Michael Fossel Michael is President of Telocyte

December 1, 2017

Big Pharma: Still Looking for the Horse

About a century ago, in a small American town, the first automobile chugged to a stop in front of the general store, where a local man stared at the apparition in disbelief, then asked “where’s your horse?” A long explanation followed, involving internal combustion, pistons, gasoline, and driveshafts. The local listened politely but with growing frustration, then broke in on the explanation. “Look”, he said, “I get all that, but what I still want to know is ‘where is your horse?’”

About three hours ago, in a teleconference with a major global pharmaceutical company, I was invited to talk about telomerase therapy and why it might work for Alzheimer’s, since it doesn’t actually lower beta amyloid levels. I explained about senescent gene expression, dynamic protein pools whose recycling rates slow significantly, causing a secondary increase in amyloid plaques, tau tangles, and mitochondrial dysfunction. The pharmaceutical executive listened (not so politely) with growing frustration, then broke in on the explanation. “Look”, she said, “I get all that, but what I still want to know is how does telomerase lower beta amyloid levels?”

In short, she wanted to know where I had hidden the horse.

The global pharmaceutical company that invited me to talk with them had, earlier this year, given up on its experimental Alzheimer’s drug that aimed at lowering beta amyloid levels, since it had no effect on the clinical course. None. They have so far wasted several years and several hundred million dollars chasing after amyloid levels, and now (as judged by our conversation) they still intent on wasting more time and money chasing amyloid levels. We offered them a chance to ignore amyloid levels and simply correct the underlying problem. While not changing the amyloid levels, we can clean up the beta amyloid plaques, as well as the tau tangles, the mitochondrial dysfunction, and all the other biomarkers of Alzheimer’s. More importantly, we can almost certainly improve the clinical course and largely reverse the cognitive decline. In short, we have a new car in town.

As with so many other big pharmaceutical companies, this company is so focused on biomarkers that they can’t focus on what those markers imply in terms of the dynamic pathology and the altered protein turnover that underlies age-related disease, including Alzheimer’s disease. And we wonder why all the drug trials continue to fail. The executive who asked about amyloid levels is intelligent and experienced, but wedded to an outmoded model that has thus far shown no financial reward and – worse yet – no clinical validity. It doesn’t work. Yet this executive met with me as part of a group seeking innovative approaches to treating Alzheimer’s disease.

Their vision is that they are looking for innovation.

The reality is that they are still looking for the horse.

October 10, 2017

Should everyone respond the same to telomerase?

A physician friend asked if a patient’s APOE status (which alleles they carry, for example APOE4, APOE3, or APOE2) would effect how well they should respond to telomerase therapy. Ideally, it may not make much difference, except that the genes you carry (including the APOE genes and the alleles for each type of APOE gene, as well as other genes linked to Alzheimer’s risk) determine how your risk goes up with age. For example, those with APOE4 alleles (especially if both are APOE4) have a modestly higher risk of Alzheimer’s disease (and at a lower age) than those with APOE2 alleles (expecially if both are APOE2).

Since telomerase doesn’t change your genes or the alleles, then while it should reset your risk of dementia to that of a younger person, your risk (partly determined by your genes) would then operate “all over again”, just as it did before. Think of it this way. If it took you 40 years to get dementia and we reset your risk using telomerase, then it might take you 40 years to get dementia again. If it took you 60 years to get dementia and we reset your risk using telomerase, then it might take you 60 years to get dementia again. It wouldn’t remove your risk of dementia, but it should reset your risk to what it was when you were younger. While the exact outcomes are still unknown, it is clear is that telomerase shouldn’t get rid of your risk, but it might be expected to reset that risk to what it was several years (or decades) before you were treated with telomerase. Your cells might act younger, but your genes are still your genes, and your risk is still (again) your risk.

