVE DECLINE.
THIS IS INTERESTING.
WITH THAT DATA WE WENT TO QUERY
THE BIOBANK BECAUSE THERE WASN'T
GOOD PROSPECTIVE DATA TO SUGGEST
MOSAIC LOSS OF Y WAS RELATED TO
CARDIOVASCULAR DISEASE MORTALITY
AND FOUND A DOSE RESPONSE
RELATIONSHIP WITH DISEASES OF
THE CIRCULATORY SYSTEM AND MEN
WHO LOST MORE OF THEIR Y
CHROMOSOME EXHIBITED MORE
CARDIOVASCULAR DISEASE AND
HYPERTENSIVE HEART DISEASE AND
WHATEVER.
WE BECAME INTERESTED IN THE
HEART FAILURE PHENOTYPE.
THIS IS WHAT THE DATA LOOKS LIKE
IF YOU LOOK AT THE SNIPS.
HERE'S THE XY AND AS MEN LOSE
THE Y CHROMOSOME THIS COULD BE
TURNER SYNDROME INTERESTINGLY
YOU HAVE PEOPLE SELF-IDENTIFIED
AS MALES AND INDIVIDUALS WITH
XYY AND MEN WHO HAVE TWO Y
CHROMOSOMES AND XYY.
BASICALLY INSTEAD OF CONTINUING
TO DO THE AGING EXPERIMENTS WE
ALSO CREATED AN ACUTE MODEL OF
NON ISCHEMIC HEART MODEL WIN
TRANS VERSION AORTIC
CONSTRICTION AND ACERBATED WHEN
THE MICE HAVE BEEN ENGINEERED TO
HAVE MOSAIC LOSS OF Y AND
THERE'S AGAIN MORE OF THIS
FIBROSIS AND INCREASE IN
FIBROTIC AREA.
IF YOU DO RNA SEQ ANALYSIS
THERE'S AN INCREASE OF TGA BETA
SIGNALLING IN THE MYELOID CELLS
AND THIS IS STRIKING AND TOOK A
WHILE TO FIGURE OUT THERE'S IN
INCREASE IN INFLAMMATION IN THE
MICE.
WE'RE GOOD AT LOOKING AT
INFLAMMATION AND COULDN'T FIND
IT.
WE THOUGHT Y CHROMOSOME WOULD BE
LIKE CHIP AND IT'S NOT.
IT'S BASICALLY PROMOTING
FIBROSIS.
FINALLY, WE WERE ABLE TO SHOW
THE TGF BETA NEUTRALIZATION WITH
A BLOCKING ANTIBODY CAN REVERSE
THE ALSO OF THE WILD TYPE IN THE
HEART.
TO ESSENTIALLY WRAP THIS UP
HERE, ORGAN FIBROSIS INCREASES
WIN AGE AND CONTRIBUTE TO 45% OF
LESS IN INDUSTRIALIZED COUNTRIES
AND ASSOCIATED WITH MORBIDITY
AND MORTALITY.
WE CONSTRUCTED A Y PROMOTES TGF
BETA SIGNALLING.
THANK YOU AND I FINISHED ONE
MINUTE EARLYMINUTE EARLYMINUTE EARLYYMINUT E EARLYMINUTE EARLY.
>> I WONDER ABOUT THE COMPARISON
ON THE GENES ON THE MOUSE AND IF
THAT GIVES YOU INSIGHT TO THE
HUMAN Y CHROMOSOME.
IF THERE'S TIME I'LL ASK ANOTHER
QUESTION TOO.
>> THAT'S RIGHT.
SO WE CAN RULE OUT A FEW, RIGHT?
SO IT'S AN IMPERFECT ANALYSIS
BECAUSE LIKE MAYBE THERE'S
SOMETHING BEING LOST ON THE
HUMAN Y CHROMOSOME WE CANNOT
REPLICATE OR FIND IN A MOUSE.
BUT WE TAKE THAT SHORT LIST OF
GENES.
THAT'S WHAT WE'RE DOING RIGHT
NOW USING THE CRISPR TO GO OUT
AND TARGET THE INDIVIDUAL CODING
LOCI AND BECAUSE WE KNOW THIS IS
AN IMMUNE EFFECT WE'RE LOOKING
AT Y CHROMOSOME GENES EXPRESSED
IN THE HEMATOPOIETIC SYSTEM TO
NARROW IT DOWN FURTHER.
IT'S NO SO MAYBE HARD TO FIND
WHAT THE GONE MIGHT BE.
WE'LL SEE.
THANK YOU FOR THE QUESTION.
>> RICHARD AND THEN FRANK AND
MAYBE THEN WE CAN CIRCLE BACK TO
PEGGY.
>> WHEN YOU DESCRIBED THE U.K.
BIOBANK THE CORRELATION OF LOSS
OF Y WITH CARDIOVASCULAR
DISEASE, A PRESUME THAT WAS NOT
THE CORRELATION WITH AGE?
>> THE EPIDEMIOLOGY WAS DONE BY
LARS FORSBERG AND I THINK HE
TOOK IT INTO ACCOUNT WHEN HE WAS
DOING HIS ANALYSIS.
THE CONFOUNDERS.
WE DIDN'T DO THAT ASPECT.
WE GAVE IT TO THE EXPERTS.
GOOD POINT
>> FRANK.
KEN, IMPRESSIVE WORK.
I WAS WONDERING, AS YOU LOOK AT
YOUR MODELS SAY THE CLONAL
HEMATOPOIESIS MANIPULATION AND
SEE THESE CYTOKINE AND IMMUNE
CHANGES, WHAT IS YOUR STRATEGY
THEN FOR COMPARING THEM TO THE
MODELS OF AGING AND I'M BIAS BY
FOLLOWING THE WORK HERE AT
STANFORD AND WATCHING THE IMMUNE
CHANGES WITH AGING AND THERE'S
SO MANY WAYS TO LOOK AT THAT
WITH LARGE-SCALE DATA AND RNA
SEQ.
>> NOT AS MUCH AS WE SHOULD.
IT'S A NEW FIELD AND WE'RE ALL
KIND OF RUSHING TO FIND WHAT ARE
THE MAJOR SIGNALS AND MECHANISM.
TYPICALLY WE TAKE A YOUNG MOUSE
AND FORCE A DISEASE ON IT IN A
CLONAL HEMATOPOIESIS MODEL AND I
THINK IT WOULD BE GOOD TO
COMPARE SOME OF THE CLONAL
HEMATOPOIESIS WITH SOME OF THE
MORE STANDARD MODELS OF AGING.
A COUPLE TIMES WE'VE DONE
EXTENSIVE MODELLING AND GOT
ANOTHER MODEL OF CLONAL
HEMATOPOIESIS WHERE WE DON'T
IRRADIATE A MOUSE AND LET THE
MOUSE LIVE TO 15 TO 18 MONTHS
AND FIND THEY BASICALLY ALSO
EXHIBIT WHAT APPEARS TO BE
ACCELERATED AGING TO THE EXTENT
IT'S BEEN LOOKED AT.
