Davies Gail, Gorman Richard, Milne Richard
This chapter was written during a moment of flux in the unravelling of the plaques, tangles, and tales that characterise over thirty years of research for treatments of dementia involving humans and animals. In the autumn of 2022, there were widely circulated reports in the mainstream media of a pharmaceutical breakthrough following long periods of investment in the so-called ‘amyloid cascade hypothesis’ (ACH). This focused on the small benefits in slowing cognitive decline for some people using the drug lecanemab. While modest, the results were reported as a significant success: ending ‘decades of failure’ and promising a step towards ‘a new era of drugs to treat Alzheimer’s’ (BBC News, 2022). However, even amid celebrations there were cautions about the wider potential of this drug, which could only be given to people with early Alzheimer’s disease who had evidence of amyloid plaques from scans or spinal fluid analysis, excluding the 98% of people who were untested, many other types of dementia, and those in the later stages of disease (Walsh et al., 2022). The success of lecanemab had been constructed, or fabricated, through careful articulation of the relations between one version of dementia, the associated animal models, targeted drug pathways, and a particular patient population. Yet, this highly specific ‘scientific breakthrough’ (Brown, 2000) achieved extensive celebratory media currency after many years of unfulfilled expectations for all those hoping for a cure for dementia. We use the story of this scientific breakthrough to frame our exploration of the organisation of translational research on dementia using mouse models of Alzheimer’s disease. We are interested in how the trajectories of drug development tightly knit together particular animals, humans, and drug pathways by focusing on the specific biological processes that can be modelled, evidenced, and altered in multi-species experimental systems (Davies, 2010, 2013b; Milne, 2020). We are also interested in the forms of dementia and other ways of doing research that fall outside of these biological pathways. While the therapeutic breakthroughs enabled by the ACH are to be celebrated, they raise a challenging issue for constructing multispecies dementia in biomedical research. Bringing animal models in the laboratory and humans in the clinic into sufficiently close relations so that manipulations in one organism effectively model processes relevant to therapeutic outcomes in another means bracketing off alternative research options and the multiplicity of human experiences of dementia. Making decisions about which animal model to progress has implications for both the animals used in research and the humans affected by this health condition. We are interested in how we might tell stories about research and drug development that are more accountable to the multiplicity of people and animals’ lives they touch. We use the concept of how mouse models are ‘fabricated’ in dementia research to focus attention on these processes of decision-making in science. We use this concept to unpack how disease models are fabricated as a way of bringing the decisions made by researchers in specific research trajectories into conversation with the decisions made by people affected by dementia who are reviewing new research proposals for medical charities. We explain our use of the concept of fabrication more fully below but note here that we consider fabrication an important process in all scientific research in which decisions to focus on certain things give shape to the tools, techniques, animals, and evidence that are built into research pathways. Yet we use the term acknowledging it can have a pejorative meaning too. These processes are fallible and open to other kinds of fabrication and forgery that reflect motivations and methods in science; though malfeasance is only a small part of the uncertainties around reproducible and responsible science (Macleod and the University of Edinburgh Research Strategy Group, 2022). The stories of dementia research contain irresponsible behaviour as well as successful breakthroughs for science; repeatedly deferred hope as well as expectations realised for people affected by dementia. We start by discussing our use of the concept of fabrication and introduce the research we draw on in this chapter. We then present two different ways of telling stories about the organisation of multispecies biomedical research on dementia. First, we trace the experimental practices used to construct mouse models within the ACH. This focuses on how researchers fabricate the animals and patient populations that link and make visible the specific biological pathways they hope will make a difference to disease trajectories. Second, we explore how people affected by dementia, acting as patient representatives in reviewing proposals for new biomedical research, locate themselves and their families within these stories of recurrent hope and delayed promise. We explore how they relate to the animals they encounter in research proposals and their responsibilities to others affected by dementia. While the future biomedical research trajectories of the ACH are underpinned by the translations made possible by transgenic animals based on specific family genomes, the patient representatives we spoke to wanted to acknowledge a wider set of relations, drawing attention to the importance of equity and balance to benefit those affected by Alzheimer’s disease now. We conclude by reflecting on the different dimensions of accountability in dementia research and the challenge of working between multispecies relations and the multiple versions of dementia.