The same could be said for the rate of response to telomerase therapy. How well (and how quickly) a patient should respond to telomerasse therapy should depend on how much damage has already occurred, which (again) is partially determined by your genes (including APOE genes and dozens of others). Compared to a patient with APOE2 alleles (the “good” APOE alleles), we might expect the clinical response for a patient with APOE4 alleles (the “bad” APOE alleles) to have a slightly slower respone to telomerase, a peak clinical effect that was about the same, and the time-to-retreatment to be just a big shorter. The reality should depend on how fast amyloid plaques accumulates (varying from person to person) and how fast we might be able to remove the plaque (again, probably varying from person to person). The vector (slope of the line from normal to onset of dementia) should be slightly steeper for those with two APOE4 alleles than for two APOE3 alleles, which would be slightly steeper than for two APOE2 alleles. Those with unmatched alleles (APOE4/APOE2) should vary depending upon which two alleles they carried.

To give a visual idea of what we might expect, I’ve added an image that shows the theoretical response of three different patients (a, b, and c), each of whom might respond equally well to telomerase therapy, but might then need a second treatment at different times, depending on their genes (APOE and other genes) and their environment (for example, head injuries, infections, diet, etc.). Patient c might need retreatment in a few years, while patient a might not need retreatment for twice as long.

 

August 10, 2017

Progeria and Telomerase

Recently, John Cooke at the Houston Methodist Research Institute, showed that telomerase, when expressed in cells from progeric children, caused a “substantial physiologically relevant and meaningful effect on the lifespan and function of the cells.” As many of you know, progeria is a disease in which young children appear old, with baldness and osteoarthritis, and usually die of advanced cardiovascular disease, such as heart attacks, typically around age twelve. In short, they appear to have extremely rapid aging. Cooke’s results suggested that telomerase might offer a therapy. Oddly enough, both Cooke and the media described this finding as “surprising”.

While these results are promising, they are hardly surprising. In 1996, I published a book going into this prospect in detail, then wrote the first medical papers on this the medical potential in JAMA in 1997 and 1998. This was followed up with a medical textbook which explored the entire area in 2004, and another book in 2015 that described the medical potential of telomerase. What is truly surprising is not the most recent results, but that anyone finds the results at all surprising.

While not actually surprising, they present a bitter irony, in that any number of deaths, including deaths of progeric children, might have been prevented and may still be prevented if we only understand and act upon what we have known for two decades and which Cooke’s results only highlight again.

The irony – and my exquisite personal frustration – is that I proposed this approach annually in our global meetings for progeric children, starting twenty years ago. For about a decade, beginning several years before the turn of the millennium, I had been part of the annual global reunion of progeric children. Each year, we gathered with perhaps three dozen progeric children and their families from around the world, giving them a chance to meet one another, to talk with experts, and … to feel normal among other children and families who had the same problems. In 1999, among those progeric children was a young boy, whose parents were both physicians, and who were desperate to find a cure for progeria. Although I explained the potential of using telomerase as an intervention, they founded the Progeria Research Foundation and aimed it solely at genetic markers rather than epigenetic intervention. They managed to get significant funding through the NIH, fund raising, and government contacts in order to fund a set of studies that localized the genetic error responsible for progeria. As I predicted, none of the subsequent therapies based on their approach have had any effect on the disease. Worse yet, and like all the other progeric children I have known over the years, their son died of progeria. Had we gone straight to telomere-based interventions rather than taking the detour, many progeric children – not merely their son — might have been treated more effectively.

John Cooke and his colleagues have done well to show that they can reverse the problems seen in progeric cells, yet others have gone further. Maria Blasco’s group, for example, has shown that she can not merely reset aging in cells, as Cooke’s group has, but can do the same in animals. Moreover, we are collaborating with her group to take this approach in our upcoming human clinical trials next year, initially aiming at Alzheimer’s disease.

The fact that this comes as a surprise, given what we have known about the potential of telomerase for more than 20 years is a tragic example of wasted opportunities, wasted funding, and wasted lives. Telomerase was shown to reverse aging in cells 20 years ago; telomerase showed its value in animals 5 years ago; Telocyte is ready to show the benefits of telomerase in human trials next year.

