I’m watching brain surgery to see if Alzheimer’s can ever be cured

Is curing Alzheimer’s disease an impossible challenge, or can we get there?

To find out that I had been invited to follow neurosurgeons at the cutting edge of dementia research.

I’m wearing scrubs in the back of the operating theater at Edinburgh Royal Infirmary. The intense focus of the dozen people in the room exudes an air of calm despite the cacophony of beeping and pumping medical machines.

The patient is sedated and draped on the operating table. I can see an MRI scan of his brain on the big screens above. The large, bright white mass of a tumor is impossible to miss. The cancer started in his colon before spreading deeper into his brain.

“It’s not on the surface of the brain, so we need to make a hole in the cortex,” professor of neurosurgery Prof Paul Brennan told me, “as small as possible but big enough that we can get down into the tumor.”

The cortex is the outer layer of the brain involved in language, memory and thought. The inner parts of the brain are softer, but the cortex needs to be cut.

Prof Brennan uses a surgical drill to remove the skull flap. The exposed brain is pink, bathed in blood, and pulsates gently in time with the heartbeat.

Standing next to me is Dr. Alzheimer’s researcher from the University of Edinburgh. Claire Durrant.

He holds a container filled with ice-cold artificial cerebrospinal fluid, which mimics the fluid that bathes the brain and spinal cord.

In most brain surgeries, the part of the cortex removed is medical waste and is thrown away. But Edinburgh is one of the few centers in the world where it is collected with permission for dementia research.

When that moment comes, it happens quickly. Prof Brennan places a section of my brain – the size of my thumbnail – in the jar to sustain it.

Then, with a short thank you, we change our clothes and head across the city towards the university.

In the back of the car, I realized that this piece of brain from a few minutes ago was still part of a man’s thoughts and fears about the surgery he was about to face.

“I always, always recognize that what we receive on what is probably the worst day of that person’s life is a precious gift,” Dr Durrant told me.

His lab is one of the few that studies live adult brain tissue to try to understand dementia and other diseases.

“We hope that by developing these techniques we will move towards a world free of many different, terrible neurological diseases,” he says.

Around one million people in the UK have some form of dementia, the most common being Alzheimer’s.

But can it ever be cured? This was the question set by Inventor Sir James Dyson guest edited BBC Radio 4’s Today program on Boxing Day.

Dr Durrant’s laboratory team is trying to answer this question by understanding the basic biology of Alzheimer’s.

There are still very important unknowns; There is no definitive explanation as to why connections between neurons, called synapses, are lost in Alzheimer’s.

Four scientists preparing brain tissue in the laboratory work synchronously like a pitstop team; This is a very brand-friendly study, sponsored by the Dementia Charity founded by Formula 1’s Jackie Stewart.

First, the brain sample was placed in jelly. It is then cut into slices 10-20 brain cells deep before being stored in special incubators to keep the tissue alive.

The team then exposes the brain slices to toxic proteins called amyloid and tau, which accumulate in the brains of people with Alzheimer’s disease. It allows them to witness the destruction of synapses and see if there is a way to stop it.

Everything Dr Durrant has seen so far convinces him that curing Alzheimer’s is not an impossible challenge.

“The evidence we have now is that it is a disease, and we know from past experience that it can be treated. Maybe one day we may find evidence that Alzheimer’s disease is inherently part of being human, but I don’t see that right now,” says the Dyson Fellow in the Race Against Dementia.

“I’ve never seen as much hope in Alzheimer’s disease research as I see right now. I’m really hopeful that we’ll see meaningful change in my lifetime.”

A ray of hope came from two drugs called lecanemab and donanemab, which slow down the pace of Alzheimer’s disease.

These were a scientific achievement, but their real-world effects on patients were labeled by some as too small to be noticeable. Neither is funded by the NHS.

But Prof Tara Spires-Jones, director of the Brain Science Discovery Center at the University of Edinburgh, thinks these two drugs “really open the door” to breaking Alzheimer’s.

He greets me from behind a giant theater curtain in his laboratory. It blocks light so it can work on a highly sensitive confocal microscope that uses lasers to illuminate brain samples.

He is investigating the role of star-shaped immune cells called astrocytes in Alzheimer’s disease.

This is part of the growing recognition that Alzheimer’s may need to be addressed from many angles.

Lecanemab and donanemab both target a toxic sticky protein called amyloid. Clinical trials of other drugs targeting the protein tau are ongoing.

The importance of the immune system, inflammation, the health of your blood vessels, and how genetics and environment combine are all furthering the understanding of Alzheimer’s disease.

Prof Spires-Jones thinks there will be three key moments:

• Drugs that significantly slow or stop disease progression in the short term
• Tools to prevent dementia altogether
• And there is a way to treat people who already have symptoms in the long term; But he admits it will be much more difficult.

He thinks we’re five to 10 years away from a “truly life-changing” treatment, and that by catching and stopping the disease early enough we’ll get to the point where “we can really make your life normal.”

But while there is optimism, research and clinical trials are still needed to prove that curing Alzheimer’s is possible.

“The human brain is so extraordinarily complex that we really need to see this in humans,” says Prof Spires-Jones.

To hear the full BBC Radio 4 Today Program with Sir James Dyson, go to BBC Sounds.

The Sir James Dyson guest edit of the Today program was made by Laura Cooper.