Lutz Frolich on Collaboration and Challenges in Alzheimer Research and Development

August 15, 2018

Can better collaboration between industry and clinicians solve the challenges that plague the Alzheimer community?

Lutz Frölich, MD, PhD

Lutz Frölich, MD, PhD, the head of the Department for Geriatric Psychiatry, at the Central Institute of Mental Health, sat with NeurologyLive to discuss a few different topics surrounding Alzheimer disease.

One was how collaboration between the researchers on the clinical side and on the pharmaceutical side is essential to furthering the understanding of the condition. He noted that in recent years, that collaboration has changed and evolved, and the community needs to adjust to it.

Frölich also spoke about the challenges that plague the Alzheimer community, which already struggles to get the funding it needs to research and develop truly effective therapies. Some of these challenges include the ever-shifting understanding of the disease’s pathology, while others consisted of maintaining the proper mindset in this space—a space that has seen failure over and over again.

NeurologyLive: As someone with a long history in Alzheimer disease research, what have you noticed that’s changed in the space?

Lutz Frölich, MD, PhD: I personally have been involved in Alzheimer’s research—clinically applied Alzheimer’s research—for more than 35 years by now. I think this is still a very, very important area of research. It has not received as much attention as cancer research, for instance, however, it will be one of the most important diseases of the upcoming years. It is really a big effort that has to be taken on by all, what is usually called stakeholders—clinicians, researchers, industry. They all definitely have to work together in order to get more effective treatments.

This collaborative effort has changed a bit in the recent years. There is much more preponderance on the side of the industry, which is forced and restrained by the huge monetary input they have to give. So, this interaction between clinical researchers and industry research has shifted a bit—and there may be a difference of perspective between the United States and the European perspective. In Europe, the general treatment for patients is much more supported and directly seen in terms of the societies, while here in the United States, a number of the patients who have no benefits in terms of health insurance really rely on taking part in clinical trials for their personal treatment of other diseases. So, there is a bit of a force on the clinical side coming from this American perspective to sort of simply perform what is done in a clinical trial, in a correct and reliable and so on fashion, rather than seeing that this is also a scientific collaboration between clinicians and industry. That was part of our poster, to pick up what issues are there from the perspective of the clinical research side in the collaboration with the industry.

To you, what are the biggest challenges that this collaboration is facing in Alzheimer disease?

LF: The biggest challenge in Alzheimer's disease is to develop effective treatments. I mean, we have seen great achievements in diagnosis. We have great achievements in understanding the basic biology of Alzheimer's disease. However, it is still not quite clear what the main streams of the particular types of pathogenesis which underlie Alzheimer's disease—amyloid cascade MS metabolism and the tau pathology—if they are really the full story, in a way.

We have great learnings about the basic mechanisms of intracellular messengers which are involved in learning and memory in general, aside from Alzheimer's pathology. This understanding is, of course, advancing rapidly and it is very interesting to see that this is also being applied to the diagnosis of disease. Those typical Alzheimer biomarkers that we have, have really advanced the diagnosis of patients who have the biology of Alzheimer's disease in the brain but yet have very mild, or even no, symptoms or minor symptoms.

In earlier times, when we were forced to wait until the patient had developed dementia, we only could diagnose Alzheimer disease by exclusion. These times are over. Here, we have the potential of diagnosing positively with the aid of biomarkers, if there is Alzheimer's biology present in the brain. This is a great achievement and hopefully will lead to a further, better treatment as the second step in a way. But I think we still have a quite a path to go and because as we know, we only have symptomatic treatments of moderate efficacy, and we would be very happy if we had better or even more treatments of this kind available.

Are there any other challenges that are not related to a lack of understanding of the condition?

LF: I think one of the greatest challenges is that there have been too high of expectations towards innovative treatments, modern treatments, immunotherapy treatments. Earlier, like 10 or 8 years back, there was the belief that one could sort of halt or stop Alzheimer's pathology by innovative, so-called disease-modifying treatments. But, we have learned from those recent clinical trials in that area that we have to dim down our expectations considerably.

Transcript edited for clarity.