This text is part of the special notebook Innovating for better care
A team of Montreal and French scientists believe they have found the mechanism underlying anorexia nervosa. This major discovery could well lead to a treatment that could change the lives of millions of people (especially women) around the world.
In Quebec, approximately 10% of women aged 13 to 20 suffer from a significant eating disorder, according to statistics collected by the University of Sherbrooke. It is estimated that between 0.5% and 4% of Quebec women will suffer from anorexia nervosa during their lifetime.
And among them, a quarter will develop the most brutal forms of the disease, which can lead to death, explains Dr.r Salah El Mestikawy, professor of psychiatry at McGill University and lead author of the article which was published last July in the journal Nature.
The Dr El Mestikawy, who previously worked at the National Center for Scientific Research (CNRS) in Paris, led a study with her former French colleagues that spanned nearly 20 years of research… and which brings hope for women suffer from anorexia nervosa, one of the deadliest psychiatric illnesses.
“Anorexia is something quite stigmatizing, from which it is difficult to escape at the moment,” notes the DD Stéphanie Daumas, researcher in neuroscience at Sorbonne University, and co-author of the study.
A mutant gene
The team of scientists detected the mutation of a gene in the striatum, a part of the brain that is involved in reward and habit formation, and which is therefore central to compulsive illnesses such as anorexia. This gene causes a decrease in a neurotransmitter called acetylcholine, which in turn causes a decrease in another very important neurotransmitter, dopamine. And it is this which, combined with certain other environmental factors, makes certain people vulnerable to a disorder such as addiction, obsessive-compulsive disorder or anorexia nervosa.
“This is very important work, because if you take all mental illnesses, there are practically none where we understand the mechanisms,” explains Dr.r El Mestikawy, who is also a researcher at the Douglas Research Center in Montreal. Take depression or schizophrenia, for example: we know a lot, but we don’t yet know the mechanism. »
“There are many studies on many different aspects of anorexia, but this disease is often treated at the metabolic level,” adds the D.D Daumas. The originality of the approach we adopted is to treat it at the central level, based on the fact that it is perhaps a cerebral dysfunction which is at the origin of this pathology. »
In the mouse study, scientists gave the rodents donepezil, a drug known to increase acetylcholine levels and which has been used in particular in Alzheimer’s patients. And indeed, the treatment worked, since it reversed the behavior associated with anorexia in mice.
From mouse to human
This success brings a breath of hope for people suffering from anorexia, since the effect has also been observed in humans. French and Canadian psychiatrists have agreed to conduct compassionate studies and offer donepezil treatment to some of their patients, and the results are significant. Psychiatrist Leora Pinhas, who is conducting studies on this subject in Montreal and Toronto, administered the drug to ten patients. Three of them are in complete remission, and the seven others have seen their condition greatly improve, rejoices the Dr El Mestikawy.
Clinical trials, including comparing the results of patients treated with placebo with those given the drug, are expected to be conducted in the coming months at Columbia University, the University of Denver and the hospital Sainte-Anne, in Paris.
The problem is that donepezil has some pretty debilitating side effects, like cramps, vomiting and diarrhea. It is therefore difficult to prescribe this long-term treatment at the moment, note the researchers.
The DD Daumas is therefore working, with his chemist colleague Nicolas Pietrancosta, from Sorbonne University, who is also co-author of the study, to modify the molecule so that it has effects only on the central nervous system, without peripheral effects.
It could take years before a drug can receive government approval and be used officially to treat anorexia. But researchers remain optimistic.
“When we find the explanation of an illness, we manage to find solutions,” says Dr.r El Mestikawy. In medicine, there are tons of examples: when we discover the bacteria that cause the plague and cholera, it’s over, the epidemics of these diseases that kill millions of people! »
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