During the virtual AAIC meeting this year, Eisai hosted a medical symposium entitled “The Development of the ATX(N) Classification System for Different Contexts of Use Across the Alzheimer’s Disease Continuum: State-of-the-art and Future Perspectives for Clinical Practice and Therapy Development.” A top-level faculty of world-class thought leaders in the field contributed to this project, including Dr. Jeffrey Cummings, a world-renowned leader in the development of new therapies for AD; Dr. Clifford Jack, a leading expert in clinical imaging research in AD; and Dr. Kaj Blennow, a world leader in fluid biomarker development for Alzheimer’s and other neurodegenerative diseases.
Dr. Cummings gave an overview of the AT(N) system and summarized the current neuroimaging, cerebrospinal fluid (CSF), and blood biomarkers of the framework. The AT(N) framework provides a guide to the biological investigation of AD, and the contexts of use include screening, diagnosis, prognosis, target engagement (in clinical trials), disease modification, and treatment monitoring. As a specific example, a study showed that in individuals with clinical presentation of mild cognitive impairment due to AD or mild AD dementia respectively, 50% and 25%, in fact, did not have amyloid-β (Aβ) pathology5. Such individuals should not be included in AD therapy trials since other non-AD pathologies likely underlie the clinical symptoms. This is just one of the examples on how the AT(N) system can be used to better design and conduct clinical trials.
Dr. Jack described the history and rationale for developing the AT(N) system. The various diagnostic guidelines in the mid-2010s contained disagreements on staging, terminology, and interpretation of biomarkers, which created uncertainty for investigators, regulators, and industry partners. The AT(N) concept was formulated in 2016 to provide a unified conceptual approach to categorize AD biomarkers at the individual level in a format that is easy to understand and use6. Dr. Jack also provided several use cases for the AT(N) system. In older adults without dementia, those with positive A biomarkers combined with either T or N biomarkers (or both) exhibited significantly faster memory decline in the next five years than those with other AT(N) profiles7. These results suggest that the AT(N) system can have prognostic value in clinical practice.
Dr. Blennow provided a comprehensive overview of the development and validation of CSF and blood biomarkers of the AT(N) system. Recent progress in AD blood biomarker development, such as plasma Aβ42/408, p-Tau1819-11, and p-Tau21712, is particularly exciting. Once developed and validated in relevant clinical populations, a blood-based AT(N) system could enable large-scale biological screening and diagnostic-therapeutic decision-making, and represents a globally accessible and sustainable solution for the next-generation AD patient journey.
To watch the three presentations and learn more about the AT(N) system, please click here.learn more about the AT(N) system