October 8, 2014

Nobel Prize for Medicine: Promising Brain / Alzheimer's Discoveries

British-American researcher John O'Keefe – with Norwegian husband and wife collaborators May-Britt and Edvard Moser – won the Nobel Prize for medicine on Monday, October 6, for demonstrating how the brain enables us to move from one location to another.

The team determined that the brain’s hippocampus acts like a kind of internal GPS (global positioning system), which helps us to navigate from place to place.

Nobelprize.org – the official website for the Nobel Prize – put it this way in the press release it issued:
How do we know where we are? How can we find the way from one place to another? And how can we store this information in such a way that we can immediately find the way the next time we trace the same path? This year´s Nobel Laureates have discovered a positioning system, an “inner GPS” in the brain that makes it possible to orient ourselves in space, demonstrating a cellular basis for higher cognitive function. 
In 1971, John O´Keefe discovered the first component of this positioning system. He found that a type of nerve cell in an area of the brain called the hippocampus that was always activated when a rat was at a certain place in a room. Other nerve cells were activated when the rat was at other places. O´Keefe concluded that these “place cells” formed a map of the room.
More than three decades later, in 2005, May-Britt and Edvard Moser discovered another key component of the brain’s positioning system. They identified another type of nerve cell, which they called “grid cells”, that generate a coordinate system and allow for precise positioning and pathfinding. Their subsequent research showed how place and grid cells make it possible to determine position and to navigate. 
The discoveries of John O´Keefe, May-Britt Moser and Edvard Moser have solved a problem that has occupied philosophers and scientists for centuries – how does the brain create a map of the space surrounding us and how can we navigate our way through a complex environment?
Enter Alzheimer’s disease
So, how does this new information help us better understand Alzheimer’s?

We’ve known that O’Keefe’s "place cells" exist in the brain’s hippocampus. We now know that the Mosers’ "grid cells" – which work so effectively in concert with the place cells – exist in the brain’s entorhinal cortex.

Both those regions -- hippocampus and entorhinal cortex -- are typically affected during Alzheimer’s early stages. Now that we understand these place and grid cells – and how they work together to establish position and facilitate navigation -- it’s no wonder that people with Alzheimer’s so often lose their way and cannot recognize their environment.

Understanding the brain’s “GPS system” may provide a key to discovering the mechanism that degrades and destroys the spatial memory so common among Alzheimer’s sufferers.

The Nobel Prize committee’s press release offered the broader potential of the work done by O’Keefe and the Mosers:
The discovery of the brain’s positioning system represents a paradigm shift in our understanding of how ensembles of specialized cells work together to execute higher cognitive functions. It has opened new avenues for understanding other cognitive processes, such as memory, thinking and planning.
A New Institute for O’Keefe
O’Keefe doesn’t plan to rest on his laurels. He’ll put all this new information to further testing next year at the brand new Sainsbury Wellcome Centre for Neural Circuits and Behaviour at University College London, where he serves as director.

His team of more than 150 scientists will use state-of-the-art lasers, molecular biology and computational modeling to explore the brain's intricate wiring. O'Keefe hopes their work will lead to new advances in our understanding of Alzheimer’s – how it develops and how science might counteract it.

O’Keefe describes the urgency of continuing research: "We all know there is a time bomb there. We are starting to get a handle on it but that doesn't mean it is going to turn into a cure in the immediate future."

O’Keefe isn’t alone is his concern about the Alzheimer’s epidemic. Last December, the Group of Eight leading industrial countries set a goal of finding a cure or effective treatment for dementia by 2025.

It’s a tall order. It’s been a decade since the last drug was approved to treat Alzheimer’s – and the approved drugs only work to ease the disorder’s symptoms. Nothing exists to slow the progression of the disease… let alone to prevent it.

Last Alzheimer's Drug Now a Decade Old
At this point, the FDA has approved six drugs to treat AD’s symptoms:

Drug name
Brand name
Approved For
FDA Approved
1. donepezil
All stages
2. galantamine
Mild to moderate
3. memantine
Moderate to severe
4. rivastigmine
All stages
5. tacrine
Mild to moderate

The Alzheimer's Association lists these bullet points to underscore AD's impact in America:
  • More than 5 million Americans are living with the disease.
  • Every 67 seconds someone in the United States develops Alzheimer's.
  • Alzheimer's disease is the 6th leading cause of death in the United States.
  • There are approximately 500,000 people dying each year because they have Alzheimer's.
  • 1 in 3 seniors dies with Alzheimer's or another dementia.
  • In 2013, 15.5 million caregivers provided an estimated 17.7 billion hours of unpaid care valued at more than $220 billion.
And those are only the stats from America.

The Nobel Prize press release ends with this sentence: "Since 1901 the Nobel Prize has been awarded to scientists who have made the most important discoveries for the benefit of mankind."

Just how much "benefit" will come from this latest prize-winning work?

Time alone will tell.

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