In the excellent book, The Innovators Prescription, the authors predict that precision medicine will replace intuitive medicine, and diseases will be defined by their underlying metabolic mechanisms, and not by the organs they affect, or the symptoms they produce. Clayton Christensen and colleagues argue that this precise definition of diseases will lead to more effective treatments. But they also show that precision medicine will show that many different diseases actually share the same underlying metabolic derangements. Many disparate diseases will therefore turn out to be just mere manifestations of the same metabolic disease.
A clear indication that precision medicine will blur the boundaries between diseases is the recent suggestion that the anti-diabetes drug Liraglutide may help to treat Alzheimer’s disease (AD). Liraglutide is a long-acting glucagon-like peptide-1 (GLP-1) receptor agonist which is effective in type 2 diabetes, a condition which is worlds apart from Alzheimer’s disease. So far removed from each other, it would be easy to dismiss any links as tenuous. But the headlines were emphatic: Drug used to treat diabetes could cure Alzheimer’s, and Diabetes drug could influence brain activity in Alzheimer’s.
It is however no hype: there is evidence that Liraglutide may benefit people with Alzheimer’s disease. Trials in animal have shown that Liraglutide promotes neuronal survival, learning and memory, and reduces neuroinflammation and amyloid plaque formation. One such study is titled Prophylactic liraglutide treatment prevents amyloid plaque deposition, chronic inflammation and memory impairment in APP/PS1 mice. Beyond animals, small human trials have shown that Liraglutide improves brain glucose metabolism in Alzheimer’s disease.
Why should Liraglutide work so well in both diabetes and Alzheimer’s, diseases with apparently different pathologies? The answer lies in insulin resistance, the underlying mechanism of type 2 of diabetes; there is now evidence that insulin resistance contributes to dementia. If this is the case, Liraglutide, by improving glucose metabolism, could potentially treat both diabetes and Alzheimer’s disease.
To explore this potential further, there is now a large multicentre trial exploring the real benefit of Liraglutide in Alzheimer’s disease. Titled Evaluating Liraglutide in Alzheimer’s Disease or ELAD, it is recruiting people with mild disease, aged between 50-85 years old, and who do not have diabetes. As they say, watch this space!
Going back to the subject of precision medicine, why not visit my other blog, The Doctors Bookshelf where I will soon be reviewing The Innovators Prescription
Thank you for keeping us always advised on scientific advancements in the medicinal world.
I have had epilepsy for 43 years now and follow Ibrahim Imam for his great articles, knowledge and fantastic information!
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So strong is the link between Type 2 DM and Alzheimer’s disease that there are those that consider Alzheimer’s Type 3 DM. Interesting article. Thank you Ibrahim!
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Thanks for that insight Philippe. Most grateful!
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“type 2 diabetes, a condition which is worlds apart from Alzheimer’s disease.” – in fact, there is a vast amount of evidence that these two disorders are metabolically linked (mitochondrial dysfunction!). My PhD is based on looking further into the mechanisms underlying the observation that diabetic patients are at a two-fold increased risk of developing dementia, specially Alzheimer’s disease. it’s great to see an article like yours as it frustrates me that not enough attention is given to cognitive impairment as a complication of diabetes (in addition to blindness, kidney failure, peripheral neuropathy etc..)!
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Many thanks for this insight Liz. It’s fascinating that there’s so much work going on in this field and the statistics are quite stark. Thanks again for your comments
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If there is a correlation between insulin-resistance and Alzheimer’s, would it be more beneficial and cost efficient to directly treat the insulin-resistance with dietary changes (ketogenic diet) instead of treating it with Liraglutide?
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I agree Katie. I can only imagine that many of us would struggle to maintain the dietary discipline required for this.
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Thank you for such an insightful article. It is surely interesting how different diseases share common underlying metabolic derangements. I am currently running a campaign to raise awareness among the younger generation of the Alzheimer’s disease. Please feel free to drop by and have a look at my page 🙂
https://theforgottenmemoryblog.wordpress.com
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Thanks for the comment. Your blog looks great-keep it up!
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