On the Vanguard of Science

Four of Brazil’s recently created National Institutes of Science and Technology are coordinated by psychiatrists, with research projects aimed at state-of-the-art scientific output.

Some research projects can set new paradigms and represent important strides in various fields of knowledge. However, the funding needed for such projects is relatively high. To encourage cutting-edge scientific output in Brazil, the National Institutes of Science and Technology (INCT) were created last year, and will receive the largest budget input for research in the history of Brazil: R$ 520 million (nearly U$ 300 million).

In December 2008, the Brazilian National Research Council (CNPq) announced the projects that were approved for participating in the program, created to improve the previously existing Millennium Institutes, which sponsor state-of-the-art research in strategic areas for the country’s development.

Of the 261 proposals that were submitted, 101 projects were selected and have already begun their activities. Four of these institutes are coordinated by psychiatrists: Flavio Kapczinski, from Rio Grande do Sul, who coordinates the Institute for Translational Medicine; Eurípedes Constantino Miguel Filho, from São Paulo, who heads the Institute for Child and Adolescent Developmental Psychiatry; Ronaldo Laranjeira, also from São Paulo, coordinator of the Institute for Public Policies on Alcohol and Other Drugs, and Marco Aurélio Romano, from Minas Gerais, who heads the Institute of Molecular Medicine.

According to the Ministry of Science and Technology, the Institutes have various objectives, including: mobilizing and convening the best research groups in cutting-edge fields of science; promote internationally competitive scientific research; develop state-of-the-art research; promote the advancement of national scientific capability, creating attractive and stimulating environments for talented students at various levels; establish programs that contribute to the improvement of science teaching and the dissemination of science for common citizens, and support the installation and functioning of laboratories in teaching and research institutions and private companies.

The Institutes were created in partnership with the Coordination for Graduate Studies (CAPES, Ministry of Education) and the State Research Foundations from Amazonas (FAPEAM), Pará (FAPESPA), São Paulo (FAPESP), Minas Gerais (FAPEMIG), Rio de Janeiro (FAPERJ), and Santa Catarina (FAPESC). A total of R$ 520 million in funds will be disbursed in the first three years. This amount includes R$ 30 million (U$ 17 million) in scholarships to be granted by CAPES, plus funds from the Ministry of Health. The project is scheduled to last five years. Funding has initially been earmarked for the first three years; after an evaluation, a decision will be made as to continuing the support for two additional years.

According to Marco Antonio Zago, President of the National Research Council (CNPq), the Institutes that have been approved will occupy a strategic position in the National System of Science and Technology, especially due to their thematic focus on specific fields of knowledge, long-term development, and greater complexity in their organization and financial size.

The National Research Council and a project coordinating committee will monitor each Institute’s performance. Given the initial goals, the program will be evaluated by the Center for Strategic Management and Studies (CGEE), a social organization supervised by the Ministry of Science and Technology.

The President of the Brazilian Association of Psychiatry (ABP), João Alberto Carvalho, commented on the approval of the four Institutes coordinated by psychiatrists: “This significant participation by our specialty in a project that involves areas like agribusiness, nanotechnology, and education highlights the quality of our science output and the need to invest in this type of research.”

Since the project specifications provide for dialogue and cooperation between the research groups, the psychiatrists that coordinate Institutes have already agreed to collaborate in the development of their specific projects, as explained by Marco Aurélio Romano from the Institute of Molecular Medicine: “The National Research Council has requested that the Institutes form collaborative networks, and the four groups headed by psychiatrists intend to create such a network.”

Ronaldo Laranjeira, coordinator of the Institute for Public Policies on Alcohol and Other Drugs, also highlighted the initiative. “The four Institutes in the field of mental health are well-positioned to collaborate. Their areas are distinct, but complementary. In addition, they are people that find it easy to collaborate. We [four coordinators] are colleagues and share similar values in relation to science. If we can’t collaborate, I don’t know who can,” he commented.

The following are summaries of the projects developed by the four Institutes coordinated by psychiatrists.

Early intervention
The Institute coordinated by São Paulo psychiatrist Eurípedes Miguel Filho seeks to implement and consolidate new approaches to the specialty, namely developmental psychiatry. According to Eurípedes, the Institute’s main idea is to implement forms of early intervention in children adolescents that show a predisposition to develop various mental disorders. “We want to work within a new paradigm, which is the idea that psychiatric disorders begin in childhood and are disorders of cerebral development,” he explained.

The Institute consists of 16 projects with specific approaches. Studies will range all the way from animal models to epidemiological research beginning in pregnancy, and including clinical trials and early intervention tests for the prevention of mental illnesses like attention deficit-hyperactivity disorder (ADHD), anxiety disorders, schizophrenia, and bipolar mood disorder, among others.

