The U.S. federal budget blues are not going anywhere anytime soon, but Sen. Roy Blunt (R-Mo.), chairman of a Senate Appropriations subcommittee, said in a March 8 hearing that Senate appropriators are committed to a $2 billion annual increase in the NIH budget, which would combine with other recent increases to boost NIH funding by more than $44 billion over the coming decade.

Blunt chaired the March 8 meeting of the Senate Appropriations subcommittee with jurisdiction over the Department of Health and Human Services, and said the hearing was to "establish our firm commitment to the National Institutes of Health," despite that the U.S. federal government's budget problems are expected to persist. Blunt pointed out that Congress recently provided a $2 billion annual increase in NIH funding along with the $480 million annual increase for cancer research included in the 21st Century Cures Act.

Blunt said, "consistent, sustained increases in funding are essential" if the government is "going to encourage young researchers" to maintain their interest and their employment in the life sciences. He said the Senate remains focused on providing an additional $2 billion a year at NIH for basic research, an amount proposed by the committee last year in its workup for the fiscal 2017 budget.

Ranking member Sen. Patty Murray (D-Wash.) said NIH is "on the cusp of major breakthroughs in so many diseases," but cited considerations such as an increase in defense spending as "a very real threat to this committee's ability to fund future research." She also cited the health care overhaul as a threat, but noted that most of the spending bills for the balance of fiscal 2017 are still in process.

One of the witnesses to testify at the hearing, Timothy Eberlein of the Siteman Cancer Center in St. Louis touted some of NIH's past successes in cancer research, including that cancer mortality is down by 25 percent since 1991. This is "a direct result of improvements in treatment" funded by the agency, Eberlein said, adding that sustained appropriations "have allowed us to understand the fundamental biology behind human disease."

Eberlein said four of five breast cancer patients receiving surgery, chemotherapy and radiotherapy might not need chemotherapy, but he acknowledged, "the scientific challenge is that we don't yet know how to distinguish between the 20 percent who need chemotherapy from the 80 percent who don't." He explained that genomic analyses of tumors and biomarkers have identified 98.6 percent of mutations associated with "human malignancy," and that a relational database tying clinical and genomic information would help providers optimize treatment.

"Having 98.6 percent [of mutations] is a wonderful start," Eberlein said, adding, "We're looking for the remaining 1.4 percent of drivers of mutations."

THE ALZHEIMER'S FACTOR

Thomas Grabowski Jr., of the University of Washington in Seattle, said one of nine Americans past the age of 65 suffers from dementia driven by Alzheimer's disease, which he said exerts "outsized" effects on patients' families. The number of Americans diagnosed with Alzheimer's will "double or even triple by 2050," Grabowski claimed.

Grabowski said Alzheimer's presents "with a lot of heterogeneity," occurs at different ages and affects different parts of the brain in different ways. Amyloid formations are not the only factor of interest to scientists, who are also examining the roles of innate immune response and protein trafficking as well. Studies of presymptomatic patients driven by amyloids are underway, and Grabowski said amylioids can be detected in the brain 15 years prior to onset of symptoms. Based on the data currently available, Alzheimer's is "a tsunami with a big iceberg in it," he said.

Grabowski said medical science has yet to determine why some people with evidence of amyloid deposition develop Alzheimer's later in life than others. A lifestyle that provides routine cognitive stimulus is still associated with delayed onset, he said, but mouse models have yet to provide proof of an effective treatment.

Grabowski said that trials of agents designed to remove amyloid deposits have not fared well, and that trials are underway to address prevention of this disease in presymptomatic individuals, including the Alzheimer's Prevention Initiative and the A4 study. The A4 study, sponsored in part by NIH, is "the acid test" for the amyloid question, he said, noting that by some accounts, the costs associated with Alzheimer's will reach $1 trillion annually by 2050.

COMMUNICABLE DISEASES

Stacey Schultz-Cherry of St. Jude Children's Research Hospital in Memphis, Tenn., a researcher in communicable diseases, said the importance of NIH funding in that area is highlighted by the fact that since 1980, one to three new pathogens transmitted to humans from animals have been identified each year. However, she said, Ebola and Zika have demonstrated that these more or less novel pathogens are not limited to the developing world.

"Stable funding for NIH is key" to building and sustaining relations with researchers in other nations, Schultz-Cherry observed, stating that an NIH grant to St. Jude led to a collaboration with researchers in another nation that aided in the effort to deal with severe, acute respiratory syndrome. Avian flu is popping up again in the U.S., she continued, and Schultz-Cherry made reference to what she said is "a disturbing trend in patents awarded to researchers in the U.S." for pathogen-related inventions. She said the global share of such patents coming from the U.S. is down to 37 percent, a sharp drop from the 60-plus percent in previous years.

Vaccines are losing efficacy in part due to limited effect in obesity, and Schultz-Cherry said a universal vaccine is in the works, although viral adaptation will require tweaks to any such vaccine. "We're making great strides, and there are many people focusing on making a universal vaccine," she stated, which could be available within 10 years, assuming NIH support remains vigorous.