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October 19, 2012
NIH Podcast Episode #0170
Balintfy: Welcome to episode 170 of NIH Research Radio. NIH Research Radio bringing you news and information about the ongoing medical research at the National Institutes of Health – NIH . . . Turning Discovery Into Health®. I'm your host Joe Balintfy, and coming up in this episode in-depth interviews on suicide prevention and autism. But first, this news update. Here’s Craig Fritz.
News Update
Fritz: NIH scientists and colleagues may have discovered why a protein called MYC can provoke a variety of cancers. Like many proteins associated with cancer, MYC helps regulate cell growth. A recent study found that, unlike many other cell growth regulators, MYC does not turn genes on or off, but instead boosts the expression of genes that are already turned on. Researchers noted that they carried out a highly sophisticated analysis of MYC activity in cells, but came away with a simple rule. MYC is not a power switch but a universal amplifier. This discovery offers a unifying idea of how and why abnormal levels of MYC are found in so many different cancer types, such as breast cancer, lung cancer, and several blood cancers. This new understanding of MYC function could influence future treatment efforts for MYC-associated tumors.
“Ana's Story,” an English and Spanish comic book to teach children and teens how to avoid sports injuries, is now available through NIH. The comic-book style format engages readers and delivers important health messages. While playing sports can improve children's fitness, self-esteem, and self-discipline, it can also put them at risk for injuries. Young athletes are particularly vulnerable because their bones, muscles, tendons, and ligaments are still growing and are prone to injury. Children between 5 and 14 years of age account for almost 40 percent of all sports-related injuries. The new story features Ana, a teen soccer player, who sprains her knee during a pick-up game at a family picnic. Ana and her family learn the best way to treat a sports injury promptly to avoid future complications. This new resource also offers specific tips on how to keep sports safe for kids and prevent injuries, such as warming up before exercise and staying hydrated. Free copies of Ana’s story are available to anyone upon request. To order, call 1-(877) 226-4267.
For this NIH news update, I’m Craig Fritz.
Balintfy: News updates are compiled from information at www.nih.gov/news. Coming up later in the program, new funding and study opportunities for autism, and research strategies for suicide prevention. That’s next on NIH Research Radio.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
High Priority Research Strategies of Suicide Prevention
Balintfy: At the NIH’s National Institute of Mental Health suicide prevention is one of the highest priorities. In a recent video, NIMH Director, Dr. Thomas Insel discussed a new national strategy that’s paving the way for reducing suicide deaths. Here’s Dr. Insel talking with Dr. Jane Pearson also at NIMH.
Insel: Jane welcome. Tell us about the national strategy and what people need to know about it.
Pearson: Sure. The original strategy came out in 2001 and that was a very broad roadmap and it had lots of opportunities for a lot of people to do a lot of things about suicide prevention – which we know is a complex problem. The update focuses our approach to this in some ways and we’ve been thinking about how to change the conversation about suicide prevention. We’re also thinking about what data we need in terms of surveillance to make it useful and timely. And probably most important for NIMH is to figure out what a prioritized research approach to suicide prevention would be.
Insel: What’s so striking is if you look at the numbers- suicide hasn’t really changed that much in terms of the rate- we’ve seen the rates of homicide go down… the rates of traffic fatalities go down… both actually lower now than the national rate of suicide. What have we learned in the last decade that now could be applied to change those statistics?
Pearson: Well, we’ve made some headway I think in terms of how to treat people who have attempted suicide. We’ve figured out how to develop treatments that could address it directly but that’s not enough. I think we’re learning that we’re going to have to think of new strategies to reach people who are not in care systems and we’re trying to understand how many people we can help within the care system. How many people outside the care system and that’s why we need that surveillance data to figure out where to put our resources. We certainly want providers to know how to treat suicidal people and I think we can certainly help develop some evidence based practices there.
Insel: So, when you say there, and you’re talking about providers, of the 35, 36 thousand suicides a year in this country, which is about four per hour, what would be the right area to focus? Is it going to be in primary care or is it going to be in a hospital settings, should it be in mental health settings? Where do you think is the most important place for us to put our energy?
Pearson: I think we’re still trying to figure that out. We’re trying to make our best estimates given what we know about who attempts suicide, who dies by suicide and what those circumstances are. But it’s still a challenge to figure out, for example, the people who die outside the care system. We’re still trying to understand what settings they might have been in, how could we have reached them, what their histories are. So, that’s part of our prioritized plan what we’re working on to understand where we can make the biggest difference.
Insel: Emergency departments, is that a place we should be looking?
Pearson: Well, it’s one place that people assume they could get care for a crisis and we’re concerned because there are no evidence based practices for providers in emergency care settings, so we would like to help them find approaches to screening, approaches to managing that risk right in the setting and also help people link to care. Because we know people don’t often seek care after they’ve been to the emergency department or don’t follow up on the referrals they are given. So part of our research approach is to think about how we can bolster evidence based practices for the places that people do go when they have self-identified. (10)
Insel: And just roughly, out of the 36-thousand, how many in a given year have actually sought treatment or had a contact with the health care system but go on to kill themselves anyway? What kind of numbers are we talking about roughly?
