Central Texas Researchers at Forefront of Personalized Medicine

From The Genes of PTSD

Excerpts from WRITTEN STATEMENT OF JOEL KUPERSMITH, MD CHIEF RESEARCH AND DEVELOPMENT OFFICER DEPARTMENT OF VETERANS AFFAIRS BEFORE THE HOUSE COMMITTEE ON VETERANS' AFFAIRS SUBCOMMITTEE ON HEALTH October 4, 2007

(Root Cause of PTSD participation highlighted)

Mr. Chairman and members of the Subcommittee, thank you for the invitation to appear before you today to discuss the Department of Veterans Affairs (VA) medical and prosthetic research program. I appreciate this opportunity to discuss the vital role VA research and development has in ensuring the health and well-being of our Nation's veterans. With me are Dr. Timothy O'Leary, Director of Biomedical Laboratory and Clinical Science Research and Development, and Dr. Michael Selzer, Director of Rehabilitation Research and Development. Introduction
Let me first say that the future of medicine is determined by research. Just as the advances in medicine that save and improve lives today would not have occurred without yesterday's research, the advances in medicine that we have all grown to expect will not occur without today's and tomorrow's research. Dating back more than 80 years, VA research has been a valuable investment with remarkable and lasting returns for veterans and the Nation as a whole. I am sure that you are familiar with the many awards won by VA investigators-3 Nobel prizes, 6 Lasker awards, and many others. But what is more important is the large number of treatments and procedures that have been developed and effectively proven by VA investigators. VA research has taken special advantage of its connection to clinical care and is replete with examples of how it has improved care, including:…………

Mental Health Research


In addition to combat-related mental health, VA continues to support a strong behavioral and psychiatric disorders research portfolio focused on further understanding and treating mental health problems in veterans. Investigations are directed toward substance abuse, PTSD, adjustment and anxiety disorders, psychotic disorders, dementia and memory disorders, and related brain damage. Many laboratory studies are being conducted to better understand the changes that take place when someone is suffering from adjustment problems or mental illness. Clinical trials are underway to test novel drug and therapy treatments specifically targeted to help veterans. Additionally, VA has a strong program for developing and implementing better mental health care, including enhancing collaborative care models, improving access to mental health care through innovations such as telemedicine and the Internet, and reducing barriers to veterans seeking mental health care. Several ongoing projects are investigating how veterans with mental illness might benefit from rehabilitation approaches, including vocational rehabilitation, skills training, and cognitive therapy to improve everyday functioning and work performance. Future research will enable VA to determine how to care for veterans with mental illness so that they can return to their highest level of functioning.

Personalized Medicine


Personalized medicine means tailoring care to the individual, in this case the veteran. In 2006, VA launched the Genomic Medicine Program as part of its Personalized Medicine Initiative. Genomic medicine is the direction for health care in the twenty-first century. It could allow VA to provide care that is tailored specifically to the genetic makeup of individual veterans, increasing the effectiveness and safety of health care and disease prevention efforts. Currently, VA is funding over 140 research projects related to genomics. These include studying the complete set of DNA of many people to determine what genetic changes are associated with a certain disease (genome-wide scans), the role of specific genes, and genetic determinants of variable responses to drugs (pharmacogenomics). These studies are investigating the role of genetics in many diseases of importance to veterans-including psychiatric disorders (e.g., schizophrenia, depression, PTSD, and anxiety); cancers of the prostate, breast, colon, lung, and bladder; heart disease; diabetes; Alzheimer's disease; stroke; Parkinson's disease; autoimmune disorders, including rheumatoid arthritis and lupus; GWVI; and chronic viral infections such as HIV. VA investigators recently conducted a genome-wide search for schizophrenia susceptibility genes. The study included 166 families with more than two affected individuals, from seven VAMCs. There are 216 affected sibling pairs in these families, comprising the largest North American sample of schizophrenic sibling pairs to date. Preliminary data from the researchers' genome scan suggest the involvement of a small region on chromosome 18. The team will continue to narrow the search by fine-mapping this region and seeking specific genes. VA has established a Genomic Medicine Program Advisory Committee comprised of the nation's leading clinicians, scientists, administrators, as well as veteran representatives. The committee has recommended the establishment of several working groups. It has also discussed issues such as who should have access to data generated by this program, assessment of veterans' attitudes towards genomic medicine, and establishing veterans' trust. An Ethics Advisory Working Group, which will report through the Genomic Medicine Program Advisory Committee, has also been established. Members of this working group include bioethicists, a member of the clergy, and veterans. The first meeting of this group was in May 2007. Topics of discussion included the ethics of the informed consent document, special populations (e.g., those with mental illness), and the role of group vs. one-on-one discussions for educating veterans about the program. In addition, last week VA held the first meeting of its PTSD Genetics Working Group to explore and define a research program to identify the genes that are important in how an individual responds to the experience of deployment, especially their response following combat exposure. By carefully characterizing those affected by combat-related PTSD and conducting genetic analyses, VA will be in a position to identify genetic variants that contribute to PTSD and other post-deployment adjustment disorders such as major depression. Once this program is established, this resource will be available for continued research including studying the genetic relationship to treatment response. ...................................

Conclusion


Because more than 70 percent of VA researchers are also clinicians caring for veterans, VA is uniquely positioned to move scientific discoveries from investigators' laboratories into patient care. In turn, VA clinician investigators can identify new research questions for the laboratory at the patient's bedside, making research one of VA's most effective tools to continue improving the care of veterans. The fundamental goal is to address the concerns of the entire veteran population from the youngest soldier who returns with injuries from recent conflicts to the aging veteran, and to use research findings proactively to benefit the future veteran. VA takes great pride in the research that keeps it at the forefront of modern medicine and health care and expects to see further remarkable discoveries in the coming decades. Mr. Chairman, that concludes my statement. I am pleased to respond to any questions you or the Subcommittee members may have. Thank you.