The fate of aducanumab, a potential Alzheimer’s treatment from Biogen, is widely seen as the last hope for an aging idea: that targeting toxic brain plaques can arrest the progress of the disease.

But there’s a similar, less-discussed Alzheimer’s treatment working through a pivotal trial. And its outcome, positive or negative, could shift the yearslong debate over how best to target Alzheimer’s. The drug is crenezumab, and like Biogen’s treatment, it’s meant to bind to beta-amyloid plaques in the brains of patients with Alzheimer’s. But AC Immune, the company behind crenezumab, is taking a novel approach to testing its worth. Instead of casting a wide clinical net for people with Alzheimer’s symptoms, the company has recruited only patients with a rare genetic mutation that almost guarantees they will develop the disease — and will treat them before any signs of dementia emerge. The study, conducted in Colombia, is expected to generate data in early 2022.

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  • The fate of aducanumab, a potential Alzheimer’s treatment from Biogen, is widely seen as the last hope for an aging idea: that targeting toxic brain plaques can arrest the progress of the disease.

    No, you still have it wrong. The original hypothesis of plaques causing AD has been dead a long time. It was succeeded (briefly, and not widely) by the notion that fibrils of amyloid protein are the actual toxic factor that causes AD. That was in turn succeeded by the current hypothesis that the toxic effects of amyloid oligomers cause AD. This has been the mainstream hypothesis for almost 20 years, and the amyloid antibody trials are intended to prevent accumulating amyloid oligomers which occurs early in disease progression. They aren’t really intended to prevent plaque formation, which occurs late in the disease and does not correlate well with disease severity. Many cognitively normal elderly die with brains full of plaques, at levels typical of people with AD. We don’t really know what amyloid does, and it has been suggested that plaque formation is a protective defense against toxins or pathogens.

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