Pearson: Well, we know from different surveys that at least 600 to 700 thousand people say in the past year they have attempted suicide and they’ve sought some medical treatment. We don’t know if they’ve gone to the emergency room or a health care provider outside that system. Because of our lack of surveillance data we just don’t know exactly where they’re being seen. So part of the challenge is to understand that flow of where patients go for help. In terms of the number of people who died who have been in the emergency department we also don’t know that. We would like to learn more. We can make some estimates but we do know that if we work harder at preventing reattempts we should have some success at preventing some deaths there as well. So we’re actually in the middle of trying to estimate what that might be and help providers- help health care systems understand what impact they could make by doing a better job to prevent those reattempts. (11)
Insel: What’s the goal? Where do you want to be in five years?
Pearson: We would really like to show that we could make a difference in changing the suicide numbers in some ways. It might be that we find out through this effort that we need that surveillance data outside the heath care systems to understand the bigger picture. And I think we’ve got a lot of help from the CDC in helping us think through how we could we get that- what’s the best way. So, it’s going to be a team effort. I think they’ll be also private entities like health care and insurance systems that might have data that we could use as well. So, we’re asking everyone to help us figure out this big puzzle.
Insel: What’s the role of the National Football League, the NFL initiative that was recently announced. How does that fit in?
Pearson: We need employers, like, we have the Army for example, focused on suicide prevention and we need their help in terms of how to talk about this in a way that if people are concerned about suicide, that they’re not embarrassed to seek treatment, that they don’t feel like they’ll be penalized for getting help. They need to know that there’s a safe way to get help. And that it could help. So, in terms of how the NFL has handled this, with their approach in integrating it into regular health care as a way of de-stigmatizing it, could be a way forward for other employers. So, it’s a great example especially for men who are often reluctant to seek help for mental health, for substance abuse issues as a way forward.
Insel: So, what about the Army? You mentioned the Army, what’s the project that we need to know about?
Pearson: So, Army STARRS is one of the largest projects on military suicide prevention and I should say risk and resilience. We’d like to understand through the study what trajectories there are in terms of individuals who have risk factors but still don’t take their own lives or attempt suicide and what protects them. We’re trying to figure out through many approaches within the study launched to a known cross sectional what those risk factors and protective factors might be. We brought to the Army what we know best about civilian suicide prevention but we know from this study, which affords us this opportunity to follow cohorts over time. A lot of information that will come back to help civilians in terms of understanding suicide prevention. (26)
Insel: One last thing. I know you’ve been deeply involved with the Action Alliance for Suicide Prevention - it’s again a national public-private partnership. You’ve specifically been deeply involved with the research task force. Where is that going and what is that supposed to accomplish?
Pearson: That group has worked very hard to identify areas where we could make some progress in suicide prevention. And I think the opportunities that have come through with the many task forces of that action alliance give us those opportunities. Some are focused on infrastructure needs. Some are focused on population needs. The research task force, they are the research prioritization task force, has worked, as you know, on defining a goal of trying to find research that would reduce the burden of suicide and we’re getting to the step now where we’re getting experts to help us think through research pathways going forward and we hope to release that next spring.
Balintfy: That was Dr. Jane Pearson at NIMH talking with NIMH Director, Dr. Tom Insel. To see the video of this interview, and to learn more about suicide research and prevention, visit www.nimh.nih.gov. Coming up, another NIMH priority: autism. That’s next on NIH Research Radio.
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NIH awards $100 million for Autism Centers of Excellence Program
Balintfy: Welcome back to NIH Research Radio. We’re turning now to autism and Autism Spectrum Disorders, in particular some new funding for research. I’m talking with Dr. Alice Kau. She’s the program director for autism research at the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development. Dr. Kau, as a reminder, can you explain a little about what Autism Spectrum Disorders are?
Kau: Sure. You know, autism now is being recognized as a group of syndromes denoted as autism spectrum disorders – and we abbreviate it as ASD – which are complex neurodevelopmental disorders. The symptoms must be present before age three but most children who eventually are diagnosed with ASD exhibit signs of ASD before and way before age two. The diagnosis of ASD is made behaviorally by assessing three areas of symptoms: impairments in social interaction, impairments in communication, and stereotypic and repetitive behaviors. The diagnosis of ASD can be made reliably before age three because the core symptoms exhibit emerge, you know, by that time.
Balintfy: What’s the prevalence of ASD?
Kau: Now according to CDC’s most recent prevalence study, about 1 in 88 children in the United States has autism and ASD are almost five times more common among boys, 1 in 54, than among girls, 1 in 252.
Balintfy: There has been a recent announcement regarding Autism Centers of Excellence. What are these centers?
Kau: The Autism Centers of Excellence or ACE research program is a trans-NIH collaboration involving five institutes. In addition to NICHD, NIDCD, NIEHS, NIMH, and NINDS are involved. ACE represents NIH’s effort in consolidating two previous autism programs. And the autism program has two components to it, one is autism centers and the other is autism network, ACE centers and ACE networks.
