From the June 2019 issue of DOTmed HealthCare Business News magazine
The use of imaging biomarkers in making an Alzheimer’s diagnosis has led to the shift in the last few years from amyloid-centric to non-amyloid imaging targeting, and introduced new forms of imaging, such as synaptic imaging and neuroinflammation imaging, for assessing. While not specific to Alzheimer’s, neuroinflammation is believed to play a major role in the neurodegeneration process of many neurological conditions, but what that role is, remains unclear.
“We do not know yet if the neuroinflammation is helping or trying to mitigate the disease process, or if the host reaction or neuroinflammation is making neurological diseases worse,” Dr. Satoshi Minoshima, 2018-2019 president of the Society of Nuclear Medicine and Molecular Imaging (SNMMI) and chairman of radiology and imaging sciences at the University of Utah, told HCB News. “To better understand these questions, we really need to have an in vivo imaging marker,” he said.
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New classes of such drugs have been developed, according to Minoshima, and looking ahead they should provide greater insight on the role of neuroinflammation in Alzheimer’s diagnoses.
Echoing this sentiment is Dr. Jason Cai, an assistant professor from the Yale PET Center at Yale School of Medicine, and part of a team that recently developed a radiotracer for measuring synaptic density, an early and robust biomarker for Alzheimer’s. “I think in the future we will see a combination of amyloid, tau and neurodegeneration PET as biomarkers for AD, hopefully together with structural information from MR imaging.”
Factors currently limiting research
With no treatment or cure in sight for Alzheimer’s, efforts to justify the development of diagnostic agents are sometimes met with skepticism.
“If there is no therapeutic to change the course of the disease, it is hard to justify complex diagnostic tests, especially when they are expensive,” said Minoshima. “With no approved outcome benefit of a therapeutic drug, we cannot change the course of the disease and make a sustainable impact on patients. I think this challenge is going to continue for a while.”
A lack of treatment also means insurers are less inclined to reimburse for diagnostic exams, said Dr. Henryk Barthel, assistant medical director at the department of nuclear medicine at the University of Leipzig, who added that once such a drug becomes available, it’s predicted that the use of molecular imaging in Alzheimer’s will “massively increase” in both clinical routine and research.
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