According to the Institute’s coordinator, this research can create a new focus for work in the specialty, which would also deal with prevention and health promotion, in addition to helping treat disorders. “With the understanding that such illnesses begin in childhood, we will attempt to find objective parameters to define intermediate phenotypes, clinical characteristics potentially suggesting that the illness will appear over time.”

According to Eurípides, these characteristics will be identified through new advances in the neurosciences, among other tools. “We will soon be able to sequence the genes in these children and − based on their genotypical, clinical, and endophenotypical characteristics − identify those at risk of developing a given disorder. For those at risk, we will test interventions in the environmental risk factors to avoid their developing the illness, the final expression of which is related to interactions between genes and the environment,” he explained.

The project contemplates studies ranging from the prenatal phase until adolescence. According to Eurípedes, the experiences are important because early interventions tend to be more effective than treatment performed after the illness appears. “In most disorders, we act in a limited way. In general we don’t have a cure in psychiatry. Most disorders evolve chronically, and we don’t achieve total recovery.”

One of the principal research projects in the Institute is an unprecedented epidemiological study in child and adolescent psychiatry in Brazil. The project will investigate the prevalence of psychiatric disorders in school-age children (first to ninth grades) in more than a thousand cities in the country. “We’re going to study all of Brazil, including the semiarid area, in order to prepare specific interventions, learning how the disorders relate to problems like dropout and disciplinary problems and sub-clinical (undiagnosed) symptoms.”

In parallel, the researchers are developing an economic study to evaluate the cost-benefit relationship of early interventions. There are also training projects for parents, teachers, and professionals in the Family Health Program and a final module on technology, in which telemedicine resources will be applied.

Eurípedes, who works at the Institute of Psychiatry (IPq) at the University of São Paulo, shares the project coordination with Luis Augusto Rohde and Marcos Mercadante (coordinator of research).

In addition to the Institute of Psychiatry, the Institute for Child and Adolescent Developmental Psychiatry includes professionals from the Federal Universities in São Paulo (UNIFESP), do Rio Grande do Sul (UFRGS), Bahia (UFBA), Pernambuco (UFPE), and Rio de Janeiro (UFRJ), in addition to the Mackenzie Presbyterian University, the Federal University in Santa Maria, the Methodist University in Rio Grande do Sul, and the Júlio de Mesquita Filho São Paulo State University (UNESP). International research centers like Yale, Texas, Harvard, Duke, Johns Hopkins, UCSD, and UCLA in the United States and the Institute of Psychiatry in London are also collaborating with the Institute.

Public policies
To approach scientific data and the public power to define measures with proven efficiency for fighting drug addictions is one of the main objectives of the Institute for Public Policies on Alcohol and Other Drugs, coordinated by psychiatrist Ronaldo Ramos Laranjeira of the Unit for Research on Alcohol and Drugs (UNIAD) at the Federal University in São Paulo.

The researcher spoke about the studies that the Institute has begun to develop. “One of the main projects is the second national survey on drug consumption patterns, which includes projects for the evaluation of relevant public policies, like the issue of drinking and driving, surveillance of sales to minors, and training for professionals working in the area of drug addiction.”

According to Laranjeira, data from the survey will allow comparisons and evaluation of the efficiency of policies adopted since the first survey, published in 2007. The project will also include research on new public policy proposals, to test their efficacy in the Brazilian reality.

In addition to professionals from UNIAD, the Institute also includes researchers from Santa Catarina (Marcos Zaleski and Tadeu Lemos, from the Federal University in Santa Catarina), Rio de Janeiro (Vilma Aparecida da Silva, from the Fluminense Federal University), Paraná (Marco Bessa, who also heads the Paraná State Association of Psychiatry), and Espírito Santo (Maria Carmen Viana, from the School of Medicine at the Vitória Mercy Hospital).

According to the coordinator, the various centers participating in the Institute will work in collaboration. “We prefer this approach, with various groups involved in the same research. But we can also conduct a study at a single center. We intend to optimize this interaction,” he explained.

According to Laranjeira, such collaboration is necessary to strengthen the work. “Although it is an important area, there are still few research groups [in alcohol and drugs] in Brazil. The main ones were invited to take part in the Institute. We attempted to combine the people that already had at least several years of experience in drug addiction research.”

The first study at the Institute seeks to measure the impact of the so-called “Lei Seca” [literally the “Dry Law” or Prohibition Act] on drinking and driving in Brazil. “We’re already evaluating this change and its impact in Belo Horizonte and São Paulo. This is already happening. We also have a book that’s practically ready, that will be released in the next few weeks, that describes the best policies related to drinking and driving,” said Laranjeira.

The study highlighted by the coordinator has the same characteristics as one performed before the “Dry Law” was enacted. It involves random breath tests with drivers in five Brazilian cities, with more than five thousand vehicles. Comparison of the results will allow the researchers to determine to what extent the new legislation has influenced motorists’ behavior.

