The genetic data of hundreds of thousands of Emiratis could help to boost understanding of Alzheimer’s disease and develop measures to slow its progression, amid an ageing global population.
Scientists and experts from the Davos Alzheimer’s Collaborative (DAC), an international initiative to promote brain health, recently met UAE health officials to discuss ways to improve patient care and utilise dementia drugs to treat people from different genetic backgrounds.
The Middle East has one of the fastest-ageing populations in the world, due to falling birth rates and people living longer. With that comes age-related disease, such as mental degeneration and dementia, with knock-on impacts for economic productivity and health care.
George Vradenburg, is founding chairman of the Davos Alzheimer’s Collaborative, an initiative launched at the World Economic Forum to unite leaders from research, industry, government to speed the discovery, development and delivery of new treatments. Mr Vradenburg said examining the Emirati Genome Programme – launched in Abu Dhabi in 2019 before being expanded nationwide – could be useful to develop a global approach to disease.
“Involving people who are not Caucasian or from the North in clinical trials and in research is of vital importance to understanding the diversity of the populations in which drugs or non-drug solutions will work,” he told The National during his visit to the UAE.
Genetic code
The Emirati Genome Programme aims to create a genetic map of UAE citizens to advance preventive health care.
As of April, it had gathered the DNA of 815,000 citizens under a nationwide mission to get to the root cause of disease before it strikes. By collecting genetic samples, scientists can better understand genetic predisposition to disease and develop a more personalised approach to care.
New drugs to tackle the early onset of Alzheimer’s disease are anti-amyloid therapies that slow down its progression. However, these drugs, lecanemab and donanemab, can cost up to $30,000 for an year's supply, so will remain unaffordable for many.
“Regulators in the United States, Japan, China, and the UAE uniquely have approved these drugs (lecanemab and donanemab) for distribution,” Mr Vradenburg said. “From a regulatory point of view, the UAE has been the most forward-looking. The challenge for the field is to understand how these medicines, and future medicines, affect populations of different genetic, cultural and social backgrounds.”
Research into the potential benefits of treating Alzheimer’s with more affordable GLP-1 inhibitors, such as Wegovy and Mounjaro, is continuing but inconclusive. Meanwhile scientists are exploring genetics to understand what preventive measures could naturally delay the onset of Alzheimer’s disease.
“The estimates are 60 to 65 per cent of dementia can be prevented by taking care of your brain during your life, through good diet, exercise, brain exercises, sleep, socialisation, reduction in diabetes, hypertension and obesity, which seems to have inflammatory effects which cause this,” said Mr Vradenburg.
“Education is a resilience factor, and we know multilingual populations have less dementia. GLP-1s, the anti-obesity drugs, actually have an independent clinical benefit for Alzheimer's.
“If you can slow the disease down earlier in its course, you'll get a bigger clinical benefit and have fewer side effects. GLP-1 drugs are very exciting because they are significantly cheaper than these other Alzheimer’s drugs. Once GLP-1 drugs come off patent, they can go generic, and treat the whole world.”
A 2024 Lancet Commission Report on dementia identified 14 modifiable risk factors that account for around 45 per cent of global cases. Despite dementia primarily affecting women, 57 per cent of the identified risk factors were more common in men.
Hearing loss, high cholesterol, brain injury, diabetes, smoking, hypertension, alcohol and social isolation were all modifiable risk factors more commonly identified in men than women.
High-risk regions
The Lancet report also found the most substantial rises in dementia prevalence were forecast for North Africa and the Middle East (367 per cent) and Eastern sub-Saharan Africa (357 per cent). Both regions have some of the world’s fastest-growing populations over 60.
Dr Mie Rizig, a clinical senior research fellow at University College London, is leading the Africa Task Force of the Davos Alzheimer’s Collaborative to improve the continent’s brain health.
“Alzheimer’s is a global challenge for the health agenda, as 70 per cent of people facing this problem will be coming from the Global South,” she said. “Africa is an important part of this because of the sheer number of people living there, and the huge genetic diversity.
“All of us originated from Africa, as a small number of people left the continent about 100,000 years ago. These populated the world and made 10 per cent of the genetic diversity. In sequencing the Emirati genome scientists discovered that the Emiratis are Admix, meaning that they are part-European, part-South Asian, part-African.
“This is hugely advantageous for drug discovery but hugely challenging, as you need to mine this data using data sets from the populations mixed together that make that cocktail.”
The DAC Africa Task Force aims to increase Africa’s preparedness for its ageing population and to develop a strategy with which Africa can lead ageing science in biology, and sociology.
“The Emirati programme is an interesting case study, as the number of genetic data generated is unprecedented,” said Dr Rizig. “It's sitting there to be mined, but you can't do that without looking at the subpopulations which are not represented elsewhere in the world. You can't complete that jigsaw without including the African genome.”
