[HN Gopher] Molecule restores cognition, memory in Alzheimer's d...
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       Molecule restores cognition, memory in Alzheimer's disease model
       mice
        
       Author : amichail
       Score  : 94 points
       Date   : 2024-08-08 18:34 UTC (4 hours ago)
        
 (HTM) web link (www.uclahealth.org)
 (TXT) w3m dump (www.uclahealth.org)
        
       | gilleain wrote:
       | From the paper :https://pubmed.ncbi.nlm.nih.gov/39106304
       | 
       | edit: ok apologies, after several attempts
       | 
       | http://www.chemspider.com/Chemical-Structure.24670873.html
       | 
       | 3-(2-Naphthylmethyl)-4-(4-piperidinyl)-1H-pyrazol-1-ol
       | 
       | (incorrect stuff removed ...)
        
         | A_D_E_P_T wrote:
         | That's not the one.
         | 
         | The fulltext of the paper is here:
         | https://www.pnas.org/doi/10.1073/pnas.2400420121#supplementa...
         | 
         | The structure is in the SI. You can draw it with SMILES code:
         | On1cc(c(n1)Cc1ccc2c(c1)cccc2)C1CCNCC1
         | 
         | At: https://www.antvaset.com/smiles-to-structure
        
           | gilleain wrote:
           | oops. shouldn't try 'research' on my phone. thanks.
           | 
           | Incidentally, I'm sure it used to be possible to google
           | search using InChI. Even using the InChI-Key now doesn't work
           | super well it seems. I have to quote it to get this PubMed
           | link:
           | 
           | https://pubchem.ncbi.nlm.nih.gov/compound/46204539
           | 
           | which actually gives a link to the patent : "Compositions and
           | methods for treating neurodegenerative diseases"
        
         | RobotToaster wrote:
         | Would it be naive to say it looks like quite a simple (and
         | ergo, cheap) molecule to synthesise?
        
       | amluto wrote:
       | It can join this one: https://pubmed.ncbi.nlm.nih.gov/26439832/
       | 
       | The obvious major caveat is that mice are not people, and that
       | mouse models of what someone thinks are Alzheimer's-like diseases
       | are not people with Alzheimer's.
        
         | newzisforsukas wrote:
         | Join it how? They seem like very different studies and
         | mechanisms.
        
           | welfare wrote:
           | I think they meant join in the sense of yet another study
           | performed on mice with promising results without any
           | indication if it will work in humans.
           | 
           | Come back after clinical trials.
           | 
           | Breakthroughs in Alzheimer's seems like the medical
           | equivalent of breakthroughs in battery tech.
        
             | newzisforsukas wrote:
             | ... no one is calling this a breakthrough though?
             | 
             | The paper itself and the article on it both state it is in
             | mouse models of disease _within their titles_.
             | 
             | Seems like many here bring up this point for no reason
             | other than to repeat it over and over as a low-effort
             | dismissal. It is exhausting to read these threads.
             | 
             | At the moment I am writing this, there is only a single
             | comment about the actual article.
        
             | gdudeman wrote:
             | I wish breakthroughs in Alzheimer's were like breakthroughs
             | in battery tech. Batteries are getting dramatically cheaper
             | and denser every year with a clear path for 10+ years of
             | improvements.
             | 
             | Alzheimer's treatments today maybe slow cognitive decline
             | by 3 months and cost a fortune.
        
           | amluto wrote:
           | Join as a promising small molecule that seems to treat a
           | disease in mice that may be related to Alzheimer's.
        
       | engine_y wrote:
       | Thanks for having 'in model mice' in the header.
       | 
       | Unfortunately mice disease models have not been showing efficacy
       | in humans.
        
         | bawolff wrote:
         | I don't think that is true in general, it more depends on the
         | disease in question.
        
       | mbStavola wrote:
       | Getting ahead of the "in mice" meme replies, it is nice to see
       | further developments in the search for a cure.
        
         | ben_w wrote:
         | Aye.
         | 
         | Lost my mum to that in the middle of the pandemic. Long mental
         | decline including hemispatial neglect*, but physically (mostly)
         | fine right up until the last few days in the care home, when
         | she forgot about drinking -- though we had to work that out
         | much later and from the autopsy as nobody around her could
         | reasonably have watched her 24/7 to count glasses of water not
         | consumed.
         | 
         | * such a bizarre thing to witness: her sitting at the dinner
         | table, the food eaten on only one side of her plate while the
         | other side was full, and her insisting the plate was empty
         | until one of us rotated it 180deg.
        
