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TX: 31.07.06 - New Hope for Dementia

PRESENTER: CAROLYN ATKINSON
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ATKINSON
Next imagine a vaccine that would prevent Alzheimer's Disease, well it's now closer than ever to becoming a reality - British scientists are about to start a trial which if it goes according to plan could for the first time slow or even the stop the disease, rather than just treating the symptoms. And as Alzheimer's research moves forward faster than ever before what is the link with diabetes - a team of US researchers are suggesting that Alzheimer's could even be called type 3 diabetes. As part of Radio 4's memory experience we're broadcasting a week of reports on dementia and I've been speaking to Dr David Wilkinson, the director of the Memory Assessment and Research Centre at Southampton's Moorgreen Hospital, about these developments in research.

WILKINSON
In Southampton we're just about to start two or three important trials. One using a vaccine and two using what we call monoclonal antibodies, which are going to try and remove the amyloid, which is the abnormal protein that's present in patients who have Alzheimer's Disease. And this is an incredibly important step forward. We had tried a vaccine about five or six years ago which did show these beneficial effects but this was a very powerful vaccine which caused some people to have some unacceptable side effects. The new vaccines have been redesigned, redeveloped and are much more safe and we hope as potent and we're really excited about the prospect of starting these clinical trials which could easily lead to a very substantial treatment for the condition in four or five years time.

ATKINSON
And we're talking about a treatment, as opposed to just treating symptoms of Alzheimer's, so that is a huge leap forward.

WILKINSON
Absolutely, for the last 10 years we've really had only some symptomatic treatments and these vaccines and these antibodies aim to really get rid of the abnormal protein which is at the heart of this disease, so we really can think of them as disease modifying treatments.

ATKINSON
And when we're talking about a vaccine normally we associate that with giving it to someone before a condition kicks in, is that what we're talking about here?

WILKINSON
Well obviously that would be the ideal, you wouldn't want a vaccine against smallpox after you've got the disease, you'd want to give it before and that would be what we ideally want to do here but of course at the moment there are two problems, one is it's actually quite difficult to identify people before they've got symptoms and the second thing of course is in terms of the early trials it's clearly quite difficult to do a trial on someone who you think might be going to get the disease at some time in the future. It's much easier to do the very early trials on people who've already got the disease and see whether you can ameliorate the symptoms they've got and perhaps reduce the progression of the disease. But once we've proved that it works and it's safe then we would be wanting to treat people before they really start to develop the signs and symptoms.

ATKINSON
And so we might be in a position one day where children at school get their BCG and their boosters and everything and in there is an anti-Alzheimer's vaccine?

WILKINSON
It sounds a bit fanciful but one could envisage that, yes absolutely. It might be that it would be more focused on certain individuals with certain genetic makeup or with certain history rather than everybody, because I think there's a lot now that's emerging from the data which suggests that this whole problem of the build up of this abnormal protein and the inability for the brain to get rid it is part of a whole collection of different lifestyle issues, if you like, and some that we're familiar with in terms of heart disease as well, which hopefully if we can change the way we live and eat over the next 40 or 50 years we might be able to do a lot to reduce the incidence of Alzheimer's as well.

ATKINSON
Now you're just back from a very large conference on Alzheimer's research and dementia research in general, which took place in Madrid and there were an awful lot of papers that were published there which have excited the world of dementia research. One of the things that was published was this link which a lot of people don't know about - the link with diabetes and the effect that insulin can have.

WILKINSON
Yes I think this sort of links in with that whole theory. I mean it's very clear over the years from epidemiological studies that people with diabetes, type 2 diabetes, have a greater risk of developing Alzheimer's Disease. And it's also clear that patients with Alzheimer's Disease have higher levels of insulin in their blood but that that insulin isn't effective. And what we've also noticed now - and this was reported in one of the papers in Madrid - was that the brain levels of insulin are also low in patients with Alzheimer's Disease. And one group from America - from Harvard - have really thought that Alzheimer's Disease could also be called a type 3 diabetes, that this is a stage of insulin resistance and low levels of insulin which may be actually producing some of this abnormal changes we see in Alzheimer's Disease. And we also saw an exciting study where intranasal insulin was used...

ATKINSON
Breathing it in.

WILKINSON
Yeah, inhaling the insulin, you can't actually give insulin in the normal way to normal people obviously because you'd lower their blood sugar but by breathing it in, in a vapour, it goes straight to the brain and doesn't alter the blood glucose levels. And what they demonstrated, in a very short study admittedly, with a small number of people, but over three weeks the patients who had Alzheimer's Disease and used this inhaled insulin had markedly improved memory.

ATKINSON
And the discovery of a new gene has also caused a lot of excitement hasn't it, linked with frontotemporal dementia, which is the second most common type of dementia in under 65s after Alzheimer's Disease. How significant is this gene being seen as?

WILKINSON
This is very important because about a third to a half of patients who have frontotemporal dementia will have some sort of family history and so it was always felt that there was a genetic component. And the gene for tau protein was identified on chromosome 17 about eight or nine years ago which explains some of the inheritance but not all. And what has been found now is a new gene - the progranulin gene - which is also on chromosome 17 and is a gene which is involved in various developments of cells - wound repair, inflammation - and this is a very important finding, not specifically for those patients of course who have got the disease but because it really advances our understanding of what's going wrong when people develop these dementias because this gene clearly gives rise to some of the findings that we see in the brains of patients with this disorder and that would allow us to understand it and maybe try and develop some treatments which can intervene.

ATKINSON
And the other key area that the scientists are all working on is the diagnosis and earlier diagnosis and easier diagnosis, but there's been quite a lot of talk about trying to spot things in people's eyes that might tell you what's going on in the brain, what can you tell us about that?

WILKINSON
Yes that was really quite an interesting piece of information from Brown University in Rhode Island where what they noticed was that in the lenses of patients with Alzheimer's Disease there was the presence of this amyloid, the very same protein that's deposited in the brain in patients and it wasn't present in people who hadn't got Alzheimer's Disease. So they're developing a way of identifying it with a laser treatment, which is completely non-invasive, to see if they can prove that this is an early detection of patients who have Alzheimer's Disease. And clearly a very simple test like that would be absolutely ideal when we have something like a vaccine and we need to give it to patients in the very, very early stages of the illness.

ATKINSON
So where are we at in terms of making progress and working towards that big breakthrough, are we at a period in time where that is now looking increasingly likely?

WILKINSON
When you think about how people felt about Alzheimer's Disease or dementia generally 10, 15, 20 years ago when I started where there was really nothing you could do except support people, to see the huge number of different developments that are taking place at the moment, it's really just fantastic, it's an extremely exciting time to be working in the field of Alzheimer's research, there are so many different avenues, so many of the different disparate research projects seem to be moving together into a sort of cohesive hole. And looking at all of these and other influences which may be predicting who will and who won't be getting the illness I think it's an incredibly exciting time and it really does look as though there are just over the horizon, which isn't very far away, there are going to be some really substantial treatments available I think.

ATKINSON
Dr David Wilkinson from Southampton's Moorgreen Hospital. And on tomorrow's Call You and Yours we want your views on coping with memory loss - have you been affected by memory loss or are you a carer for someone with dementia, have you had to cope with challenging behaviour and what has the impact been on the rest of the family, do you think there's enough support for people affected by dementia and if not what would you like to see? Perhaps you're just beginning to experience mild memory loss and maybe you have attended a memory clinic, if so has it been useful to you? Whatever you views you can call us on 0800 044 044 or e-mail via website at bbc.co.uk/radio4/youandyours and please leave your number so that we can call you back.

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