Precision Medicine for Depression: Testing Antidepressants on a "Brain in a Dish" | Dr. Talia

Okay, perfect. That way, if there's a slip up in the transfer or whatever, we both have a report. Yeah, we have two recordings, just in case. Okay, I'm going to turn my video off and let you all get started. Okay, perfect. Thank you. And hello. Hi, great to meet you. It's wonderful to meet you. This is so exciting. Me too, very happy to be here. I'm delighted. I'm really interested in what sent you down this path. But first of all, we should introduce you, your company, and then, yeah, please help me understand what set you down this path. And I'll maybe explain to you just briefly what set me down being a DA functional geneticist. Great. So I'm Dr. Talia Cohen-Salal, the CEO and co-founder of NeuroCare. I'm a neuroscientist originally. I spent about a decade in academia at Oxford, UCL, and Columbia Universities looking at underlying mechanisms of mental illness. Frustrated by the lack of direct impact I was having on patient lives, I moved to industry. I joined a precision medicine startup out in Minneapolis and then about eight years ago started NeuroCare together with my co-founder, Daphne Leifenfeld. And if I understand correctly, the idea behind NeuroCare is really to take the current medical protocols, but make them more effective. Would that be a correct answer? I would say turn them on their heads. So, oh, you mean take the current medical treatment options and make them more effective? Yes. The premise is matching the right drug to the right patient instead of a patient trying to get better at the drug that isn't suited to their biology. We create that pairing and help patients get better faster. So you do that through pharmacogenetics? Yeah, just go through your process a little bit, because I think it's really important for people to know that this option is available. I'm with you, you know, as a retired pharmacist, I can't even begin to number the prescriptions that I handed out to people and they come back with a quarter half full bottle or maybe even more. And no, this can't take this. It's not working for me. It's making me feel worse. It's really, you know, just not the option. And what else, you know, where are we going to go from here? Exactly. So basically what we do for every patient is we take a simple blood draw and then we turn those blood samples into patient neurons. How do we do that? We go from blood to stem cell to neurons. We then have a window into the brain, a model of the brain of that individual patient. We can test all the different antidepressants on that sample, on that brain in a dish instead of in the patient's brain. So we take that period of trial and error out of the patient and into the lab where it belongs. Then we create a report which has a simple understanding of which drug has the strongest impact on the brain biology. And with the disease that you're looking at or the. I guess that's the way to put it, like depression and Alzheimer's obviously have been divided into separate sort of categories. But does that make a difference to the treatment protocol or it's the same? You just look at the drug and then apply it to the individual situation. Exactly. So we think it's not just that there's a few broad categories. We think that every individual is unique or at least people are. There are so many, many, many subcategories that it's impossible to get that level of clarity or detail at the moment in science. And so that's why we treat every individual as a unique individual and see which drug would be right for them. So there's six billion different outcomes. And the other thing that we do is we also include pharmacogenomics. So we also give that report together with the neuronal readout, which allows you to combine not just which drug is best, but also help understand how your lipid metabolism enzymes are going to process those drugs as well. Yeah, that's phenomenal. What we do in our genetic testing is we do look at sort of a broad view of the mental health genes. And specifically, we're looking for like the APOE and its variation. So if we have an APOE4, then what we do is we look back at, OK, what dietary options can we implement in this person that would assist in maybe quieting that down a little bit? We are adding some pharmacogenetics to that in the next couple of months, but certainly not to the extent of the protocol that you're doing. And so if I'm from Canada, you're from the U.S., what about a Canadian patient? Is this something that like they would come down there for treatment to have this done? That's a great question. We are regular. We are regulatory approved in the United States. So, yeah, you would have to come to the United States to do that, to do the test for now. Yeah, I think one of the other sort of complications is sending blood samples here, there and everywhere, just across the border even would be quite difficult. It's important that it's regulatory approved in the site where the blood was drawn. Right. Yeah. Yeah. Very good. So you've been doing this for a few years and comparing this to what you were doing before. What? Just tell us a little bit about the outcomes that you're seeing. I am very interested in this. You know, I read this and maybe you can clarify this for me. But one of the articles I read prior to changing from pharmacy to going to genetics was, and I believed it, that close to 60 percent of females in America, that includes Canada, the United States, had been on some sort of either anti-anxiety medication or something for depression, but some something to do with the challenge in their cognitive abilities. And that that was really shocking to me that, first of all, that it was needed. And second of all, that it was so misunderstood. If