Rapid Improvement in Function in Alzheimers After Enbrel Injection

This is a look at a small but fascinating study investigating a new treatment for Alzheimer's disease.Brains in Alzheimer's disease are damaged by long term inflammation of the brain. The progressive deterioration in memory and ability to perform tasks that must have a functioning memory take their gradual toll on these patients and their families. Several million Americans are expected to be develop Alzheimer's disease in the coming decades. Effective treatments are currently poor and ineffective, so new treatments are crucial for the patients and their families.

Alzheimer's disease is a demntia resulting from inflammation and damagein the brain. The damage and inflammation occur due to a variety of chemicals that the human body produces for other purposes. One specific chemical called TNF-alpha is thought to be a main cause of brain inflammation that occurs in Alzheimer's disease. TNF-alpha is a protein molecule made by white blood cells which stimulates and activates the immune system in response to cancer or some infections. Too much of this TNF-alpha compound is believed to lead to immune system diseases wherein the immune system attacks healthy tissues, suchas joints(rheumatoid arthritis) or skin(psoriasis). The newest treatments for these diseases make use of drugs that stopTNF alpha activity, thereby reducing undesirable inflammation.

Since 1998 etanercept(aka Enbrel), a potent TNF blocking drug has been approved for human use, for rheumatoid arthritis as the first official accepted indication. Etanercept is now being used for a numerous other diseases that involve excesss TNF activity. Etanercept hooks on to TNF-alpha and stops TNF-alpha receptors on many cell surfaces. This blocking effect reduces the inflammatory effects of excess TNF-alpha. Researchers and physicians currently have extensive experience using etanercept to treat a variety of inflammatory disorders where TNF-alpha over activity is believed to play a role. Diseases such as psoriasis and Crohn's disease in addition to rheumatoid arthritis are examples of diseases that etanercept is used.

A recent fascinating study from The Department of Neurology, USC School of Medicine used injections of etanercept(Enbrel) in the posterior neck. This location of injection was used to improve delivery of the drug into the brain, where it was hoped that its anti-inflammatory activity would take effect. The study included 15 patients who were injected weekly for six months. Posterior neck injection of etanercept led to sustained cognitive improvement for these patients with Alzheimer's disease which ranged from mild to severe. Other recent studies have also supported the idea that TNF plays a major part in the brain inflammation of Alzheimer's disease.

The study authors from Department of Neurology, USC School of Medicine noted an unexpected and dramatic clinical result (which recurred in the majority of the patients that were treated with etanercept ). The dramatic but repeatedly observed response was a noticeable improvement within minutes of perispinal etanercept injection. The rapid clinical improvement in memory and symptoms required the authors of the study to add new testing procedures to their protocol-so that they could measure the improvements.

A case report of an elderly 81 year old man describes markedimprovement within 2 hours. The improvement included the ability toremember interview details, improvement in ability to do simple calculations, ability to be better oriented to where he was and what time it was. The man continued to show the improved level of brain function including memory and performance of tasks throughout the duration study and in a 14 day follow up period. Family members of the elderly patient also reported that they had noticed improvement in the patient while at home.

The report of the journal article appears in the Jan 2008 Journal of Neuroinflammation

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