           | Bluestein wrote:
           | So sorry about your loss.-
        
         | Kuinox wrote:
         | I do comment "in mice" when the title doesn't contain "in mice"
         | when it should. I see it as misleading if it doesn't contain
         | it.
        
         | Bluestein wrote:
         | We've downgraded even, from "in mice" to "in mice models" ...
         | 
         | ... don't even test on real mice anymore.-
        
       | londons_explore wrote:
       | I do wonder if medicine would do better if we simply skipped the
       | efficacy tests in animals (due to the very low accuracy of animal
       | models of diseases not well understood) and simply did animal
       | safety tests, then moved straight onto human trials.
       | 
       | Obviously the vast majority of treatments would be ineffective -
       | and this in turn should let you design multi-treatment trials,
       | where say a trial of 100 patients are used to test 50 substances,
       | with each person receiving simultaneously tiny doses of ~25
       | candidate treatments.
       | 
       | Then the patient outcomes are used to identify which of the 50
       | likely have some effect, and a trial is done of just that
       | substance.
        
         | nonrandomstring wrote:
         | It does some anomalous that some states are moving toward
         | assisted dying which (I don't personally agree with for complex
         | reasons), which is essentially a very humane stance, and yet
         | elderly people or those who are terminally ill cannot, it
         | seems, waive their "safety right" under law and consent to be
         | trial subjects for experimental drugs with high risks.
        
           | unsupp0rted wrote:
           | In Canada there's assisted dying for people with mental
           | illness: perfectly physically healthy people, who might even
           | decide to live a fair bit longer if they felt they were
           | contributing to saving lives by allowing testing.
        
             | mtlmtlmtlmtl wrote:
             | I'm not sure what you're even suggesting here. First of
             | all, according to the canadian government[1], euthanasia is
             | not currently permitted in cases only involving mental
             | illness. It's been delayed twice already, currently until
             | 2027, and may be delayed further or scrapped entirely in
             | the future for all we know.
             | 
             | Second, what would they be testing? Drugs for their
             | condition? That wouldn't apply to the type of situation
             | necessary for euthanasia under Canadian law[2]:
             | 
             | >To be considered as having a grievous and irremediable
             | medical condition, you must meet all of the following
             | criteria. You must:
             | 
             | 1. have a serious illness, disease or disability
             | 
             | 2. be in an advanced state of decline that cannot be
             | reversed
             | 
             | 3. experience unbearable physical or mental suffering from
             | your illness, disease, disability or state of decline that
             | cannot be relieved under conditions that you consider
             | acceptable
             | 
             | If there was an experimental treatment that might actually
             | help them, these criteria would not apply.
             | 
             | If you're suggesting safety testing of drugs for other
             | illnesses, that's extremely unethical and I seriously doubt
             | the medical community would be willing to do it, even with
             | consent. And I seriously doubt a number of people large
             | enough to give meaningful results would consent in the
             | first place. It's also of dubious usefulness because any
             | treatment intended for disease X might have its safety
             | profile and risk/benefit analysis altered by the presence
             | or non-presence of X.
             | 
             | 1: https://www.canada.ca/en/health-canada/services/health-
             | servi...
             | 
             | 2: https://www.canada.ca/en/health-canada/services/health-
             | servi...
        
               | daedrdev wrote:
               | However in the Netherlands it is permitted
        
           | y-c-o-m-b wrote:
           | Isn't this what the "Right to try" laws are designed for?
           | https://en.wikipedia.org/wiki/Right-to-try_law
           | 
           | Although it does seem like many companies are still not
           | allowing this. I don't know much on the topic and I'm not
           | sure why (financial reasons perhaps?) they'd refuse, but I've
           | always found it absurd that we can poison ourselves to death
           | (literally) with all sorts of substances legally, but
           | experimentation with life saving methods are restricted. I've
           | seen some very strange arguments against the experimentation
           | like "well they could die sooner!" - yeah, but that's up to
           | the person to decide, just like all other decisions they've
           | made preceding it. A patient has the right not to choose any
           | treatment at all, that could definitely make the die sooner.
           | Why is this where the line is drawn for some people? It seems
           | arbitrary.
        
             | nonrandomstring wrote:
             | I wasn't aware of this progress. Thanks for the link. It's
             | definitely an ethical hot potato. My concern would always
             | be around pressure, and being sure that a choice really is
             | a choice.
        
             | mlyle wrote:
             | The research teams want to get their drug approved so it
             | can help many people. This means proving it is safe and
             | effective.
             | 
             | Unfortunately, using it in a non-study context risks a
             | whole lot of confusion-- if the marginal, near-death case
             | that wouldn't qualify for your trial dies in a weird way,
             | what do you do?
             | 
             | Not to mention that prior to approval, there are no
             | economies of scale in production.
        
