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Masliah says that compared with a few years ago, when less than half of NIH’s portfolio in Alzheimer’s was devoted to areas other than \u03b2-amyloid or tau, it’s now more than 60% for translational studies and about 70% for basic research. \u201cI do believe there is more money available for us to explore these other ideas,\u201d says Carol Colton of Duke University in Durham, North Carolina, who studies inflammation as a possible cause of Alzheimer’s. She and others add, however, that the academics called on to review NIH grant proposals are sometimes less open-minded than NIA staff and nix proposals in new areas. They \u201cneed to catch up,\u201d Colton says.<\/p>\n
To cast an even wider net, NIA is offering 1-year funding supplements to researchers already funded by NIH in other areas who want to add an Alzheimer’s component to their research. The hope is that the extra money will lead to full-fledged proposals.<\/p>\n
Alzheimer’s grants are now much easier to get than other NIA grants: For most Alzheimer’s proposals this year, those ranked in the top 28th percentile by peer-review panels get money. For non-Alzheimer’s grants, that pay line is the 19th percentile. The competition for grants is still stiff, Hodes stresses. After all, he notes, high-quality applications for the Alzheimer’s pool of money have \u201cincreased dramatically\u201d in the last couple years \u201cas word got out.\u201d<\/p>\n
NIA grantees in fields with scarcer funding aren’t complaining, so far. Some recipients even suggest they’re benefiting because competitors in the field of aging are shifting into Alzheimer’s. \u201cParadoxically, the new funding injection could improve everyone’s chances of funding,\u201d says Duke psychologist Terrie Moffitt, a member of NIA’s advisory council.<\/p>\n
NIA HAS HAD TO BE CREATIVE<\/strong>\u00a0to cope with the tide of applications for the Alzheimer’s bounty, agency officials say. After a crushing scramble to process grant proposals last summer, this year NIA called early for proposals and scheduled peer-review panels even before it knew its final 2018 budget. Adding to the pressure, President Donald Trump’s administration imposed a federal hiring freeze last year that was only recently lifted at NIH. \u201cI think our staff has managed heroically to still be doing an extremely conscientious job. \u2026 Where we’ve compromised probably is the quality of life of a lot of our staff,\u201d Hodes says.<\/p>\nAt the NIH Center for Scientific Review in Bethesda, which arranges peer-review panels for much of the funding, \u201cWe’re handling the load as best we can,\u201d says acting Director Noni Byrnes. The pool of potential reviewers\u2014U.S. Alzheimer’s researchers who aren’t applying for the new funding themselves and so don’t have a conflict of interest\u2014is limited. So, for NIAorganized review panels, the institute is also using Alzheimer’s experts in Canada and Europe, says Ramesh Vemuri, NIA’s chief of scientific review.<\/p>\n
Clinical trials won’t be easy to staff either. Clinical researchers and neuropathologists focused on dementia are in short supply, says Alzheimer’s Association Chief Science Officer Maria Carrillo. NIA is trying to attract them by funding fellowships. Another huge problem is finding enough subjects for trials\u2014especially those who are at high risk for the disease but still without symptoms, the population on which some researchers think amyloid-busting drugs could yet work. NIA plans to launch a national recruitment strategy that includes raising awareness about trials.<\/p>\n
Looming over the massive research push is the 2025 goal. It was set when optimism ran high that drug trials based on the \u03b2-amyloid hypothesis would pan out, Carrillo and others say. But if patients must begin antiamyloid treatments well before symptoms set in, seeing clinical benefits could take decades, Gandy notes. And the chances of meeting the deadline by targeting a different disease mechanism are small; such treatments remain far off. Still, Holtzman hopes for good news from an antiamyloid treatment trial. \u201cSomething is likely to be approved by 2025. It won’t be the be all, end all,\u201d he says, but he hopes it will keep everyone motivated. \u201cBecause we don’t just need money from the NIH, we need the pharmaceutical industry to not drop out\u201d\u2014as Pfizer did this year when it announced it was abandoning Alzheimer’s research.<\/p>\n
Some researchers point to the mixed success of NIH’s other disease \u201cwars\u201d: AIDS funding hasn’t led to a cure or a vaccine, though it has yielded drugs that allow people infected with HIV to lead nearly normal lives. The war on cancer has led to treatments that are improving survival, but cancer remains the second-leading cause of death in the United States.<\/p>\n
That history makes former NIH Director Harold Varmus cautious about the 2025 goal. \u201cNo one denies the enormous need to make progress against Alzheimer’s,\u201d he says. But, \u201cI wish a date were not attached.\u201d<\/p>\n
Hodes concedes that, like real wars, disease wars can last far longer than anyone imagined\u2014or feared. But that doesn’t mean it was a mistake to launch an all-out offensive against Alzheimer’s disease, he says. \u201cIf 2025 comes and we haven’t achieved all we wanted, I’m not going to stop there and declare failure.\u201d<\/p>\n
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