Getting Rid of Amyloid...

All of the excitement ... and cautious optimism ... in Alzheimer's research has been around aducanumab.  While there are other possibilities out there, aducanumab has achieved something quite remarkable -- even if it failed to improve cognition. Researchers have shown that the malformed protein we call beta amyloid can actually be removed from the brain.  Research on the treatment was halted because it did not appear to be improving cognition, but that conclusion is being revisited.  

What's interesting to me is that the strategy aducanumab employs (using a monoclonal antibody to destroy the amyloid) is being applied in other treatments. Gantenerumab, donanemab, and BAN2401 all have been shown to remove amyloid plaques, and with BAN2401, this has been maintained for several years.  We discussed BAN2401 back in July 2018.  These treatments are all in phase 2 or phase 3 trials.  (Another one, crenezumab, appears to be flaming out...)  

As with aducanumab, the question remains whether these treatments will actually improve cognition or slow the progress of the disease.  At one time it seemed a slam dunk that, if you can get rid of the beta amyloid, you can stop the disease and improve cognition.  But now, not so much.

The question of cognitive improvement as a consequence of amyloid removal was addressed at the Clinical Trials on Alzheimer’s Disease conference we discussed on December 6, and the discussions were reviewed this week in an article in ALZForum. The article was "Amyloid Clearance: Check. Cognitive Benefit: Um ... Maybe." Presentations at the conference discussed in the article addressed the successes in amyloid removal, but were quite cautious about claiming improvement in cognition.  In their words, "There are hints—though that is all they are at this point in time—that amyloid clearance correlates with preserved memory, as well."  The ALZForum interviewed one researcher who said, "The totality of evidence now suggests anti-amyloid antibodies will work as a preventative treatment to delay AD progression."

So, stay tuned.

We are currently in Hawaii spending the holidays with family.  The temperature is pleasant, but a bit wetter than we'd hoped.  We are hopeful that you had a wonderful Christmas, Hanukkah, or whatever you celebrate, and you have a prosperous 2020!