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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

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