WE SEE MORE AGE-RELATED CARDIO
MYOPATHY AND BECOME
METABOLICALLY DYSFUNCTIONAL AND
INFLAMED.
>> WE HAVE SO MANY WAYS OF
MEASURING AGE.
LOOK FOR WARD TO SEEING THAT,
THANK YOU.
>> THAT WAS A FABULOUS TALK
EXTREMELY INTERESTING.
FROM A GRAIN STANDPOINT, YOU
SAID THE MOUSE MODEL DID SHOW
COGNITIVE DECLINE WITH THE
MOSAIC LOSS OF Y.
GIVEN YOU'RE SPEAKING OF
FIBROSIS, WHAT DO YOU THINK THE
MECHANISM IS FOR THE LOSS OF
COGNITIVE FUNCTION GIVEN THE
BRAIN DOESN'T HAVE FIBROSIS.
>> YEAH, I FL KNOW, I DON'T KNOW.
I'M LUCKY TO HAVE A GOOD STROKE
INVESTIGATOR IN MY LABORATORY
AND SHE'S INTERESTED IN A LOT OF
THESE TYPES OF ISSUES AND SHE'S
BEEN BASICALLY DOING THE STROKE
MODELS WHICH ARE HARD FOR CLONAL
HEMATOPOIESIS BECAUSE YOU SET
OFF A BOMB IN THE BRAIN AND THE
IDEA YOU'LL SEE AN AFFECT IS
TOUGH.
SHE'S THE ONE THAT SET UP THE
MODELS BUT WE FOUND THIS
COGNITIVE DECLINE AND WANTS TO
INVESTIGATE THAT FURTHER.
NOW THAT WE'VE ESTABLISHED THIS
MODEL WE CAN LOOK AT A LOT OF
DIFFERENT DISEASE PROCESSES.
I AGREE, THERE'S NO LITERATURE
OUT THERE ON FIBROSIS AND
COGNITIVE DECLINE.
I DON'T KNOW.
YOU LET A MOUSE AGE AND WE SEE A
LOT OF THING AND WE CLEAVED OUT
THE HEART FAILURE AND TAKE IT
INTO WHAT WE DO HERE, BASICALLY.
>> AND I THINK FINAL QUESTION,
PEGGY, DO YOU WANT TO CIRCLE
BACK?
>> THAT WOULD BE GREAT, THANK
YOU.
SO YOUR WORK WITH THE TET 2 AND
IL6 AND IL BETA IS WONDERFUL AND
SET THE STANDARD FOR THE FIELD.
THERE'S ABOUT 20 GENES THAT PLAY
A ROLE IN CLONAL HEMATOPOIESIS
AND TO WHAT PARADIGM A DO YOU
THINK IT WILL FULFILL THE OTHER
GENES AND B, BE RELEVANT FOR OWE
OTHER DISEASE PROCESSES THAT
HAVEN'T BEEN STUDIED YET.
>> I THOUGHT, PEGGY, WHEN ALL
THE GENES WORKED THROUGH
DIFFERENT TYPES OF MECHANISMS
THEY'RE ALL GOING TO BE WORKING
THROUGH A DIFFERENT PATHWAY AND
DIDN'T HAVE TO BE A
PRO-INFLAMMATORY PATHWAY BUT WE
LOOKED AT FOUR OR FIVE GENES AND
SEE AN IL1 BETA AND AS YOU CAN
APPRECIATE PEOPLE THINK MAYBE
ONE OF THE THINGS THAT LEADS ONE
OF THE INTRINSIC FACTORS THAT'S
OCCURRING IN THE BONE MAYOREE
THAT -- MARROW TO EXPAND IS LIKE
A FEEDBACK MECHANISM AND MAYBE
YOU CAN EXPLAINING IT BETTER
THAN I CAN TO THE AUDIENCE, AS
WE AGE THE BONE MARROW BECOMES
MORE INFLAMED AND CREATES A
SELECTIVE DISADVANTAGE FOR THE
WILD TYPE HEMATOPOIETIC CELLS
AND THE CELLS WITH MUTATIONS AN
DRIVER GENES ARE PROTECTED FROM
THE CHRONIC INFLAMMATORY STATE
AND IT'S A FEEDBACK TYPE OF A
THING.
THAT'S POPULAR.
THERE'S BEEN RELATIVELY FEW
STUDIES THAT LOOKED AT AND I'M
SURE PEGGY KNOWS THIS, EVERYBODY
HAS SMALL TINY MUTATIONS WHEN
WE'RE YOUNG WE ALREADY DEVELOPED
A LOT OF THEM BUT THEY GROW IN
SOME PEOPLE AND NOT IN OTHERS
AND THAT'S ANOTHER CHALLENGE OUT
THERE TO TRY TO UNDERSTAND
WHAT'S GOING ON IN THE
ENVIRONMENT OF THE HEMATOPOIETIC
STEM CELL ALLOWING THE MUTANT
CLONES TO SUDDENLY HAVE THE
ADVANTAGE.
>> GREAT.
THANK YOU VERY MUCH.
AGAIN, I JUST WANT TO THANK YOU,
DR. WALSH FOR YOUR REALLY
EXCITING TALK AND SHARING WITH
US THE CURRENT DATA.
AND WISH YOU ALL THE BEST SO
THANK YOU VERY MUCH.
AND I THINK AT THIS POINT WE
HAVE ONE MORE SECTION LEFT IN
OUR OPEN SESSION.
FIRST, I THINK WE'LL TAKE A
SHORT BREAK AGAIN.
SINCE WE'RE RUNNING A LITTLE BIT
LATE I THINK WE'LL JUST TAKE A
10-MINUTE BREAK AND THEN
RECONVENE TO HEAR FROM OUR
INTRAMURAL PROGRAM.
SO IT IS NOW 1:31, SO LET'S TAKE
TO 1:40 AND WE'LL COME BACK IN A
SHORT TIME, 10 MINUTES.
LATE JUST BREAK FOR 10 MINUTES.
1:42 WE'LL RETURN.
THANKS VERY MUCH.
NEXT UP WE'LL HEAR FROM
DR. LUIGI FERRUCCI FIRST
REGARDING OUR INTRAMURAL PROGRAM
REPORT.
I'LL TURN IT OVER TO LUIGI AND
HIS COLLEAGUES.
>> IT'S MY PLEASURE TO PRESENT
SOMETHING ABOUT THE INTRAMURAL
PROGRAM AT NIA AND OUR
PRESENTATION WILL BE DIVIDED IN
TWO PARTS.
THE FIRST PART IS OPEN TO THE
PUBLIC AND WE'LL HAVE SOME OF MY
COLLEAGUES TO PRESENT THEIR
SCIENCE, IN PARTICULAR, I'LL
HAVE SUSAN RESNICK FROM THE
LABORATORY OF NEUROSCIENCE
PRESENTING AND THEN FROM THE
POPULATION SCIENCE LABORATORY
AND THE GERONTOLOGY BRANCH.
