To Solve Alzheimer’s Mystery, Better Biological Clues Sorely Needed

7/29/14Follow @alexlash

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replicating the work in a prospective study”—that is, following up with a new batch of patients—”and in clarifying….how specific is the test to Alzheimer’s and not to other look-alike dementias.” Drug companies have not yet used blood tests for patient enrollment, “but pharma is definitely collecting samples in the event any of the tests can be validated,” she said.

The Eye

Imagine scanning someone’s eyes to predict Alzheimer’s. This is the most fertile ground for startups, and several are racing to build systems and prove their predictive power. Neurotrack Technologies, of Palo Alto, CA, uses a standard tablet or laptop camera to record the eye movements of a person watching images flash upon a screen. Some images are familiar, some are not. Neurotrack’s software analyzes how long the eyes linger on each image, a function of recognition memory, which is based in the brain’s hippocampus. Alzheimer’s damage starts there, likely years before the patient shows symptoms, and Neurotrack says its software can tease out subtle changes. (A healthy person spends most of the time looking at the novel images.) The test has one full data set so far: a 92-person, five-year study. A second five-year study at Emory University in Atlanta, where the test has its roots, is underway. And it has been incorporated into several studies, including the A4 presymptomatic study. “Hippocampal impairment is as early [a biomarker] as you’re going to get,” CEO Elli Kaplan told Xconomy. “We think our technology will help reduce some of the noise in the biomarker area.”

A second ophthalmological approach is a scan that measures amyloid deposits in the retina, where it turns out there are clues to many diseases, not just Alzheimer’s. But retinal amyloid seems to correlate to brain amyloid, and NeuroVision Imaging of Sacramento, CA, has a scan that can detect new plaques forming in tests three months apart, CEO Steven Verdooner told Xconomy. Those claims are based on NeuroVision’s inclusion in an Alzheimer’s trial run in part by Australia’s national science research organization. The company released interim data two weeks ago from the first 40 patients out of a planned 200 total. The number of patients tested in rigorous trials for both Neurotrack and NeuroVision are very small, to be sure. It’s early days. Both companies hope drug companies look past the small sample sizes and use the tests to help recruit patients for clinical trials. “Different companies have different criteria,” says Kaplan. Using bier tests before they’re fully validated isn’t something conservative pharma companies would typically do, but as Kaplan notes, time is passing. Vradenburg of USAgainstAlzheimer’s expresses that sense of urgency in broader fashion. If a drug has proved safe, which is critical when giving it to presymptomatic populations, the biomarker correlation shouldn’t have to be ironclad. “If you have at least some biomarkers, or strong hypotheses, regulators should lean forward” and let those at greatest risk take the drug, then follow them to understand whether the drugs are truly working. “The standard shouldn’t be that we are 100 percent certain.”

Alex Lash is Xconomy's National Biotech Editor. He is based in San Francisco. Follow @alexlash

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  • Mike Mongan

    If the incidence of Alzheimer’s has been on the rise, it may be beneficial to look at what chemicals have risen in our environment, especially in our food supply. This assumes there is a cause to the disease. People have been “getting senile” for many decades, so there may be a genetic predisposition. But there may be chemical antagonists in our food and environment.

    I remember hearing that back in the 1940′s when I was a child, there were some 40,000 common chemicals in the American environment. That number has increased dramatically. The body and brain can only process and eliminate so many. It may be impossible to go back to a simpler time. That would not eliminate the problem. It may however be productive to begin to search for non traditional antagonists.

    There has been senility in my family. So far my brother and I , both in our 70′s, are fine thus far. I am a vegetarian and prefer organic foods and lots of vitamins. He has a more traditional but conscious diet. That may not be the clue. We grew up in a polluted city back then. But those were not today’s pollutants. My career was in manufacturing, his in banking.

    If the answer lies outside of the body, it can hopefully be identified. That would at least present some avoidance strategies for individuals to adopt.