The authors report that restoring NAD+ balance in the brain -- using a compound called P7C3-A20 -- completely reversed Alzheimer's pathology and recovered cognitive function in two different transgenic mouse models (one amyloid-based, one tau-based). The mice had advanced disease before treatment began.
- There's room for skepticism. As Derek Lowe once wrote: "Alzheimer's therapies have, for the most part, been a cliff over which people push bales of money. There are plenty of good reasons for this: we don't really know what the cause of Alzheimer's is, when you get down to it, and we're the only animal that we know of that gets it. Mouse models of the disease would be extremely useful – you wouldn't even have to know what the problem was to do some sort of phenotypic screen – but the transgenic mice used for these experiments clearly don't recapitulate the human disease. The hope for the last 25 years or so has been that they'd be close enough to get somewhere, but look where we are."
- If the drug's mechanism of action has been correctly assigned, it's very plausible that simply supplementing with NMN, NR, or NADH would work equally well. The authors caution against this on, IMO, extremely shaky and unjustified grounds. "Pieper emphasized that current over-the-counter NAD+-precursors have been shown in animal models to raise cellular NAD+ to dangerously high levels that promote cancer."
There are numerous chemical supply companies that will list chemicals like this “for sale”. They might not have it in stock but they hope they’ll get your search traffic and be able to synthesize it if you place an order.
If you look at the amounts, they’re tiny. I don’t know the doses that would be used in humans but typically ordering from chemical supply shops would be economically infeasible for just about any drug. These are meant for one-off studies and experiments, not ongoing human use.
There have been a growing number of online groups arranging to do group buys of synthesized experimental drugs based on studies. I’ve followed a few of them and the results range from people losing their money, receiving product that is too contaminated to use, or in some cases they go to great lengths to verify the chemical but then discover it doesn’t do what the original study promised it would do. In some of the more horrifying cases I’ve seen forum posts from people reporting long lasting chest pains from one chemical, and another chemical was sending people into psychosis. So if (when) these chemicals start appearing on group buy sites I suggest ignoring it until more research is done. Making yourself into a lab rat is not a good idea.
> If you look at the amounts, they’re tiny. I don’t know the doses that would be used in humans but typically ordering from chemical supply shops would be economically infeasible for just about any drug. These are meant for one-off studies and experiments, not ongoing human use
I didn't get the impression that the person above was suggesting actually buying it here, but rather just pointing out that if it does prove effective in human trials, it's going to become cheaply and easily available since it's already possible to order online for research.
There appears to be some danger in using NAD+ without the supervision of an experienced physician.
"Pieper emphasized that current over-the-counter NAD+-precursors have been shown in animal models to raise cellular NAD+ to dangerously high levels that promote cancer."
Depends entirely on the stage of the disease and the aggressiveness of the cancer! Getting an aggressive brain cancer when you had early stage Alzheimer’s [1] would be tragic. The tradeoff would be years of life.
For the record, I have no idea what the actual risk tradeoff is, but the point of regulation is that nobody does. You can’t have informed consent when you can’t be informed.
[1] Aside: Alzheimer’s is relatively early stage, as dementias go. It’s frequently diagnosed by onset in younger people.
The chemical the parent comment linked is different.
NAD itself isn’t usually supplemented because it’s broken down by your digestive system. So NAD precursor supplements have been available for a while: NR and NMN specifically. These are the precursors they were talking about.
The actual drug used in this study has a different mechanism of action. It’s not directly available as a supplement, but like the parent commenter discovered you could technically find a chemical supply house to synthesize a tiny quantity of it.
There have been a growing number of online groups arranging to do group buys of synthesized experimental drugs based on studies...
There's also a good number of cases of people getting exactly what they ordered. There's been a thriving market for Retatrutide, ozempic's more powerful younger brother, for years despite it not being approved yet.
Also, people with Alzheimer's don't have the luxury of being able to wait 20 years for it to be approved.
I was actually researching this yesterday for a groupbuy, the synth is chromatography-free which means gram scale production is possible with much less cost than expected .
And there's room for thinking there's water in the ocean. We have no idea whether this would work at all or how it would work at all in humans. We have one experiment in mice, which as you say can't have Alzheimer's.
This is a nice step, like developments in fusion energy. That's part of research, and let's hope and investigate it, but it's absurd to think about it as anything but a science project right now.
Sadly, it's worse. We don't have one experiment that works in mice: we have dozens, if not hundreds. We've cured "Alzheimer's in mice" many times over. The treatments never work in humans, because it's not the same disease. We don't know the root cause of the human disease and so we can't model it accurately in mice.
> We don't know the root cause of the human disease
It's increasingly likely that there is no "root cause" to find in humans, but rather, that Alzheimer's is what happens when there's enough external stressors acting on the brain.
I've seen an analogy of a leaky roof being used: the leaks are things like age, stress, heavy metals, mold, bad sleep, bad diet. Genetics defines the original building materials (resilience) of the roof. You can put buckets under a certain number of leaks but if there are too many your ability to repair gets overwhelmed and the result is diseases like dementia.
I think something similar applies to other diseases of aging like heart disease, arthritis, osteoporosis, diabetes, perhaps even cancer.
The downside of this is that's it's hard to imagine a miracle drug being the solution. But the upside is that a combination therapy that identifies the "leaks" and works on reducing or eliminating them will likely be effective against a wide range of age related diseases.
The therapy will likely consist of drugs and supplements in combination with lifestyle changes.
I totally get that people are not mice, however animals studies have been useful for all sorts of diseases. Are they really uniquely bad for Alzheimer's?
To put it simply, mice don't get Alzheimer's. We're not studying mice with Alzheimer's, we're studying mice with an mutation chosen for resembling Alzheimer's. But we don't know whether this model replicates the actual mechanisms of the disease, or if it's superficial.
Thanks for the explanation, this really clears up the concerns here. It's easy to imagine scientists attempting to model in in mice and making real progress, but it's also easy to imagine us misunderstanding the real disease well enough such that what we've modeled in mice does not produce real results.
And the author of the paper has disclosed that they have patent on the drug being tested. Let's see if the results can be reproduced by others. Then let's see how it tests with humans.
Aren't "steps" toward fusion energy a little fake though? IIUC fusion research is a front for nuclear testing, so there's a vested interest in showing "progress" to greenwash the gargantuan spend on nuclear weapons.
EDIT referring to the need for fusion and plasma research for modeling warheads in the absence of full tests.
> Pieper emphasized that current over-the-counter NAD+-precursors have been shown in animal models to raise cellular NAD+ to dangerously high levels that promote cancer.
As someone who's seen both cancer and Alzheimer's up close, that would be a very easy choice.
From multiple personal experiences, including both of my parents, dementia is a slow, horrible death where you are robbed of your dignity and end up dragging all of your relatives through a very long, very torturous hell. You will be drooling, pissing, and shitting yourself, all while slowly reverting back to a low IQ childhood mentality where you're very likely to have outbursts and verbally or physically attack the people around you. Your loved ones will be tormented, and if you don't have loved ones then if you're lucky you'll be tossed into a room and forgotten about by underpaid, overworked staff at some run-down nursing home. If you're not lucky you'll be laying in a gutter on the street until you die.
Interestingly my wife helped a friend whose father had the disease during the pandemic.