THEY'LL PRESENT A HIGHLIGHT S S OF
THE GROUP OF THE SCIENCE THEY'RE
DOING AND IN THE CLOSED SESSION
I'LL TELL YOU MORE ABOUT THE
MORE SALIENT EVENT AND AS WE SAW
EACH OTHER LAST TIME WITHOUT
WASTING TIME I INVITE SUSAN
RESNICK TO PRESENT.
>> THE CHALLENGES STILL REMAIN.
I'VE BEEN ASKED TO PRESENT FOR
THE LABORATORY OF BEHAVIORAL
NEUROSCIENCE.
AND THE GOAL OF OUR PROGRAM IS
TO UNDERSTAND MECHANISMS OF
INDIVIDUAL DIFFERENCES AND AGE
ASSOCIATED COGNITIVE VARIATION.
FROM ANIMAL TO HUMAN MODELS WITH
THE GOAL TO PROMOTE SUCCESSFUL
OUTCOMES.
THE LABORATORY OF BEHAVIORAL
NEUROSCIENCE HAS FIVE PRINCIPLE
INVESTIGATORS NOW.
I LEAD THE LABORATORY AND SERVE
AS CHIEF AND WE'RE JOINED BY BY
THESE PEOPLE AND LAST MONTH
DR. BENJAMINI JOINED AND WILL
WORK ON INTEGRATIVE BIOPHYSICS.
I'D LIKE TO START WITH SOME OF
THE PROGRESS THAT WE'VE MADE
OVER THE LAST YEAR DESPITE THE
PANDEMIC AND THERE'S ONLY ONE
GROUP REGULARLY AT THE CENTER
OTHER THAN A FEW TEST
PARTICIPANTS THE REST OF US HAVE
WORKED REMOTELY.
THERE'S A PROGRAM CALL STARRRS,
SUCCESSFUL TRAJECTORY OF AGING
AND THIS RESERVE AND RESILIENCE
IN RATS.
THE IDEA OF RESERVE AND
RESILIENCE IS A THEME THAT CUTS
THROUGH THE LABORATORY AS WE TRY
TO LOOK FOR FACTORS THAT PROMOTE
SUCCESSFUL AGING.
THE GOAL OF STARS IS TO
ESTABLISH AN OPEN RESOURCE FOR
THE LONGITUDINAL STUDY OF
COGNITIVE IN MALE AND FEMALE
RATS AND RECOGNIZE AGE AND
RESILIENCE AGAINST ALZHEIMER'S
DISEASE AND RELATED DISORDERS.
WHAT THIS PROJECT ENTAIL IS FULL
LONGITUDINAL DATA SETS FROM MORE
THAN 700 RATS AND THE STUDY WILL
BE POWERED TO LOOK AT SEX
DIFFERENCES IN THE ANIMAL MODEL.
THEY EXPECT TO COLLECT MORE THAN
2,000 MRI DATA SETS AND
BIOSPECIMENS.
AGAIN, DUE TO COVID, THERE WERE
A NUMBER OF PROGRAM RELATED
DELAYS BUT I'M HAPPY TO REPORT
THAT THE ANIMAL MAGNET WAS
INSTALLED IN THE BRC IN LATE
OCTOBER AND THIS IS A PICTURE OF
THE INSTALLATION.
AND DR. RAFF HAS USED THE TIME
TO LOOK AT THE PHENOTYPING
STRUCTURE AND MONITORING AND
OPTIMIZATION OF THE OTHER
METHODS AND THIS IS ILLUSTRATED
IN THIS COLLAGE MUCH PICTURES.
IN THE NEXT PHASE, HIS PLAN IS
TO BEGIN THE LARGE-SCALE DATA
COLLECTION AND ESTABLISH A
WEB-BASED COORDINATION AND
DIGITAL DATA CENTER AS WELL AS A
BIOSPECIMEN REPOSITORY AND THE
SPECIMENS WILL BE DISTRIBUTED
THROUGHOUT THE EXTRAMURAL
PROGRAM AS WELL AS THE
INTRAMURAL PROGRAM.
IN MY OWN PROGRAM, WE'VE ALSO
BEEN CHALLENGED BY COVID.
OUR PET SCAN STUDIES BASICALLY
CAME TO A STOP OVER A YEAR.
WE HAVE RESTARTED SCANNING BLSA
PARTICIPANTS WIH
PARTICIPANTS BUT AT A MUCH
REDUCED RATE.
SO WE TOOK THE OPPORTUNITY TO
COMPLETE PLASMA BIOMARKERS ON
ONE HAS BEEN COMPLETED IN
COLLABORATION WITH JOHNS HOPKINS
WHO RUNS THE SAMPLE IN DUPLICATE
AND OUR TAO SAMPLES ARE PENDING
AND HOPE TO GET THEM SOON.
WE HAD A CROSS-SECTIONAL DATA
SET BASED ON THE FIRST THREE
TMRI VISITS PARTICIPANTS HAD AND
THAT WAS ABOUT 700 PARTICIPANTS
ACROSS THE FULL AGE RANGE.
THEN WE TOOK ALL OF THE
PARTICIPANT VISITS WHERE WE HAD
THE MEASUREMENTS AND THAT
CONSTITUTES OUR SPECIMEN AND
THAT WAS OVER 600 PEOPLE FOR 200
VISITS FOR THE INDIVIDUALS.
I HAVE THE RATIOS AND GFAP AND
THE RATIO DECLINES WITH AGE
CONSISTENT WITH A DECLINE IN THE
PRESENCE OF ALZHEIMER'S DISEASE,
GFAP INCREASES AND YOU CAN SEE
THESE ARE PRETTY NOISY.
DESPITE THAT NOISE WE GET GOOD
COEFFICIENTS FOR STABILITY OVER
TIME BETWEEN AROUND .7 TO .75
THOUGH THE INDIVIDUAL MEASURES
ARE QUITE A BIT LOWER.
SO WHAT DO WE SEE IN THE BLSA
WHEN WE LOOK AT PLASMA
BIOMARKERS AND PIB AT THE LAST
VISIT AND THERE ARE DIFFERENCES
BETWEEN PEOPLE WHO ARE POSITIVE
OR HAVE AMYLOID IN THEIR BRAIN
VERSUS NEGATIVE.
I WANT TO POINT OUT WE USED A
LOW LEVEL OF DETECTABLE PIB TO
CALL SOMEBODY POSITIVE IN THE
ANALYSES.
DESPITE THE LOW LEVEL, WE SEE
DIFFERENCES IN A BETA RATIO IN
GFAP AND NFL.
AS YOU'D EXPECT, GIVEN PIB SAY
MEASURE OF AMYLOID.
WHEN YOU LOOK AT HOW WELL THE
RATIO PREDICTS POSITIVITY, THE
AREA UNDER THE CURVE IS ABOUT .7
AND NOT GREAT BUT PROBABLY THE
WAY THEY'LL BE USED AS OTHERS
HAVE SUGGESTED IS TO DECREASE
THE NUMBER OF PEOPLE THAT GO FOR
PIB SCANS OR FOR AMYLOID SCANS
IN GENERAL FOR SELECTION INTO
CLINICAL TRIALS RATHER THAN AS A
STAND ALONE MEASURE RIGHT NOW.
DR. WALKER JOINED IN 2020 AND
HAS BEEN ENTIRELY REMOTE SINCE
JOINING AND DESPITE THAT HE'S
BEEN REMARKABLY PRODUCTIVE AND
DEVELOPED A SUCCESSFUL
INTRAMURAL LAB PROPOSAL WHICH
WAS SUPPLEMENTED BY THE
DISTINGUISHED SCHOLARS FUNDING
TO PERFORM PROTEOMICS AND
ADDITIONAL PLASMA P TAO AND
OTHER MEASURES USING THE
LONGITUDINAL MRI EXAMPLE.
AND HE ALSO WITH HIS GROUP
QUICKLY JUMPED INTO THE EXISTING
BLSA DATA AND DR. WALKER IS
INTERESTED IN INFLAMMATION.
THEY WERE ABLE TO IDENTIFY A
SAMPLE THAT REPORTED IN THE BLSA
HERPES VIRUS AND COMPARED THOSE
INDIVIDUALS WHO DID NOT REPORT
PRIOR HERPES VIRUS INFECTION AND
FOUND THERE WAS GREATER
LONGITUDINAL WHITE MATTER VOLUME
LOSS AS ILLUSTRATED IN THE
BOTTOM HERE THAN THOSE WHO HAD
PREVIOUSLY REPORTED A HERPES
INFECTION AND IT WAS MOST
PRONOUNCED IN THE TEMPORAL WHITE
MATTER LOSS.
AND THERE'S BEEN A STUDY DREAM,
DRUG REPURPOSING FOR EFFECTIVE
ALZHEIMER'S MEDICINE.
THIS IS A TWO-YEAR MULTI-CENTER
STUDY IDENTIFY NOVEL REPURPOSING
CANDIDATES FOR ALZHEIMER'S
DISEASE WHERE HE LEVERAGES BOTH
DEEP MOLECULAR PHENOTYPING OF
HUMAN BRAIN AND BLOOD AND BIG
DATA ANALYSIS OF REAL WORLD
OUTCOMES IN COLLABORATION WITH
EXTRAMURAL INVESTIGATORS,
THEY'VE IDENTIFIED TWO CLINICAL
DATA SETS WITH OVER 20 MILLION
OLDER INDIVIDUALS WITH CLINICAL
DIAGNOSES DATA AND USE THE DATA
SETS TO IDENTIFY TARGETS THAT
BEAR FURTHER INVESTIGATION
POSSIBLY IN RANDOMIZED CLINICAL
TRIALS AS CANDIDATE AB TREATMENT
FUTURE.
WITH HIS PROGRAM AND THE DREAM
STUDY BUT THEY'VE BEEN
SUCCESSFUL AT USING DRUG
DISCOVERY IN ALZHEIMER'S DISEASE
USING OMICS TO IDENTIFY
PLAUSIBLE TARGETS IN A RECENT
PAPER THEY IDENTIFIED THE
JAK-STAT MODULATION AS IMPORTANT
IN ALZHEIMER'S DISEASE AND NOW
TAKEN THAT WHERE THEY'RE
PROPOSING THREE DIFFERENT
COMPARISONS IN THE REAL WORLD
CLINICAL DATA SETS TO TEST
WHETHER OR NOT DRUGS THAT
MODULATE THAT PATHWAY HAVE
EFFECTS ON ALZHEIMER'S DISEASE
RISK IN THE REAL WORLD CLINICAL
DATA SETS.
IN THE LAST EXAMPLE, I'D LIKE TO
SHOW YOU PROGRESS MADE IN THE
WOMEN'S HEALTH INITIATIVE MEMORY
STUDY WE'RE ALL WORKING ON
TOGETHER WITH OTHER INDIVIDUALS
IN THE INTRAMURAL RESEARCH
PROGRAM AND AT WAKE FOREST TO
UNDERSTAND THE COGNITIVE
RESILIENCE IN APOE4 ESCAPEES AND
MAKE IT TO AGE 80 AND OLDER
WITHOUT COGNITIVE IMPAIRMENT.
SO WE WENT BACK TO THE BAG AND
PULLED SAMPLES FROM THE WOMEN'S
HEALTH INITIATIVE BASELINE FROM
THE MID 1990s AND THEN LOOKED AT
SELECTED PLASMID BIOMARKERS AND
METABOLOMICS AND WITH THE LIMIT
THE TIME I WANTED TO SHARE THE
PLASMA BIOMARKER THE REST OF
THIS IS IN PROGRESS IN TERMS OF
ANALYSIS.
WHAT WE HAVE ARE PEOPLE WHO ARE
LESS THAN AGE 80 AND IMPAIRED IN
THE RED DOTS.
PEOPLE WHO BECAME IMPAIRED AFTER
AGE 80 AND THEN RESILIENT
INDIVIDUALS.
AND THOSE ARE THE PEOPLE WHO
MAKE IT TO AGE 80 WITHOUT
COGNITIVE IMPAIRMENT.
YOU CAN START WITH THE RATIO ON
THE LEFT.
THERE'S A COUPLE THINGS THAT ARE
OBVIOUS.
ONE IS WHEN WE STRATIFY BY E4
GENOTYPE FOR ALL OF THE GROUPS,
THE E4 GENOTYPE GROUPS HAVE
LOWER ABETA RATIO AND IT'S
HIGHER IN A4 POSITIVE
INDIVIDUALS.
THAT'S ONE ASPECT.
THE SECOND IS THAT IF YOU LOOK
AT THE E4 INDIVIDUALS, YOU CAN
SEE THERE IS NOT MUCH OF A
DIFFERENCE BETWEEN THE TWO
GROUPS IMPAIRED AND BY CONTRAST
IN THE E3 INDIVIDUALS THEY'RE
IMPAIRED AFTER AGE 80, ARE
SOMEWHAT ELEVATED RELATIVE TO
THE PEOPLE WHO DEVELOPED
IMPAIRMENT BEFORE AGE 80.
AND I THINK WHAT THAT SUGGESTS
IS THAT THE E4 GROUP IS MORE
HETEROGENEOUS AND THERE'S MANY
FACTORS THAT MAY BE RELATED.
THEY MAY NOT BE AS DRIVEN BY THE
A BETA PATHWAY.