         | D-Coder wrote:
         | With mouse models, you are at least guaranteed to get results
         | within two years. Human models can take 10, 20, 30 years.
        
         | qwerty9001 wrote:
         | You need to look up more clinical trials horror stories.
         | 
         | Even after animal testing performed prior.
         | 
         | I know of participants that have passed away in such trials
         | (witnessed by relatives).
         | 
         | The "slow" process is not due to over abundance of caution. Bad
         | things unfortunately do happen.
        
           | londons_explore wrote:
           | Tiny doses can generally avoid this. When you eat a banana,
           | there are probably over 1 million different chemicals in
           | there. There are probably a few molecules that exist nowhere
           | else on earth.
           | 
           | Yet nobody is worried about the safety of a banana, because
           | the concentration of the really rare chemicals is low enough
           | to not matter.
        
             | mlyle wrote:
             | The efficacy of most new drugs is barely feasible to detect
             | at a small trial size, of the best guess for effective
             | dose, comparing against only one other option (or nothing).
             | 
             | Trying to microdose and test many things at once is going
             | to make this signal vanish to nothing.
        
               | londons_explore wrote:
               | The logical way to do it is to have doses starting really
               | tiny, then doubling every ~week.
               | 
               | Every week, patients are given a health survey, and if
               | any effect is obvious in the results data (ie. patients
               | given drug 43 have, on average, a 2 C increased core body
               | temperature), then the dosage of that specific drug is
               | either held fixed (since it is clear we have reached the
               | 'has an effect' dosage), or removed entirely from the
               | trial (if whatever the effect is is deemed likely to hide
               | more valuable yet smaller data from other drugs)
        
           | PicassoCTs wrote:
           | But you are dying already. Vanishing to be a stumbling around
           | hull, foreign to the world. If not medicated, you would be in
           | constant panic of being lost in a foreign place. Fast death
           | with a chance of healing seems preferable if chosen out of
           | ones own free will before it errodes away?
        
         | 42lux wrote:
         | This would prolong not shorten the process...
        
           | AuryGlenz wrote:
           | If it's a big enough effect size you wouldn't need many
           | people taking it, at least for something like Alzheimers. If
           | it stops/reverses it in just a few people out of 10 you'd
           | know to scale up.
           | 
           | I'd take whatever the hell you'd give me even for a .00001%
           | chance of it working at a 25% chance of it screwing me up
           | further if I had Alzheimers as well.
        
             | 42lux wrote:
             | Stochastic effects in small samples could lead us to scale
             | up treatments that only work for those specific 10 people,
             | potentially wasting resources and raising false hopes for
             | the broader Alzheimer's population...
        
               | arijun wrote:
               | And what of these mouse studies?
        
               | 42lux wrote:
               | Mice are excellent models for human disease due to their
               | genetic similarity, with 98% of human genes having mouse
               | counterparts. Their comparable reproductive and nervous
               | systems, along with susceptibility to similar diseases,
               | make them valuable research subjects.
               | 
               | DNA manipulation in mice, through breeding or gene
               | editing techniques like CRISPR-Cas, allows researchers to
               | study specific genes and diseases. Using mice is faster
               | than conducting initial studies on humans, allowing for
               | rapid testing of hypotheses and treatments before moving
               | to human trials. Mice also have much shorter lifespans
               | and faster reproductive cycles, enabling researchers to
               | study diseases and genetic effects across multiple
               | generations in a fraction of the time required for human
               | studies.
               | 
               | Maybe if OP would like to sacrifice their children and
               | grand children... sounds a bit insane doesn't it?
               | 
               | Here is a nice paper for you to read
               | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987984/
        
