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More than 5 million people are currently living with Alzheimer’s in the United States, and that figure is expected to triple by 2050. Scientists now know that the disease affects Hispanic and Latino communities disproportionately, but research is only beginning to catch up as this also happens to be the most underrepresented group in Alzheimer’s research today.
The University of Texas Health Science Center at San Antonio and The University of Texas Rio Grande Valley are teaming up to search for new treatments for this devastating disease, and possibly a cure.
Research programs at the two universities were jointly designated as one federally funded research institution in September. This formed a new Alzheimer’s Disease Research Center (ADRC) under the purview of the National Institute on Aging (NIA) and the National Institutes of Health (NIH).
The geographic area that this new ADRC focuses on — from San Antonio to Brownsville and every county in between — was selected, in part, because of the high prevalence of the disease in the majority Mexican-American population.
Statistical data also shows what scientists call “clustering.” When shown on a map, cases of Alzheimer’s can be seen “clustered” together geographically in specific communities — not spread out evenly like other diseases.
“Texas is home to one of the counties with the highest, highest proportion of Alzhiemer’s disease in the nation. That’s Starr County,” said Gladys Maestre from the Alzheimer’s Disease Resource Center for Minority Aging Research in Brownsville where she is director.
“We have so many (clusters) in such small communities in the Rio Grande Valley where you have thousands of people with Alzheimer’s.”
Maestre is hoping the resources brought onboard by the new federal research program will help the universities figure out why this is happening in South Texas communities.
The new South Texas ADRC is the first in the state and one of only 33 in the country. The designation, based largely on peer review for factors such as innovation and existing research capabilities, is a competitive one to win and maintain.
But apart from the distinction which makes the research program an NIH Center of Excellence, the designation means the South Texas community will be served with millions of dollars in federal funding towards not just top tier diagnosis and care, but also front-line clinical trials.
The universities will also now share and receive research data from all ADRC’s in the network across the country. And, perhaps most significantly, the new South Texas ADRC will make it possible to include a larger Hispanic and Latino population in the latest Alzheimer’s research.
A two-hour drive to the west of Maestre’s resource center in Rio Grande City, Antonio Falcon serves the Starr County Memorial Hospital and independently runs El Faro Health & Therapeutics, part of a separate nonprofit health care network, the Global Alzheimer’s Platform Foundation.
Dr. Falcon has served the community in Starr County for over four decades, and he says he has had to dedicate more time to serving these patients specifically over the past few years.
“I basically just do gerontology now. I just take care of older people. I stopped pediatrics and OB many years ago,” said Dr. Falcon.
“So I’m very much familiar with the problem that we have here. It shocked me because I knew we were high. I didn’t realize that we were that high.”
The population of Starr County is over 97% Hispanic, a population 50% more likely than white people to develop Alzheimer’s. The latest statistics show that 23.2% of people living in Starr County today are affected by Alzheimer’s and related dementias, compared with less than 10% in most areas of the United States.
Maestre said these numbers represent only the beginning of her research. Her resource center heads multiple programs at the university that collaborate with health organizations across the region. As one half of the new ADRC, her research program will use that outreach for the benefit of the region and to gather better data for use in research.
“The statistics that we have now are coming from the Medicare database. We really want to go to communities where these pockets have been identified. We want to go door by door. Who are they? What do they do?” Maestre explained.
“People from The Valley had to go to big cities like Houston or Dallas to get the diagnosis that is required. But this implies that a lot of people do not have the diagnosis. So imagine that right now we have these numbers without having diagnostic facilities — imagine how the situation really is here. So the university is committed to serving the community. We expect that nobody’s going to be rejected, whether they have insurance or not,” she said.
Much of the research and care provided by the new federal funds will take place at the newly built Institute of Neuroscience (ION).
The $30 million, 30,000-square foot clinic and research facility was completed in October of this year on a 35-acre stretch of land in Harlingen, Texas, donated by the South Texas Medical Foundation in collaboration with the Valley Baptist Legacy Foundation and the City of Harlingen.
ION will make technologies such as MRI, CT, PET and others available to physicians, neurologists, research scientists and students of the UTRGV school of medicine.
“We’re looking forward to establishing a residency for neurologists,” Maestre said about the new facility.
“We already have a residency for psychiatrists. But now we have equipment we didn’t have before. The new positron emission tomography (PET), for example, will allow us to see how different molecules deposit in the brain,” she said.