IF WE LOOK AT NFL WE CAN SEE IN
THE IMPAIRED AND RESILIENT
GROUPS AFTER 80 THEY'RE SIMILAR
FOR THE E3 AND E4 BUT THE PEOPLE
YOUNGER DEVELOPED IMPAIRMENT AT
YOUNGER AGES, THEY SHOW THE
ELEVATION IN THE NFL AND THEY'RE
CLOSER TO THE WHI BASELINE AND
FIVE YEARS ON AVERAGE FROM THE
BASELINE AND 80 PLUS IMPAIRED
ARE CLOSER TO 12 TO 14 YEARS
FROM THE WHI BASELINE.
SO THESE ARE JUST A FEW SNIPPETS
OF THE PROGRESS SINCE THE LAST
REVIEW AND HAPPY TO TAKE
QUESTIONS AND THANK YOU FOR
LISTENING.
>> THANK YOU, SUSAN.
WE HAVE TIME FOR A QUESTION.
IF THERE ARE NOT ANY, WE CAN
MOVE ON.
>> I HAVE A QUESTION.
THANK YOU FOR YOUR PRESENTATION,
SUSAN.
NICE TO SEE THAT WORK, AS
ALWAYS.
ARE YOU GOING TO BE USING PLASMA
BIOMARKERS TO FURTHER INFORM THE
EFFECTS OF ESTROGEN REPLACEMENT
THERAPY?
>> THERE'S A MORE SAMPLE WE'RE
LOOKING TO.
>> THANK YOU.
>> GOOD AFTERNOON, EVERYONE.
I'M LENORE LAUNER THE CHIEF OF
EPIDEMIOLOGY AND POPULATION
SCIENCES AND PLEASED TO PRESENT
A BRIEF OVERVIEW OF LEPS HISTORY
AS WELL AS FUTURE PLANS.
THE LABORATORY AIMS FOCUSES ON
RESEARCH TO FULFILL THE NIH/IRP
MISSION OF CONDUCTING HIGH
QUALITY GROUNDBREAKING RESEARCH
ADVANCING HUMAN HEALTH THROUGH
EARLY DETECTION, DIAGNOSIS AND
TREATMENT AND USING INTEGRATIVE
AND TRANSLATIONAL MODEL.
WE TAKE A WHOLE PERSON APPROACH
TO STUDY THE SYSTEMS RELATED TO
HEALTH DISPARITIES, CHRONIC
DISEASE AND BRAIN AGING AND
IDENTIFY INTERACTIONS AMONG
SOCIO ECONOMIC AND ENVIRONMENTAL
FACTORS IN RELATION TO HEALTH
OUTCOMES AND MAP OUT
TRAJECTORIES OF RISK AND DISEASE
AND INVESTIGATE SIGNATURES OF
RISK AND PROGNOSIS.
I'LL GIVE YOU A BRIEF OVERVIEW
OF WHAT OUR MOST CURRENT
RESEARCH FINDINGS ARE.
IN THE LAST DECADE THERE'S BEEN
A LOT OF CHANGES IN OUR
INFORMATION OF AGING AND
POPULATION LEVEL IN PARTICULAR.
THERE'S SOME WORKING PREMISES
THAT LEPS HAS CONTRIBUTED TO
CHANGING.
THE MOST OBVIOUS BEING BETWEEN
GENES AND AGE, THERE WAS AN
INEVITABLE DECLINE IN HEALTH
WITH FEW MEANS TO PREVENT THE
DECLINE AND AGE HAD A
CHRONOLOGIC TRAJECTORY STARTING
AT AGE 65.
SO BRIEFLY I'LL SHOW YOU SOME OF
THE CURRENT RESEARCH THAT HAS
HELPED CHALLENGE THE OLDER
PREMISES.
THEY'VE LOOKED AT THE
RELATIONSHIP BETWEEN EPIGENETIC
CHANGES ON AGE ACCELERATION AND
THE AFFECT OF AGE ON COGNITIVE
DECLINE.
WE HAVE ALSO EXAMINED BIOMARKERS
OF AGING IN THE POPULATION AND
THERE WAS AN ASSOCIATION BETWEEN
GENES AND PROTEIN NETWORKS AND
THEY PREDICT DISEASE SUGGESTING
THE USE OF SUCH NETWORKS IN
DEFINING DISEASE RISK MAY BE
USEFUL.
AND TESTS LOOKING AT TELOMERE
LENGTH AND PROTEINS HAVE SHOWN
THE MARKERS CAN VARY IN
COMPOSITION AND DEGREE OF
ASSOCIATION BY THE DIVERSITY OF
THE SAMPLE THAT IS BEING
EXAMINED.
AND SOCIAL FACTORS SUCH AS
DISCRIMINATION AND LOWER SOCIO
ECONOMIC STATUS CAN AFFECT BRAIN
DISEASE.
WE ALSO PARTICIPATED IN THE
PROJECT OF DR. DE CABOS TO
INVESTIGATE INTERSPECIES
DIFFERENCES IN METABOLISM AND
DIFFERENCES IN LIFE COURSE TRA
TRAJECTORIES IN GLUCOSE IN MEN,
MONKEYS AND MAN.
WE HAVE BEEN TAKE LIFE COURSE
APPROACH AS WE DO OUR SCIENCE.
WE WORK TO MEET THE AIMS OF OUR
STUDY.
WE DEVELOPED COHORTS AND THEY'VE
BEEN DESIGNED WITH SPECIFIC
SOURCE POPULATIONS IN MIND THAT
COULD PROVIDE INSIGHT INTO
ASPECTS OF AGING ON A POPULATION
LEVEL.
THE COHORTS ARE LARGE, DIVERSE
AND COMMUNITY BASED AND FOLLOWED
OVER TIME AND DEEPLY PHENOTYPED
WITH A WIDE RANGE OF SOCIO
ECONOMIC STATUS AND
COMORBIDITIES AND FUNCTIONAL
IMPAIRMENT AND REPRESENT OVER
THE YEARS INDIVIDUALS BORN IN
DIFFERENT BIRTH COHORTS AND
INDIVIDUALS THAT HAVE BEEN
FOLLOWED FOR MANY MANY YEARS.
THESE RESOURCES ARE ALLOWING A
WIDE RANGE OF QUESTIONS RELATED
TO MULTIPLE PHYSIOLOGIC AND
DISEASE PROCESSES AND AGING TO
BE ADDRESSED AND DISENTANGLE
TRENDS AND INTERACTIONS AMONG
DIFFERENT BODY SYSTEMS AT THE
SAME TIME.
OBVIOUSLY, THE RESOURCES AND AS
A FEDERAL INSTITUTION WE ALWAYS
WORKED COLLABORATIVELY IN THE
DESIGN AND EXECUTION OF
INTERPRETATION OF FINDINGS.
IN ADDITION AND IMPORTANTLY, THE
COHORT SCIENTISTS AND CLINICIANS
WITH A WIDE RANGE OF SKILLS HAVE
TAPPED INTO THE RESOURCES AND
HAVE ALSO CONTRIBUTED THROUGH
GRANTS AND CONTRACTS TO ENRICH
THE COHORTS THAT WE HAVE
DEVELOPED.
