Defeating Alzheimer’s by 2025 could be within reach

Not a single effective treatment for Alzheimer’s.
Not a single effective treatment for Alzheimer’s.
Image: Reuters | Nacho Doce, Edgard Garrido, Juan Medina
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Of the 10 leading causes of death in the United States, Alzheimer’s disease is the only one for which there is no effective treatment. The disease has a staggering reach: Roughly one out of every five of us is at risk of developing Alzheimer’s dementia in our lifetime. Caring for Alzheimer’s victims costs the world an estimated $604 billion each year in addition to the terrible personal costs to families. Its numbers are expected to triple to an estimated 115 million people by 2050. If nothing changes between now and then, not a single person will survive it.

In other words, Alzheimer’s is a slow-motion time bomb. The trouble is that the scale of the research has never met the size of the problem. And those of us who have worked in this field for decades have had limited success bringing attention to the magnitude of this deadly disorder.

But a more collaborative, focused approach between the public and private sectors is beginning to take hold. Scientists engaged in it are making quick progress that promises to ultimately transform Alzheimer’s from a death sentence into a preventable illness.

This new research model is emerging not a moment too soon. While Alzheimer’s kills more people than breast cancer and prostate cancer combined, the US government invests 12 times more in cancer research than research on Alzheimer’s disease. Similarly, while the federal government spends $4 billion per year on cardiovascular disease, the number of patients age 65 and older who were hospitalized with heart attacks dropped nearly 40% from 1999 to 2011. By contrast, we still spend less than 1% of the cost of Alzheimer’s care on research each year. Yet, deaths due to Alzheimer’s disease have increased by 68% between 2000 and 2010, and not a single disease-modifying drug for Alzheimer’s has made it to market.

Another problem that set research back for many years is that Alzheimer’s research tended to exist in silos. Government, the private sector, and universities each worked on separate tracks, failing to share information that could advance an effective treatment.

But now, rather than having many scientists in many places doing research independent of one another—using different methods—public and private sector collaboration is helping unite researchers around a common data set. As a result, we have reached a critical tipping point in the search for medicines that could make Alzheimer’s preventable. New investments in such collaborative research promise to keep up the momentum. To that end, a first-of-its-kind partnership launched last month in Geneva promises to fund the kind of cutting-edge research that could lead to a successful treatment within a decade.

It is a partnership that will help build upon science that has pushed our knowledge of the brain and Alzheimer’s disease to unprecedented levels. Using technology like the brain imaging known as positron emission tomography (PET) scans, researchers have come closer to unraveling the mysteries of protein deposits called amyloid plaques that are believed to contribute to cognitive impairment, while working on therapeutic vaccines that could help prevent the tangles associated with another protein in our brains called tau.

One thing we’ve learned is that while the dementia associated with Alzheimer’s—progressing from subtle memory loss to the inability to perform basic activities of daily life—typically occurs in older age, the underlying brain disease begins to develop more than a decade earlier. Public and private researchers are focused on the biomarkers present in people who may later be at risk for developing Alzheimer’s dementia and on clinical trials to reduce amyloid plaque buildup.

Already, these public-private partnerships have shown promise. The Anti-Amyloid Treatment in Asymptomatic Alzheimer’s disease (A4) study is a collaboration between the Alzheimer’s disease Cooperative Study, the National Institutes of Health, Eli Lilly, and several philanthropic organizations. The A4 study is examining whether drugs targeting amyloid plaques can inhibit memory loss in people with evidence of amyloid plaque in their brains but no outward Alzheimer’s symptoms. If A4 is successful, it could go a long way toward developing treatments to attack Alzheimer’s disease before it descends into dementia.

Other public-private initiatives, such as the Alzheimer’s disease Neuroimaging Initiative, have pioneered data sharing and provided critical information that has launched exciting secondary prevention trials.

The partnership launched last month, known as the Dementia Discovery Fund, promises to build on the progress made to date by these information-sharing models. It is the first venture capital fund in the world to focus solely on backing new and innovative ways to prevent and treat dementia. It is the result of a unique public-private partnership between the British government, business leaders, philanthropists, and several of the world’s largest pharmaceutical companies, including Johnson & Johnson. Seeded with $100 million, it grew out of an ambitious goal set by G8 ministers in December of 2013: to bring together industry and government to develop a cure or effective treatment for Alzheimer’s and similar forms of dementia by 2025.

The fund will provide a needed financial infusion to the research enterprise, enabling us to share the risk and pool resources to back the most promising ideas from any source, whether they come from small biotech companies, academic groups, or leading pharmaceutical companies. It will also enable researchers to gain expert advice from peers, particularly in early stages when such insight is critical. Companies that wish to develop projects commercially based on the research will be allowed to bid for rights, creating a virtuous cycle in which money is channeled back into the fund.

We have seen such an approach work in the past. Thirty years ago, HIV/AIDS was a death sentence. Then, government institutions, advocacy organizations, and activists started to collaborate, sharing data and building on the best ideas while creating novel regulatory pathways. After a decade of progress, it reached a turning point when the G8 pledged $1.3 billion to scale HIV efforts worldwide. As a result, for those who have access to treatment, HIV has gone from a two-year life expectancy to a nearly normal life expectancy.

The Dementia Discovery Fund and other public-private partnerships could do the same—assuming that every part of the research community steps up to make the most of them, building on each other’s efforts while maintaining our focus on achieving our common goal. Finding an effective, disease-modifying treatment for Alzheimer’s by 2025 is an ambitious target. But it is critical that we continue to work together and increase our commitment to defeat this looming public health crisis. As we gaze into the faces of our grandparents and parents—our loved ones who no longer recognize their families—and the faces of our children who will have to care for us, it is clear that we have no other choice.