A small phase 1 study at Brigham and Women’s Hospital in Boston is looking at the “safety and tolerability” of a drug researchers hope will eventually be proved to prevent and slow the progression of Alzheimer’s disease.
If all goes well, the nasal spray might eventually be approved as a vaccine for the neurodegenerative condition, which impacts millions of Americans. But the clinical process is slow by design and there’s a long path — and many hurdles — ahead.
Still, the new study is the first hint that a vaccine for Alzheimer’s might be possible. The trial is the culmination of nearly two decades of research by Dr. Howard L. Weiner, co-director of the hospital’s Ann Romney Center for Neurologic Diseases, according to a news release from Brigham and Women’s.
The release explains that the new vaccine, like other vaccines before it, uses an immune modulator called Protollin to help boost the immune response. Protollin, which is made of proteins derived from bacteria, is supposed to “activate white blood cells found in the lymph nodes on the sides and back of the neck to migrate to the brain and trigger clearance of beta-amyloid plaques,” the news release says.
Those plaques, which are sticky clumps of protein, are a hallmark of Alzheimer’s disease. They’re believed by many Alzheimer’s researchers to interfere with cell communication in the brain.
“For 20 years, there has been growing evidence that the immune system plays a key role in eliminating beta-amyloid,” said Dr. Tanuja Chitnis, a professor of neurology and lead investigator on the study. “Research in this area has paved the way for us to pursue a whole new avenue for potentially treating not only (Alzheimer’s), but also other neurodegenerative diseases.”
The 16 clinical trial participants — who are between the ages of 60 and 85 and each have early-stage, symptomatic Alzheimer’s but are otherwise in good general health — will receive two doses of the nasal spray a week apart. Besides looking at how well the spray is tolerated and whether there are health complications, the research team wants to measure what happens to white blood cells in response to the spray.
Plaques or tangles?
For decades, researchers have been considering different factors that might lead to Alzheimer’s disease — and that might be paths to prevent or cure it. So far, nothing’s truly been figured out.
Besides beta-amyloid plaques, tau tangles are found in the brains of those with the disease. Researchers aren’t sure which has more impact — or how the plaques and tangles might interplay with each other in the disease.
In 2018, Nature reported it might be time to “broaden the list of the condition’s potential causes,” since trials of drugs that were designed to remove beta-amyloid didn’t succeed in clearing the disease.
“The amyloid hypothesis has never been universally accepted, and the failed drug trials have only emboldened its critics,” the article said, noting that its supporters weren’t ready to give up hope.
The role of the tau tangles has been hard to unwind, as well.
Experts are convinced that genetics play a role in “influencing” whether one gets Alzheimer’s. But they also note that people who have genes that increase the risk of Alzheimer’s may never develop noticeable symptoms of the disease. And some people without known genetic risk sometimes do.
Aging is still the greatest risk factor, according to Alzheimer’s experts. But they also note that many people live very long lives and never develop dementia. Dementia is not considered a normal, inevitable part of aging.
In its roundup of suspected causes, Alzheimer’s News Today notes that some studies have found associations between air pollution and Alzheimer’s. And certain lifestyle choices, including smoking, alcohol consumption, being a couch potato, isolation, poor nutrition and sleep disorders, may also contribute to the development of the disease.
Do it yourself
While researchers continue to seek medications that can prevent, slow or cure the disease, there’s broad agreement that making lifestyle changes can improve the odds that you can be healthy in old age.
“Numerous studies have found that physical exercise plays a large role in healthy aging and is linked to better performance regarding working memory and cognitive flexibility,” Alzheimer’s News Today reported.
In July 2020, the Deseret News reported that despite all the disagreements and lack of clear answers about the disease, experts do agree that exercise makes a difference. Experts recommend 150 minutes of exercise a week.
The article cited a study from the National Institute on Aging that followed 3,000 participants over a lengthy period and said healthy lifestyle behaviors create “substantially lower risk” for Alzheimer’s.
“Dr. Klodian Dhana, assistant professor at Rush University, who led the study, said those who practiced two or three of the lifestyle choices had a 37% lower risk and those with four or all five had 60% reduced risk of Alzheimer’s, compared to those with no or one of the lifestyle factors,” the Deseret News reported.
Clocking more steps every day was linked to lower mortality from all causes.
“What is good for the heart is good for the brain,” Dr. Norman Foster, a neurologist and professor at the University of Utah who specializes in Alzheimer’s research, told the Deseret News. “There’s a lot of good, objective scientific evidence that supports these kinds of changes, which also make a lot of common sense.”
While researchers and clinicians continue to look for cures, there’s quite a bit that individuals can do to stay healthier and perhaps even ward off the disease.
Among the advice from experts:
- Stay active. Walk long enough and fast enough to feel warm and get your heart pumping. Do it often.
- Have stimulating conversations. Learn new things. Learning a new language is believed to be especially good. Whatever you choose to learn, it should be challenging.
- Consume high-quality, nutritious foods. Multiple experts told the Deseret News that a Mediterranean-DASH diet, which is largely plant-based, is a good choice.
As Foster said, the most important thing is to begin. Start somewhere, make it a habit and keep it up.