July 30, 2017

Of Dog, Wires, and Alzheimer’s Disease

Filed under: Alzheimer's disease,Biotech — Tags: , , — admin @ 5:23 pm

I have a dog. Without exaggeration or exception, she one of the most delightful dogs that I have ever had in my life, and I have had a great many dogs in my life. Like many dogs, she is captivated by squirrels. They are both the aim and the bane of her canine life. The other day, seeing one running along a telephone wire stretching from pole-to-pole above her head, she not only barked and chased it, she lept as high as possible, hoping to catch it. The squirrel ignored her, except to chitter and tease her futile efforts. Repeated failures did not deter my dog. Given her charming, but narrowly limited understanding of of the world, the best response to failure was to redouble her physical effort, so she barked even louder and lept even higher to catch the squirrel. To no avail. It never occurred to her that leaping at telephone wires would never capture the squirrel. In her own way, and for a dog, she is intelligent, hardworking, skilled, and energetic, but she will never catch the squirrel by leaping at telephone wires.

For decades, large (and small) pharmaceutical companies have been trying to cure Alzheimer’s disease. They can clearly see the goal above them, they have resources and intelligence enough for the effort and, despite universal failure, they continue to work even harder and leap even higher to cure Alzheimer’s. Repeated failures do not deter them. Given their charming and narrowly limited understanding of the world, the best response is to redouble their efforts, so they invest more money, invest more effort, and leap all the higher. To no avail. It never occurs to them that they are aiming at the wrong targets, without any understanding of the pathology and the underlying fundamentals of the disease. They are intelligent, hardworking, skilled, and energetic, but they will never catch Alzheimer’s by aiming at the wrong targets.

Or squirrels by leaping at telephone wires.

April 12, 2017

We Already Know It Works

Oddly enough, many investors don’t realize how far we are down the road to a cure.

In fact, most people don’t understand why such studies are done and – more to the point – why Telocyte is doing one. Just to clarify: we’re not doing an animal study to prove efficacy. We already know it’s effective in animals.

The reason we do an animal study is because the FDA, quite reasonably, requires an animal safety study in order to assess risks and side effects. Most people assume that animal studies are done to show that a potential therapy works in animals, so that it might work in humans as well. In fact, however, once you have shown that a therapy works in animals, as we have already, then before you can go on to human trials, you first need to do an animal safety study.

Animal studies are done to assess safety, not to assess efficacy.

For an initial human trial, the main question for the FDA isn’t efficacy, but safety. Sensibly, the FDA requires that the safety data be done carefully and credibly, to meet their careful standards. We know telomerase gene therapy works, but we still need to prove (to the FDA’s satisfaction) that telomerase gene therapy is safe enough to justify giving our therapy to human patients. So the question isn’t “Do we have a potential intervention for Alzheimer’s?” (which we do), but rather “Do we know what the risks are once we give it?” We’re fairly certain that we know those risk, but we need to document them rigorously.

In getting our therapy to human trials, you might say that there are three stages:

  1. Animal studies that show efficacy (already done by our collaborators).
  2. Animal studies that show safety (an FDA requirement).
  3. Human trials before release for general use (an FDA requirement).

Telocyte already has good data on the first stage: we know that telomerase is remarkably effective in reversing the behavioral decline seen in aging animals and that the same result will likely occur in aging human patients. In short, we are already confident that we can prevent and at least partially reverse Alzheimer’s disease. The FDA doesn’t need us to demonstrate efficacy: we already have good data on efficacy. What the FDA wants from us is more (and more detailed) data on the probable safety, which we’re about to provide.

While we are now ready to start on the FDA animal safety trial. Doing our FDA animal study isn’t a way of showing that telomerase gene therapy works – which is already clear from animal studies – but a detailed look at side effects, preparatory to our having permission to begin human trials next year.

Telomerase therapy works.

March 21, 2017

The Frustration of (Not) Curing Alzheimer’s

I am deeply frustrated by two plangent observations: 1) we squander scant resources in useless AD trials and 2) AD can easily be cured if we applied those same resources to useful AD trials. Applying our resources with insight, we will cure Alzheimer’s within two years.

