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Topic: Scientists have devised a blood test to detect proteins that form the plaques in the brain that are suspected to cause Alzheimer’s. They believe this may lead to being able to diagnose Alzheimer’s before showing symptoms.

More information can be found in this embargoed press release from The Rockefeller University Press.

Media are invited to attend and ask questions for some of the researchers involved. 

Who:

• Randall Bateman, MD, The Charles F. and Joanne Knight Distinguished Professor of Neurology at  Washington University School of Medicine in St. Louis  
• Nicolas Barthelemy, PhD, Instructor in neurology at Washington University School of Medicine in St. Louis
• Suzanne Schindler, MD, PhD, Assistant Professor of neurology at Washington University School of Medicine in St. Louis
• Rebecca M. Edelmayer, PhD, Director, Scientific Engagement, Alzheimer’s Association  

When: July 28, 2020. 3PM - 4PM EDT

Where: 

This live event will also be recorded and transcribed for use by media and communicators after it is concluded.

Thom: Welcome to this 麻豆传媒 Live virtual press conference. Today we have researchers that presented findings at the 2020 Alzheimer’s Association International Conference about a group of studies that have achieved the next step in creating a blood test to not only diagnose Alzheimer’s disease, but also to potentially revolutionise our understanding of disease progression and asses the efficacy of various treatments and prevention measures. This research partly was done by some of our panellists today from the Washington university in St. Louis, published in the journal of experimental medicine which is a publication of the Rockefeller University Press, as well as others who have published studies in the journal of the American medical association researchers included the University of California San Francisco, Lund University and the Banner Alzheimer’s Institute. So, we have today on our panel four experts to discuss these study findings and what they mean for the future of Alzheimer’s care. We have Dr. Randall Bateman, he is the Charles F. and Joanne Knight distinguished professor of Neurology at Washington University School of Medicine in St. Louis. 

We also have Dr. Susan Schindler, Assistant Professor of Neurology at Washington University School of Medicine in St. Louis. 

We have Nicolas Barthelemy, he is a PhD and instructor in Neurology at Washington University School of Medicine in St. Louis and we are also happy to have Rebecca Edelmayer, PhD director of scientific engagement at the Alzheimer’s association. 

Thank you to the panellists all very much for being here and I want to go to Dr. Bateman for just a little bit of some context and some general understanding about the importance of amyloid-beta and Tau Proteins and what we understand about them and their role in Alzheimer’s and why it was so important to work on devising a way to detect their presence in the blood and what that means.

Dr. Randall Bateman: Right, so we define Alzheimer’s disease as having two major pathologies in the brain and those are amyloid plaques and tau tangles. With those two pathologies we have high certainty that the thing that causes memory loss and cognitive decline in these millions of people in the US and around the world, is caused by Alzheimer’s disease because that’s how its defined. The key thing that everyone has been working on for many decades is ways to detect Alzheimer’s disease in a simple and effective way and with the news now that in blood we can measure tau species and in particular phosphor tau species that seem related to these two pathologies, it really accelerates our ability and our capacity to be able to detect Alzheimer’s disease and that’s transformational for several reasons. 

One is diagnosis in the clinic whereas before we needed PET scans or spinal taps which are expensive and invasive and difficult to do. A simple blood test is much easier and something we can implement in most medical systems.

Two – it allows us to track the disease, after people get the disease but importantly even before they have symptoms and this enables things such as prevention trials and these prevention trails promise to change the way we approach Alzheimer's disease and one day we may be able to treat it to actually prevent its onset.

Thom: Doctor Edelmayer, help us to understand a little bit of the big picture, and so as this has kind of changed the game a little bit from what Dr. Bateman said about the ability to do this out of a blood test, what are the current diagnostic tools and how are they used to asses and diagnose Alzheimer’s and how is this a leap forward?

Dr. Edelmayer: So as Dr. Bateman mentioned, we have technologies and tools today that can assist clinicians with helping them to make a diagnosis of Alzheimer's but those types of technologies are still sometimes invasive or considered invasive and they may be costly and we’re talking about PET scans or brain imaging scans, MRI’s are also used as part of that brain imaging and cerebral spinal fluid analysis and that is a technology that looks at that clear fluid that surrounds your brain and spinal cord that comes out through a lumbar puncture, but what we understand today is that these current methods of assessing Alzheimer's in living people can maybe sort of slow down the process of their diagnosis and that people may not have access to all of these types of tools and technologies. So, we think that it will be really important for families facing Alzheimer's now and in the future that they would be able to have access to these tools once they become validated and approved by the FDA as part of these types of procedures that would be important for diagnosis. We think that these tests would allow for earlier detection, allow for important care and planning steps to be able to take place earlier in the disease process and it would also potentially allow access again as I mentioned, to more people than ever before who weren’t able to receive this type of expensive or invasive care in any way and a blood test would really be sort of a boon for care of individuals that are living with Alzheimer's and their family. 

Thom: Thank you, Dr. Schindler I wonder if you can help us understand a little bit about how these blood detection bio marker tests can help us to chart the progression of the disease and one concept that you’ve worked on is the presence or the status of amyloid in the blood an indicator of how long someone may have before they start to develop symptoms. Can you tell us more about that?

Dr. Schindler: Sure and actually I wanted to make a comment about something that Dr. Edelmayer was saying that I think is really important and that is – currently in clinic we pretty rarely do see such biomarkers or amyloid PET I would say that we maybe do it in 5% of patients, not very many. But if we have a blood test I think that maybe we would do it in 80% or more of our patients that were presenting with cognitive impairment, so I think it would be used much more broadly and I think that’s really important to recognize that the current limitations of amyloid PET and CSF biomarkers means that they just don’t get used very often in the clinic even though they're available.

So, in terms of potentially staging individuals based on amyloid, so we have learned that plasma abeta 40 to the abeta 40 can tell us whether someone who is cognitively normal has amyloid deposited in the brain. 

It actually may not tell us how long it is exactly until he develops symptoms, but we think that if we add additional bio markers like ptau217, ptau181 and maybe even neurofilament light, that that might be able to help us predict when cognitively normal individuals will develop symptoms and this is something that we’re very interested in doing is – with the blood test being able to predict, not only if someone will develop symptoms but when – this would be very helpful for clinical prevention studies and obviously there are a lot of people who would like to know when they're going to develop symptoms. 

Thom: Thank you Dr. Schindler. Dr. Barthelemy, one of the things that I understand you’ve taken a look at is how tau proteins will potentially change over time and the different types of tau proteins. What can you tell us about what we know generally there and what can we determine from this phenomenon about how the tau changes, about the disease progression for Alzheimer's and using that to make accurate diagnosis and treatment?

Dr. Barthelemy: Yeah, I think for now we still have just a few analysis of plasma bio marker and plasma ptau biomarker to really find out how long they change, but we have now a good estimation of the fact that the ptau we are measuring in plasma – means 217 and 181 are well associated to what we found in the cerebral spinal fluid and definitely much more experience but the change of these ptau species in the CNS using this and we think the phosphorylation of [inaudible 09:22]  is starting really early in the ageing process, barely two decades before the symptom, just few years after the detection of the amyloid plaques and we assume those change will be re-capitated in some way in the plasma even if there is some likely limitation about analyzing plasma for now compared to the CSF due to the low amount of the ptau – we are measuring these metrics. And so, we are not going to perfectly reflect the cerebral spinal fluid change, but definitely for the convenience and the low invasiveness of the plasma collection we are going to recapitulate in some way what we found in the cerebral spinal fluid. But there is this limit about the low concentration but we assume also there is some kind of contamination in the plasma in that frame with the change in the cerebral spinal fluid because likely there is some tau [inaudible 10:36] from the periphery, barely all the cells of the body are also raising also some kind of cell and what is really testing and I think we can feel there’s a lot of hope of using the ptau species is – for example the phosphotau 217 appear to be quite specific to the central nervous system and that’s probably the reason why now we have to study – comparing the performance of plasma 181 and 217 and its likely the reason why 217 is performing probably better than 181 – that’s really the specificity compared to the – either form, released in the periphery. 

Thom: Thank you Dr. Barthelemy, we have some questions coming in from the chat, David Levine at Siam, would you like to ask this question yourself? I've made your audio live, go right ahead David.

David: Sure, so my question is basically – what is the good of early detection if you don’t have any treatments to offer patients? 

Thom: Dr. Bateman would you like to take that?

Dr. Bateman: Sure, it’s an excellent question because with most of these tests, as a physician in the clinic we think about how would we use this test and as a researcher in Alzheimer's disease we also think about how would be use it, so I would say there’s two uses for this. One is when patients come out of the clinic and they have concerns of memory loss or forgetfulness and it’s not clearly Alzheimer's disease, we have to decide how to treat them. There are specific treatments for Alzheimer’s disease, there are four approved drugs in the united states and there are many more that are now being tested and developed, in fact a recent one has been submitted to the FDA that targets amyloid plaques specifically and so in the clinic the use for finding people earlier in the disease is that when they have symptoms it helps us manage that disease and get them on treatment earlier which we think is better for them clinically. So that’s in the clinic, but there’s another side to these blood tests that’s really important and this is going to be transformational for the Alzheimer’s disease field and that’s the ability to detect the disease even before those first symptoms begin, and to your point – you might say well who would want to know if you are going to get Alzheimer's disease – especially if there’s nothing you can do about it right at this moment and we and others are running prevention trials trying to reverse the pathology of Alzheimer's disease before people get sick and if we can do that, if we can treat those people and stop them from having memory loss and cognitive decline and dementia, that’s the ideal situation for a patient. Very few patients want to be stuck with dementia and memory loss and disability, but if we can prevent those symptoms from coming on, that’s the reason we’re so excited by these kind of bio markers that can tell us years before someone gets sick that they will get sick and we think that in the right combination these blood biomarkers will also tell us about when someone will become sick and that’s going to be very useful in the clinic when we go to triage our patients for who gets on what treatment and when. 

Thom: Thank you Dr. Bateman, Dr. Edelmayer would like to add something here, go ahead Dr. Edelmayer.

Dr. Edelmayer: I think those are amazing and really important points and exactly what Dr. Bateman said is that getting people also involved in some of these types of trials early on could be crucial for helping to help their disease progression at the earliest stages and so whether or not we’re talking about even prevention trails, identifying people at the earliest stages also helps to test out some of these new diverse approaches that are being looked at in the clinic today. There are probably close to a 120 different drug therapeutics that are being tested in the clinic today and they need volunteers that will participate in these trials to help move that research forward, so identifying who is the right fit for some of these different types of new technologies that are being developed, like some of the blood tests that we’re talking about today will be crucial and I think from another aspect is – making sure that individuals have a diagnosis that might help with any type of care and planning for the future is going to be crucial because not only will it help their families plan, but it also helps for the physician to help with their care management as well.

Thom: Thank you for the question David, we have another question from Max Kozlov at the St. Louis post dispatch, Max go ahead with your question.

Max: Thanks, but I think my question is partly answered already but it sounds like you’re still hoping to reduce the amount of blood drawn for the study for this kind of analysis in the future, but I'm hoping to hear - how much would a patient – how much blood you currently need to draw and where do you hope to be and what are some of the next steps for your research?

Dr. Bateman: Yeah so, I can address that – in the clinic we typically will draw a teaspoon of blood, about 5 ml to 10 ml – 1 to 2 teaspoons of blood. These tests use probably a quarter of that, so like half a milliliter or two milliliters for the amyloid beta and the tau test respectively so we could run all of these tests on a single tube of blood obtained in the clinic. So we’re not really limited by the volume of blood that patients or research participants can provide, the reason that we care about blood volumes and getting lower amounts if that our historical studies where we collect samples over many years or decades – in those studies we try to preserve those samples for many different uses and there there’s a real advantage to using smaller volumes of blood or plasma because then we can just test many more things in those studies. But in terms of patients and I think future studies, I think the volumes are relatively small and won’t be a hindrance.

Thom: Thanks for that question Max, I want to ask Dr. Barthelemy to add on to this – as you achieved the mass spectrometry portion of this, why was it important to shoot for as your goal to be detecting very, very small concentrations and very, very small samples. What was the reason for that and how was that accomplished?

Dr. Barthelemy: I think the reason for that was – when you are ready from some other study, the ptau amount in plasma, we are going to be much less than in the cerebral spinal fluid, potentially 50 times less than the concentration we were measuring and for this reason knowing the sensitivity of the instrument we have to think about other ways to add sensitivity on the process, means getting the sample as clean as possible, get way to have the best recovery possible for the tau patients we were looking at and also tune the mass spectrometer to really focus on the sensitivity. Means there is some way, some trick I would say in the mass spectrometer to assume that and we think using potentially the most sensitive instrument available on the market in the proper way, we were able to track this low amount and the mass spectrometry has some advantage also - the kind of mass spectrometer we are using right now but really the accuracy of the measurement, means we measuring mass and the mass of our target in a really accurate way and it makes the confidence about the detection of the [inaudible 18:59] really high and likely improve the confidence overall about our ability to detect change in the positive participant compared to [inaudible 19:10]

Thom: Dr. Bateman another question from Ann at practical Neurology, can you speculate a little bit about bringing this out of the research environment and into clinical practice, and this may be something that everyone on the panel may be interested in getting their thoughts about. 

Dr. Bateman: Sure, and so there is – typically these tests go through stages, so when we start, we’re in a discovery stage and we need to keep in mind the time scale here, so in 2017 the first highly specific blood test for Alzheimer's were being reported. So, we reported amyloid beta test in the blood and that was in 2017 – that was the first discovery that it was very specific and associated with amyloid plaques. From that time – then it takes time to have those assays developed into a commercial assay that can be used in the clinic and there’s multiple levels of that, one is just the throughput and the magnitude of the number of tests goes up substantially. It also requires a lot of validation that’s been done over the past few years and then finally you have to have these tests approved in a clinical lab what’s called a Clia approved lab in the US or approved by a regulatory agency like the FDA or the EMA and that’s a whole process that takes several years. 

Now, for example there are companies – one which I co-founded with David Holtzman about 11 years ago, C2N Diagnostics, they have a Clia approved test, so in terms of ordering that test, that could be done now in the clinic, but there ahs to be more done to enable this in terms of clinical use for diagnosing patients and that includes further validation steps, its going to include regulatory review and it’s also going to include having it paid for by insurance companies and I think the Alzheimer's association could speak about that. So, these things are coming, we just now are in a stage of discovering the blood plasma phosphatide measures and so I expect those will be coming within a few years, within 1 to 2 years. 

Thom: Dr. Edelmayer can you speculate further on bringing these tests to the clinic and how families and patients with dementia and potentially Alzheimer's will benefit from this and what kind of track do you see for that becoming a reality?

Dr. Edelmayer: Absolutely and I think just to reiterate – this has really been remarkable progress that we’ve seen probably in just the past few years. Even last year at our Alzheimer's association international conference we saw some really interesting collection of research, I know Dr. Batemans work was some of that, that was presented just looking at some of the amyloid measures and then this year at the Alzheimer's association intention conference we’re really seeing I would say a breath of research that’s focused on tau and these are just some of the types of publications and research discussions that need to happen before something ends up getting approved as a diagnostic tool. One of the things that Dr. Bateman also brought up is there need to be these international standards and validation that’s put in place and one of the ways we’re trying to help foster that research is through our global biomarker standardization consortium that is bringing industry partners academic as well as government  and other non-profit leaders in the bio marker space that helps to bring these tools and standardization technologies in place for all. So I think as we continue to see this rapid progress, more and more work – once potentially approved by the regulatory agencies like the FDA – we will definitely see a need for making sure that there’s access to these types of tools and technologies as Dr. Bateman mentioned and the Alzheimer's association has  been working really hard to make sure that that ends up not being a problem for individuals who need these types of tools and technologies as part of their clinical care and so we’ve been working diligently to provide research and evidence to support the need for PET imaging, that there would be insurance reimbursement for that through a study called the imaging dementia evidence for amyloid scanning study, which is now moving into its new iteration where we will be collecting blood as well as amyloid PET imaging to kind of really balance those two types of measurements together to help with that standardization. But we will see the same type of strategy needed also for cerebral spinal fluid biomarker tests and plasma tests as we move forward into the future.

Thom: Dr. Schindler I want to get your thoughts about this question as well and I want to point out for anyone who is curious, Dr. Schindler has provided some really specific numbers in the chat about the accuracy of the relation between these tests, partly speaking to Ann from Practical Neurologist question – so thank you for that Dr. Schindler. What are your thoughts about how this can go from the research phase to the clinical phase and what more potential insights do you hope to realise once that happens?

Dr. Schindler: So, as Dr. Edelmayer was saying we’re really just had remarkable progress over the last few years and I think that one thing that’s going to be important is we’ve mostly been talking about these measures separately, so plasma AB 42 to 40, ptau isoforms and NFL as well and then we heard some data today about GFAP, I think it’s going to be really interesting to combine those different measures together and I think that its likely at some point we’ll have a panel of these markers that will be used in the clinic to help us diagnose our patients. I think that its very important to have these kind of markers in the clinic because I think the idea study has shown us that sometimes clinicians aren’t so good at diagnosing whether peoples very mild memory problems are related to Alzheimer disease or something else. And I think these tools can help us to diagnose people earlier and more accurately. So, I think they’ll be very helpful to many patients in terms of how do we get there – I think that we need some larger studies, certainly what Dr. Hansson was talking about today was pretty impressive in terms of the city size, but I think we need more studies that have a thousand people in them and studies that are more representative of the clinic population, so one thing that I mentioned in my talk today was the Seabird Study that’s been launched by Dr. Batemans group and what the study aims to do is recruit participants who look more like the sorts of people that we see in our dementia clinic. A lot of our research cohorts are pretty homogenous, they're pretty highly educated, have a relatively high socio economic status and are pretty healthy and in the clinic we get people who have a lot of medical comorbidities and a lot of issues and that’s a big part of why sometimes its difficult to diagnose them because they have a lot of things that could be contributing to their memory problems. So, I think a big part of bringing this test to the clinic is just more studies and doing studies in cohorts that’s are representative of the clinic population and then of course all the various things that Dr. Bateman outlined.

Thom: Thank you Dr. Schindler and Dr. Barthelemy, I want to ask you as well some of your previous responses referred to how we can track some of these new tests with what we know of other diagnostic  tools and see how accurate it is and see how well it helps us to understand the progression of the disease. As this goes into the clinic and we start dealing with more data from real patients and be able to analyze that further, what do you hope that that means for the next step of treating Alzheimer’s?

Dr. Barthelemy: I think first the combination of the bio marker for sure going to improve the confidence on the diagnosis and I see a nice perspective about this work because now we have a way to potentially identify individuals are risk of developing Alzheimer's dementia, before the symptoms start and I think in the future the study of such asymptomatic individuals are going to be much easier because we are going to get more support for this kind of procreation, because for now I think epidemiologic studies are more focused about people already having symptoms or having genetic risks, here we are going to have potential population to study having all the recruited based on just the plasma biomarker positivity with no symptom and it’s not their field of study because we don’t face this population, definitely are [inaudible 29:15] I think getting access to such population are quite complicated and potentially in the future because we know here this participant has amyloid positivity, tau positivity, we’re going to identify potentially new biomarker changing at the early stage of the disease at the asymptomatic phase.