He had worked as a professor and after retirement had suffered with AD for years but had stayed "independent" because his wife was high functioning mentally but low functioning physically and formed a good team.
He'd bought long term care insurance so he had the resources to afford both a room at a care home but also personal help from home aides, including my wife. He didn't really know what was going on most of the time but he never got angry or flustered and was always pleasant to deal with.
We had trouble with certain homes having a way they want to do things or requiring things that weren't really necessary, one insisted that he get a pacemaker because he had bradycardia. When he lived with his son between homes probably the most difficult thing was that he got up in the night to use the bathroom and would end up urinating in the wrong place. He got much better care than many residents because people were always coming around to see him and the staff knew that we cared and would advocate for him.
He passed away at 92 and outlived many of the people who knew him at work so he had just a small memorial ceremony. I saw it as an example of healthy aging and talked about it a lot with my wife -- and it made me think about myself and my own fear that my ability to compensate for my schizotaxia may degrade when my brain degrades and I can picture myself becoming really nasty and it gives me all the more incentive to rewrite my habits while I still can.
Sadly, cancer isn’t one singular disease. Types of cancer can be excruciatingly painful for many years, which is also tormenting to everyone around you. I wouldn’t wish either on anyone.
Cancer. The worst types of it have the advantage of killing quickly. Alzheimer's destroys the self, and you survive a long time with it, leading to much more suffering, both to you (to the extent you continue to exist) and to your family.
I have a different perspective. The worst types of cancer kill slowly and cause agonizing suffering.
Alzheimer's leads to negative outcomes for your caregivers, but by many accounts many affected individuals do not suffer all that much, if at all, due to their lack of awareness.
If I were diagnosed with Alzheimer's, I would seek out assisted suicide. But I think it's more complicated than that: its existence incentivizes pushing people toward assisted suicide. The government finds a way to help with bloated medical care budgets; unscrupulous family members guilt trip the sick to choose the option to keep the inheritance intact.
The best solution allows it for severe cases, while still investing money in research and spending money for palliative care so it remains an option and not a demand. But that's a tricky line to maintain.
My grandmother's case ended up bankrupting my grandfather and seriously straining the rest of the family. Which ultimately put my grandfather in a pennyless position when he was in his 90's, and poor state care when he was declining - not what he or my grandmother worked their entire lives for. Our family couldn't replace what was lost in the years of care for my grandmother's body, long after she herself was gone.
Never something she would have wanted, but you don't really have a choice and dignified death is never given as an option.
Its the slippery slope proved real by places like my home country of canada keeping other people from having it. I am a huge supporter of assisted suicide but what my country has gone way too far. find a way credibly Keep it to impending death with lots of pain and alzeimers like disease and you would have strong majority acceptance.
Except that time of death comes on average many years later for Alzheimer's than cancer. In the same thought, better die from heart attack instantly but unfortunately much earlier, which would be devastating for the relatives.
Is this the same NAD+ that’s prescribed by longevity / hormone clinics?
Edit: after some googling, sounds like NAD+ (which you can get from real doctors) is the “building blocks” similar to how protein is the building blocks for muscle, while the experimental compound changes/enhances how the building blocks are used inside your cells.
So you might need some NAD+ precursor like NMN and this compound for it to work in humans because by the time you’re old it’s much harder for your body to make. Was the experiment done in older mice or younger ones that have NAD+ but artificial Alzheimer’s ?
NMN and NR are both good but NMN might not be available anymore as some company decided to repurpose it as a drug instead of supplement. Best combo nowadays looks to be liposomal NR with pterostilbene, a sirtuin activator. NR boosts NAD+ (the main electron transporter in mitochondria), pterostilbene activates sirtuin SIRT1 that regulates aging. B2/Riboflavin might be a good idea as well as it is a FADH donor, secondary electron transport carrier especially in nerves/brain. B1 to the mix as every single metabolic reaction needs it and it's depleted by consuming lots of carbs or drinking alcohol, a common western diet. Niacin is less effective in raising NAD+ but the flush can open up veins and flood hard to reach extremities of the body with blood so it's probably good from time to time. Slow B3 seems to be even worse for raising NAD+.
- you took niacin too often (best to do it once a few days as body adapts quickly)
- you have a gene mutation that prevents you from absorbing enough B3 (common in some schizophrenia cases that can be managed by huge doses of daily B3, like 4-10g)
Alzheimer's is, by definition, dementia with associated amyloid plaques in the brain. Since you can't detect the plaques without cutting into the brain, the diagnosis is normally given based on symptoms of dementia (significant loss of memory or other cognitive functions) without other clear reasons (no evidence of vascular events, head trauma, brain tumors or other neurological diseases etc).
You mentioned amyloid plaques. What about tau tangles? I thought Alzheimer's required both. If someone (or some dog, for that matter) has amyloid plaques but no tau tangles, is that Alzheimer's? If they have tau tangles but no amyloid plaques, what is it?
And what about the brains that show amyloid plaques, tau tangles, and Lewy bodies? Or plaques plus vascular lesions? At autopsy, most elderly brains show mixed pathology. Does that person have Alzheimer's plus Lewy body dementia plus vascular dementia? Three diseases? Or one brain failing in multiple correlated ways that we've artificially carved into separate categories?
It sounds like we have at least five different pathological markers that correlate with cognitive decline, often co-occurring, with inconsistent symptom mapping. What makes 'Alzheimer's' a disease rather than a region we've named in a high-dimensional space we don't really understand all that well?
> What makes 'Alzheimer's' a disease rather than a region we've named in a high-dimensional space we don't really understand all that well?
Nothing. I think it's sometimes in fact called a syndrome, not a disease per se. Since we don't really understand the mechanism of action, it remains more of a diagnosis by exclusion rather than anything else.
My understanding is that amyloid plaques can actually be seen with a specialized PET scan now, so it can be more definitively diagnosed in living people.
> Pieper emphasized that current over-the-counter NAD+-precursors have been shown in animal models to raise cellular NAD+ to dangerously high levels that promote cancer.
Does this mean that people are having to trade Alzheimer in exchange for high risk of cancer? Or does this mean that we need better precursors that don't require that trade off?
There's no good evidence that supplementation with NMN, NR, etc. increases the risk of cancer in healthy people. There's some speculation that it might be risky for people with cancer to take those supplements, but the picture is far from clear. Some papers even suggest that they can be beneficial. (e.g., https://pmc.ncbi.nlm.nih.gov/articles/PMC10177531/ )
In terms of risk-benefit analysis, if this stuff actually cures Alzheimer's, then even a 10x increased risk of cancer (all types) is acceptable, as Alzheimer's is frequently a fate worse than death whereas cancer can be managed whilst keeping your personality and sanity intact. In reality, the increased risk of cancer from something like NMN is perhaps 1.005x. To all appearances, totally negligible.
The problem, for Pieper, is that NMN/NR/NADH are ubiquitous and cost pennies per dose. So, if they work (big if), this new research is unmonetizable. The team leads would win a Nobel Prize, but Big Pharma gigabucks are out of the question. Let's see what happens.
Furthermore, we don't even know whether NAD precursor supplementation works. They raise intracellular NAD+ levels, but unclear whether they raise intercellular NAD+, which is what really matters. There are also those that say NAD+ recycling matters more than we think, and precursors don't address that.
