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What can blood tell us? The next big leap is being able to detect amyloid build-up in blood samples as well as, or in place of, PET scans. That is where the DPRC’s decade-long collection of blood samples becomes particularly valuable. Dr Erin Cawston, a diagnostics neurochemistry researcher, has been involved with the DPRCs from the beginning, leading the collection of blood samples. The scale is remarkable. From each blood draw, the researchers process the samples into approximately 100 tiny tubes. There are nowmore than 100,000 of these carefully stored blood tubes gathered from approximately 1,400 participant visits. This is collected alongside years of clinical, cognitive and brain imaging data. “Our goal from the outset was to futureproof the biobank so the samples would remain useful as the cohort grew and new technologies emerged,” Erin says. When it became possible to detect amyloid traces in blood, Erin began using the samples to investigate whether blood biomarkers could help detect and track Alzheimer’s disease in the DPRC cohort. Beyond testing for amyloid, other emerging techniques are being introduced into the blood analysis, including microRNA work led by Associate Professor Joanna Williams at the University of Otago. This could give clues as to why the same underlying pathology can affect people differently. The PlatformGrant enables Erin to extend her blood biomarker work, as well as build the evidence New Zealand will need to introduce amyloid blood tests into the health system. “There’s still a lot of work to be done around which tests are going to be most useful for our population,” Erin says. “We have unique levels of comorbidities like diabetes, lifestyles, diets...all of those factors may play into it. “Then there’s the bigger picture. Can we introduce testing equitably? Are our diagnostic labs equipped to administer them? And, can we make a case fiscally for why this is important for those who may be at risk of the disease?” The team of 16 named investigators includes neurologists, experts in psychology, Māori health and imaging. A doctor’s perspective The team also includes Dr Campbell Le Heron, a Christchurch-based neurologist and dementia researcher who works with complex and younger-onset dementia cases. He says that one of the platform’s main research goals – predicting how cognitive decline is likely to progress in different people – would be life-changing for many of the families he sees. “The question that everybody asks after they have a diagnosis is: ‘What happens next?’” says Campbell. “And right now, we’re not really that good at predicting how things are going to play out.” Alongside better prediction, he believes advances in blood biomarkers will revolutionise the way cognitive impairment is diagnosed, managed and treated. Being able to distinguish between a neurodegenerative condition such as Alzheimer’s disease and other possible causes, including depression or anxiety, is critical because each requires a different approach. “For people who have problems with their thinking, whether that’s memory, language or something else, understanding what is causing it and what is likely to happen over time is really important. It’s stressful to have something going wrong and not understand why,” Campbell says. A faster, more certain diagnosis, combined with a better understanding of how the disease is likely to progress, could also help doctors like Campbell identify those most likely to benefit from emerging treatments that slow Alzheimer’s disease. Drug treatments are most effective if given early on, before lasting damage has begun to occur. “Our knowledge of what Alzheimer’s is has changed dramatically over the last 10 or 20 years. We are now in what you might call the biological era, in the sense that we understand at least some of the underlying pathology, and we have the means to measure that through imaging or fluid biomarkers. “I think there is cause for optimism,” Campbell says. “We have lots of rich, longitudinal and important data. “Now the next phase can begin, wherewe can extract meaning from it. I genuinely think wewill learn a lot from this.” Connecting with community: the importance of Māori-informed research Research built on relationships sits at the heart of another major objective of the platform. Associate Professor Makarena Dudley is a national leader in mate wareware research, and will guide the co-design of clinics with Māori, for Māori. Māori participation in the DPRCs is currently lower than the researchers would like. Dr Campbell Le Heron Dr Erin Cawston is a diagnostics neurochemistry researcher and leads the work of the blood biobank. A collection of blood samples from a DPRC participant. More than 100,000 of these blood tubes have been gathered. Two complementary projects Dr Erin Cawston also received a significant Programme Grant from the Neurological Foundation in the same funding round for her blood biomarker work. It supports a national five-year effort, co-led by Erin, Associate Professor JoannaWilliams and Dr Campbell Le Heron, to focus on developing the science behind the blood biomarker testing, and how it can be best introduced to New Zealand as a diagnostic tool for Alzheimer’s disease. Associate Professor Makarena Dudley is a national leader in mate wareware research, and will guide the co-design of clinics with Māori, for Māori. “Research works best when people can see themselves reflected in it.” Associate Professor Makarena Dudley 8 Headlines 9 Headlines