MANATEE -- Dr. Andrew Keegan and a woman were both sitting in comfortable leather chairs in his office at Roskamp Institute in Manatee County last week when Keegan, a neurologist, began asking her questions about her memory.
The woman was not a patient. She was a staff member at the Roskamp Institute who volunteered to show what a typical first interview with a neurologist about memory issues is like. The woman was responding with answers given by actual patients during their first interviews.
Keegan is Associate Director at Roskamp Institute, which was founded by the Robert Roskamp Fund in 2003.
The institute is a non-profit biomedical research center that emphasis is on understanding the causes and potential therapies for brain illnesses, including Alzheimer's disease.
"I am glad you were willing to come in today," Keegan begins the role-playing session. "Just tell me about how things have been happening? What's changed? You report some memory problems."
The woman says she is getting more forgetful.
"Are you having trouble speaking, having trouble with different words coming out?" Keegan asks.
"Yes," the woman says. "Words and putting them together."
"How about planning? Using a cell phone or remote control?" Keegan asks. "Are you having trouble figuring that out?"
The woman says she can get confused between the cell phone and the remote control for the television.
"All right," Keegan said. "We will try to sort out what is happening here. We will order some tests. We will look at pictures of your brain. We will get some lab tests and see what that shows."
"OK," the woman replies.
The short session reveals that Keegan has a soft, gentle approach in his role as clinician. That, and his boyish looks, have earned him the nickname, "Doogie Howser, M.D." among older patients who remember actor Neil Patrick Harris' turn as Doogie, the boy genius in the TV series that ran from 1989 to 1993.
"He listens, he responds, and he makes them feel like individuals that he is interested in and it happens to be the truth," said Nancy Levine, assistant administrator to the Roskamp clinic.
But what the session doesn't reveal is Keegan's aggressive other side as a scientist involved in phase two and three pharmaceutical clinical trials for Alzheimer's, as well as Parkinson's and
Keegan is testing drugs to see if they could be approved to help the brain of people with dementia.
He hopes that one day he won't have to hear patients say they are having trouble putting words together or are confused between the cell phone and the remote control of the TV.
In fact, an Alzheimer's clinical trial he is deeply involved in now, with a company called Accera, has given him hope, he said a few days ago.
An entirely new approach
Keegan is taking an entirely new approach to Alzheimer's therapy. Unlike the common amyloid or tau protein-directed therapies in development that are directed toward the plaque-like material that can build up in the brain, Dr. Keegan is aiming to improve brain cell metabolism. He is testing a drug called AC-1204 made by Accera that increases levels of ketone bodies, a source of energy linked with improved memory and cognition.
AC-1204 is something totally different, Keegan said.
AC-1204 is not a pill, it's a white powder taken with water or juice or yogurt in a shake after breakfast.
"So, we think that this method of providing gasoline or energy to the brain is an alternative method that may be more friendly for the mitochondria in the brain," Keegan said.
While the plaque-like amyloid does appear in the dissected brains of Alzheimer's patients, some Alzheimer's patients have little or no amyloid in their brains and other people with amyloid in their brains do not get Alzheimer's, Keegan said. These facts encouraged Keegan to try to attack the problem from a different angle.
"There has not been a new medication approved for Alzheimer's disease and no medicines for mitochondria impairment for 12 or 13 years," Keegan said.
"If things go well, it could be the first new drug substance approved for Alzheimer's disease since 2003," Keegan said.
AC-1204 is brain fuel
Accera is a Colorado pharmaceutical company that started in 2000 and whose mission is to develop drugs for central nervous system disorders, said Sam Henderson, vice president of research and development for Accera.
Realizing that brains run on glucose, and lots of it -- 25 percent of all the glucose produced by the body goes to the brain -- Henderson and others at Accera thought if there is a defect in glucose utilization.
It could cause stress on the brain with severe symptoms, like Alzheimer's.
"We knew from a body of literature on Alzheimer's that there is a decline in the brain's ability to use glucose," Henderson said.
Fortunately, the brain has a back-up fuel called ketone bodies, which are molecules of energy. They are normally produced by the body when it is running low on glucose, Henderson said.
"When you wake up after fasting all night, your body will mobilize fats from fat reserves and that mobilization creates ketone bodies," Henderson said. "The liver will circulate these ketone bodies for use in organs like the brain."
AC-1204 is a specialized form of fat that helps patients metabolize glucose.
"Think of a hybrid car that runs on gasoline and electricity," Henderson said. "If the carburetors are fouled, then the electric can take over. It can run better on an alternative form of energy."
The testing to see if AC-1204 works to help the memory is a double-blind study. That means half a group of patients who have already received a diagnosis of Alzheimer's disease will be given AC-1204 and half will be given a placebo, Keegan said.
Keegan is reaching out to the people of Manatee and Sarasota counties who have a diagnosis to help.
"We need people to volunteer to be in the clinical trials," Keegan said. "Those volunteers actually receive some compensation for their time and effort and all the treatments and procedures are paid for by the study."
To volunteer, people are asked to call Roskamp Institute at 941-256-8018 and say they are interested in taking part in clinical trials for mild cognitive impairment or Alzheimer's dementia, Keegan said.
"We would like to see patients who have other treating physicians or other neurologists," Keegan said. "We do not become their neurologists. We are just supervising the trials."
Information on Accera's AC-1204 is at http:// nourishadstudy.com and 1-866-405-9998.
Richard Dymond, Herald reporter, can be reached at 941-745-7072 or contact him via Twitter@RichardDymond.