Mr. Chairman and Members of the Committee:
I am pleased to present the President’s Fiscal Year 2011 Budget request for the National Institute on Aging (NIA) of the National Institutes of Health (NIH). The FY 2011 budget includes $1,142 Million, which is $32 Million more than the FY 2010 appropriation of $1,110 Million.
The National Institute on Aging leads the national effort to understand the nature of aging and the diseases and conditions that are common among older adults. In addition, we support the development of interventions that will help older adults enjoy robust health and independence, remain physically active, and continue to make positive contributions to their families and communities. We support and conduct a comprehensive and integrated portfolio of genetic, biological, clinical, behavioral, and social research related to the aging process, healthy aging, and diseases and conditions that often increase with age. We also support programs that carry out the crucial task of training the next generation of researchers who specialize in understanding and addressing the issues of aging and old age.
AN AGING NATION AND AN AGING WORLD
Our nation is currently in the midst of an unprecedented demographic shift. Data from the Federal Interagency Forum on Aging-Related Statistics indicate that the number of Americans ages 65 and older will double within 25 years. In less than 50 years, the number of “oldest old” – people ages 85 and older – may quadruple. As record numbers of Americans reach retirement age and beyond, profound changes will occur in our economic, health care, and social systems.
The changes in the American population reflect changes occurring worldwide. According to Census Bureau data, in 2008 about 7 percent of the world’s population – approximately 506 million people – were 65 years of age or older. By 2040, that number is projected to double. At the global level, this dramatic change in population demographics is expected to translate into a significant increase in death and disability related to age-related chronic diseases such as cardiovascular disease, Alzheimer’s disease, cancer, and diabetes.
NIH identifies and analyzes aging-related trends in the United States through the Health and Retirement Study (HRS), the nation’s leading source of combined data on health and financial circumstances of Americans over age 50. Now in its 17th year, HRS investigators survey over 20,000 people at two-year intervals. The study and provides researchers with an invaluable and growing body of multidisciplinary data on the physical, mental, and financial health of older Americans. HRS staff also provides advice for similar surveys in Europe, Mexico, Asia, and elsewhere. A major effort is currently underway to enhance cross-comparability of these surveys and facilitate innovative cross-national research.
UNCOVERING GENETIC CLUES TO DISEASE AND DISABILITY
The rapidly expanding field of genomics is transforming our understanding of the origins of disease and disability. The technology now exists to conduct genome-wide association studies (GWASs) – rapid comparisons of the full genomes of thousands of individuals – to pinpoint the specific genetic alterations involved in the maintenance of health and the development of disease. Identifying such changes advances our understanding of the factors that may contribute to overall disease risk as well as how genes affect development of disease. This may lead to the identification of novel disease pathways that can be targeted to develop new treatments.
The largest GWASs reported to date involving Alzheimer’s disease (AD) and Parkinson’s disease (PD) have given us important insights into both diseases. In one study, NIA-supported investigators identified two new possible genetic risk factors for late-onset AD, the most common form of the disease. The study, which pooled DNA samples from a number of European and U.S. groups, associated variations in the sequence of the CLU and PICALM genes with increased risk. The investigators also found another 13 gene variants that merit further investigation. In a separate study, an NIH-led international team of investigators found that two genes with mutations known to cause rare familial forms of parkinsonism are also associated with sporadic PD. The investigators also replicated findings from an independent study from Japan in which a different combination of genetic variants was found to increase risk in people of Japanese descent. This finding highlights the power of GWASs in comparing risk factors across different populations.
TRANSLATING BASIC SCIENCE INTO NEW INTERVENTIONS
NIA supports a comprehensive portfolio of research that builds on basic discovery to develop new preventive, diagnostic, and therapeutic interventions. One highly successful translational research initiative is the Alzheimer’s disease Neuroimaging Initiative (ADNI). ADNI investigators made a significant step forward last year in developing a test to diagnose the early stages of AD more accurately by measuring two biomarkers—tau and beta-amyloid proteins—in cerebrospinal fluid. Last year, funding under the American Recovery and Reinvestment Act (ARRA) expanded the scope of the original ADNI research by allowing enrollment of participants at an even earlier stage of mild cognitive impairment (MCI; often a precursor condition to AD), when symptoms are less severe. Other expansions planned for ADNI include a genome-wide association study of participants, which will create the most extensive and robust dataset of its kind in the AD field; a study that facilitates longitudinal analysis by the collection of additional cerebrospinal fluid from participants over several years; and a study exploring the use of positron emission tomography in conjunction with the tracer agent Pittsburgh Compound B as a tool for developing biochemical markers.
