Breakthrough In Alzheimer’s Treatment Using Focused Ultrasound With Amyloid Clearing Drug

Forbes Innovation Healthcare Breakthrough In Alzheimer’s Treatment Using Focused Ultrasound With Amyloid Clearing Drug Mill Etienne Contributor Opinions expressed by Forbes Contributors are their own. I am a physician and public health researcher Following Click to save this article. You'll be asked to sign into your Forbes account.

Got it Jan 9, 2024, 07:00am EST Share to Facebook Share to Twitter Share to Linkedin MRI guided focused ultrasound combined with aducanumab intravenous infusions demonstrated greater ... [+] reduction in amyloid plaques in brain regions treated with focused ultrasound compared to brain regions that did not get treated with focused ultrasound.

getty A recent study published in the New England Journal of Medicine demonstrated that focused ultrasound combined with an amyloid clearing drug, aducanumab, resulted in increased removal of amyloid plaque from the brain compared to treatment with aducanumab alone. The investigators also found that the procedure was safe, with no subjects experiencing brain bleeds, a key concern when treating patients with aducanumab.

In this study, two hours after receiving an infusion of aducanumab, patients had MRI guided focused ultrasound targeted at specific brain regions to open up the blood brain barrier. The BBB is a line of defense that prevents toxins and other foreign substances from entering the brain, but allows the passage of important nutrients to nourish the brain.

The BBB also prevents medications intended to treat brain disorders from adequately penetrating the brain, which makes it difficult to treat diseases impacting the brain. This study took advantage of prior research showing that focused ultrasound can temporarily open the blood brain barrier, facilitating medication entry into the brain to optimize their benefit.

The same researchers had previously demonstrated that focused ultrasound opens the BBB in patients with Alzheimer’s disease. The BBB can remain open for 24 48 hours. In this study, researchers targeted one side of the brain with focused ultrasound to temporarily open the BBB, while the other side of the brain served as a control for comparison.

Aducanumab is known to target a protein in the brain called amyloid, which is one of the defining features of Alzheimer’s disease and likely contributor to gradual, irreversible decline in cognitive function. While it’s not a cure, and not without risk, studies demonstrated it successfully removes amyloid plaque from the brain.

Three subjects enrolled in this clinical trial, two men and one woman. All three subjects had a diagnosis of mild Alzheimer’s disease. They also had an amyloid PET scan of the brain, demonstrating amyloid deposition throughout the brain. MORE FOR YOU A Psychologist Explains The 5 Phases Of Loving Relationships A Psychologist Offers 2 Tips To Be More Likable Through Conversation The Perfect Health And Wellness Weekend In Toronto Follow up brain amyloid PET scans after 26 weeks of treatment with aducanumab revealed a lower standardized uptake value ratio of amyloid from the side of the brain that had the focused ultrasound compared to the side of the brain that did not receive the focused ultrasound.

SUVR is a common approach to evaluating the amount of amyloid in the brain. Animal studies have shown an eight fold increased concentration of aducanumab in brain regions exposed to focused ultrasound, however concentration of aducanumab in the brain was not specifically evaluated in this study. There was no evidence of improved cognition in these subjects; however, with only three subjects, this was not an expectation of the study.

Headaches were the most common adverse event reported and one participant experienced head and neck discomfort. Notably, no participants experienced brain bleeds. This study offers hope for people with Alzheimer’s dementia. Since amyloid plaques have been implicated as a causative factor in Alzheimer’s dementia, hopefully, removing the plaques will be a step towards restoring the lost cognitive function.

More extensive studies with larger sample size to better understand the benefits and potential side effects of this novel approach to treating Alzheimer’s disease are needed. MRI guided focused ultrasound after intravenous infusion with aducanumab, an amyloid clearing drug, ... [+] successfully removed amyloid plaque from the brain.

Combining focused ultrasound with the aducanumab infusion was superior to treatment with aducanumab alone. This offers new hope for people with Alzheimer's disease. getty While focused ultrasound to assist drug delivery to the brain offers great promise, there are concerns like other toxins gaining access to the brain, particularly if the BBB remains open longer than the expected 24 48 hours.

Another consideration would be an alteration of the integrity of the BBB after recurrent focused ultrasound treatments, which might also make the brain more vulnerable to toxins. It is possible to determine if the BBB is open or closed by administering an intravenous contrast known as gadolinium. The brain regions with an open BBB will allow the gadolinium to enter the brain in those areas only.

One additional concern is that prior studies have shown that aducanumab infusions increase the risk of brain bleeds. A blood test predicts which patients are more likely to have brain bleeds after aducanumab infusions; potential subjects in this trial were tested and those at risk for brain bleeds were excluded from the study.

More than 6 million Americans over age 65—that’s one in nine people—have Alzheimer’s disease. Providing a medication that can halt the accumulation of amyloid plaques is exciting and can be a game changer for people living with Alzheimer’s disease. Additionally, this may offer hope for other neurological diseases that require treatment with drugs that need to cross the blood brain barrier, like brain tumors, Parkinson’s disease, schizophrenia, multiple sclerosis and epilepsy.

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