Two Major Clinical Trials for Alzheimer's

From Nature News. The US government has announced $50 million in new funding for Alzheimer's research, including two major clinical trials. One of the trials

builds on the fact that Alzheimer’s begins to attack the brain 10–15 years before symptoms appear — a conclusion confirmed by new imaging tools that allow the disease to be monitored in living people.

This trial will receive $16 million, and is the first attempt to avert the onset of Alzheimer’s by treating people who have not yet developed symptoms. It is a five-year study using an antibody called crenezumab, made by Genentech of South San Francisco, California. Already in phase II trials in patients with mild-to-moderate symptoms, the drug is thought to work by binding to fragments of amyloid-β — insoluble, neuron-damaging peptides that aggregate in the brains of those with Alzheimer’s — both neutralizing it and making it easier for immune cells in the brain to eliminate it (see ‘Neural defenders’). The Banner Alzheimer’s Institute (BAI) in Phoenix, Arizona, together with a team at the University of Antioquia in Medellín, Colombia, will test the drug against a placebo in 300 symptom-free people, two-thirds of whom carry a rare genetic mutation that makes them certain to get the disease. Mild cognitive impairment sets in at a median age of 44 in people carrying the mutation, and full-blown dementia at 49, decades earlier than is common with the more typical sporadic form of the disease.

The other trial

will receive $7.9 million and is being led by Suzanne Craft, a neuropsychologist at the University of Washington and associate director of geriatric research at the VA Puget Sound Health Care System, both in Seattle. It will test an intranasal insulin spray against placebo in people with mild cognitive impairment or early Alzheimer’s. Insulin receptors are abundant in synapses in brain regions that are important for memory and cognition, and in Alzheimer’s, amyloid-β can knock out the receptors and disrupt memory formation. Flooding rat brain cells with insulin has been found to block the fragments and protect the receptors (F. G. De Felice et al. Proc. Natl Acad. Sci. USA 106, 1971–1976; 2009). When Craft tried the strategy in humans by giving intranasal insulin to people with mild cognitive impairment or early Alzheimer’s, the results were impressive: about three-quarters remained stable or improved cognitively over the four months of treatment, Craft says.

Every bad thing people say about the government is as true of the medical research establishment as of HUD or the DOD: excessive bureaucracy, maddening paperwork, careerism, waste, and so on. Does that mean that this research is not worth doing?