Can Ruti trials an experimental technique, unprecedented in Europe, to improve Alzheimer's symptoms

BarcelonaTo combat a disease, it is essential to understand how it works. Alzheimer's is characterized by the unusual accumulation inside and outside neurons of a peptide (a protein fragment) called beta-amyloid and a protein known as tau. It is not known why this happens, but it is very likely what causes cells to break down and the brain to atrophy slowly. One of the possible treatments currently being considered is to increase the drainage of cerebrospinal fluid where these proteins are found to try to reduce their accumulation in patients with the mild stage of the disease. This is a pathway that will be studied for the first time in Europe in a clinical trial driven by the Hospital Germans Trias i Pujol in Badalona.

The study, called ALCEA (Study of the clinical and biological effects of cervical lymphaticovenous anastomosis in Alzheimer's disease), aims to determine the safety and feasibility of this technique. The technique consists of establishing a connection between the lymphatic vessels and the veins in the neck to increase drainage, a minimally invasive microsurgery that has already been performed on two patients. The results obtained so far are very preliminary, but professionals suggest that one of the patients may have experienced a functional improvement, although the current study is designed to assess the safety of the intervention.

The trial will include a total of 10 patients with early-stage Alzheimer's disease, who will be followed for a minimum of one year to observe their evolution. The study is aimed at patients diagnosed with mild-stage Alzheimer's disease being followed in the Neurology and Geriatrics clinics of the center who meet the criteria for entry. The scientists' hypothesis is that the connection between the lymphatic system and the lymph nodes constitutes a direct pathway for the elimination of cerebrospinal fluid and the proteins that accumulate in the brain and cause Alzheimer's. The technique is frequently used in the treatment of lymphedema (the abnormal accumulation of lymphatic fluid in tissues), especially in oncological surgeries or radiotherapy, with the aim of reducing fluid accumulation, improving symptoms, and preventing associated complications.

The first of the patients to undergo the intervention is Toni Reyes, a 67-year-old resident of Badalona, who was diagnosed just over a year ago. The operation took place only three months ago and the improvement in his mood and cognitive abilities has been more than remarkable, as the family itself admits. "It's been incredible," says the patient's wife, Maria Puente, to the ACN. Before going into surgery, Toni "did practically nothing" and was not understood when he spoke. Now he has started to write his name again, he plays chess with his grandson again, and they even have to tell him to be quiet when he speaks because he "doesn't stop chatting". Despite these results, professionals warn that longer follow-up is needed to draw conclusions.

Other precedents

The first clinical studies of this technique, mainly in China, have shown promising preliminary results, with improvements in cognitive parameters and biomarkers, as well as good safety of the procedure. In a recent series of 26 patients, no complications were recorded. However, these studies have important limitations, such as short follow-ups and a lack of randomized designs.

Currently, there are 21 clinical studies registered in China, one in Seoul, two in Singapore, and one in Taiwan, in addition to the one to be conducted in Catalonia, the first in Europe. For researchers, the results observed in the first intervened case reinforce the need to lead studies on this new therapeutic pathway.