Brain trivia: The human mind has more synaptic connections than the Milky Way has stars. Multiple sources estimate 100 trillion brain connections. The galaxy we live in contains between 100 billion and 400 billion stars, according to NASA.
Scientists in both disciplines have a long way to go to get specific answers.
Astronomers, however, know a lot more about their subject than neuroscientists do about theirs, said Dr. Steve Brannan, a neuroscience drug development expert. If you compared progress in understanding the mind to the advancements that took place between Galileo using a telescope to prove Copernicus’ theory that the Earth moved around the sun and the Hubble telescope’s snapshot of the Ultra Deep Field, where would you land?
“We’re a lot closer to Galileo than we are to the Hubble, maybe 100 years past Galileo,” said Brannan, keynote speaker at Fralin Biomedical Research Institute at VTC’s Precision Therapeutics symposium, which will be held Wednesday and Thursday in Roanoke.
His field recently made a 70-year leap. Both Brannan and FBRI’s Dr. Michael Halassa are associated with the schizophrenia medication Cobenfy (pronounced co-BEN-fee), which the Food and Drug Administration approved in 2024 to treat adults. Cobenfy’s introduction marks the first time in seven decades that an antipsychotic drug was approved to target something other than dopamine receptors.
The new medication’s targets are cholinergic receptors, which have a big role to play in the peripheral nervous system, affecting attention, memory and perception. While it doesn’t work for everyone, those who have positive results do not suffer from such debilitating side effects as a lack of engagement that causes many patients to discontinue their doses, Brannan and Halassa said in separate phone interviews this week.
Brannan will take the podium to outline the drug’s history, which began with a failed era as an experimental Alzheimer’s disease treatment. He was chief medical officer at Karuna Pharmaceuticals, where scientists fostered Cobenfy’s development into a schizophrenia medication before Bristol Myers Squibb bought the company for about $14 billion in 2023. He is now a private consultant and a member of the Serina Therapeutics board of directors.
Halassa, a psychiatry professor and the first faculty member of FBRI’s new Patient Research Center, joined in April from Tufts University, where he directed the neuroscience department’s translational research.
He began prescribing the new medicine to some of his patients soon after the FDA approval. The COVID-19 shutdowns inspired Halassa, then at another Boston-area school, the Massachusetts Institute of Technology, to focus on an inpatient clinical practice.
While psychiatrists were starting to prescribe it to outpatients, Halassa said he saw an opportunity to “see something like that play out in real time.” One of his patients, an older woman who had been in a group home, had become violent there and was moved to the facility where Halassa worked.
He restarted her medication but didn’t see improvement, so he added Cobenfy to her regimen. Soon after, he encountered her in the hospital’s club room.
“She was one of those people who had this empty stare, but all of a sudden, after a couple of doses, she looks at me, smiles, and I look at her face and there’s like light shining out of it compared to what I remember,” Halassa said. “So I’m like, wow, this is incredible. This is not a placebo effect, because we put people on all kinds of medications, and we never see that, and that became something that other people reported.”
Treating doctors call it an “awakening” or “clearing,” he said.
This drug will ultimately be seen as a “trailblazer” for other treatments that will follow the route to cholinergic receptors, he said.
“So that was my initial foray into what I would now consider precision psychiatry. There’s clearly a particular type of patient that responds to this medication and potentially to others in this class that we ought to be able to identify, and that’s kind of the crux of what the meeting is about.”
In one sense, precision therapeutics is the journey to a new way of doing an old thing. Every good doctor has considered individual patients’ features and has used them to make clinical determinations on medication, Halassa said.
“The problem with it is that it’s not systematic,” he said. “Each person does it in an idiosyncratic way. … There’s no formal way to do it right now, and what I think of precision psychiatry is coming up with a formal way to do it.”
Also on the agenda at this week’s symposium: using AI in mental health. Speakers will address how behavioral data, including speech and language, might help identify problems and predict treatments.
The event is open to the public, but the registry is full, according to FBRI. About half of the 150 people in attendance will be academics and half from the pharmaceutical industry, said Halassa, who organized the symposium.
Among those in attendance will be traditional drug development people. Others in attendance don’t work on psychiatry or schizophrenia at all but study the brain directly and have insights into how the brain works and how circuits work.
Halassa met Brannan at a symposium where both were invited to speak, and they chatted about Cobenfy the day before the FDA announced it had approved the treatment. It was Halassa’s first such event, but he’s attended others since and found that it is a good way to bring together a variety of interested parties.
“People in drug discovery don’t really have a very good access to modern-day neuroscience,” he said. “I thought it would be good for people in the drug development world to have access to modern-day neuroscience. I also thought that people who work on brain circuits would benefit from having exposure to the latest and the cutting edge of drug discovery.”
Practicing psychiatrists will be there, too.
“Psychiatrists are completely disconnected from both worlds, and both worlds are disconnected from psychiatrists,” he said. “If you actually think about it, it’s absolutely crazy that these things don’t happen more often, because who are these drug developers developing the drugs for? Psychiatrists ultimately are the arbiters of whether they give it to patients or not.”
It is the first such symposium in Roanoke, and there may be more, he said.
“It could become something that would be just broadly useful to our efforts at the Patient Research Center … to Virginia Tech and hopefully the region as a whole.”