THERE'S OBVIOUSLY WE HAVE AN
AMAZING NETWORK OF COLLABORATION
NOT ONLY ACROSS NIH BUT
NATIONALLY AND INTERNATIONALLY
AND MADE MAJOR CONTRIBUTIONS TO
MULTIPLE CONSORTIA WHICH
EFFECTIVELY INCREASES OUR
COLLABORATION WORLDWIDE.
SO I WOULD LIKE NOW TO GIVE YOU
A BIT HISTORY OF LEPS.
WE STARTED ABOUT 15 YEARS AGO,
THERE WAS ATTRITION IN THE LAB
DUE TO RETIREMENT.
SO BY THE 2020
BSC ONLY DR. EVANS RUNNING THE
HEATH DISPARITIES SECTION AND ME
RUNNING DIVISIONS HAVE HELPED
AND WE MADE SEVERAL
RECOMMENDATIONS HOW TO MOVE
FORWARD.
THEY ADVISED THE INSTITUTE TO
EXPAND AND STRENGTHEN LEPS WITH
A NEW LAB CHIEF WE HAVE BEEN
WORKING UNDER AN ACTING LAB
CHIEF MANY YEARS AND DEVELOP A
STRATEGIC PLAN AND ASSEMBLE THE
FULL TEAM OF NEW TENURE TRACK
INVESTIGATORS.
SPECIFIC AREAS THAT THEY
RECOMMENDED TO FOCUS ON CONTINUE
TO DO RESEARCH ON HEALTH
DISPARITIES RESEARCH, DEVELOP OR
FORMALIZE NEW RESEARCH AREAS
RELATING TO NEW CHALLENGES TO
HEALTH, TO DEVELOP NEW RESEARCH
RESOURCES SUCH AS COHORTS,
TRAINING OPPORTUNITIES AND AN
EPIDEMIOLOGIC CORPS AND CONTINUE
BRIDGING THE GAP BETWEEN THE
BASIC AND POPULATION SCIENCES.
SO NOW THESE DAYS CURRENTLY
OBVIOUSLY THERE ARE MANY
CHALLENGES TO REBUILDING AN
EPIDEMIOLOGIC PROGRAM.
THE CURRENT LANDSCAPE IN
UNDERSTANDING WHEN DISEASE HAS
BECOME MORE COMPLICATED.
THERE'S THE AVAILABILITY OF
DIGITAL TECHNOLOGY HAS CREATED A
HUGE AMOUNT OF DATA AVAILABLE
FOR US TO GAIN INSIGHT INTO
HEALTH AND ALSO LEARNING THERE
ARE MANY FACTORS BEYOND
PHYSIOLOGIC INFLUENCES THAT
INFLUENCE AN INDIVIDUAL'S
OUTCOMES AND THEY NECESSITATE
TAKING A WHOLE PERSON'S APPROACH
TO RESEARCH AS WELL AS SYSTEMS
BIOLOGY RESEARCH.
AND INCLUDE NOW IN OUR RESEARCH
LOCAL ENVIRONMENT BEHAVIOR,
SOCIO CULTURAL CONTEXT AND
BASICALLY THE OUTDOORS
ENVIRONMENT.
BASED ON THE BSC
RECOMMENDATIONS, I APPLIED FOR
THE CHIEF'S POSITION AND WAS
APPOINTED LAST YEAR.
THERE WILL BE AN INVESTMENT IN
TENURE TRACK POSITIONS WHICH WE
ARE CURRENTLY RECRUITING FOR NOW
AND I ENVISION THE LAB TO
CONCLUDE AT LEAST FOUR SECTIONS
A LITTLE BIT PROBABLY NOT
PRECISELY LABELLED BUT I
ENVISION A DATA SCIENCE SECTION
WHERE THE INVESTIGATORS WOULD
USE A WIDE RANGE OF LARGE
DATABASES TO ADDRESS
INTERSECTIONS AMONG SOCIAL,
BIOLOGIC AND CLIMATE AND
ENVIRONMENTAL FACTORS.
THERE WOULD BE BIOMARKER SECTION
FOCUSSED ON DEVELOPING
BIOMARKERS BASED ON OMICS DATA
TESTED FOR RISK ASSESSMENT IN
THE POPULATION AND EXOSOME
SECTION WHICH WOULD BE DEVOTED
TO TRANSLATIONAL RESEARCH WHERE
WE CAN ACTUALLY FOCUS ON ONE OR
TWO CORE MECHANISMS AND LOOK AT
HOW THE MECHANISMS AFFECT THE
WHOLE PERSON AS WELL AS PROVIDE
INFORMATION FOR TRANSLATIONAL
RESEARCH AND THEN FINALLY
CONTINUE WITH THE HEALTH
DISPARITIES RESEARCH CONDUCTED
BY DR. EVANS WHERE SHE'S TRYING
TO DISENTANGLE THE RELATIONSHIPS
AMONG RACE, SOCIO ECONOMIC
STATUS AND HEALTH OUTCOMES.
I WOULD ALSO LIKE TO EMPHASIZE
THAT THE HEALTH DISPARITIES AS
WELL AS METHODS DEVELOPMENT
WOULD BE THEMES RUN THROUGH THE
WHOLE RESEARCH CONDUCTED IN EACH
OF THE SECTIONS THAT WE ARE
TRYING TO DEVELOP.
THE WORK WOULD BE BASED ON THE
LEGACY COHORT S THAT WE HAVE AND
OVER TIME WE HOPE TO BE ABLE IT
PLAN NEW STUDIES.
WITHIN THE INTRAMURAL RESEARCH
ENVIRONMENT, I PERCEIVE LEPS TO
BE THE CORE OF METHODS EXPERTISE
AS WELL AS COHORTS THAT WE'VE
DEVELOPED THAT WOULD ALLOW
COLLABORATION WITH MANY OF THE
DIFFERENT LABORATORIES IN THE
IRP.
AS WELL AS PROVIDING
OPPORTUNITY TO DEVELOP TRAIN JEZ
AND ACROSS DISCIPLINARY RESEARCH
AND WE WOULD ALSO STRENGTHEN OUR
CONNECTS WITH OTHER NIH
INSTITUTES AS WELL AS NATIONALLY
AND INTERNATIONALLY AND CONTINUE
TO CONTRIBUTE TO THE CONSORTIUM
WHICH ARE ESSENTIAL FOR RESEARCH
IN GENTICS.
-- GENETICS.
I'D LIKE TO END WITH ONE IDEA
WE'VE BEEN DEVELOPING AND FUTURE
DIRECTION FOR THE LAB.
THIS WOULD BE STUDY IN LINE WITH
THE BSC RECOMMENDATION.
THE NEW RESOURCE IS STUDY THE
EFFECT OF DISASTERS AND CLIMATE
CHANGE ON OLDER PERSONS BROADLY
WE SEE THREE PHASES TO THE
TRAJECTORY OF THE DISASTER THE
BASELINE, THE INTERIM PERIOD OR
PERIOD TO SEE THE SEQUELAE OF
THE DISASTER ON HEALTH AND LOOK
AT SOMEBODY'S CURRENT HEALTH.
