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CONy 2021 | Evaluating the amyloid hypothesis in Alzheimer’s disease

Amos Korczyn, MD, Tel Aviv University, Tel Aviv, Israel, discusses the state of the amyloid hypothesis in Alzheimer’s disease (AD). The amyloid hypothesis has been the dominant theory in AD that has informed a significant proportion of AD treatments. As a result, research into alternative approaches and molecular targets such as APOE4 remains neglected and underfunded. This is particularly relevant, given that almost all amyloid-directed therapies, including passive and active immunization strategies, have failed. Recent findings from a single trial suggest that the amyloid-therapy aducanumab slows down AD progression; however, these findings are retrospective and require confirmation. Prof. Korczyn concludes by arguing that future AD research should focus on developing treatments based on other ideas such as neuroinflammation, environmental factors, and genetic risk factors such as APOE4. This interview was conducted during the virtual 2021 World Congress on Controversies in Neurology (CONy) meeting.

Transcript (edited for clarity)

As I mentioned before the huge amount of money that has been invested in trying to cure Alzheimer’s disease, it’s mainly anti-amyloid therapies, and this has failed. So for example, other targets like APOE ε4, which is an important factor, is not being given due attention and investment. So ultimately these, and the anti-amyloid therapies, have all failed active immunization, passive immunization and this and that and anti [inaudible] treatment and so on, and of them have failed so far...

As I mentioned before the huge amount of money that has been invested in trying to cure Alzheimer’s disease, it’s mainly anti-amyloid therapies, and this has failed. So for example, other targets like APOE ε4, which is an important factor, is not being given due attention and investment. So ultimately these, and the anti-amyloid therapies, have all failed active immunization, passive immunization and this and that and anti [inaudible] treatment and so on, and of them have failed so far. And the only exception so far has been the aducanumab, and this is a success, but a rather limited success. And it only applies to a small portion of the patients with Alzheimer’s disease. Those very early [inaudible] disease. And it does not stop the disease, but rather slows down. This is what the data that we have, but these data are retrospective. These data come from only a single study. They have to be reconfirmed. So for those who believe in the amyloid story, this is a sign of hope. But for many others, say they look at the empty part of the glass, and actually it’s not half empty. It’s three quarters empty and they say, “Look, enough is enough. Let’s take other targets. Let’s look at other things. And let’s talk about inflammation. Let’s talk about the other environmental factors that we know are important in Alzheimer’s disease. Let’s try and eliminate them.” And this may be much more fruitful than again barking at the amyloid tree.

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