Thom: Thank you Dr. Barthelemy, I want to ask Dr. Bateman what further studies can you see being possible now through this test detecting tau in blood plasma and using that along with other biomarkers and what progress can be made? 

Dr. Bateman: Yeah, I want to go back to David Levine’s point about the clinical utility. Its important to understand where we’re at today to know what should be done in the future and the ideal study which was sponsored by the Alzheimer's association and CMS for health in this country is clearly demonstrated that about 1 out of 3 Alzheimer’s diagnosis are wrong and so in our clinic our patients are being misdiagnosed and they're being mistreated in terms of their therapeutics and their management plans and looking for other causes of cognitive impairment and dementia. And so, that’s one of the most immediate uses that I can see for something like a blood test, is making it feasible that we’re able to get better and more accurate diagnosis for our patients so that it can be appropriately and accurately treated. In terms of the future studies what I think needs to be done is that in the ideal study and in other clinical studies of patients we need to understand how these blood biomarkers behave and the Seabird study that Susanne was referring to is meant to recruit people from the general population, so average people not super volunteers in Alzheimer's disease studies and these people will tell us a lot more about how these tests will perform in the clinics. So that’s one kind of future studies validating this blood test to be used in the clinic and demonstrating its utility. 

How good is it? How sensitive is it? How specific is it? Is it a precursor to a confirmatory test or can it be used by itself to make a secure diagnosis and to diagnose patients more accurately? That’s more on the clinical front.

We’ve talked about some of the research studies and mostly in the context of we can identify people now who have the disease with a simple blood test, we can now predict maybe who is going to get the disease with a simple blood test and that’s very important for our research studies and our clinical trials. If we can reduce the time it takes to run a trial by six months, a year, two years – that greatly accelerates our ability to test treatments. It drops the cost of the trial as well, but the key thing here is we can get to better treatments faster by using this blood test. Instead of scheduling someone 3 or 4 months down the road to get a PET scan or scheduling them to have a lumbar puncture, draw the CSF and send that off and really limiting the numbers in the enters that can be used for clinical trials, what these blood tests do is they open up our ability to have trials not of a 1000 – 2000 people but we can have trials of 10,000 – 50,000 people. We can enroll people at all centers, whether they have PET scanners or people trained to do spinal taps or not. And so, the future studies I think where this is going to go, is this opens up the ability of the research community to do all kinds of studies which were unimaginable before and that’s going to revolutionize how fast we move towards effective treatments and prevention in Alzheimer's disease. 

Now there’s the added benefit – we can actually go back in time for blood samples that have been sitting in the freezer for 5 years or 20 years or longer and figure things out like in the Framingham Heart Study – we can go back and answer questions about who had abnormal biomarkers 10 or 20 years ago and what’s happening to them today. So, this is really exciting for all of us – I want to share some of the excitement, not just for the fact we have a blood test for Alzheimer's, we have a specific way of detecting tau and amyloid in the blood, but what this means for us as a field and out ability to move towards having truly effective treatments that will stop this terrible disease. 

Thom: Thank you Dr. Bateman, if any of our media have any further questions please do chat them to us, I want to ask Dr. Edelmayer, you mentioned earlier, presentations from last year’s conference about amyloid and now we’re looking at tau and testing for it in the blood, how do you see this as having really changed the game especially in terms of the scalability and the more efficient reproducibility of these kinds of tests versus having someone coming in for a PET scan. 

