When I heard that June is Alzheimer’s and Brain Awareness Month, I immediately got a purple T-shirt from the Alzheimer’s Association with “#endalz” printed on it. This supportive sentiment is shared by most Americans. With 1 in 50 Americans afflicted, it will inevitably touch you or your family or friends, and it is currently a hopeless diagnosis.
But it is human nature to fight against hopelessness. Our scientific and medical communities have been trying to understand, treat and cure Alzheimer’s for 100 years, and while success remains elusive, they keep trying, and we all need to support them, especially as they begin to make progress.
Two people immediately come to my mind when I think of Alzheimer’s. Both were veterans of World War II. Both were accomplished in their field, and both eventually were robbed of their cherished careers by the disease.
My friends’ father, the world-renowned singer Tony Bennett, was schooled in the best and worst of humanity on the front lines of World War II. This knowledge was honed when his unit personally liberated a Nazi concentration camp, and later marching for civil rights with Martin Luther King Jr., raising money for diabetes and cancer, and putting all that humanity into music until he was forced to retire precipitously due to the disease.
The other is my uncle who was a personal bulwark and mentor, a nationally recognized surgeon whose skills were honed at the same front lines. After my father died early, my uncle was my guide and support until his mind was ravaged by the disease and he was exploited by others and I suddenly lost my guide.
There is still no magic potion to treat Alzheimer’s, but we are finally making some progress. In the first 100 years after Dr. Alois Alzheimer studied the disease under his microscope, science first tried to understand and cure the plaques and nerve tangles that characterized his patient. Treating those plaques and tangles has led us to our current plateau, where we can sometimes slow the progress of the disease at the cost of sometimes awful side effects.
In recent decades, researchers have been investigating the source of the plaques and tangles and trying to understand what unhealthy state or states cause them to develop, and if those predecessor states can be treated. The primary focus of this approach is neuroinflammation.
When the immune system of the central nervous system becomes active and releases harmful chemicals into the brain, we call it neuroinflammation. So the common wisdom is that healing the inflammation, or stopping the immune system response, may heal or at least stop the disease. But as is often said quoting Ludwig Mies van der Rohe, “God is in the details.”
A wide range of medications known to have anti-inflammatory effects have been tested against neuroinflammation and against Alzheimer’s. Both steroidal and non-steroidal anti-inflammatory drugs have been tested and failed, along with anti-inflammatory antibiotics. In some cases the results were even an acceleration of cognitive decline. National Institutes of Health data shows that more than 99% of all study candidate drugs have failed, making this the worst group of tests on record. Yet new research continues at a growing pace, and hope is warranted.
One hopeful direction is the investigation of various drugs that inhibit the cascade of chemicals that lead to neuroinflammation. In the midst of the chemical cascade is a protein called TNFα, and we already have some powerful TNFα inhibitors. Initial published results were promising, but eventually did not make it to market. Current candidate drugs look even earlier in the chain cascade, including an inhibitor of a protein called ERK which itself leads to TNFα. Early results are promising and clinical trials results are expected in a few months.
When I asked Dr. Keith Vossel of UCLA Medical School, one of the nation’s leading experts on Alzheimer’s, about recent developments, he pulled out a just-published paper about cells called astrocytes which provide both immune response and brain activity regulation. It appears that astrocyte reactivity is associated with Alzheimer’s progress, and that control of astrocyte reactivity may lead to treatments more effective than those currently available. No candidate drug is being investigated yet, but this direction is also promising.
Meanwhile, imaging techniques are advancing to the point where we can see the neuroinflammation before the plaques develop, and new treatments to target that inflammation are starting to show progress. It was not available in time for my uncle, but perhaps a treatment will be ready one day for yours.
The Alzheimer’s Association website states that the first survivor of Alzheimer’s is out there. With the advances that are coming from endless hope and determination, and from the understanding of neuroinflammation, I believe we’ll hear of that patient’s survival sooner than we might have expected.
Ken Blaker is a Los Angeles-based consultant for health care technology and software. He wrote this column for The Dallas Morning News.
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