Could explain how a compound that's already on the market and has been patented for (some) medical use at least once in 2015 (expiring 2035) might make a good case for "Big Pharma gigabucks"? I thought one reason for a lack of research into "repurposablity" of existing small molecule drugs is the fact that new applications cannot be independently patented?
You absolutely can patent existing drugs. There's a whole scummy pharma industry that takes existing drugs that are widely used off-label and patents that off-label use.
I think it’s worth addressing this with more nuance.
Companies can get a METHOD-OF-USE PATENT (MOU) on an old drug for a new INDICATION.
This gives them the exclusive right to LABEL AND MARKET that drug for that indication for a period of time.
I however, doctors can prescribe and pharmacists can substitute generics for the new indication, regardless of the MOU.
For a company to profit off an MOU, they strategically need to create a new FORMULATION. This is a new dose or delivery mechanism (extended release, topical, etc). A new formulation can be protected with conventional patents that go beyond an MOU.
With an MOU + patent on a new formulation, the company has a brand where they are the only ones allowed to make the new formulation and the only ones with a product approved to be marketed for the new indication.
Getting FDA approval for the new brand is not the main hurdle for the company. To get insurers to pay the premium they want over the cost of existing treatment options, they have to show it’s safer or more effective than those existing options. Otherwise insurance will block it.
In principle, this means that repurposing should only enable companies to profitably repurpose off patent off label applications if they can provide a real patient benefit.
Whether this is the best or most efficient way to promote this kind of innovation, or whether it works as well in practice as it would seem in theory, is a separate question.
> Pieper emphasized that current over-the-counter NAD+-precursors have been shown in animal models to raise cellular NAD+ to dangerously high levels that promote cancer. The pharmacological approach in this study, however, uses a pharmacologic agent (P7C3-A20) that enables cells to maintain their proper balance of NAD+ under conditions of otherwise overwhelming stress, without elevating NAD+ to supraphysiologic levels.
I think it means one should read the very next sentence:
> Pieper emphasized that current over-the-counter NAD+-precursors have been shown in animal models to raise cellular NAD+ to dangerously high levels that promote cancer. The pharmacological approach in this study, however, uses a pharmacologic agent (P7C3-A20) that enables cells to maintain their proper balance of NAD+ under conditions of otherwise overwhelming stress, without elevating NAD+ to supraphysiologic levels.
There’s a lot of umbrella diagnoses that would benefit from more specific diagnostics first. What we call Alzheimer’s is probably actually caused by number of different causes depending on the person. This is true of a lot of things in medicine that get grouped together. That’s why testing a drug in mouse models with all the same characteristics sometimes works but fails to translate into humans who have more variety amongst each other.
The same is true of many diagnoses like pneumonia, cancer, alopecia, essential tremor: there’s multiple different groups that would benefit from different things, and if we had better ways to identify the groups, we’d give them what works for them instead of wasting their time with the wrong treatment. As an example, antibiotics won’t work for viral pneumonia and in addition to wasting the patient’s time, actually harm your microbiome. If you had a perfect way to know which is which, you’d always get the right treatment.
I recall a University of Washington (I think it was) where they were saying they had found Schizophrenia to be a bucket diagnosis, and had discovered that multiple sets of genes were working together in specific testable ways such that there were >4 sub types of Schizophrenia each with its own set of symptoms, and ability to respond to different medications.
The researcher did a follow-up study to confirm their thesis, but I've never seen anyone else follow up on those studies (family with Schizophrenia makes me acutely aware of developments in that field)
Many disease labels just mean inflammation-of-a tissue / organ.
Worth noting that some viral inflections of the respiratory tract will have a bacterial secondary, where an either commensal bacteria has over proliferated or a pathogenic bacteria has started to get a hold, and treating the bacterial secondary can help the patient better fight the viral primary.
It's quite terrible how the medical "debugging" works or rather doesn't. You run a bunch (at best) of tests then pick the most probable diagnosis and that's about it for 99.9% of cases. And then in a review you measure that the world's best performing doctor hit 45% accuracy whereas an average one hits ~33%.
As someone who has been debugging their own chronic illnesses for the past ten years (and doing better than my doctors), I wouldn’t consider the medical diagnostic process to be “debugging” at all. And that is exactly the problem. Doctors seem to be stuck thinking like bureaucrats following probabilistic flowcharts, and they’re incapable of actually thinking about a problem and debugging it.
The behavior seems to be so deeply ingrained in every single doctor I’ve seen that it seems impossible to change. I suspect they must have this drilled into them in school and residency, then it seems like every decision is constrained by insurance requirements. As far as I can tell, the situation is hopeless.
> read their comment as "accurately diagnose before treating"
Right. And I’m arguing that’s more of a fiction than House.
In most cases, waiting for a definitive test can be more harmful than treating when the preponderance of evidence points one way. (In some cases, the test is riskier than the treatment.)
Broadening out of medicine, it’s absolutely okay in many circumstances to try a fix before you’re sure you know what the problem is.
They mean the fake Alzheimer's they induce by injecting poison into 3 month old animals or which develops in mice genetically engineered to have diseases that aren't Alzheimer's but are somewhat similar to Alzheimer's in some ways, not the kind where you wait 70 years for a human to develop which they don't even really understand what causes it.
I used to work with a guy who had been a scientist at a large pharma company (we were both working at a small biotech start-up at the time).
He told me an interesting story... basically, scientists at his company would get an extra year-end bonus if they had worked on a drug candidate that made it past animal studies and into human (clinical) trials.
He told me that one way to 'consistently' get the extra bonus was to work on candidate drugs for neurological diseases (e.g., Alzheimer's, etc.) because ... the animal models for those diseases were (generally) dog shit, so it was easy to find a drug that 'cured' whatever happened to be your neurological disease of interest in mice/rats/etc.
Then you get your bonus and the drug fails in humans.
A key challenge with Alzheimer’s is there is no good mouse model for the disease. While some approximate the phenotype, it’s not clear that the disease model as commonly studied in mice matches well with mechanisms of the human disease. There’s some thinking in the field that this could be a key reason why so many treatments have appeared very promising in mice and haven’t panned out in humans.
When enough words, framing, and unstated important premises are omitted, it crosses over from the realm of incomplete or misleading into plain outright lying in my worldview.
They claim "Reverses advanced AD in mice." What they did is reverse symptoms in genetic models.
They claim to "Restore NAD+ homeostasis," ignoring that NAD might not even be causally related to Alzheimer’s, just a side effect. It’s like saying we cured a house fire because we efficiently removed the ashes after the fire. It’s the Tau thing all over again.
The claim: "Conservative molecular signatures" when in reality, 5xFAD mice are poor predictors of human clinical success to such a degree that it’s statistically more common for mice studies to NOT transfer to human biology than to do so.
They also make unsupported claims like "Safer than NAD+ precursors (supplements)," when this is a pre-clinical assumption. No human toxicity trials are mentioned in this context, and there are always MASSIVE differences when switching to real human studies. It might be correct, but there’s no basis to say that based on this study.
Also, the senior author owns the company. The paper has the hallmarks of a "pitch deck" for the drug.
In short, it seems to me that the claim of "Full Neurological Recovery" is misleading to patients. It fails to prove that fixing NAD+ in humans will stop the disease, only that it works in mice engineered to have the disease, and only by assuming that their specific measure is a 1-to-1 with the clinical presentation of the disease. The results are likely the "best case scenario" presented to support the commercialization of P7C3-A20.
Here is the COMMON SENSE question peer-reviews should have asked.
Is low NAD+ the fire, or just the ashes?
Why should we believe this works in humans when the last 500 'cures' in 5xFAD mice failed?
Are you regrowing a brain, or just cleaning up a dirty one?
How does one molecule fix five unconnected problems simultaneously? The Context: The drug fixed inflammation, blood-brain barrier, amyloid/tau (protein folding), and memory (neuronal signaling). Drugs rarely hit four distinct biological systems with 100% success....
Where is the toxicology report that proves 'safer than supplements'?
You're asking good questions, but it's unreasonable to expect one paper to answer all of them. Probably the article should have emphasized more strongly that mouse models are imperfect, but they do show efficacy in two different mouse models, which counts for something.
> It fails to prove that fixing NAD+ in humans will stop the disease, only that it works in mice engineered to have the disease
This in particular is just not possible without clinical trials in humans. But you can't have a clinical trial without evidence of efficiency, so you need to start with mouse models, even if they are imperfect. Sadly we don't know if any of the existing mouse models are any good, but it's the best we've got.
They put themselves in the position of having to answer these questions given their claims. I’m not suggesting they should figure out everything about everything, but given the over the top claims made, these are the least they should be able to answer.
Please... people, do not get your hopes up over this one PR pump piece released on Christmas Day. This is not a legit study. (It might, perhaps, somehow, still be correct, perhaps... even broken clocks are right twice a day... but it's still not a legit study.)
Well, NAD+ kinda has the potential to fix multiple things at once if those things are caused by energetic imbalance/deficit. Re-balancing NAD+ could just fix multiple failing systems that were running low on energy and not doing their job properly as a consequence.
Not my field, but I think a big point here is this isn't purely researching into Amyloid plaques. It is way past time to explore many other possibilities and it is promising to see research in a different direction. This isn't to say Amyloid plaques aren't worthy of research, but when you slam into a wall for a few decades then maybe you should look in different directions now and again.
My cofounders mom had got Alzheimer’s at rather younger age of 60 something. It grew extremely rapid and within 2 years she grew into a vegetative state.
Given how I have seen different patients and varying pace of dementia growth - I somehow think Alzheimer’s must have multiple sub families & may appear same but must be behaving differently from their onset.
Yet another "in mice" breakthrough. The cerebral cortex of a mouse has around 8–14 million neurons while in those humans there are more than 10–15 billion. So scale this outcome by literally 1000x more neurons and wake me when the chimps are remembering how to hold a long conversation.
I don’t get this take. Like yes, we aren’t mice, and everything that works in mice won’t work in humans. But loads of things that worked in mice did wind up working in humans, which is why most groundbreaking drugs over the past decades were first explored in mice, which is why we continue to use mouse models.
I understand the compassion for animals, of course, but not this sentence. Advancing science is not "all for fame or fortune". If it cures people, I can see it. I too would love a world without animal suffering, but I'd also love to not be literally seeing (and I just came back from my parents') my dad slip more and more into nothingness at the hand of this stupid disease.
Let’s check again this sentence when you will ever get pneumonia, diabetes, serious infections, etc. It’s very easy to speak when you are healthy, and disrespectful for the people that are not lucky like you.
That’s why I think people like you should live in a place with other people that share your values, since they not compatible with the rest of “us”. Please buy some land somewhere and show us a better way of living, we all will be very happy for you.
Usual PSA: Don't wait for a cure for Alzheimers. Work towards not getting it in the first place. Alzheimers is "brain diabetes". You get it from consuming sugars and carbs. It can be easily avoided.
The authors report that restoring NAD+ balance in the brain -- using a compound called P7C3-A20 -- completely reversed Alzheimer's pathology and recovered cognitive function in two different transgenic mouse models (one amyloid-based, one tau-based). The mice had advanced disease before treatment began.
Three comments:
- You can actually buy the drug here: https://focusbiomolecules.com/p7c3-a20-nampt-activator-prone... It's a simple small molecule. If this stuff works, expect it to be everywhere within just a couple of years.
- There's room for skepticism. As Derek Lowe once wrote: "Alzheimer's therapies have, for the most part, been a cliff over which people push bales of money. There are plenty of good reasons for this: we don't really know what the cause of Alzheimer's is, when you get down to it, and we're the only animal that we know of that gets it. Mouse models of the disease would be extremely useful – you wouldn't even have to know what the problem was to do some sort of phenotypic screen – but the transgenic mice used for these experiments clearly don't recapitulate the human disease. The hope for the last 25 years or so has been that they'd be close enough to get somewhere, but look where we are."
> https://www.science.org/content/blog-post/just-how-worthless...
- If the drug's mechanism of action has been correctly assigned, it's very plausible that simply supplementing with NMN, NR, or NADH would work equally well. The authors caution against this on, IMO, extremely shaky and unjustified grounds. "Pieper emphasized that current over-the-counter NAD+-precursors have been shown in animal models to raise cellular NAD+ to dangerously high levels that promote cancer."
> - You can actually buy the drug here: https://focusbiomolecules.com/p7c3-a20-nampt-activator-prone... It's a simple small molecule. If this stuff works, expect it to be everywhere within just a couple of years.
There are numerous chemical supply companies that will list chemicals like this “for sale”. They might not have it in stock but they hope they’ll get your search traffic and be able to synthesize it if you place an order.
If you look at the amounts, they’re tiny. I don’t know the doses that would be used in humans but typically ordering from chemical supply shops would be economically infeasible for just about any drug. These are meant for one-off studies and experiments, not ongoing human use.
There have been a growing number of online groups arranging to do group buys of synthesized experimental drugs based on studies. I’ve followed a few of them and the results range from people losing their money, receiving product that is too contaminated to use, or in some cases they go to great lengths to verify the chemical but then discover it doesn’t do what the original study promised it would do. In some of the more horrifying cases I’ve seen forum posts from people reporting long lasting chest pains from one chemical, and another chemical was sending people into psychosis. So if (when) these chemicals start appearing on group buy sites I suggest ignoring it until more research is done. Making yourself into a lab rat is not a good idea.
> If you look at the amounts, they’re tiny. I don’t know the doses that would be used in humans but typically ordering from chemical supply shops would be economically infeasible for just about any drug. These are meant for one-off studies and experiments, not ongoing human use
I didn't get the impression that the person above was suggesting actually buying it here, but rather just pointing out that if it does prove effective in human trials, it's going to become cheaply and easily available since it's already possible to order online for research.
There appears to be some danger in using NAD+ without the supervision of an experienced physician.
"Pieper emphasized that current over-the-counter NAD+-precursors have been shown in animal models to raise cellular NAD+ to dangerously high levels that promote cancer."
Most people with Alzheimer’s are older and would probably trade having their cognitive abilities back even with increased risk of cancer
Depends entirely on the stage of the disease and the aggressiveness of the cancer! Getting an aggressive brain cancer when you had early stage Alzheimer’s [1] would be tragic. The tradeoff would be years of life.
For the record, I have no idea what the actual risk tradeoff is, but the point of regulation is that nobody does. You can’t have informed consent when you can’t be informed.
[1] Aside: Alzheimer’s is relatively early stage, as dementias go. It’s frequently diagnosed by onset in younger people.
The chemical the parent comment linked is different.
NAD itself isn’t usually supplemented because it’s broken down by your digestive system. So NAD precursor supplements have been available for a while: NR and NMN specifically. These are the precursors they were talking about.
The actual drug used in this study has a different mechanism of action. It’s not directly available as a supplement, but like the parent commenter discovered you could technically find a chemical supply house to synthesize a tiny quantity of it.
There have been a growing number of online groups arranging to do group buys of synthesized experimental drugs based on studies...
There's also a good number of cases of people getting exactly what they ordered. There's been a thriving market for Retatrutide, ozempic's more powerful younger brother, for years despite it not being approved yet.
Also, people with Alzheimer's don't have the luxury of being able to wait 20 years for it to be approved.
> ozempic's more powerful younger brother,
Isn't one of the major complaints is that it works too well? i. e. The emaciated look of those taking it.
I was actually researching this yesterday for a groupbuy, the synth is chromatography-free which means gram scale production is possible with much less cost than expected .
https://utsouthwestern.elsevierpure.com/en/publications/deve...
> There's room for skepticism.
And there's room for thinking there's water in the ocean. We have no idea whether this would work at all or how it would work at all in humans. We have one experiment in mice, which as you say can't have Alzheimer's.
This is a nice step, like developments in fusion energy. That's part of research, and let's hope and investigate it, but it's absurd to think about it as anything but a science project right now.
Sadly, it's worse. We don't have one experiment that works in mice: we have dozens, if not hundreds. We've cured "Alzheimer's in mice" many times over. The treatments never work in humans, because it's not the same disease. We don't know the root cause of the human disease and so we can't model it accurately in mice.
> We don't know the root cause of the human disease
It's increasingly likely that there is no "root cause" to find in humans, but rather, that Alzheimer's is what happens when there's enough external stressors acting on the brain.
I've seen an analogy of a leaky roof being used: the leaks are things like age, stress, heavy metals, mold, bad sleep, bad diet. Genetics defines the original building materials (resilience) of the roof. You can put buckets under a certain number of leaks but if there are too many your ability to repair gets overwhelmed and the result is diseases like dementia.
I think something similar applies to other diseases of aging like heart disease, arthritis, osteoporosis, diabetes, perhaps even cancer.
The downside of this is that's it's hard to imagine a miracle drug being the solution. But the upside is that a combination therapy that identifies the "leaks" and works on reducing or eliminating them will likely be effective against a wide range of age related diseases.
The therapy will likely consist of drugs and supplements in combination with lifestyle changes.
I totally get that people are not mice, however animals studies have been useful for all sorts of diseases. Are they really uniquely bad for Alzheimer's?
To put it simply, mice don't get Alzheimer's. We're not studying mice with Alzheimer's, we're studying mice with an mutation chosen for resembling Alzheimer's. But we don't know whether this model replicates the actual mechanisms of the disease, or if it's superficial.
Thanks for the explanation, this really clears up the concerns here. It's easy to imagine scientists attempting to model in in mice and making real progress, but it's also easy to imagine us misunderstanding the real disease well enough such that what we've modeled in mice does not produce real results.
No. I believe the problem is with our artificial models of Alzheimer’s in mice.
And the author of the paper has disclosed that they have patent on the drug being tested. Let's see if the results can be reproduced by others. Then let's see how it tests with humans.
Aren't "steps" toward fusion energy a little fake though? IIUC fusion research is a front for nuclear testing, so there's a vested interest in showing "progress" to greenwash the gargantuan spend on nuclear weapons.
EDIT referring to the need for fusion and plasma research for modeling warheads in the absence of full tests.
> Pieper emphasized that current over-the-counter NAD+-precursors have been shown in animal models to raise cellular NAD+ to dangerously high levels that promote cancer.
As someone who's seen both cancer and Alzheimer's up close, that would be a very easy choice.
> current over-the-counter NAD+-precursors have been shown in animal models to raise cellular NAD+ to dangerously high levels
Is this a problem with the molecule or the dose?
Uh... which one? Choice is not obvious to me, and I think it would depend on the type of cancer.
From multiple personal experiences, including both of my parents, dementia is a slow, horrible death where you are robbed of your dignity and end up dragging all of your relatives through a very long, very torturous hell. You will be drooling, pissing, and shitting yourself, all while slowly reverting back to a low IQ childhood mentality where you're very likely to have outbursts and verbally or physically attack the people around you. Your loved ones will be tormented, and if you don't have loved ones then if you're lucky you'll be tossed into a room and forgotten about by underpaid, overworked staff at some run-down nursing home. If you're not lucky you'll be laying in a gutter on the street until you die.
Interestingly my wife helped a friend whose father had the disease during the pandemic.
He had worked as a professor and after retirement had suffered with AD for years but had stayed "independent" because his wife was high functioning mentally but low functioning physically and formed a good team.
He'd bought long term care insurance so he had the resources to afford both a room at a care home but also personal help from home aides, including my wife. He didn't really know what was going on most of the time but he never got angry or flustered and was always pleasant to deal with.
We had trouble with certain homes having a way they want to do things or requiring things that weren't really necessary, one insisted that he get a pacemaker because he had bradycardia. When he lived with his son between homes probably the most difficult thing was that he got up in the night to use the bathroom and would end up urinating in the wrong place. He got much better care than many residents because people were always coming around to see him and the staff knew that we cared and would advocate for him.
He passed away at 92 and outlived many of the people who knew him at work so he had just a small memorial ceremony. I saw it as an example of healthy aging and talked about it a lot with my wife -- and it made me think about myself and my own fear that my ability to compensate for my schizotaxia may degrade when my brain degrades and I can picture myself becoming really nasty and it gives me all the more incentive to rewrite my habits while I still can.
You may find this study useful: https://www.nature.com/articles/s41586-025-09335-x
I've begun taking very small amounts of lithium orotate (5mg), among many other preventative measures.
There's definitely a thread that subclinical doses of lithium could be good for people in general.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10227915/
https://pmc.ncbi.nlm.nih.gov/articles/PMC11954165/
Sadly, cancer isn’t one singular disease. Types of cancer can be excruciatingly painful for many years, which is also tormenting to everyone around you. I wouldn’t wish either on anyone.
Cancer is better than Alzheimer’s. There is no comparison. I wouldn’t wish Alzheimer’s or dementia on my worst enemy.
Cancer. The worst types of it have the advantage of killing quickly. Alzheimer's destroys the self, and you survive a long time with it, leading to much more suffering, both to you (to the extent you continue to exist) and to your family.
I have a different perspective. The worst types of cancer kill slowly and cause agonizing suffering.
Alzheimer's leads to negative outcomes for your caregivers, but by many accounts many affected individuals do not suffer all that much, if at all, due to their lack of awareness.
Cancer times a million
Seeing my grandmother go through dementia for 10 years made me incredibly angry that we don't have assisted suicide available for people.
People with the emotional and compassionate depth of a child are the ones keeping us from allowing people to die with dignity.
If I were diagnosed with Alzheimer's, I would seek out assisted suicide. But I think it's more complicated than that: its existence incentivizes pushing people toward assisted suicide. The government finds a way to help with bloated medical care budgets; unscrupulous family members guilt trip the sick to choose the option to keep the inheritance intact.
