
Exclusive interview / Dr. Anton Titov MD and Professor Dr. Francesca Cordeiro, leading retinal disease, glaucoma, neurodegeneration, macular degeneration, retinal detachment and early Alzheimer's diagnosis eye test expert.
- So, retinal cells could be dying in the eye many years before they will start dying in the brain, thus signifying an onset of clinical Alzheimer's disease.
- Yes, absolutely, that's the hypothesis. But there is other research that has been going on again, we are looking into this as well. When you can look for the beta amyloid in plaques being deposited in the retina, so you do see that in the transgenic Alzheimer models, these experimental [mouse] models. They do have the retina affected, and they do have beta amyloid, for example, abnormally deposited in the retina. And you can image these now because there are some florescent markers, which we know the turmeric, which is that orange spice that is used a lot in curries, that actually binds beta amyloid and when it binds it fluoresces. So, in the retina you can pick up the fluorescence as a marker of beta amyloid being deposited in the retina. So, there's more and more data suggesting that these retinal changes could highlight changes before they may even happen in the brain. But these findings need to be really assessed properly in large scale population trials.
- But potentially [this eye test for Alzheimer's] could be an outpatient test, done by using the equipment that exists at ophthalmologists and optometrists, just injecting the dye under proper conditions.
- Well, actually we developed an eye drop because to be able to do this in outpatient conditions...
- Doing the eye drops, and standard scan can potentially identify people who are at higher risk [for Alzheimer's] - for early intervention...
- Yes but perhaps another, more imaginable early benefit of this would be using this "Alzheimer's eye test" to assess response to treatment. So, it's very difficult for these diseases, such as Alzheimer's, to know if your patient is responding.
- Potential test to diagnose a preclinical stage of Alzheimer's by looking how the cells die in the retina. That is the test that is undergoing clinical investigations now, developed by you. But one of the biggest problem in Alzheimer's disease clinical trials is that it takes a long, long time to determine whether a drug candidate works or it doesn't because of the very subtle changes. The test that you developed can potentially revolutionize and also compress the time frame of the trials. Could you please talk about the significance of your test, not just for the clinical practice that we just discussed, but also for the drug trials in Alzheimer's disease?
- Yes, well, actually, we've just published [test results] in Parkinson's disease model as well. And really what we are suggesting is that you can use the level of apoptosis where you see these fluorescent spots in the retina as a measure of disease activity. So, if you successfully treat your patient, then this disease activity should go down. So, the number of apoptosing cells in retina should go down. And we've shown this in a number of [disease] models but as I said, this Parkinson's disease model definitely has suggested that you can use this as an indicator of whether your treatment is successful much before you get changes seen in the brain. So, in this particular study with the Parkinson's model, we show that the retinal apoptosis have gone down well before we show that there were changes that have been reversed in the brain regarding substantia nigra [brain area affected in Parkinson's] And that is important because doing this test, which is a relatively non-invasive test and it's easy to do as you've seen yourself, it can be done in an outpatient department. It means that you can use this as a way of determining if your patient is responding to treatment at all. So, in all these diseases what we suggest is you start off with a baseline level of activity. So, you see x number of cells. Say, we're talking about 20, maybe 30 cells. If you get your patient on a good treatment, that they respond to, maybe that number will go down, we don't know the absolute numbers at the moment And we're expecting it to be much higher when you look all the way around the eye. But the importance is just a decline in the number of these apoptosing [dying] cells will be a good enough indicator that you have your patient on the correct treatment.
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