FOR THIS KIND OF STUDY WE WOULD
RELY ON MULTIPLE DATA STREAMS OF
HISTORICALLY PUBLICLY AVAILABLE
HEALTH, ENVIRONMENT, SOCIO
ECONOMIC RECORDS AND PERHAPS
ALSO CONDUCT A FACE TO FACE
EXAMINE ON A PREVIOUSLY EXPOSED
COHORT.
WE ARE LOOKING AT THE QUESTIONS
TO OLD ER PERSONS THAT NEED TO
BE ADDRESSED AND THE
MEASUREMENTS AND RESOURCES
AVAILABLE TO EVALUATE THE
AFFECTS OF THE OLDER PERSONS AND
IS THERE A SPECIFIC PERSON ONE
DUE TO WILDFIRE OR FLOODING OR
DAMAGE WE SHOULD BE STUDYING IN
PARTICULAR.
AND ONE OF THE BIOMARKERS THAT
WOULD CHANGE AND HEALTH
PARAMETERS THAT MIGHT REFLECT
THE EFFECT THE DISASTER HAS ON
HEALTH AND WHAT THE FEASIBILITY
AND FUNDING TO MOUNT SUCH A
STUDY.
THE STUDY COULD PROVIDE A
PLATFORM FOR MANY DIFFERENT
QUESTIONS RELATED TO SOCIAL AND
PHYSIOLOGIC PROCESSES AND
PROVIDE A MEANS FOR MORE
TRANSLATIONAL AND
MULTI-DISCIPLINARY RESEARCH AND
WITH THAT I WILL END.
>> THANK YOU.
IF THERE IS ONE BRIEF QUESTION.
>> CAN YOU STOP SHARING?
>> SORRY.
>> CAN YOU SEE MY SCREEN?
>> THE TRANSLATIONAL GERONTOLOGY
BRANCH LOOKS TO SEE WHAT'S
RESPONSIBLE FOR THE RELATED AGE
DECLINE IN SPECIES AND DELAY THE
PROCESS IN USING MULTIPLE
SPECIES.
WE TRY TO DESIGN AND EVALUATE
NOVEL THERAPEUTICS IN NOVEL OF
AGE AND IMPLICATIONS AND FOCUS
ON FUNCTIONAL OUTCOMES IN TERMS
OF MUSCLE FUNCTION AND TRIED TO
MAKE THE DATA AVAILABLE AND
RECRUIT AND DEVELOP THE NEXT
GENERATION OF SCIENTISTS AND AND
GET TO PLACES WHERE THEY WANT TO
BE.
THE T
THIS WAS OUR SECOND EVALUATION
AS A GROUP.
AT THAT TIME, THE EVALUATION IN
2020 WE HAD NIGEL GRIG AND JULIE
MADISON AND MYSELF AND IT WAS A
SUCCESSFUL VACCINATION OF THE
BRANCH AS A WHOLE.
IN JANUARY 2022 I CAN REPORT THE
BRANCH HAS GROWN SUBSTANTIALLY
AND WE HAD A TENURE TRACK
INVESTIGATOR HITTING THE GROUND
RUNNING.
WE HAVE AND THERE ARE SOME THAT
BECAME THE ACTING CODIRECTOR OF
THE STUDIO OF AGING AND THE MOVE
FROM THE LABORATORY ON MOLECULAR
GERONTOLOGY TO THE TRANSLATIONAL
GERONTOLOGY BRANCH.
WE TRIED TO INTEGRATE THE
INFORMATION FROM THE ENVIRONMENT
AND HOW THESE THINGS INTERACT AT
THE LEVEL OF THE ORGANISM AND
THE CELLULAR LEVEL.
AT THE CELLULAR LEVEL, WE KNOW
ALL THE INFORMATION THAT COMES
IN IS READ AT THE LEVEL OF THE
BRAIN AND HOW WE TRIED TO
UNDERSTAND HOW THIS INFORMATION
GOES DOWN.
FROM THE PLASMA MEMBRANE THERE'S
CELLULAR MARKERS AND RESPOND TO
THESE SIGNALS BY ACTIVATING THE
SIGNALLING PATHWAYS.
THESE THEN AND IT'S CONNECT HEAD
TO HALLMARKS OF AGING AND WHAT
WE'RE TRYING TO DO UNDERSTAND IS
HOW THESE MECHANISM OF HALLMARKS
THAT UNDER LIE THE PROCESS HAVE
A DIRECT EFFECT ON THE
PHENOTYPES AND UTILIZE ENERGY
AND HOW WE LOOK AT THE SYSTEMS
AND HOW THESE LEAD TO CHANGES IN
NEURODEGENERATION AND FUNCTIONAL
DECLINE AS A WHOLE AND BY
ALTERING THE ENVIRONMENT AND HOW
CAN WE DEVELOP INTERVENTIONS
THAT LEAD TO CHANGES IN
RESILIENCE AND LONGEVITY?
IN THE REPORT ON THE SLIDE DECK
YOU'LL HAVE A REPRESENTATION OF
EVERY UNIT AND THE HITS WE'RE
HAVING AND MAKE SURE YOU GET
INSIGHT ON WHAT THE NEW TRAINEES
AND RECRUITS ARE GETTING AND
WHAT OTHERS ARE DOING NOW.
THERE'S NOW A PROTEOMICS UNIT
WITHIN THE STUDY SECTION AND HIS
RECENT DIRECTIONS ARE IN THE
DEVELOPMENT OF THE NEXT
GENERATION OF AGING BIOMARKERS
WITH A FOCUS ON PROTEOMICS AND
SPECIFICALLY STUDYING SENESCENT
IN VIVO AND IN VITRO AND
INTEGRATED WITH THE NIH FAMILY
AND THE STUDY OF AGING IS
INTEGRATED WITH THE PROJECT
WITHIN MY UNIT, MY SECTION AND
LOOKING AT THE NON-HUMAN
PRIMATE.
HE'S ALSO LOOKING AT HOW PROTEIN
TURNOVER CHANGES OVER TIME IN
LONGITUDINAL STUDIES OF AGING
AND WHAT ARE THE DIFFERENT WAYS
HE CAN DEVELOP AND EVALUATE
NOVEL MARKERS OF SENESCENCE AND
BIOMARKERS ACROSS THE LIFE SPAN.
HE HAS BEEN ALREADY BEEN ABLE TO
IDENTIFY AND HIRE SEVERAL
TRAINEES AND HAS HIT THE GROUND
RUNNING IN TERMS OF GRANTS.
HE WAS ALREADY AWARDED TO STUDY
A COMPOUND IN TERMS OF THE GRANT
THAT WILL GIVE HIM FOR OVER FOUR
YEARS FOCUSSED ON SENESCENCE.