it was that if there was that much demand or if there was that much need for intervention on people. And so I don't know if that is a statistic that's been overplayed or if that's actually true. You know, if we are in that area, we have a tremendous need for some kind of mind altering medication for quite a sizable portion of the population. I mean, those numbers are higher than I've had reported for depression. But obviously, if you put in anxiety medications, you are expanding that population. Around 25 percent of the population at some point in their life will have a depressive episode and 8 percent in a given year. But it's twice as prevalent in women as it is in men. And so you might expect an eight to four ratio there to average out. And so and so what we're seeing is that even though it's more prominent in women, unfortunately, and in men, it's actually more likely to cause suicide. And so suicidality in men as a result of depression is higher. So there's definitely things to be pay attention to as a physician, as a as a caring carer and a loved one looking out for people in our own communities, making sure to look out for the symptoms and signs and make sure that loved ones are getting the care that they need and attention they need. I think one of the things that we're seeing as well in Canada is the, you know, just the results of the conflicts around the world. We have many veterans that, you know, have are suffering from PTSD, first line responders that are going through very, very traumatic incidents. You may know some of the statistics about the area where I live in, where they tried this experiment with free drug as a way to try to maybe measure some control or reduce the statistics around crime associated with opioid consumption. So they opened free drug centers. And of course, it said that ultimately resulted in a lot of diversion of those drugs into the general population rather than the use they were intended for. But is PTSD something that you also is included in your basket of treatment options? Yes. So while our validation studies have been conducted in the in the depression patient population, because a lot of the drugs that are being used are overlapping antidepressant drugs, antidepressants are being used for PTSD. So we have collaborations here starting it to do clinical trials and PTSD. And some physicians are choosing to use this off label in that area as well. So one of the other things that I've worked quite extensively with is the optimization of glutathione, particularly for the glial cells. If I'm saying that right. And I have kind of a mixed accent. My parents, my grandparents were from Missouri and Scotland. So I don't know that I ever really learned to speak English at all. There was a variety of tonalities that were used in our family. But certainly we have this abundance of cells in our brain who one of their main functions is the production of glutathione. And that's something that I personally studied, having been a brain injury survivor, making sure that the detoxification mechanisms in my brain are optimized, at least to the level that I a noticeable level in me. Is that something that you've ever looked at? Is that particular aspect? So what's important is that the brain in addition model that we're using is representative of actually the human brain. And so we've investigated what's going on in our brains. In addition, we do have both the glial cells, the immune kind of response that might be happening locally, as well as the normal neuronal populations, both positive inhibitory and excitatory neurons. So we have a representative sample, which means that impacts that are happening on those cell types. And as a result of having those cell types in the culture are being detected. And that's how we address those issues. And do you do anything in the cannabinoid area at all? In your in your protocols or are you? Yeah, that's just the question. So we so we we restrict ourselves on the bright care test, which is what we've been discussing. This test to tell you which antidepressant is best for each patient, which is available now through our website or through your physician. And that has all the kind of FDA approved drugs for depression as an indication. It has the most commonly prescribed FDA approved drugs for depression and indication. And what we are what we also do is we also have a product line one could say called PharmaCare, where we work with pharmaceutical partners to help them with drug development or demonstrating mechanism of action of new new drugs in the pipeline. And so through that, we've actually been able to partner with with different companies working in the psychedelics base, working with ketamine and some of those new new new compounds that are coming onto the market and already launched on the market with Spravato. And that allows us to be able to test and bring these compounds to the bright care platform as soon as anything is, you know, approved as a drug for specifically indicated in depression. Very interesting. We actually have a number of. I guess they're separate. They're kind of independent at the moment, but government supported certainly in the psilocybin area. A lot of work has been done here in the cannabinoid area that the regulations around that loosened up too looselyly a few years ago. And, of course, had to be reconstructed and tightened down. But we're seeing a lot of research done in that area as well. I think the one thing that's missing and what I found really exciting about what you're doing is the aspect of the pharmacogenetics being added into that where, you know, you're taking a really good look at metabolism. Also, the whole system by which even metabolism can have of those drugs can have an impact. And so what about