The best solution allows it for severe cases, while still investing money in research and spending money for palliative care so it remains an option and not a demand. But that's a tricky line to maintain.
My grandmother's case ended up bankrupting my grandfather and seriously straining the rest of the family. Which ultimately put my grandfather in a pennyless position when he was in his 90's, and poor state care when he was declining - not what he or my grandmother worked their entire lives for. Our family couldn't replace what was lost in the years of care for my grandmother's body, long after she herself was gone.
Never something she would have wanted, but you don't really have a choice and dignified death is never given as an option.
It appears that there are options for care in other countries that are much less expensive.
https://www.alzint.org/news-events/news/health-tourism-the-l...
> dignified death is never given as an option
That's not a universal law, in fact it is different in other countries, i.e. it is something that can be changed.
Not me, I’d hire someone to take really good notes and test all the promising potential treatments one after the other.
No need for lengthy approvals or a drug trial if you’re giving it to yourself. I’d want to go out doing some mfing science.
Its the slippery slope proved real by places like my home country of canada keeping other people from having it. I am a huge supporter of assisted suicide but what my country has gone way too far. find a way credibly Keep it to impending death with lots of pain and alzeimers like disease and you would have strong majority acceptance.
Except that time of death comes on average many years later for Alzheimer's than cancer. In the same thought, better die from heart attack instantly but unfortunately much earlier, which would be devastating for the relatives.
>expect it to be everywhere within just a couple of years.
there are studies about this compound from a decade ago, kinda doubt it's going to be a breakthrough at this point
Searching for "P7C3-A20" just now, looks like it's readily available now from multiple sources.
Is this the same NAD+ that’s prescribed by longevity / hormone clinics?
Edit: after some googling, sounds like NAD+ (which you can get from real doctors) is the “building blocks” similar to how protein is the building blocks for muscle, while the experimental compound changes/enhances how the building blocks are used inside your cells.
So you might need some NAD+ precursor like NMN and this compound for it to work in humans because by the time you’re old it’s much harder for your body to make. Was the experiment done in older mice or younger ones that have NAD+ but artificial Alzheimer’s ?
What’s the current state of between NMN, NR and straight-up niacin?
NMN and NR are both good but NMN might not be available anymore as some company decided to repurpose it as a drug instead of supplement. Best combo nowadays looks to be liposomal NR with pterostilbene, a sirtuin activator. NR boosts NAD+ (the main electron transporter in mitochondria), pterostilbene activates sirtuin SIRT1 that regulates aging. B2/Riboflavin might be a good idea as well as it is a FADH donor, secondary electron transport carrier especially in nerves/brain. B1 to the mix as every single metabolic reaction needs it and it's depleted by consuming lots of carbs or drinking alcohol, a common western diet. Niacin is less effective in raising NAD+ but the flush can open up veins and flood hard to reach extremities of the body with blood so it's probably good from time to time. Slow B3 seems to be even worse for raising NAD+.
> the flush can open up veins and flood hard to reach extremities of the body
What does it mean if I don’t flush? Is the supplement a dud?
I know of three possible reasons:
- your supplement is a dud
- you took niacin too often (best to do it once a few days as body adapts quickly)
- you have a gene mutation that prevents you from absorbing enough B3 (common in some schizophrenia cases that can be managed by huge doses of daily B3, like 4-10g)
> you took niacin too often
Oh yeah, I was taking it daily when I stopped flushing. Makes sense.
> and we're the only animal that we know of that gets it.
Is this actually true? I thought it was pretty common for elderly pets
Elderly pets have loss of cognitive function/memory, but I don't think it's the same disease.
What's the objective, clearly disambiguated, empirically demonstrable difference between memory loss, dementia, and Alzheimer's?
Alzheimer's is, by definition, dementia with associated amyloid plaques in the brain. Since you can't detect the plaques without cutting into the brain, the diagnosis is normally given based on symptoms of dementia (significant loss of memory or other cognitive functions) without other clear reasons (no evidence of vascular events, head trauma, brain tumors or other neurological diseases etc).
You mentioned amyloid plaques. What about tau tangles? I thought Alzheimer's required both. If someone (or some dog, for that matter) has amyloid plaques but no tau tangles, is that Alzheimer's? If they have tau tangles but no amyloid plaques, what is it?
And what about the brains that show amyloid plaques, tau tangles, and Lewy bodies? Or plaques plus vascular lesions? At autopsy, most elderly brains show mixed pathology. Does that person have Alzheimer's plus Lewy body dementia plus vascular dementia? Three diseases? Or one brain failing in multiple correlated ways that we've artificially carved into separate categories?
It sounds like we have at least five different pathological markers that correlate with cognitive decline, often co-occurring, with inconsistent symptom mapping. What makes 'Alzheimer's' a disease rather than a region we've named in a high-dimensional space we don't really understand all that well?
> What makes 'Alzheimer's' a disease rather than a region we've named in a high-dimensional space we don't really understand all that well?
Nothing. I think it's sometimes in fact called a syndrome, not a disease per se. Since we don't really understand the mechanism of action, it remains more of a diagnosis by exclusion rather than anything else.
My understanding is that amyloid plaques can actually be seen with a specialized PET scan now, so it can be more definitively diagnosed in living people.
> Pieper emphasized that current over-the-counter NAD+-precursors have been shown in animal models to raise cellular NAD+ to dangerously high levels that promote cancer.
Does this mean that people are having to trade Alzheimer in exchange for high risk of cancer? Or does this mean that we need better precursors that don't require that trade off?
There's no good evidence that supplementation with NMN, NR, etc. increases the risk of cancer in healthy people. There's some speculation that it might be risky for people with cancer to take those supplements, but the picture is far from clear. Some papers even suggest that they can be beneficial. (e.g., https://pmc.ncbi.nlm.nih.gov/articles/PMC10177531/ )
In terms of risk-benefit analysis, if this stuff actually cures Alzheimer's, then even a 10x increased risk of cancer (all types) is acceptable, as Alzheimer's is frequently a fate worse than death whereas cancer can be managed whilst keeping your personality and sanity intact. In reality, the increased risk of cancer from something like NMN is perhaps 1.005x. To all appearances, totally negligible.
The problem, for Pieper, is that NMN/NR/NADH are ubiquitous and cost pennies per dose. So, if they work (big if), this new research is unmonetizable. The team leads would win a Nobel Prize, but Big Pharma gigabucks are out of the question. Let's see what happens.
Furthermore, we don't even know whether NAD precursor supplementation works. They raise intracellular NAD+ levels, but unclear whether they raise intercellular NAD+, which is what really matters. There are also those that say NAD+ recycling matters more than we think, and precursors don't address that.
> raise intracellular NAD+ levels, but unclear whether they raise intercellular NAD+, which is what really matters
Why?
Urgh I made a mistake. I meant the other way around: intracellular matters more, but intercellular is easier to measure.
Could explain how a compound that's already on the market and has been patented for (some) medical use at least once in 2015 (expiring 2035) might make a good case for "Big Pharma gigabucks"? I thought one reason for a lack of research into "repurposablity" of existing small molecule drugs is the fact that new applications cannot be independently patented?
You absolutely can patent existing drugs. There's a whole scummy pharma industry that takes existing drugs that are widely used off-label and patents that off-label use.
