Alzheimer s disease: the state of play

Transcription

1 Alzheimer s disease: the state of play 30 th May 2012 Dr Eric Karran Director of Research ARUK

2 Scope of presentation An overview of research into the causes of dementia, with an emphasis on Alzheimer s disease Research undertaken from Alzheimer s Research UK Benchmarks on funding What impact the Prime Minister s Challenge could have How the Alliance can work together to ensure that research into dementia is properly funded

3 Predicted world prevalence of dementia WHO/Alzheimer s Disease International 2012

4 The beginning for Alzheimer s disease Alois Alzheimer Auguste D Case presented November 3 rd 1906 in Tubingen, Germany: On a peculiar, severe disease process of the cerebral cortex

5 What Alzheimer saw under the microscope

6 Features of Alzheimer s Disease Plaques (Abeta peptide) Microscopically Tangles (abnormal tau) Macroscopically

7 The amyloid cascade a hypothesis for Alzheimer s disease Gene mutations causing early onset Alzheimer s disease + Free Abeta peptide + + Deposited Abeta Down s syndrome (Trisomy 21) Major genetic risk factor? STRESS Abnormal tau From deposition of Abeta into plaques, to the beginning of detectable symptoms ~15 years

8 Revealing pathology in the living brain 71 years Normal 69 years Alzheimer s disease Amyloid plaques Brain tissue Global loss of brain tissue/year Normal Controls = 0 24% Mild to moderate AD = 2 20%

9 Risk factors for Alzheimer s disease Risk factors Protective factors Age > 65 years ApoE4 Diabetes increases risk 54% Obesity increases risk 59% CV/HTA Metabolic syndrome Depression Stress Head trauma Smoking Mediterranean Diet Physical activity Intellectual activity Social network/ activities ApoE2

10 Economic impact Total estimated worldwide costs of dementia are US$604 billion in 2010 taking into account informal care, direct costs of social and medical care - about 1% of the world s GDP World Alzheimer Report, ADI Wimo and Prince, 21 st September 2010

11 Investment ( m) Ratio bn UK data based on analysis 25 Annual Cost of disease in UK Dementia Cancer Stroke Heart disease 600 UK research funding by disease (2007-8): government and charity 500 Societal cost/research spend ratio Government Charity Dementia Cancer Stroke Heart Disease 0 Dementia Cancer Stroke Heart Disease

12 The amyloid cascade a hypothesis for Alzheimer s disease Gene mutations causing early onset Alzheimer s disease + Free Abeta peptide + + Deposited Abeta Down s syndrome (Trisomy 21) Major genetic risk factor Knowledge gap Knowledge gap Knowledge gap? STRESS Abnormal tau From deposition of Abeta into plaques, to the beginning of detectable symptoms ~15 years Knowledge gap

13 Prime Minister s challenge More than doubling overall funding for dementia research to over 66m by The combined value of the NIHR, MRC and ESRC funding for research into dementia will increase from 26.6m in 2009/10 to an estimated 66.3m in 2014/15. Major investment in brain scanning MRC will make a major additional investment in dementia research using the BioBank. MRC anticipates piloting the brain scanning of a subset of this national cohort, with a view to rolling out to ,000 participants. 13m funding for social science research on dementia (NIHR/ESRC) including 3m for public health research. 36m funding over 5 years for a new NIHR dementia translational research collaboration to pull discoveries into real benefits for patients. Four new NIHR biomedical research units in dementia and biomedical research centres which include dementia themed research will share their considerable resources and world leading expertise to improve treatment and care. Participation in high-quality research Consent to participate in research will be one of the conditions of accreditation for memory services. The MRC will spend over 3m in supporting the UK brain bank network, which connects all the UK brain banks for the benefit of donors, researchers and future patients This includes 500k a year to improve the process for donation of brain tissue by meeting the costs of collecting brain tissue through the NHS, so smoothing the pathway to donation. A major event will be staged for pharmaceutical and biotech companies to showcase the benefits of conducting dementia research in the UK, and to assess how best to remove the barriers to doing so. We will work towards recruiting 10% of patients into clinical trials. Up to 9m of DH funding will be made available for research into living well with dementia and the delivery of dementia care. The DH will increase its support for capacity-building in dementia research, focusing on nurses as well as doctors. The MRC is a leading partner in two international initiatives in the area of neurodegeneration research: the European Joint Programming initiative which aims to coordinate national efforts in this area; and the Centres of Excellence Network in Neurodegeneration (CoEN) which seeks to add value to existing investments in excellence. The world-leading MRC Laboratory of Molecular Biology (LMB) is moving to its new 200m facilities in Cambridge in the autumn Within this, the Neuroscience Research Division has been provided with an expanded budget of 29m over the next three years, with a major part of its research dedicated to dementia/neurodegeneration. The NIHR has also just completed a first-ever themed call for proposals in dementia research Some 17m will be committed to new research projects through this call, exceeding original expectations. The 18 projects to be funded range from work on better diagnosis to improving care in a wide range of settings, from individual s own homes, through residential care to specialist hospitals

14 Dementia Action Alliance Continue to advocate that research is required to enable the discovery of new therapeutics. Research into neurodegenerative diseases is significantly underfunded relative to other diseases that have significant societal and individual impact.

15 Drugs in development for AD Mangialasche et al. Lancet Neurol 2010; 9: