This is an Alzehimer’s therapy idea that will be something to watch, but I must say at the outset that I’m very much in the “Show Me” camp for now. Nature reports on a surgical procedure developed in China that claims to increase the lymphatic flow from the central nervous system and thus allow waste material to be more easily removed. This “deep cervical lymphatic-venous anastomosis” (dcLVA) procedure is the subject of several recent journal articles, but the situation for now is rather murky.
As the Nature piece details, the first report of this was in 2022, in a patient who was operated on in 2020 and who was claimed to have dramatically improved. A Chinese surgeon (Qingping Xie) performed the operation, and other surgeons (Wei Chen at the Cleveland Clinic and Weifung Zeng at Wisconsin) brought the results to wider attention. This set off a real frenzy in China, with hundreds (thousands?) of such operations being performed in a fairly uncontrolled manner around the country. The Chinese government has tried to rein that in, mandating that this work be part of actual clinical research studies, and there appear to be several such starting in various locations (and not just in China).
The data that have appeared so far seem to show some improvement in patients involved, with a few huge dramatic changes like the one that got all the attention and a lot of more modest changes. No one knows how much effect there is in general, or how long it lasts, and the hypothesis behind it all is still at the “clears out extra amyloid and extra tau and who knows what else” stage. But as the article points out, one thing that no one can get a handle on is how some of the improvements seem to happen very rapidly - implausibly so given that mechanistic hypothesis. It’s not helping that different surgeons have different ideas about how to perform the lymphatic-vascular connection in the first place. Nor that different patients have almost certainly had different severities and even underlying disease states to start with.
And there’s another wild card: Xie himself, the surgeon who kicked off this entire phenomenon, has been detained by the Chinese authorities for nearly a year now, and (typically) the government is making no statements about why this happened and what the next steps might be. I sure hope that the clinical trials that are underway can bring some clarity to this situation, because boy is it needed.
As mentioned, I’m going to wait and watch. I can picture something like this benefiting patients (which could be real, even if we don’t know exactly why), but I can also picture hype and hope getting out in front of the evidence as well. This is always the problem in Alzheimer’s research, particularly any Alzheimer’s research that offers any sort of hope of clinical impact, and there’s a lot of debris in the air that is going to have to settle before any reasonable judgement can be made.