Importantly, clinical, imaging, and biological data from ADNI are immediately made available to all qualified scientific investigators in public and private sectors worldwide, whether they are part of the study or not. Many of the tools and methods developed by the study are fueling similar efforts in Japan, the European Union, and Australia. This groundbreaking program will be active through FY2010 and is slated for potential renewal in FY2011.
NIA also supports an AD Translational and Drug Discovery Initiative to expand and intensify the translation of basic research findings into clinical studies and human trials. There are currently over 40 projects funded through this program exploring a broad range of approaches. This initiative is carried out in partnership with the National Institute of Neurological Diseases and Stroke and the National Institute of Mental Health. In addition, NIA supports a robust program of pilot clinical trials to test interventions aimed at delaying the onset of or preventing AD, MCI, and age-associated cognitive decline; slowing, halting, or, if possible, reversing the progressive decline in cognitive function; and modifying the cognitive and behavioral symptoms of AD and MCI.
A continuing translational research success story for NIH is the ongoing development of the compound exendin-4. NIA intramural investigators developed exendin-4 as a potential treatment for type 2 diabetes, a condition for which risk increases with advancing age, and the drug received FDA approval in 2005. Today, it is widely prescribed. But the story doesn’t end there: NIA investigators have now found that exendin-4 may act as a neuroprotective agent in animal models of Parkinson’s disease, Huntington’s disease, stroke, and Alzheimer’s disease. Research is continuing on this versatile compound.
The development of interventions that will extend life span as well as health span is an emerging area of study at NIA. Through the innovative Interventions Testing Program (ITP), NIA-supported researchers are investigating interventions with the potential to extend life span and delay disease and dysfunction in mice. The long term goal of this research is to identify interventions that are likely to have a beneficial effect in humans. In a recent ITP study, the drug rapamycin, used to help prevent rejection of transplanted organs in humans, was found to extend life span in mice. Rapamycin is an inhibitor of the mTOR (mammalian target of rapamycin) pathway, which helps to regulate cell growth and proliferation. Because rapamycin powerfully suppresses the immune system, its utility in extending the human life span is probably limited. However, this research has more clearly identified the mTOR pathway as important for extending life span and may lead to the development of other compounds that target this pathway in ways that do not cause harmful side effects.
USING SCIENCE TO INFORM HEALTH CARE REFORM
Research that will lead to the identification of more effective and less expensive clinical interventions is a high priority for NIA. We support a broad portfolio of comparative effectiveness research (CER). Ongoing CER research includes a large study comparing the effectiveness of an enhanced oral care intervention vs. “usual care” in preventing pneumonia among nursing home residents; a trial comparing a regional nerve block vs. routine analgesia in managing pain and maintaining function after hip fracture; and a variety of studies comparing the effectiveness of different strategies to improve health care access and quality in older patients with chronic diseases. NIA also leads a joint NIH-Agency for Health Care Research and Quality effort (supported by Department of Health and Human Services ARRA funds) to solicit research on how principles of behavioral economics could be used to encourage health care providers to incorporate findings from CER studies into their practices.
One of NIA’s most urgent priorities is to improve our ability to reduce health disparities and eliminate health inequities among older adults. NIA works to identify ways to reduce health disparities through its Resource Centers for Minority Aging Research. The Institute has also compiled a web-based toolkit on outreach, recruitment, and retention of minority populations in clinical research on aging. Through the Healthy Aging in Neighborhoods of Diversity across the Life Span study, NIA intramural researchers are continuing their efforts to disentangle the complex relationships among race, socioeconomic status, and health outcomes. Other programs, notably the NIA Alzheimer's Disease Centers, have a strong focus on minority health and health disparities in both research and outreach.
Once again, thank you. I welcome your questions.