Local clinicians battle Alzheimer's
By Lou Ortiz
After 10 years of clinical trials, there are more trials and more tests to run in the battle against Alzheimer's disease.
"We've done well over 50 clinical trials over 10 years" that have involved "several hundred people," said Dr. Marc Agronin, medical director for Mental Health and Clinical Research at Miami Jewish Health Systems.
A most recent development is a "new type of eye test for identifying Alzheimer's," Dr. Agronin said. "We will be looking for patients for it. It's still in development."
Alzheimer's is a progressive brain disease that afflicts individuals in the middle and later stages of life — usually age 65 and older — that impairs not only memory but eventually all cognitive skills over a eight- to 12-year period.
"The risk increases with age," Dr. Agronin said of Alzheimer's. "It's a disease of old age. People are living longer lives, and this explains why we are seeing more patients. There's an epidemic of this now. There are more than 5 million Americans with the disease. It is the costliest after heart disease and cancer."
"People become debilitated, they can't walk, they can't speak, they can't swallow, and then they get infections and injuries" and eventually die, he said.
"We believe it [Alzheimer's] is caused by the buildup of toxic proteins in the brain," said Dr. Agronin, referring to the beta amyloid and tau proteins. "Our clinical research is getting at the source of the disease, which is believed to be these toxic proteins."
According to the Maryland-based American Health Assistance Foundation, "One of the hallmarks of Alzheimer's disease is the accumulation of amyloid plaques between nerve cells (neurons) in the brain."
"Amyloid is a general term for protein fragments that the body produces normally," the foundation says. "Beta amyloid is a protein fragment snipped from an amyloid precursor protein. In a healthy brain, these protein fragments are broken down and eliminated. In Alzheimer's disease, the fragments accumulate to form hard, insoluble plaques."
The other protein is just as involved. "Neurofibrillary tangles are insoluble twisted fibers found inside the brain's cells," the foundation says. "These tangles consist primarily of a protein called tau, which forms part of a structure called a microtubule."
"The microtubule helps transport nutrients and other important substances from one part of the nerve cell to another," the foundation says. "In Alzheimer's disease, however, the tau protein is abnormal and the microtubule structures collapse."
Dr. Agronin started the clinical research program here in 2000.
"We've taken two steps forward," he said, "and one step back. We have a much deeper understanding of the disease process. We've been studying ways to prime the immune system to break up these toxic proteins in the brain. That has been a huge development over the last 10 years."
The second step forward is "we've been able to identify the disease in its course, because the earlier you do the better chance of slowing it down," he said. "We use a new type of brain scan. We were one of the first in the country to test this scan — the amyolid-based PET Scan."
"You can scan the brain and see the proteins that we believe cause the disease," he said. "Prior to this, we had to do a brain biopsy."
The step back involves treatment. "Today, none of the treatments have slowed down the disease," Dr. Agronin said. "Many of the newer research studies are looking for people at the earliest stages of the disease. Now with the brain scan, we can identify those who are at a greater risk of the disease."
Despite the fact there is no cure, Dr. Agronin said there is hope. His research includes testing vaccines, stimulating memory receptors in the brain, and the eye test, among other things.
"So far the vaccine appears to be safe. It is too early to know if it slows the disease," he said, adding that "if you can't breakup the proteins, we can stimulate areas of the brain that deal with memory and learning."
Dr. Agronin, a Harvard University and Yale University School of Medicine graduate, is an expert in psychiatric illnesses affecting the elderly. He has authored several books and serves as an affiliate associate professor of psychiatry and neurology at the University of Miami Miller School of Medicine.
"Our lives are dedicated to helping them," he said of Alzheimer patients. "This is our mission."
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