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Pushing boundaries in medical imaging to explore new pathways for ALS treatment

Research Impact July 13, 2022

“The idea is to not only diagnose but also to help in developing targeted treatments.” - Dr. Freimut Juengling

Neurological imaging has advanced by leaps and bounds in the past two decades. Researchers can now “see” details of biological processes at a level never previously imagined.

But we still aren’t using imaging to its full potential, says Dr. Freimut Juengling, a nuclear oncologist, neuroscientist and director of the PET/MR centre at the University of Alberta. He notes that brain scientists have some of the most sophisticated technology available for diagnosis, but he insists that there is still more that can be done to use imaging to advance treatment.

With help from an ALS Canada-Brain Canada Discovery Grant, Dr. Juengling and his team are pushing the boundaries of medical imaging and exploring new pathways for ALS treatment in the process.

From bench to bedside

Effective therapies for ALS are still elusive. One pathway that could be promising is the BDNF/TrkB signaling pathway, which sees changes in some ALS patients.

Researchers actually tested BDNF/TrkB-related treatments for ALS in the 1990s, but unfortunately the therapy didn’t live up to its potential. However, since that time, some researchers have considered whether this pathway deserves a second look as there have been questions around the effectiveness of the delivery method used in those studies.

The University of Alberta is home to a state-of-the-art piece of equipment called a PET/MR that offers the possibility of answering new insights into how BDNF/TrkB actually functions. PET/MR is a powerful tool that can “watch” chemical interactions as they happen in a patient’s body, allowing for a much sharper picture of what’s really going on inside someone.

Last year, a team of researchers at the University of Alberta developed a new PET tracer (a specific solution injected into the blood before a PET scan that allows researchers to watch chemical interactions happen in real-time) to investigate the BDNF/TrkB pathway using the PET/MR. Then, a team at McGill used the tracer to capture information about the pathway in non-ALS patients.

With the Discovery Grant, Dr. Juengling will use the technology to examine the pathway in people with ALS, comparing the results with those from participants without ALS and, hopefully, mining critical insights into how this pathway might be used to better understand the disease and possibly provide treatment.

“It was really exciting to get the grant,” says Dr. Juengling. “It's enabling research that’s from bench to bedside. What everybody is dreaming of is getting to bedside diagnostics, and possibly therapeutics. This grant is a big boost into this possibility.”

“Once we get the whole infrastructure working, this may relate to other neurodegenerative diseases as well,” he added.

“This study is going to utilize modern techniques in a way that will really help us figure out whether or not we should be taking another look at the BDNF/TrkB pathway in ALS,” said Dr. David Taylor, Vice President of Research for the ALS Society of Canada.

New ideas from oncology imaging

Dr. Juengling started as a neurosurgeon when the first neuro-imaging machines using PET were being introduced. At the time, he was asked to train colleagues on how to interpret the neuro-images – and he never went back.

“I’m an imaging guy,” he said. “It’s fascinating to look into the living brain. I just got caught by it.”

Just last year, he decided to move to Alberta from his home country in Switzerland because his oncologic imaging expertise was requested to run the PET/MR program at the Cross Cancer Institute in Edmonton. Here, colleagues had developed the new tracer, initially designed for tumor research. When he had a closer look at the molecular structure, he immediately saw its potential for ALS using PET/MR. Getting a grant to start neuro-research with the machine within the Cancer Institute was an unexpected surprise, and a perfect starter for a new neuro program.

“I'm very grateful that ALS Canada and Brain Canada offer this type of grant,” he said. “Because getting funding for the first step of novel research is always the hardest.”

Link with CAPTURE ALS a huge benefit

For Dr. Taylor, the other major advantage of this research is its link with CAPTURE (Comprehensive Analysis Platform To Understand, Remedy, and Eliminate) ALS.

CAPTURE ALS is a national platform that provides the systems and tools necessary to collect, store, share, and analyze substantial amounts of information about ALS, creating the most comprehensive biological picture of people with ALS ever.

Data from the PET tracer study will contribute a new type of data to the platform.

“The PET tracer is still evolving technology and isn’t used much in ALS research – but we should be doing more with it,” said Dr. Taylor. “This study is well-designed and will hopefully help set the stage for more PET imaging studies to be done in the future with ALS.”

Funding that makes an impact

Since 2014, ALS Canada’s partnership with Brain Canada has resulted in more than $24 million being invested in leading-edge ALS research that has helped further understanding of the disease. The Discovery Grant Program is designed to fuel innovation that will accelerate our understanding of ALS, identify pathways for future therapies and optimize care to improve quality of life for people and families affected by this devastating disease. In 2022, nine projects awarded through the 2021 Discovery Grant Program will benefit from $1.125 million in funding.

The Discovery Grant Program has been made possible with the financial support of Health Canada, through the Canada Brain Research Fund, an innovative arrangement between the Government of Canada (through Health Canada) and Brain Canada, and of the generosity of provincial ALS Societies, ALS Canada donors and community-based efforts, including 40 per cent of net proceeds from the Walk to End ALS.

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