Precision psychiatry aims to match schizophrenia patients with tailored medicines
核心洞察
Virginia Tech's Fralin Biomedical Research Institute will host a Precision Therapeutics symposium Sept. 23-24 to advance precision psychiatry and computational approaches to schizophrenia (搜索).
Cobenfy (xanomeline and trospium chloride (搜索)), the first schizophrenia (搜索) drug in decades with a fundamentally new mechanism targeting muscarinic cholinergic receptors (搜索), is highlighted as a potential turning point.
Researchers aim to identify biological differences among patients to guide treatment, moving beyond the "trial and error" approach that leaves many patients without effective symptom relief.
The Fralin Biomedical Research Institute at VTC (搜索) will convene pharmaceutical leaders, scientists, and clinicians at Virginia Tech for its Precision Therapeutics symposium Sept. 23-24, focused on precision therapeutics and computational approaches to schizophrenia (搜索). The central goal is to identify biological differences among patients that can help guide treatment, addressing a persistent challenge in psychiatric care where finding an effective therapy often remains a process of trial and error.
The human stakes of that challenge are stark. For one Australian family, the search for an effective treatment became a year of trying one medication after another as their teenage daughter slipped further away. She had been driving, working, and preparing for a university education when psychosis emerged during her final high school exams. Over the next year, her parents say she tried at least six antipsychotic medications. Clozapine, often used when other treatments fail, had to be stopped after she developed a type of heart inflammation called myocarditis.
By Christmas 2025, the family felt it was running out of options. They learned about a newly FDA-approved medicine, xanomeline and trospium chloride (搜索) (brand name Cobenfy), which was not available in Australia. They found Michael Halassa, a physician-scientist and professor who leads both laboratory and clinical research programs at the Fralin Biomedical Research Institute at VTC (搜索), and decided to bring their daughter to the United States for treatment. Within weeks of starting Cobenfy, she began looking for work, interviewed, and got a job. Her mother estimates she improved by about 50 percent, although she remains on other medications.
"The problem is for both the patient and the family — they're living in alternate realities," said Halassa. "Changes in the person's brain have affected their perception of reality. It's a tragic situation."
A different way to treat schizophrenia
For many patients, finding an effective treatment does not take that long. Robert Trestman, chair of psychiatry and behavioral medicine at the Virginia Tech Carilion School of Medicine and Carilion Clinic, noted that current treatments work for many people, often within the first few attempts. "For many, the first treatments we try are successful," Trestman said. "But there are still many people for whom we have a difficult time either reducing their symptoms or helping them to fully remit from the illness they're living with." Those are the patients that precision psychiatry is trying to address.
Stephen Brannan, a physician-scientist and former chief medical officer of Karuna Therapeutics (搜索), will be a keynote speaker at the symposium. Brannan helped lead Karuna Therapeutics' clinical development of Cobenfy — the first schizophrenia (搜索) medication in decades to work through a fundamentally new mechanism. Karuna was subsequently acquired by Bristol Myers Squibb (搜索).
For decades, schizophrenia (搜索) medications have worked primarily by blocking dopamine receptors (搜索) in the brain. Cobenfy takes a fundamentally different route, targeting the muscarinic class of cholinergic receptors in the brain that are involved in attention, memory, and perception. Whether Cobenfy marks a turning point for schizophrenia treatment remains to be seen, but Brannan expects it to be followed by other drugs targeting new pathways. "It's the first. It won't be the last," he said.
Brannan drew a parallel to the arrival of Prozac and other SSRIs, which he described as "a true inflection point." Their impact went beyond effectiveness against depression and anxiety disorders; SSRIs were far safer than the tricyclic antidepressants that preceded them, allowing primary care physicians to take on treatment that had largely been left to psychiatrists. Brannan believes psychiatry may be approaching another period of significant change.
"We know now that these diseases are heterogeneous and not every medicine works for everybody," Brannan said. "The hope with precision psychiatry is we'll get smarter about this and understand which medicines work best for which person."
Toward biological precision
The Fralin Biomedical Research Institute at VTC (搜索) brings scientific depth across the spectrum needed to advance precision psychiatry, according to Michael Friedlander, Virginia Tech's vice president for health sciences and technology and the institute's executive director. That depth spans levels of inquiry at the molecular, cellular, and neural circuit levels, and also includes human behavioral, neuroimaging, computation, and patient-based research.
"There's a lot of exciting movement in the direction to understand changes in functional brain circuitry," Friedlander said. "That will enable our researchers to strategically suggest ways to address these issues that are more based on the emerging understanding of what's actually wrong versus just treating symptoms."
FBRI has been building strength in neuroscience and psychiatry for more than a decade. Researchers, extending back to early FBRI faculty recruits Read Montague, Pearl Chiu, Brooks Casas, and Stephen LaConte, have developed a highly recognized Virginia Tech program in computational psychiatry, cognitive neuroscience, and human neuroimaging in Roanoke. Halassa builds on that foundation with a focus on the brain circuitry underlying cognition and psychiatric illness, and as the first faculty member recruited to FBRI's new Patient Research Center, he extends that work toward understanding individual patients and their responses to treatment, directly linking the lab to the bedside.
"The science has been advancing considerably the last few years," Friedlander said. "There's a tremendous unfulfilled need for these patients, and we have the right people at the right place and time here to bring together thought leaders and really develop exciting new strategies."
The symposium program
Brannan will open the scientific program with the story of KarXT, the compound that became Cobenfy, followed by researchers from Bristol Myers Squibb (搜索) and Ovid Therapeutics discussing other emerging approaches to schizophrenia (搜索). A biotechnology panel will bring perspectives from Alto Neuroscience and Syremis Therapeutics.
The symposium will also reach beyond drug development to the biological and computational tools that could make treatment more precise. Andrew Pines, an instructor of psychiatry at Harvard Medical School and a psychiatrist and research fellow at Mass General Brigham, will give a keynote on using human causal data to identify brain regions involved in psychosis. From the Fralin Biomedical Research Institute, Montague will give a keynote on his group's first-in-human direct measurement of neuromodulators in the human brain, while LaConte and Chiu will explore biomarkers, cognition, and NeuroAI.
Other sessions will examine brain mechanisms involved in psychosis, memory and planning, and whether speech and language can provide measurable clues to psychiatric illness. Industry leaders from Johnson & Johnson, AbbVie, and Rapport Therapeutics will also discuss where the field is headed.
A two-way exchange between science and care
Halassa sees an opportunity to connect an established scientific foundation more directly with psychiatric care. "We want a better framework for psychiatry," Halassa said. "There is a great opportunity to contribute to that here in Roanoke, building on the strong programs in computational psychiatry at the FBRI and the excellent clinical care at Carilion Clinic psychiatry."
Friedlander described that progress as a two-way exchange between science and patient care. "The work in the clinic can inform the research going on in the laboratory to better understand the mechanisms that cause schizophrenia (搜索), and that in turn can inform what to try in the clinic," Friedlander said. "It's part of this virtuous cycle back and forth between the lab and the clinic."
For Trestman, the promise is straightforward. "We've long awaited the ability to make informed decisions that can lead to the first treatment being definitive," Trestman said. Likewise, Brannan envisions a future in which physicians have biological information that can help guide treatment before patients cycle through multiple medications. If they fulfill their promise, Brannan said, "We're going to be in a new era of psychopharmacology."