NIH Priorities, Challenges Explored at the ACNP Annual Meeting

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CONFERENCE REPORTER

The 63rd Annual Meeting of the American College of Neuropsychopharmacology (ACNP) featured an in-depth discussion with directors from key National Institutes of Health, highlighting research and strategic priorities in psychiatry, mental health, and neuropsychopharmacology.¹ Moderated by Helen Mayberg, MD, ACNP president and director at the Center of Advanced Circuit Therapeutics at the Icahn School of Medicine at Mount Sinai in New York, the panel included George Koob, PhD, director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA); Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA); Shelli Avenevoli, PhD, acting director of the National Institute of Mental Health (NIMH); Andrea Beckel-Mitchener, PhD, deputy director of the NIH BRAIN Initiative; and Miroslaw Mackiewicz, PhD, chief of Neurobiology of Aging and Neurodegeneration, branch program director of Integrative Neurobiology, Sleep & Biorhythms at the National Institute of Aging (NIA).

NIAAA

Leading the individual reports, Koob took the stage and shared priorities from the institute’s new 5-year strategic plan. One key focus, he reported, is a “whole-person health” approach to alcohol use disorders, including integrating care for co-occurring conditions. “Alcohol affects 200 different conditions and diseases in the body. body. Most of you are familiar with liver disease, but there are profound effects on cardiovascular function, profound effects on respiratory function, and profound effects on gastrointestinal function. And that's not to mention fetal alcohol spectrum disorder and the interactions with mental illness,” he told attendees.

In discussing women’s issues as another priority, Koob highlighted the "risk severity paradox," noting that women tend to experience severe alcohol-related harms, such as blackouts, liver disease, and alcohol use disorder, at lower levels of consumption and over shorter periods than men. He also pointed out that women are less likely to receive treatment for alcohol-related issues. Research aims include studying sex differences in alcohol's effects and improving prevention and treatment strategies for women.

Regarding older adults, the last major priority, Koob emphasized the shift in alcohol's impact with age, noting that "alcohol impairs balance and coordination more as we get older," increasing the risk of falls and chronic conditions like cancer and heart disease. "Alcohol is considered now to be the largest preventable cause of cancer, except for tobacco and being overweight,” he told attenees. He also discussed mechanisms linking alcohol use to brain aging and dementia as key research areas, along with improving screening and treatment strategies for older populations​.

NIDA

Highlighting the critical role of funding in advancing science, Volkow began by sharing NIDA’s budget. “Budgets anchor us. They tell us how many degrees of freedom we have at a period in science where things are advancing so rapidly,” she noted.

Volkow also outlined promising findings with glucagon-like peptide-1 (GLP-1) receptor agonists, drugs originally developed for diabetes and obesity, saying these medications have shown potential in reducing substance use. “Patients... report that they are decreasing their drinking and interest in drugs, including alcohol and tobacco,” Volkow said, adding the agent seems to make the drugs less rewarding. Ongoing trials could solidify their role in addiction treatment. “There are data indicating that they actually may be valuable for a wide variety of neuropsychiatric diseases,” she said.

Volkow also highlighted the success of the Adolescent Brain Cognitive Development (ABCD) study, telling attendees, it is “one of the most successful projects that we've ever done." It is the largest long-term study of brain development and child health in the United States, and has an impressive 96% retention rate.

“There are, as of now, 1158 publications that are illuminating that not just the development, the developmental trajectory, of the human brain, it's diversity,” Volkow said. It's in the influence of environmental factors, the influence of genetic factors, and bringing it together in a format that is open access and allows researchers from all over the world with very different backgrounds to take advantage of it. It has advanced just our knowledge of neurobiology of development, but it also has advanced, actually, imaging technologies, per se, analytical analytics, the influence of social determinants of health. It has been extraordinary success.”

