Jon Hamilton

So today on the show, we're going to give archaea their due.

Bring it on, Kwong. You're listening to Shortwave, the science podcast from NPR.

Emily, so it seems like archaea has sort of come into their own in the scientific world in the past few decades. So walk me through that.

And John Hamilton.

Okay, so who is he?

Oh, how could I forget? The two of you were getting at this idea that maybe the building blocks for life, you know, nucleotides, amino acids, were created around those super hot vents on the ocean floor.

Weird. So, I mean, what were they?

Oh, I get it. Archaea. Archaeologist. Archaeologist.

I was waiting for that.

All right, I'm getting the theme here. Asgards, Loki, Norse mythology.

How so?

I mean, sounds plausible to me.

So bring us up to date. Give me some specifics here.

I'm getting the theme with these Archaea investigators. So this guy is on a quest now, right?

Mess with it like they stop viruses from spreading?

So he's pretty confident.

Yeah, always have been and always will be.

Well, Emily, I look forward to an Asgardian antiviral any day now.

For sure.

This episode was produced by Hannah Jin. It was edited by our showrunner, Rebecca Ramirez. Tyler Jones checked the facts. Jimmy Keeley was the audio engineer.

And I'm John Hamilton.

Or archaea, as some say. Tomatoes, tomatoes.

I do, but only because years ago I happened to run into a biologist who studies them. I have never seen archaea in the wild.

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And of course, that is in a group of patients. You can have an individual who may do much better or not be helped at all.

The differences are kind of subtle. The drug licanumab, its brand name is licembi. It was approved in early 2023. And it comes from the companies Acai and Biogen, two big pharmaceutical companies. And this drug requires an intravenous infusion twice a month for the first 18 months with the option then of switching to once a month after that. OK.

The other drug is known generically as dananamab as opposed to licanamab. And this drug is marketed in the U.S. as kasunla. It comes from the drug company Lilly. Patients who take kasunla get monthly infusions from the very start. And they can actually stop getting infusions once most of the amyloid plaque in their brain is gone, which usually takes a year, 18 months. Wow.

There are some downsides. I mean, both of these drugs are given by intravenous infusion, so they have to be given in a medical setting. But the big concern with both Casunla and Lekembe is that they can cause this swelling and bleeding in the brain. Oof. And these are side effects that don't usually cause symptoms. They're fairly rare.

But when they do, they can be serious and have been linked to several deaths.

Well, I mean, Alzheimer's itself is a fatal disease if something else doesn't kill you first. And, you know, it's a disease that many people in this country are more frightened of than cancer. So people who are living with Alzheimer's, they're often prepared to take risks. That was certainly the case with the first patient I profiled. Her name is Sue Bell.

She was one of the first people in the U.S. to get Lekembe because she was part of the clinical trial that led to the drug's approval. The second woman I profiled is on Casanla. She's a singer. Keep listening. You'll hear her do Amazing Grace in Spanish. I can't wait.

She can't work anymore, so she volunteers at a memory care unit, and you'll hear her talk about seeing her own future in the people that she takes care of.

Sue Bell started taking Lekembe in 2020 as part of a clinical trial. In 2023, when Sue was 71, she described her memory this way.

Ken is Sue's husband. We were chatting in their kitchen in St. Charles, Missouri. They were telling me how Sue's memory problems had begun about four years earlier. Did you know you were having memory problems? Could you tell? No. Well, now wait a minute.

Because you were doing some part-time substitute teaching. Sue would come home from work and tell Ken she was having trouble spelling words.

Hello, Gina.

That's part of the problem.

That's how it really all started. Next came cognitive tests, brain scans, and a diagnosis, early-stage Alzheimer's. So in 2020, Sue volunteered for a study in St. Louis. Researchers there were studying an experimental drug. Sue knew it was unlikely to help her.

The drug was Lekembe, then known by its generic name, Lecanumab. It's designed to clear the brain of beta amyloid, which forms the sticky plaques that are a hallmark of Alzheimer's. Lekembe is one of two drugs on the market that can modify the disease process rather than just treat its symptoms. Sue and Ken began making twice-monthly trips to St.

That's right. As you may know, there are now two drugs approved by the U.S. Food and Drug Administration to treat Alzheimer's disease. I now know. So I've been checking in with one person who is on each of these drugs to see how they're doing.

Louis, where she got Lekembe by intravenous infusion.

Ken and Sue knew the drug had risks and was, at best, a stopgap measure.

At first, the drug seemed to help. Sue was able to take a trip to New York.

It was really six girls.

Even when Sue's memory got worse, the couple kept making the half-hour drive from St. Charles to St. Louis for treatment. In late 2024, I got an update from Ken, but not Sue. I didn't think it would help to have her participate today, honestly. Sue's Alzheimer's had reached the point where the drug was unlikely to help.

Sue's experience with Lekembe is pretty typical, says Dr. Joyce Snyder, a neurologist at the Knight Alzheimer Disease Research Center at Washington University.

Snyder says that for all its limitations, Lekembe represents a meaningful change in Alzheimer's treatment.

Some days, though, she has trouble finding her way around her own house. On one of those days, she began asking Ken to move her to a care home. So Ken found one she liked.

Sue is still at home, but Ken says at some point she'll need more care than he can provide. Myra Solano-Garcia is 66 and has been living with Alzheimer's for more than a decade.

Sure. They are meant for people in the very early stages of Alzheimer's. So, you know, before a person's memory and thinking have gotten really bad. Both of these drugs are given by intravenous infusion and both of them clear out this protein called beta amyloid, which is what forms those kind of sticky plaques that build up in the brains of people with Alzheimer's.

But there's still a lot that Solana Garcia can do around her home in Upland, California.

And she can take part in an activity that has played a central role in her life. One reason may be the drug known generically as Denanamab and marketed under the name Casanla. It's one of two new drugs that can clear the brain of sticky amyloid plaques, one of the hallmarks of Alzheimer's. Solano Garcia grew up in New Jersey as part of a Cuban-American family with lots of singers.

Later, she ran fundraising campaigns for colleges and universities and moved to California. It was in her early 50s that Solana Garcia began noticing problems with her memory. The turning point came during COVID when she started a new job.

So she went to a neuropsychiatrist.

The doctor also referred her to the University of Southern California, which was part of a large study of Dananamab.

Solano-Garcia began going in for monthly infusions, which she didn't mind, and mental tests, which she found frustrating.

The drug didn't restore her memory, but after four years of treatment, she wasn't getting worse, at least not very quickly. So was the drug working? Not necessarily, says Dr. Lon Schneider, who directs the Alzheimer's Center at USC.

Schneider says what is clear is that after a year or more on kasunla, the beta amyloid plaques in a patient's brain are usually down to normal levels. He says that's led to a new approach with this drug, which was approved in 2024.

Schneider says at USC, doctors have a weekly meeting to discuss, among other things, which patients are candidates to stop taking Kisunla. Solana Garcia says she's one of those patients.

Oh, and both of these drugs cost more than $25,000 a year. Wow. OK.

But hardly a cure. Solana Garcia remains unable to return to her fundraising career. And she has lost much of her command of the piano. So she maintains her house, volunteers with the Alzheimer's Association, and every week she visits a local memory care unit to sing.

Solana Garcia says she's learned a lot from the residents of the unit, most of whom have advanced Alzheimer's.

It was my pleasure.

And I'm John Hamilton.

Well, they are really good at removing beta amyloid. They're only okay when it comes to slowing down the progression of Alzheimer's symptoms. So in studies, each drug had this pretty modest benefit. It reduced the rate of decline by maybe a quarter or a third.