But billions of dollars have poured into large - scale clinical
trials of amyloid - lowering therapies that so far have failed.
Several large
trials of amyloid - based therapies are underway in groups of people more carefully selected to be at high risk for Alzheimer's.
Not exact matches
Merck is the latest company to weather bad news in the Alzheimer's drug race, halting a late - stage
trial yesterday in an experimental
amyloid - targeting candidate called verubecestat after a data monitoring committee said there was «virtually no chance
of finding a positive clinical effect,» Reuters reported.
Solanezumab, a drug developed by Eli Lilly that also acts on the
amyloid hypothesis, failed some key clinical
trials, though the company is still testing it in the pre-clinical stages
of the disease.
Yanagisawa believes a simple
amyloid blood test would enable recruitment for clinical
trials of new drugs in a larger share
of the population, as opposed to only those with access to advanced academic centers.
Amyloid buildup is a key pathological feature
of Alzheimer's, and determining the degree to which someone's brain is riddled with the molecule is essential for designing effective clinical
trials.
In both
trials, levels
of two proteins that play major roles in transporting beta -
amyloid out
of the brain as well as enzymes that degrade beta -
amyloid increased significantly after administering oleocanthal.
One study, called A4 (the anti-
amyloid treatment in asymptomatic Alzheimer's
trial), will test solanezumab in 1,000 cognitively normal people age 65 to 85, who have abnormally high levels
of amyloid proteins.
This study was the first major Alzheimer's clinical
trial to require molecular evidence
of amyloid deposition in the brain for enrollment.
«We used two different antibodies — one
of which has been in clinical
trials for Alzheimer's — to neutralize the effects
of amyloid - beta and showed that you're able to rescue changes in tau,» Young - Pearse said.
Studies in mice specially bred to have features
of the disease found that DHA reduces beta -
amyloid plaques, abnormal protein deposits in the brain that are a hallmark
of Alzheimer's, although a clinical
trial of DHA showed no impact on people with mild to moderate Alzheimer's disease.
Although the variant itself is rare, the observed association with decreased plasma beta -
amyloid levels is important from the viewpoint
of Alzheimer's drug
trials.
This is a very significant discovery, as many on - going drug
trials in the field
of Alzheimer's disease focus on decreasing beta -
amyloid levels in the brain tissue.
There are a number
of reasons why the
trials may have failed, Hardy says, including the possibility that the antibody did not have high enough affinity for the particular forms
of amyloid that do the most damage in the brain, or that the patients in the
trials had already experienced too much brain degeneration to benefit.
A planned clinical
trial in people with high genetic risk
of developing Alzheimer's will put the
amyloid hypothesis to the test yet again
Billions
of dollars have been spent on clinical
trials of Alzheimer's drugs that target
amyloid plaques — the hallmark protein tangles that clog brain cells in people with the memory - robbing disease.
All previous clinical
trials designed to reduce the levels
of amyloid - beta using one therapy at a time have had limited success.
If successful,
trials in biologically defined populations could address uncertainties that have thus far stymied Alzheimer's disease drug development: Is
amyloid a trigger or driver
of downstream neuropathology?
However, despite this success, clinical
trials using these antibodies caused inflammatory side effects in the brain
of Alzheimer's patients, in particular
amyloid - related imaging abnormalities (ARIA), which results in small bleeds and dangerous brain swelling.
While some are suggesting the failure
of these BACE1
trials indicate that the
amyloid plaque hypothesis for Alzheimer's disease may in fact be wrong, other recent research still suggests more targeted methods
of inhibiting the enzyme could result in positive outcomes.
These «clinical
trials in a dish» have advanced the search for treatments for inherited conditions, such as Huntington's disease, Parkinson's disease,
amyloid lateral sclerosis, and types
of cardiovascular disease.
Should the slowing
of clinical decline be confirmed in ongoing phase 3 clinical
trials, it would provide compelling support for the
amyloid hypothesis.
Therapies applying this paradigm to clear β -
amyloid protein (Aβ) plaques and soluble aggregates from patients with Alzheimer's disease (AD) is an extremely active field
of research, with multiple active and passive Aβ vaccines currently in human clinical
trials.
If this holds up over the next few years
of larger
trials it should become very clear as to the degree to which
amyloid - β is or is not in fact the primary cause
of pathology in Alzheimer's disease.
To verify the effectiveness
of aducanumab, a
trial was set in place that involved 165 people receiving the drug and over the course
of one year it was reported that the
amyloid - beta levels in these people's brains had declined.
REVEAL - SCAN: Risk Evaluation and and Education
of Alzheimer's Disease - the Study
of Communicating
Amyloid Neuroimaging (RF1 AG047866) is the first multi-site, randomized clinical trial to examine the impact of learning amyloid imaging results in cognitively normal individuals, and its goal is to answer these que
Amyloid Neuroimaging (RF1 AG047866) is the first multi-site, randomized clinical
trial to examine the impact
of learning
amyloid imaging results in cognitively normal individuals, and its goal is to answer these que
amyloid imaging results in cognitively normal individuals, and its goal is to answer these questions.
This is especially true given the recent disappointing results in Alzheimer's disease
trials targeting
amyloid, the other major form
of pathology related to Alzheimer's disease.
Although the genetic evidence strongly supports the targeting
of γ - secretases (Szaruga et al, 2017; Voytyuk et al, 2017) to lower
amyloid - β generation in the brain
of patients, the severe side effects observed in phase 3 clinical
trials have brought γ - secretase research almost to an end (Doody et al, 2013; De Strooper, 2014).
And each and every
trial has failed, with the most recent report in the New England Journal
of Medicine showing that a drug, Semagacestat, designed to lower beta -
amyloid, actually made people more demented and increased the risk for other threatening issues.
A substudy from one
of the outpatient obesity
trials found that both the low - carbohydrate and low - fat diets led to reductions in C - reactive protein and plasma serum
amyloid A (85).
There are precedents that parallel our apparently paradoxical finding.36, 37 In a β -
amyloid immunization
trial among those with probable Alzheimer disease, immunization led to significant clinical benefit, reduced β -
amyloid load, and reduced brain volume.36 The investigators hypothesized that removal
of β -
amyloid and / or other protein constituents from brain tissue may have caused cerebral fluid shifts, resulting in brain volume reductions on magnetic resonance imaging.