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Algae triggering ALS?
NH researchers part of international effort to uncover link

03/17/16
By Ryan Lessard news@hippopress.com



 William Gilmore, 60, of Rochester was a self-employed carpenter for most of his life. Gilmore built gazebos and decks and rebuilt kitchens. He was also an avid kayaker, scuba diver, surfer, fisher and bicyclist. 

“I played just as hard as I worked hard,” Gilmore said.
But, in 2011 he started to notice that his pneumatic tools and saws were getting too heavy for him — a 6’2”, 210-lb., well-built man. His right arm had become weak.
“I thought I had an injury, work- [or] sports-related,” Gilmore said. “I was on my own for about a year just thinking that I could heal my injury and then when I realized there was something more going on with my right side, I went to see the Seacoast Orthopedic Group and they did a bunch of tests.”
At first, Gilmore says, doctors misdiagnosed the problem as something that would require time and physical therapy to overcome. But instead of getting better, his condition worsened. When it began to affect his left side as well in 2014, he went to Brigham and Women’s Hospital in Boston for second opinion. There, he was diagnosed with a form of amyotrophic lateral sclerosis, or ALS, that he says is different from the fast-acting form that killed Lou Gehrig.
“It’s a slow progression and, for the most part, it stays in the upper body,” Gilmore said.
Today, his wife helps him do basic things.
“My arms don’t work. I can’t lift anything, I can’t hold a pen, I can’t feed myself, can’t wash myself. It’s a pretty nasty setup,” Gilmore said. 
He says by 2014, he wouldn’t pick up a full cup of water.
“I couldn’t trust my hands that I wasn’t going to let it fall,” Gilmore said.
And he’s constantly reminded of his loss by the many relics of his bygone days as an active outdoorsman.
“All those things, my kayak, my dive gear, my surfboards, my bicycles, I can’t use any of it anymore,” Gilmore said.
 
Possible cause
Scientists are finding a mounting body of evidence that Gilmore’s years living and working near coastline and shoreline may be at least one key factor that led to his disease. That’s because several lakes and ponds Gilmore and others have interacted with are often host to cyanobacteria, also known as blue-green algae. The cyanobacteria, in turn, produce a toxin known as BMAA, which recent studies have shown correlates with high rates of ALS when ingested.
Dr. Elijah Stommel, a neurologist at Dartmouth-Hitchcock Medical Center who works with ALS patients, is one of the first scientists to discover a similar correlation in New Hampshire and the broader New England region. 
“Initially it was just an exercise that I wanted some students to do for me, to see where the patients were mapped out,” Stommel said. “We put them on Google Earth just to see where they were.”
What they saw was surprising — clusters of ALS patients around New Hampshire lakes.
“One [cluster] was particularly interesting around Lake Mascoma in Enfield, New Hampshire, where we found a rate of ALS that’s about 40 times higher than expected,” Stommel said. “We’ve since been doing a lot of mapping of ALS patients in northern New England.” 
At first, they had no idea why this clustering was taking place, but as they looked closer they noted that clustering was taking place around specific water bodies known to have significant cyanobacterial blooms.
“We’ve since found BMAA in some of these water bodies, so I think there’s a pretty strong link. It doesn’t prove anything,” Stommel said.
He and his team identified patients living in those clusters who had never swum in nor eaten any fish from the lake they lived near. This led them to investigate the possibility that patients had been inhaling cyanobacteria from the air, something that’s possible during its blooming season.
“We set up aerosol collectors, and we’ve actually been able to find cyanobacteria in the filters of these aerosol collectors over a relatively short time, just a few hours,” Stommel said. 
They also detected traces of cyanobacteria in patients’ lungs.
Moving forward, Stommel wants to map out patients around Lake Erie, which has been known to suffer severe cyanobacterial blooms, in an effort to get closer to understanding the risk factors involved.
“We’re trying to collaborate with the Cleveland Clinic. They have a big database of ALS patients there, and we’re going to look retrospectively at the patients in that area hopefully and see if there are high rates of ALS there or clusterings of ALS and better define some of these risk factors,” Stommel said.
 
The science
Still, very little is known about the causes of neurodegenerative diseases like ALS and Alzheimer’s. But research papers related to the environmental links to this disease and others have begun to snowball recently, thanks in part to Stommel’s work.
Just this past January, a study was published showing vervet monkeys who ingested a lifetime’s worth of BMAA grew large “tangles” in the brain consistent with those found in Alzheimer’s patients in a shockingly brief amount of time.
And Stommel said a scientist in France has connected a cluster of ALS patients near Montpellier with oysters and mussels eaten by patients. The shellfish originated in Thau lagoon, a cyanobacterial hotbed. 
Cyanobacteria has long been known for its toxins — it produces many, some of which are deadly to humans — but it wasn’t fingered as the source of BMAA until the 1970s. 
Prior to that, Army doctors in the 1940s and ’50s had identified BMAA in cycad seeds and bat meat as the cause of the now-famous ALS-like outbreak on the island of Guam during that time.
But there’s still plenty scientists don’t yet understand. Stommel says there may be genetic precursors and it may require a combination of factors not yet understood for a person to contract the neurological disease.
Another thing came out of the monkey tests that may prove helpful: a possible treatment. A batch of vervets that ate the BMAA were also given an amino acid supplement called L-serine. Those monkeys weren’t in nearly as bad shape as those that didn’t receive the supplements. Human trials have already begun for Alzheimer’s patients and the preliminary results are expected by the end of the year.
Which is good news, since cyanobacteria — the more than 2-billion-year-old algae scientists determined last fall lent our planet’s atmosphere its first breeze of oxygen — cannot be easily avoided.
“These bacteria are really found everywhere. They’re really ubiquitous,” Stommel said.





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