The first frustration is that most pharmaceutical firms and biotech companies continue to beat their heads against the same wall, regardless of clinical results. Whether they attack beta amyloid, tau proteins, mitocondrial function, inflammation, or any other target, the results have been, without exception, complete clinical failures. To be clear, many studies can show that you can affect beta amyloid or other biomarkers of Alzheimer’s disease, but none of these studies show any effect on the clinical outcome. In the case of amyloid, it doesn’t matter whether you target production or the plaques themselves. Despite hundreds of millions of dollars, despite tens of thousands of patients, not one of these trials has ever shown clinical efficacy. Yet these same companies continue to not only run into walls, but remained convinced that if they can only run faster and hit the wall faster, they will somehow successfully breach the wall. They succeed only in creating headaches, accompanied by lost money, lost opportunities, and lost patients. The problem is not a lack of intelligence or ability. The researchers are – almost without exception – some of the most intelligent, well-educated, technically trained, and hard-working people I know. The irony is that they are some of the best 20th century minds I know. The problem, however, is that it is no longer the 20th century. If you refuse to adapt, refuse to change your paradigm, refuse to come into the 21st century, you will continue to get 20th century results and patients will continue to die of Alzheimer’s disease. Money and intelligence continues to be dumped into the same clichéed paradigm of pathology, as we aim at the wrong targets and misunderstand how Alzheimer’s works. And the result is… tragedy.

The second frustration is that we already know the right target and we already understand how Alzheimer’s disease works. We are entirely able to cure and prevent Alzheimer’s disease now. At Telocyte, we already have the initial resources we need to move ahead, but it is surprising how difficult it is for some people — wedded to 20th century concepts — to grasp the stunning potential, both clinically and financially of what we are about to do at Telocyte. We can not only reverse Alzheimer’s disease, but we can also cut the costs of health care while creating a stunningly successful biotech company in the process. We have the right tools, the right people, the right partners, and the sheer ability to take this through FDA trials. Already, we have several lead investors committed to our success. We are asking for a handful of additional investors, those who can see what the 21st century is capable of and who can understand why Telocyte is both the best clinical investment and the best financial investment in innovative medical care.

 

December 29, 2016

The Ethics of Gene Therapy for Alzheimer’s Disease

The Ethics of Telomerase Treatment

 

The rationale behind telomerase therapy was first published in the medical literature two decades ago1 and has been updated and supported in academic textbooks2 and a more recent book for the public3 as well. The theoretical basis was cogent, even twenty years ago, and evidence has continued to support the hypothesis since then, in human cells, in human tissues, in informal human trials, and in formal animal trials. The potential implications of telomerase interventions in human age-related disease are unprecedented, well-supported, consistent, and feasible. The surprise is not that this approach is practical, but that it has taken so long to get telomerase therapy into clinical trials.

The reasons for the delay are complex and subtle, but are part of human nature.

For one thing, the clinical use of telomerase requires a novel and more sophisticated understanding of the aging process itself – at the genetic and epigenetic level – than has been the case until recently. Whenever a new scientific paradigm comes into play – whether a geocentric solar system, biological evolution, quantum mechanics, relativity, or anything else – it takes time for us to outgrow previous, less accurate models and to accept a more complex, but more accurate understanding of reality. Reality is not a democracy and a consensus is no guarantee of truth.

Putting it bluntly: old theories never die, their proponents do.

A second problem is credibility. In the case of telomerase clinical trials, there have been a number of cases in which individuals or companies (impatient with the regulatory delays so common in modern drug development) have attempted “end runs” of social and regulatory acceptance. Unfortunately (and perhaps unfairly), these off-shore human trials are often judged as lacking credibility and this can also undercut the credibility of other attempts. If a company evades the FDA (or the accepted regulatory agencies in other countries, such as the EMA or CFDA) and runs small off shore trials their results are not only specifically disbelieved, but result in general disbelief, even of serious biotech endeavors that DO attempt to meet FDA requirements. Moreover, the companies that attempt “end runs” often seek publicity and the outcome can be a perception that while there is significant publicity, that’s all there is. Unfairly or accurately, the academic judgement becomes one of “incredible claims, but no credible data”. Fair or unfair, just or unjust, such is human nature and such is the nature of clinical research in today’s world.

