🎙 The Future of Alzheimer's Research. Ep. 13

This month's MedEvidence guest, Dr. Steven Toenjes, MD, a board-certified neurologist, former staff neurologist in the U.S. Navy and an award-winning director of neurology residents at the Uniformed Services University of Health Sciences and decorated Navy veteran joins Dr. Michael Koren and Michelle McCormick to discuss the future of Alzheimer's research and what your gut has to do with Alzheimer's.

If you enjoyed this episode, you will loves these:

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Original Air Date: March 11, 2022

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Music: Storyblocks - Corporate Inspired

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Transcript

Michelle:
Welcome to MedEvidence Truth Behind the Data. I'm Michelle McCormick. Today, we're talking with Dr. Michael Koren and Dr. Steven Toenjes as we are discussing Alzheimer's disease. And what does your gut have to do with it? Very interesting. First of all, let me introduce Dr. Michael Koren. He is a principal investigator and cardiologist. He's a CEO and founder of Encore Research Group.

Michelle:
He has been with them for as many years. How many years, Dr. Koren?

Dr. Koren:
We started the company in 1997.

Michelle:
There you go. All right. And you've been published in some of the most prestigious journals. Our other guest today is Dr. Steven Toenjes. He's a board certified neurologist and principal investigator on multiple trials at ENCORE Research Group. He is a decorated Navy veteran and has been practicing neurology in Jacksonville for over ten years. Well, gentlemen, great discussions today about this deadly disease that 6 million Americans face and one of the top causes of death in the United States.

Dr. Koren:
This time, our second just talking about how devastating can be to some families and how it stresses people and the resources involved in treating these folks and keep them out of trouble.

Michelle:
Frustrating for loved ones, too.

Dr. Koren:
It's definitely an issue that has a lot of families very, very concerned.

Michelle:
And if there's any hope in trials and drugs, you know, we we had a very good conversation about that as well.

Dr. Koren:
Yeah. You know, we talked about at a Aducanumab, a monoclonal antibody for a human monoclonal antibody that is directed to toward clearing these amyloid plaques in the brain. And we were starting to talk about other new research and some of the lessons learned from this particular study. We mentioned the fact that there is some controversy about this particular product because it may not have great efficacy, but was still approved by the FDA.

Dr. Koren:
True.

Dr. Toenjes:
And, you know, remember where there are other antibodies in. So exactly how to how to administer these therapies and when to do it is something that's been going through the refinement process for 20 years. And so hopefully we're about to see some of the fruits of all of that labor. But there are other other studies where we have, you know, other active Alzheimer's trials that are ongoing.

Dr. Toenjes:
One particular interesting one has a little bit of the flavor of this buzz that we say the gut brain axis. There is a therapy that's currently approved by the FDA in China or their equivalent of the FDA for Alzheimer's disease. And it's really in oligosaccharides. That's an extract from brown algae, actually, that is designed to alter essentially our GI flora, the gut flora, and manipulate it in a way that influences how inflammation occurs at a distant site.

Dr. Toenjes:
And that being our brain. And as it turns out, there are a number of areas of research that are that are investigated, how we can influence a very important flora of bacteria in our gut and influence other parts of our body, such as deleterious, inflammatory responses and Alzheimer's.

Dr. Koren:
Curious about the Chinese approval, was that based on good clinical trial data or less good in your opinion?

Dr. Toenjes:
I political statements about. I think you're right. I think I think that it's comforting to know. I think for our general public, I'll say it this way that if you want to have a therapeutic FDA approved by the FDA in the United States, you have to do this study under the watchful eye of the FDA and they reserve the right to audit you at any point in time that they want.

Dr. Toenjes:
And you better have your ducks in a row. And so, you know, just quite frankly, I know nothing about Chinese equivalent of the FDA and and the general public here in the United States would would I think it would be safe to say, not have a whole lot of confidence. Processes. Yeah. Those are studies that need to be replicated.

Michelle:
It sounds like a very intense probiotic.

Dr. Toenjes:
It's so with a quote unquote, probiotics. There's there's a couple of general ways you can approach that. You know, this is an oligosaccharides. It's not actually bacteria. There are some therapeutics that are actually bacteria that are swallowing a capsule of different types of bacteria to try to have them influence the population in your gut. But this specific study is in oligosaccharides.