         | jdoe2020 wrote:
         | I work in the side of academia that feeds drug leads to pharma
         | and have seen this process.
         | 
         | The big problem aside from time is cost and scale. You might
         | start with either a million compound in silico 10000 compounds
         | in a high throughout enzyme screening program. You might get
         | 500 hits with reasonable affinity which you put those in cell
         | cultures and get 50 compounds. Then you go a small scale mouse
         | study and may get 5-10 decent hits that don't have very obvious
         | tox issues. Then you do a large mouse study of those for
         | efficacy. You will get 1-2 compounds that may be suitable to go
         | into people and there is maybe a 10% chance you get through
         | phase III and onto the market. Usually there is also a step in
         | monkeys before it goes into people.
         | 
         | The main issue here is that at each of those steps the cost
         | scales 10-100x so you really, really need cut cost as much as
         | possible and eliminate non promising candidates. Realistically
         | if a molecule doesn't work in mice sure it could work in
         | humans, but you'd be better off just doing the mouse study so
         | you only need to run one trial instead of 10 and use the
         | savings to invest in other trials.
         | 
         | Human trials are insanely expensive. One of my colleagues works
         | at a company that pays well over $100k for a single primate for
         | preclinical testing. Doing it in people is even more expensive
         | with the massive costs of just organizing and insuring a trial.
         | Comparatively it is very easy and cheap to inject a couple
         | dozen mice with a drug and watch them for 6 months.
         | 
         | Also mixing trial candidates is a really bad idea, CYP liver
         | enzyme reactions are a real thing and are often very different
         | for humans and animals. Doing it with one drug is dangerous
         | enough, but mixing 25 where one may inhibit decomposition of
         | another is a recipie for dead people. You'd also need a very
         | very large number of people (likely thousands) to deconvolute
         | the statistical noise.
        
       | Beijinger wrote:
       | "Wei et al., have studied the subunit composition of
       | g-aminobutyric acid type A receptors responsible for the tonic
       | inhibition of parvalbumin positive interneurons and identified a
       | small molecule (DDL-920) as a potent, efficacious, and selective
       | negative allosteric modulator of these receptors."
       | 
       | A SMALL molecule? And not formula? Odd.
        
         | dillydogg wrote:
         | I the term small molecule has a specific meaning in biopharma
         | and the biochemical formula is almost certainly not going to
         | reveal much information. Might as well just use the convention
         | of the compound ID.
         | 
         | Related, in the supplemental data the compound's reference is
         | Ref XX. Must have slipped by the reviewers.
        
         | aftbit wrote:
         | I'm not entirely sure I understand your comment, but "small
         | molecule" is a drug discovery term of art, and includes things
         | with relatively high molecular weights and complex formulae.
         | Anything sub-1000 daltons is generally considered a "small
         | molecule".
         | 
         | https://en.wikipedia.org/wiki/Small_molecule
        
           | Beijinger wrote:
           | With a PhD in Chemistry, I understand what a "small molecule"
           | is. But by looking at the link for a few seconds, I found no
           | further information about the compound. I am not a big fan of
           | "secret sauce". Maybe I missed it in the paper.
        
       | harles wrote:
       | I love that "in mice" is in the title (both on HN and in the
       | original article). It seems like a promising result and I really
       | appreciate them not over hyping it.
        
       | RivieraKid wrote:
       | Alzheon's ALZ-801 pill should be approved within a year and
       | should be basically an Alzheimer cure for 15% (current phase 3
       | trial) and later 2 thirds of people.
       | 
       | I've recently learned about this and was surprised it's somewhat
       | under the radar. Am I missing something?
        
       | robwwilliams wrote:
       | The fundamental problem of the great majority of so-called "in
       | mice" studies is their use of exactly 1 (one) fully inbred type
       | of mouse -- C57BL/6J. Would you trust N=1 clinical trials?
       | 
       | In this particular PNAS study you have to be hard-core reader and
       | rummage around in the Methods section to uncover this awkward
       | detail:
       | 
       | "Mouse strains used were C57BL/6J (Black 6, Jackson Laboratory;
       | JAX stock #000664), JAX stock #003725 (Gabrd-/- mice on a
       | C57BL/6J background..."
       | 
       | No wonder translation fails so often. It is not the mice, it is
       | scientists cutting corners!
       | 
       | Some of us working with mice use many different genotypes of mice
       | to ensure somewhat more robust results that have a better chance
       | to generalize across mouse genomes and perhaps even human
       | populations.
       | 
       | This is not new news. Here is a classic on this topic in
       | Alzheimer's research published in Neuron in 2019:
       | 
       | https://pubmed.ncbi.nlm.nih.gov/30595332/
       | 
       | One more point: There is a great deal of variation in expression
       | of key genes/proteins mentions in this recent PNAS study, in
       | particular parvalbumin and the GABA receptors.
       | 
       | For example parvalbumin protein levels in the hippocampus of
       | different strains of mice at different ages vary over a 20-fold
       | range. Here are the hard data from GeneNetwork.org;
       | 
       | https://genenetwork.org/show_trait?trait_id=61839_VFHILDKDKS...
       | 
       | And GABA receptors also have high levels of variation in
       | hippocampus and other brain regions. Here is a good paper that
       | compares mouse and human GABA receptor variation.
       | 
       | https://pubmed.ncbi.nlm.nih.gov/22506031/
        
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