Dr. Edelmayer: I want to reiterate; I think my colleagues here have made some great points particularly Susan had mentioned earlier that we’re probably going to be looking at a panel of different types of things that we want to be testing. There may not be one single diagnostic tool that we want to use in the future but as we continue to learn more about what each of these different blood biomarkers, cerebral spinal fluid biomarkers and even PET biomarkers are telling us, it helps us paint a picture for each patient and as we continue to develop those tools, when you start putting all of that together it helps provide not only individuals, their families and clinicians tools to help make a better and more accurate diagnosis. So, I think that - and then as Randy was even mentioning we might even be able to move into the stages of prognosis and prediction as we learn more about what these types of biomarkers are telling us, through longer longitudinal studies in different populations. I think this is some of the first most exciting data and it is true – it has been a very exciting day, we actually got to watch Dr. Bateman moderate a session at AAIC today that was highly attended. Thousands of people are watching this and Susanne was able to present as well. So, we’re seeing this kind of discussion happen across the scientific community and now its up to all of these amazing scientists and researchers and clinicians around the world to continue to build that body of knowledge that’s necessary to support approval of these types of tools as part of care. 

Thom: Dr. Bateman you mentioned the difficulty with an accurate Alzheimer's diagnosis and the levels to which patients are misdiagnosed and then not treated properly. Can you tell us a little bit more about what other similar diseases could be on the differential diagnosis with Alzheimer's, that this could help to rule out?

Dr. Bateman: Yeah so one of the key things is when people go in to see their regular physician or even when they come to a specialty clinic like ours where we only specialize in memory disorders, the key thing is to understand what is causing the cognitive impairment, cause that directly drives how you treat it. And so, in order for us to know what causes the disease we have to make a diagnosis and for the past over 100 years since Alzheimer's existed, in large part we’ve done this through clinical syndrome, because people have short term memory loss that’s slowly progressing over time. There are things that masquerade that and because of that we began using MRI scans to look at the structure of the brain and try to rule out things like strokes as a cause of vascular dementia or rule out tumors or hydrocephalus. There are some thyroid disorders, vitamin deficiencies that can masquerade as in depression, anxiety and even ageing itself can sometimes present as these subjective concerns about memory. So, when someone comes into the clinic, our job is to figure out which of these is causing their concerns and how to best manage and handle that. If we correctly make the diagnosis of Alzheimer's disease, as I said there’s standard treatments that we have for that – then that’s fine. If we miss a diagnosis for Alzheimer's disease, then we’re not treating that person appropriately, but perhaps what’s even more problematic is that if we think it’s Alzheimer's and it’s not, and then we don’t look for these other things. We may not appropriately treat depression or hydrocephalus strokes or tumors and so we really need a way to correctly positively ID the disease and this is what some of these blood tests, this is what the CSF test and the PET scans, this is the power of those tools, is we can actually detect the changes of Alzheimer's that exist in the brain – we can detect that in these blood tests and by demonstrating that Alzheimer's exists in that persons brain, we make a positive confirmed diagnosis that allows us to treat the Alzheimer's and not have to worry so much about these other things, but if we don’t find it its even more powerful, because then we know to look for something else that’s causing that persons cognitive decline and memory impairment.

Thom: Thank you Dr. Bateman, we had another question from David at Scientific American in a chat about the article that just came out earlier this afternoon in the New York Times, this article covered your research as well as the other researchers that were presenting at todays event at the conference, David asked if you or the other panelists have any thoughts you’d like to add about that article and reporting on your study?

Dr. Bateman: Yeah I’d like to say something and then maybe Nico could say something, its quite remarkable that the two groups in parallel we had developed these phosphotau in blood at the same time, reported them at nearly the exact same time, both papers were released today and so the group in Sweden and the group in St. Louis unbeknownst I think to each other, we coordinated perfectly, so we’re delighted that it came out together and nothings better than knowing that you're on the right track when someone else independently does a very similar thing. That gives us very high confidence, two independent groups found the same thing, we know we’re on the right track. And I’d just like to call out Nico on this that Nico a long time ago way back in 2015 which in our timelines is a long time ago, really began exploring these phosphotau species in the brain, translated that to cerebral spinal fluid and then from cerebral spinal fluid to blood and not just ptau217 and 181 but literally dozens of other forms of tau he elucidated how they changed, where they changed, and why they changed and what is the relationship for them  and its that kind of scientific powerhouse that leads to these kind of advancements. I would just make a plug here that this is the reason why we need to continue to support basic research in this area that that’s the foundation upon which these great tools, these blood tests for Alzheimer’s disease are built, and its people like Nico and Susanne and others that really help accelerate the development of these things moving forward.