I think it’s worth addressing this with more nuance.
Companies can get a METHOD-OF-USE PATENT (MOU) on an old drug for a new INDICATION.
This gives them the exclusive right to LABEL AND MARKET that drug for that indication for a period of time.
I however, doctors can prescribe and pharmacists can substitute generics for the new indication, regardless of the MOU.
For a company to profit off an MOU, they strategically need to create a new FORMULATION. This is a new dose or delivery mechanism (extended release, topical, etc). A new formulation can be protected with conventional patents that go beyond an MOU.
With an MOU + patent on a new formulation, the company has a brand where they are the only ones allowed to make the new formulation and the only ones with a product approved to be marketed for the new indication.
Getting FDA approval for the new brand is not the main hurdle for the company. To get insurers to pay the premium they want over the cost of existing treatment options, they have to show it’s safer or more effective than those existing options. Otherwise insurance will block it.
In principle, this means that repurposing should only enable companies to profitably repurpose off patent off label applications if they can provide a real patient benefit.
Whether this is the best or most efficient way to promote this kind of innovation, or whether it works as well in practice as it would seem in theory, is a separate question.
Could you name some examples so that I can read more about this?
This one is the most recent one: https://www.polsinelli.com/publications/federal-circuit-clar... There was also GSK vs Teva case.
Thank you! The technical term seems to be Second Medical Use patent.
> industry that takes existing drugs that are widely used off-label and patents that off-label use
I wonder why "wide off-lable use" shouldn't be considered prior art?
You don't patent a use. You're thinking trademark.
Keep reading:
> Pieper emphasized that current over-the-counter NAD+-precursors have been shown in animal models to raise cellular NAD+ to dangerously high levels that promote cancer. The pharmacological approach in this study, however, uses a pharmacologic agent (P7C3-A20) that enables cells to maintain their proper balance of NAD+ under conditions of otherwise overwhelming stress, without elevating NAD+ to supraphysiologic levels.
I think it means one should read the very next sentence:
> Pieper emphasized that current over-the-counter NAD+-precursors have been shown in animal models to raise cellular NAD+ to dangerously high levels that promote cancer. The pharmacological approach in this study, however, uses a pharmacologic agent (P7C3-A20) that enables cells to maintain their proper balance of NAD+ under conditions of otherwise overwhelming stress, without elevating NAD+ to supraphysiologic levels.
It means we have no idea if this would work or how it would work, and discussing it as a treatment for humans is badly mistaken.
It's a quality of life vs years left calculation you have to make on a case by case basis.
You can't make calculations without data, and in this case you have none: we have no idea of the effects on humans.
[dead]
There’s a lot of umbrella diagnoses that would benefit from more specific diagnostics first. What we call Alzheimer’s is probably actually caused by number of different causes depending on the person. This is true of a lot of things in medicine that get grouped together. That’s why testing a drug in mouse models with all the same characteristics sometimes works but fails to translate into humans who have more variety amongst each other.
The same is true of many diagnoses like pneumonia, cancer, alopecia, essential tremor: there’s multiple different groups that would benefit from different things, and if we had better ways to identify the groups, we’d give them what works for them instead of wasting their time with the wrong treatment. As an example, antibiotics won’t work for viral pneumonia and in addition to wasting the patient’s time, actually harm your microbiome. If you had a perfect way to know which is which, you’d always get the right treatment.
Precision medicine takes this even further.
I recall a University of Washington (I think it was) where they were saying they had found Schizophrenia to be a bucket diagnosis, and had discovered that multiple sets of genes were working together in specific testable ways such that there were >4 sub types of Schizophrenia each with its own set of symptoms, and ability to respond to different medications.
The researcher did a follow-up study to confirm their thesis, but I've never seen anyone else follow up on those studies (family with Schizophrenia makes me acutely aware of developments in that field)
https://source.washu.edu/2014/09/schizophrenia-not-a-single-...
oh, would you look at that - a newer study https://biology.ucdavis.edu/news/discovery-hints-genetic-bas...
You’re right, disease labels aren’t diagnostic.
Many disease labels just mean inflammation-of-a tissue / organ.
Worth noting that some viral inflections of the respiratory tract will have a bacterial secondary, where an either commensal bacteria has over proliferated or a pathogenic bacteria has started to get a hold, and treating the bacterial secondary can help the patient better fight the viral primary.
It's quite terrible how the medical "debugging" works or rather doesn't. You run a bunch (at best) of tests then pick the most probable diagnosis and that's about it for 99.9% of cases. And then in a review you measure that the world's best performing doctor hit 45% accuracy whereas an average one hits ~33%.
As someone who has been debugging their own chronic illnesses for the past ten years (and doing better than my doctors), I wouldn’t consider the medical diagnostic process to be “debugging” at all. And that is exactly the problem. Doctors seem to be stuck thinking like bureaucrats following probabilistic flowcharts, and they’re incapable of actually thinking about a problem and debugging it.
The behavior seems to be so deeply ingrained in every single doctor I’ve seen that it seems impossible to change. I suspect they must have this drilled into them in school and residency, then it seems like every decision is constrained by insurance requirements. As far as I can tell, the situation is hopeless.
Always profile before you optimize.
> Always profile before you optimize
Not necessarily. Often, treatment and testing can be done in parallel.
In many cases, the treatment is also a test. Every time you apply topical antibiotics to a cut, you’re testing for antibiotic resistance.
I had read their comment as "accurately diagnose before treating"
It's not "House" where you guess something, provide a treatment, watch as things get worse, then change diagnosis in the real world is it?
> read their comment as "accurately diagnose before treating"
Right. And I’m arguing that’s more of a fiction than House.
In most cases, waiting for a definitive test can be more harmful than treating when the preponderance of evidence points one way. (In some cases, the test is riskier than the treatment.)
Broadening out of medicine, it’s absolutely okay in many circumstances to try a fix before you’re sure you know what the problem is.
> you’re testing for antibiotic resistance
...and also develop one.
This is great news for mice who have something vaguely similar to Alzheimer’s.
Of which there are none except for the few we tried to genetically modify so they kinda get something maybe sorta similar
But there’s good news. They’re all going to be fine, except for the ones who aren’t.
Merry Christmas!
They mean the fake Alzheimer's they induce by injecting poison into 3 month old animals or which develops in mice genetically engineered to have diseases that aren't Alzheimer's but are somewhat similar to Alzheimer's in some ways, not the kind where you wait 70 years for a human to develop which they don't even really understand what causes it.
> the fake Alzheimer's they induce ....
I used to work with a guy who had been a scientist at a large pharma company (we were both working at a small biotech start-up at the time).
He told me an interesting story... basically, scientists at his company would get an extra year-end bonus if they had worked on a drug candidate that made it past animal studies and into human (clinical) trials.
He told me that one way to 'consistently' get the extra bonus was to work on candidate drugs for neurological diseases (e.g., Alzheimer's, etc.) because ... the animal models for those diseases were (generally) dog shit, so it was easy to find a drug that 'cured' whatever happened to be your neurological disease of interest in mice/rats/etc.
Then you get your bonus and the drug fails in humans.
Lather, rinse, repeat.
Agree. As far as I remember, mice don't get real Alzheimer, so they only have a model that is somewhat similar.
Let's hope the cure can be transfered to humans, but I think the chances are extremly low.