The second focus of the Institute’s work will be the effect of liquor advertising on teenagers’ behavior. “Next, we will study the impact on teenagers of changes in the inspection of liquor distribution and sales,” commented Laranjeira.

The Management Board of the Institute for Public Policies on Alcohol and Other Drugs consists of six researchers from the field of drug addiction: Ilana Pinsky, Sérgio Duailibi, Hamer Nastasy Palhares Alves, Neliana Buzi Figlie, Marcelo Ribeiro de Araújo, and Cláudio Jerônimo da Silva.

Molecular Medicine
The National Institute of Science and Technology, coordinated by Marco Aurélio Romano, has its headquarters in Belo Horizonte, capital of the State of Minas Gerais, and seeks to basic and technological science with medical practice in various specialties. “The project’s main objective is to install a PET (Positive Emission Tomography) Center in Belo Horizonte,” explained the coordinator.

According to the researchers in charge of the Institute of Molecular Medicine, the project is intended to promote a qualitative and quantitative change in the technological level of the research in the member groups, including the production and development of radiopharmaceuticals. Thus far in Brazil, there are no research centers with such characteristics, which involve both the preclinical and clinical phases.

According to Romano, the proposal was developed because the National Nuclear Energy Commission installed one of the world’s most sophisticated cyclotrons (which produce radioactive markers) on the campus of the University of Pampulha in Belo Horizonte. “Since there is a problem of half-life with these isotopes (carbon 11, for example, loses half of its radioactive material in just 20 minutes), it’s best to be as close as possible to the source,” he commented.

Thus, the project is intended to install a center for PET-CT (positive emission tomography-computed tomography) for clinical trials in various medical specialties and a second center for tests in animals. “We will thereby complete this chain, ranging from the production of new radiopharmaceuticals to clinical application, in addition to the use of established isotopes,” remarked Marco Aurélio Romano.

In addition to psychiatry, which will work mainly with patients with Alzheimer disease, schizophrenia, and bipolar mood disorder, other specialties participate in the institute: pediatrics is searching for applications for lymphoma and kidney diseases, oncology is mainly researching applications for lung cancer, cardiology has specific applications, and nuclear medicine will administer the unit with applications for follow-up of chemotherapy, breast cancer, and prostate cancer, among others.

In the field of mental health, the equipment can assist in the evaluation of therapeutic strategies, since it allows comparison of groups that respond as opposed to those that are refractory to treatment, identifying regions of the brain in which the drugs produce the most alterations. In other words, their use is not only diagnostic, but can assist in the follow-up of clinical responses.

Thus, one of the studies planned by the Institute will follow patients over 60 years of age with depression to identify those with the greatest odds of developing dementia. “We know that one-third of individuals with late-onset depression present demented states. With PET, we are able to measure the accumulation of a protein related to Alzheimer disease. It is thus possible to identify the most susceptible individuals and begin to treat them,” explained the Institute’s coordinator.

Translational Research
The prime focus of the Institute for Translational Medicine is to apply the basic research findings to the clinical context in order to develop new treatments. Psychiatrist João Quevedo, one of the project’s coordinators, spoke about the group’s objectives. “We propose to work with projects from a relatively new field, translational medicine, which approaches a given health problem all the way from the lab bench to clinical application, with the development of new drugs.”

According to the researchers, the main difficulty in translational medicine is to identify in basic science the most promising results for patent production. The group will thus be making a qualitative leap by electing “biochemical targets”, essential reactions for treatment of each disease. Next, by combining techniques that allow identifying the profile of these proteins, like proteomics and transcriptomics, the project aims to develop specific drugs to correct the functioning of the biochemical targets. “The challenge is to search for the information at the lab bench, identify what can be clinically relevant, transfer this to clinic practice, and take the reverse path: in the clinic, identify the relevant questions and search for the answer in basic science”, summed up Quevedo.

The Institute includes researchers from seven groups (four in the State of Rio Grande do Sul and one each in Santa Catarina, São Paulo, and Rio de Janeiro) that will interact to optimize human and financial resources. According to their characteristics, each team will conduct studies in areas where they already have expertise. In Rio de Janeiro, for example, the research will focus mainly on anxiety disorders. “Each center continues to develop its object of study, but now with support from the other centers in terms of human resources, infrastructure, and financing. As if your research partner’s laboratory were right next to yours,” remarked Quevedo.

According to Quevedo, the background of the professionals working in the Institute will also facilitate the implementation of translational research. “We have highly specialized individuals in basic science, clinic science, and others with a mixed background. Based on the characteristics of the human resources that have pooled together, we manage to implement the translation process naturally.”

As explained by this psychiatrist, the main feedback from the Institute to society lies in the development of new drugs. “Our idea is that these pharmacological solutions should involve potential applicability and generation of new patents, producing intellectual property for the country,” he concluded.

Click and find out more about ABP