Dr. Toenjes:
That's an extract from brown algae. It's not an actual bacteria.

Dr. Koren:
Okay. So I guess replace should define the microbiome for folks in understand that. Let me get a little jargony here.

Dr. Toenjes:
So the what our intestines are are loaded with bacteria, and those bacteria are very important to our own function and they can go awry and make you quite miserable. And most people have probably had the experience of altering their gut flora with antibiotics and have torn their GI tract up or gotten other complications and allowed deleterious organisms to take hold and start to grow.

Dr. Toenjes:
Most people have heard of of C. diff as a complication of antibiotics. That's just tipping the balance in the wrong way for a particular bacterium that can kill you. It can be so severe and so, you know, learning a lot about the way that we can control or influence one of the most important parts of physiology within our body.

Dr. Toenjes:
That actually has to do with other organisms that live within our body.

Dr. Koren:
So just a little bit of an aside, but it's interesting in terms of how science evolves and how thinking evolves is something that I share with some of the staff earlier in the week, which is when I was in high school, I used to play Trivial Pursuit. And one of the questions was what's the largest organ in the body?

Dr. Koren:
And the answer was the liver. And there was a solid organ that was considered the largest organ in the body. Then I went to medical school and they asked the question. I raised my hand, Oh, it's the liver. They said, no, it's the skin to skin. Even though you don't think of it as a solid organ is everywhere and it has a lot of biological functions.

Dr. Koren:
And that's actually the largest organ in the body. And so that's cool. So I got into cardiology, I was in my cardiology fellowship and they said, What's the largest organ? The body? And I raised my hand and I said, The skin. So it's the endothelium, which is what lines all the blood vessels everywhere in the body. So if you add up all the cells, in the end, the thallium, it's equal to or greater in volume than the skin.

Dr. Koren:
And recently I was at a conference and they said, what's the largest organ in the body? And I said, The endothelium. They said, No, it's the microbiome.

Michelle:
Oh, killing it way down here. Right.

Dr. Koren:
And so the actual ways of all these bacteria is could be five or ten lbs worth of weight in a body that's responsible for these very, very interesting functions. Obviously, that the way our GI tract works is is importantly regulated by the microbiome. But it turns out there may be a lot of other things, including the inflammatory states of our body and the ability to affect certain proteins, including some of these unfolding concepts that we talked about earlier.


Dr. Toenjes:
I like that story. The and I, I would have I would follow that up with with a reference to a joke. Okay. Every different specialty in medicine, we have jokes about the specialty. And the jokes are a little bit true. And within the.

Michelle:
Business, jokes can be.

Dr. Toenjes:
A little.

Michelle:
Bit funny.

Dr. Toenjes:
Right? And within the neurology world, I think that our our historical joke is a historical joke. That's not really true so much anymore. But this is the joke. So I ask you, do you know how many neurologists it takes to change a light bulb?

Michelle:
I would say none. Give it to the other guy in the room to do.

Dr. Toenjes:
The answer is we can't change a light. And that's the silliness of it.

Michelle:
Right. Right.

Dr. Toenjes:
Realistically, with the explosion of therapeutics and all of these things that we're talking about with research, that's not that's becoming a not so accurate joke anymore with the explosion of therapeutics, particularly in the neuroscience world. And, you know, that's why we're so hopeful with with the things that we've been discussing here, particularly therapeutics as it pertain to Alzheimer's and the research which is ongoing.

Michelle:
So, All right, back to the original question then. What does our gut have to do with it?

Dr. Koren:
So we're running clinical trials as we speak to determine whether or not changes in the microbiome will help memory. And somebody can call us, and if they're interested, we can get them involved in the program as we speak. And it's one of many approaches that are being looked at in terms of understanding this phenomenon of of how different parts of our body interact with each other and affecting one can have positive influences in other parts of our body.

Dr. Koren:
And, you know, there are many lessons in medicine that have have taught us that, in fact, these things could can have a huge impact. So you just and this is a little bit off subject, but is somewhat relevant is in congestive heart failure, which is an area that I've worked in for 30 years. We've gone from talking about using devices to using pills to back to using devices as the best way of treating it.