A third problem is a general misunderstanding of the role of telomerase in cancer. Telomerase never causes cancer, although small amounts can be necessary to permit cancer. More striking, however, is the role of telomerase in genomic stability: telomerase upregulates DNA repair, drastically lowering the risk of cancer. Dividing cells – including cancer cells – require at least minimal telomerase, yet a significant presence of telomerase (and sufficiently long telomeres) is protective against cancer. Some have even suggested that cancer is a disease of the young, and attribute it to the presence of telomerase, but the clinical reality is that cancer increases exponentially with age and that this increase is directly attributable to the down-regulation of DNA repair due to telomere shortening. In short, telomerase can be used to prevent cancer.

A fourth problem is a naïve conception of the pathology that underlies Alzheimer’s disease (and other age-related diseases). Citing data on mice, genetically altered to express a human amyloid protein, they extrapolate the results to human Alzheimer’s patients without appreciating the complex cascade of pathology that actually occurs in humans, let alone the differences between mice and human patients.

Finally, some people argue with the ethics of treating Alzheimer’s disease in clinical trials at all, let alone by using gene therapy. One wonders whether they have ever spend a year or two watching a loved one slide down into the abyss. I have known hundreds, perhaps thousands, of Alzheimer’s patients and their family members. Almost without exception, most would do literally anything, try literally anything in an effort to find a cure. The pity of AD is that it is 100% fatal and there is NO effective therapy – at the moment. While few of us would risk an experimental gene therapy (even one as promising at telomerase) to treat wrinkles or osteoporosis (particularly since neither one is fatal), all of us would consider such therapy to treat Alzheimer’s disease. It is scarcely surprising that scarcely a day goes by without someone contacting me, asking about potential treatments for Alzheimer’s disease. These are not people who live in ivory towers, these are not people with a “degree in microbiology”, these are people who are deeply and personally affected by the tragedy.

They’ve BEEN there. They UNDERSTAND.

One critic of gene therapy noted that: “there are 7 patients killed by gene therapy clinical trials” (over the past 20 years). Compare this with the seven hundred thousand Alzheimer’s patients who died in 2016 alone of not having had gene therapy. Why would I choose to be one of 700,000 deaths per year?

For those of us who have spent decades treating dying patients, for those of us who have Alzheimer’s disease, and for those of us who are terrified by what is happening to those we love who have Alzheimer’s disease, the ethics of using gene therapy to try curing the most frightening disease on earth are clear enough.

The ethical weight lies on the side of compassion.

 

 

  1. Fossel: Reversing Human Aging (1996) . Banks and Fossel: Telomeres, cancer, and aging – Altering the human lifespan (JAMA, 1997). Fossel: Telomerase and the aging cell – Implications for human health (JAMA, 1998).
  2. Fossel: Cells, Aging, and Human Disease (Oxford University Press, 2004).
  3. Fossel: The Telomerase Revolution (BenBella Press, 2015).

November 22, 2016

Teaching Cells to Fish

Aging is the slowing down of active molecular turnover, not the passive accumulation of damage. Damage certainly accumulates, but only because turnover is no longer keeping up with that damage.

It’s much like asking why one car falls apart, when another car looks like it just came out of the showroom. It’s not so much a matter of damage (although if you live up north and the road salt eats away at your undercarriage, that’s another matter), as it is a matter of how well a car is cared for. I’ve see an 80-year-old Duesenberg that looks a lot better than my 4-year-old SUV. It’s not how well either car was made, nor how long either car has been around, but how well each car was cared for. If I don’t care for my SUV, my SUV rusts; if a car collector gives weekly (even daily) care to a Duesenberg, then that Duesenberg may well last forever.

The parallel is apt. The reason that “old cells” fall apart isn’t that they’ve been around a long time, nor even that they are continually being exposed to various insults. The reason “old cells” fall apart is that their maintenance functions slow noticeably and that maintenance fails to keep up with the quotidian damage occurring within living cells. If we look at knees, for example, the reason that our chondrocytes fail isn’t a matter of how many years you’ve been on the planet, nor even a matter of how many miles a day you spend walking around. The reason chondrocytes fail is because their maintenance functions slow down and stop keeping up with the daily damage. As it turns out, that deceleration in maintenance occurs because of changes in gene expression, which occur because telomeres shorten, which occur because cells divide. And, not at all surprisingly, the number of those cell divisions is related to how long you’ve been on the planet (how old you are) and how many miles you walk (or if you play basketball). In short, osteoarthritis is distantly related to your age and to the “mileage” you incur, but not directly so. The problem is not really the age nor is it the mileage; the problem is the failure to repair the routine damage and THAT failure is directly controlled by changes in gene expression.

