Much Ado About Blood Test for Alzheimer's Disease

Contributed by: Dennis Fortier, President, Medical Care Corporation

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The general press is widely reporting today on a blood test for predicting Alzheimer's Disease (AD). The media coverage is based on a study conducted at Georgetown University Medical Center and published in Nature Medicine. Despite the intense focus, there really may be very little news in this story.

It is unclear why CNN would report this as a "first-of-its-kind" study, when dozens of such studies have been presented and published over the last decade (we wrote in this space about one from Johns Hopkins and another from Scripps). Past studies have been based on various, different elements in the blood but have, in some instances, shown similar levels of predictive accuracy. This study was certainly among the most accurate, but even these results need to be considered in the context of how AD progresses

In terms of AD progression, there seems to be a fairly low level of appreciation, among health reporters, about the underlying nature of the disease. To suggest that we can somehow predict sudden and stark symptoms that mark the beginning of AD, is to ignore decades of research showing that pathological changes associated with the most common forms of the disease, progress slowly for decades before damaging the brain enough to produce symptoms. At best, this new blood test might give insight that a person is in that long, variable process. But bear in mind, autopsy data show that nearly everyone has AD pathology in the brain after age 65, though most do not have any AD symptoms. Therefore, a test to detect what we currently believe to be the pathology, just isn't yet very informative.

Furthermore, a new blood test that suggests those pathological changes are underway is great, but physicians can already detect such murky signs in many ways (MRI scan, spinal tap, PET Scan, etc.). Blood tests have general advantages in terms of cost and convenience, so the reported accuracy of this test is certainly a welcome step forward. But it probably doesn't provide a lot of new insight about whether or not  a person is progressing toward the symptomatic stage of AD.

Finally, the fervor from the ethicists about the moral dilemmas associated with AD diagnoses, is misplaced. If some society wants to make a universal decision about whether or not every citizen should or should not have access to such tests, then the ethicists should weigh in. In our society, where people can decide for themselves if they wish to see a doctor and complain about a symptom, there really is no moral dilemma: those who want information will seek out such tests, and those who do not, will not.

The Case For Alzheimer's Research

Contributed by: Dennis Fortier, President, Medical Care Corporation

The case for funding Alzheimer's research, and for participating in such research,  is a compelling one.

You've all heard or read the numbers: more than 5 million Americans diagnosed, probably at least that many in early stages and not yest diagnosed, with all numbers approximately tripling by 2050.  Neither our health care system nor our society can absorb the looming impact of this epidemic.

In this excellent opinion piece posted at CNN, Dr. Ronald Petersen of the Mayo Clinic describes an approach to averting a national, disease-driven crisis.  I encourage you to click through and read it.

Does Alzheimer's Begin in the Liver?

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Have we been looking in the wrong place?  After all the years of studying the brain, could it actually be the liver that holds the root cause of Alzheimer's disease? 

This intriguing question has been raised by a recent publication in The Journal of Neuroscience Research.  The study, conducted by a joint team of researchers from Scripps Research Institute and Modgene, LLC, showed an interesting result in mice.  The study found a high correlation between the accumulation of liver-based, messenger RNA, expressed for genes known to correlate with early onset Alzheimer's disease, and susceptibility to the disease.  This suggests that some process outside of the brain, might be responsible for triggering the complex cascade of Alzheimer's pathology.

Importantly, a drug shown to reduce the amount of amyloid in the blood stream, also showed a reduction of amyloid in the brain.  That would not be surprising, except for the fact that the chosen drug does not pass easily through the blood/brain barrier.  Therefore, it is reasonable to conclude that amyloid load in the blood may be an important driver of higher amyloid levels in the brain.

This differs from the current understanding that amyloid plaques in the brain are formed from amyloid that was produced in the brain.  In fact, most research on Alzheimer's treatments has been focused on reducing amyloid production in the brain, or clearing amyloid from the brain.  The demonstration that amyloid may arrive in the brain from other parts of the body, may be the most important aspect of this exciting new research.

As is often the case with such novel findings, this is very early stage work that will require years of additional validation and refinement before meaningful conclusions can be drawn.  However, it is an intriguing approach, and it expands our general scientific view of potentially effective avenues to treatment.

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The Uncertain Future of Alzheimer's Research

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Is this a crisis?  Two news items with similar themes, springing from disparate sides of the research funding equation, have been in the press this week.

First, I noted that the CEO of Eli Lilly, making a keynote address at The Economist's 2011 Pharma Summit, shared his strong view that current regulatory environment cannot sustain ongoing investment toward much needed innovation.  He made these comments specifically in regard to the neuroscience field, where the diseases are complex, developing new treatments costly, and economic returns uncertain.

His unspoken message was that major R&D investments from big pharma may not be sustained, even as the aging of the population increases the need for better treatments of Alzheimer's disease and other age-related conditions.

Secondly, Reuters has reported the view from academia that prospects for future investment in the neuroscience field will be bleak without new incentives to encourage such spending.  An excellent article summarizing the situation suggested patent law and the regulatory pathway as two areas where governments can cooperate with industry, to improve prospects for a return on new investment.

This is something to think about.  For sure, the need for better AD treatments is dire and will only intensify in the coming years and decades.  At the same time, profit driven pharmaceutical companies must strategically allocate their investment funds into areas that optimize a return.

Remember, there is no moral obligation for any corporation to perform "in the interest of humanity".  To the contrary, corporations have a legal obligation to perform "in the interest of their shareholders", which is to optimize economic returns.  Sometimes, helping humanity translates into profits, but the correlation is far from perfect.

Going forward, the best and most immediate solutions will likely come from a well orchestrated effort between private economic interests, academic resources, and prudent public policy that reduces barriers and provides the right motivation to invest.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

Blood Test for Diagnosing Alzheimer's: A Major Leap Forward?

Contributed by: Dennis Fortier, President, Medical Care Corporation

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With so many of the news stories I summarize here, I include caveats about the long and arduous path that basic science must travel before a clinically beneficial advance becomes available to the public. The same caveat applies to the heavy coverage of a new, blood-based diagnostic test recently developed by the Scripps Research Institute and published in the January 7 issue of Cell.

Having said that, this scientific approach strikes me as one worthy of the frothy press it has already spawned.

The approach is exciting in its novelty. Rather than identifying the specific antigens that cause an immune response (production of antibodies) at early stages of a particular disease, and then screening the blood for the presence of those antibodies, the Scripps researchers took another path. They skipped the step at which conventional science is currently focused. That is, they did not bother with the daunting challenge of identifying which specific antigens might stimulate an immune response to fight in early stage Alzheimer's disease.

Rather, in their study, they loaded the blood with thousands of synthetic molecules designed to bind to antibodies of all sorts. By then analyzing the results from patients with Alzheimer's compared to those with Parkinson's and those deemed "healthy", they detected clear evidence that Alzheimer's patients had a much higher concentration of two particular antibodies in their blood. The conclusion, which must be validated with more data, is that these two antibodies are bio-markers for early-stage Alzheimer's disease.

This may prove to be extremely valuable in detecting early stage disease presence, but may pay other dividends as well. If these antibodies do indeed indicate a response to Alzheimer's pathology, then this study may also shed important, new light on the actual disease process which, in turn, could accelerate research on new treatments

Obviously, there is much science to conduct before the world can benefit from this research. But the prospect of leap-frogging one nagging problem in the process, the identification of specific antigens that indicate Alzheimer's, is an exciting proposition.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.