Eric Reiman: aiming to prevent Alzheimer's disease

Eric Reiman: aiming to prevent Alzheimer's disease

August 3, 2017

  • Eric Reiman is the co-director of the ASU-Banner Neurodegenerative Disease Research Center, CEO of Banner Research, Executive Director of the Arizona Alzheimer's Consortium and a professor in the School of Life Sciences, ASU


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  • Illustration by Jason Drees
    Biodesign Institute


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August 3, 2017

What will it take to prevent Alzheimer's disease by 2025? Eric Reiman, Executive Director of the Banner Alzheimer's Institute in Phoenix (Arizona, USA), has an answer. “It will take the right prevention trials, methods, and enrollment strategies to rapidly test, find and approve prevention therapies in people at genetic or biomarker risk. It will take shared urgency, courage and commitment, new collaborative models, and extensive data sharing. It will take a multi-faceted approach to optimize availability, affordability, and appropriate use of treatments. A suggested treatment will need to work, and we now have a chance to find out.”

Alzheimer's disease was not always his focus. As a medical student at Duke University (Durham, NC, USA), he took care of a terminally ill boy. As he watched the parents reduce their hospital visits, he was deeply affected by their withdrawal's toll on the child. This lead to an interest in bereavement and the decision to become a psychiatrist.

When Reiman and his family relocated to Washington University (St Louis, MO, USA) in 1983, he received parting advice from his former Psychiatry Chairman, Keith Brodie: “Develop cutting-edge research skills. Choose a productive mentor who will promote your growth. And look into PET—they invented it there.” He took that advice, working in the lab of Marcus Raichle (Professor of Radiology, Neurology, Neurobiology and Biomedical Engineering). Reiman's first research article demonstrated PET's promise in the study of psychiatric disorders. However, his out-of-the-box idea for a new image analysis method was groundbreaking for studies of the human mind and brain. As detailed in Raichle's Brief History of Human Functional Brain Mapping, Reiman proposed to transform everyone's brain images to the same size, shape, and brain atlas coordinates, then average the spatially standardised images to distinguish otherwise imperceptible biological changes from noise, and make it possible to map brain regions involved in normal and abnormal behaviours.

In 1988, he and his family moved to Phoenix, Arizona, where he demonstrated an uncanny ability to build impactful collaborations. He joined a non-profit health system now called Banner Health, developed a leading brain imaging research program, and forged close collaborations with researchers from different disciplines and institutions in Arizona. He and his colleagues conducted ground-breaking studies of emotion, memory, appetite, and pain, and they introduced new experimental paradigms and image analysis techniques to advance their research.

Moved by the impact of Alzheimer's disease on affected persons and families, and inspired by the 1993 discovery of APOE ε4 as the major susceptibility gene for the disease, Reiman turned his attention to the fight against Alzheimer's disease. He came up with the idea of using brain imaging measurements to detect and track the disease course and dramatically accelerate the evaluation of prevention therapies in unimpaired people at genetic risk. Reiman, along with Richard Caselli and colleagues, initiated a study of unimpaired people with 1, 2, or no APOE ε4 alleles, published in a landmark article in 1996. His work presaged the study and conceptualisation of preclinical Alzheimer's disease, implicated even earlier neurodevelopmental changes, and led to a new era in research into the prevention of Alzheimer's disease.

Reiman led the first major genome-wide association of the disease, worked with the US National Institute on Aging in creating the Alzheimer's Disease Genetics Consortium to find susceptibility genes, and established the Arizona Alzheimer's Consortium, the leading state-wide collaboration in research into Alzheimer's disease. In 2006, Reiman, Pierre Tariot, and colleagues established the Banner Alzheimer's Institute to find prevention therapies within a generation, establish a new standard of dementia care, and forge new models of research collaboration. They established the Alzheimer's Prevention Initiative (API) to accelerate the evaluation of prevention therapies in people at increased genetic or biomarker risk and to find reliable markers by 2025.

Among other studies, the API includes a Colombian prevention trial, lead by Francisco Lopera, done in the world's largest autosomal dominant Alzheimer's disease kindred that includes individuals with two APOE ε4 alleles, which Reiman calls “a life-changing experience”. The API also includes paradigm-setting scientific and data-sharing strategies, and exceptionally large registries and gene-matching programs to promote enrolment in prevention trials. Called one of the “world changing ideas” by Scientific American, the API has galvanised Alzheimer's disease prevention research.

“Eric's research over the last twenty years has made fundamental contributions to our understanding of early Alzheimer's disease,” says Nick Fox, Professor of Clinical Neurology at University College London, UK. “This laid the groundwork for his setting up the Alzheimer's Prevention Initiative and launching major clinical trials in preclinical Alzheimer's disease—remarkable achievements that were only possible because of Eric's energy and passion and ability to carry people with him.”

“Eric's scientific achievements have been remarkable, but his signature strength may be his ability to create coalitions of large and sometimes rival groups,” adds Caselli, Professor of Neurology at the Mayo Clinic in Phoenix, AZ. “He is instinctually kind, inclusive, and appreciative, all traits of a great leader.”

 

This story appeared in the journal Lancet Neurology