アルツハイマー病疾患修飾薬の展望とバイオマーカー診断の現状

抄録

Disease-modifying anti-amyloid antibodies for Alzheimer's disease (AD) were approved in Japan this year and hold the promise of being included under healthcare coverage. The treatment of dementia is now at a major turning point.

Imaging technology for neurodegeneration has entered the era of proteinopathy imaging, starting with amyloid PET. Meanwhile, technological developments have made it possible to image tau lesions by tau PET, and prenatal diagnosis of tauopathy is improving dramatically.

In our cohort study, we performed amyloid and tau PET and compared changes in diagnosis, treatment, and management before and after PET. The results showed that the results of the two PETs changed the diagnosis of dementia by 35% and the treatment and management by 30%. (Shimohama S., 2022) In addition, we compared various blood biomarkers using highly reliable plasma samples obtained in the above study. As a result, we found that the HISCL amyloid-β42/40 ratio had high diagnostic accuracy (AUC:0.950). (Bun S., 2023) Furthermore, we were able to construct a predictive model of AD pathology with extremely high accuracy (AUC=0.994) based on comprehensive proteomics (3000 protein quantifications) using machine learning. This inexpensive and non-invasive blood biomarker can be a powerful tool for the upcoming introduction of dementia disease-modifying drugs.

In this talk, I will outline the prospects for AD disease-modifying drugs and the current status of protinopathy imaging and fluid biomarkers, and discuss the next-generation dementia treatment system.