08:28pm Saturday 25 February 2017

Prevention is better than cure. Also for Alzheimer’s disease!

 “The search for a treatment of Alzheimer’s Disease is slow”, admits KU-Leuven honorary doctorate and Harvard professor Dennis J. Selkoe. “However, I remain convinced that we are making progress.” He questions whether we will ever be able to cure the disease entirely. “But preventing Alzheimer’s should be feasible.”

Selkoe honorary doctorate, lecture for all
On Tuesday 5 February 2013 at 19:00, Dennis J. Selkoe will give the presentation “Preventing Alzheimer’s disease” in the Large Auditorium (“Grote Aula”) of the Maria Theresia College. He will focus on the progress and obstacles in current research into Alzheimer’s disease and the development of preventative medication. The lecture will be held in English. Please register via www.vib.be/dennisselkoe. Participation is free of charge.

Alzheimer icon
The seventy-year-old neurologist Dennis J. Selkoe is the most cited Alzheimer scientist in the world. He is Vincent and Stella Coates Professor of Neurologic Diseases at the prestigious Harvard Medical School (Boston, USA) and has dedicated his entire career to unraveling the molecular mechanisms behind Alzheimer’s disease. With his work, Selkoe has had a fundamental effect on opinion about essential cell biology processes – such as protein transport – an about neurodegenerative conditions including Parkinson’s Disease, Huntington’s Disease and Alzheimer’s Disease and other forms of dementia.

“It is important to strike before the brain starts to degenerate”, according to Dennis J. Selkoe. “And according to the most recent data, for patients with Alzheimer’s disease this can be as early as 20 to 25 years before the first memory problems are confirmed.” Therefore, according to Selkoe, it is not surprising that the most recent clinical studies – on people with mild to moderate dementia – did not result in the anticipated breakthrough: in these studies, we only start treatment once the brain has already suffered irreparable damage.

The fruits of 30 years of research
“Thirty years of Alzheimer’s research has taught us a lot”, according to Selkoe. “We have unraveled a complex network of dozens of bio-molecules and cell components that are involved in one way or another in the development and the evolution of Alzheimer’s Disease. A field of research that still provides new elements and new insights every day.” It is as if the scientists are completing a complex puzzle. Each new piece gives a better insight into the whole of the puzzle. To date we have succeeded in placing hundreds of pieces of the puzzle, but nobody knows exactly how big the whole puzzle will be. They started 30 years ago with laying just two pieces: the β-amyloid protein (involved in the formation of the Alzheimer’s plaques) and the tau protein (the important component of Alzheimer’s tangles).*

*The plaques and tangles are typical (microscopic) lesions that occur in the brains of patients with Alzheimer’s Disease and were described by the German neurologist Aloïs Alzheimer more than 100 years ago. The protein composition of these plaques and tangles was discovered during the mid 1980s.  

The pharmaceutical industry has tested roughly eighty Alzheimer medicines. Some in more advanced phases of study than others. There has been no significant breakthrough yet.  However, Selkoe feels that these studies have taught us a lot. “The failures have resulted in disappointment for patients, their families, doctors and scientists. However, these efforts are not lost. On the contrary, they have taught us what might work and what will not and the steps that we need to take from here. Based on these studies, we can set out new directions to target this condition.”

Much earlier diagnosis and treatment
For atherosclerosis (“hardening of the arteries”) or high blood pressure, we expect nothing less than treatment at the earliest possible stage in order to prevent further problems. We advise these people to stop smoking, eat more healthy food, exercise more and we give them statins or beta-blockers. All in order to prevent them from suffering a heart attack or a stroke. According to Selkoe, we need to adopt the same strategy in order to be successful in the treatment of Alzheimer’s disease: to act when the neurodegeneration has only just started. Perhaps we should switch from talking about “treatment” to talking about “prevention”. Just as we currently use statins and beta-blockers to prevent a heart attack or stroke. We should treat neurodegeneration in the same manner in order to prevent loss of memory and other cognitive problems.

“We have the diagnostic instruments available for this”, according to Selkoe. “Using biochemical tests, we can detect the early phases of neurodegeneration specific to Alzheimer’s disease in the cerebrospinal fluid. This can also be done using a PET scan of the brain. These changes can be detected years – possibly even decades – before the first functional limitations occur.”

Prevention trials
“This paradigm shift necessitates a thorough revision of the clinical research into Alzheimer’s disease”, according to Dennis J. Selkoe. “Although it will require significant efforts, prevention studies into Alzheimer’s Disease are possible. Provided the studies are set up correctly and the patient population is chosen correctly. For example, by including people with a high genetic risk of the condition who are still in the pre-clinical phase.” 

Unfortunately, according to Selkoe, there is no new therapy on the immediate horizon for the current generation of Alzheimer’s patients. But we have an obligation to continue the search. The obligation to say to healthy people in their thirties, forties and fifties – and particularly to their children – that we are doing everything we can to find a treatment for Alzheimer’s disease for their generations. “We have no choice”, concludes Selkoe. “The patients and their families who I see every day remind me of Winston Churchill’s incitement: ‘… never, never, ever quit!’”.

VIB scientists Bart De Strooper (VIB Research Centre for Developmental Mechanisms of Diseases, KU Leuven) and Christine Van Broeckhoven (VIB Department of Molecular Genetics, University of Antwerp) for part of the world’s elite in the field of Alzheimer and dementia research. Bart De Strooper and Wim Robberecht (VIB scientist and KU Leuven neurologist) together were promoters of the honorary doctorate for Dennis J. Selkoe.

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