本章撰写于一个变革时刻,在长达三十多年的涉及人类和动物的痴呆症治疗研究中,斑块、缠结和各种故事不断涌现。2022年秋,主流媒体广泛报道了在对所谓的“淀粉样蛋白级联假说”(ACH)进行长期投资后取得的一项药物突破。这一突破聚焦于使用药物lecanemab对一些人减缓认知衰退的微小益处。尽管效果有限,但这些结果被报道为一项重大成功:终结了“数十年的失败”,并有望迈向“治疗阿尔茨海默病药物的新时代”(BBC新闻,2022)。然而,即便在欢庆之中,人们也对这种药物的更广泛潜在影响有所警惕,该药物只能用于那些经扫描或脑脊液分析有淀粉样斑块证据的早期阿尔茨海默病患者,排除了98%未经检测的人群、许多其他类型的痴呆症患者以及疾病后期患者(沃尔什等人,2022)。lecanemab的成功是通过精心阐述一种痴呆症、相关动物模型、靶向药物途径以及特定患者群体之间的关系构建或编造出来的。然而,在多年来对治愈痴呆症的期望落空之后,这一高度特定的“科学突破”(布朗,2000)却在媒体上获得了广泛的欢庆传播。我们利用这一科学突破的故事来构建我们对使用阿尔茨海默病小鼠模型进行痴呆症转化研究组织方式的探索。我们感兴趣的是药物开发轨迹如何通过关注在多物种实验系统中可以建模、证明和改变的特定生物过程,将特定的动物、人类和药物途径紧密联系在一起(戴维斯,2010年、2013b;米尔恩,2020)。我们还对这些生物途径之外的痴呆症形式和其他研究方式感兴趣。虽然ACH带来的治疗突破值得庆祝,但它们在生物医学研究中构建多物种痴呆症方面提出了一个具有挑战性的问题。将实验室中的动物模型与临床中的人类建立足够紧密的联系,以便在一个生物体中的操作能有效地模拟与另一个生物体治疗结果相关的过程,这意味着排除其他研究选项以及痴呆症患者的多种人类经历。决定推进哪种动物模型对研究中使用的动物和受这种健康状况影响的人类都有影响。我们感兴趣的是如何讲述关于研究和药物开发的故事,使其对它们所涉及的众多人和动物的生活更具责任感。我们利用痴呆症研究中如何“构建”小鼠模型这一概念,将注意力集中在科学中的这些决策过程上。我们用这个概念来剖析疾病模型是如何构建的,以此将特定研究轨迹中研究人员做出的决策与审查医学慈善机构新研究提案的痴呆症患者及其家属做出的决策联系起来。我们将在下面更全面地解释我们对构建这一概念的使用,但在此指出,我们认为构建是所有科学研究中的一个重要过程,在这个过程中,专注于某些事物的决策塑造了研究途径中所使用的工具、技术、动物和证据。然而,我们使用这个术语时也承认它可能带有贬义。这些过程是易出错的,并且容易受到其他种类的构建和伪造的影响,这些构建和伪造反映了科学中的动机和方法;尽管不当行为只是围绕可重复和负责任科学的不确定性的一小部分(麦克劳德和爱丁堡大学研究战略小组,2022)。痴呆症研究的故事既包含不负责任的行为,也包含科学上的成功突破;既包含反复推迟的希望,也包含痴呆症患者实现的期望。我们首先讨论我们对构建概念的使用,并介绍我们在本章中借鉴的研究。然后,我们呈现两种讲述关于痴呆症多物种生物医学研究组织方式故事的不同方式。首先,我们追溯在ACH内用于构建小鼠模型的实验实践。这聚焦于研究人员如何构建动物和患者群体,这些动物和患者群体将他们希望能对疾病轨迹产生影响的特定生物途径联系起来并使其可见。其次,我们探索作为患者代表审查新生物医学研究提案的痴呆症患者如何在这些反复出现希望和延迟承诺的故事中定位自己和他们的家庭。我们探索他们如何与研究提案中遇到的动物相关联,以及他们对其他痴呆症患者的责任。虽然ACH未来的生物医学研究轨迹是基于基于特定家族基因组的转基因动物所实现的转化,但我们与之交谈的患者代表希望承认更广泛的一系列关系,提请注意公平和平衡对现在受阿尔茨海默病影响的人的重要性。我们通过反思痴呆症研究中责任的不同维度以及在多物种关系和多种痴呆症版本之间开展工作的挑战来得出结论。
Psychopharmacol Bull. 2024-7-8
Autism Adulthood. 2024-12-2
2025-1
Autism Adulthood. 2024-12-2