Dr. Koren:
And it has to do with increasing understanding. And sometimes I hear patients say, well, you guys keep on changing your mind about what's best. Well, when I change your mind, we're just getting better and better data and responding to the better and better data. So, you know, for example, one of the huge issues in clinical medicine right now is how to keep people out of the hospital that have congestive heart failure.

Dr. Koren:
And we we've known that if you're really, really compulsive with all the treatments, then you tend to stay at the hospital. But that's hard for a lot of people. So one of the interesting things that that again, connects different parts of the body and that's why I'm bringing this up, is we're working now on an app that a person can speak to to determine if they're having a congestive heart failure or failure exacerbation is their CHF getting worse?

Dr. Koren:
They said, well, what is their voice have to do with anything? Well, think about it. If there is swelling or edema in your voice, the tone may change. That would be hard for the average person to pick up at a computer may pick it up. A computer could also pick up how many words are in a sentence between voice, between breaths.

Michelle:
And if breaths can be labored? Yeah.

Dr. Koren:
Yeah. But just counting the number of words that you speak between breaths is something a computer can do relatively easily. And that changes in congestive heart failure. So again, there are things you would never think of that may be good ways of understanding a particular disease process. And we're running trials on all these things, by the way. And the gut brain connection is an example of this.

Dr. Koren:
Right. The microbiome is very, very important in determining overall body inflammation. We know that overall body inflammation has a huge impact in a lot of functions, including vascular and brain functions. And that's what we're actually looking at. And sometimes it may seem crazy, but we do clinical trials that prove that that crazy idea actually works.

Michelle:
Well, how do you get involved with a clinical trial if you I mean, people have bad guts. We eat bad food, we're uncomfortable, distressed all the time. How do we determine if it's something more serious, like colorectal cancer or even, you know, something that can be treated over the counter? How do we get involved in a trial that can help move this this forward?

Dr. Koren:
Well, just, you know, on our website, we have a website search dot com called the Anchor Research Group. You can just get on there, Jake's research and you can set an appointment for whatever therapeutic area you may be interested in. Of course, we have great physicians in this community and they're there at the ready to help people understand things, and a lot of us participate in clinical trials as the 100 people here in northeast Florida that are running these studies and participating in clinical trials.

Dr. Koren:
So there are tremendous opportunities. I think our our phone number to calling is 9047300166. And this is that give that number a call and say, hey, I'm worried about my memory and and my gut. Flora, I heard about you. Sign me up.

Michelle:
Well, I mean, but what I mean, I have I have memory and I occasionally have stomach distress. I would I, you know, do I qualify for virtual trial? I don't think so. But I'm just saying, you as a whole, who.

Dr. Koren:
Again, will have people that will screen patients and sometimes they're just what we call the worried well, and a lot of worried. Well, people actually end up in in vaccine studies. For example, we talked about RSV. When we're talking about COVID and RSV is the next virus that we're all concerned about. And we're doing studies as we speak to protect healthy people from that virus.

Dr. Koren:
So there's a lot of opportunities in research here in northeast Florida, and we'd encourage people to give us a call in. And if they're interested in these concepts, I think they'll find that research is a tremendous learning experience. You meet great people like Dr. Changes and other staff members and you're contributing to society because one of the beauties about clinical research is that we learn collectively the information that we derive from you.

Dr. Koren:
It's not shared based on your specific name or we don't identify the patient. But collectively this gets put together and we learn throughout the world from from these experiences. And that's a key difference between research and just being treated by your doctor. Your doctor will do the best that he or she can do to keep you out of trouble.

Dr. Koren:
But we don't collect the information. So the learning that comes from collecting of information is unique to clinical trials.

Michelle:
All right. Well, Dr. Michael Koren ad Dr. Steven, just what final word would you like to say today about our conversation on Alzheimer's disease?

Dr. Toenjes:
I just it's a disease that is affected your family. You personally or your loved ones. You know, there's a whole world of, you know, resources available to you and and part of that world includes the research world and investigate it and and try to move forward as best you can. And there's a lot of a lot of help available.

Dr. Toenjes:
And so I you know, just just trying to figure out what you can because there's a lot of people that can they can do a lot of things to help you.

Dr. Koren:
Amen.