hormone like are you seeing, you know, one of the trends that we've seen, at least in Canada, I'm assuming it's going to be so in the United States is a reduction quite a bit earlier in testosterone levels in young men. And then also disruptions in women's hormone panels at an earlier age than before. And I don't certainly sleep disruption can be one of those things and, you know, stress things that can interrupt sleep disruption. But do you look at those panels as well? Is that something that you would include like testosterone, estrogen, progesterone or any of the other hormone panels? No, we don't today. It would be great to give everybody as much information as they could possibly get, but that's not included in our panel today. OK, so and that's more of a long term like you have to, you know, put those results over time as well. It's not something that you can just, OK, let's do a test today and that's going to be accurate for, you know, a period of time. It's something that's a trend line that we have to follow over time. So that makes sense that that would be a little more difficult. What what do you see like your future vision for. I guess we're moving ahead like your your work has been primarily in depression and and then do you see is there a pattern emerging between the different diagnoses as far as the protocols that you're implementing is concerned? Yes, so we've we've developed a platform which basically allows us to create patient neurons rapidly for every individual and we can test them to see which drug is most effective for them. The neurons that we've that we are expert at creating at the moment, cortical neurons, frontal cortical neurons, the area most implicated in psychiatric illness. So kind of natural indications to move on in this area where this is implicated is obviously bipolar, schizophrenia and other psychiatric illnesses. But it it is also quite easy to adapt the final stages of our protocol to do other brain regions. And so we could also work on, for example, Parkinson's disease. But actually, our first indication that we want to tackle next is going to be ADHD. So we'll be looking to kind of bring in our clinical trials into that state, into that area as soon as as soon as we're able. An area that I was able to do a small trial in in 2016. And so we we were trying to avoid drugs, to be honest with you. And these children were already on some protocols and we wanted to see if there was something we could do outside of that. So we literally provided glutathione precursors, so not glutathione itself. I don't think glutathione, exogenous glutathione is really of any clinical significance in this area. And of course, cells has have their own ability to create glutathione if they're given the raw ingredients. So we provide a glutathione precursors with a mix of vitamin methylated, like B12, B9, just just a small panel of the B vitamins because of the work of Dr. Robert Hugo here at UBC, where he had worked extensively in the dosages of B vitamins to try and just as a treatment modality for depression. And and he had got into just slightly into the ADHD. But we found that by doing providing those things, we did see a significant improvement in symptomology in those children. And, you know, it was unfortunately a very small 56, 56 individuals and not a not a very long trial. But we had enough to know that, you know, increasing the availability of glutathione and increasing, of course, making sure they're getting B vitamins was was having some impact. So I don't know if that's something that you've looked at or had looked at in the past or if that's any part of your protocol now at all, either. No, but I think what's important is that treatment is holistic, right? So obviously, we're, you know, targeting we're allowing families and patients and loved ones to know which traditional FDA kind of root medication is going to be helpful to them is going to be best for them. But unfortunately, I feel in health care too much physicians rely on just the medication. But it's much more than that. They should obviously be doing lifestyle changes. Everybody agrees that healthy diet, exercise, outdoor time, all of these things improve mental health in general and depression as well. And also diet. Diet's very important to go back to ADHD and exercise. And so all of these extra things that people should be doing anyway are often not being discussed by the doctor as part of the treatment regimen. They just kind of often just refer to the medications as a company. While we do help you choose the medication, we fully advocate for a more holistic approach. You need to be training your brain, one might say, with cognitive behavioral therapy or good exercises to be in a better place with those medications. Changing your environment so that the triggers aren't there are difficult to deal with. So you've highlighted a very interesting route with the vitamin B12 and in ADHD. But I think in general, it's the best practices for treating is not just looking down the medication route, but also all the other supplements and alternatives that complement it. So the reason we kind of chose that there's a gentleman in New York, Dr. Albert B. Crumb. I'm not sure if you've ever heard of him or familiar with him. He's a Nelson Marquis Award winner for his work in glutathione optimization. And so we use his product because his product had been in a clinical trial with the NFL Players Association where they had used it to see if they could stave off some of the challenges that come with getting your head knocked around hundreds of times in your career and had some proof of that. And then his product was used to reduce reactive oxygen species during hyperbaric oxygen therapy very successfully. So just sort of looking at that