ONE OF THE THINGS IS HE'S A
LEADER IN THE DEVELOPMENT OF NEW
PROTEOMICS MARKERS AND AUTHORED
THE PAPER IN 2020 HE DEVELOPED
THE ASSOCIATE D SYMPTOMS AND HE'S
LOOKING AT THE ASSOCIATION
BETWEEN THE MARKERS IN
ASSOCIATION WITH MORTALITY
MARKERS AND THE OUTCOMES OF
HEALTH AND SURVIVAL AND LOOKING
AT HOW THE AGING PROCESS CHANGES
THE PROTEINS AT THE LEVEL OF THE
PLASMA MEMBRANE AND ALL THIS IN
THE CONTEXT OF SENESCENT CELLS.
FLOU WE HAVE -- NOW WE HAVE THE
PAPERS LINED UP AND STARTING TO
GET PUBLISHED.
SHE HAS RECENTLY HIRED TWO NEW
TRAINEES AND HAS BEEN GETTING
AWARDS AS A PERSON AND ALSO MOST
OF HER TRAINEES HAVE BEEN
EXTREMELY SUCCESSFUL GETTING
AWARDS AS WELL AS GRANTS FROM
BOTH SCIENTIFIC DIRECTOR OF
AWARDS AND THE RFA WITH NIA AND
NIEHS AND IN A PAPER PUBLISHED
WITH THE MECHANISM OF DISEASE
WAS THE POTENTIAL OF ATM
NEGATIVE KNOCKOUT AND BASICALLY
IF YOU SUPPLEMENT MICE AND LOOK
AT THE BALANCED LINEAGE YOU SEE
IT DOESN'T REALLY PRODUCE ANY
CHANGES BUT WHEN YOU DO THIS
WITH OLD WILD TYPE ANIMALS CAN
SEE THERE'S AN OVERLOAD AND
SUPPLEMENT THE ANIMALS WITH THE
LONG-TERM AFFECTS TO SEE WHAT
THE OUTCOMES WOULD BE WITH
LONG-TERM TREATMENTS.
LAST ON THE LIST, THE CHIVE OF
THE GENOMIC SECTION MOVING TO
THE TRANSLATIONAL GERONTOLOGY
BRANCH HAS BEEN ABLE TO RECRUIT
OR INHERIT SOME PEOPLE TO HIS
NEW GROUP AND CONTINUES TO BE
EXTREMELY ACTIVE WITH THE
GENOMIC INTEGRATE AND PUBLISHED
A PAPER IN NATURE COMMUNICATIONS
LOOKING AT TCOMBATTING CANCER AND
USED AN APPROACH OF TARGETING
THE CELLS AND YOU CAN SEE WHEN
HE USED BRCA 2 DEFICIENT MICE
THEY EXHIBIT AN INCREASED GROWTH
INHIBITION WHEN TREATED WITH THE
INHIBITOR.
THIS S A NEW LINE OF
INVESTIGATIONS HE'LL BE LOOKING
AT THE DIFFERENT METERS AND HOW
THEY INTERACT IN TUMOR CANCER
GROWTH.
THE TRANSLATIONAL GERONTOLOGY
BRANCH IS CONNECTED TO DIFFERENT
UNIVERSITIES THE U.S. AND THE
WORLD.
WE REMAIN A CORE CENTER OF
INTERACTION WITH HUGE
INTEGRATIVE PROJECTS AND THIS IS
ONE OF THEM AND ALL THE
INVESTIGATORS WITHIN THE
INVESTIGATIONAL GERONTOLOGY
BRANCH HAVE CONNECTIONS WITH
MULTIPLE UNIVERSITIES ACROSS THE
U.S. INCREASING THE WE DO HERE.
THIS IS THE GOAL FROM 2017 TO
2019.
THIS IS WHAT WAS PRESENTED TO
THE BOARD OF SCIENTIFIC
COUNSELORS IN 2020.
IN THE SPAN OF YEARS WE
PUBLISHED 276 ARTICLES AND LOTS
OF THEM WERE IN THE TOP 20%
ARTICLES OF OUR RESEARCH.
RIGHT NOW THE OTHER DAY WITH THE
IMPACT OF THE 2020 IN THIS TWO
YEARS WE HAVE ALREADY PUBLISHED
242 PAPERS AND THIS IS MORE THAN
10,000 CITATIONS AND YET TOO
EARLY TO SAY HOW MANY PAPERS
WILL END UP TOP FOUR CITATIONS.
IT REMAINS PRODUCTIVE AND
CONNECTED AND CONTINUE TO
INCREASE THE NUMBER OF
INTERACTION BETWEEN INTRAMURAL
AND EXTRAMURAL RESEARCHERS
REMAINING ACCESS AND THE DATA WE
HAVE PRODUCING.
YOU SEE THE PAPER AND GRANTS AND
AWARDS AND FELLOWSHIPS WE'RE ALL
GETTING AND THIS IS ALL OF US
NOT JUST A FEW OF US WITHIN AND
BENEATH THE SURFACE THERE'S A
LOT OF THINGS THAT GO UNSEEN.
THERE'S MULTIPLE PEOPLE THAT
CONTRIBUTE TO THE SUCCESS OF THE
TRANSLATIONAL GERONTOLOGY BRANCH
AND A PICTURE OF THE CURRENT
MEMBERS AND WE CANNOT BE
TOGETHER THANKS TO COVID BUT I
HOPE VERY SOON WE'LL ABLE TO GET
A CELEBRATION TO THE SUCCESS
TGB2020 TO PREPARE FOR THE NEXT
ONE COMING UP IN 2024.
I'M HAPPY TO ACHE ANY QUESTIONS
YOU MAY HAVE.
>> ARE YOU INTERACTING WITH THE
COMMON FUND INITIATIVE AND IF
SO, HOW?
>> THAT'S A FANTASTIC QUESTION.
WE JUST SUBMITTED A U54 PROPOSAL
THAT WAS AN RFA FROM THE SUNMET
DEDICATED TO THE MOUSE WE HAVE A
CON -- CONSORTIA FROM THE MAYO
CLINIC AND WE WELCOME THE PEOPLE
THAT WERE SUCCESSFUL IN SECURING
THE HUMAN SENESCENCE.
WE'RE INTEGRATING OR TRYING TO
BE INTEGRATED AS MUCH AS
POSSIBLE.
>> LUIGI, ANY FINAL REMARKS
BEFORE WE END THE CLOSED
SESSION.
>> THANK YOU FOR TRE
PRESENTATION.
YOU CAN SEE WHAT A GOOD POSITION
I AM WORKING WITH FANTASTIC,
PRODUCTIVE CREATIVE SCIENTISTS.
I COULDN'T ASK FOR MORE.
THANK YOU VERY MUCH.
>> THANK YOU TO OUR SPEAKERS IN
THE INTERMURAL PROGRAM.
THIS THEN CONCLUDES THE OPEN
SESSION OF OUR NATIONAL ADVISORY
COUNCIL ON AGING.