Yeah, we got it!
This is eyewatering. My father and grandfather died early due to this condition. Hope for many.
A key challenge with Alzheimer’s is there is no good mouse model for the disease. While some approximate the phenotype, it’s not clear that the disease model as commonly studied in mice matches well with mechanisms of the human disease. There’s some thinking in the field that this could be a key reason why so many treatments have appeared very promising in mice and haven’t panned out in humans.
This is totally improper reporting of the study.
When enough words, framing, and unstated important premises are omitted, it crosses over from the realm of incomplete or misleading into plain outright lying in my worldview.
They claim "Reverses advanced AD in mice." What they did is reverse symptoms in genetic models.
They claim to "Restore NAD+ homeostasis," ignoring that NAD might not even be causally related to Alzheimer’s, just a side effect. It’s like saying we cured a house fire because we efficiently removed the ashes after the fire. It’s the Tau thing all over again.
The claim: "Conservative molecular signatures" when in reality, 5xFAD mice are poor predictors of human clinical success to such a degree that it’s statistically more common for mice studies to NOT transfer to human biology than to do so.
They also make unsupported claims like "Safer than NAD+ precursors (supplements)," when this is a pre-clinical assumption. No human toxicity trials are mentioned in this context, and there are always MASSIVE differences when switching to real human studies. It might be correct, but there’s no basis to say that based on this study.
Also, the senior author owns the company. The paper has the hallmarks of a "pitch deck" for the drug.
In short, it seems to me that the claim of "Full Neurological Recovery" is misleading to patients. It fails to prove that fixing NAD+ in humans will stop the disease, only that it works in mice engineered to have the disease, and only by assuming that their specific measure is a 1-to-1 with the clinical presentation of the disease. The results are likely the "best case scenario" presented to support the commercialization of P7C3-A20.
Here is the COMMON SENSE question peer-reviews should have asked. Is low NAD+ the fire, or just the ashes?
Why should we believe this works in humans when the last 500 'cures' in 5xFAD mice failed?
Are you regrowing a brain, or just cleaning up a dirty one?
How does one molecule fix five unconnected problems simultaneously? The Context: The drug fixed inflammation, blood-brain barrier, amyloid/tau (protein folding), and memory (neuronal signaling). Drugs rarely hit four distinct biological systems with 100% success....
Where is the toxicology report that proves 'safer than supplements'?
You're asking good questions, but it's unreasonable to expect one paper to answer all of them. Probably the article should have emphasized more strongly that mouse models are imperfect, but they do show efficacy in two different mouse models, which counts for something.
> It fails to prove that fixing NAD+ in humans will stop the disease, only that it works in mice engineered to have the disease
This in particular is just not possible without clinical trials in humans. But you can't have a clinical trial without evidence of efficiency, so you need to start with mouse models, even if they are imperfect. Sadly we don't know if any of the existing mouse models are any good, but it's the best we've got.
They put themselves in the position of having to answer these questions given their claims. I’m not suggesting they should figure out everything about everything, but given the over the top claims made, these are the least they should be able to answer.
> the senior author owns the company
Unfortunately, the moment I saw reference to NAD+ I started looking for this. Thank you.
I can't upvote your comment enough.
Please... people, do not get your hopes up over this one PR pump piece released on Christmas Day. This is not a legit study. (It might, perhaps, somehow, still be correct, perhaps... even broken clocks are right twice a day... but it's still not a legit study.)
Stopped clocks.
Broken clocks can be broken in ways that causes them to be up to and including never correct.
;)
Well, NAD+ kinda has the potential to fix multiple things at once if those things are caused by energetic imbalance/deficit. Re-balancing NAD+ could just fix multiple failing systems that were running low on energy and not doing their job properly as a consequence.
Related: Recently another study on a mouse model had similar effects when using lithium orotate:
https://www.science.org/content/blog-post/lithium-deficiency...
It's a useful discovery. The real proof and utility is if what they learned from "mouse-heimer's" can be applied to human Alzheimer's.
That’s so obvious I can’t believe I didn’t think of it, and / or that I haven’t seen it before.
Mouse-heifer’s! <knee slap>
Not my field, but I think a big point here is this isn't purely researching into Amyloid plaques. It is way past time to explore many other possibilities and it is promising to see research in a different direction. This isn't to say Amyloid plaques aren't worthy of research, but when you slam into a wall for a few decades then maybe you should look in different directions now and again.
My cofounders mom had got Alzheimer’s at rather younger age of 60 something. It grew extremely rapid and within 2 years she grew into a vegetative state.
Given how I have seen different patients and varying pace of dementia growth - I somehow think Alzheimer’s must have multiple sub families & may appear same but must be behaving differently from their onset.
Boosting NAD has a been the focus of taking NMN supplements. Seems like NMN is a dud for boosting NAD. I wonder if P7C3-A20 can be used instead?
"Seems like NMN is a dud for boosting NAD" what gives you that notion?
[dead]
GOOD point by my wife, how does this affect those with apoe4 status. And also is there any connection with the recent lithium findings.
"Animals" suggests more than one kind of animal.
Which animals besides mice does this cause a full neurological recovery in?
I really don't see how you can make an animal model of something you don't fully understand in humans.
Just because you made an animal have similar symptoms doesn't mean the animal has Alzheimer's!
I suspect that animal models hinder rather than help science progress because most of the animals models will turn out to be entirely wrong.
Yet another "in mice" breakthrough. The cerebral cortex of a mouse has around 8–14 million neurons while in those humans there are more than 10–15 billion. So scale this outcome by literally 1000x more neurons and wake me when the chimps are remembering how to hold a long conversation.
> Yet another "in mice" breakthrough
I don’t get this take. Like yes, we aren’t mice, and everything that works in mice won’t work in humans. But loads of things that worked in mice did wind up working in humans, which is why most groundbreaking drugs over the past decades were first explored in mice, which is why we continue to use mouse models.
[dead]
[flagged]
> all for fame and fortune
I understand the compassion for animals, of course, but not this sentence. Advancing science is not "all for fame or fortune". If it cures people, I can see it. I too would love a world without animal suffering, but I'd also love to not be literally seeing (and I just came back from my parents') my dad slip more and more into nothingness at the hand of this stupid disease.
[flagged]
If you don’t want to be complicit you can always stop taking any drug
I take none and haven’t in over a decade.
Let’s check again this sentence when you will ever get pneumonia, diabetes, serious infections, etc. It’s very easy to speak when you are healthy, and disrespectful for the people that are not lucky like you.
Do you eat meat?
No.
You don’t need to answer a rethorical question.
[dead]
Given the choice between a drug saving the life of my (future) child or sacrificing animals I know what I'd choose.
I’d choose the animals over your child too.
That’s why I think people like you should live in a place with other people that share your values, since they not compatible with the rest of “us”. Please buy some land somewhere and show us a better way of living, we all will be very happy for you.
Usual PSA: Don't wait for a cure for Alzheimers. Work towards not getting it in the first place. Alzheimers is "brain diabetes". You get it from consuming sugars and carbs. It can be easily avoided.
What a ridiculous statement. By your logic, anyone with alzheimer’s got it from eating sugars and carbs and simply didn’t choose to avoid it.
Sugars and carbs also keep you alive. Please keep your mortality neurosis to yourself.