and seeing, OK, this does actually have an influence on the brain. Maybe that's something that we could give these children work very, very well. It's easy to take. It's just a sublingual little powder under your tongue. So that that seemed to work out very well. Fantastic. Yeah, yeah, yeah. It's something you might want to have a look at at some point. But because it is FDA, he actually has had a number of FDA supervised clinical trials on his product as well. So, you know, it's not something that's sort of just out there as a product. It's been very, very well researched. He's actually 94 and still works every day in his office. It's an amazing individual. So one of the like I I guess, you know, this is a great conversation because literally, you know, what I'm doing is coming at it from that aspect of how can you improve nutrition and lifestyle? And are those things really being looked at? You know, are your is your protein intake adequate? Is your omega fatty acid levels like where are they at? Are they reaching a good level and so on? And and so they're like you say, it's a holistic approach. And then if you can ease the difficulty of finding the drugs that actually work for people, that's just really a tremendous contribution to ongoing health, mental health care. In Canada, we have an actually dedicated day to anybody who's working in mental health care at all. And, you know, it's actually called it's a communication day. So people, you know, it's a dedicated day where people, scientists, et cetera, will come together and discuss what they're doing and so on and so forth. And that might be something great initiative. Yeah, it's a great initiative and it's probably something that you should be aware of and be invited to participate in at some point as well. But this is this is really great. I mean, I'm just amazed that there's things available and people don't know about them. And that's one of the purposes for me doing these podcasts is really to bring innovations to people that they're not aware of. And areas where they're still struggling and certainly, you know, the awareness of mental health issues, fortunately, has got more attention and more communication around it than in the past. You know, it used to be I'm going to say it was sort of this. Yes, it existed, but we don't really want to talk about it. Area of life, but it's very important area of life. And I'm grateful that we're now facing up to it and saying, no, no, there's problems and we need to deal with them. Is there anything else that you would like to tell me? You know, this this is I really want people to the people that see this. I really want them to get a feel for you and where you're heading next and maybe what they can watch and expect and look for. Just anything else that you'd like to contribute as our time sort of comes to a close? Well, we just really want to make sure that anybody who's suffering, suffering with depression, suffering through that trial and error process knows that there's now a tool there to help them get to the best fit medication for them sooner and faster, sooner and better. And to do that, they just can go to our website, W.W. Neurocare, K.A.I.R.E. Dotcom, and they can order the test directly or they can bring it to their physician and we can help communicate and understand how this how this test works, what it really means to grow a brain in addition, test it for all the different antidepressants. And we look forward to helping people get better. So so one of the things that I want to pick up on there, you said they could go to their physician. So if if I was to go to a physician and say, hey, I would like to have a neuro care test. Is there authorized like you have authorized the partners in that regard or is that something that they can order? We we have authorized partners, but if they wanted to, they if they wanted to stick with their own physician, either they could just order the test through us and then bring the report to their physician. And the physician can reach out to us if they want to learn how to interpret. It's pretty straightforward. But we also have a physician portal physician onboarding. We help physicians understand what this test is. So really, by bringing it to their physicians, they're they're educating their physicians. Look, there's this new test you might not have heard of. We're we're a very young company in this time. And it takes time to create awareness of new technologies. Definitely. Yeah. No, no. I'm really happy that I can give you this platform and hear from you. We see more and more people reaching out for alternatives. It's really one of the reasons that I decided to step away from pharmacy and have the ability not be regulated. You know, we're regulated against actually telling people about innovations, at least in our jurisdiction here. So it's one of the reasons I stepped away from pharmacy is I wanted the opportunity to be able to say honestly to people, listen, there is something else. And now that I can say not only that, you can go to your physician or you can go to this Web site, you can order this test. And then, you know, you're not stepping outside of your own physician's relationship. And exactly. Yeah. Yeah. So it keeps that that relationship intact as well. So, well, thank you very, very much for taking the time. I know that Amelia said we had about a half an hour. So we're coming to the close of that. So thank thank you once again. And we'll we'll bring this. I'll turn this into a YouTube and then, you know, you can clip it and do whatever you'd like with it for your purposes and put it on your Web site. Or if you use it in your marketing material, that's great. I plan on doing the same. So what happens? I'm just going to stop the recording right now.