The differences between centers and networks are based on the design and the funding mechanism. ACE centers involves multidisciplinary coordinated programs or research that demonstrate cohesion and synergy across research subprojects and that are conducted at one institution. ACE network on the other hand are multi-site projects focusing on a specific topic of research commonly used for recruitment purpose. Both ACE centers and networks focus on supporting the broad research goals of the 2011 interagency autism coordinating committee’s strategic plan for autism research.
Balintfy: So there are nine new grantees getting $100 million of funding from five NIH institutes. What does this mean for ASD research?
Kau: Well it definitely means, shows NIH’s commitment in autism research. It also allows very large collaborative projects to take place. The design of ACE centers and networks allows large project that would not be otherwise carried out or even submitted to NIH funding. I can give you one example. One of the new ACE network involving four data collection sites and plans to recruit a large sample of individuals with ASD matched to normal controls and unaffected siblings and to examine sex-specific differences in ASD. They will connect enormous amount of behavioral, genetic and neurological data and then the total simple will be 625 individuals from age 7 to 17. So such a large project is usually unlikely to take place and funded without such an initiative from NIH.
Balintfy: Why is that kind of data and research important for ASD?
Kau: Well for example in this case, as I mentioned before, the relative prevalence between boys and the girls, in order to compare and contrast boys and girls, you need to have enough numbers of girls. So if you have only one site of research conducting and recruiting subjects, you would take like ten years or maybe even fifteen years to recruit enough subjects. But by having four sites, we can actually conduct research in five years.
Also, you know, in order to draw definitive conclusions, you need to have very well matched control samples. So that adds another level of challenge in recruitment. So it’s not just matching the boys and the girls with autism but also matching the IQ, the age, all these cognitive functioning between all the samples and it’s a huge challenge.
Balintfy: Are there some other grants or maybe some of the other research projects that you would highlight or summarize?
Kau: Sure. I thought I’ll talk about treatment projects that are funded through this cohort of ACEs because we’re always looking for treatments and these are just two very meritorious application that we are just thrilled to be able to found fund them.
The first one I want to talk about is a randomized double-blind control trial of intranasal oxytocin treatment for autism and the goal is network is to assess oxytocin efficacy in an improvement of core reciprocal social behavior deficits in autism. Up to this point, there is no biological treatment available to treat the core symptoms of autism, the social impairment. So this is really – it’s one opportunity to see if this will work.
The investigators are Dr. Lin Sikich from University of North Carolina Chapel Hill and there are three other treatment sites at Mt. Sinai School of Medicine, Vanderbilt University, and Seattle Children’s Research Institute. In addition, there will be a genetic center headed by Dr. Simon Gregory from Duke University and he will focus on how gene variations influence response. So this is – you know, if we could have some answers to it, we might even be able to predict which child would benefit from such treatment so.
Balintfy: Dr. Kau you said there’s another one?
Kau: Right. The second one I like to highlight is an intervention designed for children with minimal verbal abilities. Now it’s so important for this study to take place. It’s estimated that 30% to 40% of school-aged children with autism remain minimally verbal even after receiving years of intervention and this group of children are often excluded from treatment trials because they don’t talk and they are excluded from neuroimaging trials because they are low functioning, they can’t follow instructions. So they are what I call the neglected group of children with autism.
This study will assess a novel adaptive intervention for this group of children first by comparing two treatment approaches and second by assessing whether a parent training component would provide additional benefit. The treatment, two treatment approaches are one approach is a child-led play approach. So the therapies will follow the children’s lead, you know, play approach. The other is the traditional discreet trial adult-led more like didactic type of intervention. Children will be randomly assigned to one of the two conditions and the beauty of this study is that after six weeks, the investigator will assess their responses, all the children’s responses to the benefits of either type of intervention. And early responders, if the children show responses to such treatment you know, from the first six weeks, they will be further randomized to two conditions, one therapist only, the other with therapist and parent training. So the goal is to assess whether adding a parent training component would actually improve the outcome even more. The nonresponders actually will receive both intervention approach. So the assumption is maybe one is maybe they need even more enhanced intervention. You know, so it’s a more intense training.
Another unique feature of this study is the treatment setting. The treatment will be conducted every day at school, at school setting for four months, not in the hospitals, not in the institution, not in the lab but at the school where the children go every day.
Balintfy: So it sounds like these funding opportunities are not just for the scientists but they’re also opportunities for more patients to get involved with clinical trials?
Kau: Absolutely, yes. Okay. So once they are in the trial, they get assessment, they get attention and the parents and the whole infrastructure’s activated. It’s very exciting.
Balintfy: Thanks to Dr. Emily Kau at the Eunice Kennedy Shriver National Institute of Child Health and Human Development. For more about the recent ACE funding awards, visit www.nichd.nih.gov. And for more about autism and ASD, visit www.nimh.nih.gov.
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Balintfy: That’s it for this episode of NIH Research Radio. Please join us again on Friday, November 2 when our next edition will be available. If you have any questions or comments about this program, or have story suggestions for a future episode, please let me know. Send an email to NIHRadio@mail.nih.gov. Also, please consider following NIH Radio via Twitter @NIHRadio, or on Facebook. Until next time, I'm your host, Joe Balintfy. Thanks for listening.
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