W

hy are there no good drugs to treat Alzheimer’s? More than 20 years after scientists discovered that mutations in three genes can cause the devastating disease, and that the apoE gene increases people’s risk for it, there are only four FDA-approved drugs to treat Alzheimer’s. And they do little but slow symptoms (if that).

Over the last decade, more than 99 percent of the new compounds tested against Alzheimer’s have failed in clinical trials, costing their developers billions of dollars and crushing the hopes of the 5.5 million (and counting) Americans with the disease.

Readers joined STAT reporters Sharon Begley and Damian Garde on Monday as they moderated a chat with Alzheimer’s expert Dr. Reisa Sperling of Brigham and Women’s Hospital. We aimed to cover a lot of ground: What drugs are in the pipeline, the therapeutic approaches, and which diet and lifestyle habits might prove protective. Sperling, who has relationships with several biopharma companies, also talked about her “A4 Study,” which is testing a new therapy in patients who are at high risk for Alzheimer’s, but as yet have no symptoms.

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Here’s a transcript of the conversation.

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  • Did not see my prior comment about prions (misfolded protein) — anyone searching for them in A.D. patients’. CSF or brain tissue? Anout 1:19 comment by Mr Mills, no mention made of possible early diagnosis of atypical amyloid in eye lenses if AD patients using laser ophthalmoscopes. Furthermore, if such atypical amyloid is there, why not come up with in vitro assay of rat lenses in medium containing possible amyloid dissolving agents?

  • Sorry I missed the call, thanks for the transcript. Missing from the discussion is the realm of bioelectricity along with biochemistry in the brain to reset biochemical and bioelectrical pathways. Some research suggests this could be helpful for both diagnostic and treatment purposes. How about a future interview on that approach to AD?

  • The Australians have researched sound waves to break up amyloid plaques in mice that recover 75% of cognitive function. The Australians were hoping to begin human trials in 2017. Do you know if this research and if trials have started with reportable results?

    • Yes, a most intriguing Australian study about use of specific ultrasound frequency. We need more multimodal approaches yet pharma generates and receives most of the research money in order to commercialize the findings. Suggests that public and foundation research funding should be targeted to other and multimodal approaches.

  • If plaques and tangles are a symptom but not the cause of AD, what potential AD causes are you most excited about studying now.

  • While I understand it is probably self-evident that starting treatment earlier could be better, does that explain why RCTs have yet to show stat sig reduction in decline at later stages? If a drug fails to slow rate of decline at later stage, is there really anything important to be learned by a large trial at an earlier stage. This always seems like a poor use of resources to me, but is that fair on my part?

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