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11 February 2015

Brain Biomarkers 2015

Director of Healthcare Innovation, Jenny Barnett looks back on the Brain Biomarkers meeting on the advances occuring especially in Alzheimer's and Dementia research.

 Author: Jenny Barnett, Director of Healthcare Innovation


Last week I attended the third Biomarkers for Brain Disorders meeting at the Wellcome Trust’s Genome campus just outside Cambridge. This biennial meeting is somewhat unique in its balance of academic and industry participants, including big pharma and small diagnostics companies, as well as research groups from around the world. Having attended each of these meetings over the past 5 years it is great to see the progress that is occurring in the field, even if the ‘magic bullet’ blood test for Alzheimer’s remains out of reach.

One important development is the very large-scale collaborations that are now coming to fruition in Alzheimer’s and other neurodegenerative diseases.  These include private-public partnerships and pre-competitive consortia such as the Investigative Medicine’s Initiative EMIF and EPAD projects and the UK Dementias Platform, many of which Cambridge Cognition is a partner in. The open data approach has revolutionised genetic research, by requiring individual research projects and grants to contribute their raw data to the larger body of research, as well as using it to test their own hypotheses. While the technicalities of how to share data efficiently and securely are not trivial, the efforts required have paid off enormously in terms of increased understanding of genetic contributions to common diseases. If we are on the brink of a similar step-change in data use and neurobiological understanding in brain disorders then it is going to be a very exciting field to work in over the next few years.

Another important shift evident at the meeting was the continued interest in ever-earlier intervention in Alzheimer’s. This has led to increased study of the course of disease progression in patients who are biomarker positive but show no clinical symptoms (so-called preclinical or presymptomatic patients). Understanding what would be optimal patient selection criteria and regulatory-compliant endpoints for studies in this population is challenging. We believe that sensitive cognitive tests such as the Cantab PAL have a distinct role to play in defining those individuals most at risk, i.e. those who show cognitive function that is within the normal range, but poorer than that expected for someone of their age, sex and educational level, or those who appear to show greater than expected age-related cognitive decline.  Domain-specific cognitive tests like the Cantab PAL which are highly sensitive to normal cognitive aging are capable of detecting the effects of interventions on early disease course, in a way in which tests like the ADAS-cog cannot.  It is great to see an increasing interest in intervening at this very early stage of disease, where biological or lifestyle interventions could more plausibly prevent disease progression and keep people cognitively well for longer.  

Finally it was interesting to see some emerging consensus about how a cascade of biomarkers might be used in order to detect at-risk individuals for trials or public health strategies. This might start with inexpensive and non-invasive assessments such as cognitive assessment, and proceed through a number of stages of increasingly complex and invasive assessments, up to CSF assays or PET scans to confirm and differentiate disease pathologies. We know that there is already great variation between countries’ diagnostic processes in the diagnosis of AD dementia; from countries like Sweden where lumbar puncture is routine practice to others where even a basic diagnostic process is not universally available.  Refining the most effective and cost-effective strategy for the detecting prodromal or preclinical Alzheimer’s is an ongoing process, but one to which hearteningly large amounts of data and brainpower are now being applied.  

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