Addressing the critical role of infrastructure and data in advancing science, Volkow underscored the need for integration across disciplines. She highlighted the potential of artificial intelligence in leveraging vast datasets to inform early detection, disease prediction, and the development of interventions. Volkow emphasized the importance of systematic data collection, saying, “If we can all come together and participate in the gathering and collection of this data, we will be able to... integrate how the brain is connected as we know more and more about the circuitry and the cells and the diseases

NIMH

Avenevoli, Acting Director of the National Institute of Mental Health (NIMH), discussed initiatives in precision psychiatry, focusing on data-driven approaches to better predict and treat mental health disorders. the focus on leveraging biomarkers to tailor treatment approaches. She discussed the precision psychiatry initiative’s efforts to refine depression treatment selection, stating it "is very much focused on identifying biomarkers for existing treatments of depression to aid us in selection for treatments for individuals."

She also highlighted NIMH’s Accelerating Medicine Partnership Schizophrenia (AMP SCZ), an international collaboration developing tools that explore trajectories and endpoints in individuals at clinical high risk for psychosis. A resulting dataset was published in June, and another data upload is planned for later this month as part of the observational study (N=1940). They are also conducted a proof of principle trial.

Finally, she noted that in 2024, the NIMH celebrated its 75th anniversary.

NIH BRAIN

Also celebrating a milestone this year—a 10th anniversary— Beckel-Mitchener spoke about the NIH BRAIN Initiative. The initiative’s mission is “to revolutionize our understanding of the human brain by accelerating the development and application of innovative technologies,” she told attendees. The BRAIN initiative is unique as it was designed to work closely and collaboratively with many of the NIH institutes. She outlined the initiative’s achievements in innovative neuroimaging and data-sharing technologies, which are enhancing research into brain circuitry and mental health disorders. She stressed the importance of inclusivity and open science, saying, “We are building an inclusive workforce... and ensuring that everything we do is ethical.”

VA

Representing the Brain, Behavioral, and Mental Health Broad Portfolio of Department of Veterans Affairs for the NIH leadership forum, Smyth spoke of the VA's robust portfolio and strategic priorities for advancing mental health research, which includes PTSD, suicide prevention, pain management, opioid use, and military exposure-related conditions.

The VA’s Precision Mental Health Initiative is rooted in the Million Veteran Program, the world’s largest genomic database tied to a health care system, now with over 1,050,000 enrollees. “This makes us the largest genomic database in the world affiliated with a health care system,” she told attendees, underscoring the program's focus on leveraging genetic, lifestyle, and environmental data to advance brain and mental health research​.

She also detailed the VA’s emerging research into psychedelic therapies for mental health. “We started a psychedelic research initiative in January of this year,” Smyth noted, adding that the VA had published its first request for applications focused on mental health uses for psychedelics. This reflects the VA’s commitment to exploring innovative treatments for veterans​.

Among the VA’s strategic priorities, Smyth highlighted efforts to increase veterans' access to high-quality clinical trials and to ensure that VA research translates into real-world benefits. “We are focused on increasing the substantial real-world impact of VA research, putting our VA data to work for veterans, and actively promoting diversity, equity, and inclusion within our sphere of influence,” she stated. These goals align with the VA’s 7 cross-cutting priorities, including addressing health disparities and improving outcomes for women veterans, she added​.

NIA

The NIA is the third-largest institute at NIH, driven by strong congressional support, Mackiewicz told attendees, adding the institute is celebrating its 50th anniversary. Mackiewicz emphasized its commitment to diversity and inclusion across its research initiatives.

He described the NIA’s leadership in Alzheimer’s Disease and Related Dementias (ADRD) research, with ongoing analysis of priority areas expected to yield a critical report by early 2025. In this area alone, there are 67 active pharmacological trials, 152 active nonpharmacological trials, and 201 active trials in dementia care and caregiving. Plus, 21 trials exploring the disease process; 17 examining diagnostic tools, assessments, and imaging studies; and 3 looking at treatments for neuropsychiatric symptoms.

The session concluded with a moderated question and answer session, based on questions submitted by audience members, discussing everything from determining which institute to address when interested in conducting a study, how to share and use data better, and the importance of diversity in clinical trials and research.

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Reference

1. Q&A Forum with Institute Directors. 2024 ACNP Annual Meeting. December 8 – 12, 2024. Phoenix, Arizona.