So what?

The telomeres and gene expression may play a central role, but if your age and the “mileage” is distantly causing all those changes in cell division, telomere lengths, gene expression, and failing cell maintenance, then what’s the difference? Why bother with all the complexity? Why not accept that age and your “mileage” are the cause of aging diseases and stop fussing? Why not simply accept age-related disease?

Because we can change it.

The question isn’t “why does this happen?” so much as “what can we do about it?” We can’t change your age and it’s hard to avoid a certain amount of “mileage” in your daily life, but we CAN change telomeres, gene expression, and cell maintenance. In fact, we can reset the entire process and end up with cells that keep up with damage, just as your cells did when you were younger.

Until now, everyone who has tried to deal with only the damage (or the damaged cells) failed because they focused on damage rather than focusing on repair. For example, if you focus only on cell damage (as most big pharma and biotech companies do when they go after beta amyloid or tau proteins in trying to cure Alzheimer’s disease), then any clinical effect is transient and the disease continues to progress – which is why companies like Eli Lily, Biogen, TauRx, and dozens of other companies are frustrated. And small wonder. Or if you focus only on the damaged cells (and try removing them), then the clinical effect is not only transient, but will end up accelerating deterioration (as discussed in last week’s blog, see figure below) – which is why companies like Unity will be frustrated. Their approaches fail not because they don’t address the damage, but because they fail to understand the deceleration of dynamic cell maintenance that occurs with age – and fail to understand the most effective single clinical target. The key target is not damage, nor damaged cells, but the changes in gene expression that permit that damage, and those damaged cells, to lead to pathology. We can’t cure Alzheimer’s or osteoarthritis by removing senescent cells, but we can cure them by resetting those same cells.

Why you shouldn't kill senescent cells.

Why you shouldn’t kill senescent cells.

In the cases of removing senescent cells (an approach Unity advocates), wouldn’t it be better to remove the damaged cells and then reset the telomeres of those that remain? But why remove the damaged cells if you can reset them as well, with the result that they can now deal with the damage and remove it – as well as young cells do?

Why remove senescent cells at all?

While you could first remove senescent cells, then add telomerase so that the remaining cells could divide without significant degradation of function, why would you bother? You could much more easily, more simply, and more effectively treat all the cells in an aging tissue, reset their aging process and have no need to ever remove senescent cells in the first place. Instead of removing them, you simply turn them into “younger” and more functional cells. For an analogy, imagine that we have a therapy that could turn cancer cells into normal cells. If that were true, why would anyone first surgically remove a tumor? If you could really “reset” cancer cells into normal cells, there would be no need to do a surgical removal in the first place. While there is no such therapy for cancer cells, the analogy is still useful. Removing senescent cells is not only counter-productive, but (if we reset gene expression) entirely unnecessary.

Removal is unnecessary (both as to cost and pathology), risky, and medically contraindicated. You’d be performing a completely unnecessary procedure when a more cost-effective and reliable procedure was available. It would be exactly like removing your tonsils if you already had overwhelming data showing that an antibiotic was reliable, cheap, and without risk.

A cell with full telomere lengths – regardless of prior history – is already superior. The accumulated damage is not a static phenomenon, but a dynamic one. Reset cells can clean up damage. This is not merely theory, but supported well in fact, based on both human cells and whole animal studies. We shouldn’t think of damage as something that merely accumulates passively. All molecules are continually being recycled. The reason some molecular pools show increased damage isn’t because molecules denature, but because the rate of turnover slows, thereby allowing denatured molecules (damage) to increase within the pool.