Thom: Dr. Barthelemy would you like to add anything to that?

Dr. Barthelemy: Yeah I want to add also something about this two method study, highlighting actually the two method employed for demonstrating the same thing are really totally different, in some way that the Oskar Hansson group is using the immunological assay and by using mass spectrometry which is more physical technique than biochemical technique, means I think we can be really confident about the outcome since two independent techniques proved the same thing yeah.

Thom: Yeah that’s very interesting, so they are using immunological assay to detect tau in the blood rather than mass spectrometry like you did?

Dr. Barthelemy: That’s correct yeah. 

Thom: Very interesting. Dr. Schindler any thoughts about additional comments on the New York Times article about your work today.

Dr. Schindler: I think it was a nice article and pretty comprehensive, I don’t think I had anything specific that I would say – I would also echo that I think its very powerful that we two different groups using different cohorts, different techniques and having the same findings, that’s very reassuring.

Thom: Dr. Edelmayer, yeah thank you Dr. Schindler, Dr. Edelmayer what do you see coming on the horizon now in Alzheimer's research with these breakthroughs coming so quickly year after year it seems as Dr. Bateman said, five years seems like even longer in the progress of all this. What should we look forward to AAIC 2021?

Dr. Edelmayer: Oh my gosh! So many things we hope, I mean that’s really our goal is to continue this momentum. I think we’re at an era now where things are really starting to change for this field because there’s been such rapid development for some of these biomarkers, to just make sure we bring it back to that because a lot of people are incredibly focused on the treatment which absolutely there’s an urgent need there, but until we understand how to study the brain, diagnose what’s wrong, we need to be able to use those types – develop those tools to do that and so I think that some of the biomarker work actually gets not enough credit for what’s been happening in terms of the progress for this field and I think what’s been coming out over the past few years has been really instrumental in moving the field forward. I think we really look forward then to seeing some new and approved treatments, hopefully in the next few years and hopefully we’ll see some of that coming out at AAIC and I know many on this team that are on this call today are also very hard at work looking at a very particular population that dominantly inherited Alzheimer's disease network and their trials unit that’s going on around the world right now and we – I think what will be important for the future is that we continue to expand upon the research that’s focused on biomarkers throughout different populations, so we understand not only what are they telling us in the dominantly inherited Alzheimer's disease but also sporadic Alzheimer's, other types of neurodegenerative disease as well and not only across those populations but we need to start talking more about the races and ethnicities that are included in those broader populations so that we know what stories these biomarkers tell for everyone. So, I think there’s a lot of exciting work that’s coming down the pike but I hope to see you all at AAIC next year to see some of that reported.

Thom: Thank you very much Dr. Edelmayer and your colleague at the Alzheimer's association shared in the chat a very helpful link for anyone interested in seeing more about the blood biomarkers studies here done by the group that we’re with in our panel, as well as the others that presented at todays meeting. You can follow that link to see more about that, and a comment from Ann at practical Neurology, thank you for your comment Ann, nothing better than repeatable results in science and she says thank you for sharing your knowledge and that you’re all inspiring. Thank you very much Ann. With that I think we’ll draw to a close, thank you to Dr. Schindler, Dr. Bateman, Dr. Barthelemy and Dr. Edelmayer – thank you all very much to the folks at the Alzheimer's Association for helping to coordinate this. The PIO’s and communicators at Washington university as well as Rockefeller press. The publisher of the journal of experimental medicine who helped us to coordinate this as well, thank you very much everyone and congratulations on your outstanding research work making news today and thank you very much, have a great rest of your day everyone and take care.