About 250 miles north of Harlingen in San Antonio, Sudha Seshadri is the founding director of the Glenn Biggs Institute for Alzheimer’s at UT Health Science Center. The Glenn Biggs Institute (GBI), the other half of the ADRC, will provide the additional resources necessary for both programs to collaborate on something scientists currently think may lead to the breakthrough cure for Alzheimer’s — genetic research.
Seshadri said that many of the breakthrough drugs we are now familiar with for other diseases were discovered through this kind of research, including one of the most popular types of cholesterol drugs in use today — PCSK9 inhibitors.
“The way we knew that PCSK9 might be important for cholesterol was because there were some families of African American ancestry in Houston, who had very low risk of heart attacks,” explained Seshadri. “So by expanding the people among whom we are looking for new genes, we will likely find new pathways. So that’s the value of having diversity.”
Under the direction of Seshadri, GBI has carried out this type of genetic research in San Antonio for the past four years to better understand Alzheimer’s, related dementias and the brain.
“We then established a brain bank and biobank with a focus on understanding the disease in Hispanics. Now our partners at UTRGV bring a 95% Hispanic community together across South Texas,” Seshadri said.
Seshadri believes this newly eligible population represents a significant step forward for genetic research at GBI.
“When we do these studies, it’s like searching for a needle in a haystack. We need very large numbers of people or we need large families where we can track the progress of a genetic marker,” said Seshadri. “I think South Texas gives us the opportunity for both. There are large affected families and there is also the opportunity to recruit a large number of Hispanic persons into the studies.”
But Seshadri also said that while a genetic explanation for the geographic clustering of Alzheimer’s is a very good bet, it’s not guaranteed to be the only cause.
“About 50% of heritability is still unexplained,” Seshadri said about understanding the disease through the lens of genetics.
Another possibility that could help explain disease clustering like the kind seen in Alzheimer’s is what health research scientists call social determinants of health. These are economic and social conditions that affect individual differences in health status. These conditions can include things such as poverty, early family separation and chronic stress.
While the exact cause of Alzheimer’s is not yet fully understood, current research points to a high probability of a combination of both genetic and social determinant factors.
Back in the Rio Grande Valley, Maestre’s research will focus on social determinants in Alzheimer’s patients — using sample data from the same majority Mexican-American population in South Texas that Seshadri will use for genetic research.
“We know there are social determinants of health, and we know of the suffering of the region,” Maestre said about this research approach. “We are definitely trying to have a complete view of the person, you know, not only organ by organ. So we want to integrate the anthropological aspects. It’s not just a biological thing.”
While the first floor of ION in Harlingen houses 22 clinical offices for neurology, the second floor is dedicated to research. Maestre is working with the institute’s newly appointed director, Ihsan M. Salloum, to bring methods into the clinic that may shine a light on these social factors.
“I want to see what can make the brain more active and healthier,” Maestre said.
ION will expose patients to music, art, virtual reality experiences and other social and cultural activities that Maestre believes may help to alleviate neurological symptoms. Her research also pays special attention to the effects of physical environments on the brain.
“I’m very interested in how architecture actually helps the brains of patients,” said Dr. Maestre.”
Community outreach has given Maestre the ability to increase contact with organizations, health care practitioners and artists, which she hopes will lead to more specific research studies of social determinants in the future.
The River Pierce Foundation in San Ygnacio, Texas, is one of the organizations Maestre has made contact with. It’s about a three-hour drive from ION and an hour past Starr County.
Cristopher Rincon is the director at San Ygnacio. The organization works to preserve historical architecture in the U.S.-Mexico border and is based in Zapata County which is included in the new South Texas ADRC.
He said that he has been able to see his organization and the region from a new perspective after being exposed to Maestre’s research.
“She said this is one of those places like Venice, Italy, that does not fit on a grid. And you have to look for landmarks and commit it to memory in a very different way and create what she calls an ‘imageability’ of the place. And that’s where she is in her research and it’s become very relevant to San Ygnacio,” he said.
Maestre’s research has provided a new measure of value to the work that River Pierce is doing in Zapata, Rincon said.
“The neurological data is very important for what we’re observing as artists. In a rural area like this, relating to the architecture this way does add to the mental health stability,” explained Rincon.
“To have an institution that is finally backing it up with, you know, this is the data. I’m very grateful to have that.”
The faculty network accessible through ION began to accept its first patients in November. The network includes nationally- and internationally-renowned scientists and master clinicians from across the university system and with expertise on a broad range of neurological and neuropsychiatric disorders.
Community members can sign up for clinical trials in eight different areas of neurological research on the Institute of Neuroscience website.