YSM Issue 91.3
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PHOTOGRAPHY BY XINYUAN CHEN<br />
Researchers and doctors can now read PET images<br />
to directly measure cognitive decline using the<br />
tracer 11 C-UCB-J to measure protein SV2A and<br />
identify the synaptic density in the brain.<br />
occurs. With the development of SV2A-<br />
PET imaging, researchers are now able<br />
to measure synaptic connections in the<br />
brains of living humans using tracers that<br />
bind to this protein.<br />
Because the measurement of SV2A can<br />
indicate synaptic density and synaptic loss,<br />
it can be used to measure cognitive decline.<br />
Researchers used a radioactive tracer,<br />
called 11C-UCB-J, that binds to the SV2A<br />
protein, and set out to compare whether<br />
tracer binding of SV2A could be used as<br />
a quantitative measure of synaptic density.<br />
These measurements were taken using Positron<br />
Emission Tomography (PET) scans,<br />
an imaging test that uses radioactive tracers<br />
to detect targeted areas in the body. PET<br />
scans of patients injected with radioactive<br />
tracer 11C-UCB-J can detect SV2A and<br />
show how much is present.<br />
Researchers found that patients affected<br />
by Alzheimer’s had a reduced amount of<br />
the tracer binding to SV2A in the hippocampus,<br />
a region of the brain involved with<br />
memory. This may be confirmation that the<br />
cognitive decline of Alzheimer’s is directly<br />
related to a reduction of synaptic density.<br />
Furthermore, the measurement of protein<br />
SV2A will help to evaluate changes in<br />
synaptic density overtime. This may lead to<br />
early detection of disease and faster drug<br />
development. “There is so much variability<br />
in this disease–in the way it progresses<br />
and in the exact types of symptoms people<br />
have,” Mecca said.<br />
Prevention<br />
Current medications for Alzheimer’s do<br />
not stop the progression of disease and have<br />
only a modest effect. “We do not recommend<br />
early treatment right now with current medications<br />
since there is no evidence that they<br />
help during early disease stages,” said Mecca.<br />
In addition, the potential benefit must be balanced<br />
with the possible negative side effects<br />
associated with medication use. For some patients,<br />
current medications are more of a burden<br />
than an aid. “Once the patient has lost<br />
a lot of synaptic density, it may be too late,”<br />
Chen said. As a result, future treatments may<br />
need to begin as early as possible. The earlier<br />
that experimental treatments may begin, the<br />
better chance there is for it to work.<br />
Though amyloid PET is a great tool for detecting<br />
early signs of disease, and identifying<br />
a high-risk population, these scans are not<br />
helpful without effective preventive treatment.<br />
“People are very knowledgeable, [and] if they<br />
feel like they have something, they will find a<br />
specialist to check if it is really cognitive decline<br />
or just their anxiety,” Chen said. In this way, education<br />
for detecting Alzheimer’s symptoms<br />
is necessary, and self-awareness–differentiating<br />
between accidentally forgetting your keys<br />
on the way to work and getting lost on the way<br />
home after taking the same route every day for<br />
three years–is very important.<br />
In addition to drugs, Alzheimer’s patients<br />
may be treated for neuropsychological<br />
symptoms, such as depression, anxiety,<br />
or irritability. Educating family members,<br />
finding resources for support, and enrolling<br />
in behavioral therapy are all methods for reducing<br />
the progression of this disease. For<br />
some, the neurodegenerative decline of Alzheimer’s<br />
seems to occur much faster than<br />
others. Those with a strong family history<br />
for this disease are at a higher risk for developing<br />
Alzheimer’s, but inherited genetic<br />
ABOUT THE AUTHOR<br />
neuroscience<br />
PHOTOGRAPHY BY XINYUAN CHEN<br />
Dr. Mecca, a member of the Yale research team, is<br />
pictured in front of PET images of the brain, which<br />
exhibit the differences in synaptic density between<br />
a normal adult and an Alzheimer’s patient.<br />
Alzheimer’s from a single gene mutation is<br />
extremely rare. “[Alzheimer’s] is an unavoidable<br />
disease unless you can really find what<br />
the cause for this disease is,” Chen said.<br />
The research team hopes to increase the<br />
number of participants in this study and<br />
collaborate with other Alzheimer’s research<br />
teams to better study the measurement of<br />
synaptic density and cognitive decline–especially<br />
how synaptic density changes over time.<br />
In addition to studying synaptic density, these<br />
researchers are pursuing other projects to further<br />
explore the impact of other proteins and<br />
signals in the brain that contribute to Alzheimer’s.<br />
One project aims to use tracers to<br />
identify a relationship between neurofibrillary<br />
tangles and patterns of synaptic density.<br />
“There is a lot we can do to characterize this<br />
disease, and also some goals for developing<br />
tools that can help us to do good clinical trials<br />
to find disease cures,” Mecca said. The future<br />
of Alzheimer’s research is a positive one. With<br />
a better understanding for the mechanisms<br />
of this disease, there is a greater chance at detecting<br />
Alzheimer’s disease early and slowing<br />
its progression–and maybe even preventing it<br />
from ever occurring.<br />
LAUREN KIM<br />
LAUREN KIM is a sophomore prospective Neuroscience major in Timothy Dwight College. She has<br />
been writing for the Yale Scientific since her freshman year. She also volunteers at Yale New Haven<br />
Hospital in the Elder Horizons program and is a member of Yale’s varsity fencing team.<br />
THE AUTHOR WOULD LIKE TO THANK Ming-Kai Chen and Adam Mecca for their time and<br />
enthusiasm for sharing their research.<br />
FURTHER READING<br />
Chen, Ming-Kai, Adam P. Mecca, et al. “Assessing Synaptic Density in Alzheimer Disease With Synaptic<br />
Vesicle Glycoprotein 2A Positron Emission Tomographic Imaging.” JAMA Neurology 75, no. 10 (2018):<br />
1215. doi:10.1001/jamaneurol.2018.1836.<br />
FOCUS<br />
www.yalescientific.org<br />
October 2018<br />
Yale Scientific Magazine<br />
20