Try this analogy: we have two buildings. One is run by a company that invests heavily in maintenance costs, the other is run by a company that cut its maintenance budget by 50%. The first building is clean and well-kept, the second building is dirty and poorly-kept. Would you rather raze the second building and then rebuild it or would you rather increase the maintenance budget back to a full maintenance schedule and end up with a clean building? This is precisely the case with young versus old cells: the problem is not the dirt that accumulates, the problem is that no one is paying for routine maintenance. There are cells that are “too senescent” to save, but almost all the cells in human age-related disease can be reset with good clinical outcome. There is no reason to remove senescent cells any more than (in the case of a dirty building), we need to send in the dynamite and bulldozers.

Too often, we try to approach the damage rather than looking at the longer view. Instead of addressing the process, we address the outcome. It’s like the problem that often occurs in global philanthropy, where we see famine and think we can solve the problem with food alone. While the approach is necessary – as a stopgap – many are surprised to find that simply providing free food for one year, results in bankrupt farmers and recurrent famines in the following years. Or we provide free medical care in a poor nation, then wonder why there is a dearth of medical practitioners in years to come, without realizing we have put them out of business and accidentally encouraged them to emigrate to someplace they can make a living and feed their families. We intend well, but we perpetuate the problem we are desperately trying to solve. Treating famine or medical problems, like treating the fundamental causes of age-related disease, is not simple and cannot be effectively addressed with band aids and superficial interventions, such as addressing damage alone or removing senescent cells. Effective clinical intervention – like effective interventions in famine or global healthcare – require a sophisticated understanding of the complexity of cell function, an understanding of the dynamic changes that underlie age-related pathology.

An adage (variously attributed to dozens of sources) about fish and fishing provides a useful analogy here:

Give a man a fish, and you feed him for a day.

Teach a man to fish, and you feed him for a lifetime.

If we want to intervene effectively in age-related diseases – whether Alzheimer’s, osteoarthritis, or myriad other problems of aging – we shouldn’t throw fish at medical problems.

We should teach our cells to fish.

 

November 15, 2016

Close to a Cure

We are now within two years of a cure for Alzheimer’s disease.

What a brash and disruptive claim! What hubris! Yet events are coming together, underlining a new and far more complete understanding of the disease, illuminating the cause, supporting the ability to intervene, safely and effectively. We finally see a way to intervene in the basic pathology, underlining the potential to both prevent and cure Alzheimer’s disease.

But why has it taken so long? Why was Alzheimer’s disease first defined 110 years ago, and yet remains totally beyond our ability to intervene even now? Why have all other approaches, whether those of big pharma or those of biotech, failed utterly? Why has not a single clinical trial shown any ability to change the progress of this frightening disease? Why is Alzheimer’s disease not only called “the disease that steals human souls”, but also called the “graveyard of companies”? Why has every single approach (which has at most shown only an effect on biomarkers, such as beta amyloid), still failed to show any change in the cognitive decline in patients with this disease? Why have we failed universally, until now?

Because every approach has concentrated on effects, not on causes.

Currently, most approaches target beta amyloid, many target tau proteins, and some target mitochondrial function, inflammation, free radicals, and other processes, but no one targets these problems as a single, unified, overarching process. Alzheimer’s isn’t caused by any one of these disparate processes, but by a broader, more complex process that results in every one of these individual problems. Beta amyloid isn’t a cause, but a biomarker. Equally, tau proteins, phosphodiesterase levels, APOE4, presenilins, and a host of other markers are effects, not causes. The actual cause lies upstream and constitutes the root cause of the dozens of separate effects that are the futile downstream targets of every current FDA trial aimed at Alzheimer’s disease. Understanding this, we will be targeting the “upstream” problem, rather than the dozens of processes that others target individually and without success. Our animal studies support the ability to effectively intervene in human disease: when we say that we are about to cure Alzheimer’s disease, we base claim that on a clear and consistent theoretical model, supported by equally clear and consistent data.

