KEEPING HOPE ON THE HORIZON. Alzheimer’s disease is increasingly in the spotlight after a number of high-profile clinical trial failures—an alarming trend as an estimated 5.5 million adult Americans live with this disease, which disproportionally affects the aged population. Because the over 65 population is projected to double by 2050, the number of new cases of Alzheimer’s and related dementias is expected to soar. Consequently, Alzheimer’s disease is projected to overwhelm the national health care system, affecting 16 million Americans and costing Medicare and Medicaid $1.1 trillion by 2050. Yet, the stark reality remains that no therapeutic has been approved to prevent, slow, or cure Alzheimer’s disease. Not one.
An infusion of philanthropic funds can de-risk a sector and demonstrate a proof-of-concept. Philanthropy can act where other entities cannot—bridging sectors without consideration of partisanship, bottom lines, or policy stances and providing support where most needed.
In our 2018 AD report, and in all of our Giving Smarter Guides, the Center for Strategic Philanthropy (CSP) strives to provide deep scientific insight into the issues and to outline a concrete and actionable set of options for all philanthropists—no matter their size or location. We welcome all feedback regarding our findings, as well as partners in our quest to advance scientific knowledge through philanthropy. The stakes are high, and time is short. Let’s work together to get this right.
Supported by the S Family Foundation, the Milken Institute CSP brought together 30 experts in AD earlier this year to assess the current state of the field and to identify concrete opportunities where philanthropic capital could make a real difference. The top five are listed below.
Support Collaborative Basic Science
Our understanding of the causes of AD and its contributing factors is limited. A historical, intensive focus on one protein, amyloid, may have stifled exploration into other dynamics, causing a lack of diversity in the clinical pipeline. Directed investment into the complex interplay of the full range of biological players promoting neurodegeneration would fill in critical knowledge gaps—gaps that could be turned into new therapeutic targets.
Focus on Biomarkers of the Disease
Currently, the only definitive diagnosis of AD is made after death. Current tools to provide interim diagnoses are expensive and invasive, including brain imaging tests or sample collections through a spinal tap. Additionally, cognitive tests used in the clinic are not sensitive enough to detect problems until the disease has progressed significantly. Investment into novel tools that are more sensitive, less invasive, and less expensive to measure AD could help change the disease trajectory for scientists, clinicians, and patients.
Enable Data Science
More data exists than ever before and are growing exponentially with the expansion of biological techniques examining whole genomes, proteomes, and beyond. Many systems have emerged to fill immediate data needs; however, these systems rarely talk to one another, limiting the ability to share or combine datasets. With big data comes five even bigger breakthroughs, but the ability to store, access, and analyze these data are paramount. Philanthropists can help support the crosstalk between big data platforms to unify existing data and can sponsor the integration of data scientists into neuroscience.
Untangle Risk Factors
The AD field is in the early days of understanding risk factors beyond certain genes. Complicating matters is the lack of diagnostic tools for AD, as well as the co-illnesses that coincide with AD. These issues challenge the ability to untangle AD risk factors from those of other dementias or diseases. Understanding what factors contribute to an individual’s risk of AD is a first step to learning how to mitigate risk. Philanthropists should support long-term efforts to proactively screen patients for disease biomarkers, as well as the studies to follow these individuals over time to assess risk factors.
Reinforce the Clinical Pipeline
No therapeutic has been approved to prevent, slow, or cure AD. The complexity of the disease has made development of model systems to test novel therapeutics challenging, and the long timescale of disease progression has prompted industry to shave off time by skipping vital steps in the process. Support by philanthropists to develop and expand model systems would benefit the early clinical pipeline. Additionally, investment into the development and implementation of a “trial-ready” cohort would allow for adaptable clinical trials that fully utilize their potential patient population.
In this Giving Smarter Guide, we outline the key barriers to progress within the AD field and identify areas where philanthropic capital can be leveraged to generate an outsized impact. We hope to provide a roadmap for philanthropists and foundations alike to invest their funds strategically and make strides in the fight against AD.