Investigators at the Cedars-Sinai Regenerative Medicine Institute have discovered eye abnormalities that may help reveal features of early-stage Alzheimer’s disease. Using a novel laboratory rat model of Alzheimer’s disease and high-resolution imaging techniques, researchers correlated variations of the eye structure, to identify initial indicators of the disease.
Alzheimer’s disease is the leading cause of dementia, which is characterised by loss of memory and a progressive decline in cognitive function. To date, more than 26 million people are estimated to suffer from the disease and the number is expected to quadruple by 2050. Despite the disease being described over a century ago, treatment and understanding of the disease remain rather limited.
‘Detecting changes in the brain that indicate Alzheimer’s disease can be an extremely challenging task,’ said Shaomei Wang, MD, PhD, lead author of the study and an associate professor in the Regenerative Medicine Institute and Department of Biomedical Sciences. ‘By using the eye as a window to brain activity and function, we may be able to diagnose patients sooner and give them more time to prepare for the future. Options may include earlier enrolment in clinical trials, developing support networks and dealing with any financial and legal matters.’
Using both animal models and post-mortem human retinas from donors with Alzheimer’s disease, researchers found changes in the retinal pigment epithelial layer, which harbours the supportive cells located in the back of the eye, and in the thickness of the choroidal layer that has blood vessels providing nutrients to the retina. Changes in these two regions were detected using sophisticated, state-of-the-art imaging and immunological techniques.
With high-resolution, microscopic imaging and visual acuity measurements, investigators were able to monitor tissue degeneration in the cell layer and vascular layer at the back of the eye, as well as decline in visual function, that were strongly associated with Alzheimer’s disease.
‘Greater magnitude in these eye abnormalities may mean a greater chance of a patient having Alzheimer’s disease,’ said Alexander Ljubimov, PhD, director of the Eye Program within the Regenerative Medicine Institute and co-author of the study. ‘We found that a rat model showed similar signs to the human ailment in the eye. If true in a larger number of humans, these findings may be used to study Alzheimer’s disease mechanisms and test potential drugs.’
Though additional research is needed to investigate the mechanisms of these ocular changes in relation to changes in the brain, investigators hope to ultimately aid early diagnosis of Alzheimer’s disease by studying the most approachable part of the central nervous system: the eye. Cedars-Sinai has been at the cutting edge of studies on the eye and Alzheimer’s disease with a previous report showing amyloid plaques, a hallmark of Alzheimer’s disease, also build up in the eye using a similar animal model of the disease.
‘It is fascinating that the eye may provide such a window to the brain and eventually predict diseases such as Alzheimer’s, although more human studies are now needed to confirm this animal work,’ said Clive Svendsen, PhD, director of the Cedars-Sinai Regenerative Medicine Institute and a co-author on the study. Other members of the Regenerative Medicine Institute Eye Program, include Yu Chun Tsai, PhD, a post-doctoral fellow; and Bin Lu, MD, PhD, and Sergey Girman, PhD, both project scientists. Cedars-Sinai Medical Center

When stem cells are used to regenerate bone tissue, many wind up migrating away from the repair site, which disrupts the healing process. But a technique employed by a University of Rochester research team keeps the stem cells in place, resulting in faster and better tissue regeneration. The key is encasing the stem cells in polymers that attract water and disappear when their work is done.

The technique is similar to what has already been used to repair other types of tissue, including cartilage, but had never been tried on bone.

‘Our success opens the door for many

Women

Experts from the Too Fit to Fracture Initiative presented the results of an international consensus process to establish exercise recommendations for people with osteoporosis, with or without spine fractures. The results were presented at the World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases in Seville, Spain.

Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method, the international multidisciplinary panel examined literature on exercise effects on: 1) falls, fractures, BMD, and adverse events for individuals with osteoporosis or spine fractures; and 2) pain, quality of life, and physical function after spine fracture. Evidence was rated as high, moderate, low, or very low.

In addition, a consensus process was used to established recommendations on assessment, exercise, and physical activity in the context of three cases with varying risk – one having osteoporosis based on bone density; one having osteoporosis and 1 spine fracture; and one having osteoporosis and multiple spine fractures, hyperkyphosis and pain.

The panel recommends that all individuals with osteoporosis should engage in a multicomponent exercise programme that includes resistance and balance training; they should not engage in aerobic training to the exclusion of resistance or balance training.

Other key points included:
current national physical activity guidelines are appropriate for individuals with osteoporosis in the absence of spine fracture, but not for those with spine fracture;
after spine fracture, aerobic activity of moderate intensity is preferred to vigorous; physical therapy consultation is recommended;
daily balance training and endurance training for spinal extensor muscles are recommended for all individuals with osteoporosis;
restrictions are a disincentive to activity participation, and for people with osteoporosis but no history of spine fracture, desired activities should be encouraged if they can be performed safely or modified;
health care providers should provide guidance on safe movement, rather than providing generic restrictions (e.g., lifting);
physical or occupational therapist consult is recommended for advice on exercise and physical activity among those with a history of spine fracture, particularly in the presence of balance or posture impairments, pain, comorbid conditions or that increase the risk of adverse events with exercise or activity, or unsafe movement patterns.

Lead author Dr Lora Giangregorio, University of Waterloo, Waterloo, Canada, stated, ‘People with osteoporosis and spinal fractures should be encouraged to participate in resistance training and balance training, as the strongest evidence we have supports multimodal exercise programs. We have developed evidence-based recommendations, as well as a report that addresses the ‘frequently asked questions’ of patients and health care providers around physical activity. We hope that the recommendations are helpful to health professionals worldwide as they guide their osteoporosis patients in safe, effective – and enjoyable – exercise regimens.’ International Osteoporosis Foundation