Within the next few months, we will begin our FDA toxicity study, preparatory to obtaining an IND that will permit us to begin our FDA human trial. Our toxicity study will take 6 months and will meet FDA requirements for human safety data. Our first human trial is planned to begin one year from now and is intended to show not only safety, but a clear efficacy. We will include a dozen human volunteers, each with (not just early, but) moderate Alzheimer’s disease and our human trial will last 6 months, including a single treatment and multiple measurements of behavior, laboratory tests, and brain scans. We expect to show unambiguous cognitive improvement within that six-month period. We are confident that we cannot merely slow, not merely stop, but reverse much of the cognitive decline in our twelve patients. We intend to demonstrate an ability to cure Alzheimer’s disease clearly and credibly.

Curing Alzheimer’s requires investments of money, time, and thought. The toxicity study costs 1 million dollars; the human trial costs 2.5 million dollars. Telocyte has half a million dollars committed to this effort and at least one group of investors with a firm interest in taking us all the way through the human trials. We are close and we grow closer each day.

After 110 years, we are about to cure Alzheimer’s.

November 8, 2016

Revolution in Medicine

Every pharmaceutical firm, every biotech company, every hospital, every clinic, and every conference makes revolutionary claims, albeit seldom with any logic or thought behind the claims. Every product is a “revolutionary” therapy, every surgery is a “revolutionary” procedure, and everyone has a “revolutionary” way of looking at clinical medicine. Reality is strikingly different. Despite claims to the contrary, almost all advances in medicine are accretionary, not revolutionary. About sixty percent of all FDA applications for “breakthrough” status are turned down for not being breakthroughs, but merely incremental advances (if that). Even granting a third of these applications is overly kind, but then breakthroughs, like revolutions, are remarkably rare. I am reminded of my years consulting for hospitals around the world, where I was entertained to find every hospital, in every town, in every country, bragging that they were ranked as “one of the best ten hospitals!” Sometimes, they bragged that they were THE best hospital. Somehow, it appears that thousands of hospitals are among the best ten hospitals and hundreds are THE best hospital. In the entire world or on that block?

It clearly depends on who’s counting and on who does the ranking.

Therapies are much the same: they are seldom “the best” (in the world?) and they are almost never revolutionary. To the contrary, almost all current therapy is based on incremental change: we find a slightly better statin, an antibiotic with slightly less resistance (at least this year), and a procedure with a slightly lower risk. We rank our interventions by statistical significance and we deal with percentage points in the adverse effect profile. Scarcely the stuff of revolution.

We can do better; much better. To do so, however, requires both an open mind and a very disciplined one. We need both creativity and intelligence to envision a path to revolutionary therapies. If we do so, we may be able to cure diseases that are thought to be “incurable”, a true revolution I both clinical thinking and clinical practice.

Many people, in a totally practical vein, think of diseases in three categories. The first includes those diseases that we have “cures” for, by means of vaccines, antibiotics, and routine surgeries (think of tetanus, cellulitis, and appendicitis). The second category includes diseases for which we have no cure yet, but for which we see a cure on the horizon (think of treating sickle cell anemia with gene therapy). This second category includes type 1 diabetes: while we use insulin to good effect, we eagerly imagine the days when we simply replace the missing cells in the pancreas and truly cure diabetes. While we have – or imagine that we may soon have – true cures for these diseases in both the first two categories, the third category brings a sense of futility. When it comes to age-related disease (think of Alzheimer’s disease, cardiovascular disease, osteoporosis, etc.), we are caught up by the assumption that while we can treat symptoms, use grafts or stents, lower the risk factors, or replace the damaged part (a total knee replacement comes to mind), we will never be able to entirely prevent or cure the underlying disease. After all, they’re simply the outcome of aging, yes? And who could possibly change the aging process?

Oddly enough, we already have.

We first showed we could reverse cell aging in 1999, followed by the reversal of tissue aging (in the laboratory) in the following few years. The question isn’t “can we reverse the aging process in human cells or tissues”, but “can we reverse the aging process in human patients”? Can we take someone with age-related disease, treat them, and reverse the disease reverse at the cellular and genetic levels? Can we prevent and cure age-related disease? Based on both theory and animal data, the answer is almost certainly to be “yes, we can”. All it requires is intelligence, a modicum of work, and a small commitment of funding.

Instead of treating Alzheimer’s as something to live with, we can treat it and have it be something we can live without. Only then we will have a true revolution.

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